HEALTH INSURANCE FOR CONTRACT EMPLOYEES

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP82-00357R000600020002-6
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 7
• Document Creation Date: November 17, 2016
• Document Release Date: July 5, 2000
• Sequence Number: 2
• Content Type: REGULATION

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HEALTH INSURANCE FOR CONTRACT EMPLOYEES
1. ELIGIBILITY RECUIREMENTS: Participation under this pro-
gram is limited to full-time contract employees (a) who are United
States citizens or resident aliens, (b) whose employment relation-
ship is comparable to that of appointed employees, and (c) whose
services have been approximately equated to the General Schedule
salary levels of appointed employees for compensation purposes.
2. PREMIUMS
a. A part of the premium payments will be provided by the
employer. The employee's portion of the monthly premium
will be $1. 70 for the Single Plan And $6. 70 for the 1 amily
Plan.
b. In addition to the monthly premium, the employee must
pay an initial member ship fee of $1. 00.
c. All premiums must be paid by payroll deductions as author-
ized by the ernplol,ee on his application form.
BENEFITS UNDER BASIC PLAN
a. In-patient Cara
(a) Room and board, regardless of type of room, not to ex-
ceed $20 per day for not more than 90 days,
(b) Hospital extras, not to exceed $202. 50 PLUS 80% of
covered charges in excess of $202. 50 but with limit of
$5, 000.
b. Out-patient Care: Benefits limited to maximum allowance
of $202.50.
c. Surgejj: Benefits are established by a Relative Value
Schedule which fixes rates based on the severity of various
operations. Maximum payment under thts schedule is $500,
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d. Maternity: Benefits payable ONLY under Family Plan.
(1) Normal Delivery
(a) Room and board not to exceed $16 per day for not
more than 8 days.
(b) Not to exceed $20 for anesthesia.
(c) Not to exceed $80 for doctor.
(2) Abnormal Delivery
(a) Room and board and hospital extras as in paragraph
3a above.
(b) For Caesarian section, not to exceed $150 for doctor.
(c) For miscarriage, not to exceed $50 for doctor.
3. Exclusions: This plan does NOT provide benefits for the
following:
(1) Expenses incurred while individual was not covered by
this plan.
(2) Hospitalization or treatment provided or paid by the
U. S. Government.
(3) Illnesses or injury covered by workmen's compensation
or similar legislatio.a.
(4) Cosmetic surgery and dental work, except for repair of
accidental injury.
(5) Alcoholism or drug addition.
(6) Eyeglasses, hearing aids, and examination for them.
(7) Routine physical examinations and immunizations.
(8) Any unreasonable charges or those for "personal com-
fort" services of a luxury nature.
(9) Any injuries caused by act of war occurring on or after
effective date of coverage.
4. MAJOR MEDICAL _BENEF ITS: Provides for payment, after
the insured has paid-out $100_himself, of 80% of all covered medical
expenses which are not reimbursable under the br-isic plan during
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sions, Exceptions and Limitations: This provision
X !MI
not covert
(6) Covered charges will be reduced by the amount of benefits
payable or value of services provided (I) under any other plan
for which any employer of the protected person or dependent
makes payroll deductions or contributions, or (2) under any
Federal, state or other governmental program.
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*14W "aye
each calendar year. The $100 deductible can be paid out as ex-
pense in connection with hospitalization or with out-patient treat-
ment in a hospital, doctor's office, or at home. $100 of de-
ductible expenses must be paid out by the policyholder for any
covered member of the family before additional expenses qualify
for major medical benefits.
a. Maximum Payment: The maximum payment under this
provision is $10, 000 for all accidents or sicknesses or any
combination thereof for each insured person. However, after
a total of at least $1, 000 has been paid under this provision
for expenses incurred by any one person, an amount of $1, 000
will be added to the balance of his maximum payment each
year until the balance is again restored to $10, 000.
b. Covered Charges: The covered charges referred to are
for hospital expenses, surgical fees, and certain other medi-
cal costs which are not reimbursable under the basic plan.
The latter covers charges for services, medicines and supplies
prescribed by a doctor reasonably necessary for treatment of
an injury or illness and which are not of a luxury nature and
unreasonably priced.
c. Exclusions, Exceptions and Limitations: This provision
does not cover:
(1) Dental services rendered by a physician or dentist ex-
cept for those resulting from accident occurring while in-
sured under this plan.
(2) Eye refractions or the fitting or cost of eyeglasses or
hearing aids.
(3) Cosmetic surgery except for repair of accidental in-
juries sustained while insured under this provision.
(4) Alcoholism or drug addiction.
(5) Pregnancy, including resulting childbirth, miscarriage,
or abortion.
(6) Covered charges will be reduced by the amount of bene-
fits payable or value of services provided (1) under any other
plan for which any employer of the protected person or de-
pendent makes payroll deductions or contributions, or (2) under
any Federal, state or other governmental program.
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I"W
d. Record of Expenses for Claim: It will be necessary to
maintain complete and accurate records for each insured
person for each charge made toward the $190 deductible
and for each charge for which claim for benefits will be
made. Benefits for medical expenses are often payable
even though not involving hospitalization, so it is important
that small expenses be itemized. Keep in mind that the
"deductible" is applied once each calendar year. A claim
should be filed as soon as the expenses of any individual
family member exceed the $100 deductible. Bills and re-
ceipts should be itemized and should show:
(1) The date services and supplies are received.
(2) The name of the family member concerned.
(3) The name of the attending physician.
(4) The prescription number of drugs and medicines.
Expenses applied against the "Deductible" in the last three
months of a calendar year will also be credited against the
"Deductible" for the next year.
5. APPLICATIONS
a. Application forms and instructions for their completion
should be obtained through the employing unit.
b. The initial enrollment period will expire on 1 December
1960. During this period, there will be no physical require-
ments to be met nor will there be any waiting period.
c. After the initial enrollment period, only new employees or
employees being converted to contract employee status will be
eligible to apply and they must apply within 60 days of employ-
ment in contract status. Any other contract employee who is
otherwise eligible must wait %inti.l the next "open period" for
enrollments.
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6. EFFECTIVE DATE OF ENROLLMENT
a. For those employees payrolled on a biweekly or 28-day
basis, enrollments or changes in enrollments become ef-
fective on the first day of the first biweekly pay period in
hhich the employee is in pay status which begins not less
than 14 calendar days after the application is received by
the Insurance Branch.
b. For those employees payrolled on a monthly basis, en-
rollments or changes in enrollments become effective on the
first day of the first monthly pay period in which the employ-
ee is in pay status which begins not less than 14 calendar
days after the application is received by the Insurance Branch.
All bills will be paid by the insured and receipts therefore
forwarded to the Insurance Branch through appropriate adminis-
trative channels. Reimbursement will be made in cash to the in-
sured or his representative. (See paragraph 4d above concerning
claims under "Major Medical". )
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S-E-C-R-E-T
(When Filled In)
COMPLETE IN DUPLICATE & RETURN BOTH COPIES TO THE INSURANCE
BRANCH THRU APPROPRIATE ADMINISTRATIVE CHANNELS
HOSPITALIZATION APPLICATION DO NOT WRITE IN THIS BLOCK.
(CONTRACT PLAN)
POLICY NO.
*NAME OF EFFECTIVE
EMPLOYEE DATE
(First) (Middle) (Last)
CODE
DATE OF BIRTH
MONTHLY PREMIUM
MARRIED b SINGLE C77
SINGLE PLAN Z FAMILY PLAN /
(TO BE COMPLETED BY DIVISION)
(PERSON TO CONTACT)
FULL TIME EMPLOYEE AYES (DIVISION]
4 NO
U. S. CITIZEN RESIDENT ALIEN
L-----
(EXT.)
,
(ROOM NO.) (BLDG.)
COVERED BY PRESENT "10-UP" PLAI4;: DATE OF EMPLOYMENT AS CON -
[--J YES 4"/ NO TRACT EMPLOYEE
*PLEASE NOTE: "Name of Employee" EMPLOYEE'S PAYROLL NO.
and "Employee's Signature" should
agree with the one shown on contract IS EMPLOYEE PAYROLLED
with the Agency. 28 days C Monthly ci
Bi-weekly Li
IF FAMILY PLAN, COMPLETE FOLLOWING:
NAME OF WIFE/HUSBAND
(First) (Middle Initial)
CHILDREN UNDER 19 (A protected person's children shall include unmarried
children under age 19. Also, any step-children, legally adopted children, and
foster children provided such children are dependent upon the protected person
for support and maintenance, )
NAME DATE Or BIRTH NAME DATE OF BIRTH
I hereby authorizedeductions from my salary for payment of premiums under
this contract.
*EMPLOYEE'S
SIGNATURE
(See instructions above following*)
Administrative Officer of Division
( When Filled In
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