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Health insurance plan 4: HMO coverage status recode

Codes and Frequencies

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For persons in families with at least four private insurance plans, HI4HMOCOVR is a recoded variable that indicates whether the fourth plan mentioned was a health maintenance organization (HMO) or a non-HMO ("Blue" plan or other), and the actual plan type based on the name of the insurance plan. This variable is similar to HI4HMO which reflects a yes/no response to the question, "Is this (name) plan a Health Maintenance Organization or HMO?"

The 1986Field Representative's Manual, provided the following definitions, which were not substantially changed through 1996.


The 1986 definition was as follows:

Health Maintenance Organization (HMO) : A health care plan that delivers comprehensive, coordinated medical services to enrolled members on a prepaid basis. There are three basic types of HMOs:

  • Group/Staff HMO: Delivers services at one or more locations through a group of physicians that contracts with the HMO to provide care or through its own physicians who are employees of the HMO.
  • An Individual Practice Association (IPA): Makes contractual arrangements with doctors in the community, who treat HMO members out of their own offices.
  • Network HMO: Contracts with two or more group practices to provide health services.

An HMO differs from other health insurance because it directly provides its members with most or all of their health care while traditional health insurers simply process the claims. An HMO assumes responsibility for providing the treatment as well as paying the bills.

Related variables

Please use the IPUMS NHIS drop-down menus and search function for other related variables.

Data Collection Process

Details about the characteristics of insurance plans (such as HI4HMOCOVR) reflect plans for any family member in the household. In order to determine if the person (rather than someone else in the family) was covered by this plan, analysts should use the variable HI4PCOV (Health Insurance Plan 4: Person's Coverage Status), which indicates whether the person was covered by the plan.

Users are strongly encouraged to review the user notes Insurance Data Collection and Private Insurance Definitions.

Information was collected on the details of up to four plans per family for 1992-1996 and five plans per family for in 1986 and 1989.


Users may also want to see the related variables HI1HMOCOVR through HI5HMOCOVR. Likewise, the variables HI1PCOV through HI5PCOV indicate coverage status for each plan.

Users may prefer to use the constructed variable HIPTYPER, which was created by IHIS staff and which indicates whether the person was covered by any plan that is an HMO.

The Field Representative's Manuals (for years in which HI4HMOCOVR was collected) specifically instructed interviewers to record the plan name and not the type of plan. The plan names were matched against a "master list" and recoded to insurance type (see HI4TYPE).

Definition of Private Coverage
For 1993 to 1996, respondents with any private health insurance, including single service plans, were asked for the plan name but only those with general purpose plans were asked if the plan was an HMO. Those with single service plans were not asked if the plan was an HMO.


HI4HMOCOVR is completely comparable over time.

HI4HMOCOVR is not fully comparable with reported HMO coverage for 1997 forward since HI4HMOCOVR reflects edits based on the plan name.

Because of the editing process that NCHS used to verify insurance status for 1997 forward, users should be cautious in analyzing type of insurance plan (e.g., HMO, FFS, PPO, etc.) status over time. The pre-1997 variables, such as HI4TYPE and HI4HMOCOVR reflect reporting of private coverage that has not been verified for accuracy (i.e., not been subject to NCHS editing).


  • 1986: Persons with 4 private health insurance plans that pay for any part of a hospital doctor, surgeon's or dentists pill (excludes Medicare and single service plans).
  • 1989;1992: Persons with private health insurance other than single service plan.


  • 1986, 1989, 1992