Appendix A SURVEY QUESTIONNAIRE NOTE:

Transcription

1 Appedix A SURVEY QUESTIONNAIRE NOTE: The fllwig pages reprduce the survey questiaire set t the cercial health isurers. The questiaire was dified slightly fr the Blue Crss/Blue Shield plas ad Health Maiteace Orgaizatis t iclude prper terilgy ad reflect differeces i ratig ad erllet practices. 45

2 CONGRESSIONAL OFFICE OF TECHNOLOGY ASSESSMENT DIAGNOSTIC AND PREDICTIVE MEDICAL TESTS PROJECT SURVEY OF HEALTH INSURANCE COMPANIES I. GENERAL INFORMATION Cpay: Address; Ctact Pers: Title: Telephe: PLEASE NOTE: This suey fcuses three health isurace ppulatis (1) -- Idividuals wh seek isurace idepedetly ad withut ay assciati with a eplyer r ebership grup f ay kid. (2) Idividually uderwritte grups, thse i.e., grups which are t sall t qualify fr experiece ratig ad whse ebers ust be idividually uderwritte. (3) All ther grups, eplyee i.e., ad ther grups which d t require idividual uderwritig (except i the case f late etrats). Please refer ly t these three ppulatis whe respdig t the questiaire. Cversis shuld be excluded fr yur respses. I additi, we prefer that yu exclude Medigap isurace fr yur respses. If, because f reprtig r ther reass, yu ust iclude Medigap plicies, please check the bx belw: YES, Medigap plicies ad statistics are icluded i ur respses t this survey. QUESTIONS: Please call Jill Ede at the Office f Techlgy Assesset (telephe: ). Page 1 46

3 II. UNDERWRITING PRACTICES A. Fr each categry f cverage, please esthate the prprti f health isurace applicats fr wh: Idividually All Idividual Uderwritte GrOUDS Other Grups 1. A attedig physicia stateet (APS) is required. % % % ** If a ApS is required, which f the fllwig factrs trigger a APS request? (check all that apply) [ ] diagsis r sypts reprted applicati r exaiati [ ] age [ ] sex [ ] M.I.B., Ic. [ ] ispecti reprt [ ] sexual rietati [ ] drug abuse histry [ ] late grup applicat [ ] gegraphic area [ ] ther, please specify: 2. A physical exa is cducted. z % ** If a physical exa is cducted, which f the fllwig factrs trigger a request fr a physical? (check all that apply) [ ] diagsis r sypts reprted applicati [ ] APS fidigs [ ] age [ ] sex [ ] MIB, Ic. [ ] ispecti reprt [ ] sexual rietati [ ] drug abuse histry [ ] late grup applicat [ ] gegraphic area [ ] ther, please specify: Page 2 47

4 3. Bld r urie screes are perfred. Idividual % Idividually All Uderwritte GrOUDS Other GruDs % % ** If screeig is perfred, please idicate the aes f the tests icluded i the scree: (Or attach a list) Bld Urie 4. A fiacial r persal ivestigati is cducted (e.g.,tr vehicle r credit checks). % % % Page 3 48

5 B. Fr idividually uderwritte applicats, please idicate the iprtace f each f the fllwig factrs i deteriig isurability: (Nte the respse defiitis belw. Fr each factr, place a check i ly e f the clus. ) 1. age 2. type f ccupati 3. avcati (e.g., skiig r skydivig) 4. fiacial status (i.e., ice r credit wrthiess) 5. health edagerig persal habits (e.g., alchl r drug abuse) 6. health ehacig persal behavir (e.g., preiu credits fr -skers) 7. illegal r uethical behavir (e.g., criial r questiable busiess practices) 8. place f residece 9. sexual rietati 10. ther, specify: PLEASE NOTE THESE DEFINITIONS: Verv Iprtat Iprtat Uiprtat Never Used Verv IDrtaC - Critical t uderwritig prcess;ca affect acceptace/rejecti. Iprtat - Always csidered but will ever by itself affect acceptace/rejecti. It ay, hwever, ifluece cverage liits (e.g.,exclusis r waitig perid) ad/r preiu. Uiprtat - Rarely affects acceptace/rejecti, cverage liits, r preiw -- uless i cjucti with ther re iprtat factrs. Never Used - Never csidered. Page 4 49

6 c. Please aswer the fllwig questis regardig yur cpay s AIDS plicies: Idividual Idividually Uderwritte CruD All Other Gru 1. D yu attept t idetify applicats wh have bee expsed t the AIDS virus?(check e fr each categry) - yes -, but pla t -, ad plas t ther, specify: *W If yes (r, but pla t ), please idicate the fllwig: (All thers g t questi #2, ext page) a. ScreeiE ethd (check all that avplv) : - questi(s) applicati attedig physicia stateet - ELISA ly - ELISA ad Wester blt (if psitive ELISA) - T-cell subset study ther bld tests, specify: Page 5 50

7 Idividually Al 1 Idividual Uderwritte Grups Other Gru~s b. Which avdlicats are (r will be) reauired t have a AIDS bld test? All applicats Applicats at high risk fr AIDS c. If ly applicats at hi~h risk fr AIDS are tested. wh is selected? (check all that applv) all ales applicats with histry f sexually trasitted disease hephiliacs applicats with histry f receivig bld trasfusis drug abusers ther, specify: 2. Hw ay f yur isureds have yu reibursed fr AIDS-related clais? - - please specify related tie perid: 3. If available, please idicate yur cpay s prjected AIDS-related clais csts fr $ $ s 4. If yur cpay has had AIDS-reiated clais, what percet f the idividuals with AIDS have bee fud t have a preexistig cditi fr AIDS? (check e fr each categry) - 0 percet - 1 t 9percet - 10 t 50 percet - greater cha 50 percet Page 6 51

8 5. Des yur cpay pla t d ay f the fllwig, i respse t the fiacial ipact f AIDS (please check all that apply): - Withdraw fr the idividual health arket altgether - Exclude AIDS ad/r sexually trasitted diseases fr idividual health cverage - Reduce cpay expsure i the idividual ad sall grup health arkets (e.g., by itrducig re restrictive uderwritig guidelies). - Expad HIV r ther testig f applicats - Other, specify: 111. INDIVIDUAL AND SUALL GROUP STATISTICS A. Average uber f applicatis per year B. Please idicate prprti f idividuals that are: (ubers shuld ttal 100%) Idividual Plicies Idividually Uderwritte Gruvs - accepted at stadard rates % % - cvered with a exclusi waiver ~ % % - cvered with a rated preiu ly % % cvered with a exclusi waiver ~ rated preiu % % - declied % % 100 z 100 % c. If ebers f idividually uderwritte grups are t rated, ridered, r declied a idividual basis,what prprti f the grups, as a whle, are: accepted with a rated preiu % - declied % Page 7

9 1 AIDS ad Health Isurace: A Survey February 1988 OY 4J w v 00 $. e-l 0 c., u) L Q L1 &l M u alal &5 * 20 AJ.4 - c 0 v.?4 a $! 4 w al!% E u I, I, 1+ w r-l d 53

10 AIDS ad Hea[th Isurace: A Survey February 1988 I z Ld -e - ~Q e ,. c-l 0 I r- t-1. A - l 1-, - a) e Is./4 a ul 0 CL w0 ȧl.-l.+ D.!-4 al A al Ii u v t-l.4 WI aj E w a!- 4 : c c 2 W, (?Y u (u ( c! a w x c a), al ( d c..+ a a), c 0 VI w-i u u s r5 f= c.d (3.+ w-l I-4 3 l-( 1+ 2 a) 4 a. 0 al u w : a. 0 a) I E W a) Ml JJ c 8 54

11 A. w N a) Ml 2 LI u 6 ul 4!-l (=4 55

12 AIDS ad Health Isurace: A Survey February 1988 IV. NATERIAL REOUESTS Please attach a saple f the fllwig (fr idividually uderwritte applicats ly): idividual applicati idividual plicies r brchures 3. actedig physicia stateet (if used) 4. lab reprt fr (if used) 5. list fuisurable edical cditis, diagses i.e., fr which cverage will t be ffered (I f a cplete list is uavailable, please list the fiftee st c uisurable cditis). 6. list f (If a edical cditis requirig a teprary r peraet exclusi waiver (if used) cplete list is uavailable, please list the fiftee st c cditis). 7. list f (If a edical cditis requirig a rated preiu (if used) cplete list is uavailable, please list the fiftee st c cditis). V CO14NENT~ Please retur survev i the eclsed. staped evelde t: Jill Ede, Office f Techlgy Assesset, Health Prgra, Uited States Cgress, Washigt, D.C Page 11 56