PvtNonGroupIns 1.1

The PvtNonGroupIns module determines which individuals have a private non-group health insurnace plan in their name, how many months they have it, what type of plan it is, and how much it costs.

Who has a plan, and for how long?

The PvtNonGroupIns module starts by selecting individuals under 65 who indicate that they have a private plan in their own name (input variable HealthOtherPrivatePlan = 1 if input year is 1993 or earlier, otherwise HealthCoveredOwnNonGroup = 1). Each of these individuals is then examined to determine which months they were not covered by an employer plan or by Medicaid. Coverage by an employer plan is indicated via the program rule MonthlyEmployerCoverageType. Usually, this rule should refer to an output variable from the EmpSponsoredHealthIns module. Medicaid coverage is indicated via the pair of program rules MonthlyMedicaidEligibilityType and AnnualMedicaidEnrollmentType. Both these rules should usually refer to output from the Medicaid module. If an individual is enrolled in Medicaid that year (AnnualMedicaidEnrollmentType), then they are considered to be covered by Medicaid in those months in which they are actually eligible for Medicaid (MonthlyMedicaidEligibilityType). The result of this determination of how many months an individual is not coverd by an employer plan or by Medicaid, and therefore is covered by a private non-group plan is stored in the variable NumberOfMonthsWithPNG.

What type of plan is it?

The PvtNonGroupIns module recognizes three types of plans - Family, Dual, and Single. Once an individual is determined to have a plan, the type of that plan is based primarily on the input variable HealthWhoElseInOtherPlan as follows:

HealthWhoElseInOtherPlan = 1, 3, or 5 then type = family
HealthWhoElseInOtherPlan = 2 then type = family unless the person is single and has just one child in which case type = dual
HealthWhoElseInOtherPlan = 4 then type = single

Note that for determining if a person has a dual plan, not all children in the family are counted. Rather, only those children who are young enough to be covered by their parents' plan are counted as "children". Thus, a family could have more than one child but the parent would still be considered to have a dual plan if only one of those children was young enough to be covered by the parents' plan. Information as to whether a child is young enough to be covered is given via the program rule HealthUnitMemberType. This rule usually refers to an output variable from the EmpSponsoredHealthIns module. The result of plan-type determination is stored in the variable PNGType.

What does the plan cost?

The PvtNonGroupIns module uses the information on the plan type (PNGType), the number of months of coverage (NumberOfMonthsWithPNG), and the individual's age to determine the annual cost of private non-group coverage. The following four program rules give the monthly cost for each plan type (note that premiums are different for single plans depending upon the sex of the plan holder):

PremiumsForFamilyCoverage
PremiumsForDualCoverage
PremiumsForSingleFemales
PremiumsForSingleMales

Each of these rules has seven values for each state. For a given state, there are seven premiums - one each for the following age categories:

Under 30
30-39
40-44
45-49
50-54
55-59
60-64

Researching these rates can be time consuming. Consequently, the PvtNonGroupIns module was designed assuming that the premiums in these rules are not necessarily in the same year dollars as the input data. The program rule AdjustmentToPremiums can be used to inflate/deflate the premiums to the desired year dollars. The final cost (annual basis) is computed as the adjusted premium amount times the number of months of coverage, and is stored in the output variable AnnualPNGPremiumPaid.

Summary Tables

The PvtNonGroupIns module creates only one output table. This table shows the number of persons who purchase a plan, and the average annual premium paid as well as the the total amount spent on those plans. The table summarizes this information by plan type and the total cash income of the purchaser's family. The income variables to include in the measure of family income are specified through the program rule AnnualPNGIncomeVariables.