SUMMARY ANALYSIS OF CODED OMAHA AND GHI HOSPITAL AND SURGICAL CLAIMS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-04718A001000100009-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 28
• Document Creation Date: December 9, 2016
• Document Release Date: June 1, 2001
• Sequence Number: 9
• Content Type: SUMMARY

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Sumary Analysis of Coded G =ha and
G H1 } ospita l and Surgical Claims
116
1, General
A. Covereg : The survey included C i
c S covering illnesses which commenced pr or to 19R.
B6 Illnesses: Types of illnesses for which claims had been submitted
----
have Gen categorized into bh irL een (13) groupings? Codes and
definitions are included as Attachrxnent 16
C, Ratio of Claims to Poll Tiolders (1901:. Comparing the claims for
Mnesses caaencinxa the policies in force as of
31 M 1953, the following has been determined:
:rnouror
ft,plia
gg~ PPy
OHI
25X9A2 A6
?
policy holders appx=or cpiW 7 rdeix Tian the indemnity; pregnancy
claims cost the policy holder about 44.7 per cent more than the in-
do-mmityo while the indemnity for TB claims was about 10,9 per cent
more than the actual. cost, (See page 10)
C6 R~ He$liads Approximately 866 per cent of the Omaha claim-
were for illnesses incurred outside the United States,
were for illnesses incurred in the United States a
Calendar Tr 195'3
Number of Policies in Ratio of Claims
Claims
I ' s s r 3:I to P o l i c y
r Ming in b&05 dsys of hospitalization- Of the
, . c'aa~tnal. nen,seryOared to Ind
: The actual expense to Omaha
25X9A2 D.
25X9A2
25X9A2
ants were hospitalized less than il) days,, with about 47,1 per cent
hospitalized less than 5 days,, and D-5.4 per cent ware hospitalized
10 days or more. (See page: 19)
e and Sex: Of th per cent) were 'M M 'o lnesses in rre t e poll cy holder, gyres accounted for
per cent) of the claims, and daughters, sons and husbands
accounted for per cent,
About 52 per cent of the claims were for illnesses incurred by females,
and 817,9 per cent of the illnesses were for male personnel and 0.1 per
cent of the claims were of an anndete nnined sax,
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Cover MR: A total of _ claims had been submitted through 1953
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in:.
E. Actual Su ical Cost to Polk Holder: Of the 68;3 clams involving
surgical costs the policy ho r, 91 policy holders (or 13.3 %)
-id less than X25.00, 192 policy holders (or 2811) paid less than
5O..00, but 206 (or 30.2%) paid 4150,00 or more.
F. Extra Cost: Of the 871 policy holders PayIna "extra?", 283 policy
holders (or 32.5%) paid x25.00! or lees 503 or 57.8%) paid $50.00
or less and 34 policy holders (or 3.9%5 paid "l $L O0 or more.
GHI Clam
A. Cove e: A total of had been submitted through
or 865], hospitalized c ya, a which 8350 days (or 96.5 were.
covered by benefits. The difference is accounted for I W: overstaying
discharge hour (not allowed), overstaying child's tonsilectoz y (1 day
allowed), adult (2 days).. overstaying maternity (8 days allowed),
B. Actual erase C red to Benefits: Due to insufficient G HI data,
is prat c to present, any actual eq)ense information comipared.
to benefits,
25X9A2 C. Claims by Year of Illnesses: Of the
M M~Miilr IA ifin lei A ~
25X9A2 messes commenced( prior 1952 illnesses commenced in
1952, and illnesses commenoed in 1953,
D. Type and Sex of Clainant: Of the chimes or about
71were ` y a policy holder were for, the wife
of the policy holder and were for sons, daughters
and husbands,
25X9A2
25X9A2
25X9A2
25X9A2 Ids. claimants accounted fo olaix 39,
25X9A2 { ') of the i3~88es, the
25X9
wor.en accounted for _ {58.5 of the claims, and? (2.I ) were un-
determined,
E. D Hospitalized: Of the or 91. per cent were 25X9A2
hospitalized arras than 10 ys and a Out 3,/a r cent were in. 25X9A2
the hospital 10 days or more (See aection I
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Glossary of Terms Used in Attached Analysis of O a and GUI
Hospital and Surgical Claim
Benefits:
{C) iA Monies paid to policy holder members at the rate of N$9d00 per dry
for room and board regardless of room and board cost, and reimbur-
sements paid for dependency room and board. .Cteimbursenents is the
term used for monies paid for dependency room and board at the
actual cost rate, if less than ?.;9GOO per day; the riaximum. is '9a00
per day, This rate of X9.00 per day changed from ti 6 00 per day
as of 1 September 1953.
Extra benefits changed as of 1 September 1953 from ?30Q00 (allo-
cated) to 4,135?00 (unallooated)m
Claim
Co wencin: Table headings reading "Illnesses CommEencing", means that the ill-
.V1. ness comenced prior to 1952, in 1952 or in 1953 as the case may be,
Surgical Cost:
((3~w1AIA _p. Means the gross amount of money expended by the policy holder
to satisfy the surgical bill
Percent of
Claim Covered
by Benefits:
P_HA . . The ratio of benefits to the actual expenses.
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Hospital and Su.rg5.oaI Codes
Code I]e inition
Cll. Eye, ear, nose, and throat
02 Genital and urinary<
03 Heart and cimu1atoa:yu
O1 Pregnancy and complications therefroni
05 Cancer (including tumors,, etc 4 )
06 Tuberculosis and tests therefor,
07 Accidents
08 Other (including childhood diseases, bone
and riuocular,, hernia, surgery, etc.).
09 Digestive, from stomach on outs,
10 fiespira.to:r.- (including col.ds., pluex?isy, etc.
1) D mat.o ogy (inncl.uding cysts,, etc.).
12 In c'Os l,, ue rvou. ; M b.x"tt .a,, etc,,
13 Undefi.n d,,
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Index
OMAHA CLAIMS Section
Suma.xy of Claims by T" ae of Illness A
Illness Commencing Prior to 1952 A3.
Illness Come encing in 1952 A2
illness Commencing in 1953 A3
Per cent of Difference between Benefits and
Actual Cost B
Illness Commanoing Prior to 1952 81
Illness Commencing in 1952 B2
Illness Commencing in 1953 83
Geographic Origin of Illness C
Actual Surgical Coss
Table D
Graph D1
Actual Extra Costs
Table
Graph El
Number of Lys Hospitalized
Table F
Graph Fl
Type of Sec of Claimant G
Swanary of Claims by Type of Illness H
Illness Cannmenoing Prior to 1952 Hi
Illness Commencing in 1952 Ii2
Illness Commencing in 1953 H3
Days Hospitalized
Table I
Graph
Ii
Type and Sex of Claimant d
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NO. Nob Days
A al
des
02
02
03
04
05
06
07
08
09
10
34
13
Su rj of Omaha Hospital and Surgical C3a1
(By Type of Illness)
Based on Claims Submitted Through 1953
Rim; M
.90-82 .. ft~ !M MUM
6665 $115x405 49,744 329,01 4 $36,617
322 9,51 2,417 3,161 3,933
389 8,664 3,050 2,049 3,565
270 3,8169 2,036 525 1,
3w
2279 40,222 16,818 12,965 10,1439
132 4,039 994 1,032 2,01,3
111 1,,046 764 282
325 4,247 2,370 720 1,157
989 13,125 7,272 1,536 4,317
,079 20,783 8,322 6,029 6,9432
1421 4,366 3,018 155 4193
98 1,550 708 277 565
176 2,053 1,318 10 725
74 1,930 657 585 --w
$172,878
$55,58o
470,683?$46,6$.
14,953
2,718
8,303 3,9932
13,076
3,656
4,8148 4,572
5,215'
2,143
S
1,556 AS L6
72,720
21,009
34,289 17,1412
6,11
1,228
2,557 2,331
9143
589
3514
43114
1,749
1,1439 1,126
15,754
7,303
3,737 4,7114
26
140
8
462
10
6
5
,
,
4,773
,90
5,273
3,249
871 1453
1,902
47
730 625
3.,1.07
1,977
180 950
3,375
950
1,400 1,025
Of the 160 "other" illnesses, the following. specific il.lue ses resulted in seven
or more c1ai4?
HTe rr e (Type un1n o ) t< . 4 8
Hernia x o a o n 0 o 0 a a 0 a 15
Infections (Gener1) d . . a 9
poliomyelitis O. a... b* 7
A tote]. of 75 different illnesses are indicated is the "other" category.
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S nx?y of Osaka Hospital and Surgical Claims
(By Type of rilwas)
Illnesses Commes ing Prior to 3952
25X9A2
NO a or No , Day
Benef ito
Actual Coat
rot al - 3271
$58,575
42Pi,281 ,15,463. $18,833
684,925
$279269
$34,847
$22,809
.ode:
663
7
1
336
14
392
1
935
01
175
4,783
' 1,291 1,557 1,935
,8
,
,
,9
02
193
4,243
1,1487 964 1,792
6,041
1,800
2,198
2,0 3
03
123
1,917
868 420 629
2,994
985
1?172
837
04
1030
18,606
,2140 16,712
7,654 6
31,606
9,4o0
15,214
6,,992
q5
93
2,789
,
701 700 1,388
4s15
2
864
1,,640
1,689
06
50
531
296 235
6
5
25
307
07
102
1,772
737 345 690
2,008
559
769
680
08
516
6,883
3,993 841 2,049
8,603
16,166
2,051
2,,386
09
536
11,336
1,008 3,818 3,510
3.3,255
3,784
5527
357
088
10
237
2
,423
1,581 122 720
2,760
10806
466
0
U
57
,
850
1423 1316 293
iga16
288
1635
293
12
108
,309
1
792, 10 507
2,277
1,365
180
732
13
51
,
1,133
450 33.0 373
1,9167
661
875
411
-7-
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Sunary of 0 ha hospital, and Sargical Claims
(By Type of Illness)
Illnesses Commencing in 1952
No. of
No. Days
Beneft
Actual Cost
Claims
In Fiosp-
T was ~xx
Extras
of
?
110
r
.
Total
2017
.. $35352
$15025
$8538
$1-1769
$55993
$16956
$22967
$0070
Code:
01
102
:.1:t 0,
782'
1013
1307
5038
9614
2768
1306
02
1.05
2372
841
560
971
14096
961
1434
1698
03
95
1485
738
105
6142
1906
880
.
381
612
04
70`? .
12690
5263
3979
3448
214910
6667
11,636
6637
05.
26
789
216
217
356
1.37
301.
433
400
06
48
351
31
227
227
07
93
1276
7014
228
3144
1231
509
396
326
08
321
h h29
21.413
565
3.724
5065
2087
1216
1782
09
321
6252
2467
1615
2170
8913
2809
3767
2337
10
121
12514
964
-
290
1482
859
331
292
1.1.
16
3145
87
80
178
521
116
227
178
12
140
1453
2714
m.
179
1473
291.
-
179
13
22
553
198
175
180
9144
276
375
293
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S ry of Oman Hospital and Surgical 41aimms
(By Type of 111noss?
Illnesses Commencing in 1953
NO. of
NO# Days
Benefits
Actual Cost
I
M2
i
Total _
1377
421478
1'10438
$5045
$59955
03963
$11355
$12869
$7739
Codes
01
45
1625
344
:590 '
. 691
.2252
418
1143
691
02
91
2049
722
525
802
2939
892
1216
831
03
52
467
430
37
278
-
37
04
542
8926
3901
2746
2279
16164
4942
7439
3783
05
13
461
77
115
269
786
60
484.
242
06
13
1614
117
47
154
107
-
.47
07
130
:x.99
929
147
123
1078
681
2710
123
08
152
1813
1139
130
544
2066
1050
470
546
09
222
3195
1847
596
752
39-12
1869
1331
772
10
63
689
473
33
183
1031
584
294
153
11
25
355
198
63
94
365
143
68
154
12
28
291
252
-
39
357
318
-
39
13
1
214
9
100
135
484
13
150
321
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Suw,zry of Omaha Hospital and Surgical Claims
(by Type of Illness)
Based on Claims Submitted Through 1953
(1)
No. of
Cl is
(2)
No. Days
_rxti Hose,
(3)
Total
Benefits
Total
Ac tun)
L- RSC
(5)
D fer-
ence
(6)
Percent
of Claim
Covered
by
Benefits
6665
,">11 X405
:17267F,
X57473
6648
01
.122
9511
1495
5442
63,6
02
389
p
8664
13r~`!E:r
U.12
6603
03
270
3869
521;
1346
74.2
04
2279
40222
72710
321888
55 :, 3
05
132
4039
611.6
2077
66.o
06
in
1.031.6
90
X103
110.9
0
325
4247
L3t4
67
98.4
08
989
13125
15754
2629
8303
09
1079
20783
26140
5357
79.5
10
421
4366
5273
907
82.8
ii
93
1550
1902
352
81.5
12
176
2053
3107
1054
66.1.
13
74
1930
3375
1445
57.,2
Percent#
Difference
between
Benefits &
Actual
ftoe"o
,+352
:3fr 4
33.7
25.8
44.7
34.0
-10.9
1.6
1607
20.5
17.2
18 05
33.9
42.8
(7)
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Summary of Omaha Hospital and Surgical Claims
M Type of Illness)
Illnesses Commencing Prior to 1952
25X9A2
(6)
(1)
(5)
percent
of Claim
(7)
(1.)
N
f
(2)
N
D
(3)
Total
Dif
Covered
% of Di'
ov o
Claim
o. 8
ays
In Hoan.
Total
Benefits
Actual.
Coet
Between
Cull &
by
San
s
Between
_t
.,
Total
3271
$58575
$84925
$26350
69,0
31.0
Codes
01
175
4783
76
2880
62,4
37
6
02
193
1243
6th
1798
702
.
29.8
0
04
123
1,917
2994
1077
64.o
36.0
6
05
1030
93
166
06
2789
31606
13000
58.9 66,5
~3Q5
0
50
533.
562
31
07
102
1772
2008
236
88 02
ll 8
08
516
6883
6603
1720
'800
20.0
09
536
11336
13255
1919
8505
1405
10
1
237
2423
2760
337
878
1202
1
12
57
850
1016
166
8307
163
1
108
1309
2277
968
57,5
42.5
3
51
11.33
1947
814
5802
1108
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S Cary of 0m Hospital and Surgical Claims
Y Type of Illness)
Illnesses Cothmencing Prior to 1952
25X9A2
1
No. of
C1.ains
2
No. 7 kys
In Hosrna
(3)
Total
Benefits
Total
Actual
Cost
Dif
Between
Cola 3 &3 & 4
(6)
Percent,
of Claim
Covered
by
ru;fits
(7)
% of DI
Between
alt
To-.tL.
M
2017
$35352
rp55993
)20641
63,,1
36.9
Code
01
102
3103
5038
1935
6id6
38,,4
02
105
2372
4096
172b
57,x9
42.1
03
95
1485
1906
4.21
77:,9
2241
di
707
12690
2494o
12250
tG,a9
49,1
05
26
789
1137
348
69,4
30,,6
06
48
351
227
-124-i'
154,,6
1-54a6
07
93
1276
1231
-45
103 W7
-3.7
08
321
4429
5085
656
87-.1
12.9
09
321
6252
8913
2661
701.
29,,9
TO
1.21
1.255t;
1482
228
84,6
15.4
11.
16
345
521
.176
666,2
338
1.2
40
453
473
20
95,8
4.2
13
22
553
94 4
391
58 6
41.4
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Sumtnaary of U ha Hospital and. Surgical Clams
( Pe of Illness)
Illnesses Jonnenc: in 1953
(6)
25X9A2 Percent
() (5) or claim (7)
(1) (2) (3) Total Dif Covered % of Dif
No,, of No0 Days Total Actual Between by Between
Claimi In Nos emni Cost Cols I Indem~~"
Total
1377
$2178
$31963
$10185
67.2
32,8
C ode
01
45
1625
2252
627
7202
2708
02
91
2049
2939
890
6907
30ry3
03
52
1467
315
-152
1h803
-4803
0
542
8926
16164
7238
5502
4,,8
05
13
1461
786
325
587
4103
06
13
164
154
-1.0
1O,,5
-6;,5
07
130
1199
1.078
-121
LU02
11,12
08
152
1813
2066
253
87 0 8
12,2
09
222
31.95
3972
777
80GL.
19,6
10
63
689
1031
342
66 O8
33o2
11
25
355
365
10
97 03
2.,7
12
28
291
357
66
8101
1.8 U5
13
1
244
984
20
5o.4
14906
-1.3-
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our ,miry of Omaha C .aims by Geographic Origin of Illness
(By;" ex and Year of Coa encement)
25X9A2 (6)
Percent
(5) of Claim
(2) (3) (.) % of Covered
Total Indemm Actual Differ- differ. by
CWXIM n?~. i Cost ence anee In
T11ne= . within United States
Male
C' :m=e oi t prior 1:52
I.1e
Fe'x':+.?e
C~E^%r 7?`iEf : n in 2.952
Caa, in 1.953
l
77364 '129912 $525-48
11133 27 T 2 9
59231 102270 43039
' 3 90 4020 6 r i
299159 148313 18364
247-67 42960 1869
5996 -910-2 32
18269 33158 154y~yy
89
12838 23038 10200
25 2839 11013 20199 9186
38041
122 1
25 780
18516
5
12522
1100gy8~ 855
77-1.9
86,0
MOT
5539
40a4 59.6
3~ .7 Z37.
42 o1 57.9
;37.0 6)3.0
3,9 66.1
43.5 38.0 62,,0 ~5605
3 z ;.12
L5.T .545
1515.3 55.7
377 W.-3
4505 54.5
42966 4925 11.5 8805
ri772- 32 5 IM 3
31237 5451 1705 825
21249 2733 12.9 871
=OX 15276 2754 18 a0 1o .,c
12792 1907 1,.9 8501
29 --22 77 i
9851 2132 21 a6 78 01.E
8925 285 3~2 96E,8
6110 571 9.3 90.7
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Actual u gic . Cost to (haha Policy W,ldero
(wed o 683 noi.dences't)
Selected Groupings
C ,3
1OOu0
Lose than $25
91
13.3
13,)
5 tbri $49
101
1.4.3
2
$50 thm $74
99
14.5
42,6
$75 thru $"
72
10.5
53,11
$100 t& i $124
81
114 9
65,,o
$125 trite. .4.9
3,3
4.8
1`
$150 t# . $174
82
12.0
81.>
$175 tlar $199
29
4,..2
86,.1
$200 t1 . $224
45
6.6
927
$225 thrm $U9
6
0m 9
9j, 6
2
27
$274
50t
$
20
2.9
96 5
p
P
~ q~'
~,~y
$275 yhqi 2/I
5
n
0.,8
/y ffb2
$300 and Over
19 (a)
2.8
i OO D
(a) Distribution:
$30,4
$3351
$34,9-1
$350-5
$375?..."?1
3
$500 -2
0550--2
S65o-
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
ACTUAL SURGICAL COST TO OMAHA POLICY HOLDERS
(Based on 683 Inoidex :ens)
S aiei:t d Groupings
Less than $25
$25 thru $49
$50t,674
5 10 15 20 25 30 3 40 45 50 55 ou
$100 three x149
$150 and Ow* r
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
J PIT4L ;'IR., Sa PAID W Z POLICY HOWUNDER OMAHA, CONTRACT
Extras Incidence
(Based on 871 Claims)
Cumulative
Q p
Dumber
EMCent
,tio
Total
871
1001,0
$25 and less
283
32.5
32.5
$26 thru $50
220
25.3
57,8
$51 thru $75
162
18.6
76.4
$76 thru $100
96
111.0
87.4
$101 thru $125
55
63
93.7
$126 thru $150
21
2~4
96.1
$151 over
34 (a)
309
100.0
(a) Distribution-,
$151 t $175
13
$176 thru 4200
5
$201 thru $225
5
$226 thru $250
2
$251 thru $275
3
$276 thru $ 300
2
X301 thru $325
2
26 thru50
1
668 only
1.
-17-
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718A001000100009-2
HOSPITAL EXTRAS
PAID BY OMAHA POL"I"CY HOLDERS
(Based on 871 Extra Incidences)
(Selected Groupings)
9Jf.JdA isil O o'e..9`
0 5 10 15 20 25 30 15 40 45 50 % 60
26 thru $150
$51 thru $75
Policy Holders paying
$100 or less for
Extras a a a
Policy Holders paying
101 or more for Extras
Approved For Release 2001/08/07 : CIA-RDP78-04718A001000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
Number of DaC 1. .ante Hospitalized
AgELAMU&UNA
25X9A2 cumulative
L. r n Ratio
Total
xM
Less than 5
47.1
4701.
5-9
37.5
846
10-14
103
949
15-19
1.9
96.8
20 - 24
oU6
97G .
25 ax.+ 29
0.7
9801
39-and-over -,.,.-, _ l v
--MOOS _0
Ave. no. of day3 7.5 xxxx
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
t~l'I. 3:I6. CLAIMANTS
NUMBER OF HOSPITALIZED DAYS
(Selected Groupings)
Days
WM7-
0 5 10 15 PO 25 30 35 40
klosp1 Llizod loess Wan
10 days
45 50 55 60
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
S am 7 of ha Hospital and Surgi,oa1 Claims
T&c h 1953
By Type of Claimant
25X9A2
TOT1L
Pol ey Holder
Others
ALI
I&Z
Wife
43.0
Daughter
4.6
Son
9.0
Husband
001
1CC
4.3, ,3
43 ova
Male 6
Female 9.0
Undetermined 0 2A
Approved For Release 2001/08/07 : CIA-RDP78-04718AO01000100009-2
 Approved For Release 2001/08/07 : CIA-RDP78-04718A001000100009-2
"e of Ills
4J124Lo s, n o e,u v` s o ?o G? rj
92196
02. Gen. & Urinary,)
04 Preg 0 & Cornpl. m .
j"'S( ?c5 ?:J QO4j RIp ^()i ~iM1CL 6
O6 9 vS 3 4'~ h ~p ~S 0 V 0 0 it O m A
0~k} .gtr3~.^. ;. Lr3 i rn' ,;acmrun
08
Digestive,..,_ 6~aeoaretrvrcon
09 Digesti`fie,uaoa._
IGO,, a 004-00..000011
~y~~ G ti A 4 V~ t4 f! A p V C} f> 9 fl 9
+i.~p{j b~ ~.M1 c~