EMPLOYEE SERVICES INSURANCE AVAILABLE TO AGENCY EMPLOYEES

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP86-00964R000100110056-4
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 22
• Document Creation Date: December 14, 2016
• Document Release Date: July 24, 2003
• Sequence Number: 56
• Publication Date: July 29, 1954
• Content Type: REGULATION

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29 July 1954
a. Pending publication of a Regulation on Employee Services, this Notice
announces two new insurance plans and summarizes the coverage and
eligibility requirements of the life and health insurance plans currently
available to personnel through facilities in the Agency. In certain
instances, security considerations have precluded an individual's appli-
cation for coverage, or the approval thereof, under the old plans
described.
b. It is the purpose of this Notice to describe the available life and
health insurance plans to employees so that they will have adequate
information on which to base their decisions concerning this important
aspect of their welfare. In this connection, the Agency has developed
these insurance programs in order to provide employees with better
benefits and to avoid the following problems:
(1) Commercial insurance companies have become somewhat cautious about
selling insurance to Agency employees because of the possibility
of hazardous duty. As a result, some companies will insure Agency
employees only for limited amounts and usually under conditions
which preclude the payment of benefits as the result of hazards
sometimes found in overseas areas.
(2) Because of security considerations, it is sometimes difficult to
release sufficient information to insurance companies so that under
their policies they can appropriately pay claims.
c. These insurance plans are sponsored by the Government Employees Health
Association, Inc., (GEHA), which is a nonprofit organization made up
entirely of Agency personnel. Administration of this program is effected
by the Insurance and Claims Branch, Employee Services Division, Office of
Personnel. With regard to this insurance, employees will direct any
inquiries concerned with life and health insurance to the Insurance and
Claims Branch. Inquiries must not be directed to the companies under-
writing insurance plans previously or currently sponsored by GEHA.
d. Attached is a brochure entitled "Life Insurance and Health Insurance"
prepared by GEHA, which explains in considerable detail the premiums
and benefits of the new insurance programs now being offered to employees.
The attention of all employees is specifically invited to the announcement
that the initial application period for these new insurance plans will
take place during the period 1 August 1954 to 31 October 1954.
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PERSONNEL
29 July 195+
e. Applications for these insurance plans may be obtained from the Insurance
and Claims Branch, Curie Hall, extensions
Two life insurance plans are available for Agency employees, as indicated
below. For several years eligible Agency employees have been able to purchase
the War Agencies Employees Protective Association (WAEPA) life insurance
through CEHA. At this time, (EH1A announces that it is offering a new life
insurance policy which can be purchased by all Agency personnel in varying
amounts of face value at very low premium rates. See Attachment 1 for a
comparison of these life insurance plans.
This new term life insurance,, as described in the attached brochure, may
be purchased by members of GEHA who are Staff Employees, Staff Agents, or
Contract Employees, or who are civilian or military personnel detailed to
the Agency (in the case of Contract Employees) evidence of insurability
by medical examination is a :requirement in addition to approval of the
application by the Station or Mission Chief and evidence of an. appropriate
contract on file at headquarters). The relationship and procedures be-
tween CEHA and the underwriting company for this policy are such that
when necessary for security :reasons, the names of employees or their
beneficiaries will not be given to the insurance company. Furthermore,
it will be possible to handle benefit payments, when necessary, through
channels which will not reveal the beneficiaries' association with the
Agency.
Subject to security considerations, WAEPA term life insurance and acci-
dental death coverage is currently available to civilian Staff Employees
of the Agency through GEHA. The eligibility of Staff Agents, Career
Agents and Contract Employees must be determined on an individual case
basis. Military personnel are not eligible. All applicants must be
citizens of the United States or have taken out first papers toward
citizenship. The coverage provided and related premiums, based on the
employee's salary, are described in WAEPA brochures available from the
Insurance and Claim Branch. It is anticipated that this policy will
continue to be available to eligible employees.
3. HEALTH INSURANCE
The Agency has been sponsoring two insurance programs for hospitalization and
surgical coverage through the management of GEHA and the Insurance and Claims
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PERSONNEL
29 July 1954
Branch, Employee Services Division, Office of Personnel. One has been a
policy underwritten by the Mutual Benefit Health and Accident Association
of Omaha, Nebraska. This insurance coverage is now replaced by a new plan,
underwritten by the same company. The new policy is a substantial improvement
over the old one and in its premium range represents one of the finest "health"
insurance "packages" available to any group of people in the country. The
second insurance plan which has been available is Group Hospitalization Incor-
porated (GHI) with its supplemental surgical service coverage. Attachment 2
compares the benefits and premiums of the new Mutual of Omaha plan and GHI.
a. New Mutual of Omaha Health Insurance Plan
In offering the new policy the insurance company has required that the
old master policy contract be terminated at the earliest practicable date.
In this connection current subscribers to the old Mutual of Omaha
policy should convert to the new plan during the initial application
period for new Mutual of Omaha Health Insurance which will take place
during the period 1 August to 31 October 1954. However, employees
who are overseas will be able to continue their old Mutual of Omaha
plan until it is administratively feasible for them to convert. The
new insurance plan, as described in the attached brochure, may be pur-
chased by members of GEHA who are Staff Employees, Staff Agents, or
Contract Employees or who are civilian or military personnel detailed
to the Agency (in the case of Contract Employees, evidence of insurability
by medical examination is a requirement in addition to approval of the
application by the Station or Mission Chief and evidence of an appro-
priate contract on file at headquarters). As in the case of the new life
insurance, the procedures between GEHA and the underwriting company have
been developed specifically with a view to security considerations.
Suitable credentials will be given to all subscribers as a guarantee
for immediate admittance to any hospital. Claim payments up to the full.
limit of the subscriber's contract are guaranteed to the hospital. This
eliminates the possibility of rejection of any claim. A subscriber may
authorize the Insurance and Claims Branch to pay the hospital directly.
Subject to security considerations, GHI insurance with its surgical
service coverage is currently available to Staff Employees including
military personnel detailed to the Agency who hold positions comparable
to Staff Employees. The eligibility of Staff Agents must be determined
on an. individual basis. Other personnel may not apply for this insurance.
Such personnel currently covered by this plan are not affected by this
limitation. This insurance program provides "service" type coverage
(certain costs are handled directly between the hospital and/or doctor
and GHI). This "service" feature is not available when the individual
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PERSONNEL
29 duly 195+
and his family are overseas, in which case GHI reimburses the certificate
holder, at substantially lower benefits rates through the Insurance and
Claims Office. In general, this program cannot be handled in as secure
manner as the new Mutual of Omaha health insurance plan. It is antici-
pated that the GHI plan will continue to be available to employees.
FOR THE DIRECTOR OF CENTRAL INTELLIGENCE:
L. K. WHITE
Deputy Director
(Administration)
L ISTRI 3UTION : ALL EMPLOYEES
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NOTICE NI
COMPARISON OF LIFE INSURANCE PLANS
New United Benefit Life Insurance Plan
(Schedule of benefits and monthly premiums)
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Class
Face Amount Accidental Total
Monthl
y
Death Benefit Coverage
Premi2
Ms
Class 1
$ 3,000 plus $ 3,000 $ 6,000
$ 1.83
Class 2
$ 6,000 plus $ 6,000 $ 12,000
$ 3.66
Class 3
$ 9,000 plus $ 9,000 $ 18,000
$ 5.19
Class 4
$ 12,000 plus $ 12,000 $ 21,000
$ 7.32
Class 5
$ 15,000 plus $ 15,E $ 30,000
$ 9.15
These five classes enable employees in all grades to purchase the
amount of insurance suitable to meet their requirements.
This new plan is so designed that any amount of premiums paid over and
above claims paid, plus a fixed percentage for administrative costs, plus a
small contingency reserve, will be returned annually to GEHA, Inc. as a refund
of unearned premiums which may be allocated to reserve funds or dividend
distribution. Should our "'experience rating" continue in somewhat the same
ratio as during the past seven years, this annual refund should be appreciable.
A further highly desirable feature is the "level premium" from age 18 to
65 which assures no advance in premium rates at ages 41 and 51 as exists in
the present WAEPA contract.
W EPA Life Insurance Plan
(Schedule of benefits and monthly premiums)
Age
Group
Basic
Salary
Present
Face Amount
Accidental
Death Ben,
Total
Coverage
Monthly
Premium
Up to 40 inc.
Less than $33,200
$ 6,000
$ 7,500
$ 13,500
$ 4.17
$3,200 and over
$ 12,000
$ 15,E
$ 27,E
$ 8.33
41-50 mold.
Less than $3,200
$ 6,000
$ 7, 500
$ 13, 500
$ 5.21
$3,200 and over
$ 12,000
$ 15,000
$ 27,000
$ 10.42
51-65 i.ncld.
Less than $3,200
$ 6,000
$ 7,500
$ 13,500
$ 6.25
$3,200 and over
$ 12,000
$ 15,000
$ 27,000
$ 12.50
There are but two classes available under the WAEPA r.1an as Billows:
Employees earning less than $3,200 may apply for the small plan listed above
whereas employees making more than $3,200 per annum are obliged to purchase
either the full amount of coverage or none at all. There are no intermediate
classes as in the new United Benefit Plan.
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NOTICE ,
25X1 MC? or severa years the WFAPA plan has refunded no cash dividende to LIFE-A,
Inc. despite the fact that they have realized a very large profit front premium
payments in ratio to claims paid.
The WAEPA plan also has no provision for considering experience ra
and there is therefore no provision for dividend returns.
WAEPAt 'Insurance is
effective the date ap-
pl.iation and premium
are received in Insur-
ancrr & Claims Branch.
WA'A: Any employee Eligibility
eTi.gible to apply
prier to age 60 and
the insurance terminates
at age 6r.
Application for insurance
is open to all civilian
employees who may have
overseas travel orders or
"who may go overseas at
some future date" or "who
may be in training for
overseas duty."
WAEaA: Medical exami- Medical Examination
nat;7 on required when-
ever physical history
stauement indicates
that such examination
is necessary.
WAEP'A: Upon termination Conversion
of Government employment
or a=t attaining the age
of 65, member may convert
without medical examination
to any-standard form of
life policy other than term
issued by the Equitable Life.
UNITED BENEFIT: All civilian
employees as well as detailed
military personnel or, active
duty or detailed civilian per-
sonnel are eligible to apply
for this plan prior to the age
of 60.
Application for insurance is
open to all civilian employees
or detailed civilian or military
personnel without reference
to possible overseas duty or
travel orders.
UNITED BENEF r: No medical
examination required if :insur-
ance is requested during Annual
Application Period. Requests
for insurance presented out-
side of an Annual Application
Period may subject applicant
to medical examination, depend-
ing upon contents of physical
history statement, except EOD
within 60 days and except over-
seas returnee within 60 days
of arrival.
Upon termination of Government
employment or at attaining the
age of 65, member may convert
without medical examination to
any standard form of life policy
other than term issued by United
Benefit Life.
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WAEPA: No coverage Disability Waiver
of Premium
Accidental Death
Benefit
accidental death benefits:
1. Bacterial infections
(except pyogenic infection
arising from accidental
wound).
UNITED BENEFIT: Any member be-
coming totally and presumably
permanently disabled at any
time prior to the age of 60 for
a period of 6 months, has his
future premiums automatically
waived until recovery or until
death regardless of age.
UNITED BENEFIT: Exclusions from
accidental death benefits:
1. Bacterial infections
(except pyogenic infection
arising from accidental wound).
2.
Any kind of disease.
2. Any kind of disease.
3. Medical treatment 3.. Medical treatment (except
(except from accidental
injuries).
from accidental injuries).
b.
Suicide.
1..
Suicide.
5?
Air flight in non-
5.
Does not cover death
scheduled flight.. unless
under orders of the U.S.
Government and in any
flight as a crew member
of the plane.
caused directly or indirectly
by an injury sustained by the
certificate holder while he is
acting as a pilot, co-pilot,
or crew member of any aircraft.
Any certificate holder travel-
ing as a passenger on any air-
craft is fully covered.
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CURRENT GHI CONTRACT
(OVERSEAS)
Hospitalization Benefits
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ATTACHMENT 2
CCUP_ARISON OF HEALTH INSURANCE PLANS
THE NEW MTJTUAL OF OMAHA HEALTH PLAN
(OVERSEAS)
Hospitalization Benefits
1. Hospital Room and Board: $10.00 per day for
21 days with 90-day interval on freauency. plus
$64.00 for 16 allocated hospital extras, except
maternity - see No. 5 below.
2-. Plus out-patient emergency up to......... $10
within 2 hours of accident.
3. Effective date of Contract - 1st of next month.
4s, Waiting Period. None for the applicant who
joined initially in March 1953, and has con-
tinued his insurance without lapse, or for the
FAD since then. Otherwise 10 months for mater-
nity, tonsillectomy, adenoidectomy and for pre-
existing conditions.
1. Hospital Room and Board: $9.00 per day for
90 days with no limit on frequency (1 work-day
break) plus all hospital extras up to $135.00
nnallocated, except maternity - see No. 5 below.
2. Plus out-patient emer ency up to ........ $135
within hours of accident.
3. Effective date of Contract - Date of filing of
application.
i. Waiting Period. No waiting period is required
regardless of conditions existing prior to ap-
plication except for the following instances
regarding maternity: A waiting period of 9
months is required for maternity during the
ini-cial application period unless the applicant
has current Group hospitalization and surgical
coverage sponsored by the Association. Also,
such waiting period is required when application
for health insurance is made subsequent to this
initial application period expiring 31 October
1954.
5. Maternity .. $9.00 per day room and board for 5. Maternit - $9.00 per day room and board for
d$ ays except Caesarean, termination of ectopic 8 days, except Caesarean, termination of ectopic
pregnancy and miscarzage, for which hospitaliza- pregnancy and miscarriage, for which hospitaliza-
tion benefits are 1 above. tion is 1 above; (Omaha's national average for
normal delivery is 6.6 days).
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6. TB, mental disorders, nervous disorders and
quarantinable diseases - 10-day limit during
any 12-month period for No. 1 above.
7. Ambulance.- Does not pay.
8. X-Ray - pays only if connected with surgery
within 3 days and in a hospital.
9. Dependent Children - Added after 90th day to
18th birthday,
10, Congenital Anomalies - Not covered.
11. Pre-existing Conditions - Not covered if member-
ship falls below 7 per cent of the potential
number of subscribers.
12. Laboratory Tests - Only initial test, i.e.,
urinalysis and blood count,
13. Tonsillectomy and Adenoidectomy - 1 day for
children, 2 days for all others.
lit. Diagnosis - Not covered.
15. Service-Connected Disability - Not covered.
16. Physical Therapy - Not covered.
17. Specify Members of Family nor Coves?age. Yes,
name and date of birth must be sent in, other-
wise not covered.
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New Omaha. (Overseas) Hospitalization
6. Same as No. 1 above, full coverage as other
illnesses,
7. Ambulance. - Pays, up to limit of $25.00.
8. X Rey - pays, no restriction if in hospital or
authorized clinic.
9. Dependent Children - Added after lath day to
19th birthday,
10, Congenital Anomalies - Full coverage at any
age after the 14th day following birth.
11, Pre-existing Conditions - All are covered.
12. Laboratory Tests - All covered under hospital
extras.
13. Tonsillectomy and Adenoidectomy - As No. 1
above.
11i, Pi sonosis - Covered, up to full 90-day per od,
thereby covering possible complications.
15. Service-Connected Disability - Covered, in any
but Government hospitals.
16. Physical Therapy - Covered.
17. Specify Members of Family for Coverage. No.
specification; automatic coverage.
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GHI (Overseas) Hospitalization
1$. Private Nurses. - Not covered.
19, Premium Based on Experience - No.
20. Plastic Surgery - Not covered unless the in u
is received after individual is a subscriber.
21. Dental Surgery - If hospitalized, will pay only
if performed by an M.D.
22? Out-patient surgical services. Not covered.
(DOMESTIC-
Hospitalization Benefits
1. Hospital Room and Board: Plus 16 named (allo-
cated) extras for 21 days (Semi-private - Parti-
cipating Hospital) with 90-day interval on fre-
quency plus $5.00 per day for addition.' 180 days.
If private room, $10.00 per day 2212 for room and
board,
0
New Omaha (Overseas) Hospitalization
18. Private Nurses. - Not covered.
19. Premium Based on Experience - Yes, yearly
modification possible.
20. Plastic Surgery - Covered regardless of when
injury was received, except cosmetic surgery.
21. Dental Surgery - If hospitalized, will pay if
performed by a dentist, a dental surgeon or an
I.D.
22. Out-patient surgical services. Up to $135.00
for hospital miscellaneous expense benefits
incurred in connection with a surgical opera-
tion when the member is not hospital confined.
Hospitalization Benefits
1. Hospital Room and Board: Up to $13.50 per day
for the 90 days with no limit on frequency
(1 work-day break), plus all hospital extras up
to $202.50 unallocated, plus 75 per cent of the
next $5,000.00 of hospital extras.
2. Plus out-patient emergency up to .......... 510.00 2. Plus out-patient ever Plus out-patient ever ency up to ....... $202.50
within n hours accident, ~ n hours or acent,
3. Through 22 - Same as Overseas except No. 5, -
maternity, which benefit is No. 1 above here for
Caesarean, termination of ectopic pregnancy and
miscarriage.
3. Through 22 - Same as Overseas except No. 5 -
maternity which benefit is No. 1 above here for
Caesarean,termination of ectopic pregnancy and
miscarriage and except for No. 6, which benefit
is.No. 1 above here.
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= If in participating hospital, the benefits are t}ose
of local Blue Cross in that area.
- If in non-participating hospital, the benefits are
the same is the overseas rates,
Surgical Benefits
(Examples)
GHI Surgical New Mutual of Omaha Health
100. .
140. .
100. .
175. .
125.
75.
.
200. . .
809
. .
150.
175. ? .
150..
250. .
55. ..
55. ..
60. ..
165. . .
85. ..
2000
. .
35...
25 . . .
50. ..
200. .
150..
2000 .
3, 000
Average $ 125
Average 3 132.00
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Hernia, unilateral . . . . . . . 3100,00
Hernia, bilateral . . . . . . . 1110.00
Appendectomy . . . . . . . . . . 100,00
Radical mastectomy . . . . . . . 187.50
Fracture of spine . . . . . . . 93.75
Hip dislocation. . . . . . . . . 113.75
Prostatectomy . . . . . . . . . 187.50
Normal delivery. . . . . . . . . 80.00
Caesarean . . . . . . . . . . . . 150,00
Removal of kidney. . . . . . . . 250.00
Removal of cataract. . . . . . . 187.50
Gastrectomy. . . . . . . . . 250.00
Tonsillectomy. . . . . . . . . . 55.00
Adenoidectomy. . . . . . . . . . 55.00
Hemorrhoidectomy . . . . . . . . 62.50
Hysterectomy . . . . . . . . . . 165.00
Amputation - arm, foot . . . . . 125.00
Skull fracture - compound. . . . 250.00
Fracture of base of spine. . . . 62.50
Bronchoscopy . . . . . . . . 50.00
Varicocele removal . . . . . . . 62.50
Thyroid removal. . . . . . . . . 187.50
Mastoidectomy, simple . . 125.00
Mastoidectomy, radical . . 187.50
e 3,157-50
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NO
Premium Costs
GHI NEW MUTUAL OF OMAHA HEALTH
Premium (Monthly) Premium Month
Ho . Surgical Total Hos . Sung cal Total Diff.
1.70 1.00 2.70 . . . . Individual contract . . . . . . . . . . . . 2.70
3.70 3.20 6.90 individual and spouse and children. . . . . 7.98 11.08
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LIFE INSURANCE
AND
HEALTH INSURANCE
N
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 Approved For Release 2003/08/13': CIA-RDP86-00964R000100110056-4
LIFE INSURANCE
HEALTH INSURANCE
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FOREWORD
CONTENTS
PAGE
FOREWORD ............................................................................................ 3.
INTRODUCTION .................................................................................. 4
THE LIFE INSURANCE PLAN .......................................................... 5
Eligibility .............................................................................................. 5
Schedule of Benefits and Monthly Premiums .................................. 5
Selection of Class .................................................................................. 5
Accidental Death Coverage ................................................................ 6
Limitations ............................................................................................ 6
Conversion Privilege ............................................... ............................. 7
Premium Waiver for Total and Permanent Disability .................. 7
Continuation of Insurance upon Termination of Employment.... 7
Payment of Insurance Benefits ............................................................ 7
Medical Examination .......................................................................... 7
Application Procedures ........................................................................ 8
THE HEALTH INSURANCE PLAN ................................................ 9
Eligibility .............................................................................................. 9
........... ........ . 9
Monthly Premiums ................................ ...........................
Health Insurance Coverage ................................................................ 9
Hospital Service Benefits in the United States .................................. 9
Hospital Service Benefits Overseas ...................................................... 11
Surgical Benefits in the United States and Overseas ........................ 13
Waiting Period ...................................................................................... 14
Continuation of Insurance upon Termination of Employment.... 14
Extended Benefits ................................................................................ 14
Payment of Insurance Benefits ............................................................ 14
Medical Examination .......................................................................... 14
Application Procedures ........................................................................ 15
Conversion Privilege ..................... _..................................................... 16
CONDITIONS OF MEMBERSHIP IN GEHA .................................. 16
It is our objective to offer the best and least expensive
employee and family protection against death, accident, and
illness that it is possible to provide and to make these benefits
available under such conditions that all members of the Asso-
ciation may participate without concern for revealing
administrative procedures. We believe that this objective has
been attained.
The following. pages describe two new separate group plans
in the fields of life insurance and health insurance. Both
plans provide these important. features; consideration of the
different earning levels of all of our members; more complete
protection; dividends; extended coverage after termination;
and adjustment of future premiums as experience warrants.
The Insurance and Claims Office will furnish additional
information and assistance to individual members who wish
to apply for either or both of these plans of group insurance.
GOVERNMENT EMPLOYEES
HEALTH ASSOCIATION, INC.
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THE LIFE INSURANCE PLAN
INTRODUCTION
The Life Insurance Plan consists of group term life insurance
providing protection for the family against death of the employee,
including accidental death. The Health Insurance Plan substantially
protects the employee and his family against hospitalization and
surgical costs.
Each plan is administered by the Government Employees Health
Association, Inc., constituted for this purpose, and briefly known
as GEHA.
The Life Insurance Plan will be known and operated as:
"GEHA-Life"
The Health Insurance Plan will be known and operated as:
"GEHA - Health"
The Life Insurance Plan is underwritten by the United Benefit
Life Insurance Co. of Omaha, Nebraska. The Health Insurance Plan
is underwritten by the Mutual Benefit Health and Accident Association
of Omaha, Nebraska.
The latter company is the largest exclusive health and accident
company in the world. Mutual of Omaha's companion company,
United Benefit, is among the top 6% of the Nation's life companies,
and has over I V4 billion dollars of life insurance in force.
ELIGIBILITY
All members of the Government Employees Health Association,
Inc. in good standing and who are under the age of 60 are eligible to
purchase the life insurance coverage which includes a double indemnity
accidental death provision. The insurance may be held until the
member reaches age 65 when it is cancelled if not converted.
Detailed military personnel on active duty who are members of
GEHA and meet the above age requirement are eligible to purchase
life insurance. These military members may retain their insurance
for the full duration of their membership in the Association. This
same opportunity is extended to detailed civilian personnel who are
members of GEHA.
The death of any member of the GEHA who is or becomes a
member of the military services of this or any other country, which
results from an Act of War, whether declared or undeclared, is not
covered under this contract.
SCHEDULE OF BENEFITS AND MONTHLY PREMIUMS
The face amounts of life insurance, accidental death benefits and
monthly premiums of the five classes of insurance that may be selected
by members of GEHA are as follows:
Accidental Monthly
Death Benefit Premium
Class 1 ..................$ 3,000.................. plus..................$ 3,000..................$1.83
Class 2 ..................$ 6,000......:........... plus..................$ 6,000..................$3.66
Class 3 ..................$ 9,000.................. plus..................$ 9,000..................$5.49
Class 4 ..................$12,000..................plus..................$12,000..................$7.32
Class 5 ......... ......... $15,000.................. plus .................. $15,000........... ....... S9.15
Initial Selection
A member earning $3,200 or less annually may select, initially,
Class 1 or Class 2. A member earning $3,201 or more may select,
initially, any one of the five classes.
Subsequent Changes
A member may change to the next class for which he qualifies,
within sixty days of a grade change in salary. Within-grade step
increases are not to be considered.
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A member may apply for benefits of a higher class at any time by
furnishing the Association satisfactory evidence of insurability by
medical examination. In that event the member must retain the
coverage of the higher class for 12 continuous months, in order to
retain his membership in the Association and this insurance coverage.
A member may change to a lower class only if he has held his
current coverage for 12 continuous months or more.
CONVERSION PRIVILEGE
A certificate holder may convert his insurance to any permanent
plan of life insurance, other than term, underwritten by the United
Benefit Life Insurance Company, without physical examination, when
he reaches the age of 65 or within 31 days after termination of his
employment.
PREMIUM WAIVER FOR TOTAL AND PERMANENT
DISABILITY
The double indemnity provision covering accidental death is
automatically included. This accidental death benefit feature insures
the member against loss of life resulting directly, and independently
of all other causes, from bodily injuries produced solely through
accidental means.
If the bodily injuries sustained by the insured member result in
loss of life within ninety days from date of accident, such amount of
Principal Sum in force on the life of the member will be paid to the
named beneficiary.
The accidental death benefit does. not cover death caused directly
or indirectly, wholly or partly
(a) By bacterial infections (except pyogenic infections which shall
occur with and through an accidental cut or wound), or
(b) By any kind of disease, or
(c) By medical or surgical treatment (except such as may result
directly from such treatment made necessary by injuries
covered by this policy), nor shall it cover
(d) Suicide or any attempt thereat, while sane or insane, nor
(e) Death from any injuries sustained as the result of or while
participating in aeronautics, aviation, air travel or air trans-
portation except as a passenger. The term "passenger" is
understood to exclude pilot, copilot, and all other members
of the crew, engaged in the operation of the aircraft.
(f) Death after any premium has been waived."
In the event a certificate holder becomes totally and, presumably,
permanently disabled prior to the age of 60, his insurance will remain
in force without payment of premium until recovery or death regardless
of age.
CONTINUATION OF INSURANCE UPON TERMINATION
OF EMPLOYMENT
The life insurance will continue in effect for 31 days following
termination of employment.
The beneficiary may elect to have the death benefit paid as
follows,
in a lump sum, or
in a series of monthly installments, or
partly in a lump sum and the balance in a series of monthly
installments.
The beneficiary may be changed at any time upon the written
request of the certificate holder.
No medical examination is required from an applicant member
during the' Annual Application Period or from an overseas returnee on
permanent change of station within 60 days after arrival, or from an
applicant during the first 60 days after entry on duty. Members
applying under any other than the above circumstances must show
evidence of insurability by medical examination.
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APPLICATION PROCEDURES
Application for membership in the Government Employees
Health Association, Inc. may be submitted to the Insurance and Claims
office within 60 days after an employee has entered on duty, or within
60 days after an employee has returned-permanent change of station
-from an overseas assignment, or on the occasion of the Annual
Application Period. The current Application Period extends from
1 August 1954 until 31 October 1954.
Other than during the above periods an em to ee m k
p y ay ma e ap-
plication showing evidence of insurability by medical examination.
The life insurance becomes effective the day the application is received
and payment made to the Insurance and Claims office.
Persons whose applications for membership are approved will
become members. of the Government Employees Health Association,
Inc. upon the payment of a one dollar membership fee. Employees
who are currently members of the Association may continue their
membership without the payment of an additional membership fee.
Applications for life insurance coverage must be accompanied by
payment of the first two months premium and the membership fee in
the Association. Checks in payment of premiums should be made
payable to "GEHA-Life".
THE HEALTH INSURANCE PLAN
ELIGIBILITY
All employees wherever located, who are members of the Govern
ment Employees Health Association, Inc., in good standing are eligible
to purchase the health insurance coverage for themselves and their
families.
MONTHLY PREMIUMS
Monthly premiums for the single member
listed below:
Hospital and Surgical Services
y
rem
Single (member only) ....................................................$2.70
Family (member, spouse and all children between
the ages of 14 days and 19 years)* ................................$7.98
*Married children or children separately insured under the Health Insurance Plan
are excluded.
HEALTH INSURANCE COVERAGE
The Health Insurance Plan provides hospital and surgical
service benefits for all types of illness or accidents including the
following:
1. Tuberculosis
2. Heart conditions
3. Mental and Nervous disorders
4. Quarantinable diseases
5. Cancer
6. Pre-existing diseases
The Health Insurance Plan has only two exclusions. It does
not cover:
1. Claims which are properly payable under the Federal Em-
ployees Compensation Act, or similar legislation.
2. Claims for services other than those provided by the hospital.
(i.e. special or private nurses or doctors. calls).
HOSPITAL SERVICE BENEFITS IN THE UNITED STATES
The benefits listed below are available under the Health Insur-
ance Plan to insured members and their dependents in any hospital
they may select within the continental limits of the United States.
and the family are
Monthl
P
ium
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 1. Hospital Room and Board:
(Private or Semi-private
Room)
2. Hospital Extras:
(unallocated)
3. Normal Maternity:
4. Abnormal Maternity:
(Caesarean, Termination of
Ectopic Pregnancy and Mis-
carriage)
5. Tonsillectomies and
Adenoidectomies:
6. Out-Patient Emergency
Service:
7. Out-Patient Surgical
Services
9. Anesthesiologist:
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Up to $13.50 per day Room and
Board for up to 90 continuous
days with no limit on frequency
(one-day return to work break
except normal maternity. (See No.
3 below)
Up to $202.50 plus 7570 of the
covered hospital extras up to
$5,000.00 of benefits.
$9.00 per day Room and Board for
8 days.
Up to $13.50 per day Room and
Board for 90 days plus extras-as
paid in Nos. 1 and 2 above.
Up to $202.50 for injuries requiring
medical attention within 24 hours
of accident.
Up to $202.50 for hospital miscel-
laneous expense benefits incurred
in connection with a surgical op-
eration where the member is not
hospital confined.
Fees for transportation to and from
hospital paid under hospital extras
in No. 2 above. (Limit $25.00).
Up to $25.00 for other than regular
hospital personnel for administra-
tion of anesthetic paid under hos-
pital extras.
10. Medical Services in
Hospital or authorized
Clinic:
(including X-ray, labora-
tory tests, physical therapy,
and diagnosis)
Paid under hospital extras in No.
2 above.
The benefits listed below are available under the Health Insurance
Plan to certificate holders and their dependents in any hospital they
may select outside the continental limits of the United States.
1. Hospital Room and Board:
(Private or Semi-private
Room)
Up to $9.00 per day Room and
Board for up to 90 continuous
days with no limit on frequency
(one-day return to work break)-
except normal maternity (see No.
3 below).
2. Hospital Extras:
(uaiall3cated)
3. Normal Maternity:
4. Abnormal Maternity:
(Caesarean, Termination of
Ectopic Pregnancy and
Miscarriage)
5. Tonsillectomies and
Adenoidectomies:
6. Out-Patient Emergency
Services:
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Up to $135.00.
$9.00 per day Room and Board for
8 days.
Up to $9.00 per day Room and
Board for 90 days plus extras-as
paid in Nos. 1 and 2 above.
Up to $135.00 for injuries requiring
medical attention within 24 hours
of accident.
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7. Out-patient Surgical Up to $135.00 for hospital miscel-
laneous expense benefits incurred
in connection with a surgical op-
eration where the member is not
hospital confined.
Fees for transportation to and from
hospital included under hospital
extras in No. 2 above (limit
$25.00).
9. Anesthesiologist: Up to $25.00 for other than regular
hospital personnel for administra-
tion of anesthetic paid under hos-
pital extras.
10. Medical Services in Hospital Paid under hospital extras in No.
or authorized Clinic: 2 above.
(including X-ray, labora-
tory tests, physical therapy,
and diagnosis)
Amputation-arm, foot..$125.00
Skull fracture-compound 250.00
Fracture of base of spine 62.50
Bronchoscopy .................. 50.00
Varicocele removal ........ 62.50
Thyroid removal ............ 187.50
Mastoidectomy, simple.... 125.00
Mastoidectomy, radical.. 187.50
Normal delivery .............. 80.00
Caesarean ........................ 150.00
Abdominal operation
for extra-uterine
pregnancy .................... 150.00
Abortion or miscarriage.. 50.00
2. Services Related to Surgery: Paid under hospital extras.
SURGICAL BENEFITS IN THE UNITED STATES AND
OVERSEAS
Benefits for surgical service performed in a hospital, doctor's office,
or at home, listed below, are available under the Health Insurance
Plan to certificate holders and their dependents, no matter in what
part of the world they are located. Benefits for dental surgical services,
however, are available only if they are performed in a hospital.
BENEFIT
1. Surgical services Up to $250.00 paid in accordance
EXAMPLES
with the master schedule.
(Available for inspection).
FROM THE SCHEDULE
Hernia, unilateral ..........$100.00
Hernia, bilateral ............ 140.00
Appendectomy ................ 100.00
Radical mastectomy ........ 187.50
Fracture of spine ............ 93.75
Hip dislocation .............. 43.75
Prostatectomy .................. 187.50
Removal of kidney ........ 250.00
Removal of cataract ...... 187.50
Gastrectomy .................... 250.00
Tonsillectomy l 55 nn
Adenoidectomv
Hemorrhoidectotny ........ 62.50
Hysterectomy .................. 165.00
(Anesthetist, X-ray,
Clinical laboratory)
3. Dental Surgical Services:
Paid in accordance with No. 1
above if performed in a hospital
by a dentist, dental surgeon, or
4. Plastic Surgery:
an M. D.
Paid in accordance with No. 1
(for injury incurred at any
above.
time, except for cosmetic
surgery)
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WAITING PERIOD
No waiting period is required regardless of conditions existing
prior to application except for maternity in the instances described
below.
A waiting period of 9 months is required for maternity when
application for health insurance is made during the initial Applica-
tion Period-1 August to 31 October, 1954-if the applicant does not
have current group hospitalization and surgical coverage sponsored
by the Association.
A waiting period of 9 months is required for maternity when
application for health insurance is made subsequent to the initial
Application Period-1 August to 31 October 1954.
CONTINUATION OF INSURANCE UPON TERMINATION
OF EMPLOYMENT
The health insurance will continue in effect until the end of the
month in which employment terminated. Maternity benefits are
extended for a period of 9 months subsequent to the termination of
employment of the certificate-holder, provided the female member
or the dependents of a male member have been insured for the
previous nine months.
EXTENDED BENEFITS
Benefits for hospitalization and surgery performed .during L 11c;
continuance of disability are payable within thirteen weeks following
the date such disability terminated the employment of the member.
PAYMENT OF INSURANCE BENEFITS
The benefits provided in the Health Insurance Plan will be
paid to the insured member upon the submission of his claim to the
Insurance and Claims Office. Such claims must be substantiated by
receipted bills from the appropriate hospital or clinic, doctor or
dental surgeon.
duty. Members applying under any other than the above circum-
stances must show evidence of insurability by medical examination.
APPLICATION PROCEDURES
Application for membership in the Government Employees Health
Association, Inc. may be submitted to the Insurance and Claims Office
within 60 days after an employee has entered on duty, or within 60
days after an employee has returned-permanent change of station-
from an overseas assignment, or on the occasion of the Annual
Application Period. The current Application Period is from 1 August
until 31 October 1954.
Other than during the above periods a member may make
application showing evidence of insurability by medical examination.
Persons whose applications for membership are approved will
become members of the Association upon the payment of a one dollar
membership fee. Employees who are currently members of the Govern-
ment Employees Health Association, Inc. may continue their member-
ship without the payment of an additional fee. Application for health
insurance must be accompanied by the payment of premiums for two
months and the membership fee in the Association. Checks in payment
of premiums shall be made payable to "GEHA-Health".
MEDICAL EXAMINATION
No medical examination is required from an applicant member
during the period of an Annual Application Period, or from an over-
seas returnee on permanent change of station, within 60 days after
arrival, or from an applicant during the first 60 days after entry on
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CONVERSION PRIVILEGE
Upon termination of membership in the Association by reason
of termination of employment, the insured employee may convert his
health insurance to an individual policy offered by the Mutual Benefit
Health and Accident Association of Omaha without evidence of insur-
ability, at a slightly increased rate, providing the employee
(a) is less than 75 years of age
(b) applies for the conversion. policy within 30 days of termina-
tion of his group insurance.
This insurance may include the employee and all of his depend-
ents who were insured under his group certificate. Coverage for
dependent children terminates at age nineteen, but they may apply
for a conversion policy on an individual basis.
The insurance will be effective on the date the application and
the required premium are accepted by the Company, and will continue
in force for not less than six months after the effective date. Renewal
after the first six months will be subject to the consent of the Company.
CONDITIONS OF MEMBERSHIP IN GEHA
The Board of Directors of the Government Employees Health
Association, Inc. determines all matters concerned with eligibility for
and retention of membership in the Association.
To be eligible to purchase insurance coverage, a person must be
a member of the Association, in good standing.
Premiums on certificates must be paid and maintained a minimum
of two months in advance. The certificate of any person not complying
with this requirement will be cancelled automatically at the end of
the period for which his premium has been paid.
The Association will maintain exclusive relationships with the
underwriting companies. Under no circumstances may a member of
the Association make direct contact with these companies or their
agents.
This Booklet is distributed for the purpose of
presenting general information only. Its contents
are not to be accepted or construed as a substitute
for the provisions of the Master Policies.
GOVERNMENT' EMPLOYEES
HEALTH ASSOCIATION, INC.
THE LIFE INSURANCE PLAN and THE HEALTH INSURANCE PLAN
Underwritten by
UNITED BENEFIT LIFE INSURANCE COMPANY
Omaha, Nebraska
MUTUAL BENEFIT HEALTH AND ACCIDENT ASSOCIATION
Omaha, Nebraska
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I