(UNTITLED)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-04718A001000100004-7
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 11
• Document Creation Date: December 9, 2016
• Document Release Date: June 1, 2001
• Sequence Number: 4
• Content Type: REPORT

PART Ii
Approved For Release 2001/08/07: CIA-RDP78-04718AO010 al- =
b. Existing available protective measures as to disability - excerpted from
TAB D
(1)
Against permanent and total disability there are these four measurest
Individual's own commercial Ordinary Life policy in which
disability coverage may be secured for small additional
premium, or a straight commercial disability policy.
1. Commonly these disability features cost in the neighbor-
hood of $100oO0 annually for a benefit of 0200.00 per
month, have "white collar" risk restriction, exclusion
for military service in time of war and air flight in
nonscheduled service.
disability coverage for an additional premi.umoxamp e.
per month benefit for a yearly preriium Of $111.40 on a $109000
life policy).
Federal Employees Compensation Act
to This Act provides cor!pensation for disability (and full
it offered in nn-r.
i
.(b) National Service Life Insurance to which a veteran may add some
( l *50 00
(a)
(c)
ncur es s
medica1 care) reeulting from
forr^ance of duty or from diseases pro dmately caused by
employment for as long as the disability continueso
The maximum monthly benefit provides two4thirdn of the
employee salary up to and including 0S@13, 58% of a
GSmlYt, and 53% for a GS415a.
(d) The Civil Service Retirement Act
1.
This Act provides disability benefits f'or life without
regard to performance of duty, provided the employee has
a mi nimom of 5 years civilian service and is total
disable d o
2b The benefitsare based on salary and length of service. A
GS-9 with 8 years service (including military) would receive
$50.00 per month. A GS-13 with lh years service would re-
ceive h6,00 per month.
(2) Against temporary disability, there are these four measurest
(a) Federal Dnpioyeea Compensation Act
(see b(l)(c) above)
"' low
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(b) Public Law 110
lo This Act provides benefits to employees (only) assigned
to. permanent duty stations outside the Continental Uo Sao
its territories, and possese;ions for illness or injury
requiring hospitalization and which occur in line of duty*
2? The benefits are payment of travel expenses to and from
an appropriate hospital or clinic and payment of cost of
treatment*
(c) A group hospitalization and. surgical benefit plan adnin;stered
under Government Foployees Health Association (CIA), underwritten
by Mutual Benefit Health and Accident Association of Omaha,
Nebraskan
(d) A I-roup hospitalization and surgical benefit plan administered
under Government Employees Health Association (CIA), under-
written by Group Hospi tali zati on, Inc*
(e) These general observations are pertinent here in respect to
these two plmnso
1m Omaha was offered to Agency employees in August 191:8; GHI
was offered in parch 1953. .Omaha B s maxi mum membership was
as of l June 195! - predom-
e effect of Omaha?s raise
in benefits to ?O per day from $6.0U, and $135400 in
hospital extras instead of $30?00, is too recent to be
assessedo) OHI has grown to in about 15 months
from a ~ nucleus of old G an us rose transfers o
20 Both plans confine eligibility to Staff Employees and, Staff
Agentso
'J? Omaha is superior on the whole as it stands, for the over-
seas employee who has his dependents with himo
ho GHI is superior on the whole ror the employee resident in
the Uo S ? but, because of the nature of the 0HI hoanitalic
zation plan, a dollar value is impossible to obtain, in
the domestic eases0
? Omaha is cheaper than Gill even if the surgical benefits
were matched* (per Omaha's firm offer to match see
page 16)
6? Neither plan pays off if FECA does*
? U
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7o Neither plan meets the criterion set by Dr. George f'aehrm
Medical Director of the Health and Insurance Plan of
Greater New York 4 HIP* (See TAB E, Appendix XI for his
Congressional testimony and Appendix XII for description
of HIP*) i.ee benefits are almost. enti rely confined to
hoani taltal and surgical costs o ' Dr. Baehr holds that 90%
of the costs of it nesses arise outside a hospital -'in
the doctor's office and in the home4 This view suggests
remedying our unsatisfactory situation as to a hospitali-
zation and surgical plan as such and then dealing with
outside hospital costs separately.
Neither plan offers catastrophe insurance which,-written
on a "deductible" basis (the same principle as. in auto-
mobile collision insurance), is a relatively cheap addition,,
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f)
Detailed comparison of tea and OHI
1.
OVEPSM
OMAHA Hospitalisation
1.
Hyosp. Board & Room: $9 per day for 31 days
with no limit on frequency, plus
$135 for hospital extras.
2.
Plus surgical as shown below.
3?
Plus out-patient emergency :up to.........
within 24 hours of accident
$135
4. Effective date. lot of the next month.
Waiting period. Maternity only. 9 months
but coverage extends 9 months beyond
termination of contract.
6. Maternity. $9 per day for 14 days
plus up to $45 total for Hosp. extras.
7 . T.B., mental and nervous disorders and
quarantinable diseases - same as No. 1.
above,
13 -
OVERSEAS
01 1!o22italization
1. Rosp. Board & Roan: $10 per day for
21 days with 90 day interval on
frequency., plus
$64 for hospital extras.
2. Plus surgical as shown below.
3. Plus out-patient emergency up to... $ 10
within 2 hours of accident
4.
Effective date.
let of the next mouth.
5.
Waiting ep riod?.
None if participation is
7 of BHA and no extension beyond. termina-
tion of contract for pregnancy.
6.
Maternity. $9 per day for 8 days
except Caesarean, termination of ectopic
pregcaatacy and miscarriage, for which
hospitalization benefits are 1. above
T.H., mental and nervous disorders and
quarantinable diseases - 10 day limit in
any 12 month period for No. 1. above.
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aas
2.
119PE _'"ion
Board & Rocco $9 per da
1? loop. with no limit on frequencY
for 31 ~?
for ~-.. ~ctras
Plus $135 m"? for hoseit
2. Plus surgical as shown below
beat emergeny up to $135
3 . Plus out-pa Of acc idt
within 24 hours
4. samples (Hospitalization only)
Bd.. ' & ROOM
90
$
Li=mn of $135
270 126 Plus a
90 to cover all hospit%'
126 extras
90
27
appendeCtMI
ccap. i racture
bilat. hernia
unilat? hernia
hysterectaay
~orrhoidectCEW
tonsilleatcM
GPI Hosts i.tatiZ3t.
late Service for 21 days (semi private.
1. g c. pits,l) with 90 day interval on
frequency $10 per day if in private room.
Plus $5 per day for al itiama] 180 days
2 Plus surgical as sham belCV
$10
3. plus out-patient emerge1Y up
within 2 hours of accident
xamples (Hospita7.isetion only) s
Bd 8a 1oo91 (diff.
135
405
45
189 / 63)
135 f 45
3.3355 / 645
40 13
Plus the hospital 'was,
(i6 listen' which range
frCSL $50 fox' the simplest,
complicated app'`
to very substanti e1
amaults for the serious
or conpi case.
on Board ROM than t -HA
'~ 500 V vat" Board & Room $13.50 > day
*1 (Basj typical pxesenis absorbed by an CqWletelY?
5.
Same as overseas
6.
Sam as overseas
Sam as overseas
6.
Same as arveraeas
7.
Same as overseas
7
Same as overseas
SWM
14
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Overseas and Dc atic
CKM Surgical
50.....Hernia Ing. util.... ...$ 100
MI Surgical
$ = $77
This is 60% of tai
75. . . .Hernia Ing, bilat......
100....Appendectomy.... .......
100.... Rsdical Haatectooy
o~.....
50....Fracture of spine......
35.... Hip dislactitia;
150....FrostatectcI7r.......... 50.... Nrn mal delivery.......
loo. ...Caesaresn ..............
150....Remo al of Kidney......
50.....Removsl of Cataract....
100.... Ce.strectc y............
?..-
25.... Tcnsillectampr......
to
y~r.... ? , ? . ? ,
25.... Adenaidec
j
~~
25....H hoidectc ....... 60
150.... Hysterectomy.......??9. 165
$1235 $ 5
$123
N.B. The surgical fees scheduled
are accepted by the surgeon
as full payment for a single
participant-if his income
does not exceed $3000.00
eth, for a family partici-
pant, if the family income
does not exceed $5500.00.
(The above, of course, disregards frequency of
occurrence - is set forth as a quick look.)
r+T
- 15 -
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Mon
4. aim Premiums month
ooap. ?!F ~3-10ai Total
GRI Premiums emsonthly)
HOOP.
Sur Total Diff.
$1.60 Individual contract $1.70 $1.00 $2.70 /
1.10
4.75 Individual & spouse contract. 3.70 3.20 6.90 /
2.15
6.00 Indiv. & spouse & children... 3.70 3.20 6.90 /
.90
If CKM should match CHI on
surgical., monthly total Premiums
would be
otal
Diff.
T
Total
$1.60/ .16$1.76
4.75 / .89 = 5.6p41
6.00 / .$0 6.80
`i6
$2.70 / .94
6.90 / 1.26
6.90 ? .10
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 Approved For Release 20011466W: CIA-RDP78-04718AO01000100004-7
(g) Summary comparison of these two plans'
14 Overseas enersl hos itallzation
OMAHA is far superior to G HI.
2. overseas maternity hospitalization
s substantially super or to GHI in normal pregnancy.
In the cases involving Caesarean, termination of ectopic
pregnancy and miscarriage (av. 10%9 per Dro Tietjen), GUI
is substantially superiore
overseas surgical.
MW A- only bu7o as good as GHI.
`" AHA s su stantially !1 !BIOR to 0til in either a normal
or abnormal case*
io
70
80
Domestic maternit hospitalization
WA-HA is substantially superior o GHI in normal pregnancy.
In 10% of the cases involving Caesarean, terani ti on of
ectopic pregnancy and miscarriage, GHI is substantially
superior..
Domestic surgical
A is my bU* as good as GHI
Fees are the same in each plan as between overseas and
domestic., However, OMAHA?s fees are all lower than GHIQ
For individual contract OMAHA charges 60% of GHI; for
individual and spouse OMAHA charges 70% of GHI; for in-
dividual, spouse and, children OMAHA charges 88% of GHI,'
but OHI doesn?t offer just an individual and spouse con-
tract at a lower rate than one inclusive of childreno
Net on the above a if OMAHAs surgical could meet GHI, it
is a better plan than GHI for overseas if the dependents
are with the employee. Even if OMAHA's surgical meets GHI,
it is not as good a buy for domestic assignment.
As to hospitalization, the two plans are strictly comparable
in respect to an overseas location of the individual with
family, but impossible of comparison in the domestic situ-
ation. This is because the Gill hospitalization benefit is
buried under the completely untranslatable "full service
benefits" with participating hospitals. While the non'
complicated case calls for a minimal few hospital extras,
the complicated case under CHI gets 16 of them free and as
many times as necessary. These variables cannot be assessed
dollar-wise for purpose of comparison with OMAHA.
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?SECR~a.
Even though it is true that the ser{ously complicated
case is statistically in the low frequency category, the
great dollar benefits undor GHI are nevertheless there
for the individual who wants to insure against precisely
such a risko
It ray be held that benefits In a serious case ride on
the backs of the non-complicated ma3orl ty in respect to
fees, and also that throwing in "the works" for every
member is misleading persuasion. However, the minority
who do get caught in heavy extras can't pay with statisticso
The simplest and blandest appendectomy calls for about
$50,00 in hospitalization extraso From there it could go
anywhere in cost while the patient still lives
co Pregnancy hospitalization contains the same problem
but not as seriously so. In 90% of pregnancy cases
the normal ones - OMAHA is a better buy, but not so
if one wishes to insure against costs arising out of
the minority of cases (i?e. Caesarean section, terminate
tion of ectopic pregnancy or miscarriage)o Here till
is superior*
Again in the domestic hospitalization field GHI adds
a fillip for the unusual case and ,dare 65o00 per day
for 180 days on top of the 21 "full" service benefit
days, (Room and board plus 16 named extra) Strictly
from the point of view of' frequency statistics,, this
might be labeled a "came-on"o
co Also,. in the GHI brochure is seen the same hand as
immediately above, i.e., the illustrated cases are
not the usual ones, They are i n .the relatively
frequent category,, but because there are a three
of them,-the coloration seems to be present, These
cases are cancer (1tt!c9 o1S benefits), fractured
vertebrae ($33700S benefits) and gall stones ($518.90
benefits)Q
GHI requires a 90 days interval between discharge and
reentry to a hospital* OMAHA requires one day* Here
GHI is inconsistent with the preceding tactics as to
minority occurrences.
eo OMAHA?s fee schedule is superior both in dollars,
f, GHI, being so firmly -enmeshod in legielttion and so
integrated with the large and necessarily unwieldy
Blue Cross, presents practically no possibility of
modification in plan to suit us, whereas OMAHA is
completely flexible ? even to a tailored plane
118m
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IYTl7]r[}
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25X1A9a
25X1A9a
OMAHAes service to,us in the settlement of claims
is "vastly better" than 0H10' .Mro
characterizes OHI as a "bickering, negotiating
outfit" a
Comparison of these two plans in-some small items is
important also because of the effect in irritation and
dollars.
Ambulance.
GHI won't pay to and from a hospital; Omaha will.
Xa-Rays .
GHI won't pay unless the X.Ray is in connection with
surgery performed within three days" time. Omaha will
pay with no surgery nor time restriction if the XRey
is taken in a hospital or eli nice
Hospital Extras.
GHI will pay on sixteen specific hospital extras
without limit. Omaha pave on all extraa up to
their established max1v7 m of # 135.004
Type of Hospital*
GHI's reimbursement is dependent upon type of
hospital, as followsg
Participating hospital - full benefit; member
hospital of another hospital service plan gets the
prevailing service of that plan; nonparticipating
hospital gets only up to $10.00 per day for 21 days,
plus $64400 for hospital extras (the same as the
GHI overs?ess rate). Omaha on the other hand reim-
burses the same all over the world in any hospital
of the indivi.dualgs own choice.
Room and Board.
The "full service benefit days" under 0111 pertains
to a semi-private room, but if the individual chooses
or really needs a private room, 0HT allocates only
$10.00 per day. Omaha on the other hand paye the
contract guarantee for any aceormrodati ono
Dependent Children.
Under GHI, they are added when 90 days old, and
carried to the 18th birthday. Under Omaha, they are
added when III days old and carried to the 19th
birthday. This may well be important In connection
with congenital anomalies.
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izik~iiwx
-- Tuberculosis and Mental or Nervous Disorders.
Under GUI, these are covered for only 10 days during
any 12-month period. Under Omaha, they are covered
for the same number of days and same frequency (one
day break only) as all other accidents or illnesses.
-- Congenital Anomalies. (viz: cleft palate., congenital
hernia)
Under G"UI, not covered at all. Under Omaha., 'full
coverage at any age, after 14 days from birth.
-- Outpatient Emergency First Aid..
GM requires reporting within two hours of accident,
else they won't pay. Omaha allows 24 hours.
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