4. In (month), how much did [you/your family] spend for health insurance premiums for (plan name)? Please include payroll deductions for premiums.
Mark (x) only one.
Read if necessary: the cost of the plan refers to the premiums, which are regular payments for health insurance coverage only, not for health care services. Frequently, these payments are made by payroll deduction.
1[] Zero
2[] $1-$9
3[] $10-$19
4[] $20-$49
5[] $50-$99
6[] $100-$199
7[] $200-$499
8[] $500 or more
9[] DK