HOSPITAL AND SURGICAL INSURANCE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80-01826R000900120012-1
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 10
• Document Creation Date: December 9, 2016
• Document Release Date: October 27, 2000
• Sequence Number: 12
• Content Type: MISC

Approved Fcfelease 2001/03/04: CIA-RDPW01826R0009001200
roAR
Hscirital ,111 quraloi,1 7.?-,nnen
c'.3Kacal.
Hospital and eurC..eal C-,:out) Insaranet P1-..-zs are available to
k:ency employees throu:h the Government 177..11oy,ss Poodth
n charitable corporation, incorporatA undo- the laws of the
Pistrict of Oelumbia. Tho rood for this \911Jelo fcr the processing
of insurance applioati)ne? payronts rad ele arc-o out of the
operstional and security requironents of the Agency that precluded
nola,s1 application vn4 claim Tabnission by P7,eney cnplo:1,oes. As a
cer-lIney to the requieorunt fo,.. a prei.,-;r vele'ot CIA providea for
tht adAlni,lt"ntion of :13 00V.a4nnant En:Joy:on Hatlth 4ssociation as
C gratniteuu :,urvlee to these employee availin thomsolron of the
n;-vLsa. With the oxouptLon or the methol of lolte%Lion? payhpat
cf promirms arid claim .-ub:As,-tin and payncat, tho Gr,,5p insurance
Plane availebl t ths present tiro (Mutu.11 of Omaha and Group Hos-
p1tlitionTncsrporTat,d) do not differ from those offered by the
L)aluo companis2 to the general public. Tho benefits are the 32E00
P24.1W7aaq..9.r
The attached papur, Annex It sets forth a comparison of the
befits offered by Group Hospltalization Medical Sorvioa and the
b(tts offered by Mutuel of Omaha. Penned changes of Mutual or
-sisoigalted ns "GEPA Pmoont Plant" right-hand column) have
been ii,r4e to reflect i=es,sed efits that Were effective 1 Sep-
toz;bor 1953.
Approved For Release 2001/03/04: CIA-RDP80-01826R000900120012-1
N
Approved For %lipase 2001103104i CIA-RDP80-04,26R000900120012-t
CO:TMS011
of
Tr D']J":-ITS
OfforeJ By
1=1.1L11211111L111tiMA IY2q.
No Dollar
Limit
Mese
Services
Covered
In Full
Rega-ffler,s
Of Cost
For 21 Days
tach
Nospit31
ConfiDmnt
UjI,EgTn
USJLMtTD
LULI2,1ITED
UALIMI5I1,1)
? (Those rut ed
' in .offieial
formularies)
T.LILIMIT7D
-1JiL.THITLO
iTijLtigTA.)
ILILI21.1T71)
UMITISTri
ULLflTTSD
7.:LTAIT:D
Clood and
1-:100
not inclos1(.3d
HOSPITAL, sTuric7.3
Semiprir,te accommodations
(cost in Washinzton arca,
$9 to $13.50 a day)
Heals and special diets
General nursing care
(Medicines
(Cystoscopic room
(Sterile Tray Service
(Drossin7s
(Plaster casts
(Intravenous solutions
and injections
(Sera (except blood and
blood plasma)
(Analgesic care
Oecovery room
(Oxygen and use of equipment
for administering oxygen
13
d Transfusions -
r:LT.T?1) Operating room
LE:ITED'
(1st uri-
nalysis and
blood count)
Laboratory '77,zamin,..i.tions
Iii 1D Maternity Benefits
($9 a da 7 for 3 days;
full s72rvioe benefits
for ectrTic pregnancy,
miscarriage; f:330 for
normal delivery; --)150
Caesarea q sction. nlls
Offered. By
,2jal-??Zaf'trltj,?:La,l
)
)
)
)
)
,p9 A Bay
? nivaTED
LiaThD

y13%Uoi
LT2,17T-.0.
(;9 n day foi'. jay?
plus'L'hr.; 00 11.11a1lotted..
.;14,0 for miserlage;
35-0 for delivery;
,.1.JDO. for 02esaren
sect10,1.)
ApproveeMarRelease:2001/03/04 : CIA-RDP80-01826R000900120012-1
patholoy r
Approved For Vease 2001/03/04 : CIA-RDP80-6026R000900120012-1
Offered By
Servicc:=
CCP:. 47(r.-3c..1 Continued
Up to ?"10" Physician
LLIELQ2 R.7.1,-T-i1). TO 5UTI]qY
Offered By
/10res,,pt_Plan
Up to LO
Uo Limit On
jurriber Of
Procedure
r110 to '240
(For each Fi-
ministration
of anoh,3sia
AnostheList
to !-,3.5 2.y
(For each
X-ray)
Up to 25 Clinical Laboratory
For each :xaminations
laboratory
leamination)
Included In
435.00
II
traTIO cellansous
Expense
L-Dri.T11) Allouance
(1) Medical Service allowances available while subscriber is hospi-
talized for and is receiving surgical or obstetrical services
covered by the Plan. Complete coverage rezerdless of cost if
sobacrkbees income is within specified
(2) Osrlplote coverage for el gible perticnts.
ClassifA
I. Sin! le- pleber only
TE3 CCST (Par Month)
Group Hospitalization
Married msrliber and spouse
21arried moTriber spoueo and
all children
TV. ,Member and all children, .ehere
there is no adult et.lpendent
ember and one child ihere
there is no adult de7.eadcnt
$2.70
6.90
G7HAls
reent plia
4.75
6.00
6.90
4.75
5.40
Approved For Release 2001/03/04 . CIA-RDP80-01426R000900120012-1
s -2.
01'r:17.1D ,t1P
CriOSS)
.4
LA T2ATIO 1, TX. Tr:
TTTS OF
1.3.0.211t,
n A.participant is admitted to a partici-
ing hospital the Hospital Service (kn-
ot mill offer, for each hospital confine-
.
t 21 days of 'hospital care with fUll
Ice benefits in seml-private accommoda-
ns, plus 180 additional days for which
Plan will proVide an allowance of $5 a
a total of 201 benefit days for each
finemont. Successive confinements shall
ti
th
ds
.co
- be considered to be continuous and to con-
stitute a single coninoment if discharge
from and readMiSsion to a hospital occur
thin A 90-day period.
ftl.,(.77,21Avs fa.:1zzrenoiedgrzi
al,7>sed tee the -07,itIonjts.
di charm from. thr, hosritt -11 and
1.2.2a2ta1
? Benefits during the fullbenefit days will
ilclud4.the follirrin.7, hospital services
egardlas of
mi-private roam _ccommodations for
20 3 or 4 persons (prnvailins rates
in the 7.:aehitilton area hospitals range
froli $9 to 113.50 a day). If a parti-
cipant occloi7,tatrivate room, by
choice or becarse of his condition, he
will receive a credit of $10 a day
toward the hospital's charge for the
room occupied'.
- Including special diets
-General nUrsinel service
,0ystoseopid room
, Anal:vale date
'Recovery' room
drugs and medloines listed in
the official formUlaries
. pressings
Plaster cast _
TntratenoUS souttons re injections
? .$teril?ray Servide
Virst urinalysis and complete blood count
Operating' neon
0.17,71Use1
The GTAiA policy will pa kperses
incurred in a hospital not elcesedin
a day for not exceedin3 31 hospital.
- for any one disability.
Benefit days will be fully ronewed for
each new illness and cach ;Oi colqeat
provided at least on dab
from hospital betwee-) illoesss.
r-
The GM policy offers a total
allowance of a day (a5 note.41y3-4's)
toward the hospital's charge for I,ecw,
accommodations, meals and spacial diets,
and general nursing s?rvice.
The Insurance Cany offdra rot to
0135.00 unallocated az the resillt of
lany one accident or otokness for libora-
,Logy services, use of oparatin7 room,
administration of anaoth tics and
ro.ray services.
R080-01826R000900120012-1
. _
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14,
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Approved For ROase 2001/03/04: CIA-RD,P80-0106R000900120012-1
) 17:17FITr.", OT,72T-7) 13f r-Jr:f"7
CMS'S)
w,,Tnity Bonof4t
he Family Hospital Service Contract pro-
1,ides an alloance of up to $9 a day for
maximnM of eight days of hospital care
cr any one presnnncy after thepentract
hat been in continuous, effect for a period
Alf 10. months.
Full Rospital Service Benefits, including
t,se of the delivery room and labor room
rill be provided for Caesaren deliveries,'
termination of ectopic pregnancies, and
riscarriases.
(See also Surzioal Donofits for Obste-
trics.)
q=2,112LFP'r-Ild out-PatiqXkfaa122,
allouanco up to *10 Is prolAded for out-
atient service for (1) emergency first aid
Tkthin two hours after an accident, or (2)
of operating room facilities when a
general anesthetic :1.8 .VOCid.
-r A
r
Benefits for tlic removal of tonFils or
adenoids are pz-o-;11 after thr,,1 Contract
-s been io effect oontinuously for 10
onths, and aro limited to ono lay for
hildren and two days for r.!:Oults.
,berculovel
ontO or Nervorw ,sordew's
Vnen theparticiant is accepted'for treat.4
rt by-a gsnerni fietal, Up to 10 deys9
o,%rfn T,T3.1 e fo" ,-?11Trnr,=,ry 4-11onr-
cu1osis and meatal ,or nervous 1isor4ers
curing ay 12 consecOtive months
r=TTS OTT--;q7D B7 GITdAtS F!.:S'M PLATA
If a member of the ramily Group is con-
fined to a hospital for childbirth,
abortion, nisoarriago or any other
complication of presnlacy uhile the
policy is in force and nine months after
its date or issue, the -olicyTd11 pay
not to exceed 9 for not exeoedins 14
days tovand hospital charges. In addi-
tion, there is an allouanca of up to
.:14,11.00 un 'flatted tov'ard the chires.
Femalc members are covered effective uith
dal:e of policy. Th-:re is a nine month
waiting period for ulTres of members0
Aceid221:121 r.,...,-rt_ituszsz.perlefit, Outside Ho.
Dependents and meMbers are covered uith
effective date of policy if admitted
to hospital as outpatient.
krs,112. or Adqnalt
*9 a day plus 4135.00 touard miscollaneouE,
hospital oxpense. No uaitins period.
(1203.60-01-2 DipercliV;1
vr,??4-13. or
Maximm of 31 dnysl care will bo provide6.,
for pu1monel7 tuberculosis, mental or
norVous disorderso
Approved For Release 2001/03/04 iaCIA-RDP80-01826R000900120012-1
,
Approved ForR?e2Q01/03/04:CIA-RDP807. 26R000900120012-1' I
"s7:72MTIIPTIS 0 - J-1111) G1,5211 PPT
_
,
7urgica1 benefits are offered If
member of the Family Group undergoes
operation E-7-,Talt
Operations
Any operation not enumerated will be
covered and the Association vill"
mine the amount of re*Imbureemelt, if
anY. Tt-PZ mqT;te. wandeal Proceq3.1k:rgA
perfomed Ihmaq.17t cLame pbdoninal
0121L culAtaf',Z741. E10,0rA
OP
It OF1mBED ST'SIV MSDICA RN,IC'EL j0.0
. ._ ,_ )?, ,
' . (E SHLEID
. . ,
Si :ical Service be available etN1,t
",..21t-ta la nftamauz to help pay the doctor(
for, the following, services rendered in a 1
-, hosPital by a participating physician:
Zgr...i.:Slaz=---including the treatment of
fractaree and dislocations. Tonsillec-
tomies and adanoidectemics are covered
after a 10-month waiting period. (Benefits
'
.r4 proved for more than one surgical
pr cedure regardless of whether they are
.
pe fore. through the name abdominal inci
Biro)
,
Fgjglatetrica--care of miscarriage?
ec opic pregnancy or delivery, including
af ercare in the hospital by the p!nysi-
ci --to subscribers enrolled under the
Fa iv Contract after a 10 -month waiting
pe iod. (See pnge 6 for allowances.)
rit.t Adate, sIN-V.Administration of
- -- r_.
anesthetics, diagnostic x-ray services,
clinical laboratory exeminations These
re ated services are available while a
Ain seriber is hospitalized for and is
.reae1.7!..yag surgical or obstetrical
services covered by the Plan.
Eme,,k1-1Z1 QVIst: 9.ut
cl
El
T e Surgical Plan offers benefits for the
f1lodn.. 0:12rrentlY specified Services
^ en rer,4ared in the home or in the
d ctor's office: emergercy treatment of
f tures ezd-dlolocations; excision of
sUperficial tmnors and cysts; external
=booed hemorOftolds; delivery;
turing lacerations (up to $15); nasal
lyp removal; ch,slazion removal; probing
ar duet (Initial-); end circumcision.
bilitv fro" 7:10?1, 3:47ieftte
_Surgical Plan offers service benefits-.
t t vill Llaier Aws0,A11111.,s, 91.F-toTZIA
jag= (including charges for x-raY,
aneathetics and pathology) if the
BUtscriber is a single participant and
his income does not eXdiedfra,000. a year
or a family participant ana the family
came does not exceed :'5?500 a year. If
e subs ox ibeils inaome 4xceeds 1i so
?iota -13pric:ivaotpirportv49491/03/0 : CI
(44pendinsLupon Vbe-iiireall)r-o6Mure)
-to& -;;17.7W,174: ? :
(See example , pages 8 and 9)
The GFRA policy offer the maternit
benefits set forth in the eaaE,151es
of payments on page. 6.
These Related Sevices are
in Miscellaneous RoSpital empene
which?the allowance of $135.00 in
provided.
It!oze Care
Surgery performed at the dotoru'i3
office is covered.
The G7HA policy does not offer Lervice
benefits. It provides only the asountz
set forth in the Schedule of Operations
regardless of the policy holder's
income. Maximum allowance.1.50.
-RDP80-01826R000900120012-1
Approved For Release 2001/03/04 : CIA-RDP80-01826,R0009001
k.4
P.A.INEVES ti:ifT.EN21: i3Yt:1:!il1i0.4.3, SEI:i1CP To
INCOZ472S E'XCEED VIE -AMOZ.J.kiT THAT ENTIT1E6 TZT.24 To 17U.L.Y4 SERVICE ETRE-
I.Td; OF PAYMENTS OFFSTED BY Trf,..3 Gt2LA. POLICY
Hernia (Inguinal Unilateral)
Hernia (Inguinal Bilateral)
Appendactomy
Fracture of Spine
Dioloation (Eip)
Prostatectomy
Pregnancy (Normal Delivery)
Pregnancy (Caesarean)
Removal of Kidney
Mactoldectory (One Side)
BTain tumor or abecato
Bemorhoidectomi-7 (Internal)
TonvSlleetoFry an.d. Adenoldecty
AdminL4tratica of Ausothetico
(depeajlng upon surgical al.
obt4tetrIca1 procedure)
Xray Service
(depending upon part of
body %-myed)
Clinical Laboratory Examinations
(depending upon type of
ezaminatione la addition to
fit u,rinalysin and blood
count proyided by Gr411oHoc-
pitalizatien)
Medical
Service
$100
$ 50
140
75
100
100
125
59
75
15
200
150
80
50
150
175
100
250
100
250
150
60
25
50-55
25
$10 to $40()
(For each
administration
of anaathecia)
$5 to $35(1)
(For each
x-,ray)
Up to $25(1)
(For each
laboratory
ersaination)
These cervices
included in
Miscellaneous
Hospital eiPenes
for which maxima
allouanceds $135
unallocated"
( 2!Vailallle while a subcCriber is tosnitallsel en_ is recetrinz
surgical or obetetriCal azzvicsz c7;7'ered TW Vads,1 Servicen
-6-
Appto, ved Fpr, ase 2001/03/04: CIA-RDP80-01826R000900120012-1
' I ,
?
GE
Approved For RIbase 2001/03/04 : CIA-RDP80-0
LT HOSPITALIZAT AT4T ICL
CONDITIONS N,
j
The Hospital and aargical Service Plano
d1 not cover; Vorlalonla 0opepatiom
ca es; military service. connected dAsa-
. bi ities; congenital anomalies; plastic
or cosmetic surgery (nnla2z required
.
be?e of injuries received after the
pa ticipant Is enrolled). ? Tha.Rospital
Service Contract .does not cover rest
cures, nor hogpitslisatioa required pri7
marily for diagnosis or physical
th rapy.- The SurgiCal Sarvine Con ract
do s not cover dental.zarvices, Rprains,
st'ains, contusions, starillgation
ex egt for valid medisel reasonse or
serzrices in home or office other
than thoe specified in the Zlohedule
Fees in affect when the service is
pr Vidod.-
-I t_,lavz Ls12. .ii,,_
-existing condi tioaz ? other than
Qt
a
nee COY 2 -eeei.
er a 10-vionth waning period.. Dens-
e for obstetrical =le and for the
oval of tonsils ana admoido ars
liable after 10 ;aontLz.
J
6R000900120012-1
PRES2'.L.
1 Benefits are act pdif t 2ozz
arises out of ex in couror of
the memberf's occupa?on az thiz is
covered by EmployWz Ap:ation.
Act.
. There is a niaa mo
' period applicable U-1-41i. to ant,,117
benefits.tor the wivet ef rn
For a coraparizon uf the acl/ar value pf bar:pato
received bry Group Hospttalization nnd Medical
Service mbacribors (actual cease) end the dollar
value of the 7:,onefits they yoyld we received
under tha GERA policy, sae pg eo n anO. 9.
Approved For Release 2001/03/04: CIA-RDP80-01826R000900120012-1
Approved For Release 2001/03/04: C1A-RDP80-01820R000900120012-1
?111al:::.
Charges Covered Charges Covered
Chtro?,,e, CHr-NISDC Mr 07P421.1A
il
II
!;
E)
i
,
inys pecve,ta eccommo-
Jations (er',1;1? .
VI days semi te ac -
caomodatio 5 (1,?,11
$ 63.00
154.00
$ pb.,00
1.5i1,00
':--eating or
42000 z.7
42.00
boratory C'-;.',/i7.17?,,, i Ur: il
12000 c'
8.75
Al.esthetist
50.00 *
50..01
4,-ray
100 ,.,
165,C;)
.',thologist
41.50 *
/-1,:,543
covery mom
, 2.50
2.50
M acinal
131.6o
161060
AYgon
10.00
10,00
hysicien
410.00
410.00
'
.., cellaneoue---
$ 36.00
126000
/
(Total Allov
ance for 4iis-
135,00 -(Iselle5,-3cus
Cdoop4a1
rYlApeases?
150.00
Totals $1.760.60 $1,1.23.35 $447,00
Amount paid by subscriber $ 45025
Amount subscriber would have paid if
coversd by GYFA policy $723.60
)OT E1 All ofVie' aha!-,:vis for hpspits1 services retlized by the patio- this
case iere covered In full hy the wabzeriber"s Clroup Iibspitalisation ConUact
e7Cept $J45.25 of'hich lfas for e pllvata roer.', $3.25 for laboratory e7.aM.ma-
ticna, End14-for miscellaneoz ,Its.m Him incos uao lfithin the prescribed
amount that entitled him to fall Su;:giaal Stz,:ci-iso Benefits end his Surgi,c?l
Contract COVZre. the clnrges for physiclans0 twinrice in f0.1, The -8.nolmt
the GEM polioy Ilunla have allowed for the physician in this assa is not
known; however, in tTs,,in example, the na'ziaum allenmnce of $150 has 1,6en used.
Under the GYLFA Pizr: vM.ch offer $9-$:;35415 e the subsoil:1s! Taxgad haTe had to
pr $723.60 of the aIove bill. .
The GUM Plam, $135,rlo for twe of recovery zoom, Medicines and 0-47gen
uhloh, An We case, cost a total of $194.10.
*These charges vhich amotated to $350.5G are covered in full hy the subscriber's
Group Hospitalisation andHe%lrglcal Cmtracts e2cest for 3,25, These charges
are ino1-4Zed ta.tIgiedelleatous Chirges" by the OEM Plan and are covered only
hY the, Maximu allovance for mi=ellaneous charEes which.in this enample, is
$135.00., 441Oce1leacous Clarges4 az,czed tbe indemnity plan's 110 by $19505,.
5 '
Approved FOr Release 2001/03/04 : EJ/A-RDP80-01826R00090,0129012-1-
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Approved For
ase 2001103/04 :CIA-RDP8041j26R000900120012-1
iagnosis: CV
Signism
16 days semi,,privs..te
modatioas $13,50
flaw,
IP.eratinv room
irst urtnalysi ami
eomplete blood count
4nesthet1st,
aboratory Services
oentgellologist (K-rey)
1
;7'
edications (inelvai
nz sera
and intneranous solutions)
een
essiago
'hysician
Totals
$216,00
62,5o *
7000 e
70000 0
194003 .T4
Y.!5000
ICO D6
2514,075
154.65
Charges Covered
4YLOHIAZDC
$216,00
82050
7000
70000
194.00
125,00
18006.5
254,75
154065
JE4,10 2y2442
$2"764*55 $10?84?,55
Amoun6 paid by subscr1br NONE
Amount eabscribcP tiottla h9,o
covored by cv.111 po:%-loy
if?
115000
,overa6
trk
tal 01
tnce for
eollareeus
L11 of tho.chages for hospital services ref:pared by teepatient
hie case werg.ecv0. in frIl by the fullscriborls Group Hospitalization Con-
raet, Her in wi ;he prescribed amgant that entitled Ilto
ull 'Surgical Service Bonolitg mna ht r Surgical Coatract covered Win chay&J,
or physicians sernees Infill
nder GER.!:1s Plan
3?355.55 nf
e 14147n Plan
thie es;,
the w" .,,,criber ou1d Lnye iad
OG -)13.5000 fQ 1nC31,oxygen and drwkAne_;a 111,141
'005.
A.
The e charge , amouLtea to ziA-780500 were covered in Mil by i; 1;f5
cribors Group Keis7)it81isatioa aeJA. Surgical Contracts. These chex4;ve
minded in Nilis011encoue E;:pensce4 by thoSAHA Plan and are_overof:i oay
the mnxImuu 61,1clmnco for mincolINne:otte charges which is $135.000 "Miec
anoous E7pennes" excelid ths -plaa?s allowance by $343.56.
Approved For Release 2001/03/04 : CIA-RDF'80701626R000900120012-1
-9-