SUMMARY ANALYSIS OF CODED OMAHA AND GHI HOSPITAL AND SURGICAL CLAIMS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-01826R000600140006-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 41
• Document Creation Date: December 9, 2016
• Document Release Date: July 7, 2000
• Sequence Number: 6
• Content Type: SUMMARY

Approved FohiVelease 2000/08/16 : CIA-RDP8d '1826R000600140006-9
Sweaty Analysis of Coded Omaha and
OH1 Hospital and Surgical Claim
I. General
A. Coverage: The survey included 1129 Omaha claims and 1865 an
s covering illnesses which commenced prior to 1954.
R. Illnesses: Types of illnesses for which claims had been smutted
have en categorized into thirteen (13) groupings. Codes and
definitions are included as Attachment 1.
ng the claim
C. Ratio of Claims to Policy Holders (1953 :. _ Conpari for
sasses commanc3ng In --1953 'i. the policies in force as of
31 May 1953, the following has been determined:
Calendar Yr 1953
Number of Policies in Ratio of Claims
Inmvor Claims Force 5Z3 53 to Po Holder
110 B ha Claims
239
822
25X9
Cower e: A total of 1129 claims had been submitted through 1953,
re Ling in 6665 days of hospitalization. Of the 1129 claims, 679
were for illnesses incurred in the United States and 450 claim
were for illnesses incurred outside the United States.
B. Actual dense Coed to Inds: The actual expense to Omaha
policy holders approached l 3 more than the indemnity; pregnancy
claims cost the policy holder about 44..7 per cent more than the in-
demnitys vittle the indemnity for TB claims was about 10,9 per cent
more thau the actual cost. (See page 10)
C. D a Hospitalized: Approximately 84.6 per cent of the Omaha claim-
ants wore hospitalized less than 10 days, with about 47.1 per cent
hospitalized less than 5 days, and 15.14 per cent were hospitalized
10 days or more.(See page 19)
D. TyDe and Sex: Of the 1129 Omaha claims, 489 (or 43.3 per cent) were
or illnesses incurred by the policy holder, wives accounted for
485 (43.? per cent) of the claims, and daughters, sons and husbands
accounted for 155 claims or 13.7 per cent.
About 52 per cent of the claims were for illnesses incurred by females,
and 47.9 per cent of the illnesses were for male personnel and 0.1 per
cent of the claims were of an undetermined sex0
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Omaha
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E. Actual Surgical Cost to ?olo Holder: Of the 683 (lairs involving
surgic costs to the policy holder, 91 policy holders (or 13.3 %)
paid less than 125.00, 192 policy holders (or 28..E paid less than
5O.OO, but 206 (or 30.2%) paid 150.00 or more.
F. Extra Cost: Of the 871 poll cy holders paying "extr?z ", 283 Policy
ir r 32.5%) paid *25.00. or less 503 (or 57.E%) paid $50.00
or less and 314 policy holders (or 3.9%) paid 3151.C) or more.
III. CIS Claims
A. Govera t A total of 1865 t claims had been submitted through
r 8651 hospitalized days, of which 8350 days (or 96.5%) were
covered by benefits. The difference is accounted for by: overstaying
discharge hour (not allowed), overstaying child's tonsilectony (1 day
allowed). adult (2 days), overstaying maternity (8 days allowed).
B. Actual 1 nse Conted to Bene fits t Due to insufficient OHI iata,
it Impractical puny actual expense information conpaa
to benefits.
C;V Claims b Year of Illnesses: Of the 1865 OHI claims, 632 (33.96) 3 .ia
neases commenced prior to 1952, 411 (22.0%) illnesses commenced in
1952s and 822 (4t4.1,Z) illnesses commenced in 19539
D. Type and Sex of Claimant: Of the 1865 elaima, 505 claims or about
27.1,% wee y" Me F11 cy holder, 747 claims or 40.1% were for, the wife
of the policy holder and 613 claims or 32.8% were for sons, daughters
and husband
Tale ola wants accounted for 729 clams (39,1%) of the illnesses., the
women accounted for 1091 (58.5%) of the claims, and 45 (2.4%) were un-
determined.
E. Da s Hos italized; Of the 1865 claimants, 1705 or 91.t4 per cent were
hospitalized Te than 10 days and about 8.6 per cent (160) were in
the hospital 10 days or more. (See seotio I)
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Glossary of Terms Used in Attached Analysis of Omaha and GUI
Hospital and Surgical. Claims
Benefits x
liAllAJ monies paid to policy holder rieibers at the rate of $9.00 per day
for room and board regardless of room and board cost, and rei niburr
sertersts paid for dependency room and board. 1ei.,mburserrents is the
tern used for monies paid for dependency room and board at the
actual cost rate, if less than ?,9.00 per day, the riaximur is V"9,00
per day. This rate of ~~9.00 per day changed from .OQ per day
as of 1 September 1953,
Extra benefits changed as of ]. September 1953 from ,i3O?00 (allo-
cated) to ""'135,,00 (unallocated).
'Claims
Conmonain t Table headings reading "illnesses Cop ienoing"v means that the i I.--
ness commenced prior to 1.952, in 1952 or in 1953 as the ease may be,,
Surgical Cost:
OWJI&:) _~~K Means the gross amount Of Money expended by the policy holder
to satisfy the surgical bill,,
Percent of
Claim Covered
by Benefits:
tCi k1A The ratio of benefits to the aotua:L expenses,,
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Hospital and Durgica1 Codes
-U-L ]'4n
01 Eye, ears nose, and throat.
02 Genital and ur .nary,
0~31 Heart and circulatory,
and i'..'"`
04 Pregnanc
.t - - 1- ' - - - ? ? -
08 Other (including childhood diseases, bone
and nusc ular, hernia, surgery, etc.).
09 Digestive, from stomach on out.
10 inspiratory (including colds,, pluerisy, etc.),,
11 Dermatology (including cysts, etco),
12 l ental, nervous, bx xIm, etc a
13 Undefined.
W Tuberc osls and tests therefor,
07 Accidevlts
p
y
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 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
S ry of Claims by Type of Illness A
Illness Commencing Prior to 1952 Al
Illness Commencing in 1952 A2
Illness Commencing-in 1953 A3
Per cent of Difference between Benefits and
Actual Cost B
Section
Illness Commencing Prior to 1952 BI
Illness Commencing in 1952 B2
Illness Commencing in 1953 B3
Geographic Origin of Illness C
Aotual Surgical Costs
Table D
Graph Dl.
Actual Extra Costs
Table
Graph
Number of Days Hospitalized
Table
Graph
E
El
F
Fl
Type of Sex of Claimant G
GHI CI.AINS
Summary of Claims by Type of Illness H
Illness Commencing Prior to 1952 HL
Illness Commencing in 1952 H2
Illness Commencing in 1953 R3
Days Hospitalized
Table
Graph
I
I1
Type and Sex of Claimant j
A5-
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 Approved For Release 2000/08/16 : CIA-RDP80-01.826R000600140006-9
Se rr,.ry of Omaha Hospital and Surgical Claims
(By Type of Illness)
Based on Claims Submitted Through 1953
r
No. of No. Days
Benefits
Actual..h enses
Mai= In Hose
?
2 L
tra
To
v g
...
.
-
.~.
,-
Total
1129
6665
*415,405
b9s744 $29,044
036,617-172,878 05,580 iG7O,683 W,615
"ode:
01
130
322
9,531
2,417 3,161
3,933
14,953
2,718 8,303
3,932
02
73
389
8,664
3,050 2,049
3.565
13,076
30656 4,848
4,572
03
400
270
3,869
2,036 525
1,308
5,215
2,143 1,556
1,516
04
339
2279
40,222
16,8i8 12,965
10,439
72,710
21,009 34,289
17,412
05
40
132
4,039
994 3,032
2e013
6,316
1,228 2,557
2,331
06
6
Ui
1,0!06
764 1~1
282
943
589
3514
07
77
325
4,247
2070 720
1?1
4014
1,749 1,439
1,126
08
160.a/
989
13,125
7,272 1,53$
4,r317
15#754
7,303 3,737
14,71)
09
130 1,079 20,783
.8,,322 6,029
6,432
26,140
8,462 10,773
6x905
10
72 421 4,366
3,018 155
4193
5,273
3,249 871
1,453
34 98 1,550
708 277
565
1,902
547 730
625
12
17 176 2,053
1018 10
725
3.,107
1,977 180
90
13
9 74 1,930
65't 585
688
3,375
950 1,400
1,025
a/ Of the 160 ''otdier' illnesses,, the following specific illnesses resulted in seven
or more clai st
Hemorrhage (Type unlmo!m). .. 8
Hernia . . . . n . . . . . . . 15
Infections (Genet.) . . . . . 9
Polio relitis . . . . . . . . 7
A total of 75 different 113-nesses are indicated in the "other" category.
-6-
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 Approved For Release 2000/08/16 : CIA-RDP80-01,826R000600140006-9
Simm-try of Omhn Hospital and Surgical Claims
(By Type of I1lwas )
Illnesses Co nmenccing Pr?ior to 1952
Ito. of Mod Days
Benefits
Actual Cost
a v asp urg
Claim In Has . T
?
Total
525
3271
$58,575 924,281 $152461
$18,833
084,925
$27,269
$34,847
$22,809
Codes
01
63
175
4,783. 1,291
1,557
1,935
7,663
1,336
49392
1,935
02
33
193
4,243 1,487
964
1,792
6,Ohl
1,800
2,198
2,043
03
18
123
1,917 868
420
629
2,994
985
1,172
837
04
148
1030
18,605 7,654
6,240
1,712
31,606
9,400
15,214
6,992
05
26
93
2,789 701
700
1,388
4A93
864
1,640
1,689
06
3
50
531 296.
235
562
255
P
307
07
31
102
1,772 737
3115
690
2,008
559
769
680
08
67
516
6083 3:993
841
2,049
8,603
10,166
2,051
2086
09
66
536
11,336 4,008
3,818
3,510
13,255
3,7811.
5:675
3:796
10
42
237
2,1,23 1,581
122
720
2,,760
1,806
2116
708
U.
16
57
850 423
3.34
293
1,016
288
435
293
12
6
108
1,309 792
10
507
2,277
1,365
180
732
13
6
51
?,133 450
310
373
1:947
661
875
1111
_7-
Approved For Release 200Q/08/16 : CIA-RDP80-01826R000600140006-9
 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
Sumaaaax:y of Omaha Hospital and Surgical C1ains
(By Type of Illness)
Illnesses Commencing in 1952
No n of
No. Bays
Benefits
Actt^,, Cost
C1as
in Ham
Tot
osp Extr
dot f~
iu
Esc
Tot 1
? a5
2017
$35352
515025
$8538
$1.1789
$55993
$16956
$22967
$16070
Code:
01
45
102
3-1,03
782
1014
1307
5038
964
2768
1306
02
20
1Ot5
2372
81?1
560
971
la096
96)
i.1a31a
1698
03
15
915
3105
738.
105
642
1906
880
381;
642
014
108
707
12690
5263
3979
3148
24940
6667
U636
6637
05
7
26
789
21E
217
356
1137
3014
1433
Iaoo
06
3
48
351
351
w
227
227
-
..
07
25
93
1276
704
248
314
1231
509
396
326
08
63
321
4429
21140
565
1724
5085
2087
1216
1782
09
142
321
6252
2467
1615
2170
8913
2809
3767
2337
10
18
121
12514
9614.
w
290
1482
859
331.
292
31
10
1.6
345
87
80
178
521
1.16
227
178
12
7
1+0
1453
274
-
179
473
2914
179
13
2
22
553
198
175
180
944
276
375
293
-8-
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 Approved For Release 2000/08/16 CIA-RDP80-01826R000600140006-9
Swmary of (rMa Hospital and Surgical Claims
(By Type of Illness)
Illnesses Commencing in 1953
No. of
Noa Days
Eenefjt
s
Actual Cost
Claims in
SEM
Ems
a
Total
239
1377
Y'-21478
$10438
$5045
$5995
$31963
011355
$12869
$7739
Code:
01
02
22
45
1625
344
-59o
691 .
2252
418
1143
691
0
20
93.
2049
722
525
02
8
2
1216
831
3
7
52
467
430
ft,
37
315
278
04
83
542
8926
3901
2746
2279
16
37
05
06
7
13
161
77
115
786
60
7-484
3 783
2#2
07
2
21
13
1
0
164
3.17
-
17
154
107
,
-
2
08
30
3
15"
1199
81
92
9
123
1078
681
2711
123
09
22
3
113
130
51
2066
lo5o
470
516
222
3195
1847
596
752
3972
86
10
12
6
1
9
1
772
8
3
25
689
473
33
183
10 1
584
294
153
12
4
28
291
198
63
94
365
8
68
154
13
1
1
244
9
100
39
135
57
484
311
13
-
150
39
321
.9d
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 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
Surr: ry of Oraha Hospital and Surgical Claims
(BY Type of Illness)
Based on Claims Submitted Through 1953
(1)
No. of
(2)
ido. Days
(3)
Total
Total
Aotua.!
(5)
Differ-
n
(6)
Percent
of Claim
Covered
by
(7)
Percen
Difference
between
Hematite p:
Actual
e
ce
Benefits
- _Expense
Total
1129
666
,` 115405
.1p"1726-V!
X57473
66 8
33 2
Cam:
01
02
130
322
9511
1 95
5442
63
6
36
4
03
73
389
8664
13o?
4212
0
66
3
.
33
01,
ho
339
270
2279
3869
0222
5215
72_71o
1346
3
87
4
74.2
.7
25.8
05 06
11r
8
132
x13
!x039
1
6
011,6
20
66,o
4407
34Qo
07
77
.
325
10
4
4247
913 3
4314
03
67
IZOQ9
1009
08
160
8
8
98 64
146
09
1
9
g
9
13125
15754
ry[ X
2629
83
3
`} [
16
7
10
30
1079
20783
26144
5357
,
79
5
6
20
5
11
72
I
421
4366
2
1
907
,
82
8
0
2
1
12
3
4
98
1550
902
352
8
81
5
7.
18
5
13
17
176
2053
3107
1054
0
66a
,.
33
9
9
74
1930
3375
1445
5702
,
42.8
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 Approved For Re'Ibase 2000/08/16 : CIA-RDP80-0 6R000600140006-9
Suz ary of Omaha Hospital and Surgi.oal Claim
(By Type of Illness)
Illnesses Connenoi,ng Prior to 3,952
(1}
No, of
Claims
(2}
No. Days
In Ho
(3)
Total
Benefits
Total!
525
3271
$58575
Codes
01
63
175
4783
02
33
193
4243
03
18
123
1917
04
148
103o
18606
05
26
93
06
3
50
07
1
6
102
1772
08
7
516
6883
09
66
2
7
11336
10
42
3
2423
U.
16
57
850
12
6
108
1309
13
6
51
1133
(6)
Percent
(4) of C3AiM
Total Dif Covered % of)Dif
Actua7! Between by Between
Cost Cola do Benefits ,
084925 $26350 69.0 31.0
7663 2880 62.4
6041 1798 70.2
2994 1077 64.o
31606 ~. 66.5
2008 236 88,2
8603 1720 8oao
13255 1919 85.5
2760 337 87.8
71.016 166 83.7
2277 968 57.5
1947 814 5802
 Approved For Release 2000/08/16 : CIA-RDP80-01626R000600140006-9
Summary of O th Hospital and Surgical Chins
(By 'Type of Illness)
Illnesses Comrnth c g Prior to 1952
)
No, of
Claims
(2)
Noy '`,ays
In Hosp
(3)
Total
Bon fits
(4)
Total
Actual.
Cost
(.5)
Dif
Between
Cols 3 4
(6)
Pegcent
of Claim
jover?ed
by
3
Y *
(7)
% of DU
Between
'
wane
-~r i
s
V
tti.?rW.+u.t.- -
_3
-OC
To . ;
365
2017
$3.5:352
$55993
r20641
63,1
36-9
Code,
01
2
45
102
3103
5038
1935
61 .,6
38
4
0
20
105
2372
h096
1724
57.9
.
421
03
15
95
11485
1906
421
77
;9
22
7
04
05
108
707
12690
24940
12250
.
509
.
,,
49
1
6
7
26
789
1137
348
69
4
n
30
6
0
3
48
351
227
-124
.
154 ., 6
.
-
6
54
a7
08
25
93
1276
1.231
2.45
103,17
.
0
7
'
3
0
63
321
!x429
>O85
656
87,1
0
.
12
9
9
10
42
8
321
6252
8913
2661
70.1
.
29
9
3
1
1
121
1254
1482
228
84:,6
.
15
4
.
12
10
16
345
521
1.76
66,, 2
,
33
8
1
7
40
453
1?3
20
95;8
.
2
4
3
2
22
553
944
391.
58,6
0
41044
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 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
Sw nary of Om-.1m Hospital, and Surgical C1< iir
(33d Type of Illness)
Illnesses Commenc in .1953
(1) (2) (3)
NOQ o. No. D-,-ys Total
Claims In Hospo II
(6)
Percent
(4) (5) of claim (7)
Total Bif Covered % of Dif
Actual Between try Between
Cost cols 3 & 4 Inderu ty 3
ots1
239
1377
$ 221x78
$31963
$10485
67.2
.
3298
C ode
01
02
22
45
1625
2252
627
627
72
2
8
27
03
20
91
201x9
2939
890
9
69
7
0
30
01
7
52
267
315
-152
9
3
118
.3
4
05
83
542
8926
161611
7238
.
5592
44
8
06
7
13
461
786
325
58
7
.
07
2
2
13
1610
1510
?10
.
106
5
-605
08
1
130
1199
1078
-121
,
131
2
11
2
0
30
152
1813
2066
253
3
87
8
-
.
12
2
9
10
22
222
3195
3972
777
.
80
4
,
19
6
11
12
8
63
689
1031
342
,
66
8
,
33
2
12
tt
25
28
355
365
10
.
97 o3
,,
2,7
13
1
1
291
214
-3
4
66
81.5
1805
2140
50.4
149n6
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 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
tSuz r;r of Or, i ! Clad= by Geog phic Origin of Illness
(By Sex and Year of Cormencemerr . )
(1) (2) (3) (14) % of
Total Indem- Actual Differ- differ-
I11a-w4 s
1111n
.z..t'e in Unified at es
1.11 ye3~' 'Wut ide United States
Fen:? e
J1:1or to 1952
vi I
r Cl v r? '-E- In 953
C=~ nib Cost ante enwe
122 :~
25780
1188!16
12522
679 $7734 x;;129912 65248 40.4
E6 I.H133 27 ,2 9370-9 340 .
L.53 59231 102270 43O39 42.1
i t~o259 6 9Th V151
7e?
'r 33' ~. Ol 9 3309
224 29949 i.8313 18364 3800
227 24267 4296O 1869 43.5
7 5993 "9
20 2 322 3
1h9 18269 33758 15489 150 9
I1 12838 23038 10200 440
31 1 2839 1014 -3M-
80 12013 20199 9186 45.5
450
z
300
186
a
118
136
I6~
1~V
92
128
90
42966 4925 11x5
11729 73-2 --V.3
31237 5457 17.5
212109 -2T33 1209
-
M3
15276
11 12792
7719 9851
8640 8925
5539
6.1.0
-O,
27511. 18ao
1907 14@ 9
Q2 ,..
2132 21.6
2852
-WO -10,
571 903
(6)
Percent
of Claim
Covered
by
Indemnity
59.6
656
579
61?0
0
62.0
A 56
4.1
54.1
7507
Z~ .73
54.5
885
Or, 3
82.5
8701
1005
82,,0
85,11
1-07-7
``--
78.4
11-07
90.7
C
m14
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To ll
Actual Surgical. Cost to Omaha Policy -Holderm
(Based on 683 Incidences)
Selected Groupings
Less than $25
$25 thru $49
$ thm $74
$75
thru $99
91
101
99
$1 tbxu $124- 81
#125 thru $149
33
$150 thm $174 82
$175 tbru $199 29
$2OO thm $224 .45
$225 thrn -$249: 6
$250 thm $274 20
$275 tbru $299 5
~3OO and Over 19 (a)
(a) D3atribution:.
335 -1
$349---.1
$350- -5
$375--.--1
$400--3
19
100.0
13.3
14.8
23,1
14.5
42.6
10.5
53.1
11.9
10' 51 0
4.8
69.8
12.0
81.8
62
.=J.i
6.6
92..7
0.9
9 .6
2.9
96.5
0.8
2.8
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 Approved For Release 2000/08/16 : CIA-RDP80-01826R000600140006-9
ACTUAL SURGICAL COST TO OHAHA POLICY 13OLDER.S
(Ba-sed on .683 In :idoness)
Salasr.eh of the above measures or Instruments is analysed herewith:
(1) Individuaalca own commercial policies
(a)
A typical Ordinary Life policy with disability (and
preum waiver) inclusion is that of ( .iaardian Life of
New York, N. Y.
to For an annual premium of $$,63 at age 35, Guardian
will pay $10,00 per month per $1,000 of policy face-
amount,
20 Exclusions are self-inflicted in jury$ military service
in time of war and air fl. .ght except on coaacraerciaaal
schecie1ed air lines*
to The benefit from an accidents
$1OOa0O per month for life
(4OpO0 " " " partial disability for 3 caoio)
2n The benefit from sickness:
$.OO per month for lire
($Oa oO " n n partial disability for 3 "so)
3o The premiu a $5OaOO per year to a preferred white
collar risk
TAB D
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(b) A typical co ercial straight disability policy is that
written by Mutual Benefit Health and Accident Association
of Omahas, Nebraska o
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$40,00 if benefits start on the 8th cosy
35000 " 16th
32.50 " tt " n " 31st
30.OO 61st
27050 91st "
4. The above benefits can be purchased in multiples
of $50000 with proportionate difference in pre-
mium.
6. Until 6 months ago, sir flight in non-scheduled
service was excluded. Now it is in-a sided, for an
additional annual premium of $3,00 per $1004MO
benefit.
The policy is issued annually so that the Company
my refuse renewal if initial benefit-days
provision is abased?
(2) National Service Life Insurance or U. S. Government Life
Insurance
(a) This legislation permits the World War II Bolo. on
return to inactive dut*r, to purchase life insurance in
one of seven different policies to which he may add
disability coverage for an extra premiumo Examples
Term life policy of $10,000 facer-amount at age 35
can add a disability feature paying benefit of $50,00
per month for an annual additional premium of $114,404
(b) Uo S4 Government Life Insurance before World War II
permitted a veteran to keep a policy containing dies
ability provisions and add more if he chose for
additional premium. Such a policy is no longer
available.
(3) Federal Employees Ca txpenssition Act,
(a)
The Federal Employees Compensation Act provides compensa-
tion for disability (and full medianl care) resulting from
injuries suffered in performance of duty or from diseases
proad .tely caused by emp oymen , for as long an the
disability continues*
1o This Act-is an exclueivp remedy, but does not pre-
vent the beneficiary from electing to receive the
benefits of the Civil Service Retirement Act if
he so desires but he cannot receive such benefits
concurrently .with those under FECAo
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2. Al]. hazardous or semi-hazardous duty risks are
covered?
3. Exclusions are disabilities resulting from will-
ful misconduct, self--inflicted action, or intoxica-
tibn-
4o he monthly schedule of benefits ares
a. To indivickal with no dependents $ 66-2/3% of
salary lose not to exceed $525.00 monthly.
This maximum benefit of $525.00 provides a
benefit of 66-2/3% up to the maximum salary of
( 13, 58%' of raxitoam salary, of GS-14 and 53%
of maximum salary of GS-15Q
bo To individual with one or more dependentst
759 of salary* loss an salary up to $5040
ennualll 66-2/3% of salary* lose an salary
above $-5640o The total benefit not to exceed
$52560. per month (this maxim= is an annual
salary rate of $6300 - about the middle of the
GS-n scale)?
c. In either case above, plus varying specific
number of weeks of compensation 0 66-2/3% of
the salary, rate, for permanent anatomical
losses.
In either case above, plus $75.00 per month,
if an attendant is required, plus $50.00 per
month for rehabilitation training if needed.
Clearly, this is excellent coverage in the performance
of duty areas
(1k) Civil Service Retirement Act
(a) The Civil Service Retirement Act provides disability benefits
to employees of the U 6 S. Government with and without perfor-
mance or lime of dety qualification, provided the employee
has acquired minimum eligibility of 5 years of civilian
Salter rate includes amounts withheld for tax and retirement purposes
plus value of subsistence quartera9 etc.
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 1. 1
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servic3, ' and is totally disabled,
1a Exclusions are injuries or disease due to vicious
habits, willful misconduct or intemperances
2. The benefit is based on base salary and length of
service, This latter factor, of course, autos tically
describes the nature of the plan and hence,, for an
agency made up so heavily of youth, we find but small
oompensatory contribution. This is illustrated as
follows t
Min o
G5m9
Highest ava 5 Y'rm emery 836000
Civilian creditable service 12 years
,1itazy service 2 years
8360oOO
x1o%
x 34
$5060000
5 yoare
3 years
5060,00
x 105%
6"
x8
1755060 annually
146030 month3y 50.60
ca AgRin st Disabil Disability
(1)
Federal fnplcyeea`\Compensation Act
(2) Public Last 110
(3) The group hospitalization and surgical plan a .nistered under
Government Employees health Association CIA), underwritten by
Mutual Benefit Health and Accident Association of Omaha, Nebraska
(hereinafter designated CI`4AHA)o
(1) The group hospitalization and surgical plan adm'nistered under
Government Employees Health Asssooiatimi" (CIA)p underwritten
by Group Hospitalization Inc 4, (hereinafter designated OM) a
# Under 5 years of civili:sn service or more than 5 Years with no vic r
or dependent 'children, the Act provides for a lump turn of the amount
paid in, plus interest*
Goverment I;4nployees Health Association, This in an incorporated assc cia-
ti'.ai within CIA, with officers elected nnnual].y by its Hoard of Directors,
organized in August 1948 for the vaarpose of administering a hospitalization
and surgical benefit plan underr itten by Mutual Benefit Health and Accident
Association of Omaha,, Nebraska, The Acuociatian now embraces GUI also,
offered to employees in March, 1953? This Association In entirely separate
from, Pnd not to be confused Kith, the Agency cover bank account for
WAEPA preniums designated as GEHA, Inc.
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d,, Each of the above treasures is anelyzed herewith:
(1)
(2)
Federal Employees Compensation Act (see b, (3) above)
Public Law 110
(a)
vicious habits, misconduct, or intemperance0
This Act provides substantial disability benefits to
employees of the Agency assigned to permanent du
stations outside the Continental U. S , i s rrr ies,.
an possessions 3 for injuries or illness requiring
hospitalization and which occur in line of dut
+~rr~r w rri~
10 E=lusions are injuries or illness resulting from
Also, ss shown above, T!)I (refer to recommendations
of the Legislative Task Force).
2a The benefits are t
(3) and (1s)
a. Payment of travel expenses to and from an appro.
priate hospital or clinic (including an attendant,,
if necessary)*
b. Payment of the cost of treatment.
O1AHA and GHI hospitalization and surgical plan
(a) There are two hospitalization and surgical plans available
to staff Employees and Staff Agents (only) under process
which are designed to protect aeaurit7Q Both plans pay sub-
stantial benefits to help meet hospital and surgical expenses
arising out of injuries and i3lneesa
(b) The first plan made available to employees ( In August 1918)
is CMAHA& It presents a straight indemnification arrange.
meat, i.e., explicit cash reimbursement,
(c) The 2nd plan, made available in March 1953, in GHI' This
plan is one of 80 Blue Crose plans in the U,% So and Canada,
which have Inter-Plan service (reciprocal) Benefit Agree.
merits with 4500 participating hospitals. If the admitting
hospital is accredited but not participating in the Inter-
Plan Agreement, cash allowances are provided. GHI is
partially a benefit and partially an index ifioatia m
arrangement,
(d) Omaha combines in one contract specific surgical benefits
within the Hospital Service Plan, OU -separates the
405-
M D
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(e)
Hospital Service Plan from the Surgical Service Plan.,
and for separates fees the individual buys one or both,
Both CHARA. and (II provide coverage for the fvaidly for
differing fees a The same benefits are extended to tie
family as to the individual contracting - if so con-.
-tractedo
Both O a and (I exclude coverage for injuries or
illness arising out of or in the case of employment,,
ip ooe where ACA coverage obtains.
Each plan is analyzed and compared hea ith, separately
as to overseas and domestic situation
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OVERSEAS
Ho pitalizatian
Hosp, Board & Room: $9 per day for 31 deya
with no limit on freqvencyt plus
$135 for hospital extras
2, Plus surgical as shy below.
I'Ius7 cut-patient emergency up to -,4135
40
Effective date. let of the next month
Waiting periodq, Maternity only (see below).
6, Materni Waiting period 9 months and coverage.
aid 9 months beyond term of contract,
es 'CiT
%a) $9.00 per day for ]k. days
plus up to $45 total for Hoop& extras,
Hospitalizatica
Hospa Board & Rooms $10 per day for 21
days with 90 day .ntemal on frequency,
plus
for hospital extras
2.
Plus surgical r as shown below,
3
Plus out--patient emergency up to o,,,,$ 200
Z
Effective date.
let of the next moth.
5m
Waiting period.
See *1 below.
Maternity,#1 Whiting period - ncneo l No
extension beyond term of contract.
(a) $9.00 per day for 8 days
except Caesarean, termination of
ectopic pregnancy and miscarriage,
for which hospitalization benefits
are l above
*1 As of 5 Feb 1954 Gill eliminated all waiting
periods for members oua+mtly in d and
for E0Dts who accept (S within the 1st
60 days of employment. These waiting perm
iode were: Pre-existing conditions o 1 yr.-
Maternity, tonsillectomy, adenoidectomy
10 months,
m7-
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(maple) G it Sur cal.
This is 6t'YjU of
a
$1060
?.075
6,00
50oa.allernia Ingo uail.oo.004$ 100
750000 ' ff bilat9cooOO 140
1000. . Appendectomy.. x00004000 100
100 ,,a o ,Radical Maetector o, a o a 175
50g!!00..Fr eture of sp3~,ne.o0000 125
35oe.o p disloc tiono.o.6600 75
1500000Proststectr..0o...0.0200
50. o . ?Norma3. deli.very.. o . r . o 0 80
1t~..0oC`ae a1L'.9Tboeaa.oo...so.o 150
150 a . ? oRemi oval of Isi.dr:ey.. . o a 175
50000* " " Cataract.-... 150
1000 r,. oG?etriati or..0 a 00 e.0 250
25. a a aTonsilleet? efsssrrs.? 5+5
250orAdenoiCectcW.aeroa..oe ,575y
25, aooa+Iemorrhoidecto+1 '?a0oyo? 60
15DooeJj te'xectomy..........0 165
$rm $MW
(7he above, of course, disregard frequency of
occurrence is set forth as a quick looko )
Individual Contract.... 0x. 00000000
Individual & Spouse contract.. . 0 0
Indiv0 & spouse P_ children,,,*,,,,
m8-
RLBa Below the 5th step
increase of a GS-9
and including the
Minimum of OB-100
the surgical fees
scheduled are ac-
cepted by the par-
ticipating surgeon
as fall payments
Costa (mct )
Rua o Sur ca gal -r.ff-
e
3070 3.20 6090
3.70 3.20 6.90
IC
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WASHIN G It?
Rosptn zatian
off
WASHINGTON
Honpitalizat
1,
Hoap. Board & Room' $9.00 per day
for 31 days with no limit on frequency
Plus $135 max. for hospital extras
Hosp. Complete Service for 21 days (Bead-pri-
vate, partic8 hospital) with 90 days interval
on frequencyo $10.00 per day if in private
room.
2?
Plus surgical as shown above
Plus $5 per day for additional 180 days
(See below)
3.
Pius outpatient emergency up to
$135
2 0.
Plus surgical as shown above
.40
Examples (Hospitalization only):
3,
Plus outpatient emergency up to
lid & Rom
Normal
4,
Examples (Hospitalization only')s
Bd. & Room s'l (cliff a )
$ 90
270
126. (Plus a maximum of $135
90 (to cover all hospital
1.26 (extras
90
27
appendectaW
comp, fracture
bilat, hernia
unilate. "
bysterect *
heYmorrhoidectos r
t sillectmW
10 days
30 "
14 -t
10
0
3
^ 135 (1 45)
^ 135 (1 45)
40 (/ 13)
Plus the hospital extras,
(16 listed) which range
from $50 for the simplest,
uncomplicated appendectonW
to very substantial
amounts for the serious
or complicated case.
Net 2 50% greater on Board & Room than CIKAHA
*1. ? Basic costs of Board & Room @ $13.50 per day
(typical ? presently) is absorbed by GHI
conplstely?
405 (s35)
189 (~ 63)
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(f) Summary Comparison of these two plans s
1Q Overseas general hospitalization
MW-VI-far superior to Mg.
Overseas maternity hospitalization
s substantially superior to CHI in normal pregg
nancy. In the cases involving Caesarean, termination
of ectopic pregnancy and miscarriage (av.. 10%, per
Drs Tietjen), CHI is substantially superior;
Overseas surgical,
WAHA is as good as CHI.
Domestic general hos italization
UMHA is substantially INFERI to GHI in either a normal
or abnormal cased
Domestic maternity hospitalization
HA Is substantially supers r to GM in normal preg-
nanoye In 10% of the cases involving Caesarean, teiiaina4
tier of eotopic pregnancy and miscarriage, (CHI is
substantially superior.
Domestic surgical
MA is only as good as GHI,
7a Fees are the same in each plan as between overseas and
domestic, However, CMAHAee fees are all loner than GHI.
For individual contract OMAHA charges 60% of CSI; for
individual and spouse OMA,H,A charges 70% of GHI for
individuals spouse and children OMAHA charges 88% of (iiI,
but GHI doesnet offer just an individual and spouse con-
tract at a lower rate than one inclusive of children,
~o Net on the above - if OMAHAss surgical could meet GHI,
it is better than Gill for overseas if the dependents
are with the emplayee, Even if OMAHAgs surgical masts
GHI, it is not a.s good a buy for domestic assignment,
BHA has offered to match- Gill surgical benefits with small increase
in premium as follows t single contracts, plus $?16; individual and
spouse, phis $?89; family, plus $.80o See Appendix X10
TABD
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 x
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90
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 datnestic
situation. This is because the OHI hospitalization bene-
fit is buried under the completely untranslatable "full
service benefits" with participating hospitals.
While the non-complicated case call for a minimal few
hospital extras, the complicated case under GHI gets
16 of them free and as many times as necessary. These
variables cannot be assessed dollar wise for purpose of
comparison with Cho
Even though it is true that the seriously complicated
case is statistically in the low frequency category, the
great dollar benefits under GUI are nevertheless there
for the individzal who wants to insure against precisely
such a risk.
It may be held that benefits in a serious case rids on
the backs of the non-complicated majority in respect to
fees., and also that throwing in "the works" for every
member is misleading persuasion. However, the minority
who do gst caught in heavy extras can?t pay with
statistics.
The simplest and blandest appendectomy calls for about
$50.00 in hospitalization eras. From there it could
go anywhere In cost while the patient still lives.
a0 Pregnancy hospitalization contains the same problem
but not as seriously so0 In 90% of pregnancy cases
the normal ones - C 4AHA 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, ter-
mination of ectopic pregnancy or miscarriage). Here
GHI is superior.
b. Again in the domestic hospitalization field Gill
adds a fillip for the unusual case and offers $5.00
per day for 180 days on top of the 21 f ll service
benefit days* Strictly from the point of view of
frequency statistics, this might be labeled a
"consm.n".
Also, in the GHI brochire is seen the same hand as
immediately above, ice., the illustrated cases are not
the u5ua1 ones. They are in the relatively infrequt
category, but because there are tai a of them, the
coloration seem to be present? These cases are cancer
TAHD
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do
25X1A9a
25X1A9a
Comparison of these two plans is important also because
of the effect of small items in irritation and dollars,
(14 49.15 benefits), fractured vertebrae (337005
benefits) =ind gall stones (518.90 benefits),
GUI requires a 90 day interval betreen discharge
and reentry to a hospital, C AHt requires one day.
Here GUI is inconsistent with the preceding tactics
as to minority occurrences.
C IAHAes fee schedale is superior both in form and
in dollars;
GHI, being so firmly enmeshed in legislation and so
integrated with the large and necessarily unwieldy
Blue Cross presents practically no possibility, of
modification in plan to suit us, whereas 0MAHA is
completely flexible m even to a tailored plan.
Cm's service to us in the settlement of claims
is "vastly better" than GHI0
characterizes GM as a "bickering,,
negotiating outfit."
100 "Fine Print"
Ambulance
MI won't pay to and from 'a hospital; Omaha will0
X -Rays
G II wons t pay unless the X?Ray is in 'connection with
surgery performed within three dayea time. Omaha will
pay with no surgery nor time restriction,,
co Hospital Extras
CHI will pay on certain specific hospital extras
without limit0 Omaha pays on all extras up to their
established maximum of $135000
Type of Hospital
GHI?s reimbursement is dependent upon type of
hospital, as follows:
T1B D
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Participating hospital ? full benefit; member
hospital of another hospital service plan gets the
prevailing service of that plan; non-participating
hospital gets only up to $10.00 per day for 21 days,
plus $6,00 for hospital extras (the same as the GHI
overseas rate), Omaha on the other hand reimburses
the same all over the world in any hospital of the
individual6s on choice,
Room and Board
The "full service benefit days" under GHI pertains
to a semi.-private room, but if the individual chooses
or really needs a private room, GUI allocates only
$10,00 per day, Omaha on the other hand pays the
contract guarantee for any accannwdation.
Dependent Children
Under (TI, they are added when 90 days old, and carried
to the 18th birthday. Under Omaha, they are added
when i!& days old and carried to the 19th birthday.
This my well be important in connection with con-
genital anomalies.
Tuberculosis and Mental or Nervous Disorders
Under GHI, these are covered for only 10 days daring
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
Under CHI, not covered at all. Under Omaha., full
coverage at any age after 11 days from birth.
Outpatient Emergency First Aid
GHI requires reporting within two hours of accident,
else they won't pay. Qmaha allows 24 hours,
TAB D
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