STATISTICAL REPORTS INSTRUCTIONS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP86-00964R000100120027-5
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 7
• Document Creation Date: December 14, 2016
• Document Release Date: July 22, 2003
• Sequence Number: 27
• Publication Date: June 10, 1960
• Content Type: REPORT

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Statistical Reports
A, General
Appendix C of the contracts between the United States Civil Service Commission
and the carriers provides that the carriers shall maintain certain statistical
records and provide certain statistical. reports to the Commission. In accordance
with these requirements carriers are requested to provide data separately for
active employees., retired employees., and survivor annuitants,, as indicated in
these instructions and the accompanying formats of the tabulations, These in=-
structions and the table formats relate only to item B. oeurelo Appendix C.
l., Table formats.- - The a; comparing table formats are .intended as guides
indicating the data requested- the detail in which they are to be presented
and to assure uniformity., among the different carriers., of the character of the
data reported.
These formats are not "forms" to be filled out and the carrier may adjust
them., if necessary,, to fit his statistical procedures. However., they should be
followed as closely as possible and may be used as ftforms& if conveient,
2 a Basis of re o ^ti-. r, Data with respect to item B will be reported on
a 100% bass,
D date of the ~~rr~eggc--__r~~ts ? Reports are due within 60 days after the
end of per i. cover=epor?ts,
4, Source of the data- m Data for item B of Appendix C will be obtained
from the e . ne s iegistration Form (Standard Forms No, 2809),
All the data requested are precoded on Form 2809, except (a) the employeena
State of residence (Part A9 item 4) (b) whether the enrollee is an active em.,
ployee or an annuitant-, and (c) data on conversions. I box on the extreme right
of Part A. item 4 is provided for yoi to write in your own State Code.
With respect to annuitants_, none will be eligible to register in the initial,
enrollment period. Therefore original enrollments will not include annuitants.
As covered employees. retire on or after the effective da e of the Act, their,
transfer from employee enrollment to annuitant enrollment will be effected
through Standard Form 2810 OQNgtice of Change of Bnrollment Status.,A
Data on conversions will, be found on F2= 2810 IgNotice of Change of Enrolla-
ment Status,19
B, Explanation of Tables
Tables Al -.through A- request data with respect to original enrollments
covering the registration period. of June I to June 30th inclusive, These tables
should include all registrations received on or before July 3l9 19600
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a
Table A-l will also cover the initial registration period and is to be sub-
mitted annually thereafter as of the end of the contract year, Tables Amt to
A?h reports are leone-short" reports,
Tables A. 5 summarizes the enrollment at the end of each calendar quarter
commencing with the quarter ending September 309 1960..
Table B summarizes data on conversions from coverage under the FEHB program
to individual coverage as enrollees cancel their enrollments.or are separated
from civilian Federal employment, It covers a contract period, The first
report will be as for October 319 1961.
Table C. relates to the first NOpen Season" (October 1 - October 158 19619
inclusive) in which enrollees who desire to do so will be free to transfer
from one plan (or Option) to another, This is a "one-shot"/report and covers
only the period October 1 r. October, 19619 inclusive.
Column numbers have been assign to each column in the Tables, In each
column requiring totals or subtotals, the columns from which the totals or
sub-totals are to be derived are indicated. thus.- (3+4) in a given column'-in-
dicates that for., each item., this column will show the sum of column 3 and of
column 4.
Table A. 1
Part A is the total of Part'B (high option) and Part C (low option). Ex-
planations which follow apply equally to Parts B and C, The Option for which
the enrollee has enrolled is indicated on the Registration Form 2809 in Part
B, 1. at the extreme right "enrollment code number," The first ,2 digits of
this number indicate your carrier code number. The last digit indicates the
option and coverage the.enrollee has selected.
Last digits 19 29 and 3 are for high option, Last digits 4q. 5,, and 6 are
for low option. Last digit; 1 signifies high option coverage for self only3
last digits 2 and 3 signify high option family coverage, Last digit 4 signi es
low option coverage for self only- last digits 5 and 6 signify low option fam;.ly
coverage,
Column 1. This is the employeeus State of residence, It will be found on
Form `8o ,Part A9 item 4. On the extreme right a box has been provided for
your State code.
Colo 20 This is the sum of column 3
Column 3, This is the sum of column. 5
Column .,. This is the sum of column 7
+ column 1,
+ column 6,
+ column 8.
Employees enrolled for self only. Form 28098 Part B. 1 for
s y. Form 2809, Part B. 1 last digit of enrollment code-.' Number
1 for high option, 1 for low option.
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Columns 6 72 and 8 I'F i e& E tpl.c es and dependents under family coverage.
Foy $O Part B I last digits of enrollment code numbers 2 and 3 for high
optiong 5 and 6 for low option.
Column 6s Form 2809, Part Bh l and above code numbers
Column 7$ Spouse under family coverage. Form 2809,9 Part Be 29 Code
Column 88 Children under family coverage. Form 28099 Part Be 2,, last
code num"Ber
used minus le
LIJ
Table A-22
iT
Column 1, The year of birth of each enrollee and his dependents is & own
oonnoorm ?2809,9 Part A. 2 for the enx'ollee- and in Part Be 2 of the form for
each dependent.
Cow The sum of colas 3 and 4
Column 3 7 + 8 + 12
Column 9 +10 + 13
Column 5 7 + 9
Column 6
W as ae W 8 + 10
Colter 7 8 Form 2809,9 Part A. 5 Male code 1,,, Female code z s
Form 2809, Part; Be l,9 enrollment code numbers ending with lg 29 or 3 for
high option
Columns 9 10 Form 2809, Part B. I enrollment code numbers endin with
for low options Part A. 5 male code ,9 female code
Column 11 Sum of columns 1.2 + 1,,3
Columns 12
1,, 2,9 ar
Table A. 3
13 Form 28099 Part Be I enrollment code numbers ending with
or high options, 4. 59 or 6 for low option.
Column l Option and coverage for which employee has enrolled, From Form
2809,9 rt Be I last digit of enrollment code number High Option is in4-
sated by lit digits ig 2 f, and 30 - Low Option by 4
-, 5,9 and fa. Enrollment
for Self only is indicated by last digit 1 for High Option,, 4 for Low
Option- Family enrollment by last digit 2 for High Option, 5 for Low Option
Family - Female employee with non-,dependent husband by last digit 3 for High
Option., 6 for Low Option.
Column 2 Sum of colunm 5 + colunm 8.
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Column 3
Sum of cola 6 + column 9e
Coluar
4
Sum of column 7 + column 10.
Column
5
Sum of column 6 + column 7.
Column
6
Male from Form 2809,9 Part A. 5 code IV Dried Part A. 3
c e
Column
7
Form 28099 Part Ao 5 ode
Part A. 3 code
Column
8
Sum of columno 9 + 10
Column
9
Form 2809,, Part A. 5 code
D Part A. 3 code
Column
Table A. 4
10
Form 2809,, Part A. 5 code
Part A. 3 code
Column I
From Form 28099 Part A. 7
Column 2 Sum of columns 3 + 4 + 5
Column, 3 Sum of colrna 7 + 11
Column Sum of cola 8 + 12
Column 5 Sum of columns 9 + 13
Column, 6 Sum of columns 7 ,+ 8 + 9
Columns 7~ 89 9 Form 2809 Part B. 1 enrollment code numbers
column 10 Sum of col is U + 12 + 33
Cow p 12,, 13 Farm 2809, Part B. 1 enrollment code numbers.
Table A.
Column l See Table A.:3 Column i
Column 2 S of colu= 3 + 4
Column 3 Number of active empiaees enrolled
Column 4 Sum of columns 5 4 6
column 5 From Form 2810 "Notice of Change in Enrollment Statue
larTf and Part H
Column 6
From Form 2810 Part B and Part H
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Table B
Column 1 From Form 2810 "Notice of Change in Enrollment Status"
A0 6, Enrollment Code Number (see Table A. 3 for explanation
of number)? and Part B,
Column 2 Sum of columns 3 + 4
Column 3 Sum of columns 6 + 9
Column 4 Sum of columns 7 + 10
Column 5 Sum of columns 6 + 7
Column 6 77 9 10 Form 2810p, Part A. 5 designates whether enrollee
Is an
active ?mployee or an annuitant- your recordBwill also show this.
Your records will indicate whether the conversion is for single or
family coverage,
Column 8 Sum of columns 9 + 10
Data from Form 2809, The first column on the left are the enrollment code
numbers of the plans and options from which enrollee has transferred to
your plan and are shown in Part D, 1 of the Form. The 6 columns on the
rig are for your code numbers indicating the option and coverage to
which the enrollee has transferred anA appear on Part B. 1 of the Form,
It will be noted that the first column shows all the enrollment code
numbers for the two Government-wide plans. For the other plans., the
carriers are grouped together into 3 categories with the option and
type of coverage shown separately for each group, Each carrier should
add., as an additional category,, his own code and option numbers in the
first column to report and know the number of enrollees changing from
one option to another and/or from one type of coverage to another with-
in his own plan*...
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Supplement 1
SUPPLEMENT TO STATISTICAL REPORTS INSTRUCTIONS OF JUNE 10, 1960
PAGE 1.
Item B.
PAGE 2.
Table Formats
Paragraph 2, third line, last word: correct to read
"convenient".
Source of the data:
Paragraph 2. Add: Separate codes should be provided
for. (a) District of Columbia, (b) territories, de-
pendencies and trusteeships of the United States, and
(c) foreign countries.
Last Tine: Insert "such" between "all" and "registrations".
Paragraph 1, third line. Third word should read:
"one-shot"
Paragraph 5, fifth word: correct to read "assigned".
Item Table A-I.
Column 1. Add: In parts A, B, and C, subtotals should be shown
separately for: United States (including District of
Columbia); U. S. territories and dependencies; and
foreign countries.
Carriers with enrollments in one state only should, if
conven:.ent, show data for parts A, B, and C on one
table. Column 1 will then have the following items on
separate lines: the name of the state (e.g. California);
part A, both options; part B, high option; part G, low
option. Each of the other columns will then show the
data on separate lines for part A, part B, and part C.
Carriers with only one option will so indicate.
PAGE 3.
Item Table A-2 Please insert "Total" as the first line in Column 1,
- ~~ above "under 19". This was omitted in error. Appro-
priate totals should be shown in each column.
ADDITIONAL INSTRUCTIONS
General. Throughout the tables there will be items
which are not applicable in your case. In such a
situation write "not applicable" in the appropriate
place in the proper column.
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Carriers will note that many of the totals on certain
tables should be the same as the totals on one or more
of the other tables. For example, the total of each
column of Table A-l, part A, equals the sum of the
total of each corresponding column in Table A-l, part B,
plus the total of each corresponding column in Table A-l,
part C. Other examples are shown below.
TABLES WITH CORRESPONDING TOTALS (EXAMPLES)
Table A-art A
Column 2
-- same
as Table
A-2,
Column 2
Column 3
-- same
as Table
A-2,
slim of Columns 5 and 6
same
as Table
A-3,
Column 2
same
as Table
A-4,
Column 2
Column 4
-- same
as Table
A-2,
Column 11
Column 5 -- same as Table A-3 "both options", entry for
"self only" in Column 2
same as Table A-4, Column 3
Column 6 -- same as Table A-3 sum of entries for "Family"
and "Family - Female employee with nondependent
husband" in Column 2
same as A-4 sum of Columns 4 and 5
Table A-2
Column
3
-- same as
Table
A-1, part B, Column 2
Column
4
-- same as
Table
A-1, part C, Column 2
Column
5
-- same as
Table
A-3, Column 5
Column
6
-- same as
Table
A-3, Column 8
Column
7
-- same as
Table
A-3, item High Option, Total; Column 5
Column
8
-- same as
A-3,
High Option Total in Column 8
Column
9
-- same as
A-3,
Low Option Total in Column 5
Column
10
- same as
A-3,
Low Option Total in Column 8
Column
1.2
- same as
A-1,
part B, Column 4
Column
13
- same as
A-1,
part C, Column 4
Table A-4
Column 6 -- same as Table A-1, part B, Column 3
Column 10 - same as A-l, part C, Column. 3
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