ADMINISTRATION OF THE EMPLOYEE ORGANIZATION AND ASSOCIATION PLANS - FEDERAL EMPLOYEES HEALTH BENEFITS ACT - UNDERWRITTEN BY THE MUTUAL BENEFIT HEALTH AND ACCIDENT ASSOCIATION (MUTUAL OF OMAHA)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP87-00868R000100060022-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: December 22, 2016
• Document Release Date: July 16, 2009
• Sequence Number: 22
• Content Type: MEMO

Approved For Release 2009/07/16: CIA-RDP87-00868R000100060022-6
7'0: He pi al Adnzznz Tmtors
".RE: Adininistralion of the Employee Orqanization and ssocial
P
oyz
of s
Federal Employees Health Benefits Act - Underwritten by the Mutual
Benefit Health and Accident Associations (Mutual of Omaha) .
Federal Employees Health Benefits Act of 1959 ivhicli provides for the establ sz h
ment of a Hcal/h Benefits program for o.overnmenl employees and their depc,idenits
became effective July 1, 1960. Among the Plans approved by the Civil Service
Commission are four emploi,cc organization and association plans underwritten by
Mutual of Omaha. These Plans are sponsored by (1) the American Federation of
Government Employees, (2) the Government Employees Benefit Association, (3) the
Governnneni Employees Health Association (referred to as "The Association '9, and
(4) the American Foreign Service Protective Associations.
In. the interest of continuing the mutually satisfactory systems between the adynittingr
offices of the local hospitals and Mutual of Omalus relative to the hospital admissions
of persons insured under our Group Programs, Mutual of Omaha has prepared its
identification rnaterial.for ease of operation in this connection and has established
a set of Guarantees to assist the hospital admitting offices. Mutual of Omaha and the
United Slates Civil Service Commission are hopeful hail these systems ivill enable
all government employees insured under Plans underwritten by Mutual of Oinaha
to be admitted to your hospitals ucithout the requirement of a deposit payment or
evidence of ability to pay.
A description of the support nnaterial and the system of guarantees as they apply to
each of the four plans follows:
Each gove'rrinient employee insured lender one of the above plans will be given
an identification card, (sam.ples attached). You will note that when the Plan has
two options a separate and different colored card is issued for each option.
The reverse sid
h
e of eac
. curd 4ii es a brief summary of the hospital benefits
payable for the applicable option of the Plan under u;hich the ,.-overnment employee
is insured, and should be of great assistance to. tjie hospital adrrizltiu office in
dcler'nmlinin,r the type, the size, and the amount of benefits.
Mutual of Omaha will guarantee benefits without reservation for the holders of
identification cards of the Government Employees Benefit Association and the
Government Employees Health Associaliori (else Assoc ation).~ IT WILL NOT BE
NECESSARY FOR THE HOSPITAL ADMITTING OFFICE TO VERIFY COVERAGE
FOR THESE TWO PLANS.
When the patient being admitted is insured under the Plan of Insurance available
to members of the American Federation of Government Employees, we ask that
the hospital verify coverage with the American Federation of Government Einployces
Insurance Department. In the Washington, D. C. area, coverage niay be verified
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by calling REpublic 7-1705. If the hospital is located outside of the Washington,
D. C. area, wire collect to American Federation of Government Employees
Insurance Department, FAX, Was'hingtorr, D. C.
Mutual of Omaha guarantees payment for holders of AFGE identification cards
from the time of admission to the time the hospital receives confirmation from
AFGE, provided that the hospital forwards a request for confirmation (I)v collect
telegram) to AFGE within 6 {tours after- admittance. Before payment is made
by Mutual muter this guarantee for a person not otherwise eligible for benefits,
the hospital must attempt to collect the amount from the patient.
Complete instructions concerning verification of coverage and the system. of
guarantees is shown on the identification cards issued to insured members of
AFGE. (See attached samples. )
It is not anticipated that the local hospitals will have any great volume of admissions
for insured members of the American For'eigut Service Protective Association;
howezver, the same system of guarantees applies to this Insurance Plan as for the
American. Federation of Goverranrenl Employees. Coverage can be, verified by
contacting the American Foreign Service Protective Association, 1908 G Street,
N. 14r., Washing ton 6, D. C. ('Ational 8-4104).
The hospital admitting office should obtain an "assignment of benefits" forma at
the time.of,.adrrrission, if benefits are lobe paid directR. to the hospital. Mutual
of Omaha does not presently plan to furnish the hospitals with claim forms,
since all that is required . front the hospital for the support of a claim for benefits
is an itemized hospital bill (the regular claim .form (samples attached) is coin-
pleted by the attending physician and the insured); and it is felt that the hospitals
would prefer to prepare their' billings under their regular' billing system and
that any special insurance form would involve additional work for the hospital
staff. Likewise, since most hospitals have designed and prefer to use their own
"assi, nrnenl of benefits "form, no special form has beerLPrcj?a ; 1 4'?~.l .p (? )ose
by Mutual of Orn.aha. If at a later ~tatc Et is Tet. -~ rrriraed that special, forms will
siirrf~ii`fi the procedures for the hospitals, Mutual of Orrr(r/ca will be glad to prepare
this special materidl. (Note: Any of the Standard Report Fortis approved by
the health Insurance Council are acceptable to Mutual of Omaha. )
Note on assignments: Since Civil Service regulations require that two identifica-
tiorr cards be issued to the insured when family coverage is invoiced (one for the
insured and one for' the spouse) the hospitals are cautioned to be sure that the
"assignment of benefits "form is.signed by the principal insured or policyholder.
Should an "assi."j7rmer7t foYrn"inadrrertently be si nrcd by the dependent spouse,
Mutual of Omaha will honor- llei,_, assi,;n 7nent, hul for legal reasons must issue
the benefits draft jointly to the insured and the hospital. This latter method of
payment.could place an additional burden on the hospital collections office, and
we arc sure that the hospitals will desire to avoid this whenever possible.
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0 3. S
All of the four plans referred to will be serviced by the Washing-ton, D. C. office
of the mutual of Ommaha; Joseph E. Jones, General Agent, 109 Ring Building,
Washington 6, D. C. (Telephone: FEderal 8-3000). Should the local hospitals
experience any difficulties in connection with these Plans of Insurance; or if the
hospital administrators and their staff need any assistance or have any suggestions
concerning the procedures outlined here, we hope that you mill feel free to contact
the Mutual of Omaha office.
Thank you for your cooperation and assistance.
Joseph E. Jo' es, general Agent
Mutual of Oma
Approved For Release 2009/07/16: CIA-RDP87-00868R000100060022-6