GOVERNMENT EMPLOYEES HEALTH ASSOCIATION POLICY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP87-00868R000100060091-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 19
• Document Creation Date: December 22, 2016
• Document Release Date: July 16, 2009
• Sequence Number: 91
• Publication Date: March 7, 1960
• Content Type: MISC

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STAT
W7 '-'~ gov-
OF OMAHA
OMAHA, NEBRASKA THE LARGEST EXCLUSIVE HEALTH & ACCIDENT COMPANY IN THE WORLD
March 7, 1960
STAT
Government Employees' Health Association, Inc.
c/o Joseph E. Jones Agency
1200-18th St., N.W.
Washington 6, D.C.
STAT
This letter will confirm our understanding that the
premium contained in the group insurance contract filed
with the United States Civil Service Commission in
compliance with the Federal Employees' Health Benefits
Act is a gross premium from which the Government will
deduct their )4% reserve, and the balance will be
forwarded to us as our net premium.
.relo.
A. W. Randall
Vice President
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1JJAU
OMAHA
Z
i lr I
Secretary President
- r /
~li-if`~~ -1
(Hereinafter called the Association)
IN CONSIDERATION of the application of
GOVERNMENT EMPLOYEES HEALTH ASSOCIATION, INC.
(Hereinafter called the Policyholder)
for this policy, copy of which application is attached hereto and made a part hereof, and in consider-
ation of the payment by the Policyholder of the initial premium and of the payment thereafter by the
Policyholder, during the continuance of this policy, of all premiums as they become due, as hereinafter
provided,
HEREBY INSURES as protected persons members in good standing of the
Government Employees Health Association, Inc. who are eligible for health
benefits in accordance with the Federal Employees Benefits Act of 1959 and
authorized regulations thereunder, and
HEREBY AGREES to pay, with respect to the protected persons insured
hereunder, in accordance with and subject to all the terms, conditions and
limitations of this policy, the benefits described in the Plan of Insurance
selected by the protected person, if and when any such protected person be-
comes entitled thereto.
n~iN
l-:
The term of this policy begins on the effective date at 12:01 A.M., Standard Time of the place where
the main office of the Policyholder is located, from which date and time all policy years and months shall y:<
be computed, and ends on the first anniversary thereof, but the policy may be renewed from year to year,
as hereinafter provided, upon due payment of premiums.
The provisions set forth on the following pages are a part of this contract as fully as though recited
at length over the signatures hereto affixed.
IN WITNESS WIIEREOF, MUTUAL BENEFIT IIEALT}I & ACCIDENT ASSOCIATION has
caused this policy to be ::gned by its President and its Secretary. r y
k X&
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uMAWIltw rnvvlaIUAD W
1. 'ELIGIBLE PERSONS. The following persons shall be eligible for insurance hereunder:
Members in good standing of the Government Employees Health Association, Inc., and
who are eligible for health benefits in accordance with the Federal Employees Benefits
Act of 1959, and authorized regulations thereunder.
2. PROTECTED PERSONS: A protected person is one who is eligible for insurance, who has
made appropriate application therefor, and who is currently paying the required contribution.
Each protected person's insurance shall become effective on the day specified in the
Federal Employees Health Benefits Act of 1959 and authorized regulations thereunder.
If a protected person is confined in a hospital on the date such person becomes eligible
for insurance hereunder and is eligible for benefits for such confinement under discontinued
group policy GMF-1514, such person's insurance shall not become effective until final dis-
charge from the hospital.
If a protected person was not insured under discontinued group policy GMF-1514, such
person's insurance shall become effective on the date he becomes eligible hereunder, not-
withstanding the fact such person is confined in a hospital; provided, however, that benefits
for that period of hospital confinement shall not exceed, in the aggregate, $500.00 if the
protected person selects Plan of Insurance No. I and $1,000.00 if the protected person selects
Plan of Insurance No. II.
3. AMOUNTS OF COVERAGE. The benefits and amounts for which a protected person is covered
under this policy shall be those benefits and amounts shown in the Plan of Insurance which
he selects.
4. TERMINATION OF INDIVIDUAL INSURANCE. The insurance of any protected person shall terminate
on the date this policy is terminated or on the day specified in the Federal Employees Health
Benefits Act of 1959 and authorized regulations thereunder subject to any extensions of
coverage or conversion privilege under such Act or regulations.
5. CONVERSION PRIVILEGE. If a protected person ceases to be within the class or classes
of persons eligible for insurance under this group policy, such protected person shall be
entitled to have issued to him, without furnishing evidence of insurability, an individual
policy, or, if the protected person's dependents were also insured under this group policy,
a family policy; provided that such protected person makes written application and the
first premium payment therefor to the Association within thirty-one days after termination
of his insurance under this group policy. The form of the individual or family policy,
the coverage thereunder, and all other terms and conditions thereof shall be as provided
by the rules of the Association for such individual or family policy at the time of such
application. Such individual or family policy may, at the option of the protected person,
be guaranteed renewable, except that it may be cancelled for fraud, over-insurance, or
nonpayment of premiums. Under the family policy the protected person may include only
those of his dependents, excluding any dependent children over age 17, who were insured
under this group policy on the date his insurance terminated. Dependent children over
agewho were insured under this group policy on the date the protected person's insur-
ance terminated shall have the privilege to convert to an individual policy in the same
manner and subject to the same rules as apply to the protected person.
The individual or family policies, if issued, shall become effective on the day the
application is signed or on the date of termination of insurance under this group policy,
hich are payable under this group policy shall
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whichever is the later, and any bene
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ami
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be excluded from coverage under the individual or
Form 586 MGM
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I regardless of any provision contained in thin conversion privilege, the issuance of any
policy described herein shall be subJect to all of the rules and reg'ul.ations of the state
in which application in m de.
6. CONTINUPJ E OF POL 'cY. This policy may be continued in force for a further term of one
year upon the payment, prior to the expiration of the grace period immvdlately folicving the
anniversary date of the policy, of the premium for the insurance so continued. In ac^ordance
with General Provisions 7, 8 and 9 relating to pnyrarnt of premiums. At least sixty days
notice prior to the renewal date must be given to the Association prior to termination by
the Policyholder or by the U.S. Civil 3ervi'e Cormnission; however, nothing herein shall be
construed to prohibit the modification of this policy by rnutu+l agreeraen'. of the parties.
7. EXPERT!. E RATII;iG. On the first polic'r anniver,~ary and upon each pretniuia due date there-
after, providing the then current pr.emlam rate:. have been in effe?:t for at learnt twelve
months, the Association shall have the right to c r ;r the premium rates at which further
premiums shall be computed, but ro in-reace shall be retrc>a(,t.ive.
The Association may, on any anniversary date of this policy) reduce the premium rates for
the policy year just completed. Should the Policyholder qualify for any retroactive rate re-
fund, such refund shall be made at the end of each contract period.
8. PAYMENT OF PREMIUMS. The premium for this policy shall be calculated as follows:
Benefits described in Plan of Insurance No. I
Protected Person ................$1.48
Protected Person and one
or more Dependents .............$4.06:
Benefits described in Plan of Insurance No. II
Protected Person ................$1.62
Protected Person and one
or more Dependents ...........$6.47
The initial bi-weekly premium shall be due on the 1st day of July, 1960,,.(herein called the
effective date). Subsequent premium shall be payable biweekly in advance thereafter during
the continuance of this policy. The premium due on the effective date hereof and on each
subsequent due date shall be the sum of the individual premiums of each protected person
determined according to his respective benefits and his classification at the time the premium
is due.
All premiums or installments thereof are due and payable in advance at the Home'Off ice of
the Association in Omaha, Nebraska, or to a designated agent on or before the due date.
Premiums may be paid bi-weekly at the Association's rates
therefor. The payment of any premium or installment thereof shall not maintain the policy
in force beyond the due date of the next premium or installment, except to the extent herein-
after expressly provided. The Association operates on the full legal reserve basis and the
contingent mutual liability hereunder shall not exceed one additional premium in the amount
of the premium required herefor.
9. GRACE IN PAYMENT Of P'RYa1UMB---TURNA:IIrATION OP POLICY. A wra. " l,.riou ' tttirty (,Ile lays
Will he grauted to the t'olieyhulder for t.? ,'u~ tut'ni , f c v# ry premium du:' it ier the itiitiai preTr um I uric:c u', cli
time this policy shall teuiatn in 'orce, mil,sthe or th' Associai4on-hall havt' arxr'n previou r.te?
that the policy is to bo teruunazed as of the du- dp.to oof such pr niiiiru in whist' e%or.t tyo gra,e herioft will be
allowed. I
ati?fl of t e g a e p,~Yiod. 66% p+)itcy
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h
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ore t
If such notice is not giNeil xitd the yre".n um i not pii,1 01
Wr'tti'A txt 'h w Lon, not ie. this f:vr
? t ~, t' ,~ ~i,, a
may be terminated by the A-.,i(kvi itimi by s
days thereafter, such termination shall be efft'?'tl- 1i, Ti- e%t,,It of su h i`oti''r?, or 1'. writt+'IS not a '6 Rlvt'';I by th!'
Policyholder to the Association during the ; r:ii e p+'t'i4"d 'ha` ih? t?.'' ''y im t.~ terminated. t it i'+,!:c ltotd~'r ~t:all
be liable to the Asscx'intion for th, pro rats prtinwml f( r the perrkl fr-m the due date of surh premium to the date
of such termination.
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TERMINATION OF DEPENDENT INSURANCE. The protected person's insurance with respect to any
dependent shall terminate on the date this policy is terminated or on the day specified in
the Federal Employees Health Benefits Act of 1959, and authorized regulations thereunder
subject to any extensions of coverage or conversion privilege under such Act or regulations.
Plan of Insurance No. I
Insurance Benefits for Protected Persons and Dependents
HOSPITAL EXPENSE BENEFITS
Daily Room Limit .....................$13.50
Maximum Miscellaneous Hospital
Expense Benefit .....................$202.50 plus 80%
of balance up to a
maximum of $5000.00
Maximum Outpatient Benefit ........... $202.50
1A?T A.
}IcrJ'ITAL ri ,ar> I4_t4:7rrr
HOSPITAL ROOM BEA;1`Yrr -- if .t protertvc? prr:3crn or a% n1.i~+1.hie lex;?t~:frrr., `nec,eeucat- of accidental
bodily injuries or ri.ckIleri:;, sr.a11 be cr. heri`*1 .~!' is`s~`!tm1 ract'f,i=-xerat.
HOSPITAL 0UIPATIENT EXPENSE BENEFITS -- (A) If a protected person or an eligible dependent,
while insured under this policy, shall, becau-,e of' accidental bodily injurie.., require emer-
gency outpatient hospital attention within(orty-eightyhours after the accident, the Asso-
ciation will for the expense actually incurr y the protected person,?duriz.
orty-eight our , for care, treatment and services of the type described under MISCELLANEOUS
SE BENEFITS, but not to exceed, in the aggregate, the b!aximurn Outpatient Benefit.
(B) In case of hospital confinement of a protected person or an eligible dependent for a
surgical operation resulting from accidental bodily injuries or sickness, and for which there
is no charge for room and board made by the hospital, the Association, provided such confine-
ment occurs while the protected person or dependent is insured under this policy and further
provided that in case of accidental bodily injuries no benefits are payable under paragraph
(A), will pay for the expense actually incurred during such confinement for care, treatment
and services of the type described under MISCELLANEOUS HOSPITAL EXPENSE BENEFITS, but not to
exceed, in the aggregate, the Maximum Outpatient Benefit for all such expense incurred for
any one period of hospital confinement.
Form 586MGM
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OUTPATIENT SERVICE IN A RECOGNIZED HOSPITAL OR CLINIC -- If a protected person or an eligible
dependent shall, while insured under this policy, receive outpatient services in a hospital
or clinic recognized and registered by the American Medical Association in their census of
hgspitals entitled "Hospital Service in the United States", the Association, providing no
benefits are payable under any other provision of this policy, will pay for the expense ac-
tually incurred for such service of the type described in the policy under MISCELLANEOUS
HOSPITAL EXPENSE BENEFITS, but not to exceed, in the aggregate, the Maximum Outpatient Bene-
fit for any one accident or sickness.
SUCCESSIVE PERIODS OF HOSPITAL CONFINEMENT -- Successive periods of hospital confinement
shall be considered one period of hospital confinement unless the subsequent confinement
commences after complete recovery from the injuries or sickness causing the previous confine-
ment, or unless the subsequent confinement is due to causes entirely unrelated to the causes
of the previous confinement, or in the case of a protected person, unless the subsequent
confinement commences after return to active work on full time.
MATERNITY BENEFITS -- If a female protected person or a dependent wife, while insured under
this policy, shall become confined in a legally constituted hospital as a result of preg-
nancy, including resulting childbirth or miscarriage, the Association will p6y benedits as
(a) Normal Maternity - the Association will pay benefits up to $10.00 per day
during the period of hospital confinement, but not to exceed 8 days for any one
pregnancy.
(b) Abnormal Maternity (Caesarean, Termination of Ectopic Pregnancy and Miscarriage) -
the Association will pay for the expense actually incurred during the period of
hospital confinement for hospital care, treatment and service (of the type described
under HOSPITAL ROOM BENEFIT and MISCELLANEOUS HOSPITAL EXPENSE BENEFITS) received by
the female protected person or dependent wife in her own behalf, but not to exceed,
for any one pregnancy, the limits specified for any one period of hospital confine-
ment under HOSPITAL BOOM BENEFIT and MISCELLANEOUS HOSPITAL EXPENSE BENEFITS.
In case the female protected person or dependent wife is not hospital confined at any time
during pregnancy, but is cared for at home by a registered graduate nurse, the Association,
provided maternity benefits would have been payable if the protected person or dependent wife
was hospital confined, will pay for the expense actually incurred for such nurse's fees,
but not to exceed $36.00 for any one pregnancy.
Maternity benefits for female protected persons are not payable unless, in addition to
the premium for the protected person, a dependent premium is also paid on her behalf during
that period of her pregnancy in which she is among the classes of persons eligible for this
insurance.
EXCEPTION -- This HOSPITAL EXPENSE BENEFITS provision does not cover pregnancy, including
resulting childbirth or miscarriage, except as provided under MATRNITY BENEFITS. This pro-
vision is also subject'to the EXCLUSIONS AND LIMITATIONS section of the General Provisions.
Further, if a protected person or dependent is eligible for benefits under discontinued policy
GMF-1514, the amount payable under this HOSPITAL EXPENSE :BENEFITS provision shall be reduced
by the amount of hospital benefits payable under such discontinued policy.
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If a protected person or an eligible dependent, while insured under this policy, shall,
because of accidental bodily injuries or sickness, have an operation performed or a
dislocation or fracture repaired by a legally qualified physician or surgeon, the
Association will pay for the expense actually incurred by the protected person, but not
to exceed the Maximum Payment specified for such operation in the following Schedule:
Maximum
Payment
Hip, vertebra, ankle-joint, elbow
or knee-joint (patella excepted). 43.75
Shoulder ....................... ... 31.25
Lower jaw, collar bone, wrist or
patella .......................... 18.75
For dislocations requiring an open
operation, the maximum amount of
payment is 2 times amount indicated.
Form 586M3M
Maximum
Payment
EXCISION OR FIXATION BY CUTTING
Hip-joint ......................$187.50
Shoulder, knee-joint, semilunar
cartilage, elbow, wrist or
ankle-joint ....... .... ....... 125.00
Removal of diseased portion of
bone, including curettage
(Alveolar processes excepted). 62.50
EAR, NOSE OR THROAT
Fenestration, one or both sides 250.00
Mastoidectomy, one or both
sides
Simple ....................... 125.00
Radical.... ................. 187.50
Tensillectomy,adenoidectomy,
or both ....................... 55.00
Sinus operation by cutting
(puncture of antrum excepted). 62.50
-septum ........................ 62.50
Tracheotomy .................... 62.50
Any other cutting operation.... 18.75
EYE
Operation for detached retina.. 250.00
Cataract, removal of........... 187.50.
Any other cutting operation in-
to the eyeball (through the
cornea or sclera) or cutting
operation on eye muscles...... 125.00
Removal of eyeball............. 93.75
e'. .:............ 25.00
FRACTURE. Treatment of
Thigh, vertebra or vertebrae,
pelvis, (coccyx excepted)..... 93.75
Leg, kneecap, upper arm, ankle
(Pott's) ...................... 62.50
Lower jaw, (Alveolar process
excepted) collarbone, shoulder
blade, forearm, wrist (Coiled),
skull** .... ... * ...........31.25
Hand, foot***.*** ......... o .... 18.75
Fingers or toes, each.......... 12.50
- rn
Rib or ribs, three or more..... 31.25
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ABDOMEN
Appendectomy, freeing of adhesions
or exploration of, or cutting in-
to, the abdominal cavity.........$100.00
Removal of, or other operation on
gall bladder ..................... 150.00
Gastroenterostomy................. 187.50
Resection of stomach, bowel or
rectum............. .............. 250.00
ABSCESSES. (See Tumors)
AMPUTATIONS
Thigh, leg ........................ 156.25
Upper arm, forearm, entire hand
or foot.. ........................ 125.00
Fingers or toes, each ............. 18.75
BLOOD TRANSFUSION, each..... 31.25
BREAST
Removal of benign tumor or cyst
requiring hospital confinement... 62.50
Simple amputation ................. 125.00
Radical amputation ...... ........ 187.50
CHEST
Complete thoracoplasty, transthor-
acic approach to stomach, dia-
phragm, esophagus, sumpathectomy
or laryngectomy .................. 250.00
Removal of lung or portion of
lung...... ....................... 250.00
Bronchoscopy, esophagoscopy....... 50.00
Induction or artificial pneumo-
thorax, initial .................. 31.25
refills, each (nor more than 12). 12.50
CYSTS. (See Tumors)
DISLOCATION. Reduction of
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w
Maximum
Payment
(Continued) yment
If eounpound fracture, maximum
amount of payment is 12 times
amount indicated. If open op-
eration, maximum amount of pay
meat is 2 times amount indicated.
(Bone grafting or bone splicing
considered as open operation;
skeletal traction pin is not so
considered.)
GENITOURINARY TRACT
Removal of, or cutting into
kidney..... ............ e, ........ $250-00
Fixation of kidney ................ 187.50
Removal of tumors or stones in
ureter or bladder
by cutting operation............ 125.00
by endoscopic means............. 43.75
Cystoscopy........................ 31.25
Removal of prostate by open
operation ........................ 187.50
Removal of prostate by endoscopic
means... # ..... *.* ........... *~ ... 125.00
Circumcision ...................... 18.75
Varicocele, hydrocele, orchidectomy
or epididymectomy, single........ 62.50
bilateral..... 93.75
Hysterectomy ...................... 165.00
Other cutting operations on uterus
and its appendages with abdominal
approach....................... 125.00
Cervix amputation ................. 62.50
Dilatation and curettage (non-
puerperal), cervix cauterization
or conization, polypectomy, or
any combination of these......... 31.25
Vaginal plastic, operation for
cystocele or rectocele........... 93.75
GOITRE
Removal of thyroid, subtotal...... 187.50
Removal of adenoma or benign tumor
of thyroid ....................... 125.00
BERNIA
Single hernia........ ...... ....... 100.00
More than one hernia .............. 1+0.00
JOINT
Incision into, tapping excepted... 31.25
LIGAMENTS AND TENDONS
Cutting or transplant, single..... 62.50
multiple .......................... 93.75
Suturing of tendon, single........ 43.75
multiple...... ................... 62.50
Maximum
Payment
OBSTETRICAL PROCEDURES
Delivery of child or children..$ 80.00
Caesarian section.............. 150.00
Abdominal operation for extra-
uterine pregnancy..*.,., ... *.* 150.00
Miscarriage.................... 50.00
PARACENTESIS
Tapping ........................ 18.75
PILONIDAL CYST OR SINUS
Removal of... .................. 62.50
RECTUM
Hemorrhoidectomy, external..... 31.25
Internal or internal and ex-
ternal ....................... 62.50
Cutting operation for fissure. 31.25
Cutting operation for throw-
bored hemorrhoids............ 18.75
Cutting operation for fistula-
in-ano, single ............... 62.50
multiple.. .................. 93.75
SKULL
Cutting into cranial cavity
(trephine excepted)........... 250.00
trephine ...................... 31.25
SPINE OR SPINAL CORD
Operation for spinal cord tumor 250,00
Operation with removal of por-
tion of vertebra or vertebrae
(except coccyx, transverse or
spinous process) .............. 187.50
Removal of part or all of
coccyx, or of transverse or
spinous process, .............. 62.50
TUMORS
Benign or superficial tumors and
cysts or abscesses requiring
hospital confinement.......... 31.25
not requiring hospital con-
finement ..................... 12.50
Malignant tumors of face, lip
or skin ....................... 62.50
VARICOSE VEINS
Injection treatment,complete
procedure,
one or both legs ............. 50.00
Cutting operation, complete
procedure,
one leg.... .................. 62.50
both legs .................... 93.75
Form 5867's3M
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Conditions:
(a) Any cutting operation not specified in this Schedule will be covered and the
Association will determine the amount of payment (based on the amount pay-
able for an operation of similar average severity).
(b) Two or more surgical procedures performed through the same abdominal incision
will be considered as one operation (the most expensive surgical procedure
shall govern).
(c) Where two or more operations are performed during one period of disability,
but not through the same abdominal incision, the amount payable for each
shall not exceed the Maximum Payment specified for each and the amount pay-
able in the aggregate shall not exceed the Maximum Payment for the most ex-
pensive operation listed in the S-hedule.
(d) Benefits for the Obstetrical Procedures specified in this Schedule shall be paid
if the procedure is performed while the female protected person or dependent wife
is insured under this policy. Obstetrical Benefits for the protected person are
not payable unless, in addition to the premium for the protected person, a dependent
premium is also paid on her behalf during that period of her pregnancy in which
she is among the classes of persons eligible for this insurance.
SUCCESSIVE OPERATIONS -- Successive operations shall be considered to have been per-
formed during one period of disability unless the subsequent operation is performed
after complete recovery from the injuries or sickness causing the previous operation,
or unless the subsequent operation is due to causes entirely unrelated to the causes
of the previous operation, or in the case of a protected person, unless the subsequent
operation is performed 'after return to active work on full time.
EXCEPTION -- This SURGICAL OPERATION EXPENSE BENEFITS provision does not cover preg-
nancy, including resulting childbirth or miscarriage, except as provided in the Sched-
ule under the section entitled "Obstetrical Procedures This provision is also sub-
ject to the EXCLUSIONS AND LIMITATIONS section of the General Provisions.. Further,
if a protected person or dependent is eligible for benefits under discontinued policy
GMF-151, the amount payable under this SURGICAL OPERATION EXPENSE BENEFITS provision
shall be reduced by the amount of surgical benefits payable under such discontinued
policy.
HOSPITAL EXPENSE BENEFITS
Daily Room Limit ................$20.00
Maximum Miscellaneous Hospital
Expense Benefit ..................$202.50 plus 80%
of balance up to a
maximum of $5000.00
Maximum Outpatient Benefit ........ $202.50
FARTA.
EOSPI I. E.YP .'~aG ~ .' ITS
MTIZ'L ROOM BE W T_'.^ -- Ifs prcteoted person or an e1i4ible d-ece :dent, c ~c,u. e of a_c' de tal
bodily injuries or sickness, shall be c oA.t ' as a r ~
..~~d '?...
~ e - i..-_ t a Vr3.,
t;.t'ut
,.
hospital, the Association provided such hcToital
person or dependent is insured under t'_-is pclirc y, -,rill pay benefits for the ex; nse^
incurred by the protected person for ho:.pital rc Lm and board c? .. ring thperici of hoapi`.al ,
confinement, but not to exceed the 'Daily Roc= Li--'- Per day nor to exceed 90 days for any one
period of hospital confinement.
Form 586? Z4
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 MISC41 A..nOUS HC:?^T"'..
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.which benefits azu pm-Lu unuer Lae preceaing paragraph, the Asse7 M*'cn will pay for the
expense actually incurred by the protected person for all other nece'ssa care and t t
meat for which the hospital makes a charge (excluding charges made byte protected person's
regular and custo:.ar- car es made by the, ambulance company for transportation to, and from the
hospital in an ambulance (up to $25.00 for any one period of hospital confinement),,
but not to exceed, in the aggregate, the `axin..zm Miz^.ellanerazs Ho::pital Expensy
Benefit for all such expense incurred for any one period of hospital confinement.
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to in tle a ;3ta t '-e 5< r'-. , axi :u^z Outpatient re :_ it.
(B) In case of hospital confinement of a protected person or an eli
ibl
d
d
;
e
epen
ent for a
surgical operation resultinZ fro= accidental bodily injuries or ;ic:-
ne:; and for which t ter,.
is no charge for room and board node by the hospital, the Ao.o iation p ror''ve''...
ti. i' such Cowl .ne-
rtent occurs while the protected person or dependent is insured under this policy and further
in case of accidental bc`~..i i
provided that ~~~ iI1jilr?o no benefits ar payable under (A), will pay for the expense actually incurred durin such c.c :fin>Want f
cr ca-e, tr ea :meat
and services of the type described u::d?-ar MIxE' * ;:;?,L'.~ ..'LL but not to
exceed, in the a:7jre~>te, the ??:axirr.si C?utp:atient Benefit for all such expense incurred for
any one period of hospital confinement.
OUTPATMIT SMVICE IN A RECCC":S HC.PI:'AL OR CLINIC If a protected person or an eligible
dependent shall, while insured uniler.this policy, receive outpatient see-vices in a hospital
or clinic recognized and re
{
_i
ist
r
"-
d b
th
>~
nan ?,yd
g
e
e
y
e al
a1
, iAyJO^_iatton in their census of
hgspitale. entitled "::ospital 3e^r.ce in * e United the ,soOciaticn r- rid rte;
benefits are payable under any ot:er, provision of this policy, will pay for the ex en e ac-
tually incurred for such service O. the ty e described in t he p Cli
' u der ~? :
0~ T
.r Qi
~
7
. i
JJ
HOSPITAL =.,3E but not to .ex eed in the ag,re;ate, the :?axi Outpatient Bene-
Pit for
any one accident or sickness.
StCCESSN'r PEMICDS --
OF ROgPr:r~I. CO.i
CC i'J^ ric a Cf ho ni`_al ccnfi
? 'sZt
shall be considered one oericd C: h J "81 i. e e .4 31
C nnences after ccnolete recovery fr-m the in?uries or Ji_!^.~,JJ ca .J `_e trevl u:> ^.:in?_
ment, or unless the subse:iuent ^_ery ?.^. neat is due to ca? ="ti
of the ?-1i :r~r>i3t t: to `hA^_315?_3
previous cony i
t
neo+en
. r in the case of a protected re ^ z, unless the subse u.ent
confinement commences after to active work on full tree.
MATERNITY BZ-N-:z S -- If a z'e.:,ale protecte : p4r_on or a pen !..t wife, while insured under
this policy, shall become confined to a l,;ill, c^stit,y ' i as a result of preg_
t33Y1Cy, including ^y'i1.: iat
resulting .i yr r aJ, ar~ ,~ ~, the
flJ Y /- L av.` Mil
~~~f
$J' - ~ne its JJ
f oT l ows
;
(a) "+or~..nl Maternity - the Association will pay ben?ef:ts up to b~;oo per day
`
_ c*.
during ,.he period of hosp' _ ?al a,..n ~incn.J eni ;., but not to e:t=ee~.. -7 ;; L .7a;;s .or a.?2,r one
preincy.
(b) Abnormal ~'ster pity (Caesarean, .e=inatIcn of topiC .ire agcy and ~f? a {.a;e)
- the Association will pay for the expense ant,,; lly the
hospital confinement for hospital c.are_, treatment and set{ _e Ccf t e type re3?ry' ed
under HOSPT AL ROOM 2--= : and "' ,CE'~.-... 3 ~r^^I:AL SB "/3 reedy by 117 the female protected per son or dependent -wife in her own behalf, c:zt not to exceed
for any cne pregnancy, the limits specified for any one period of hcs;Ital confine-
.
- _ r meat under HCSPIT \L R^C'1 an I: C =-1'' J 1 C . 7 , Worn, 586mM 10 . ??-~_ - 2-_ --_ _ .
Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
 In case the female ny time dur-
inn n,-ennnnrv v,,,4 Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
vided maternity benefits would have been payable if the protee p rso Uo` dependent n, pro-
ctecT person or dependent wife
was hospital confined, will pay for the expense actually incurred for such nurse's fees, but
not to exceed $36.00 for any one pregnancy.
Maternity benefits for female protected persons are not payable unless, in addition to
the premium for the protected person, a dependent premium is also paid on her behalf during
that period of her pregnancy in which she is among the classes of persons eligible for this
insurance.
EXCEPTION -- This :0SPITA.L E ;3E W IT3 provision does not cover pregnancy, including
resulting childbirth or miscarriage, except aa provided under =N1 ?E., 'S. This pro-
vision is also subject to the EXCLU3IO 3 A:0 Li'ITATIO:;3 section of t
h
e General Provisions .
Further, if a protected person or dependent is ell ible for benefits under discontinued policy
GMF-151L, the a ;ount payable under this H."'77 17,1L T_iCS provision shall be reduced
by the amount of hospital benefit3 payable under such discontinued policy.
PART B.
SURGICAL OPERATION EXPENSE BENEFITS
If a protected person, while insured under this policy, shall, because of accidental bodily
injuries or sickness, have an operation performed or a dislocation or fracture repaired by a
legally qualified physician or surgeon, the Association will pay for the expense actually in-
curred by the protected person, but not to exceed an amount to be determined by multiplying
the Relative Value Units listed below for the surgical procedure performed by the Unit Value
of-$5.00. If the surgical procedure is not listed below, the Company will determine the maxi-
mum amount payable for such procedure. A surgical procedure of an equivalent gravity and
severity included in the California Relative Schedule shall be used as a 'basis of the
Company's settlement.
All
Anesthosiology will also be payable in accordance with the full C-ilifornia Relative Value
Schedule.
Description of Surgical Procedure
SCHEDULE
Relative
Value
ABDOMEN Units
Appendectomy ... 35
Colectomy, partial, with anastomosis
and with or without proximal colostomy 80
Total gastrectomy ? ... ? .... ... 100
Gastroduodenostomy .. . . ... . . . . ... 50
Cholecystectomy................. 55
Cholecystectomy with exploration of
common duct ? , . ? . ? ............ 65
ABSCESS
Drainage of subcutaneous abscess (where
not specified elsewhere), ... .. . ... 1
AMPUTATION OF
Finger ............... ? ....... 13
Toe 10
Hand... ? . ........... ....... 30
Forearm .. .................... 30
Foot at ankle . ? ? ............... 40
Leg ....?....? ............... 40
Arm...?.? .................?? 30
Thigh ....... ? ... ? ? ... ? ....... 50
Thigh at hip .......... ? . ? . ? ..... 80
BREAST
Radical mastectomy, including breast,
pectoral muscles and axillary lymph
noics.. .... ?....?. ?.? ?...... 60
Complete (simple) mastectomy 30
Form 586MGM Page 11
Description of Surgical Procedure Relative
CHEST Value
Units
Total or subtotal lobectomy .. 100
Thoracotomy, exploratory, including
control of hemorrhage and/or biopsy
and cardiac massage .. , . , ... .
Pneumothorax: intrapleural injection of
air, initial...................
.
Pneumothorax: intrapleural injection of
air, subsequent .......
Bronchoscopy, diagnostic ...........
Bronchoscopy, with removal of foreign
body ........................
EAR
Myringotomy: tympanotomy; plicotomy.
Mastoidectomy, simple . .. . .
Mastoidectomy, radical .. ... ? ,
Fenestration of semicircular canals
ESOPHAGUS
Esophagotomy for removal of foreign
body ........................
EYE
Removal of foreign body from surface of
cornea ...... .?
Reattachment of retina, electro-coagula-
Lion, initial ........ ........ .
Extraction of lens, intracapsular or ex-
tracapsular, unilateral ,
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 Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
Description of Surgical Procedure Relative
Value
EYE (Cont'd) Units
Sclerectomy for glaucoma, with scissors,
punch or trephination (Lagrange, Holth,
Elliott) . . . . . . . . . . . . . . . . . . . . . . 80
Enucleation of eyeball (bulb or globe) ... 30
Pterygium .................... 20
Blepharectomy incision or excision of
Meibomian glands (chalazion), single.. 5
FRACTURES, Treatment of
Collar-bone .. . ................. 10
Shoulder blade . , , ... , .... , .. 10
Forearm, one bone ............... 10
Tarsals ....................... 8
Metatarsals. . .... . .......... . so 7
Os calcis...................... 15
Thigh .......... ............. 30
Upper arm ..................... 15
Lower leg, one bone . . . . . . . . . . . . .. 15
Forearm, two bones .............. 15
Kneecap ..................... 10
Pelvis, not requiring traction ........ 10
Lower leg, two bones ............. 20
Lower jaw.................... 5
Carpals ....................... 8
Metacarpals ..................... 7
Nose ......................... 5
Rib. . # . o .... * ... so .. 6 ........ 2
Sternum .................... 10
Vertebrae, compression ........... 20
Finger ....................... 5
Toe ......................... 3
The amounts shown above are for simple frac-
tures. For a fracture requiring an open opera-
tion with bone grafting, bone splicing, or me-
tallic fixation at point of fracture, the maxi-
mum will be twice the amount for the corre-
sponding simple fracture. For a compound
fracture, the maximum will be one and one-
half times the amount for the corresponding
simple fracture.
GENITOURINARY TRACT
Nephrectomy . , ................ 70
Nephropexy: fixation or suspension of mov-
able kidney (independent procedure) ... 60
Nephrolithotomy, removal of calculus 70
Cystoscopy with fulguration of bladder
tumor, initial..... ... .:,, ..... 25
Prostatectomy, suprapubic, one or two
stages. .. .... 70
Transurethral electroresection of prostate,
partial, initial ................ 40
Prostatectomy, perineal, subtotal , .... 70
Orchidectomy, simple, unilateral..... 20
Epididymectomy, unilateral ......... 30
Excision of hydrocele, unilateral...... 20
Form 5862GM
Description of Surgical Procedure Relative
Value
GENITOURINARY TRACT (Cont'd) Units
Excision of varicocele (independent. pro-
cedure), unilateral . ... 30
Radical hysterectomy for cancer
(Wertheim) ......... ... ...... 80
Removal of extrauterine embryo (ectopic
pregnancy), by laparotomy. ..... .. , . 40
Hysterectomy (with or without dilation and
curettage and surgery on tubes, ovaries,
ligaments, etc.) ... . ...... . . . ... . 50
Dilation and curettage of uterus (independ-
ent procedure) .......... . . . . . . . . 10
GOITRE
Thyroidectomy, total or complete ...... 60
HERNIA
Hernioplasty: Herniorrhaphy, Herniotomy,
Inguinal, unilateral .... . ... .
Hernioplasty: Herniorrhaphy, Herniotomy,
Inguinal, with appendectomy ......... 40
JOINTS AND DISLOCATIONS
Arthroplasty
Shoulder ....................... 70
Hip. . ........... ............ 100
Knee......... ................. 80
Elbow ..... ..... ............. 60
Wrist ......................... 50
Ankle ......................... 60
Arthrotomy
Shoulder ....................... 30
Elbow..... ................... 30
Wrist . . . . . . . . . . . . . . . . . . . . . . . . . 30
Hip . . . . . . . . . . . . .oca . . . . . . . . . . . . 50
Dislocations
Finger ...... . . . . . . . . . . . . . . . . . . 3
Toe ........................... 3
Shoulder . .. ............... 5
Elbow ......................... 8
Wrist .......... 7
Ankle . ... .................. 10
Lower Jaw ........ ......... .... 5
Hip ........................... 15
Knee ....... .................. 10
5
For a dislocation requiring an open operation,
the maximum benefit for such dislocation shall
be twice the applicable amount listed above.
NOSE
Antrum puncture, unilateral .......... 2
Excision of nasal polyp ..~./:. , ..... 2
Septeetomy: submucous resection ..... 30
Suimucous resection of turbinate, complete
or partial, unilateral or bilateral (inde-
pendent procedure) ........ ...... 10
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 AML
Descriptiono] Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
..c0%.A. Ap WVA LJuL81i,a. r iu%,--uure Relative
Value Value
OBSTETRICAL PROCEDURE
Delivery of child or children. . . . 16
Caesarean Section. . . . .-. . . . . 30
Miscarriage. . . . . . . . . . . . 10
RECTUM
,omplete proctectomy, combined abdomino-
perineal, one or two stages . . . . .100
Hemorrhoidectomy, external only ...... 5
Hemorrhoidectomy, internal and external. 25
Fistulotomy or fistulectomy, simple . . . . 20
Fissurectomy, with or without
sphincterotomy..... ' ............. 15
SKULL
Osteoplastic craniotomy (other than opera-
tion for brain tumor) .............. 100
Trephination (or burr holes), exploratory,
unilateral .................. 35
THROAT
Tonsillectomy, with or without adenoidec-
tomy, any age .. .... -.. ..... 15
Laryngoscopy, direct, diagnostic (independ-
ent procedure) .................. 10
,L_) Two or more ,;urdri.l },rc rriazf ,,. ? 'r:, +c t
rc t~ , he ae a ~c~,~inesl .nt:l~slurt
will be CCT;`'.jdi rcd & ; )n,!? in ( to :.4 ni;n:l`t _v., 3urf'tCdl. rrocedurc
vha11 go'. rn\,
N. -Where two or ?none.. C`pvrEi+u~:','3 !L: E' ?,t j'~;^sr'(I ~~"IYlt Gilt' j,erirx' of di biItty,
Units
TUMORS
Excision of pilonidal cyst or sinus ...... 20
Excision of cyst, fibroadenon,a or other
benign tumor, aberrant breast tissue,
duct lesion or nipple (including any other
partial mastectomy), unilateral....... 15
Local destruction of small benign n.eo-
plastic, cicatricial, inflammatory or
congenital lesion, one ......... . . . . 3
In case of X-ray or radium treatment for any
of the above listed tumors, the maximum bene-
fit payable for the entire course of treatment
including surgical removal shall be that pro-
vided for its surgical removal.
Ligation and division and complete stripping
of long or short saphenous, veins . . .. -. 25
.Conditions: v C
rut. not ttnt' ::i!)I;tIr..91.. :!!.. 1,sc ill jo.yable for ea,--h
shall not, exceed the M'i: o'Li tY aOT''t Hl_(i the azJctilt. p3'.'-
able in not
'r.' ~ ?^, i'wy^.tFn , for the ro,..xt ex-
pensi-,e op'ration 1 gi'l'l !n t.';
Benefits for the Obstetrical Procedures specified in this Schedule shall be paid
if the procedure is performed while the female protected person or dependent wife
is insured under this policy. Obstetrical Benefits for the protected person are not
payable unless, in addition to the premium for the protected person, a dependent
premium is also paid on her behalf during that period of her pregnancy in which she
is among the classes of persons eligible for this insurance.
SUCCF.SSWE 0r_E'RATI0ti. ''(, 'on31th re to ::ave been T;er
formed during one per i o.1 of d : rill) ::It' ?)er or me'd
r
after complete recovery from the bill:.^1,. r + ?t pc.e red char es incurred for the followin, serv ceps
,
and treatments anct suppien which are recornmenoled by the attending physician la thti
di
agnosis aad treatmentf a in ill
on ury o;ncas:
(a) Hospital charges for room and board, excluding any charge in excess of $20
00
.
for hospital confinement in a private room.
(b) Hospital charges for drugs, ined,cine's and other services and suppiies, if used whale
confined in the hospital as a resident p..tiini,
(c) fiospttal charges for ouipatiect sf~rvicrs in connecticxi with sl) a surgical op atior,
or related charges incurred withir, forty-eighi hoard after the surgery is pert -1+-t
or (2) emergency treatment for accidental bodily injuriina incurred withtn forty-e1 ;M
hours after the accident.
2. overed Surgical Chares - the covered charges incurred for the following services.
a s trade by Z physician or surgeon for the performance of an operation or tl o
repair of a dislocation or fracture (excluding assisting surgeon's charges).
(b) Charges for the services of a professional anesthetist, providing the anesthetist Is
not employed by a hospital which submits a charge to the protected person or dependent
for his services.
3. Other Covered Charges - those covered charges incurred for the following servic{ssa grad
supplies which are recommended by the attending physician in the diagnosis and tr eatnneui
of an injury or illness, and which art not included in the description of Covered Hospital
Charges or Covered Surgical Charges above:
Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
 Ot; Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
"~" r~~"' ???~-`?- ? ~'~ ue stn Outpatient.
(b) Charges made by & physician for medical services, i . udifig his active services a.r
an assistant surgeon.
(c) Charges made by a registered graduate nurse or qu.illfled physiotherv.pist, exct pt
for services rendered by a person who ordinarily resides in the protected pcrson's
household or is a member of his family.
(d) Charges for local professional ambulance service, and if the injury or illneyx regt;area
special and unlqu- hospital treatment, transportation within the United States or Ca,arida
to the nearest hospital equipped to furnish the treatment not available in a local rio?pital,
by professional ambulance, railroad or commercial airlines on a regularly scheduled
flight.
(e) Charges for the following additional services and supplies. drusfs arts medicines
requiring a physician's written prescription; dfng*nostic X- ray and laboratory service;
oxygen and the rental o, equipment for its administration; blood or blood plasrn.a and
its administration; radium, radioactive isotopes and X-ray therapy; casts, splints,
braces, trusses and crutches; rental of hospital type bed, wheel chair, iron lung or
similar durable therapeutic equipment; artificial limbs and eyes to replace natural
limbs and eyes lost while insured under this provision; dental services rendered by a
physician or dentist for the treatment of an injury to the jaw or to natural teeth,
including the initial replacement of these teeth and any necessary dental X-rays
resulting from an accident occurring while insured under this provision, provided the
treatment is rendered within six rnontris from the date of the accident.
NERVOUS 'OR MENTAL DISORDERS - If a protected person or an insured dependent shall incur
covered charges because of a nervous or mental disorder, the following conditions shall also apply:
1. Covered Hospital Charges, charges for convulsive or shock treatment and charges for
surgery performed as a result of a nervous or mental disorder shall be compensable in
the same manner and subject to the same limitations and conditions as any other illness.
2. For all other covered charges incurred as a result of a nervous or mental disorder or
combination thereof, the Association, providing such charges are incurred while the pro-
tected person or dependent is totally and continuously disabled, will pay 50% of
covered charges in excess of.the Deductible Amount; provided, ho.rever, that the
maximum payable for professional psychiatric treatment by a physician at home, the
office or the hospital shall not exceed $15.00 per visit and not more than 50
visits during any one calendar year.
COMPLICATIONS OF PREGNANCY - Complications of pregnancy shall be defined to include only
the following:
1. Surgical operations for extrauterine' pregnancy;
2. lntra-abdominal surgery after termination of pregnancy;
3. Pernicious vomiting of pregnancy; and
4. Toxemia with convulsions.
If a female protected person or a dependent wife sha11 incur covered charges because of compli-
cations of pregnancy, as herein defined, the Association will pay benefits in the same rnanneerand
subject to the same limitations and conditions as any other illness, provided:
I. If such female protected person or dependent wife is eligible for maternitybenefi;a .rider
any other benefit provision of this group insurance plan for expenwes incurred, payment
for complications of pregnancy under this provision shall be in lieu of such n slernity
benefits.
2. If such female protected person or dependent wife is not eligible for maternity benefits
under any other benefit provision of this group insurance plan for expenses incurred,
the amount of benefits payable for complications of pregnancy shall be reduced by $250.C0.
COMMON ACCIDENT - If a protected wersor, aruct one or more d,!i cnoenta or if two or more depend-
ents, while insured under this proviaiof+, are inured in the satr.e accident, all covered charges
incurred as a result of such accident nail: be combined and only one Deductible Annual shall be.
charged, if applicable, against such covered ch-*rge,y, regarc-iiess of the number of indiv;vuain
Involved.. This combined Deductible Amount shall alsoo, apply to future reapplications of the Deduct-
ible Amount for such common accident; however, nothing herein shall be construed to reduce the
Maximum Payment for each insured person
Fo.-m 586 M
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 Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
W
DEFINITIONS - As used in this provision:
1. A physician or surgeon shall be defined as one who is duly licensed to prescribe and ad-
minister all drugs and to perforce all surgery.
2. The term "hospital" shall be defined as an institution which provides overnight inpatient
care, has full diagnostic and thernpeut is facilities under the supervialori of a staff of
physicians and twenty-four hour nursing 3'-r%-ices by registere,7 graduate nurses, and
such institution is not, other than incidentally, a nursing home, or a place for rest, or
for the aged, drug addicts or alcoholics,
EXCEPTIONS AND LiMMITATIONS - This provision does not cover:
I. Dental services rendered by a physician or d+?ntiat except as specifically provided under
"Oth
C
d C
er
overe
harges; or
2. Eye refractioua or the fitting or coat of eyeglasses of t .earing aids; or
3. Cosmetic surgery except for the repair of ace id~ntai inj:ariees sustained while insured under
this provision; or
4. Alcoholism or drug addiction; or
5. Pregnancy. including resulting childbirth, miscarriage or abortion, or resulting com-
plications, except as provided under the paragraph entitled COMPLICATIONS OF
PREGNANCY; or
6. Nervous or mental disorders except as provided unclear the paragraph entitled NERVOUS
OR MENTAL DISORDERS.
7. Covered Charges will be reduced by the amount of benefits payable or value of services
provided (a) under any other plan for which any employer of the protected person or
dependent makes payroll deductions or contributions, or (b).under any federal, state or
other governmental program,
8. This provision is alro subject to the exceptions contained In the EXCLUSIONS AND
LIMITATIONS section of the General Provisions.
Form 586MGM 16
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 Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
SETTLEMENT OF CLAIMS W
PAYMENT OF CLAIMS. All indemnities provided by this policy will be payable within sixty
days after receipt of due proof. All indemnities shall be payable to the protected person.
If any benefits of this policy shall be payable to the estate of the protected, person or to
a protected person or beneficiary who is a minor or otherwise not competent to give a valid---__
release, the Association may pay to the hospital, physician or surgeon, on whose charge_.or fee
claim is based, any sums due for Hospital Expense Benefits, Surgical Expense Benefits or Medi
cal Expense Benefits toward satisfaction of any amounts still owed such hospital, physician or
surgeon, and any balance of such sums may be paid, up to an amount not exceeding $1,000.00,
to any relative by blood or connection by marriage of the protected person or beneficiary who
is deemed by the Association to be equitably entitled thereto. Any payment made by the Asso-
ciation in good faith pursuant to,this provision shall fully discharge the Association to the
extent of such payment.
FREE CHOICE OF PHYSICIAN. Each protected person shall have free choice of physician or
surgeon, legally practicing, and the doctor-patient relationship shall be maintained at all
times.
MEDICAL EXAMINATION. The Association shall have the right, through its medical examiner, to
examine any protected person so often as it may reasonably require during the pendency of a
claim hereunder, and the right and opportunity to make an autopsy in case of death where it
is not forbidden by law.
NOTICE AND PROOF OF CLAIMS. Written notice of injury or of sickness, for which; claim is made,
must be given the Association at its Home Office in Omaha, Nebraska, within sixty days after
the date of the accident or within sixty days after the commencement of the sickness. Proof
of such injury or sickness must be furnished to the Association at its Home Office in Omaha,
Nebraska, within ninety days after the end of the period of disability for which claim is
made. Failure to furnish notice of proof within the required time shall not invalidate nor
reduce any claim if it shall be shown that notice or proof was given as soon as was reason-
ably possible.
The Association will furnish such forms as are usually furnished by it for filing proofs
of loss. If such forms are not so furnished before the expiration of fifteen days after the
Association receives notice of any claim hereunder, the person making such claim shall be
deemed to have complied with the requirements of the policy as to proof of loss upon submit-
ting within the time fixed herein for filing proofs of loss, written proof covering the oc-
currence, character and extent of the loss for which claim is made.
If any time limitation of this policy with respect to giving notice of claim or furnish-
ing proof of loss is less than that permitted by the law of the state in which the main office
of the Policyholder is located at the time the policy is issued, such limitation is hereby
extended to agree with the minimum period permitted by such law.
LEGAL PROCEEDINGS. No action at law or in equity shall be brought for recovery under this
policy prior to the expiration of sixty days after proof of loss has been filed in accordance
with the requirements of the policy and no such action shall be brought at all unless brought
within two years from the expiration of the time within which proof of loss is required by
the policy.
If any time limitation of this policy with respect to bringing an action at law or in
equity is less than that permitted by the law of the state in which the main office of the
Policyholder is located at the time the policy is issued, such limitation is hereby extended
to agree with the minimum period permitted by such law.
CONFORMITY WITH STATUTES. Any provision of this policy which, on its effective date, is in
conflict with Public Law 86-382, Federal Employees Health Benefits Act of 1959 and author-
ized regulations thereunder is hereby amended to conform to the minimum requirements of
such Act and regulations.
.Form 586MGM
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 Approved For Release 2009/07/16: CIA-RDP87-00868R000100060091-0
u ,
ar
Z4
1'.1 -j ni
-A L
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