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-RDP87-00868R000100060024-4
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: December 22, 2016
• Document Release Date: July 16, 2009
• Sequence Number: 24
• Content Type: MEMO

Approved For Release 2009/07/16: CIA-RDP87-00868R000100060024-4
'TO: Hospital Administrators
RE: 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).
The Federal Employees Health Benefits Act of 1959 which provides for the establish-
ment of a Health Benefits Program for government employees and their dependents
became effective July 1, 1960. Among the Plans approved by the Civil Service
Commission are four employee 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
Government Employees Health Association (referred to as "The Association'9, and
(4) the American Foreign Service Protective Association.
In the interest of continuing the mutually satisfactory systems between the admitting
offices of the local hospitals and Mutual of Omaha relative to the hospital admissions
of persons insured under our Group Programs, Mutual of Omaha has prepared its
identification material 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 States Civil Service Commission are hopeful that these systems will enable
all government employees insured under Plans underwritten by Mutual of Omaha
to be admitted to your hospitals without the requirement o a deposit payment or
evidence of ability to pay.
A description of the support material and. the system of guarantees as they apply to
each of the four plans follows:
Each government employee insured under one of the above plans will be given
an identification card (samples attached). ' You will note that when the Plan has
two options a separate and different colored card is issued for each option.
The reverse side of each card gives a brief summary of the hospital benefits
payable for the applicable option of the Plan under which the government employee
is insured, and should be of great assistance to the hospital admitting office in
determining the type, the size, and the amount of benefits.
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 Employees
Insurance Department. In the Washington, D. C. area, coverage may be verified
FOR THESE TWO PLANS.
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 Association (the Association). IT WILL NOT BE
NECESSARY FOR THE HOSPITAL ADMITTING OFFICE TO VERIFY COVERAGE
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by calling REpublic 7-4705. If the hospital is located outside of the Washington,
D. C. area, wire collect to American Federation of Government Employees
Insurance Department, FAX, Washington, D. C.
Mutual of Omaha guarantees payment for holders of AFGE identification cards
froni the time of admission to the time the hospital receives confirmation from
AFGE, provided that the hospital forwards a request for confirmation (by collect
telegram) to AFGE within 6 hours after admittance. Before payment is made
by Mutual under this guarantee for a person not otherwise eligible for benefits,
the hospital zrncst attempt to collect the amount from the patient.
Complete instructions concerning verification of coverage and the system of
guarantees is shozcnn 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_e . Service Protective Association;
however, the same system of guarantees applies to this Insurance Plan as for the
American Federation, of Government Employees. Coverage can be verified by
contacting the American Foreign Service Protective Association, 1908 G Street,
N. W. , Washington 6, D. C. (NAtional 8-4104).
The hospital admitting office should obtain an "assignment of benefits" form at
the time of admission, if benefits are to be paid directly to the hospital. Mutual
of Omaha does not presently plan to furnish the hospitals With claim forms,
since all that is required from the hospital for the support of a claim for benefits
is an itemized hospital bill (the regular claim ,form (samples attached) is com-
pleted by the attending physician and the insured); and it is fell 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
"assignment of benefits "form, no special. form has bee rz ~?yej?ul cif~tir;..flajs.llcrpose
by Mutual of Omaha. If at a latca- (tote-it i- rev, r)'iiiz_ed that special forms will
si.ifp*tfl''the procedures for the hospitals, Mutual of Omaha will be glad to prepare
this special material. (.dote: Any of the Standard Report Forms approved by
the Health Insurance Council are acceptable to Mutual of Omaha. )
Note on assignments: Since Civil Service regulations require that two identifica-
lion cards be issued to the insured when family coverage is involved (one for the
insured and one fo)-' 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 "cis sign.ment form" inadvertently be signed by the dependent spouse,
Mutual of Omaha r.eill honor the assignment, but for legal reasons must issue
the benefits d;-aft jointly to the insured and the hospital. This latter method of
payment could place an additional burden on the hospital collections office, and
we are sure that the hospitals will desire to avoid this whenever possible.
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 :u rui its e zuuulu// 10 . L,i/'H-rwr ot-ooooorwjoo i uouu/-'+-'+
3. 1
All of the four plans referred to will be serviced by the Washington, D. C. office
of the Mutual of Omaha; Joseph E. Jones, General Agent, 102 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 will feel free to contact
the Mutual of Omaha office.
Thank you for your cooperation and assistance.
Joseph E. Joi4s, General Agent
Mutual of Oma
Approved For Release 2009/07/16: CIA-RDP87-00868R000100060024-4