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Analysis of
HEALTH AND INSURANCE PLANS
U D COLLECTIVE BARGAINING,
N ER
LATE 1955




• Life Insurance
• Accidental Death and
Dismemberment
• Accident and Sickness
• Hospitalization
• Surgical
• Medical
• Maternity

Bulletin No. 1221
UNITED STATES DEPARTMENT OF LABOR
James P. Mitchell, Secretary
BUREAU OF LABOR STATISTICS
Ewan Clague, Commissioner

Analysis of
HEALTH AND INSURANCE PLANS
UNDER COLLECTIVE BARGAINING,
LATE

1 9 5 5

•

Life Insurance

•

Accidental Death and
Dismemberment

•

Accident and Sickness

•

Hospitalization

•

Surgical

•

Medical

•

Maternity

Bulletin No. 1221
November 1957

UNITED STATES DEPARTMENT OF LABOR
James P. Mitchell, Secretary
BUREAU OF LABOR STATISTICS
Ewan Clague, Commissioner

For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington




25, D.

C.

Price 50 cents




Preface
P r o te c tio n a g a in st the e c o n o m ic h a z a r d s o f o f f -t h e -j o b in ju r ie s , i l l n e s s ,
and death through v olu n ta ry group p r o g r a m s , fin a n ced in whole o r in p art by the
e m p lo y e r , co n stitu tes a r e la tiv e ly new and h ig h ly valu ed p art of the co m p e n sa tio n
r e c e iv e d by w o r k e r s in the U n ited S ta te s . T r a d e union in te r e s t in h ea lth and in ­
su ra n ce p r o g r a m s has b een a m a jo r fo r c e in the grow th o f th e se v o lu n ta ry in s u r ­
ance p la n s .
Althou gh unions have long b een c o n c e rn e d with the health and s e c u r ity
o f th e ir m e m b e r s and have p ro vid ed s o m e p r o te c tio n through u n io n -s p o n s o r e d
b e n e fic ia l p r o g r a m s , the p ast 12 y e a r s have w itn e sse d a phenom enal grow th o f
p re p a id p r o g r a m s under c o lle c tiv e b a rg a in in g a g r e e m e n ts . In 1 9 4 5 , an e s tim a te d
h a lf m illio n w o r k e r s w e r e c o v e r e d by th ese p r o g r a m s . B y m i d -1 9 4 8 , this fig u r e
e x c e e d e d the 3 -m il lio n m a r k .
Two y e a r s la t e r , about 7 m illio n w o r k e r s w e re
r e c e iv in g s o m e type o f h ea lth and in su ra n c e p ro te ctio n under c o lle c tiv e b a rg a in in g
a g r e e m e n t s . In e a r ly 1 9 5 4 , o v e r 11 m illio n w o r k e r s — a p p r o x im a te ly 70 p e r c e n t
o f a ll w o r k e r s under la b o r -m a n a g e m e n t c o n tr a c ts — w e re p rovid ed with at le a s t
1 type o f h ealth and in su ra n c e b e n e fit. B y the end of 195 6, it w as e s tim a te d that
in e x c e s s o f 12 m illio n w o r k e r s w e re c o v e r e d .
D u rin g the e a r ly s ta g e s of this d e v e lo p m e n t, unions co n ce n tra te d m a in ly
on n eg o tia tin g new p la n s , b rin gin g e x istin g plans within the sc o p e o f the a g r e e m e n t,
c la r ify in g the le g a l a s p e c ts o f b a rg a in in g on the s u b je c t, and d ealing with the m a n y
new and fo r m id a b le te c h n ic a l p r o b le m s in h eren t in the e s ta b lis h m e n t o f p la n s . A l ­
though c o lle c t iv e ly b a r g a in e d plans have continued to sp re a d during r e c e n t y e a r s ,
attention has been in c r e a s in g ly c e n te r e d on b road en in g the c o v e r a g e o f e x istin g
plans to include dependents and r e tir e d w o r k e r s , adding new b e n e fit s , and in ­
c r e a s in g the le v e l of b e n e fits .
In r e s p o n s e to public and g o v e rn m e n ta l n eeds fo r in fo r m a tio n in this f ie 'd
o f in d u stria l r e la tio n s , the U . S . D e p a rtm e n t of L ab or* s B u rea u of L a b o r S ta ­
t is t ic s h a s , sin c e 1 9 4 5 , p r e p a r e d a n u m b er of stu d ies dealing with health and in ­
su ra n c e p lans under c o lle c tiv e b a r g a in in g . T h e s e stu d ies in clu d e : P e r io d ic r e ­
p o rts on the o v e r a ll grow th of e m p lo y e e b e n e fit p lans under c o lle c tiv e b a rg a in in g
a g r e e m e n t s , including data on m eth od s oi fin ancing and types o f b e n e fits p ro v id e d ;
r e p o r ts p rovid in g d e ta ils on the types and am ounts of b e n e fits p ro vid ed fo r s e le c te d
in d u s tr ie s ; s u m m a r y d ig e s ts of s e le c te d p r o g r a m s ; and changes in p r o g r a m s o f
m a jo r c o m p a n ie s . T he B u rea u a ls o m ain tain s a file of s e le c te d plans fo r public
u s e , as p ro vid ed b y s e c tio n 211 of the L a b o r M a n a g e m e n t R e la tio n s A c t , as
a m e n d e d . In a d d ition , data on the p re v a le n c e of health and in su ra n c e b e n e fits have
b e en obtain ed in the v a r io u s wage s u r v e y s undertaken by the B u re a u .
A s p a r t of this continuing p r o g r a m , the B u re a u , in 1 9 5 5 , u n d ertook a d e ­
ta ile d s ta tis tic a l a n a ly s is of the p r o v is io n s o f 300 s e le c te d health and in su ra n c e
p r o g r a m s under c o lle c tiv e b a r g a in in g , each c o v e r in g 1 ,0 0 0 o r m o r e w o r k e r s . The
r e s u lts of this stu d y , as p r e s e n te d in this b u lle tin , r e fle c t the m o s t c o m p r e h e n s iv e
and p en etratin g a n a ly s is m ad e by the B u rea u to date in this p a r tic u la r fie ld . The
c o m p le x itie s o f h ealth and in su ra n c e p r o g r a m s and the g r e a t v a r ie ty of p r o v is io n s
p re se n te d m a n y new and d iffic u lt te ch n ica l p r o b le m s , in clu ding the n e c e s s ity o f
d e v isin g a p ro ce d u re fo r coding and m achine tabulation o f the s ta tis tic a l d ata.
T h is b u lletin p r e se n ts d e ta ile d s ta tis tic s on plan p r o v is io n s and r e la tiv e ly b r ie f
su m m a r iz a tio n s of the s t a t is t ic s ; it d oes not p u rp o rt to r e p r e s e n t a guide o r te x t­
book on health and in su ra n c e p la n s .
T h is study was conducted in the B u r e a u 's D iv is io n of W a g e s and In d u stria l
R e la tio n s under the s u p e r v is io n o f E van K e ith R o w e , who p re p a re d this
rep ort
with D oroth y K ittn e r G r e e n e . H a r r y E . D a v is and H a r r y L . L e v in a lso p a r t ic i­
pated in the a n a ly s is of plans and in the p rep a ra tio n of the r e p o r t .
T h is study
w as under the g e n e r a l d ir e c tio n o f Josep h W . B lo c h , c h ie f, B ran ch of In d u stria l
R e la tio n s A n a ly s is .
iii




N ote on C h a n g es S in ce L a te 1955

H e a lth and in su ra n c e plans are flu id p r o g r a m s , in the s e n s e that the typ es
and le v e ls of b e n e fits a re s u b je c t to r e la tiv e ly fre q u e n t c h a n g e . A l l plans in clu d ed
in this study w e r e in e ffe c t in la te 1 9 5 5 . A s b e s t the B u re a u can d e te r m in e fr o m
an e x a m in a tio n o f s e ttle m e n ts r e p o r te d in its m o n th ly r e p o r t on C u r r e n t W age
D e v e lo p m e n ts , p ro b a b ly about 80 p e r c e n t o f the plans stu died had not b e e n changed
in any r e s p e c t b y m i d - 1 9 5 6 , and a m a jo r ity had not b e en changed b y the end o f
1 9 5 6 . The B u re a u has no m e a n s o f r e a d ily d e te rm in in g the ex ten t to w hich ch an g es
n eg o tia ted in 1 9 5 6 and 1 9 5 7 , s o m e o f which w e re m in o r in c h a r a c t e r , w ould a lte r
the c e n tr a l te n d e n c ie s r e fle c t e d in the tab u lation s p r e s e n te d in this b u lle tin . The
m a jo r p u rp ose of this stu d y , it m u s t be e m p h a s iz e d , w as to p rovid e a b e n c h m a r k
a g a in st which future ch an ges in c o lle c t iv e ly b a rg a in e d plans can be m e a s u r e d . It
is e x p e c te d , m o r e o v e r , that the a v a ila b ility of data of this type fo r the f i r s t tim e
w ill in i t s e l f fu lfill an u rgen t public and g o v e r n m e n ta l n e e d .
T h e B u rea u is now b rin g in g up to date its 1 9 5 4 D ig e s t o f One H undred
S e le c te d H ealth and In su ra n ce P la n s U n d er C o lle c tiv e B a rg a in in g (B B S B u ll.
N o . 1 1 8 0 ). The new D ig e s t , w hich w ill be a v a ila b le in the S p rin g o f 1 9 5 8 , w ill
p rovid e the d e ta ils of c u r r e n t p la n s . M e a n w h ile , so m e in d ica tio n o f the fr e q u e n c y
and n atu re o f the ch an ges being m a d e in m a jo r p lan s m a y be obtain ed fr o m the
B u r e a u 1 s m o n th ly r e p o r t on C u r r e n t W age D e v e lo p m e n ts .




IV

Contents
Page
M a jo r fe a tu r e s of h ealth and in su ra n c e plans _______________________________________
S cop e and m eth od of s t u d y ___________________________________________________________
T y p e s of b e n e fits stu died ________________________________________________________
V a ria tio n s a m o n g p lan s __________________________________________________________
F in an cin g c o n c e p ts ________________________________________________________________
P r e v a le n c e of b e n e f i t s _____ __________________________________________________________
A c tiv e w o r k e r s _____________________
D ependents of a c tiv e w o r k e r s __________________________________________________
R e tir e d w o r k e r s ____________________________________________________________________
D ep end en ts of r e tir e d w o r k e r s __________________________________________________
E lig ib ility r e q u ir e m e n ts _____________________________________________________________
E ffe c t of age on b e n e fits fo r w o r k e r s _____________________________________________
V a ria tio n in am ount o f b e n e fits b a se d on s e x ___________________________________
Financ i n g ________________________________________________________________________________

1
1
1
3
4
5
5
5
8
8
11
12
12
12

L ife in su ra n c e ______________________________________________________________________________
B e n e fits fo r a c tiv e w o r k e r s _________________________________________________________
B a s is fo r d e te r m in in g am ount of in su ra n c e _________________________________
A m o u n t of in su ra n c e ______________________________________________________________
V a ria tio n s in am ount b a se d on s e x _____________________________________________
R ed u ction of b e n e fit during a ctiv e e m p lo y m e n t _____________________________
B e n e fits fo r r e tir e d w o r k e r s _______________________________________________________
B e n e fits fo r dependents of a c tiv e w o r k e r s _______________________________________
P e rm a n e n t and to ta l d is a b ility p r o v is io n s _____________________________

21
21
21
22
23
24
24
26
26

A c c id e n ta l death and d is m e m b e r m e n t b e n e fits ___________________________________

29

A c c id e n t and s ic k n e s s b e n e fits ________________________________________________________
N o n occu p ation a l b e n e fits _____________________________________________________________
W a itin g p e r io d ______________________________________________________________________
B a s is fo r d e te r m in in g a m o u n t __________________________________________________
A m o u n t o f b e n e fits _________________________________________________________________
V a ria tio n s in am ount b a se d on s e x _____________________________________________
D u ra tio n of b e n e fits __ _ _________________________________________________________
_
R ed u ction of b e n e fits during a c tiv e e m p lo y m e n t ____________________________
O ccu p ation a l b e n e fits _________

33
33
33
34
37
37
39
39
40

H o sp ita l b e n e fits _________ ____________ _____________________________________________________
T y p e s of plans __________________________________________________________________________
D u ra tio n of b e n e fits ______________________________ _____________________________________
R o o m and b oard a llo w a n ce s _________________________________________________________
S e r v ic e plans ____________ ___________________________________________________________
C a s h p l a n s __ ______ __________ ______ ___________________________________________________
M a x im u m a llow an ce _____________ __________________________________________________
H o sp ita l e x tr a a llo w a n c e s ________ ___________________________________________________
R edu ction of b e n e fits during a c tiv e e m p lo y m en t _______________________________
B e n e fits fo r r e tir e d w o r k e r s and d e p e n d e n ts____________________________________

41
41
41
45
45
45
45
47
49
49




v

Contents - Continued
Page
Surgical benefits _____________________________________________________ „________
T y p e s of plans ______________________________________________________________
C a s h plans __________________________________________________________________
A m o u n t of benefits _______________________________________________________
Reduction of benefits during active e m p l o y m e n t ___________________________
Benefits for retired w o r k e r s a n d dependents ______________________________

53
53
53
54
56
58

M e d ic a l b e n e fits _____________________________________________________________________________
C a s h p lan s ________________________________________________________________________________
L o c a tio n of tr e a tm e n ts ____________________________________________________________
W a itin g p e r io d _______________________________________________________________________
B a s is o f p ay m en ts _______________
A m o u n t of a llo w a n ce _______________________________________________________________
M a x im u m a llo w a n c e ________________________________________________________________
In -h o s p ita l c o n su lta tio n a llo w a n c e ______________________________________________
S e r v ic e p l a n s _____________________________________________________________________________
R ed u ctio n of b e n e fits d uring a c tiv e e m p lo y m e n t ________________________________
B e n e fits fo r r e tir e d w o r k e r s and dependents ____________________________________

59
59
60
60
62
62
63
65
65
65
65

M a te rn ity b e n e fits __________________________________________________________________________
A c c id e n t and s ic k n e s s b e n e fits _______________________________________________________
Q u a lify in g p e r i o d ____________________________________________________________________
A m o u n t o f b en e fits __________________________________________________________________
D u ra tio n o f b e n e fits ________________________________________________________________
H o sp ita l b e n e fits ________________________________________________________________________
T y p e s of p lans ________________
Q u a lify in g p e r i o d ____________________________ . ______________________________________
_
R o o m and b oa rd a llo w a n c e s _______________________________________________________
H o sp ita l e x tr a a llo w a n c e s ________________________________________________________
L u m p -s u m allo w a n ce fo r h o sp ita l c a r e _______________________________________
S u r g ic a l b e n e fits ________________________________________________________________________
Q u a lify in g p e r i o d ____________________________________________________________________
A m o u n t o f b e n e fits ________________________________________________________________
M e d ic a l b e n e fits _________________________________________________________________________
G e n e ra l lu m p -s u m a llo w a n ce ________________________________________________________

69
70
70
70
72
72
73
74
74
77
79
79
79
80
81
81

O th er m e d ic a l c a r e b e n e fits _____________________________________________________________
M a jo r m e d ic a l b en e fits ________________________________________________________________
P r e v a le n c e ____________________________________________________________________________
T yp e and am ount o f d ed u ctib le ___________________________________________________
B e n e fit am oun ts _____________________________________________________________________
B e n e fit p e r i o d ______________________________
P o lio m y e litis b e n e fits _________________________________________________________________
O u t-p a tie n t d ia g n o stic X - r a y and la b o r a to r y b e n e fits __________________________
S u p p lem en tal a c c id e n t b en efits ______________________________________________

83
83
83
84
84
84
84
86
87




vi

Contents - Continued
M a jo r F e a tu r e s o f H e a lth and In su ra n ce P la n s
Page
T a b le s :
H ea lth and in su ra n c e plans A -l.
D istr ib u tio n of plans stu died by w o r k e r s c o v e r e d ,
in d u stry d iv is io n , and type of b a rg a in in g unit ____________________
A - 2.
D istr ib u tio n of plans stu died by in d u stry group ____________________
A - 3.
B e n e fits p ro v id e d a c tiv e w o r k e r s by m eth od of
fin a n c in g , la te 1955 ____________________________________________________
A - 4.
P r e v a le n c e of b e n e fits by group c o v e r e d , in d u stry
d iv is io n , and type of b arg a in in g unit, la te 1955 ________________
A - 5.
B e n e fits p ro v id e d dependents of a c tiv e w o r k e r s by
m eth od of fin a n cin g , la te r 1955 _____________________________________
A - 6.
R e la tio n sh ip of b e n e fits p ro v id e d a ctiv e
w o r k e r s and th e ir d ep en d en ts, la te 1955 __________________________
A - 7.
B e n e fits p ro vid ed r e tir e d w o r k e r s by m eth od of
fin a n c in g , la te 1955 ____________________________________________________
A - 8.
B e n e fit le v e ls fo r w o r k e r s r e tir in g at age 65
c o m p a r e d with th o se p ro v id e d im m e d ia te ly
b e fo r e r e tir e m e n t, la te 1955 ________________________________________
A - 9.
L en gth of tim e b e n e fits a v a ila b le to r e tir e d
w o r k e r s , la te 1955 _____________________________________________________
A - 10. B e n e fits p ro v id e d dependents of r e tir e d w o r k e r s by
m eth od of fin a n cin g , la te r 1955 _____________________________________
A - 11. R e la tio n sh ip of b e n e fits p ro v id e d r e tir e d w o r k e r s
and th e ir d ep en d en ts, late 1955 ____________________________________
A - 1 2. E lig ib ility r e q u ir e m e n ts by type of b e n e fit,
la te 1955 _________________________________________________________________
A - 13. M ain ten an ce of b en e fits fo r a c tiv e w o r k e r s ,
A - 14.
A - 15.
A - 1 6.

A - 17.
A - 18 .

A - 19.

E ffe c t o f age at h ir in g on a v a ila b ility o r le v e l of
b e n e fits fo r a c tiv e w o r k e r s , la te 1955 ____________________________
V a r ia tio n in am ount o f b e n e fits b a s e d on s e x ,
la te 1 9 5 5 ___________________________________________________
R e la tio n sh ip o f m eth od o f fin a n cin g plans as a w hole
fo r a c tiv e w o r k e r s and plan fo r th e ir d ep en d en ts,
late 195 5 ___________________________________________
M eth od o f fin an cin g in d ividu al b e n e fits fo r a c tiv e
w o r k e r s and th e ir d ep en d en ts, la te 1 955 _________________________
R e la tio n sh ip of m eth od of fin a n cin g plan as a w hole
fo r r e tir e d w o r k e r s and plan fo r th eir
d e p en d en ts, late 1 9 5 5 _________________________________________________
M ethod of fin ancing in d ividu al b e n e fits fo r r e tir e d
w o r k e r s and th e ir d e p e n d en ts, la te 195 5 _________________________

2
2
5
6
7
7
9

9
10
10
11
13

15
15

16
17

18
19

L ife In su ra n c e
L ife in su ra n c e B -l.
B a s is of d e te rm in in g am oun t by type of
b arg a in in g unit, la te 1 9 5 5 -------------------------------------------------------------------B -2 .
D istr ib u tio n o f plans p ro vid in g fla t am ount by
am ount p ro v id e d , la te 1955 __________________________________________
B -3 .
D istrib u tio n o f gradu ated plans by am ount p ro vid ed
w o r k e r s ea rn in g $ 3 ,0 0 0 and $ 4 ,0 0 0 y e a r ly , la te 1955 __________




v ii

21
22
22

Contents - Continued
Page
T a b le s : - C on tin ued
L ife in s u r a n c e - C on tin ued
B -4 .
D is tr ib u tio n of p lans p ro vid in g a fla t am ount by
am ount and n u m b er of w o r k e r s c o v e r e d by
p la n s , la te 1955 _______________________________________________________
B -5 .
D is tr ib u tio n of plans graduating am oun t a c c o rd in g
to ea rn in g s alone by am ount p ro v id e d w o r k e r s
e a rn in g $ 4 , 000 y e a r ly and n u m b er of w o r k e r s
c o v e r e d by the p la n s , late 1955 ____________________________________
B -6 .
D is tr ib u tio n of p lans by am ounts p ro v id e d w o r k e r s
at a g e s 65 and 70 who r e tir e d at age 65 and ea rn ed
$ 4 , 0 0 0 y e a r ly p r io r to r e tir e m e n t, la te 1955 __________________
B -7 .
E ffe c t of len gth of s e r v ic e on am ount p ro vid ed
r e tir e d w o r k e r s , late 1955 ________ _________________________________
B -8 .
D is p o s itio n of life in su ra n c e b e n e fits under p e rm a n e n t
and to ta l d is a b ility p r o v is io n s , la te 1955 ______ _________________
B -9 .
E lig ib ility r e q u ir e m e n ts to r e c e iv e p e rm a n e n t and
total d is a b ility b e n e fit s , la te 1955 ________________________________

23

23

25
25
27
27

A c c id e n ta l D eath and D is m e m b e r m e n t B e n e fits
A c c id e n ta l death and d is m e m b e r m e n t C -l.
B a s is of d e te rm in in g am ount of b e n e fit, late 1955 ______________
C -2 .
R e la tio n sh ip of a c c id e n ta l death b en efit to am ount
of life in su r a n c e p ro v id e d w o r k e r s ea rn in g
$ 3 , 0 0 0 and $ 4 , 0 0 0 y e a r ly , la te 1955 _________________________ _
C -3 .
D is tr ib u tio n o f p lans p rovid in g fla t am ount
by am ount p r o v id e d , late 1955 ____________________________________
C -4 .
D is tr ib u tio n of plans gradu ated a c c o r d in g to ea rn in g s
alone by am ount p ro v id e d w o r k e r s earnin g
$ 3 , 0 0 0 and $ 4 , 0 0 0 y e a r ly , la te 1955 ___________________________

29

30
30

31

A c c i d e n t and S ic k n e s s B e n e fits
A c c id e n t and s ic k n e s s D -l.
T y p e s of d is a b ility c o v e r e d by in d u stry
d iv is io n , la te 1955 ___________ ____ ________________ ______ .____________
D -2 .
W a itin g p e rio d fo r w e e k ly n on occu p ation al
b e n e fits , la te 1955 ______ ______________________ ______ ______________ ~
D - 3.
B a s is fo r d e te rm in in g n on occu p ation al b en efit
am ount by type of b arg a in in g unit, la te 1955 —___________ ______
D -4o
D is tr ib u tio n of plans p ro vid in g a gradu ated n o n o c ­
cu p a tio n al b en e fit by am ount p ro v id e d w o r k e r s
earn in g $ 4 , 000 y e a r ly , late 1955 _____ ____ ______________________
D -5 .
D is tr ib u tio n of plans p rovid in g a fla t am ount by
am ount of w e e k ly n on occu p ation al
b e n e fit, la te 1955 _____________________________________________________
D -6 .
D istrib u tio n of plans by am ount of w eek ly n on o ccu ­
pational b en efit p rovid ed w o rk e rs earn in g $ 4 , 000
y e a r ly and d uration of b en efit p e r io d , la te 1955 ---------------------




v iii

33
34
36

36

36

38

Contents - Continued
Page
T a b le s : - C ontinued
A c c id e n t and s ic k n e s s - C on tin ued
D -7 .
C h ange in b a s is of w e e k ly n on occu p ation al ben efit
p ay m en t due to a g e , la te 1955 -------------------------------------------------------------D -8 .
R e la tio n sh ip betw een am ount of w e e k ly n o n o c ­
cu p ation al and o ccu p a tio n a l b e n e fits p ro v id e d
w o r k e r s ea rn in g $ 4 , 000 y e a r ly , la te 1955 -------------------------------------

39

40

H o sp ita l B e n e fits
H o sp ita liz a tio n E -l.
T y p e s of plans fo r w o r k e r s and dependents by
type of b arg a in in g unit, la te 1955 ----------------------------------------------------E -2 .
D istr ib u tio n of plans by duration of fu ll-b e n e fit
p e r io d fo r w o r k e r s and dependents and type o f
r o o m and b oa rd b e n e fit, la te 1955 ___________________________________
E -3 .
R e la tio n sh ip of p r o v is io n s fo r w o r k e r s and
d ep en d en ts, la te 1955 ___________________________________________________
E -4 .
D istr ib u tio n of plans by d uration of fu ll-b e n e fit
and extended c o v e r a g e p e rio d s fo r w o r k e r s
and d ep en d en ts, la te 1955 ______________________________________________
E -5 .
D istrib u tio n of plans by d a ily r o o m and b oard
a llo w a n ce for w o r k e r s and dependents and
duration of fu ll-b e n e fit p e r io d , la te 1955 __________________________
E -6 .
D istr ib u tio n of plans by m a x im u m r o o m and b oa rd
a llo w a n ce fo r w o r k e r s and d ep en d en ts, la te 195 5 -----------------------E -7 .
M ethod of sp e c ify in g a llo w a n ce fo r h o sp ita l e x tr a s
fo r w o r k e r s and d ep en d en ts, la te 1955 _____________________________
E -8 .
D istr ib u tio n of plans p ro vid in g fu ll r e im b u r s e m e n t of
c h a r g e s fo r h o sp ita l e x tr a s up to a fix e d m a x im u m
by am ount p ro vid ed w o r k e r s and d e p en d en ts,
la te 1955 _______ _____________________________________________________________
E -9 .
D istrib u tio n of plans p ro vid in g fu ll r e im b u r s e m e n t
of c h a r g e s fo r h o sp ita l e x tr a s up to a fix ed
am ount with add ition al r e im b u r s e m e n ts on a
p e rc e n ta g e b a s is by am ount fo r w o r k e r s and
d ep en d en ts, la te 1955 ____________________________________________________
E - 1 0 . D istr ib u tio n of plans by d uration of fu ll-b e n e fit
p e rio d fo r r e tir e d w o r k e r s and th eir dependents
and type of r o o m and b oa rd b e n e fit, la te 1955 _____________________
E -ll.
D istr ib u tio n of c a s h plans by d a ily ro o m and b oa rd
a llo w a n ce fo r r e tir e d w o r k e r s and th eir
d ep en d en ts, la te 1955 ____________________________________________________

42

43
43

44

46
47
48

49

50

51

52

S u r g ic a l B e n e fits
S u r g ic a l F -l.
T yp es of plans c o v e r in g w o r k e r s and d ep en d en ts,
late 19 55 __________________________________
F -2 .
C a s h plans with in c o m e lim ita tio n fe a tu r e s ,
la te 1955 ____________________________________________________________________




IX

53
54

Contents - Continued
Page
T a b le s: - C on tin ued
S u r g ic a l - C on tin ued
F -3 .
D is tr ib u tio n of p la n s by the m a x im u m sch ed u le and
a p p e n d e cto m y a llo w a n c e fo r w o r k e r s and
d e p e n d en ts, la te 1 9 5 5 ____________________________________ ____________
F -4 .
D is tr ib u tio n o f p lans by to n s ille c to m y a llo w a n ce
fo r w o r k e r s and d e p e n d en ts, la te 1 955 __________________________
F -5 .
D is tr ib u tio n o f p lans by the m a x im u m sch ed u le and
a p p e n d e cto m y a llo w a n ce fo r r e tir e d w o r k e r s and
d e p en d en ts, la te 1955 ______________________________________ __________

55
56

57

M e d ic a l B e n e fits
M e d ic a l G -l.
T y p e s of p lans c o v e r in g w o r k e r s and d e p e n d en ts,
la te 1955 ________________________________________________________________
G -2 .
C a s h p lan s w ith in c o m e lim ita tio n fe a tu r e s ,
la te 1955 ________________________________________________________________
G -3 .
D is tr ib u tio n o f c a s h p lan s by a llo w a n c e p ro v id e d
fo r d o c to r*s tr e a tm e n t fo r w o r k e r s and
d e p e n d en ts, la te 1955 _______________________________________________
G -4 .
D is tr ib u tio n of c a s h p la n s a c c o r d in g to when p a y ­
m e n ts b egin fo r d o c t o r 1s tr e a tm e n t in o ffic e
and h o m e , fo r w o r k e r s and d e p e n d en ts, la te 1 9 5 5 _____________
G -5 .
D istr ib u tio n o f p lans p rovid in g c a s h a llo w a n ce fo r
d octor*s tr e a tm e n t fo r w o r k e r s and dependents
by m a x im u m am ount p ro v id e d and b a s is of
p a y m e n t, la te 195 5 ___________________________________________________
G -6 .
T y p e s o f d o c t o r f s tr e a tm e n t fo r w hich b e n e fits w e re
extended to r e tir e d w o r k e r s and d ep en d en ts,
la te 1955 ____________________________________________________
G -7 .
D is tr ib u tio n o f c a s h p lans by a llo w a n c e p ro v id e d fo r
d o cto r*s tr e a tm e n t fo r r e tir e d w o r k e r s and
d e p e n d en ts, la te 1955 ___________________________________
G -8 .
D is tr ib u tio n o f c a s h p lan s extend in g b e n e fits to
r e tir e d w o r k e r s and dependents by m a x im u m
am oun t p r o v id e d , la te 1955 ________________________________________

59
60

61

61

64

66

67

67

M a te rn ity B e n e fits
M a te rn ity
H - 1.
H -2 .
H -3 .
H -4 .




B e n e fits p ro v id e d w o m en w o r k e r s , late 1955 ------------------------------B e n e fits p r o v id e d w o r k e r s 1 d e p e n d en ts, la te 195 5 --------------------A v a ila b ility of b e n e fits to new ly in su r e d w o r k e r s
and d e p e n d en ts, la te 1955 __________________________________________
D istr ib u tio n o f p lans provid in g a fla t a c c id e n t and
s ic k n e s s b e n e fit by am ount p ro v id e d w o m en
w o r k e r s , la te 1955 ___________________________________________________

x

69
70
71

72

Contents - Continued
Page
T a b le s :

- Continued

M a te rn ity - C on tin ued
H -5 .
D istr ib u tio n o f p lans p rovid in g a g rad u ated a c c i ­
dent and s ic k n e s s b e n e fit by am oun t p ro v id e d
w om en w o r k e r s earn in g $ 3 , 0 0 0 y e a r ly ,
la te 1955 _________________________________________________________________
H -6 .
T y p e s of h o sp ita l plans fo r w o r k e r s and
d e p en d en ts, la te 1955 _________________________________________________
H -7 .
D istr ib u tio n of p lans p ro vid in g h o sp ita l b e n e fits by
d uration of fu ll-b e n e fit p e r io d and type of
r o o m and b oard b en e fits fo r w o r k e r s and
d e p en d en ts, la te 1955 _________________________________________________
H -8 .
D istr ib u tio n of plans p ro vid in g h o sp ita l b e n e fits by
d a ily r o o m and b oa rd a llo w a n c e and d uration of
fu ll-b e n e fit p e r io d fo r w o r k e r s and d ep en d en ts,
la te 1955 _________________________________________________________________
H -9 .
D istr ib u tio n o f plans p ro vid in g h o sp ita l b e n e fits by
m a x im u m r o o m and b oa rd a llo w a n ce fo r w o r k e r s
and d ep en d en ts, late 1955 ___________________________________________
H -1 0 .
M ethod o f sp e c ify in g a llo w a n ce fo r h o s p ita l e x tr a s
fo r w o r k e r s and d ep en d en ts, la te 195 5 __________________________
H - l l . D istr ib u tio n of p lans p ro vid in g fu ll r e im b u r s e m e n t
of c h a r g e s fo r h o sp ita l e x tr a s up to a fix e d
m a x im u m by am ount p ro v id e d w o r k e r s and
d ep en d en ts, la te 1955 _________________________________________________
H - 1 2 . D istrib u tio n of plans sp e c ify in g a fla t am ount fo r
r o o m , b o a r d , and h o sp ita l e x tr a s fo r w o r k e r s
and d e p e n d e n ts, la te 1955 ___________________________________
H - 1 3 . D istr ib u tio n of p lans by s u r g ic a l a llo w a n ce s p e c ifie d
fo r d o c t o r s fee fo r d e liv e r y fo r w o r k e r s and
d ep en d en ts, la te 1955 _________________________________________________
H -1 4 .
T y p e s of d o cto r*s tr e a tm e n t fo r w hich m e d ic a l
b e n e fits w e r e p ro v id e d to w o r k e r s and d ep en d en ts,
by type o f b e n e fits , la te 1955 _______________________________________
H - 1 5 . D istr ib u tio n of plans p ro vid in g lu m p -s u m a llo w a n ce by
am ount fo r w o r k e r s and d ep en d en ts, la te 1955 _________________

72
73

75

76

77
78

78

79

80

82
82

O th er M e d ic a l C a r e B e n e fits
O th er m e d ic a l c a r e b e n e fits 1 -1 .
D istr ib u tio n of p lans p ro vid in g c a s h p o lio m y e litis
b en efit to w o r k e r s and dependents by am ount
p ro v id e d and p e r io d o f tim e during w h ich e x ­
p e n se s in c u r r e d w e re c o v e r e d , la te 1955 _______________________
1 -2 .
D istr ib u tio n of p la n s p ro vid in g c a s h p o lio m y e litis
b en e fit to w o r k e r s and dependents by am ount
p ro v id e d and its r e la tio n to oth er b e n e fits ,
la te 1955 _________________________________________________________________




xi

85

86




Analysis of Health and Insurance Plans Under Collective Bargaining
Late 1955
Major Features of Health and Insurance Plans
H ealth and in su ra n c e plans n o r m a lly include one o r m o r e o f the fo llo w in g
ty p es of b e n e fits : L ife in s u r a n c e , a c c id e n ta l death and d is m e m b e r m e n t, a ccid e n t
and s ic k n e s s (ex clu d in g s ic k le a v e , State w o r k m e n 's c o m p e n sa tio n and te m p o r a r y
d isa b ility p a y m e n t s ) ,1 and h o s p ita l, s u r g ic a l, and m e d ic a l c a r e .
S o m e p lans
contain s p e c ia l b e n e fits which su p p lem en t the a llo w a n ce s n o r m a lly p ro vid ed fo r
h o s p ita l, s u r g ic a l, and m e d ic a l c a r e (i. e . , b a s ic plan b e n e fits ).
A m o n g th ese
s p e c ia l b e n e fits are th ose p ro vid ed fo r p o lio m y e litis and a c c id e n ta l in ju ry and
during extended p e rio d s of illn e s s (c a ta stro p h e or m a jo r m e d ic a l). T h e s e s p e c ia l
b e n e fits , as w e ll as the p r o v is io n s under the b a s ic plan applying to m a te r n ity
c a s e s , a re tre a te d s e p a r a te ly in this stu dy.
T h is s e c tio n d e s c r ib e s the sco p e and m eth od o f study and the n atu re of
h ealth and in su ra n c e plans as a w h o le , in clu ding the su b je c t of fin a n c in g . In su b ­
seq uen t c h a p te r s , each of the in dividu al b e n e fits is a n a ly z e d .

Scope

and M eth od o f Study

F o r this stu d y , the B u re a u a n a ly zed 300 s e le c te d h ealth and in su ra n c e
p la n s under c o lle c tiv e b a r g a in in g , 2 in e ffe c t in la te 1 9 5 5 . The plans w e re s e le c te d
to p ro v id e a b ro a d ly r e p r e s e n ta tiv e p ictu re of health and in su ra n ce b e n e fits under
p r o g r a m s c o v e rin g 1 ,0 0 0 o r m o r e w o r k e r s .
In this s e le c tio n , the fa c to r s given
p r im a r y c o n sid e ra tio n w e re in d u s tr y , geog ra p h ic lo c a tio n , union, type of b arg a in in g
u n it, and s iz e (as m e a s u r e d by w o r k e r c o v e r a g e ).
The 300 plans studied c o v e r e d 4 , 9 8 1 , 0 0 0 w o r k e r s o r o v e r 40 p e rc e n t of
the e stim a te d total n u m b er of w o r k e r s c o v e r e d by h ealth and in su ra n c e plans under
c o lle c tiv e b arg a in in g (table A - l ) . 3 The plans v a r ie d in c o v e r a g e fr o m the m in i­
m u m of 1 ,0 0 0 w o r k e r s c h o se n fo r this study to h a lf a m illio n . O n e -th ir d of the
p la n s , c o v e rin g o v e r tw o -fifth s o f the w o r k e r s , w e r e n eg o tia ted by m u ltie m p lo y e r
g r o u p s . S lig h tly m o r e than tw o -th ir d s of the p la n s , c o v e r in g about the s a m e p r o ­
p o rtio n of w o r k e r s , w ere in m an u fa ctu rin g in d u s tr ie s .
V ir tu a lly e v e r y m a jo r
m a n u factu rin g and n on m anu factu rin g in d u stry group w as r e p r e s e n te d in the s e l e c ­
tion (tab le A - 2 ) .
T y p e s of B e n e fits S tu d ied . — L ife in su ra n c e b e n e fits a r e p ro v id e d as eith er
a fla t am ount; an am ount gradu ated a c c o rd in g to e a r n in g s , s e r v i c e , o c c u p a tio n ,
e t c . ; o r a co m bin a tio n of th ese two m eth od s of p rovid in g b e n e fits .
E a c h type
p ro vid es a c a sh p aym en t in the event of death and fre q u e n tly in the ev en t of p e r ­
m an en t and total d is a b ility .

1 At the time of this study, 4 States had enacted temporary disability legislation.
2 The meaning of the phrase “ under collective bargaining” as used in this study requires a brief examination. Many employers and unions
independently sponsored and financed insurance plans for many years before they came under collective bargaining and a large number of work­
ers are now covered by plans that are not collectively bargained. Many of the programs now under collective bargaining were originally insti­
tuted by the employer and subsequently brought within the scope of the agreement with or without change. Similarly, union sponsored and
financed programs have been brought within the collective bargaining area, with the employer paying all or part of the co st. For the purpose
of this study, plans under collective bargaining include: (1) Those established for the first time as a result of collective bargaining; and
(2) those originally established by either employer or union but since brought within the scope of the agreement, at least to the extent that
the agreement establishes employer responsibility to continue or provide certain benefits.
3 Throughout this bulletin, all coverage data relate to the number of active workers covered by the plans. For example, when reference is
made to dependent coverage, the extent of such coverage is expressed in terms of the number of active workers covered by plans which ex­
tend or provide the specified benefits for dependents. No attempt was made to determine the number of dependents, retired workers, or de­
pendents of retired workers covered by the plans in this study.







T A B L E A - l . — Health and in surance plans:

D istrib u tion o f plans studied by w o r k e rs c o v e r e d , in d u stry d iv is io n , and type o f b arga in in g unit
M anu factu ring

A ll in d u stries
Single e m p lo y e r

A ll plans

W o rk e rs c o v e r e d

A ll p la n s.stu d ied _____

__ _____ _

300

to 2 , 000 w o r k e r s
---------------------2, 000 to 3, 000 w o r k e r s __ ------- ----------3, 000 to 4 , 000 w o r k e r s
______ _____ _
4 , 000 to 5, 000 w o r k e r s _________________
5, 000 to 7, 000 w o r k e r s __ __ __ ------- _
7, 000 to 10, 000 w o r k e r s _ __ ___ _____
10, 000 to 15, 000 w o r k e r s
---------------- „
15, 000 to 25, 000 w o r k e r s _______________
25, 000 to 50, 000 w o r k e r s ____________ _
50, 000 to 100, 000 w o r k e r s ______________
100, 000 w o r k e r s and o v e r ______________

___

42
41
42
23
32
25
32
25

1, 000

N O TE :

22
5

1
1

100

4. 981

200

2 .8 2 2

59
97
138
99
186
203
374
451
749
329

33
25
29
15

46
61
95
65

2,296

9
16
13

21

120

18
19
19

145
224
343
418
194
1, 112

1
2
3

6

8
11
7
13

6
10
2
5

2 .1 5 9

12
36
44
34

66

58
151
108
331
135
1 ,1 8 4

179
28

20

27

12

18
18
18
17

12
3

6

S ingle e m p lo y e r

W o rk e rs

39

39
49

4
4
5
5

88
52
104
145
213
311
418
194

1,112

6
2
6
1
2
2
2

671

6
10
16

21
37
17
71
15
63
135
281

W o rk e rs
P lans

(0 0 0 's )

( 0 0 0 's)

2 .7 2 6

M u ltie m p lo y e r

W ork ers
P la n s

P lans
(0 0 0 ' s)

(000* s)

(000* s)

N onm anufacturing

M u ltie m p lo y e r

W o rk e rs
P lans

P lans

Plans
(0 0 0 's )

S ingle e m p lo y e r

W o rk e rs

W ork ers

W ork ers
P lans

M u ltie m p lo y e r

to

( 0 0 0 's )

21

97

61

5
5

7

5

2

12
6
13
16

_

-

6

12
8

3
3

1 ,4 8 7

32

3
5
5
7
5

_

_

8

-

-

_

-

"

27
27
13
29
41
80
93
268

3

1
1

1
2

-

903

B eca u se of rou n d in g, sum s o f individual item s do not n e c e s s a r ily equal to ta ls.

T A B L E A - 2 . — Health and in su ra n ce plan s:

D istrib u tio n o f plans stu died by in d u stry group

W o rk e rs
Ind ustry group

W ork ers
Industry group

P lans

P lans
(000* s)

(0 0 0 's )
A ll plans stu died _____ .----------------------------------------

300

4, 981

M anu factu ring - C ontinued

M anu factu ring --------------------------

218

3 ,3 9 7

F o o d and k in d red p rod u cts _____________________
T o b a c c o m an u fa ctu res __________________________
T e x tile m ill p ro d u cts ___________________________
A p p a re l and oth er fin ish ed textile
p rod u cts ------------------------------------------------------------L u m b er and tim b er b a s ic p r o d u c t s ------------------F u rn itu re and fin ish ed w ood p rod u cts _________
P a p e r and a llie d p rod u cts ______________________
P rin tin g and p u b lis h in g _________________________
C h e m ica ls and a llie d p rod u cts ________________
P e t r o le u m and c o a l p rod u cts __________________
R u b ber p rod u cts _________________________________
L e a th e r and lea th er p rod u cts __________________
S ton e, c la y , and gla ss p rod u cts ----------------------P r im a r y m eta l in d u stries ______________________
F a b r ic a te d m eta l p rod u cts _____________________

16
2
12

145
7
49

M a ch in e ry (e x c e p t e le c t r ic a l) _________________ _
E le c t r ic a l m a c h in e ry _____________________________
T ra n s p o rta tio n equipm en t _________________ __ _
Instrum ents and r e la te d p rod u cts ----------------------M is ce lla n e o u s m an u fa ctu rin g ___________________

6

433
44
58
44
24
83
81

N O TE :

3
5
13

6

9

8
7

1
1
1
0
20
1
1

122
68

77
563
79

N onm anufacturing

----------------------

M ining— cru d e p e tro le u m and natural
gas p ro d u ctio n ______________________ ___ _____
C o n stru ctio n ____________________________________
T ra n s p o rta tio n ____________________________________
U tilit ie s : E le c t r ic and gas _______________________
R e ta il and w h o le s a le tra d e
---------------------------- H otels and resta u ra n ts ________________________ S e r v ic e s __________________________________ ____ M is ce lla n e o u s non m anu factu ring ------------------------

B eca u se o f rou n d in g, sum s o f individual item s do not n e c e s s a r ily equal to ta ls .

24
14
25

179
254
1 ,0 1 8
31
40

82

1 ,5 8 4

5
16

295
165
812
33
90
56
127
5

8
8

21
10
13
5

10
2

3
A c c id e n ta l death and d is m e m b e r m e n t b e n e fits a ls o p rovid e c a sh p aym en ts
and a re g e n e r a lly lin k ed to the am ount of life in su r a n c e in e ffe c t fo r the in d iv id u a l.
T h is fo r m o f in su ra n c e m a y c o v e r o ccu p a tio n a l in addition to n on occu p ation al c a s e s .
A c c id e n t and s ic k n e s s c o v e r a g e p ro v id e s paym ents to c o m p e n sa te p a r tia lly
fo r the lo s s o f w age in c o m e fo r a s p e c ifie d p e r io d — u su a lly a c e r ta in n u m b er o f
w eek s fo r each d is a b ility or during the y e a r .
It g e n e r a lly a p p lie s to a c c id e n ts
and i l ln e s s e s a r is in g o ff the jo b ; s o m e plans a ls o c o v e r occu p a tio n a l c a s e s , s u p ­
p le m e n tin g w o r k m e n ^ c o m p e n s a tio n . U nlike o th e r b e n e fits which m a y be extended
to dependents and r e tir e d w o r k e r s , th is b e n e fit is a v a ila b le only to a c tiv e w o r k e r s
b e c a u s e it is dependent upon an e m p lo y m en t r e la tio n s h ip . P a id s ic k le a v e , State
w o r k m e n ^ c o m p e n sa tio n b e n e fits and te m p o r a r y d is a b ility p aym en ts fr o m State
o p e ra te d plans a re not a n a ly ze d in th is s t u d y .4
H o s p ita liz a tio n , s u r g i c a l, and m e d ic a l c a r e b e n e fits s e ld o m a r e a v a ila b le
fo r o th er than n on occu p ation al d i s a b i l i t i e s .5 T h e s e b e n e fits are p ro v id e d in two
m a jo r f o r m s — c a s h o r s e r v i c e . C a sh plans p rovid e stip u la ted am oun ts tow ard the
c h a rg e m a d e to the in dividu al fo r h osp ita l r o o m and b oa rd and e x tr a s e r v i c e s ,
and, in the even t s u r g ic a l and m e d ic a l b e n e fits are p ro v id e d , fo r s e r v ic e s r e n ­
dered.
S e r v ic e -t y p e p la n s p rovid e no ca sh p aym en ts to the in d iv id u a l, but pay
the fu ll c o s ts of s p e c ifie d h o s p ita l, s u r g ic a l, and m e d ic a l c a r e fo r s p e c ifie d p e r i­
ods o f t im e .
The types of b e n e fits which m a y be d e sig n a te d as m e d ic a l c a r e b e n e fits
(oth er than h o s p ita liz a tio n and s u r g ic a l) are v a r ie d .
In this stu d y , the te r m
"m e d ic a l b e n e f i t s " is lim ite d to p aym en t fo r d o c t o r !s v i s i t s , w hether at the h o s ­
p ita l, d o c t o r ^ o f f ic e , o r in the w o rk er*s h o m e .
T h e s e b e n e fits do not in clu de
v is its m ad e by the attending su rg e o n in the h o sp ita l in con n ection with s u r g ic a l
p r o c e d u r e s .6 A llo w a n c e s fo r s u r g ic a l p r o ce d u r e s are c o v e r e d in the s e c tio n on
s u r g ic a l b e n e fits .
O th er fo r m s o f m e d ic a l c a r e b e n e fits , such as o u t -o f -h o s p it a l a llo w a n c e s
fo r d ia g n o stic la b o r a to r y and X - r a y p r o c e d u r e s , a re tre a te d s e p a r a te ly under the
O th er M e d ic a l C a re B e n e fits se c tio n of this stu dy.
V a r ia tio n s A m o n g P l a n s . — T he types and am ounts of b e n e fits p ro vid ed
by health and in su ra n c e plans under c o lle c tiv e b arg a in in g v a r y w id e ly . A plan m a y
c o n s is t of one b e n e fit (e . g . , life in su ra n c e ) which a p p lies to the w o r k e r only o r
it m a y in clu de a ll typ es of b e n e fits fo r the w o rk e r and h is d ep en d en ts. In a d d i­
tio n , a plan m a y a ls o extend so m e b e n e fits to the r e tir e d w o rk e r and his d e ­
p en d en ts. In the s a m e m a n n e r , b e n e fit le v e ls and the length of tim e during which
b e n e fits a re p ro vid ed d iffe r c o n s id e r a b ly am ong p la n s.
T y p e s and am oun ts of b e n e fits m a y a ls o v a r y within plans o p e ra te d by a
m u ltip la n t co m p an y o r b y a m u ltie m p lo y e r group c o v e r in g a wide g e o g ra p h ic a r e a .
F o r e x a m p le , h o s p ita l, s u r g ic a l, and m e d ic a l b e n e fits p ro vid ed through Blue C r o s s

If the accident and sickness benefit, under plans in those States having temporary disability legislation, was provided as part of a pri­
vately insured multibenefit program, then the benefit was considered within the scope of this study.
5 Two plans in this study provided these benefits for occupational disabilities and one plan made available hospital and surgical benefits
for such ca ses. These plans specified that the level of benefit would be the difference between the workmen’ s compensation payment and
the amount specified under the plan.
In addition to the general exclusion of benefits for occupational disabilities, most plans specifically excluded one or more nonoccupa­
tional disabilities. Among such exclusions were treatment for alcoholism , narcotic addiction, se'f-inflicted injuries, and cosmetic surgery.
Some plans, although covering certain types of disabilities, limited the duration of amount of benefits available for their treatment. Examples
of disabilities subject to such limitations were mental and nervous disorders, tonsillectom ies, and poliom yelitis. These restrictions and
limitations are not discussed in this study.
6 Under some plans, medical benefits, as herein defined, are payable although surgery occurs during hospital confinement; various tech­
niques are used to determine the amounts payable in such cases. These techniques are not described in this study.




4
and B lu e S h ie ld p r o g r a m s g e n e r a lly v a r y
w h ere su ch va ria tion s o c c u r r e d under a
p l a n , th e p r o v i s i o n s c o v e r i n g th e l a r g e s t
a t i o n s in b e n e f i t s a l s o o c c u r r e d in s o m e
q u ir e m e n t s o f S tate t e m p o r a r y d is a b i lit y
t o t h o s e p r o v i s i o n s c o v e r i n g the l a r g e s t

f r o m l o c a l i t y to l o c a l i t y . 7 In t h is s t u d y ,
p a r t ic u la r m u ltip la n t o r m u lt ie m p lo y e r
grou p of w o r k e r s w e re a n a ly zed . V a r i­
o f the p l a n s s t u d i e d b e c a u s e o f t h e r e ­
la w s . H e r e , to o , a n a ly sis was co n fin e d
group of w o r k e r s .

F in a n c in g C o n c e p t s . — T a k in g a h ea lth and in s u r a n c e p la n as a w h o l e ,
f i n a n c i n g m a y b e d e t e r m i n e d in 1 o f 2 w a y s : E i t h e r th e e m p l o y e r p a y s th e e n t i r e
c o s t ( a " n o n c o n t r i b u t o r y " pla n ) o r th e w o r k e r c o n t r i b u t e s a p o r t i o n o f th e c o s t
( a " c o n t r i b u t o r y ” o r " j o i n t l y f i n a n c e d " p l a n ) . W h e n the e m p l o y e r p a y s th e e n t i r e
c o s t , o b v i o u s l y the b e n e f i t p a c k a g e p r o v i d e d to e a c h g r o u p c o v e r e d ( a c t i v e w o r k e r s ,
d e p e n d e n ts o f a c t iv e w o r k e r s , r e t i r e d w o r k e r s , and d e p e n d e n ts o f r e t i r e d w o r k e r s )
and e a c h in d iv id u a l b e n e fit a r e e m p l o y e r fin a n c e d o r n o n c o n t r ib u t o r y . H o w e v e r ,
w h e n th e w o r k e r c o n t r i b u t e s to the c o s t o f the p l a n , in the v a r i o u s w a y s in w h i c h
j o i n t l y f i n a n c e d p l a n s h a v e b e e n s e t u p , th e d e t e r m i n a t i o n o f the m e t h o d o f f i n a n c ­
ing f o r e a c h g r o u p c o v e r e d and e a c h b e n e fit p r o v i d e d b e c o m e s d if fic u lt . F o r p u r ­
p o s e s o f t h i s s t u d y , p l a n a n d b e n e f i t f i n a n c i n g w a s d e t e r m i n e d in the f o l l o w i n g
m anner:
1.
F o r ea ch g rou p , i. e. , a ctiv e w o r k e r s , dependen ts o f a ctiv e w o r k e r s ,
r e t i r e d w o r k e r s , a n d d e p e n d e n t s o f r e t i r e d w o r k e r s , the b e n e f i t p a c k a g e w a s c l a s ­
s i f i e d a s j o i n t l y f i n a n c e d i f (a ) b o t h the e m p l o y e r a n d w o r k e r c o n t r i b u t e d t o w a r d
th e c o s t o f o n e o r m o r e b e n e f i t s p r o v i d e d the g r o u p o r (b ) th e w o r k e r m a d e a
g e n e r a l c o n t r i b u t i o n t o w a r d th e c o s t o f a l l b e n e f i t s p r o v i d e d to a l l g r o u p s c o v e r e d
b y th e p r o g r a m .
B e n e fits f o r a g ro u p w e r e c o n s id e r e d as e m p l o y e r fin a n c e d if
th e e m p l o y e r p a i d the e n t i r e c o s t o f t h e s e b e n e f i t s .
S im ila r ly , b e n e fits fo r a
g r o u p w e r e c l a s s i f i e d as w o r k e r f i n a n c e d i f the w o r k e r p a i d the e n t i r e c o s t o f a l l
b e n e f i t s e x t e n d e d to th a t g r o u p .
2.
D e t e r m i n a t i o n o f the m e t h o d s o f f i n a n c i n g i n d i v i d u a l b e n e f i t s w a s
m o r e c o m p l e x . T h i s d e t e r m i n a t i o n i n v o l v e d n o t o n l y th e p r o b l e m s i n h e r e n t in the
g r o u p c o n c e p t b u t a l s o th e p r o b l e m s a r i s i n g o u t o f th e v a r i o u s w a y s o f i d e n t i f y i n g ,
e a rm a rk in g , o r d irectin g w o r k e r s 1 c o n tr ib u tio n s .8
F o r e x a m p le , P la n A p r o ­
v i d e d b e n e f i t s f o r b o t h the w o r k e r a n d h i s d e p e n d e n t s .
T h e pla n c a l l e d f o r a
s i n g l e c o n t r i b u t i o n b y th e w o r k e r t o w a r d th e t o t a l c o s t o f t h e p r o g r a m ; th e e m ­
p l o y e r p a i d the b a l a n c e o f c o s t .
T he w o r k e r 's co n trib u tio n w as not e a r m a r k e d
fo r a s p e c ific b e n e fit n o r fo r b e n e fits fo r a p a rticu la r g r o u p , i. e. , w o r k e r s o r
d e p e n d e n t s . U n d e r P l a n B , p r o v i d i n g s i m i l a r b e n e f i t s , th e w o r k e r ' s c o n t r i b u t i o n
w a s s p e c i f i c a l l y a l l o c a t e d t o w a r d the c o s t o f a l l b e n e f i t s f o r h i s d e p e n d e n t s . H e
m a y h a v e p a i d f o r t h is c o v e r a g e i n f u l l o r in p a r t , b u t h i s o w n b e n e f i t s w e r e
s o le ly e m p lo y e r fin a n ce d .
P l a n C e a r m a r k e d th e w o r k e r ' s c o n t r i b u t i o n f o r o n e
o f h is o w n b e n e fit s and on e f o r h is d e p e n d e n t s . W h en o t h e r g r o u p s ( r e t i r e d w o r k ­
e r s a n d d e p e n d e n t s ) a r e b r o u g h t u n d e r c o v e r a g e o f a p l a n , the v a r i a t i o n s in m e t h ­
o d s o f fin a n cin g in d iv id u a l b e n e fit s a r e o b v io u s ly m u lt ip lie d .
In c l a s s i f y i n g m e t h o d s o f f i n a n c i n g i n d i v i d u a l b e n e f i t s , the f o l l o w i n g a p ­
p ro a ch was used:
If b o t h the w o r k e r a n d e m p l o y e r m a d e a c o n t r i b u t i o n t o w a r d
th e c o s t o f s p e c i f i c b e n e f i t s , th e f i n a n c i n g o f the b e n e f i t w a s c l a s s i f i e d a s c o n ­
t r i b u t o r y . If th e w o r k e r o r the e m p l o y e r p a i d the e n t i r e c o s t o f s p e c i f i c b e n e f i t s ,

^ B lue C ross plans are sponsored by nonprofit incorporated a ffilia te s of the Blue C ross C om m ission of the Am erican H ospital A s s o c ia tio n
throughout the United States. T h ey primarily provide hospital care b e n e fits on a s e rv ice b a s is . Blue Shield p la n s , spon sored by State or
lo c a l m edical s o c ie t ie s , make available allo w a n ce s for su rgica l e x p e n s e s ; a large majority a lso provided a llo w a n ce s for m edical e x p e n s e s .
T h e se a llow a n ces are provided in a cco rd a n ce with fe e sch e d u le s approved by the participating d o cto rs . Under both Blue C ro ss and Blue
Shield p la n s, individual and fam ily co v e ra g e are available on a group b a s is . In most areas, the B lue C ross plan a cts as the adm inistrative
agen cy for the 2 plan s.
., , ,
.
.
,
8 In itially, many plans included only 1 or 2 b e n e fits . Subsequently, additional b en efits were p rovided, forming over time a com prehensive
program. On the other hand, particu larly in recen t years, new ly esta b lish e d programs have tended to be com prehensive at their in cep tion .
A s a result of these variation s in developm ent, the financing arrangements of plans re fle c t co n sid e ra b le v ariation s.




5
they w e r e c la s s ifie d as w o r k e r fin a n ce d or e m p lo y e r fin a n ce d , r e s p e c t i v e ly .
If
a c o n t r i b u t i o n w a s m a d e b y th e w o r k e r t o w a r d th e c o s t o f a l l b e n e f i t s f o r a g i v e n
g r o u p (w ith th e e m p l o y e r p a y i n g th e b a l a n c e o f c o s t ) , e a c h b e n e f i t p r o v i d e d th e
c o v e r e d g r o u p w a s c l a s s i f i e d a s j o i n t l y f i n a n c e d . I f e i t h e r th e w o r k e r o r th e e m ­
p l o y e r u n d e r w r o t e the e n tir e c o s t o f a ll b e n e fit s fo r a g iv e n g r o u p , e a c h b e n e fit
w a s c l a s s i f i e d as w o r k e r fin a n c e d or e m p l o y e r fin a n c e d , dep en d in g upon w h ich
p a r t y m a d e th e c o n t r i b u t i o n . 9
P re v a le n ce

o f B e n efits

A c t i v e W o r k e r s . — N e a r l y a t h i r d o f th e p l a n s ( 9 4 ) , c o v e r i n g a b o u t th e
s a m e p r o p o r t i o n o f w o r k e r s , p r o v i d e d a l l b e n e f i t s w i t h i n th e s c o p e o f th e s t u d y ---life in s u r a n c e , a c c id e n t a l d eath and d i s m e m b e r m e n t , a c c id e n t and s i c k n e s s , h o s ­
p i t a l , s u r g i c a l , a n d m e d i c a l b e n e f i t s (t a b le A - 3 ) .
The next m o s t freq u en t c o m ­
b i n a t i o n , f o u n d in 51 p l a n s , i n c l u d e d a l l b e n e f i t s e x c e p t a c c i d e n t a l d e a t h a n d
d ism em b erm en t.
S l i g h t l y f e w e r p l a n s ( 4 7 ) , in a d d i t i o n t o e x c l u d i n g a c c i d e n t a l
death an d d i s m e m b e r m e n t , d id n ot p r o v id e m e d i c a l b e n e f i t s .
N e a rly tw o -th ird s
o f th e p l a n s c o v e r i n g a b o u t th e s a m e p r o p o r t i o n o f the w o r k e r s p r o v i d e d a t l e a s t
5 o f th e 6 b e n e f i t s s t u d i e d .
T A B L E A - 3 . ---H ea lth and in s u r a n c e p la n s:

B e n e f its p r o v id e d a c tiv e w o r k e r s b y m e th o d of fin a n c in g , la te 1 9 5 5

(x in d ic a te s b e n e fits p r o v id e d un der plan; d a s h e s , no b e n e fit s p r o v id e d )
P la n b e n e fit s for a c tiv e w o r k e r
A ll
fin a n c e d by 1 --A c c id e n ta l
p la n s
E m p lo y e r and
W eek ly
E m p lo y e r on ly
death
w orker
L ife
a c c id e n t
and
S u r g ic a l M ed ic a l
H o s p ita l
W o r k e rs
W orker s
W o r k e rs
in s u r a n c e
and
d is m e m ­
N u m b er
P la n s
P la n s
sic k n e s s
berm ent
(0 0 0 *s)
(0 0 0 *s)
(0 0 0 »s)
B e n e f its p r o v id e d

300
X
X
X
X
X
X
X
X
X
X
X
”

X
X
X
X
X
X
X
~

X
X
X
X
-

X
X
X
X
X

X
X
X
X
X
X
X
X
X
X
X
X
X

X
X
X
X
X
X
X
X
X
X
X
X
X
X

X
X
_
X
X
X
-

X
X
X
X
-

4 .9 8 1

162

2, 244

138

2 ,7 3 8

94
51
47
35
19
14
13
8
5
4
4
2
1
1
1
1

1 ,5 5 5
976
637
435
396
89
120
591
54
71
22
11
10
9
4
3

50
23
20
22
7
9
11
7
4
3
3
1
1
1

505
597
131
281
316
55
112
91
52
68
20
2
10
4
~

44
28
27
13
12
5
2
1
1
1
1
1
_
1

1 ,0 5 1
379
506
154
80
34
8
500
2
3
1
9
_
9
_
3

-

1

1 P la n s w e r e c l a s s i f i e d a s jo in tly fin a n c e d if the w o r k e r c o n tr ib u te d , to w a r d the c o s t of 1 or m o r e of the
b e n e fit s or i f th e e m p lo y e r c o n tr ib u te d o n ly a p a r t o f th e c o s t s of th e b e n e f it s .
NOTE:

B e c a u s e o f r o u n d in g ,

su m s o f in d iv id u a l it e m s do not n e c e s s a r i l y eq u a l t o t a ls .

A l l b u t a f e w o f th e p l a n s s t u d i e d p r o v i d e d h o s p i t a l a n d s u r g i c a l
a n d l i f e i n s u r a n c e t o a c t i v e w o r k e r s (t a b l e A - 4 ) .
F o u r ou t o f 5 p l a n s
a c c i d e n t a n d s i c k n e s s c o v e r a g e a n d n e a r l y 2 ou t o f 3 p r o v i d e d m e d i c a l
A b o u t h a l f o f th e p l a n s i n c l u d e d a c c i d e n t a l d e a t h a n d d i s m e m b e r m e n t

b e n e fits
p rov id ed
b e n e fits.
b en efits.

D e p e n d e n t s o f A c t i v e W o r k e r s . — T h e v a s t m a j o r i t y o f p l a n s (2 7 9 ) e x t e n d e d
s o m e type o f b e n e fit to d ep en d en ts o f a c tiv e w o r k e r s . T he m o s t c o m m o n p a ck a g e
f o r t h i s g r o u p , p r o v i d e d in h a l f o f the p l a n s e x t e n d i n g b e n e f i t s , i n c l u d e d h o s p i t a l ,

B en efits which were entirely worker financed were co n sid e re d within the s c o p e of the c o lle c t iv e ly bargained program. In the c a s e o f
ben efits for the activ e worker and his depen dents, the p ra ctice o f having the worker pay for a particular type of co vera ge can be view ed
m erely as 1 variation o f c o u n tle ss financing arrangements. The same reasoning a p p lies to b e n e fits for retired w orkers. In any event, the
worker or retired worker gains the advantage of group rate p articipation under the plan, w hich otherw ise may not be ava ila b le .







TA BLE A - 4 , — H ealth and in su ran ce plans: P r e v a le n c e of b e n e fits by groups c o v er e d , ind ustry d iv isio n , and type of bargaining unit, la te 1 95 5
A ll in d u stries
A ll plans

B en efits and groups co v er e d

Single e m p lo y er
W orkers

W orkers

A ll plans studied _______________________

P lan s

S in gle e m p loyer
P lan s

P la n s

M u ltiem p loyer

W orkers

W orkers

(0 0 0 * s)

(0 0 0 * s)

N onm anufac tur ing

M u ltiem p loyer

W orkers

W orkers

(0 0 0 * s)

(00 0 * s)

Sin gle em p lo y er

P la n s

P lan s

P lan s

M anufacturing
M u ltiem p loyer

W orkers
P la n s
(0 0 0 * s)

(00 0* s)

(0 0 0 * s)

300

4 , 981

200

2 ,8 2 2

100

2 ,1 5 9

1 79

2 ,7 2 6

39

671

21

97

61

1 ,4 8 7

284
7
146

4 ,3 5 2
215
3 ,1 0 8

193
2
128

2 ,7 6 9
24
2 ,2 7 3

91
5
18

1 ,5 8 3
191
834

174
2
112

2 ,6 7 5
24
2 , 189

39

671

-

19

94

10

451

16

85

52
5
8

911
191
383

154
5

2 ,2 5 0
58

89
3

1 ,5 1 3
27

65
2

737
31

83
3

1 ,4 8 7
27

24
1

195
14

6
-

26
-

41
1

542
17

239

3 ,6 9 5

167

2 ,5 4 0

72

1, 155

1 59

2 ,4 9 8

31

621

8

42

41

533

293
278
67
56

4 ,9 0 8
4 ,2 7 9
1 ,7 8 4
1 ,7 2 9

199
193
58
49

2 ,8 1 3
2 ,7 6 1
1 ,4 2 3
1 ,3 8 0

94
85
9
7

2 ,0 9 5
1 ,4 9 8
361
349

178
173
48
41

2 ,7 1 7
2, 686
1 ,3 7 4
1 ,3 3 5

39
33
4
2

671
591
33
20

21
20
10
8

97
95
48
45

55
52
5
5

1 ,4 2 3
907
329
329

2 94
263
58
48

4, 917
4, 190
1 ,7 4 5
1 ,6 9 0

200
186
50
42

2 ,8 2 2
2 ,7 7 2
1 ,3 9 0
1 ,3 4 8

94
77
8
6

2 ,0 9 5
1 ,4 1 8
355
342

179
166
42
35

2 ,7 2 6
2 ,6 7 7
1 ,3 4 5
1 ,3 0 5

39
30
3
1

671
576
26
14

21
20
8
7

97
95
45
43

55
47
5
5

1 ,4 2 3
842
329
329

193
145
35
31

3, 683
2 ,7 7 4
1 ,4 9 1
1 ,3 4 6

127
104
28
26

1 ,9 0 3
1 ,7 8 3
1 ,0 1 5
1 ,0 0 5

66
41
7
5

1 ,7 8 0
992
476
341

110
93
24
23

1 ,8 2 2
1 ,7 4 3
1 ,0 0 2
994

27
13
3
1

6 06
459
149
14

17
11
4
3

81
39
13
11

39
28
4
4

1 ,1 7 5
533
327
327

L ife in su ra n ce

A ctive w o rk ers ---------------------------D ependents of a c tiv e w o rk ers _ _
_
R etired w o rk ers ----------------------- --

-

-

-

A ccid en ta l death and
di s m em b e r m ent
A ctive w o rk ers ____ __________________
R e tir ed w o r k e r s _______ ______________
W eekly a c cid en t and s ic k n e ss
A ctiv e w o rk ers

___

__ __ ____

__

H o sp ita liza tio n
A ctiv e w o r k e r s -------------- ------------D ependents of a c tiv e w o r k e r s -----------R e tir ed w o rk ers --------------------------D ependents of r e tir e d w o r k e rs _________
S u rg ica l
A ctiv e w o rk ers ------------------- —
D ependents of a c tiv e w o r k e r s ___________
R e tir ed w o rk ers --------------------------D ependents of r e tir e d w o rk ers _________
M ed ica l
A ctiv e w o r k e r s __________________________
D ependents of a c tiv e w o r k e r s ___________
R e tir ed w o rk ers ________________________
D ependents of r e tir e d w o rk ers _________

NOTE: B ec a u se of rounding, su m s of individual ite m s do not n e c e s s a r ily equal to ta ls .
w o r k e rs c o v er e d by the p la n s. S ee footnote 3, p. 1.

A ll co v er a g e data show n in th is study r ela te to num ber of active

7

s u r g i c a l , a n d m e d i c a l b e n e f i t s ( t a b l e A - 5 ) . 10
P la n s exten d in g on ly h o s p ita l and
s u r g i c a l b e n e f i t s a c c o u n t e d f o r a n a d d i t i o n a l 115 p l a n s . T h u s , b o t h h o s p i t a l a n d
s u r g i c a l b e n e f i t s w e r e p r o v i d e d b y m o s t o f th e p l a n s s t u d i e d ; m e d i c a l b e n e f i t s
w e r e l e s s c o m m o n l y e x t e n d e d to d e p e n d e n ts (ta b le A - 4 ) .
A c c id e n t and s ic k n e s s
b e n e f i t s , f o r th e r e a s o n p r e v i o u s l y g i v e n , w e r e n o t a v a i l a b l e t o d e p e n d e n t s . L i f e
i n s u r a n c e , a lth o u g h a p p l i c a b l e , w a s p r o v i d e d to d e p e n d e n ts in o n ly s e v e n p l a n s .
T A B L E A - 5 . — H e a lth and in s u r a n c e p la n s: B e n e f its p r o v id e d d e p e n d en ts o f a c tiv e w o r k e r s
b y m e th o d o f fin a n c in g , la te 1 9 5 5 1
(x in d ic a t e s b e n e fit s p r o v id e d un d e r p lan, d a s h e s , no b e n e fit s p r o v id e d )
P la n b e n e fit s £o r d e p e n d e n ts o f
A ll p la n s p r o v id in g
a c tiv e w o r k e r s fin a n c e d b y 2 —
b e n e fit s for
E m p lo y e r and
d e p e n d e n ts of
A c c id e n ta l
W ork er on ly
E m p lo y e r on ly
w orker
d eath
a c tiv e w o r k e r s
L ife
W o r k e rs
W ork ers
W ork ers
W orkers
H o sp ita l S u r g ic a l M e d ic a l
and
in s u r a n c e
P la n s
P la n s
P la n s
N u m b er
d is m e m ­
( 0 0 0 ’s)
(0 0 0 *s )
( 0 0 0 's)
(0 0 0 *s)
berm ent
B e n e f its p r o v id e d

279
_

_

_

-

X
X
“

-

_

X
X
X
X
X
”

X
X

X

-

_

X
X
X

X
X

-

4 ,2 8 8

120

1 ,7 2 1

108

2 ,0 3 5

51

532

140
115
16
4
3
1

2 ,7 0 0
1 ,2 6 6
98
65
150
9

59
45
10
3
2
1

1 ,0 9 9
343
78
52
139
9

58
45
3
1
1
“

1 ,3 0 5
697
9
13
11

23
25
3

296
226
10
-

-

-

1 B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s un d er c o lle c t iv e b a r g a in in g c o v e r in g a p p r o x im a te ly 5 m i l ­
lio n w o r k e r s .
2 P la n s w e r e c l a s s i f i e d a s jo in tly fin a n c e d if th e w o r k e r c o n tr ib u te d to w a r d th e c o s t of 1 o r m o r e o f h is d e ­
p e n d e n t’s b e n e fit s or if th e e m p lo y e r c o n tr ib u te d o n ly a p a r t o f th e c o s t s o f th e b e n e f it s .
NO TE:
B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s do n ot n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e data
sh o w n in th is stu d y r e la te to n u m b e r o f a c tiv e w o r k e r s c o v e r e d by th e p la n s .
S ee fo o tn o te 3 , p. 1.

W it h th e e x c e p t i o n o f l i f e i n s u r a n c e , th e l e v e l o f th e b e n e f i t s e x t e n d e d t o
d e p e n d e n t s o f a c t i v e w o r k e r s w a s i d e n t i c a l t o th a t p r o v i d e d th e w o r k e r in a l a r g e
p r o p o r t i o n o f th e p l a n s ( t a b l e A - 6 ) . In e a c h o f th e f e w c a s e s o f d e p e n d e n t s 1 c o v ­
e r a g e u n d e r l i f e i n s u r a n c e , th e b e n e f i t l e v e l w a s l o w e r f o r d e p e n d e n t s t h a n f o r
w orkers.

T A B L E A - 6 . — H e a lth and in s u r a n c e p lan s: R e la tio n s h ip o f b e n e fits p r o v id e d a c tiv e w o r k e r s
and th e ir d e p e n d e n ts, la te 1 9 5 5 1
L ife in s u r a n c e
B e n e f it l e v e l fo r d e p e n d en ts
o f a c tiv e w o r k e r

H o s p ita l b e n e fit s
P la n s

P la n s
(00 0» s)

A ll p la n s p r o v id in g b e n e fit s fo r
a c tiv e w o r k e r s and d e p e n d e n t s __
B e n e f its
Sam e
L ess
one

fo r d e p e n d en ts:
a s fo r a c tiv e w o r k e r ____
than fo r a c tiv e w o r k e r in
o r m o r e r e s p e c t s _____ —

S u r g ic a l b e n e fit s

M e d ic a l b e n e fit s

W ork ers

W ork ers

W orkers

P la n s

W ork ers
P la n s
( 0 0 0 ‘ s)

( 0 0 0 ‘ s)

( 0 0 0 * s)

7

215

215

272

4 ,2 1 5

257

4, 126

141

2 , 750

208

7

3 ,5 3 6

171

3 ,2 0 4

104

2 ,4 6 0

64

679

86

922

37

290

1
B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s un d er c o lle c t iv e b a r g a in in g c o v e r in g a p p r o x im a te ly 5 m i l ­
lio n w o r k e r s .
N O T E: A ll c o v e r a g e d ata sh o w n in th is stu d y r e la te
fo o tn o te 3, p. 1.

to

n u m b e r o f a c tiv e w o r k e r s c o v e r e d b y th e p la n s . S e e

Six plans provided hospital and surgical benefits for dependents but not workers; 4 plans provided medical benefits for dependents
but not workers. These plans covered workers in the maritime industry who received free medical and surgical care in U. S. Public Health
Service hospitals and out-patient facilities under the United States Maritime law.




8

R e t i r e d W o r k e r s , — S l i g h t l y m o r e th a n h a l f ( 1 5 5 ) o f th e p l a n s , c o v e r i n g
a b o u t t w o - t h i r d s o f th e w o r k e r s i n th e s t u d y , e x t e n d e d o n e o r m o r e b e n e f i t s t o
r e t i r e d w o r k e r s ( t a b l e A - 7 ).
The m o s t c o m m o n e x te n s io n c o n s is t e d o f life in ­
s u r a n c e a l o n e , a c c o u n t i n g f o r m o r e th a n h a l f o f a l l p l a n s p r o v i d i n g b e n e f i t s f o r
r e t i r e d w o r k e r s . T h i s b e n e f i t in c o m b i n a t i o n w i t h h o s p i t a l , s u r g i c a l , a n d m e d i c a l
c o v e r a g e r e p r e s e n t e d a f a r l e s s p r e v a l e n t p a c k a g e , b u t the n u m b e r o f w o r k e r s
c o v e r e d b y th e 2 6 p l a n s e x t e n d i n g t h e s e b e n e f i t s to r e t i r e d w o r k e r s w a s a b o u t
e q u a l t o th e n u m b e r c o v e r e d b y the 86 p l a n s p r o v i d i n g l i f e i n s u r a n c e o n l y . A l ­
th ou gh e x t e n s io n to r e t i r e d w o r k e r s o f a il b e n e fit s a v a ila b le to a c t i v e w o r k e r s
( w i t h th e e x c e p t i o n o f a c c i d e n t a n d s i c k n e s s ) i s p o s s i b l e , o n l y 4 p l a n s in th e s t u d y
p r o v i d e d th is f u l l p a c k a g e .
A b o u t h a l f o f th e p l a n s p r o v i d i n g l i f e i n s u r a n c e f o r a c t i v e w o r k e r s a l s o
e x t e n d e d th is b e n e f i t t o r e t i r e d w o r k e r s ( t a b l e A - 4 ) . S u b s t a n t i a l l y s m a l l e r p r o ­
p o r t i o n s o f th o s e p la n s p r o v id in g h o s p it a l, s u r g i c a l , an d m e d i c a l b e n e f it s f o r
a c t i v e w o r k e r s m a d e c o v e r a g e a v a ila b le to r e t i r e d w o r k e r s .
In a m a j o r i t y o f p l a n s w h i c h e x t e n d e d a c c i d e n t a l d e a t h a n d d i s m e m b e r ­
m e n t , h o s p i t a l , s u r g i c a l , a n d m e d i c a l b e n e f i t s t o th e r e t i r e d w o r k e r , h e w a s
c o v e r e d b y th e s a m e l e v e l o f b e n e f i t s p r o v i d e d th e w o r k e r b e f o r e r e t i r e m e n t
( t a b l e A - 8 ) . 11 U n d e r s u c h p r o v i s i o n s , the w o r k e r f a c e d n o r e d u c t i o n in p r o t e c t i o n
w h e n he r e t i r e d at a g e 65.
M o s t p l a n s , h o w e v e r , r e d u c e d th e a m o u n t o f l i f e
i n s u r a n c e f o r the r e t i r e d w o r k e r .
T h is p r a c t i c e m a y b e a ttrib u te d to s e v e r a l
f a c t o r s : ( a ) the c o s t o f p r o v i d i n g f u l l c o v e r a g e w h e n p a y m e n t i s a c e r t a i n t y , a s
it w o u l d b e in th e c a s e o f l i f e i n s u r a n c e , m a y b e e x c e s s i v e in c o m p a r i s o n w i t h
th e c o s t o f o t h e r b e n e f i t s th a t m i g h t b e o b t a i n e d ; ( b ) t h e r e m a y b e l e s s n e e d t o
p r o v id e in c o m e f o r a s u r v iv in g d ependen t; and (c ) s u c h in s u r a n c e m a y b e c o n ­
s i d e r e d p r i m a r i l y a m e a n s to c o v e r the c o s t o f f i n a l i l l n e s s e s a n d f u n e r a l e x p e n s e s .
A lth o u g h m a n y w o r k e r s s t o o d to l o s e a l l h e a lth and in s u r a n c e p r o t e c t i o n
u p o n r e t i r e m e n t and o t h e r s w e r e s u b je c t to r e d u c e d p r o t e c t i o n u p o n r e t i r e m e n t ,
r a r e l y d id a p l a n th a t e x t e n d e d b e n e f i t s to r e t i r e d w o r k e r s i n c l u d e p r o v i s i o n s f o r
d i s c o n t i n u a n c e o f s u c h b e n e f i t s d u r i n g the r e t i r e m e n t p e r i o d ( t a b l e A - 9 ) .
Thus,
a s l o n g a s a w o r k e r s o c o v e r e d w a s in a r e t i r e d s t a t u s , w h i c h g e n e r a l l y m e a n t
a s l o n g a s h e l i v e d , h e d id n o t f e a r l o s s o f a b e n e f i t b e c a u s e o f h i s a g e .

D e p e n d e n t s o f R e t i r e d W o r k e r s . — S l i g h t l y m o r e th a n a t h i r d o f th e p l a n s
p r o v i d i n g b e n e f i t s f o r th e r e t i r e d w o r k e r , c o v e r i n g m o r e th a n h a l f o f th e w o r k e r s
u n d e r s u c h p l a n s , a l s o e x t e n d e d o n e o r m o r e b e n e f i t s to h i s d e p e n d e n t s ( t a b l e A - 1 0 ).
T h e s e r a t i o s w e r e l o w in c o m p a r i s o n w i t h the e x t e n s i o n o f b e n e f i t s to d e p e n d e n t s
o f a c t i v e w o r k e r s , a n d w e r e a t t r i b u t a b l e in l a r g e p a :t t o th e f a c t th a t l i f e i n s u r ­
a n c e w a s the o n l y b e n e f i t p r o v i d e d r e t i r e d w o r k e r s u n d e r m o r e th a n h a l f th e p l a n s
f o r th a t g r o u p .
H o w e v e r , m o s t o f the p l a n s e x t e n d i n g h o s p i t a l , s u r g i c a l , a n d
m e d i c a l b e n e fit s to r e t i r e d w o r k e r s a l s o m a d e s u ch p r o t e c t i o n a v a il a b le to th e ir
d e p e n d e n ts (table A - 4 ) .
B e n e fits p r o v id e d d ep en d en ts o f r e . i r e d w o r k e r s in clu d e d h o s p it a liz a t io n ,
s u r g ic a l , and m e d i c a l c a r e .
T h e m o s t f r e q u e n t l y p r o v i d e d p a c k a g e (in 31 o f 5 6
p l a n s ) i n c l u d e d a l l t h r e e b e n e f i t s . T h e s e 31 p l a n s a c c o u n t e d f o r n e a r l y 80 p e r c e n t
o f th e w o r k e r s c o v e r e d b y a l l p l a n s e x t e n d i n g b e n e f i t s .
E v e r y p lan exten d in g
b e n e fit s to d e p e n d e n ts o f r e t i r e d w o r k e r s in c lu d e d h o s p it a l iz a t i o n .
S ix o u t o f 7
and 4 ou t o f 7 p la n s p r o v i d e d s u r g i c a l and m e d i c a l b e n e f i t s , r e s p e c t i v e l y .

F o r t h is a n a l y s is , b e n e fit s a v a ila b le to the w ork er r e tirin g at a g e 65 w ere c o m p a r e d w ith t h o s e a v a il a b l e to him im m e d ia te ly p r io r to
re tire m e n t ( i . e . , at a ge 6 4 ). It is s u b s e q u e n t ly n o te d (t a b le A -1 3 ) that b e n e fit s f o r the m l i v e w o rk e r m ay h a v e b e e n r e d u c e d a s he r e a c h e d
a c e r t a in a d v a n c e d a g e .







TABLE A - 7 .— Health and in su ran ce plans: B en efits provided r e tir e d w o r k e rs by m ethod of fin an cin g, late 1 95 5
(x in d icates b en e fits provided under the plans; d a s h e s, no b e n e fits p rovided)
B en efits provided
A ccid en ta l
death
L ife
H ospital
and
in su ra n ce
d is m e m ­
b erm en t

P lan b en efits fo r r e tir e d w ork ers fin anced by 2 —

A ll plans extending
b en efits to
E m p loyer only
r e tir e d w ork ers

Su rgical M edical

W orkers
P lan s

N um ber
( 0 0 0 's )

E m p loyer and a c ­ E m p loyer and r e ­
tive w orker
tir e d w orker
W orkers
W orkers
W orkers
P la n s
P lan s
(0 0 0 * s)
(0 0 0 « s )
( 0 0 0 's )

R e tir ed w orker
only
W orkers
P lan s
( 0 0 0 1 s)

O ther
W orkers
P la n s
(0 0 0 's )

155
X
X
X
X

_

-

-

X
X
X
X
X
X

X
~

-

-

-

X

X

X

-

X

-

_
X

X
X
X
X
X

X
_

_
X
X
X
X

3, 195

82

1 ,5 0 5

14

463

39

971

9

136

11

120

86
26
19
9
6
4
2
2
1

1 ,2 7 6
1 ,2 5 3
363
39
25
41
45
135
17

57
10
3
4
5
1

683
553
89
18
20
6

13
_

446
_

54
637
228
22
_
4
9

6
.

80
_

3
4
4
_
_

12
63
46
_

-

_

2

_

_

135
-

_
_
17

-

-

_

1

7
12
12
5
_
1
1

_

_

_

-

1

17

~

_

_

_
1
1
1

_
5
14
36

_

_

_

"

-

-

-

of 1 or m ore of the

A ll c o v er a g e data shown in th is study r e la te

A ccid en tal death and
d ism em b erm en t
b en efits
W orkers
W orkers
P lan s
( 0 0 0 f s)
( 0 0 0 's )

B en efit le v e l for r etir ed w orkers
P lan s
A ll plans extending b en efits to
r e tir e d w o rk ers ............. ........ .... _
B en efits for r e tir e d w orker:
S am e as for active w orker
b e fo r e r e t ir e m e n t _______________
L e s s than fo r a ctive w orker in
one or m o re r e s p e c ts ___________

H osp ital b e n e fits

S u rg ica l b en efits

P la n s

M ed ical ben efits

Wo rk ers

W orkers

P lan s

P lan s

W orkers
(00 0 «s)

(000« s)

( 0 0 0 ‘ s)
67

1 ,7 8 4

58

1 ,7 4 5

35

1 ,4 9 1

41

39

1 ,4 0 7

39

1 ,4 2 5

25

1 ,2 3 1

17

28

377

19

320

10

260

146

3 ,1 0 8

5

58

29

726

4

2 117

2 ,3 8 3

1

1 B a sed on a study of 300 health and in su ran ce plan s under c o lle c tiv e bargaining co v er in g a p p roxim ately 5 m illio n w o r k e rs.
2 Includes 8 plans which m aintained sam e le v e l of in su ra n ce on r e tir e m e n t fo r a s p e c ifie d p eriod only, e . g. , 1 y e a r .
NOTE: B eca u se of rounding, sum s of individual ite m s do not n e c e s s a r ily equal to t a ls .
la te to num ber of a ctive w orkers c o v ered by the p la n s. See footnote 3, p. 1.

re­

to num ber of a c tiv e

TABLE A - 8 . — Health and in su ran ce plans: B en efit le v e ls for w o rk ers r etir in g at age 65 com p ared with th ose
provided im m ed ia te ly b efore r e tir e m e n t, la te 1 9 5 5 1
L ife in su ran ce

_

_

1 B a se d on a study of 300 health and insurance plans under c o lle c tiv e bargaining co v erin g ap p roxim ately 5 m illio n w o r k e rs.
2 P la n s fo r the r etir ed w orker w ere c la s s ifie d as join tly fin an ced if the w orker (r e tir e d or a c tiv e )
contribu ted tow ard the c o s t
tired w o r k e r s ' b e n e fits or if the em ployer contributed only a part of the c o s t s of the b e n e fits.
NOTE: B ec a u se of rounding, sum s of individual ite m s do not n e c e s s a r ily equal to ta ls.
w o rk ers c o v er e d by the p la n s. See footnote 3, p. 1.

_

_

A ll c o v er a g e data shown in th is study

re­




TABLE A - 9 .— H ealth and insurance plans:
L ife ins urance
B en efits a v a ila b le

W orkers
Plans
(0 0 0 *s)

L ength of tim e b en efits ava ila b le to r e tir e d w o r k e r s , late 1955 1

A ccid en ta l death
and d is m e m b e r ­
m ent b en efits
W orkers
P lan s
(00 0*s)

H osp ital b en efits
P lans

S u rg ic a l b en e fits

W orkers

O

M ed ical b en efits

W orkers
P lan s

(00 0*s)

W orkers
P lan s

(0 0 0 *8 )

(000»s)

A il plans extending b en efits to
r e tir e d w o r k e r s --------------------

146

3 ,1 0 8

5

58

67

1 ,7 8 4

58

1, 745

35

1 ,4 9 1

F o r duration of r e tir e m e n t -------F o r sp e c ifie d p erio d ---------------

144
2

3 ,0 7 9
29

4
1

44
14

63
4

1, 747
37

54
4

1, 708
37

32
3

1 ,4 5 7
34

1 B a se d on a study of 3 00 health and insurance plans under c o lle c tiv e bargaining co v erin g a p p ro x im a tely 5 m illio n w o r k e r s .
NOTE: A ll c o v er a g e data shown in th is study rela te to num ber of a c tiv e w o r k e rs c o v er e d by the p la n s.

See footnote 3, p. 1.

TA BLE A - 1 0 . — H ealth and insurance plans: B en efits provided dependents of r e tir e d w o r k e r s by m ethod of fin ancing, la te 195 5 1
_______(x in d ica tes b en efits provided under the plans; d a sh e s, no b e n e fits p rovid ed )_____________________________
All plans extending
benefits to

B en efits provided
A ccid en ta l
death
L ife
and
H ospital
in su ra n ce
d is m e m ­
b erm en t

S u rgical

M edical

dependents to
r etired w ork ers
W orkers
Number
(0 0 0 *s)

Plan b en e fits for dependents of r e tir e d w o r k e rs fin anced b y * —
E m ployer only
W orkers
P lans
(0 0 0 * s )

E m p loyer and
a c tiv e w ork er
W orkers
P lan s
(0 0 0 * s )

56
-

-

X
X
X

X
X

X
-

1 ,7 2 9

18

6 57

1

31
17
8

1 ,3 4 6
344
38

11
4
3

559
87
11

1
-

_

17
17
-

*

E m p loyer and
r e tir e d w ork er
W orkers
Plans
(0 0 0 * s )

R etired w orker only
W orkers
P lan s
(0 0 0 *s )

11

1 04

26

950

6
5

52
52

13
8
5

717
205
27

1 B ased on a study of 3 0 0 h ealth and in su ran ce plans under c o lle c tiv e bargaining coverin g ap p ro x im a tely 5 m illio n w o r k e rs.
* P la n s fo r the dependents of the r etir ed w orkers w ere c la s s ifie d as jo in tly financed if the w ork er (a ctiv e or r e tir e d ) contributed tow ard the c o st of 1
or m o re of the b e n e fits for the r e tir e d w o r k e r l s dependents or if the em p loyer contributed only a p art of the c o st of the b e n e fits.
NOTE: B ec a u se of rounding, sum s of individual item s do not n e c e s s a r ily equal to ta ls.
w o r k e rs co v er e d by the p la n s.
See footnote 3, p. 1.

A ll c o v er a g e data show n in this study r e la te to num ber of a c tiv e

11

In a l m o s t a l l c a s e s , th e l e v e l o f b e n e f i t s p r o v i d e d d e p e n d e n t s o f r e t i r e d
w o r k e r s w a s i d e n t i c a l t o th a t f o r r e t i r e d w o r k e r s ( t a b l e A - 11),,
T h u s , b o t h th e
r e t i r e d w o r k e r an d h is d ep en d en ts u n d e r th o se p la n s exten d in g b e n e fit s g e n e r a lly
c o u l d e x p e c t th e s a m e trea tm en t,,
T A B L E A - l l . — H e a lth and in s u r a n c e p la n s: R e la tio n s h ip o f b e n e fit s p r o v id e d r e t ir e d
w o r k e r s and th e ir d e p e n d e n ts, la te 1 9 5 5 1
S u r g ic a l b e n e fits

H o s p ita l b e n e fits
B e n e f it le v e l fo r d e p e n d en ts
o f r e t ir e d w o r k e r

W orkers
P la n s

P la n s

P la n s

( 0 0 0 rs )

(00 0*s)

(00 0*s)
A ll p la n s e x te n d in g b e n e fit s to r e t ir e d
w o r k e r s 3.nd d e p e n d en ts .... -

M e d ic a l b e n e fit s

W o r k e rs

W o r k e rs

56

1 ,7 2 9

48

1 ,6 9 0

31

1 ,3 4 6

52

1, 7 02

47

1 ,6 8 7

28

1 ,3 2 3

4

-

27

1

3

3

23

B e n e fit le v e l fo r d ep e n d en ts:
L e s s th an fo r r e t ir e d w o r k e r in one

1 B a se d on a
5 m il lio n w o r k e r s .

stu d y o f 3 0 0 h e a lth and in s u r a n c e

N O T E: A ll c o v e r a g e
S e e fo o tn o te 3, p. 1.

data

sh o w n in th is

p la n s u n d er

stu d y r e la t e

c o lle c t iv e

to n u m b e r

b a r g a in in g

of a c t iv e

w orkers

c o v e r in g

a p p r o x im a te ly

c o v e r e d b y th e

p la n s .

A l a r g e r p r o p o r t i o n o f s i n g l e - e m p l o y e r p l a n s p r o v i d e d f o r th e e x t e n s i o n
o f in d iv id u a l b e n e fit s to d e p e n d e n ts o f a c t i v e w o r k e r s , and to r e t i r e d w o r k e r s and
t h e i r d e p e n d e n t s th a n d i d m u l t i e m p l o y e r p l a n s ( t a b l e A - 4 ) c
E lig ib ility R eq u irem en ts
A l t h o u g h e m p l o y e e p a r t i c i p a t i o n in m a n y p l a n s w a s a u t o m a t i c o r a c o n ­
d i t i o n o f e m p l o y m e n t , th e w o r k e r w a s g e n e r a l l y n o t c o v e r e d i m m e d i a t e l y u p o n
b e i n g h i r e d . 12
U s u a lly a s p e c i f i e d p e r i o d o f e m p l o y m e n t had to b e c o m p l e t e d
b e f o r e p lan c o v e r a g e w a s a v a i l a b l e . 1 * R e q u ir e d p e r io d s o f e m p lo y m e n t t o r plan
p a r t i c i p a t i o n w e r e e x p r e s s e d in t e r m s o f h o u r s , d a y s , w e e k s , o r m o n t h s .
For
th e p u r p o s e o f t h is s t u d y , a l l p e r i o d s w e r e c o n v e r t e d t o a m o n t h l y b a s i s w h e r e v e r
p o ssib le .
U n d e r the p la n s s tu d ie d , i f a w o r k e r p a r t i c i p a t e d a s s o o n a s h e w a s
e lig ib le , a p h y s ic a l e x a m in a tio n w as n ot r e q u ir e d .
H o w e v e r , i f th e w o r k e r d i d
n o t c h o o s e t o p a r t i c i p a t e a t th a t t i m e a n d l a t e r d e c i d e d t o d o s o , h e w a s u s u a l l y
s u b je c t to a p h y s ic a l e x a m in a tio n .
A l l p l a n s d i d n o t s p e c i f y th e s a m e p e r i o d o f e m p l o y m e n t t o q u a l i f y f o r
the v a r i o u s b e n e f i t s i n c l u d e d i n th e p l a n . A b o u t 1 o u t o f 5 p l a n s m a d e a d i s t i n c t i o n
in th e r e q u i r e m e n t s f o r v a r i o u s b e n e f i t s .
In v i r t u a l l y a l l p l a n s w h e r e t h is d i s ­
tin ction w a s m a d e , d iffe r e n t e m p lo y m e n t p e r io d s w e r e r e q u ir e d f o r life in s u r a n c e
a n d a c c i d e n t a n d s i c k n e s s b e n e f i t s th a n w e r e r e q u i r e d f o r h o s p i t a l , s u r g i c a l , a n d
m e d i c a l b e n e f i t s ; u s u a l l y a s h o r t e r p e r i o d o f e m p l o y m e n t w a s r e q u i r e d f o r the
la tte r b e n e fit s .

12 Under plans to which the worker is required to contribute, he is often given the choice of whether he desires to participate or not;
under some contributory plans, however, this choice is preempted by the provisions of the plan agreement and participation becomes a con­
dition of employment, i. e., automatic.
Eligibility requirements as discussed in this section refer only to the period of employment required of the worker before he is eligible
to participate in the plan. Under some plans, further requirements are necessary to receive certain benefits. For example, a waiting period
may be specified for the receipt of accident and sick ness benefits, and maternity benefits may not be available until the member has been
covered for 9 months or more. These requirements are discussed in subsequent sections of this study.
In addition to specifying an employment requirement, a few plans also required a period of union membership. This period rarely ex­
ceeded the employment requirement.




12

A l t h o u g h th e e m p l o y m e n t r e q u i r e m e n t s t o p a r t i c i p a t e in th e p l a n s r a n g e d
f r o m n o n e ( c o v e r e d i m m e d i a t e l y u p o n h i r e ) t o o v e r 12 m o n t h s , a l a r g e m a j o r i t y
o f the p l a n s , c o v e r i n g a s t i l l l a r g e r p r o p o r t i o n o f w o r k e r s i n th e s t u d y , r e q u i r e d
l e s s th a n 4 m o n t h s 1 e m p l o y m e n t f o r p l a n p a r t i c i p a t i o n ( t a b l e A - 1 2 ).
T h e h e a lth and i n s u r a n c e p la n s r a r e l y r e q u i r e d a w o r k e r to a tta in a c e r ­
t a i n a g e b e f o r e h e c o u l d p a r t i c i p a t e in th e p l a n .
T o th e e x t e n t th a t s u c h a g e s
w e r e s p e c i f i e d , th e y w e r e g e n e r a l l y s o lo w that fe w o r n o w o r k e r s w e r e l i k e l y
to b e a f f e c t e d . H o w e v e r , an im p o r t a n t a s p e c t o f p la n e li g ib il it y , p a r t i c u l a r l y f r o m
the v i e w p o i n t o f th e n e w l y h i r e d o l d e r w o r k e r , i s w h e t h e r a d v a n c e d a g e i s a b a r r i e r
to q u a lif ic a t i o n f o r p la n p a r t i c i p a t i o n .
T h is a s p e c t is d i s c u s s e d b e l o w .

E ffect of A g e

on B en efits

for

W orkers

A n o u tsta n d in g c h a r a c t e r i s t i c of h ea lth and in s u r a n c e p lan s u n d e r c o l l e c ­
t i v e b a r g a i n i n g , i n s o f a r a s th e o l d e r w o r k e r i s c o n c e r n e d , i s the g e n e r a l a b s e n c e
o f p r o v i s i o n s b a r r i n g th e p a r t i c i p a t i o n o f o l d e r w o r k e r s , w h e t h e r n e w l y h i r e d o r
lon g e m p lo y e d .
O n l y 3 p l a n s d i s c o n t i n u e d 1 o r m o r e b e n e f i t s f o r th e e m p l o y e d
w o r k e r a t a c e r t a i n a g e a n d e a c h a p p l i e d th e b a n t o w o r k e r s a t 65 y e a r s o r o l d e r
(ta b le A - 13). A s li g h t ly l a r g e r n u m b e r o f p la n s ( l l ) w ith h e ld c o v e r a g e u n d e r 1 o r
m o r e b e n e f i t s f r o m w o r k e r s h i r e d a f t e r a s p e c i f i e d a g e ( t a b l e A - 1 4 ).
R e d u c t i o n s i n th e a m o u n t o f b e n e f i t s , d u r a t i o n , o r o t h e r m o d i f i c a t i o n s
b a s e d on a g e a lo n e w e r e m o r e c o m m o n . W h e r e s u ch lim it a tio n s o c c u r r e d , they
w e r e u s u a l l y a t a g e 60 o r 65 ( t a b l e A - 1 3 ) .
F o r e x a m p l e , 17 p l a n s r e d u c e d the
a m o u n t o f l i f e i n s u r a n c e in e f f e c t f o r a c t i v e w o r k e r s a t a g e 6 5 . E i g h t p l a n s r e ­
d u ced m e d i c a l b e n e fit s at age 60.
R e d u ctio n o f b e n e fits w as m o s t fre q u e n t fo r a c c id e n t and s ic k n e s s c o v ­
erage.
A b o u t a f o u r t h o f th e p l a n s , c o v e r i n g s l i g h t l y m o r e th a n a t e n t h o f th e
w o r k e r s r e c e i v i n g a c c i d e n t and s ic k n e s s b e n e f it s , had a g e r e s t r i c t i o n s . W ith one
e x c e p t i o n , th e p l a n s w i t h a g e r e s t r i c t i o n s s p e c i f i e d a g e 60 a s the t i m e w h e n a c ­
cid e n t and s ic k n e s s b e n e fits w e r e r e d u c e d .
T h e r e d u c t i o n o r l i m i t a t i o n s a p p l i c a b l e to e m p l o y e d o l d e r w o r k e r s a l s o
a p p l i e d t o n e w l y h i r e d o l d e r w o r k e r s . In a d d i t i o n , s o m e p l a n s r e d u c e d o r e l i m ­
in ated c o v e r a g e f o r n ew w o r k e r s on ly .
T h e c o m b i n e d e f f e c t o f th e t w o t y p e s o f
r e s t r i c t i o n s is s h o w n in t a b l e A - 1 4 . C o n s i d e r i n g th e n a t u r e o f s o m e o f th e r e ­
d u c t i o n s a n d th e a g e s a t w h i c h t h e y w e r e e f f e c t i v e , th e i m p a c t o f a g e d i f f e r e n t i a ­
t i o n o n th e n e w l y h i r e d w o r k e r s e e m e d , o n th e w h o l e , t o b e r e l a t i v e l y m i n o r .

V a r i a t i o n in A m o u n t o f B e n e f i t s

B ased

o n S e x 14

W o m e n w o r k e r s , e x c e p t i n m a t e r n i t y c a s e s , w e r e g e n e r a l l y a s s u r e d the
s a m e l e v e l o f b e n e f i t s a s m e n u n d e r th e p l a n s s t u d i e d ( t a b l e A - 1 5 ).
U n d e r th e
r e l a t i v e l y fe w p la n s m a k in g a d is t in c t io n (2 2 ), a c c i d e n t and s i c k n e s s and l i f e i n ­
s u r a n c e b e n e f i t s w e r e m a i n l y i n v o l v e d . N o v a r i a t i o n e x i s t e d in s u r g i c a l a n d m e d i ­
cal b en e fits.
F in a n cin g
A m a j o r i t y o f th e p l a n s p r o v i d e d th a t a l l b e n e f i t s f o r a c t i v e w o r k e r s w e r e
t o b e p a i d f o r e n t i r e l y b y th e e m p l o y e r .
H o w e v e r , in t e r m s o f the n u m b e r o f
w o r k e r s c o v e r e d , s l i g h t l y m o r e th a n h a l f w e r e u n d e r j o i n t l y f i n a n c e d p r o g r a m s
14

Maternity care benefits provided under accident and sick ness, hospital, surgical, and medical provisions of these plans are discussed
in a separate section of this study.







TABLE A - 1 2 .— Health and insurance plans:

(000‘ s)

Accidental death
and dism em ber­
ment benefits
Workers
Plans
(000*s)

Life insurance
Eligibility requirements

Workers
Plans

Eligibility requirements by type of benefit, late 1955
Accident and sick ­
ness benefits

Hospital benefits

Workers
Plans
(00Q‘ s)

(000‘ s )

(000‘ s)

(000‘ s )

Medical benefits

Workers
Plans

Plans

Plans

Surgical benefits

Workers

Workers

A ll plans providing benefits ----------

284

4,352

154

2 ,2 5 0

239

3, 695

*299

4 ,9 7 2

*300

4,981

3 197

3, 707

After employment for:
Less than 1 month -------------------1 and less than 2 months ---------2 and less than 3 months ---------3 and less than 4 months ---------4 and less than 5 months ---------6 and less than 7 months ---------8 and less than 9 m o n th s ---------12 and less than 13 months ------

59
34
19
65
7
36
1
11

1,494
261
111
553
88
520
6
92

32
19
14
33
4
13
1
2

541
146
75
339
65
81
6
7

54
35
21
55
6
11
1
3

986
651
114
502
53
171
6
20

68
39
21
58
6
31
1
5

1 ,4 6 8
326
108
558
77
547
6
62

68
39
20
60
6
32
1
5

1,4 6 8
277
106
569
77
597
6
62

45
23
10
40
2
21
1
2

860
176
54
376
44
562
6
42

F irst of month following com ­
pletion of employment for:
Less than 1 month -------------------1 and less than 2 months ---------2 and less than 3 months----------3 and less than 4 m onths----------4 and less than 5 months----------5 and less than 6 months----------6 and less than 7 m o n th s ----------

2
18
4
7
1
1
6

13
293
546
43
3
125
11

2
11
5
6
1

13
250
557
34
3

31
370
1 ,0 9 7
43
14

3
28
7
8
2

31
370
1 ,0 9 7
43
14

-

-

-

-

-

-

3

20
334
555
41
3
125
7

3
28
7
8
2

2

2
21
4
6
1
1
4

8

56

7

55

3
20
5
5
1
7

31
329
960
23
11
55

Othe r ------------------------------------------------

13

192

9

130

8

106

14

209

14

209

12

178

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 m illion workers.
* Includes 6 plans which provided benefits for dependents but not for w orkers.
3 Includes 4 plans which provided benefits for dependents but not for w orkers.
NOTE:

Because of rounding, sums of individual items do not necessarily equal totals.




T A B L E A - 1 3 .— Health and in su ra n ce p lan s:

L ife in su ra n ce
P r o v is io n

W ork ers
Plans
(000*8)

M aintenance o f b e n e fits f o r a ctiv e w o r k e r s , late 1955

A ccid e n ta l death
and d is m e m b e r ­
m ent b e n efits
W o rk e rs
Plans
(000*s)

A ccid e n t and s ic k ­
n ess b e n e fits

H ospita l b e n e fits

W o rk e rs
Plans

Plans

S u rg ic a l b e n e fits

W o rk e rs

(000*s)

M e d ica l b en efits

W o rk e rs
Plans

W o rk e rs
Plans

(000*s)

(000*8)

(000*8)

A ll plans p rov id in g b en efits
fo r a ctiv e w o r k e rs -----------------------

284

4 ,3 5 2

154

2 ,2 5 0

a237

3 ,6 7 5

293

4 ,9 0 8

294

4 ,9 1 7

193

3 ,6 8 3

M aintained at con stant le v e l
w ithout re g a r d to a g e -------------------

264

3 ,5 8 8

153

2 ,2 4 3

182

3 ,2 5 7

287

4, 665

290

4, 711

184

3 ,5 2 0

_

_
-

54
53

414
401
13
-

R ed u ced at s p e c ifie d age --------------A ge 60 ----------------------------------------A ge 65 -----------------------------------------A ge 66 ----------------------------------------A ge 68 ----------------------------------------A ge 70 ------------------------------------------

19
17

761
752

-

7
-

D iscontinued at s p e c ifie d a ge ------A ge 65 -----------------------------------------A ge 68 -----------------------------------------A ge 70 ------------------------------------------

1
1

1
1

-

2

3
3
-

-

1
-

1

7
7

1

-

1
-

1

5
5

6
1
2

1
200

1
2

3

42

-

-

-

5
5

_

_

-

-

243

3

_

_

1

-

-

-

1

B ased on a study o f 300 health and in su ra n ce plans under c o lle c t iv e b arga in in g co v e r in g a p p ro x im a te ly 5 m illio n w o r k e r s .
E xclu d es 2 plans p rov id in g on ly fo r occu p ation a l d isa b ility b e n e fits .
N OTE:

B eca u se o f rou nding, sum s of individual item s do not n e c e s s a r ily equal to ta ls.

201
1
200

9

8
1

163
43

120
-




T A B L E A - 1 4 .— Health and in su ra n ce p la n s:

E ffe c t o f age at h irin g on a v a ila b ility o r le v e l o f b e n e fits f o r a ctiv e w o r k e r s , late 1955

L ife in s u ra n ce
P r o v is io n

W o rk e rs
Plans
(0 00 *s)

A ll plans p ro v id in g b e n e fits fo r a ctiv e
w o r k e r s -----------------------------------------------

A ccid e n t and s ic k ­
n e ss b e n e fits

H o sp ita l b e n e fits

S u rg ic a l b en efits

W o rk e rs

W ork ers

(000*8)

(0 0 0 ‘ s)

W o rk e rs
Plans

P lans

Plans

Plans

M e d ica l b en efits

W o rk e rs
(0 00 *s)

(000*s)

284

4 ,3 52

154

2 ,2 5 0

*237

3 ,6 7 5

293

4 ,9 0 8

294

4 ,9 1 7

193

3 ,6 8 3

252

A v a ila b ility o r le v e l o f b en efit not a ffe cte d
b y age at h irin g -----------------------------------------------R ed u ced b e n e fit p ro v id e d if h ired a fte r age —

3 ,3 3 0
649
35
53
552

148
4
-

1 ,8 0 3
25
_

2, 770

4 , 628
280
3 38

288
4
3 2

4, 673
238
3 38

3 ,4 8 2

16

286
7
3 2

182

2
2

179
56
3 54

3
_

42
-

-

6
-

-

-

1

1

1

1

-

-

-

-

■

5
•

21
1

60 ---------------------------------------------------- ----------- ----65 --------------------------------------------------------------------66 --------------------------------------------------------------------68 --------------------------------------------------------------------7 0 ---------------------- ---------------------------------------------B en efit not a v a ila b le if h ire d a fter a g e ----------50 ---------------------------------------------------------------------

O ther --------------------------------------------------------------------

A ccid e n ta l death
and d is m e m b e r ­
m ent b e n e fits
W orke rs
Plans
(000*s)

3
15

1
1
.
7

1

4

3
3
4

2

7
_
225

10
12

203
_
.
148

-

2
-

1
I
_

2

9
_
422
415
7
-

-

2
-

1
-

1
■

866

3

438
428
_
40
35
5
“

1

200

2

B ased on a study of 300 health and in su ra n ce plans under c o lle c t iv e b a rg a in in g c o v e r in g a p p ro x im a te ly
E xclu d es 2 plans p rov id in g only fo r o ccu p a tio n a l d is a b ility b e n e fits .
In clu des 1 plan c o v e r in g 37, 000 w o r k e rs w hich p ro v id e s a re d u ce d am ount o f in su ra n ce if h ire d a fte r
a ft e r , sa m e b en efits a r e p ro v id e d as f o r em p loy ee h ir e d p r i o r to age 60.
4 In clu des 2 plans co v e rin g 135, 000 w o rk e rs p r o v id in g a re d u ce d am ount o f in su ra n ce to w o r k e r s
c o v e r in g 1 3 ,0 0 0 w o r k e r s that do not p ro v id e life in su ra n ce to w o r k e rs b e co m in g union m e m b e rs at age 56 o r

2

200

2

1
*

10

3

9

1

200

3

80

120

-

-

1

1

-

5 m illio n w o r k e r s .

*

3

N O TE :

b e c o m in g
la te r .

un ion m e m b e r s

Life in su ra n ce
P r o v is io n

W o rk e rs
Plans
(0 00 *s)

55 and 2 plans

284

4 ,3 5 2

154

No v a ria tio n in am ount ------------------------------------V a r ia tio n in am ount -----------------------------------------

2 73

4 ,2 4 0

151
3

1
1

112

V a ria tio n in am ount o f b e n e fits b a s e d on s e x , late 1955 1

A ccid e n ta l death
and d is m e m b e r ­
m ent b e n e fits
W o rk e rs
Plans
(000*s)

A ll plans p ro v id in g b e n e fits -----------------------------

A ccid e n t and s ic k ­
n e ss b e n e fits

H o s p ita liz a tio n

P lans

*237

3 ,6 7 5

2 ,2 2 9

224
13

3 ,4 8 4
192

21

B eca u se of rou nding, sum s o f individual ite m s do not n e c e s s a r ily equal to ta ls.

M e d ica l

W o rk e rs
P lans

(0 00 *s)

(000*s)

2 ,2 5 0

S u rg ica l

W o rk e rs

‘W o rk e rs
Plans

W o rk e rs
Plans

(0 0 0 's )

(000*s)

293

4 ,9 0 8

294

4 ,9 1 7

193

3 ,6 8 3

291

4 , 883
25

294
“

4 ,9 1 7

193

3, 683
■

2

B ased on a study of 300 health and in su ra n ce plans un d er c o lle c t iv e b a rg a in in g co v e r in g a p p ro x im a te ly 5 m illio n w o r k e r s .
E x clu d es 2 plans p rov id in g b en efit on ly fo r occu p a tio n a l d is a b ilit ie s .

N O TE :

a fte r age

T here­

B eca u se o f rou nd ing, sum s o f individual ite m s do not n e c e s s a r ily equal to ta ls.

T A B L E A - 1 5 . — -Health and in s u ra n ce p lan s:

3

age 60 f o r f i r s t 36 m onths o f em p loy m en t.

16
(t a b l e A - 3 ) . S o l e l y i n t e r m s o f th e s c o p e o f th e p l a n s a n d n o t the l e v e l o f b e n e ­
f i t s , th e p r o v i s i o n f o r w o r k e r c o n t r i b u t i o n s w a s a p p a r e n t l y n o t a m a j o r f a c t o r i n
d e t e r m i n i n g th e n u m b e r o f b e n e f i t s p r o v i d e d f o r a c t i v e w o r k e r s .
E m p lo y e r f i ­
n a n c i n g w a s p r e d o m i n a n t in t h o s e p l a n s i n c l u d i n g f i v e o r m o r e b e n e f i t s .

U n d e r m o s t p l a n s c o v e r i n g th e d e p e n d e n t s o f a c t i v e w o r k e r s , th e e m ­
p l o y e r p a i d a l l o r a p a r t o f th e c o s t o f p r o v i d i n g t h e s e b e n e f i t s ( t a b l e A - 5 ). L e s s
th a n 1 o u t o f 5 p l a n s f o r d e p e n d e n t s w a s f i n a n c e d e n t i r e l y b y the w o r k e r . S i m i l a r
t o p l a n s c o v e r i n g th e w o r k e r , t h e r e w a s l i t t l e e v i d e n c e th a t the m e t h o d o f f i n a n c ­
in g d e t e r m i n e d th e s c o p e o f th e p l a n ( n u m b e r o f b e n e f i t s p r o v i d e d ) .

W h e n p l a n s c o v e r i n g th e w o r k e r w e r e e m p l o y e r f i n a n c e d , the b e n e f i t s e x ­
t e n d e d to h i s d e p e n d e n t s w e r e , in m o s t c a s e s , a l s o e m p l o y e r f i n a n c e d ( t a b l e A - 1 6 ) .
A s i m i l a r r e l a t i o n s h i p a l s o e x i s t e d i n t h o s e i n s t a n c e s w h e r e the p l a n s f o r a c t i v e
w o r k e r s w e r e jo in tly fin a n ced .

T A B L E A - 1 6 .— H e a lth and in s u r a n c e p la n s : R e la t io n s h ip o f m e th o d o f fin a n c in g
p la n a s a w h o le f o r a c t iv e w o r k e r s and p la n f o r t h s ir d e p e n d e n t s , la te 1955
M e th o d o f fin a n c in g p la n a s a w h o le
f o r a c t iv e w o r k e r s and d e p e n d e n ts 1

fc
l1

___

W ork ers
P la n s
(0 0 0 * s)
300

P la n f o r a c t iv e w o r k e r s fin a n c e d b y e m p lo y e r -------------------------------------------P la n f o r d ep e n d e n ts fin a n c e d : B y e m p l o y e r -------------------------------------------B y e m p lo y e r and w o r k e r ---------------------B y w o r k e r ------------ -----------------------------------D e p e n d e n ts * b e n e fit s n o t p r o v id e d --------------------------------------------------------------P la n f o r a c t iv e w o r k e r f in a n c e d b y e m p lo y e r and w o r k e r -----------------------P la n f o r d e p e n d e n ts fin a n c e d : B y e m p l o y e r -------------------------------------------B y e m p lo y e r and w o r k e r ---------------------B y w o r k e r -----------------------------------------------D ep e n d e n ts * b e n e fit s n o t p r o v id e d --------------------------------------------------------------

4 , 981

162
107
5
31
19
138
13
103

2 ,2 4 4
1 ,6 6 4
43
346

20
2

192
2 , 738
57
1 ,9 9 2
186
503

1 P la n s f o r the a c t iv e w o r k e r o r t h e ir d e p e n d e n ts w e r e c l a s s i f i e d a s jo in t l y fin a n c e d
i f the w o r k e r c o n tr ib u t e d t o w a r d the c o s t o f 1 o r m o r e o f the b e n e fits f o r the g r o u p s p e c i ­
f i e d o r i f the e m p lo y e r c o n tr ib u t e d o n ly a p a r t o f the c o s t o f the b e n e f i t s .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
A i l c o v e r a g e d ata s h o w n in this stu d y r e la t e to n u m b e r o f a c t iv e w o r k e r s c o v e r e d b y the
p la n s .
S ee fo o t n o t e 3, p . 1.

E a c h o f th e
b y th e e m p l o y e r i n
j o r i t y o f c a s e s , th e
en tire c o s t o f e a c h
in su ra n ce ).

in d iv id u a l b e n e fits p r o v id e d a c tiv e w o r k e r s w as fin a n ce d s o le l y
the m a j o r i t y o f c a s e s ( t a b l e A - 1 7 ).
In c o n t r a s t , in th e m a ­
w o r k e r e i t h e r s h a r e d the c o s t w i t h th e e m p l o y e r o r p a i d the
b e n e f i t e x t e n d e d to h i s d e p e n d e n t s ( w it h the e x c e p t i o n o f l i f e

U n d e r m o s t p l a n s e x t e n d i n g c o v e r a g e to r e t i r e d w o r k e r s a n d to t h e i r
d e p e n d e n t s , th e e m p l o y e r c a r r i e d a l l o r p a r t o f th e c o s t o f p r o v i d i n g t h e s e p l a n s
( t a b l e s A - 7 a n d A - 1 0 ). In v i r t u a l l y a l l c a s e s w h e r e b e n e f i t s c o v e r i n g th e r e t i r e d
w o r k e r w e r e e m p l o y e r f i n a n c e d , b e n e f i t s e x t e n d e d to h i s d e p e n d e n t s w e r e a l s o
e m p l o y e r f i n a n c e d ( t a b l e A - 1 8 ) . H o w e v e r , w h e r e the r e t i r e d w o r k e r c o n t r i b u t e d
t o w a r d h i s b e n e f i t s , h e p a i d the e n t i r e c o s t o f the b e n e f i t s e x t e n d e d to h i s d e ­
p e n d e n t s in th e l a r g e m a j o r i t y o f th e c a s e s . W i t h the e x c e p t i o n o f
life in s u r ­
a n c e f o r th e r e t i r e d w o r k e r , l e s s th a n h a l f o f the p l a n s r e q u i r e d the e m p l o y e r
to b e a r the e n t i r e c o s t o f th e i n d i v i d u a l b e n e f i t s p r o v i d e d the r e t i r e d w o r k e r a n d




Method of financing individual benefits for active workers and their dependents, late 1955
Active workers

Life insurance
Workers
Plans
(000 *s)

Weekly accident and
sickness benefits

Hospital benefits

Plans

Plans
(000*s)

Medical benefits

Workers

Workers

Workers
Plans

Surgical benefits

Workers
Plans
(0 0 0 's )

o
o
o

Method of financing benefits

Accidental death
and dism em ber­
ment benefits
Workers
Plans
( 0 0 0 's)

C
D
O
o
o




TABLE A - 1 7 .— Health and insurance plans:

A ll plans providing benefits ----------

284

4, 352

154

2 ,2 5 0

239

3 ,6 9 5

293

4, 908

294

4, 917

193

3, 683

Employer only -------------------------------Employer and worker ------------------___________
Worker o n l y ________

167
117
"

2,248
2,105
-

106
48
-

1, 120
1, 129
-

136
94
9

1,693
1,933
69

83
109
1

2 ,3 6 3
2 ,5 3 2
13

185
108
1

2 ,3 9 3
2 ,5 1 1
13

127
64
2

1 ,8 4 6
1,811
28

Dependents of active workers
Hospital benefits

Life insurance

Surgical benefits

Medical benefits

A ll plans providing benefits — -------

7

215

278

4, 279

263

4, 190

145

2, 774

Employer only _______________________
Employer and w o rk e r----------------------Worker only _________________________

5
2
-

191
24
“

122
107
49

1 ,7 4 4
2 ,0 0 7
529

110
103
50

1 ,642
2 ,0 0 7
541

63
57
25

1,161
1,2 8 7
327

—

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 m illion w orkers.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals.
workers covered by the plans.
See footnote 3, p. 1.

All coverage data shown in this study relate to number of active

18

his dependents (table A - 19).
Although a substantial proportion of the plans r e ­
quired the retired w orker to pay the entire cost of hosp ital, s u rg ic a l, and m ed ical
benefits if he wished to continue coverage fo r h im se lf and his dependents, the
retired w orker gained the advantage of gro u p -rate participation which otherw ise
would not have been available to h im .

T A B L E A - 1 8 .— H e a lth a n d i n s u r a n c e p la n s : R e la t io n s h ip o f m e th o d o f fin a n c in g p la n a s a w h o le f o r r e t i r e d
w o r k e r s an d p la n f o r t h e ir d e p e n d e n t s , la te 1955 1
W orkers

M e th o d o f fin a n c in g p la n a s a w h o le f o r
r e t i r e d w o r k e r s and d e p e n d e n ts *

P la n s

A l l p la n s e x te n d in g b e n e fit s to r e t i r e d w o r k e r s ----------------------------------------------------------------

155.

3 ,1 9 5

P la n f o r r e t i r e d w o r k e r fin a n c e d b y e m p l o y e r ----------------------------------------- -----------------------P la n f o r d e p e n d e n ts fin a n c e d : B y e m p l o y e r ------------------;----------------------------------------------B y r e t i r e d w o r k e r o n l y ---------------------------------------------D e p e n d e n ts 1 b e n e fit s n o t p r o v i d e d -----------------------------------------------------------------------------------P la n f o r r e t i r e d w o r k e r fin a n c e d b y e m p lo y e r and a c t iv e w o r k e r -----------------------------P la n f o r d e p e n d e n ts fin a n c e d ; B y e m p lo y e r and a c t iv e w o r k e r -----------------------------D ep e n d e n ts * b e n e fit s n o t p r o v i d e d ------------------------------------------------------------------------------------*
P la n f o r r e t i r e d w o r k e r fin a n c e d b y e m p lo y e r and r e t i r e d w o r k e r ----------------------------P la n f o r d e p e n d e n ts fin a n c e d : B y e m p lo y e r and r e t i r e d w o r k e r ---------------------------B y r e t i r e d w o r k e r -----------------------------------------------------D e p e n d e n ts 1 b e n e fit s n o t p r o v i d e d -----------------------------------------------------------------------------------P la n f o r r e t i r e d w o r k e r fin a n c e d b y r e t i r e d w o r k e r -------------------------------------------------------P la n f o r d e p e n d e n ts fin a n c e d : B y r e t i r e d w o r k e r -----------------------------------------------------D e p en d en ts * b e n e fit s n o t p r o v i d e d -----------------------------------------------------------------------------------P la n f o r r e t i r e d w o r k e r fin a n c e d b y m e th o d o t h e r than th o s e s p e c i f i e d -------------------D ep en d en ts* b e n e fit s fin a n c e d : B y e m p lo y e r and r e t i r e d w o r k e r -------------------------B y r e t i r e d w o r k e r o n l y -------------------------------------------D e p e n d e n ts * b e n e fit s n o t p r o v id e d ----------------------------------------------------------------------------------

82
18

1, 505
657
7
841
463
17
446
971
95
805
71
136
55
81

1 B a s e d o n a stu d y o f
5 m il l i o n w o r k e r s .
2 P la n s f o r the r e t i r e d
o r a c t iv e ) c o n tr ib u t e d t o w a r d
c o n tr ib u t e d o n ly a p a r t o f the

300

h e a lth

and

in s u r a n c e p la n s

(0 0 0 * s )

un der

c o lle c t iv e

1
63
14

1
13
39
9
19

11
9
3

6
11
2

120
9
82
28

3

6
b a r g a in in g

c o v e r in g

a p p r o x im a t e ly

w o r k e r s o r t h e ir d e p e n d e n ts w e r e c l a s s i f i e d a s jo in t ly fin a n c e d if the w o r k e r ( r e t i r e d
th e c o s t o f 1 o r m o r e o f the b e n e fit s f o r the g r o u p s p e c i f i e d o r i f th e e m p lo y e r
c o s t s o f the b e n e f i t s .

N O T E : B e c a u s e o f ro u n d in g , s u m s o f in d iv id u a l i t e m s d o not n e c e s s a r i l y e q u a l t o t a l s .
s h ow n in t h is stu d y r e la t e t o n u m b e r o f a c t iv e w o r k e r s c o v e r e d b y th e p la n s .
See fo o t n o t e 3,

A ll c o v e r a g e
p . 1.

da ta

Significantly, under 16 life insurance plans covering a lm o st a half m illion
w o rk e rs, the em ployer and the active w orker shared the cost of the insurance
which becam e available to the w orker on retirem en t without further contribution
on his p art.
This provision m ay re flec t an aw areness of w orkers that, if they
are to contribute to the cost of health and insurance ben efits, it m ay be e a sie r
to pay while they are a ctiv ely em ployed fo r the benefits they w ish to receiv e in
a retired status.







T A B L E A - 1 9 .— Health and in su ra n ce p lan s:

M ethod o f fin a n cin g individ u a l b e n e fits fo r r e t ir e d w o r k e r s and th e ir d e p en d en ts, la te 1955
R e tir e d w o r k e r s

M ethod o f fin a n cin g ben efits

L ife in su ra n ce
W o rk e rs
Plans
(000*s)

A ll plans extending b e n e f i t s ____

___________

Employer only
_ ... .....
E m p lo y e r and r e t ir e d w o r k e r _ _______ _ ___
E m p loy er and a ctiv e w o r k e r __ ________________
R e tire d w o r k e r o n l y ___________________________
O ther
__ ____________ __ _____ _______________

A ccid e n ta l death
and d is m e m b e r ­
m ent b en efits
W o rk e rs
P lans
(000‘ s)

H osp ita l b e n efits

S u rg ic a l b e n e fits

W o rk e rs
(000*s)

3, 108

5

58

67

1 ,7 8 4

58

1 ,7 4 5

97

2, 295
128
495
94
96

2
1

10

29
14

746
119
17
902

22

713
118
17

16
7

10

1

17
17
14

1
23

(000*s)

(000*8)

146

16

W o rk e rs
P lans

P lans

P la n s

M e d ica l ben efits

W o rk e rs

13

1
22

896

35

16
6
1
12

1,491
744
52
17
678

D ependents of r e t ir e d w o r k e rs

A ll plans extending b en efits ______________________

56

1 ,7 2 9

E m p lo y e r on ly
_ ________________________________
E m p lo y e r and r e t ir e d w o r k e r -----------------------------E m p lo y e r and a ctiv e w o r k e r _____________________
R e tire d w o r k e r o n l y ______________________________
Other
_
__

1
1
1
26

18

657
104
17
950

1

_

48

1 ,6 9 0

15

647
104
17
922

13

_

_

_

1
1
1
21

31

1
1
6
1

1 ,3 4 6

559
52
17
717
_

B a sed on a study o f 300 health and in su ra n ce plans under c o lle c t iv e barga in in g c o v e r in g a p p ro x im a te ly 5 m illio n w o r k e r s .

N O TE : B e ca u s e o f rou nding, sum s o f individual ite m s do not n e c e s s a r ily equal to ta ls.
c o v e r e d by the plan s. See footnote 3, p. 1.

A ll c o v e r a g e data show n in this study re la te to nu m ber o f a ctiv e w o r k e rs




21

Life Insurance

N in ety -five percen t (284) of the plans studied provided life insurance fo r
the active w ork er. This benefit provided both o n -th e -jo b and o ff-th e -jo b coverage
fo r the w o rk er.

In m o st c a s e s , the type of insurance provided was group te rm , with no
cash su rren d er, p aid -u p , or other nonforfeitable fe a tu res. Some plan s, how ever,
m ade available insurance with paid-up or cash surrender values payable to w orkers
upon term ination of em ploym ent in addition to or in lieu of group term insu rance.
A few p la n s, which for the purpose of this study were considered as having a
life insurance benefit, provided a cash benefit s e lf-in s u re d by the em ployer or
fund to which the em ployer contributed; com m only this was re fe rre d to as a
"fu n e r a l" or "d e a th " benefit.

Benefits fo r A ctive W orkers

B asis for D eterm ining Amount of In suran ce. — The amount of life insurance
provided was either a flat or uniform amount (the sam e amount applied to ail
w ork ers
re g a rd le ss of earnings or length of se rv ice le v e ls ); an amount grad­
uated according to such factors as earnin gs, s e r v ic e , union m em b ersh ip , e t c .;
o r , in a few c a s e s ,
a combination of a flat amount plus a graduated amount
(table B - l ) .
While considerably m ore plans (177 of the 284 plans) were of
the fla t-p a y m en t type, a slightly la rg er number of w orkers w ere covered by
plans providing a graduated amount than w ere covered by flat-p aym en t plan s.
Only 3 pla n s, covering approxim ately 9 , 000 w o rk e rs, stipulated a different ba sis
fo r determ ining the amount of insurance available to m en and women w o rk e rs.

T A B L E B - l . — L ife in s u r a n c e :

B a s i s o f d e t e r m in in g a m o u n t b y typ e o f b a r g a in in g unit, la te 1955
T y p e o f b a r g a in in g unit
A ll p lan s
S in gle e m p lo y e r

B a s i s o f d e t e r m in in g a m ou n t
W o rk e r s
P la n s

P la n s
( 0 0 0 's )

300

4 , 981

200

2,

P la n s p r o v id in g l i fe in s u r a n c e ___________________
F la t a m o u n t
.
__
G r a d u a t e d ___________________________________________
E a r n in g s 1 _
S e r v i c e __________________________________________
L e n g th o f u n ion m e m b e r s h ip
S e r v i c e and e a r n in g s _
O th er
F la t a m ou n t p lu s am ou n t g r a d u a te d a c ­
c o r d in g to e a r n in g s o r s e r v i c e 2

284
177

4,
2,
2,
1,

193
98
90
72

4
7
4

352
000
289
922
52
148
84
83

5

64

5

75

12

W ork ers
P la n s
( 0 0 0 's )

( 0 0 0 's )

A l l p la n s s tu d ie d ___________________________________

102

M u lt ie m p lo y e r

W ork ers

11
-

6
1

10U

2 , 159

2 , 769
687
2, 018
1, 887
43
79
9

91
79

3

1, 583
1, 313
271
35
9
148
5
74

64

*

-

822

1
2
3

1
4

1

1 3 p la n s c o v e r i n g 9, 000 w o r k e r s p r o v id e d a fla t a m o u n t f o r w o m e n .
2 4 p la n s c o v e r i n g 6 2, 000 w o r k e r s p r o v id e d a fla t a m o u n t p lu s an a m o u n t b a s e d on e a r n in g s .
NOTE:

B e c a u s e o f ro u n d in g ,

s u m s o f in d iv id u a l it e m s d o not n e c e s s a r i l y e q u a l t o t a l s .

Slightly m o re than half of the sin g le -e m p lo y e r plans provided uniform
insurance benefits (table B - l ) .
Because graduated benefits were m o re ch ar­
a c te r istic of the la rg e r sin g le -e m p lo y e r plan s, how ever, graduated plans a c ­
counted fo r nearly three tim es the number of w orkers covered by plans with
uniform am ounts.
In contrast with s in g le -e m p lo y e r plan s, an overwhelm ing
m a jo rity of the m ultiem ployer plans studied provided a flat amount.




22

A m o u n t o f I n s u r a n c e . — U n d e r th e 1 7 7 p la n s p r o v i d i n g a f i a t a m o u n t , th e
l i f e i n s u r a n c e b e n e f i t r a n g e d f r o m $ 4 0 0 to $ 1 0 , 0 0 0 .
W e l l o v e r h a l f o f th e p la n s
p r o v i d e d l e s s th a n $ 2 , 500 (t a b le B - 2 ) .
O f th e 2 m i l l i o n w o r k e r s c o v e r e d b y
f l a t p l a n s , a l m o s t h a l f w e r e u n d e r p la n s p r o v i d i n g l e s s th a n $ 1 , 5 0 0 .
B e n e f it
l e v e l s o f $ 3 , 0 0 0 o r m o r e a p p l i e d t o l e s s th a n a f o u r t h o f th e w o r k e r s .
T A B L E B - 2 . — L ife in s u r a n c e : D is tr ib u t io n o f p la n s p r o v id in g f la t
a m o u n t b y a m o u n t p r o v id e d , la t e 1 9 5 5 1
W ork ers
A m o lint o f in s u r a n c e

P la n s
( 0 0 0 * s)

'A ll p la n s p r o v id in g f la t a m o u n t ________________

2 177

2 ,0 0 0

U n d er $ 1 , 0 0 0 in s u r a n c e _ _
$ 1 , 0 0 0 b u t l e s s than $ 1 , 5 0 0 ____________________
$ 1 , 5 0 0 b u t l e s s than $ 2 , 0 0 0
_ _
$ 2 , 0 0 0 bu t l e s s than $ 2 , 5 0 0 _____ ________ ___
$ 2 , 5 0 0 b u t l e s s than $ 3 , 0 0 0 ____________________
$ 3 , 0 0 0 b u t l e s s than $ 3 , 5 0 0 _
$ 3 , 5 0 0 b u t l e s s than $ 4 , 0 0 0 __ __ „ ____ ___
$ 4 , 0 0 0 bu t l e s s than $ 4 , 5 0 0 ____________________
$ 4 , 5 0 0 bu t l e s s than $ 5 , 0 0 0
$ 5 , 0 0 0 b u t l e s s than $ 6 , 0 0 0 ____________________
$ 6 , 0 0 0 and o v e r __

18
48
15
38
9
17
14
7
4
5
2

376
592
66
287
197
137
140
52
71
71
12

1 B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s u n d er c o l ­
l e c t iv e b a r g a in in g c o v e r in g a p p r o x im a te ly 5 m illio n w o r k e r s ; o f t h e s e ,
2 8 4 p la n s p r o v id e d a lif e in s u r a n c e b e n e fit .
2 4 o f t h e s e p la n s p r o v id e d a lo w e r b e n e fit fo r w o m e n .
NO TE: B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s
n e c e s s a r i l y e q u a l t o t a ls .

do not

T h e a m o u n t s o f l i f e in s u r a n c e a v a i l a b l e t o w o r k e r s e a r n in g $ 3 , 0 0 0 a n d
$ 4 , 0 0 0 y e a r l y — a r b i t r a r i l y s e l e c t e d e a r n in g s l e v e l s — a r e s h o w n in t a b l e B - 3 f o r
th e 75 g r a d u a t e d p la n s p r o v i d i n g a n a m o u n t b a s e d o n e a r n in g s a l o n e .
U nder
t h e s e p l a n s , th e l i f e i n s u r a n c e f o r a $ 3 , 0 0 0 - a - y e a r w o r k e r r a n g e d f r o m l e s s
th a n $ 2 , 0 0 0 t o $ 8 , 0 0 0 .
F o r th e $ 4 , 0 0 0 - a - y e a r w o r k e r , 12 p la n s p r o v i d e d $ 8 , 0 0 0
or m ore.
F o u r - f i f t h s o f th e p la n s a s s u r e d w o r k e r s e a r n i n g $ 3 , 0 0 0 a n d $ 4 , 0 0 0
a y e a r a n a m o u n t e q u a l to o r e x c e e d i n g t h e ir a n n u a l i n c o m e s .
T A B L E B - 3 . — L ife in s u r a n c e : D is tr ib u tio n o f g r a d u a te d p la n s by a m ou n t p r o v id e d
w o r k e r s e a r n in g $ 3 , 0 0 0 and $ 4 , 0 0 0 y e a r l y , la te 1 9 5 5 1
$ 3 , 0 0 0 - a - y e a r w orker $ 4 , 0 0 0 - a - y e a r w orker
W orkers

W o r k e rs

A m o u n t o f in s u r a n c e

P la n s

P la n s

( 0 0 0 *s)

(0 0 0 's )
A ll p la n s p r o v id in g a g r a d u a te d am o u n t
b a s e d on e a r n in g s a lo n e 2 _ ----- --------U n d er $ 2 , 0 0 0 in s u r a n c e ____________ ____ —
$ 2 , 0 0 0 bu t l e s s than $ 2 , 5 0 0 ----- __ __ -----$ 2 , 5 0 0 bu t l e s s than $ 3 , 00C ___________________
$ 3 , 0 0 0 b u t l e s s than $ 3 , 5 0 0 ----- ----- --- _
$ 3 , 5 0 0 but l e s s than $ 4 , 0 0 0 ___________ __
$ 4 , 0 0 0 bu t l e s s th an $ 4 , 5 0 0 ____ ____ __
$ 4 , 5 0 0 b u t l e s s than $ 5 , 0 0 0 ___________________
$ 5 , 0 0 0 b u t l e s s than $ 6 , 0 0 0 ___________________
$ 6 , 0 0 0 bu t l e s s than $ 7 , 0 0 0 __ ----- __ __ —
$ 7 , 0 0 0 bu t l e s s than $ 8 , 0 0 0 _______________ —
$ 8 , 0 0 0 bu t l e s s than $ 9 , 0 0 0 ___________________
$ 9 , 0 0 0 bu t l e s s than $ 1 0 , 0 0 0 _____________ __
$ 1 0 , 0 0 0 and o v e r ____________________ _________

3 75

1 ,9 2 2

3 75

1,922

2
7
6
26
6
8
5
5
6
3
1

11
63
34
6 43
76
659
159
60
174
40
5

-

■

1
2
2
5
6
21
10
9
6
1
7
4
1

2
30
9
25
378
283
220
514
211
5
182
60
5

-

-

1 B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s u n d er c o lle c t iv e b a r g a in in g c o v ­
e r in g a p p r o x im a te ly 5 m illio n w o r k e r s : o f t h e s e , 2 8 4 p la n s p r o v id e d a lif e in s u r a n c e b e n e fit.
2 3 p la n s p r o v id e d a f la t a m o u n t fo r w o m e n .
3 7 p la n s p r o v id e d a l e s s e r a m o u n t fo r w o m e n .




NOTE:

B e c a u s e o f ro u n d in g , s u m s o f in d iv id u a l it e m s do not n e c e s s a r i l y e q u a l t o t a ls .

23

T h e a m o u n t s o f in s u r a n c e p r o v i d e d u n d e r b o t h g r a d u a t e d a n d f l a t p la n s
v a r i e d c o n s i d e r a b l y a m o n g p la n s o f a p p r o x i m a t e l y th e s a m e s i z e , a s m e a s u r e d
b y w o r k e r c o v e r a g e ( t a b le s B - 4 a n d B - 5 ) .
O n th e w h o l e , p la n s c o v e r i n g b e t w e e n
1 ,0 0 0 (th e m i n i m u m s i z e u s e d in th is s t u d y ) a n d 5 ,0 0 0 w o r k e r s p r o v i d e d a l o w e r
l e v e l o f i n s u r a n c e th a n th e l a r g e r p l a n s , b u t n o c l e a r d i f f e r e n c e w a s in d i c a t e d
a m o n g th e 3 o t h e r s i z e g r o u p in g s u s e d .
TABLE B - 4 . — L ife in su ra n ce: D istrib u tio n of plans providing a fla t am ount by am ount and num ber of
w o rk ers c o v ered by p la n s, la te 1 9 5 5 1
P lans c o v er in g —
Amount of in su ra n ce

A ll
plans

1 ,0 0 0 to
5, 0 0 0
w ork ers

5, 0 0 0 to
10, 0 0 0
w ork ers

10, 0 0 0 to
2 5 ,0 0 0
w o rk ers

2 5 , 0 0 0 or
m ore
w ork ers

A ll plans providing life in su ra n ce --------------

284

139

56

54

35

A ll plans providing oth er than a fla t am ount —
A ll plans providing a fla t am ount --------------Under $ 5 0 0 in su ra n ce ------------------------$ 5 0 0 but le s s than $ 1 , 0 0 0 ------------------$ 1 , 0 0 0 b u t le s s than $ 1 , 5 0 0 ----------------$ 1, 500 but le s s than $ 2 , 0 0 0 ----------------$ 2 , 0 0 0 but le s s than $ 2 , 500 ----------------$ 2 , 500 but le s s than $ 3 , 000 ----------------$ 3 , 0 0 0 but le s s than $ 3 , 500 ----------------$ 3 , 500 but le s s than $ 4 , 0 0 0 ----------------$ 4 , 0 0 0 but le s s than $ 4 , 500 ---------------$ 4 , 500 but le s s than $ 5 , 0 00 ---------------$ 5 , 0 00 but le s s than $ 6 , 000 ---------------$ 6 , 0 0 0 but le s s than $ 7 , 0 0 0 ---------------$ 7, 000 and over ---------------------------- ;
—

107
2 1 77
1
17
48
15
38
9
17
14
7
4
5
1
1

43
96

21
35

22
32
1
1
8
2
5
3
4
3
2
1
2
_
*

21
14

-

-

10
29
12
24
3
7
5
2
2
2

3
8
1
6
2
5
5
3
-

1
1

-

"

-

3
3
-

3
1
1
1
1
1
-

“

1 B ased on a study of 300 health and in su ran ce plans under c o lle c tiv e bargaining c o verin g ap ­
p r o x im a tely 5 m illio n w o r k e r s.
2 4 of th ese plans provided a lo w er b en efit for w om en.

TABLE B - 5 . — L ife insu ran ce: D istrib u tio n of plan s graduating am ount accord in g to earn ings alone by
am ount provided w o r k e rs earn ing $ 4 ,0 0 0 y e a r ly and num ber of w ork ers c o v ered by the p lan s, late 1 95 5 1

Amount of in su ra n ce

A ll plan s providing life in su ra n ce -------------A ll plans providing a fla t am ount or an
am ount b a sed on fa c to r s oth er than
ea rn in g s a l o n e ----------------------------------A ll plans providing an am ount b a sed on
ea rn in g s alon e 2 ---------------------------------Under $ 2 , 0 0 0 in su ra n ce ---------------------$ 2 , 0 0 0 but le s s than $ 2 , 500 ---------------$ 2 , 5 0 0 but le s s than $ 3 , 000 ---------------$ 3 , 0 0 0 but le s s than $ 3 , 5 0 0 ----------------$ 3 , 500 but le s s than $ 4 , 0 0 0 ----------------$ 4 , 0 0 0 but le s s than $ 4 , 500 ----------------$ 4 , 5 0 0 but le s s than $ 5 , 0 0 0 ----------------$ 5 , 0 0 0 but le s s than $ 6 , 0 0 0 ----------------$ 6, 0 0 0 but le s s than $ 7, 0 0 0 ----------------$ 7 , 0 00 but le s s than $ 8 , 0 0 0 ----------------$ 8 , 0 0 0 but le s s than $ 9 , 0 0 0 ----------------$ 9 , 0 0 0 but le s s than $ 1 0 , 0 00 ---------------$ 1 0 , 0 0 0 and o v e r ------------------------------

A ll
plans

P lans co v erin g —
1 ,0 0 0 to
5, 0 0 0
w ork ers

5, 0 0 0 t/O
10, 000
w o rk ers

284

139

56

54

35

209

111

43

35

20

3 75
1
2
2
5
6
21
10
9
6
1
7
4
1

28
1
1
2
3
1
10
5
1
1
1
2

13

-

“

1 0 ,0 0 0 to
2 5 ,0 0 0
w ork ers

2 5 , 0 0 0 or
m ore
w ork ers

19

15

-

-

-

-

-

-

-

-

1

1
1
6
1
5
-

-

-

4
1
1
2
2
1
1

-

2
3
“

1 B ased on a study of 3 0 0 h ea lth and in su ran ce plans under c o lle c tiv e bargaining
p r o x im a tely 5 m illio n w o r k e r s.
2 3 plans provided a fla t am ount for w om en.
3 7 plans provided a le s s e r am ount fo r w om en.

1
4
1
3
2
3
_
1
_
~
coverin g ap ­

V a r i a t i o n s in A m o u n t B a s e d o n S e x . — G e n e r a l l y , b o t h w o m e n a n d m e n
w o r k e r s w e r e p r o t e c t e d b y th e s a m e a m o u n t o f l i f e i n s u r a n c e .
A t th e a s s u m e d
$ 3 , 0 0 0 a n d $ 4 , 0 0 0 e a r n in g s l e v e l s , a l e s s e r a m o u n t w a s p r o v i d e d f o r w o m e n
th a n f o r m e n in o n ly 11 p l a n s . U n d e r 4 p l a n s , th e b e n e f i t s f o r m e n a n d w o m e n




24
w o r k e r s w e r e g r a d u a t e d o n s e p a r a t e s c a l e s ; 3 p la n s g r a d u a t e d th e a m o u n t o f l i f e
in s u r a n c e p r o v id e d m e n bu t g ra n te d a ll w o m e n w o r k e r s a u n ifo r m an d lo w e r
a m o u n t ; a n d u n d e r 4 f l a t - p a y m e n t p l a n s , w o m e n r e c e i v e d a l o w e r a m o u n t th a n
m en.
U n d e r 9 o f th e 11 p l a n s , w o m e n
a m o u n t p r o v id e d m e n w o r k e r s , a s in d ic a t e d
th e a b s o l u t e d i f f e r e n c e s r a n g e d f r o m
$300
p r o g r a m , m o s t w e r e b e tw e e n $ 1 ,4 0 0 and $ 2 ,

r e c e i v e d a t l e a s t 50 p e r c e n t o f th e
in th e f o l l o w i n g t a b u la t io n .
A lt h o u g h
u n d e r 1 p la n t o $ 4 , 600 in a n o t h e r
600.

$ 3 , 0 0 0 -a -y e a r w o r k e r
P e rc e n t o f am ount o f in su ran ce
p ro v id e d m en w o rk e rs
that was p rov id ed
w om en W orkers
A ll plans p rov id in g le s s in su ran ce fo r
w om en than fo r m en w o rk e rs ------------------------30 p e rce n t
31 p e rce n t
3 7 p e rce n t
50 p e rce n t
60 p e rce n t
63 p e rce n t
67 p e rce n t
86 p e rce n t

------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------

NOTE:

B eca u se o f rounding,

$ 4 , 0 0 0 -a -y e a r w o r k e r

W ork ers
Plans
11

(000«s)
112

»

]
5
1
2
1

4
3
51
-

11
9
35

W o rk e rs
Plans

(000*8)

11

112

2
-

-

6

-

-

5
1
1
1
1

51
8
11
1
35

sum s of individual item s do not n e c e s s a r ily

equal totals

R e d u c t i o n o f B e n e f it D u r in g A c t i v e E m p l o y m e n t . — U n d e r 19 p l a n s , a
r e d u c e d a m o u n t o f l i f e i n s u r a n c e c o v e r a g e w a s p r o v i d e d th e w o r k e r u p o n a t t a i n ­
m e n t o f a s p e c i f i e d a g e (t a b le A - 1 3 ).
In a b o u t h a lf o f t h e s e p l a n s , f u r t h e r r e ­
d u c t io n s w e r e m a d e a t s p e c i f i e d in t e r v a l s to a c o n s t a n t l e v e l w h i c h w a s m a i n t a in e d
f o r th e r e m a i n d e r o f th e w o r k e r * s a c t i v e e m p l o y m e n t .
R e d u c t i o n s in b e n e f i t s
w e r e m o r e c o m m o n u n d e r g r a d u a t e d p la n s th a n u n d e r f l a t p l a n s .
T w o p la n s
r e d u c e d b e n e f i t s a t a s l i g h t l y e a r l i e r a g e f o r w o m e n th a n f o r m e n a n d o n e r e ­
d u c e d th e b e n e f i t f o r m e n b u t n o t f o r w o m e n .

B e n e fits

fo r R e tir e d

W o r k e r s 15

O f th e 1 4 6 p la n s e x t e n d in g l i f e i n s u r a n c e t o r e t i r e d w o r k e r s (t a b le A - 8 ),
109 r e d u c e d th e a m o u n t i m m e d i a t e l y u p o n a w o r k e r * s r e t i r e m e n t a t a g e 6 5 . M o r e
th a n f o u r - f i f t h s o f t h e s e p la n s r e d u c e d th e i n s u r a n c e in e f f e c t to a c o n s t a n t l e v e l
w h i c h h e ld t h r o u g h o u t th e r e t i r e m e n t p e r i o d .
A f e w p la n s r e d u c e d th e a m o u n t
o f i n s u r a n c e in e f f e c t i m m e d i a t e l y u p o n r e t i r e m e n t a n d a t s p e c i f i e d i n t e r v a l s
t h e r e a f t e r . O f th e 3 7 p la n s th a t d id n o t r e d u c e th e l e v e l o f i n s u r a n c e u p o n r e t i r e ­
m e n t , 8 m a i n t a in e d th e i n s u r a n c e l e v e l f o r a l i m i t e d p e r i o d , e . g . , a y e a r , a n d
th e n r e d u c e d it to a c o n s t a n t l e v e l b e n e f i t f o r th e r e m a i n d e r o f th e r e t i r e m e n t
p e r io d .

15 F or
retirem ent

this a n a ly s is , b e n e fits a vailable to worker retiring at age 65 were com pared with th o se a v a ila b le to him im m ediately prior to
(i. e ., at age 64).
It has been p reviou sly noted that b e n e fits for the activ e worker may have be e n re d u ce d as he reach ed a

certain age.




25

T h e a m o u n t s o f l i f e in s u r a n c e a v a i l a b l e u n d e r th e 146 p la n s t o m e n a f t e r
r e t i r e m e n t a t a g e 65 a r e i l l u s t r a t e d in t a b l e B - 6 , c o m p u t e d f o r m e n e a r n in g
$ 4 , 0 0 0 y e a r l y p r i o r t o r e t i r e m e n t . L e s s th a n h a l f th e p la n s f o r w h i c h a m o u n t s
c o u l d b e c o m p u t e d p r o v i d e d $ 1, 5 0 0 o r m o r e f o r t h e s e r e t i r e d w o r k e r s . A n a m o u n t
e q u a l t o o r in e x c e s s o f t h e i r a n n u a l i n c o m e i m m e d i a t e l y p r i o r to r e t i r e m e n t w a s
a v a i l a b l e in l e s s th a n 15 p e r c e n t o f s u c h p l a n s . T h e a v e r a g e i n s u r a n c e e x t e n d e d
th e $ 4 , 0 0 0 w o r k e r u p o n r e t i r e m e n t w a s $ 1, 6 8 4 .
A t a g e 7 0, th e a v e r a g e i n s u r a n c e
l e v e l f o r r e t i r e d w o r k e r s w h o h a d e a r n e d $ 4 , 0 0 0 y e a r l y d r o p p e d t o $ 1 ,2 6 7 , o r
2 5 p e r c e n t b e l o w th e l e v e l a t th e s t a r t o f th e r e t i r e m e n t p e r i o d (t a b le B - 6 ) .
U nder
t w o p la n s , i n s u r a n c e w a s c a n c e l e d .
T A B L E B - 6 . — L if e in s u r a n c e : D is t r ib u t io n o f p la n s b y a m o u n ts p r o v id e d w o r k e r s at a g e s 6 5
and 7 0 w ho r e t i r e d a t a g e 6 5 a n d e a r n e d $ 4 , 0 0 0 y e a r l y p r io r to r e t i r e m e n t , la t e 1 9 5 5 1

A m o u n t o f in s u r a n c e

A ll p la n s e x te n d in g l i f e in s u r a n c e to r e t i r e d
w o r k e r s a t s p e c i f i e d a g e _________
_____
G r a d u a t e d p la n s b a s e d o n f a c t o r s o th e r
th a n e a r n in g s a lo n e ____________________________
F l a t a m o u n t o r an a m o u n t b a s e d
o n e a r n in g s a lo n e 2
___________________________
U n d e r $ 5 0 0 in s u r a n c e _______________________
$ 5 0 0 b u t l e s s th a n $ 1 , 0 0 0
$ 1 , 0 0 0 b u t l e s s th a n $ 1 , 5 0 0
.............
$ 1 , 5 0 0 b u t l e s s th a n $ 2 , 0 0 0 __ ___
______
$ 2 , 0 0 0 b u t l e s s th a n $ 2 , 5 0 0 ________________
$ 2 , 5 0 0 b u t l e s s th a n $ 3 , 0 0 0 _______
______
$ 3 , 0 0 0 b u t l e s s th a n $ 3 , 5 0 0
___
...........^
$ 3 , 5 0 0 b u t l e s s th a n $ 4 , 0 0 0
...... . ............
$ 4 , 0 0 0 b u t l e s s th a n $ 4 , 5 0 0
. ..
$ 4 , 5 0 0 b u t l e s s th a n $ 5 , 0 0 0
...
_ _
$ 5 , 0 0 0 b u t l e s s th a n $ 7 , 5 0 0
_ ...... .................
$ 7 , 5 0 0 an d o v e r _______________________________
A v e r a g e in s u r a n c e fo r $ 4 , 0 0 0 - a - y e a r
w o r k e r a t s p e c i f i e d a g e 3 _______________________

I m m e d ia t e ly a f t e r
r e tir e m e n t at
a ge 65
W orkers
P la n s
(0 0 0 « s)
146

3 ,1 0 8

R e t ir e d w o r k e r at
a g e 70
W ork ers
P la n s
( 0 0 0 * s)
144

3 ,0 7 9

29

1 ,0 2 0

29

1 ,0 2 0

117
1
17
50
7
17
2
2
6
3
1
7
4

2 ,0 9 0
7
541
992
80
185
6
4
80
13
3
141
38

115
1
18
54
8
15
2
3
4
5
2
3

2 ,0 6 1
7
548
1 ,0 0 3
160
219
6
16
40
39
8
15

_

_

$ 1 , 684

$ 1 ,2 6 7

1 B a s e d on a s tu d y o f 3 0 0 h e a lt h and in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v ­
e r i n g a p p r o x im a t e ly 5 m i l l i o n w o r k e r s .
2 6 p la n s p r o v id e d a l e s s e r a m o u n t f o r w o m e n .
3 A r i t h m e t i c a l a v e r a g e ; a m o u n t o f in s u r a n c e p r o v id e d to a $ 4 , 0 0 0 - a - y e a r m a n b y e a c h
p la n w a s w e ig h t e d b y to t a l n u m b e r o f w o r k e r s c o v e r e d b y th a t in s u r a n c e p la n .
NOTE:

B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l i t e m s

do n o t n e c e s s a r i l y e q u a l t o t a l s .

U n lik e p e n s i o n a n n u i t ie s b u t s i m i l a r t o l i f e in s u r a n c e f o r th e a c t i v e
w o r k e r , r e l a t i v e le n g t h o f s e r v i c e w a s n o t a n im p o r t a n t c o n s i d e r a t i o n in th e
d e t e r m i n a t i o n o f th e a m o u n t o f l i f e i n s u r a n c e r e t i r e d w o r k e r s r e c e i v e (t a b le B - 7 ) .




T A B L E B - 7 . — L if e in s u r a n c e : E f f e c t o f le n g th o f s e r v i c e on a m o u n t
p r o v id e d r e t i r e d w o r k e r s , la t e 1 9 5 5 1
W ork ers
P r o v is io n

P la n s
( 0 0 0 r s)

A ll p la n s e x te n d in g l i f e in s u r a n c e
to r e t i r e d w o r k e r s ______________________________
A m o u n t n o t a f f e c t e d b y s e r v i c e ------------------G r a d u a t e d b y s e r v i c e (tw o o r
m o r e g r a d u a t io n s ) ______________________________
S m a l l e r a m o u n t i f s e r v i c e l e s s th a n
s p e c i f i e d p e r io d ________________________________
O th e r -----------------------------------------------------

146

3 ,1 0 8

119

2 ,0 9 7

14

872

4
9

12
127

1 B a s e d o n a s tu d y o f 3 0 0 h e a lt h an d in s u r a n c e p la n s u n d e r c o l ­
l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly 5 m i l l i o n w o r k e r s .

26
L>ess th a n a f i f t h o f th e 1 4 6 p la n s e x t e n d in g l i f e i n s u r a n c e v a r i e d th e a m o u n t o f
c o v e r a g e f o r r e t i r e d w o r k e r s a c c o r d i n g t o le n g t h o f s e r v i c e o r p e r i o d i n s u r e d .
U n d e r a l l b u t s i x p la n s e x t e n d in g b e n e f i t s to r e t i r e d w o r k e r s , r e t i r e d
w o m e n a n d m e n r e c e i v e d th e s a m e b e n e f i t . T h e s i x p la n s th a t p r o v i d e d a s m a l l e r
b e n e fit to r e t ir e d w o m e n a ls o g a v e a c t iv e w o m e n w o r k e r s le s s life in s u r a n c e
c o v e r a g e th a n a c t i v e m e n w o r k e r s .

B e n e fit s f o r D e p e n d e n ts

o f A c tiv e

W ork ers

S e v e n p la n s e x t e n d e d l i f e i n s u r a n c e c o v e r a g e t o o n e o r m o r e o f th e w o r k ­
e r ^ d e p e n d e n t s . U n d e r tw o p l a n s , b e n e f i t s w e r e r e s t r i c t e d t o th e d e p e n d e n t w i f e ;
th e r e m a i n d e r c o v e r e d b o t h th e d e p e n d e n t w i f e a n d c h i l d r e n . N o n e o f t h e s e p la n s
c o n t in u e d d e p e n d e n t s ' c o v e r a g e a f t e r th e w o r k e r * s e m p l o y m e n t w a s t e r m i n a t e d . A l l
p la n s w i t h d r e w c o v e r a g e f o r d e p e n d e n t c h i l d r e n a f t e r t h e y a t t a in e d a s p e c i f i e d a g e .

A f i x e d a m o u n t o f c o v e r a g e , a s i n d i c a t e d in th e f o l l o w i n g t a b u la t io n , w a s
p r o v i d e d th e d e p e n d e n t w i f e . T h e a m o u n t s p e c i f i e d f o r d e p e n d e n t c h i l d r e n v a r i e d
a c c o r d i n g t o a t t a in e d a g e .

A m o u n t o f in s u r a n c e

P la n s
(0 0 0 fs )

A ll p la n s p r o v id in g li f e in s u r a n c e to d e p e n d e n t ----D ependent
w ife

D e p e n d e n t c h ild r e n
M in im u m

$500
$500
$500
$ 1 ,0 0 0

7___________ 2 1 5

M a x im u m

-

.

$100
$100
$50

$250
$500
$500

2
2
1
2

139
42
10
24

N O T E : A ll c o v e r a g e sh ow n in th is ta b u la tio n r e la t e to the n u m ­
b e r o f a c t iv e w o r k e r s c o v e r e d b y the p la n s . S ee fo o t n o t e 3, p . 1.
P erm a n en t and

T o ta l D is a b ility P r o v is io n s

T y p i c a l l y , th e l i f e i n s u r a n c e p la n s s t u d ie d p r o t e c t e d th e c o v e r e d w o r k e r
in th e e v e n t o f p e r m a n e n t a n d t o t a l d i s a b i l i t y .
S p e c i f i c p r o v i s i o n s o u t lin in g th e
d i s p o s i t i o n o f l i f e i n s u r a n c e b e n e f i t s in s u c h c a s e s w e r e in c l u d e d in a l m o s t 9 o u t
o f 10 p la n s (t a b le B - 8 ) .
T h e m o s t c o m m o n m e th o d o f s e ttle m e n t u n d e r p e r m a n e n t and to ta l d i s a b i l i t y p r o v i s i o n s p r o v i d e d f o r th e m a i n t e n a n c e o f th e f u l l v a lu e o f th e l i f e i n ­
s u r a n c e f o r th e d u r a t io n o f th e w o r k e r * s d i s a b i l i t y (t a b le B - 8 ) .
M a in t e n a n c e o f
i n s u r a n c e c o v e r a g e f o r th e d i s a b i l i t y p e r i o d o r f o r a l i m i t e d p e r i o d w a s p r o v i d e d
in a b o u t 7 o u t o f 10 p la n s w it h p e r m a n e n t a n d t o t a l d i s a b i l i t y f e a t u r e s .
U nder
v i r t u a l l y a l l r e m a i n i n g p l a n s , a c a s h s e t t l e m e n t o f th e f u l l v a lu e o f th e i n s u r a n c e
w a s m a d e w h en p e r m a n e n t and to ta l d is a b ilit y o c c u r r e d .
U s u a l l y , u n d e r th is
t y p e o f s e t t l e m e n t th e f a c e v a lu e o f th e l i f e i n s u r a n c e w a s p a id in m o n t h ly i n ­
s t a l l m e n t s to th e d i s a b l e d w o r k e r .




27

G e n e r a l l y , in o r d e r t o b e e l i g i b l e f o r t h e s e b e n e f i t s , th e d i s a b i l i t y m u s t
h a v e o c c u r r e d b e f o r e a s p e c i f i e d a g e , m o s t f r e q u e n t l y a g e 60 (t a b le B - 9 ) . O n ly
23 o f th e 2 4 9 p la n s p r o v i d i n g th is b e n e f i t d id n o t s p e c i f y a n a g e r e q u i r e m e n t .
U n d e r a fe w p la n s , a s tip u la te d a m o u n t o f s e r v i c e o r in s u r e d c o v e r a g e w a s r e ­
q u i r e d in a d d it i o n t o a n a g e r e q u i r e m e n t .
In m o s t i n s t a n c e s , th is p e r i o d d id
not e x ce e d 1 y e a r.
T A B L E B - 8 . — L ife in s u r a n c e : D is p o s it io n o f lif e in s u r a n c e b e n e fit s
u n der p e r m a n e n t and to ta l d is a b ility p r o v is io n s , la te 1 9 5 5 1
W ork ers
M ethod o f s e t t le m e n t 2

P la n s
(0 0 0 *s )

A ll p la n s p r o v id in g lif e in s u r a n c e

. .... _

284

249

3 ,9 7 9

53
10
10

730
172
102

2
1

33
39

1 18
27

1, 191
428

24

1 ,2 1 2

2

19

1
1

A ll p la n s w ith p e r m a n e n t and to ta l
d is a b ilit y p r o v is io n s
. ....................
F u ll a m o u n t o f in s u r a n c e paid in:
I n s t a llm e n t s
_ .
....
L um p su m _
. ..
. __
I n s t a llm e n t s o r lum p su m (o p t io n a l) __
P o r tio n of in s u r a n c e p a id in in s t a llm e n t s ,
b a la n c e m a in ta in e d for:
D u r a tio n o f d is a b ilit y .....
S p e c ifie d p e r io d .... _
F u ll am o u n t o f in s u r a n c e m a in ta in e d for:
D u r a tio n o f d is a b ilit y
S p e c ifie d p e r io d _
...
... __
S p e c ifie d p e r io d ; r e d u c e d am ou n t fo r
d u r a tio n o f d is a b ility _
P o r tio n o f in s u r a n c e d is c o n tin u e d ,
b a la n c e m a in ta in e d fo r d u ra tio n of
d is a b ilit y
_..... .
F u ll a m o u n t o f in s u r a n c e m a in ta in e d or
p a id in in s t a llm e n t s (o p tio n a l)
O th er
_..

4 , 352

4
50

1 B a s e d on a stu d y of 3 0 0 h e a lth and in s u r a n c e p la n s un der
c o lle c t iv e b a r g a in in g c o v e r in g a p p r o x im a te ly 5 m illio n w o r k e r s .
2 U n d er 2 8 p la n s d if fe r e n t m e th o d s o f s e t tle m e n t w e r e p r o v id e d
if d is a b ilit y o c c u r r e d b e fo r e o r a fte r a s p e c if ie d a g e o r w ith l e s s
th an a s p e c if ie d am o u n t o f s e r v ic e .
In th e s e c a s e s th e lo w e r a g e
o r s e r v ic e r e q u ir e m e n t w a s u se d to c l a s s i f y th e p la n p r o v is io n s .
NO TE: B e c a u s e o f ro u n d in g ,
n e c e s s a r i l y e q u a l t o t a ls .

T A B L E B - 9 . — L ife in s u r a n c e :

S e r v ic e o r in s u r e d
c o v e r a g e r e q u ir e m e n ts

s u m s of in d iv id u a l it e m s do not

E lig ib ilit y r e q u ir e m e n ts to r e c e iv e p e r m a n e n t and to ta l d is a b ility b e n e f it s , la te 1 9 5 5 1
P la n s p r o v id in g
p e r m a n e n t and
to ta l d is a b ility
b e n e fit s

B e n e fits a r e a v a ila b le if d is a b ilit y o c c u r s —
P r io r to a g e
A t an y a g e

60

P la n s

P la n s
(0 0 0 *s)

P la n s
(0 0 0 » s )

O th er

65

W o r k e rs

W o r k e rs

W o r k e rs

(W orkers

W orkers
P la n s

(0 0 0 *s)

P la n s
(0 0 0 *s)

( 0 0 0 rs )

A ll p la n s p r o v id in g b e n e fit s —

249

3 ,9 7 9

23

784

186

2 , 732

38

413

2

50

N o s e r v ic e o r in s u r e d
c o v e r a g e r e q u ir e m e n t s -----S e r v ic e r e q u ir e m e n t o f ------1 y e a r -----------------------10 o r m o r e y e a r s ----------I n su r e d c o v e r a g e of ----------1 y e a r -----------------------2 y e a r s ----------------------10 y e a r s ---------------------1 5 y e a r s --------------------O t h e r ------------------------------

237
2
1
1
9
6
1
1
1
1

3 ,2 8 1
86
80
6
601
28
18
415
140
11

22
1
1
*

778
6
6
"

176
1
1
8
6
1
1

2, 058
80
80
583
28
415
1 40
11

37
1
1
-

395
18
18
~

2
-

50
~

1 B a se d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s
5 m illio n w o r k e r s . Of th ese , 2 8 4 p la n s p r o v id e d lif e in s u r a n c e .




1

u n d er c o lle c t iv e

b a r g a in in g

c o v e r in g a p p r o x im a te ly




29
Accidental Death and Dismemberment Benefits

A c c i d e n t a l d e a th a n d d i s m e m b e r m e n t b e n e f i t s w e r e p r o v i d e d b y 1 5 4 o f th e
3 0 0 p la n s s t u d i e d . 16 U n d e r a ll b u t 3 o f t h e s e p la n s , t h is b e n e f i t w a s g r a n t e d in
a d d it io n to l i f e i n s u r a n c e ; th e 3 e x c e p t i o n s , c o v e r i n g a p p r o x i m a t e l y 1 5 ,0 0 0 w o r k ­
e r s , p r o v i d e d n o l i f e i n s u r a n c e . U n lik e l i f e i n s u r a n c e , s l i g h t l y m o r e th a n a t h ir d
o f th e a c c i d e n t a l d e a th a n d d i s m e m b e r m e n t b e n e f i t p r o v i s i o n s c o v e r e d o n ly o f f t h e -jo b a c c id e n ts .

Workers
Item
Plans

(0 001s)

A ll plans providing accidental death and
dismemberment benefit ________________

154

2 ,2 5 0

Occupational and nonoccupational cases
covered _________________________________________
Nonoccupational cases covered ________________

100
54

1,672
577

NOTE: Because of rounding, sums of individual items do not n ec­
essa rily equal totals.

T h r e e - f o u r t h s o f th e p la n s p r o v id in g an a c c i d e n t a l d e a th a n d d i s m e m b e r ­
m e n t b e n e f i t s t i p u l a t e d u n i f o r m a m o u n t s f o r a ll c o v e r e d w o r k e r s (t a b le C - l ) . T h e
b a s i s f o r d e t e r m i n in g th e a m o u n t o f b e n e f i t w a s f o r th e m o s t p a r t th e s a m e a s
th a t f o r l i f e i n s u r a n c e . W h e r e t h e r e w a s a d i f f e r e n c e , d e t e r m i n a t i o n o f th e a m o u n t
o f li f e in s u r a n c e c o v e r a g e w as b a s e d o n s u c h f a c t o r s as e a r n in g s , s e r v i c e , e t c . ,
w h e r e a s a f l a t a m o u n t o f a c c i d e n t a l d e a th a n d d i s m e m b e r m e n t b e n e f i t w a s s p e c i f i e d .
TAB LE C - l . - —Accidental death and dismem berment:
B asis of determining amount of benefit, late 1955 1
W orkers

B asis of determining amount of accidental
death and dismem berment benefit

Plans

A ll plans providing benefit 2 ____________________

154

2 ,2 5 0

_________________________________ _
Flat amount
Graduated ______________________________________ _
Earnings 3 _ ___________________________________
Earnings and service _____ ________________
Other

114
40
35
3
2

1,090
1, 159
1,1 1 5
24
20

(000«s)

1 Based on a study of 300 health and insurance plans under c o l­
lective bargaining covering approximately 5 m illion workers.
2 1 plan provided for dismemberment benefits only.
3 1 plan covering 3 ,0 0 0 workers provided a flat amount for
women.
NOTE: Because of rounding,
necessarily equal totals.

16

sums of individual items do not

One plan included in the 154 provided only accidental dismemberment benefits.




30

U n d e r m o r e th a n 70 p e r c e n t o f th e p l a n s , th e a m o u n t p r o v i d e d f o r a c c i ­
d e n t a l d e a th w a s th e s a m e a s th e l i f e i n s u r a n c e c o v e r a g e f o r a m a n e a r n in g $ 3 , 0 0 0
o r $ 4 , 0 0 0 a y e a r ( t a b le C - 2 ) . O n e o u t o f f i v e p la n s p r o v i d e d a l o w e r a c c i d e n t a l

T A B L E C - 2 . — A c c id e n ta l d e a th and d is m e m b e r m e n t: R e la tio n s h ip o f a c c id e n ta l d e a th b e n e fit
to a m o u n t o f lif e in s u r a n c e p r o v id e d w o r k e r s e a r n in g $ 3 , 0 0 0 and $ 4 , 0 0 0 y e a r ly , la te 1 9 5 5 1
$ 3, 0 0 0 - a - y e a r - w o r k e r $ 4 , 0 0 0 - a - y e a r - w o r k e r
A m o u n t o f a c c id e n ta l d e a th b e n e fit

W o r k e rs

W o rk ers
P la n

P la n
(00 0*s)
A ll p la n s p r o v id in g a c c id e n ta l d e a th b e n e fit
and lif e in s u r a n c e
_ _
__
A c c id e n ta l d e a th b e n e fit w a s —
M o r e th a n fa c e v a lu e o f lif e in s u r a n c e
T r ip le th e fa c e v a lu e _
L e s s th a n t r ip le but m o r e th an d ou b le
th e fa c e v a lu e
D o u b le th e fa c e va lu e
L e s s th an d o u b le th e fa c e v a lu e
S a m e a s th e fa c e v a lu e o f lif e i n s u r a n c e ___
L e s s th a n th e fa c e v a lu e o f lif e in s u r a n c e _
M o re th a n o n e - h a lf th e fa c e v a lu e
___
O n e - h a lf th e fa c e v a lu e
. ...
L e s s th a n o n e - h a lf th e fa c e v a lu e _______
O th er
_ _ ___
_ _

(00 0*s)

150

2 ,2 1 8

150

2 ,2 1 8

7
1

103
1

6
1

96
1

1
2
3
112
30
9
14
7
1

49
4
49
1, 105
980
69
818
94
30

1
2
2

49
4
42
1, 0 9 2
995
83
818
94
35

n o

32
11
14
7
2

1
B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s u n d er c o lle c t iv e b a r g a in in g c o v e r ­
in g a p p r o x im a te ly 5 m il lio n w o r k e r s .
NOTE:

B e c a u s e o f ro u n d in g , s u m s o f individual- it e m s do not n e c e s s a r i l y e q u a l t o t a ls .

d e a th b e n e f i t . T h e a m o u n t o f th e a c c i d e n t a l d e a th b e n e f i t e x c e e d e d
l i f e i n s u r a n c e s p e c i f i e d u n d e r th e p la n in o n l y a f e w c a s e s .
Of
p r o v i d i n g a u n i f o r m a c c i d e n t a l d e a th b e n e f i t , m o r e th a n f o u r - f i f t h s
b l e l e s s th a n $ 3 , 0 0 0 (t a b le C - 3 ) .
T h e s e p la n s c o v e r e d a s i m i l a r




T A B L E C - 3 . — A c c id e n ta l d e a th and d is m e m b e r m e n t: D is tr ib u t io n of
p la n s p r o v id in g fla t a m o u n t by am ou n t p r o v id e d , la te 1 9 5 5 1
W orkers
A m o u n t o f b e n e fit 2

P la n s
(0 0 0 *s)

A ll p la n s p r o v id in g a c c id e n ta l d e a th b e n e f i t ___

153

2, 2 33

A ll p la n s p r o v id in g o th e r th an a fla t am ou n t —
A ll p la n s p r o v id in g a fla t a m o u n t______ ________
$ 5 0 0 but l e s s th an $ 1, 0 0 0 __________________
$ 1, 0 0 0 but l e s s th an $ 1, 5 0 0
$ 1, 5 0 0 but l e s s th an $ 2 , 0 0 0 _______________
$ 2 , 0 0 0 but l e s s th an $ 2 , 5 0 0 _______________
$ 2 , 5 0 0 but l e s s th an $ 3, 0 0 0 _______________
$ 3 , 0 0 0 but l e s s th an $ 3 , 5 0 0 _______________
$ 3, 5 0 0 but l e s s th an $ 4 , 0 0 0 _______________
$ 4 , 0 0 0 but l e s s th an $ 4 , 5 0 0 _______________
$ 4 , 5 0 0 but l e s s th a n $ 5 , 0 0 0 _______________
$ 5 , 0 0 0 but l e s s th an $ 6 , 0 0 0 _______________
$ 6 , 0 0 0 and o v e r _____________________________

40
113
5
40
14
26
10
8
2
3
1

1, 159
1, 0 7 4
19
286
68
1 88
282
68
43
33
40
40
6

3

1

1 B a s e d on a stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s u n d er c o l ­
le c t iv e b a r g a in in g c o v e r in g a p p r o x im a te ly 5 m illio n w o r k e r s .
2 1 p la n p r o v id e d a l e s s e r am ou n t fo r w o m e n .
NOTE: B e c a u s e o f rou n d in g, s u m s of in d iv id u a l it e m s do not n e c ­
e s s a r i l y e q u a l t o t a ls .

th e a m o u n t o f
th e 113 p la n s
m a d e a v a ila ­
p r o p o r tio n o f

31
all w orkers under fla t plan s.
In about a third of the 35 graduated p la n s , the a c ­
cidental death benefit was le s s than the annual incom e for a $ 3 ,0 0 0 - and a $ 4 ,0 0 0 a -y e a r worker (table C - 4 ) . Both m en and women w orkers received the sam e a c c dental death benefit under all except 1 of the flat plans and 2 of the graduated on es.
T A B L E C - 4 . — A c c i d e n t a l d e a th a n d d is m e m b e r m e n t : D is t r ib u t io n o f p la n s g r a d u a te d
a c c o r d in g to e a r n in g s a lo n e , b y a m o u n t p r o v id e d w o r k e r s e a r n in g $ 3 , 0 0 0
a n d $ 4 , 0 0 0 y e a r l y , la te 1955 1
$ 3 , 0 0 0 -a -y e a r -w o r k e r $ 4 , 0 0 0 -a -y e a r -w o r k e r
A m ou n t o f b e n e fit 2

W orkers

W ork ers
P la n s

P la n s

(0 0 0 fs)

( 0 0 0 *s)
A l l p la n s p r o v id in g a c c id e n t a l d e a th b e n e f i t _
_
A l l p la n s p r o v id in g fla t a m o u n t o r a m o u n t
b a s e d o n f a c t o r s o th e r th an e a r n in g s a l o n e _
_
A l l p la n s p r o v id in g a m o u n t b a s e d on
e a r n in g s a lo n e _
U n der $ 2 , 000
$ 2 , 000 bu t l e s s th a n $ 2 , 500
$ 2 , 50 0 bu t l e s s th an $ 3, 000
$ 3 , 0 0 0 b u t l e s s th a n $ 3 , 500
$ 3 , 5 0 0 b u t l e s s th a n $ 4 , 000
$ 4 , 0 0 0 b u t l e s s th a n $ 4 , 5 0 0
_ _ _
___ __ _ _ _
$ 4 , 50 0 b u t l e s s th an $ 5, 000
$ 5 , 000 bu t l e s s th an $ 6 , 000
.........................
$ 6 , 0 0 0 b u t l e s s th a n $ 7 , 0 0 0
_

153

2 ,2 3 3

153

118

1,

118

11 8

1, 115
143
50 6
23
2 07
69

35
-

110

8

1

8

3

49
-

5
7
3

35
2
6

5
10

3
5

-

2

4
5
1

1 B a s e d on a s tu d y o f 300 h e a lth an d in s u r a n c e p la n s u n d er c o ll e c t iv e
in g a p p r o x i m a t e l y 5 m i l l i o n w o r k e r s .
2 p la n s p r o v id e d a l e s s e r a m o u n t fo r w o m e n .

NOTE:

B ecau se

o f r o u n d in g ,

s u m s o f in d iv id u a l it e m s

2 ,2 3 3

1

, 118

1, 115
141
427
204
3
82
85
104
71

b a r g a in in g

cover­

d o not n e c e s s a r ily e q u a l t o t a ls .

In alm ost all p lan s, m u ltid ism em berm en t benefits— a cash paym ent made
in case of lo ss of 2 or m ore lim b s , com plete lo ss of sight, or lo s s of sight in
1 eye plus lo ss of 1 lim b due to accidental ca u ses— were fixed at the sam e lev e ls
provided for accidental death.

W ork ers
A m o u n t o f m u ltid is m e m b e r m e n t b e n e fit

P la n s

(OOP 1 s )

A l l p la n s p r o v i d i n g a c c i d e n t a l d e a t h a n d
m u l t i d i s m e m b e r m e n t b e n e f i t s ----------------------------

153

2 ,2 3 3

S a m e a s d e a t h b e n e f i t _______________________________
G r e a t e r t h a n d e a t h b e n e f i t -------------------------------------

149
4

2 ,2 1 8
15

Under all plans, the amount of the single dism em berm en t benefit— cash
amount payable for lo ss of 1 lim b or sight of 1 eye— was half o f the m ulti d ism e m ­
berm ent benefit.
Under only one plan was a m odification made in the accidental death and
d ism em berm ent benefits provided w orkers upon the attainment of a specified age
(table A - 13).
In this plan, benefits were discontinued at age 6 8 .
Accidental death and dism em berm en t benefits w ere extended to retired
w orkers by only 5 of the 154 plans providing this benefit for active w o rk ers. E x ­
cept in one c a s e , the amounts extended were the sam e as those provided the a c ­
tive w orkers before retirem en t.







33
Accident and Sickness Benefits 1
7

F o u r-fifth s (239) of the plans studied provided cash accident and sick n ess
benefits. Under all except 2 of these plans, w orkers received payment for time
lo st because of nonoccupational (o ff-th e -jo b ) accidents or illn e s s e s ; in the 2 e x ­
ceptions, payment was lim ited to c a se s involving occupational d isa b ilities (table
D - l ) . M ore than 1 out of 5 plans also provided benefits for disa b ilities arisin g
fro m occupational c a u se s, thus supplementing w orkm en’ s com pensation paym ents.
T A B L E D - l . — A c c id e n t and s ic k n e s s :

T y p e s o f d is a b ility c o v e r e d b y in d u s tr y d iv is io n , la te
M a n u fa c t u r in g

A ll in d u s tr ie s
T y p e s o f d is a b ilit y c o v e r e d

( 0 0 0 1 s)

( 0 0 0 's )

300

1

4 , 981

218

3 ,3 9 7

82

1, 5 8 4

239

_____________________________________

A l l p la n s p r o v i d i n g a c c i d e n t a n d
s ic k n e s s b e n e fits
_________________________________
N o n o c c u p a t io n a l and o c c u p a t io n a l:
A c c i d e n t a n d s i c k n e s s ______________________
N o n o c c u p a t io n a l o n ly :
____________________
A c c id e n t and s ic k n e s s
O c c u p a t io n a l o n ly :
A c c i d e n t a n d s i c k n e s s ______________________
A c c i d e n t o n l y __________________________________

W orkers
P la n s

P la n s
( 0 0 0 * s)

A l l p la n s s t u d i e d

N o n m a n u fa c t u r in g

W orkers

W orkers
P la n s

1955

3 ,6 9 5

190

3 , 11 9

49

57 5

50

1 ,6 9 5

43

1 ,5 9 0

7

10 6

187

1 ,9 8 1

147

1 ,5 3 0

40

451

-

-

1

9

-

-

1

10

1
1

9
10

1
I n c l u d e s 5 p l a n s , c o v e r i n g 5 8 , 0 0 0 w o r k e r s , w h ic h p r o v i d e d b e n e f i t s f o r n o n o c c u p a t i o n a l a c c i d e n t a n d s i c k n e s s
and o c c u p a tio n a l a c c id e n t o n ly .

NOTE:

B ecau se

of

ro u n d in g ,

su m s

o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y

eq u a l t o t a ls .

In the la rg e m ajority of c a s e s , the accident and sick n ess benefits w ere p ro ­
vided through group insurance; self-in suran ce by a fund to which contributions w ere
made was the other method used to provide benefits. A lm o s t a ll of the plans p ro ­
vided the benefit in term s of a weekly payment to elig ib le w orkers fo r a specified
number of weeks per d isability or per y ea r. A w orker becam e eligible for benefit
coverage after com pleting the eligibility requ irem en ts, if any, stipulated in the plan
(table A - 12). Once these requirem ents were m et, a sick or injured w orker quali­
fied for weekly payments either im m ediately or after a specified waiting period.
In all c a s e s , the disabled person m ust have been under the c a re of a
qualified physician in order to receive benefits. Under many plans, m o re o v e r, the
disability had to be attested to in writing by the physician.
H ow ever, only a
few plans required the worker to be confined to his hom e or to a hospital in
order to qualify for benefits.
Nonoccupational Benefits
Waiting P e rio d .— Under a substantial m a jo rity of plans, the tim e when bene­
fit payments began differed according to the type of d isa b ility , i. e ., sick n ess or a c ­
cident (table D -2 ). P ro v isio n s governing payments for accident c a s e s , in the great
m ajority of in stan ces, were far le s s re stric tiv e than those for sic k n e ss. M ost f r e ­
quently, benefit payments for nonoccupational accidents began im m ediately (166 plan
In con trast, a waiting period for sick ness benefits was specified in all plans. 18

17
Paid sick le a v e , State workm en's com pensation b e n e fits, and temporary d isa b ility payments from State-operated plan s are not ana­
lyzed in this study.
on p.

P rovisions
70.

relating to ava ilab ility of accident and s ic k n e ss b en efits for d isa b ilitie s or a b se n c e s due to pregnancy are d isc u sse d

T h is has reference only to provision s of the accident and s ic k n e ss ben efit p lan s included within the scop e of this stud y. No deter­
mination w as made as to the p revalence of paid sic k leave plan s which might have provided paym ents during this waiting period. T o the
extent that such paym ents were provided, the waiting period under the accident and s ic k n e s s plan had lit t le , if any, e ffe c t.




34
In m o re than 4 out of 5 p lan s, benefits w ere not payable in case of s ic k ­
ness until after the seventh day. H ow ever, if the w orker was hospitalized p rior
to com pletion of the waiting period , som e plans began paym ents with the fir s t day
of h osp italization. Nine plans provided retroactive paym ents foliowing the c o m ­
pletion of the waiting period or an extended period of disability under specified
conditions (see footn otes, table D - 2 ).

T A B L E D - 2 . — A c c id e n t and s ic k n e s s :

W a i t in g p e r i o d f o r w e e k l y n o n o c c u p a t i o n a l b e n e f i t s ,

l a t e 1 95 5
W orkers

T y p e o f b e n e fit a n d w a it in g p e r i o d

P la n s
(0 0 0 »s)

A l l p l a n s s t u d i e d _________________________________________________________________

300

4 , 981

A l l p la n s p r o v id in g n o n o c c u p a tio n a l a c c id e n t an d s ic k n e s s b e n e fit s

237

3, 675

B e n e fits b e g in a fte r :
A c c id e n t

S ic k n e s s

I m m e d i a t e l y ___________________
I m m e d i a t e l y ___________________
I m m e d i a t e l y ___________________
3 d a y s ___________________________
3 d a y s ___________________________
6 d a y s ___________________________
7 d a y s ___________________________
7 d a y s o r w h en h o s p it a liz e d
U p o n b e i n g h o s p i t a l i z e d ____
O t h e r ____________________________

3 d a y s ___________________________
7 d a y s ___________________________
7 d a y s o r w h en h o s p it a liz e d
3 d a y s ___________________________
7 d a y s ___________________________
13 d a y s _________________________
7 d a y s ___________________________
7 d a y s o r w h en h o s p it a liz e d
U p o n b e i n g h o s p i t a l i z e d ____

22
122

1
2 1

22
8

4
4
5
42
5
3
5

4

3
4
5

284
, 439
817
108
13
286
429
232
47
21

1 I n c lu d e s :
1 p l a n c o v e r i n g 2 5 , 0 0 0 w o r k e r s w it h a w a it i n g p e r i o d o f 3 d a y s o r u n t il h o s p i t a l i z e d , w h i c h e v e r
o c c u r r e d f i r s t ; 1 p la n c o v e r in g 2 , 0 0 0 w o r k e r s p r o v id in g f o r r e t r o a c t i v i t y o f b e n e fit p a y m e n t t o 1 st d a y o f d i s a b i li t y i f
h o s p i t a l iz e d p r i o r to c o m p le t i o n o f th e 3 - d a y w a it in g p e r i o d .
2 I n c l u d e s 2 p l a n s c o v e r i n g 5 , 0 0 0 w o r k e r s p r o v i d i n g f o r r e t r o a c t i v i t y o f b e n e f i t p a y m e n t t o 1 st d a y i f d i s a b i l i t y
la s te d fo r a s p e c ifie d p e r io d .
3
I n c l u d e s 1 p l a n c o v e r i n g 19, 00 l w o r k e r s p r o v i d i n g f o r a w a i t i n g p e r i o d o f 3 d a y s o r u n t il h o s p i t a l i z e d , w h i c h ­
0
e v e r o c c u r r e d fir s t .
4
T h e s e 4 p la n s p r o v id e d f o r r e t r o a c t i v i t y o f a c c id e n t b e n e fit s to 1st d a y a n d r e t r o a c t i v i t y o f s ic k n e s s b e n e fit to
8 th d a y .
5
I n c lu d e s : 1 p la n c o v e r in g 1 1 ,0 0 0 w o r k e r s p r o v id in g f o r r e t r o a c t i v i t y o f b e n e fit p a y m e n t t o 1 st d a y i f d i s a ­
b i li t y la s t e d f o r a s p e c i f i e d p e r i o d ; 1 p la n c o v e r in g 1 0 , 0 0 0 w o r k e r s th a t p r o v i d e d b e n e f it s f o r h o s p i t a l iz e d c a s e s o n ly ;
a n d 1 p la n c o v e r in g 3, 0 0 0 w o r k e r s p r o v id in g th a t, f o r d i s a b i li t ie s d u e t o a c c id e n t s , b e n e fit w a s r e t r o a c t i v e t o 1st d a y
a f t e r c o m p le t i o n o f w a it in g p e r i o d .

NOTE:

B e c a u s e o f r o u n d in g ,

s u m s o f i n d i v id u a l i t e m s d o n o t n e c e s s a r i l y e q u a l t o t a l s .

B asis fo r Determ ining A m ount. — A s in the case of life insurance and
accidental death and d ism em berm en t b en efits, nonoccupational accident and sickness
benefit paym en ts, fo r the m o st p art, w ere determ ined either as a uniform amount
fo r ail w orkers or as an amount graduated according to earnings (table D -3 ).
Although a substantially la rg e r num ber of plans (134) provided a uniform (flat)
benefit, those plans (9 7) which graduated the amount according to earnings covered
n ea rly as m any w o rk e rs. In a ll plan s, the b a sis (flat or graduated) used in d e ­
term ining the amount fo r wom en w orkers was the sam e as that for m en .
Under plans providing a fla t am ount, variations in earnings among w orkers
did not a ffect the amount of the weekly benefit except in four plans which stipulated
that the weekly benefit could not exceed a specified percentage of earnings (before
deductions).
Two plans specified a m axim um of 66^/3 percent of earnings and
the other 2 specified 70 percen t. Under plans graduating the benefit according to
earn in gs, stipulating both a m inim um and m axim um was the predom inant practice
(71 o f 9 7 ).
U n d e r graduated plans, the a m o u n t of the p a y m e n t w a s either (l) a fixed
percentage of w e e k l y earnings (36 plans), or (2) a n a m o u n t graduated according to




35
a schedule of earnings cla ssifica tio n s (6l plan s). A s shown below , under plans
using the fo rm e r m ethod, 50 percent of weekly earnings was the low est and m o st
com m on ratio sp ecified .

W ork ers
P e r c e n t o f e a r n in g s s p e c ifie d

P la n s

(0 0 0 »s)

A l l p la n s d e t e r m in in g a c c id e n t an d s ic k n e s s
b e n e f i t s o n a p e r c e n t a g e o f e a r n i n g s b a s i s ___ _________36___________ 4 1 6
50 p e r c e n t _______________________________________________
60 p e r c e n t _______________________________________________
65 p e r c e n t _______________________________________________
6673
p e r c e n t ___________________________________________
70 p e r c e n t _______________________________________________
O t h e r ______________________________________________________

14
7
1
9
3
2

221
66

35
46
17
32

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c ­
e s s a r il y e q u a l to t a ls .

Under 10 of these 36 pla n s, m inim um and m axim um dollar amounts w ere
sp e cified , 19 plans lim ited only the m axim um amount payable; and 2 , only the
m inim um amount.
F ive plans did not specify either a m inim um or m axim um
am ount. The m inim um and m axim um amounts specified under the 31 plans having
such provisions are listed below :
Ite m

P la n s

A l l p la n s d e t e r m in in g a c c id e n t an d s i c k n e s s b e n e fit on
a p e r c e n t a g e o f e a r n i n g s b a s i s w it h a s t i p u l a t e d
m in i m u m a n d / o r m a x i m u m w e e k l y a m o u n t _________________ __________31

M in im u m
am o u n t

M a x im u m
am ou nt

$ 1 2 .5 0

$ 3 0 .0 0 ________________________
$ 3 0 .0 0 _________________________
$ 3 0 . 00 _________________________
$ 3 3 .0 0 _____________________
$ 3 5 . 00 _________________________
$ 3 5 .0 0 _________________________
$ 4 0 . 00 _________________________
$ 4 0 . 00 _________________________
$ 4 0 . 00 _________________________
$ 4 1 . 50 _________________________
$ 4 2 .0 0 ________________________
$ 5 0 . 00 ________________________
$ 5 5 .0 0 _________________________
$ 6 0 . 00 _________________________
$ 6 0 . 00 _________________________
$ 7 5 . 00 _________________________
$ 8 5 . 00 _________________________

$ 1 0 .0 0
$ 2 5 . 00
$ 1 0 . 00
$ 1 0 .0 0
$ 2 5 . 00

i 1)

$ 3 0 . 00
$ 3 5 . 00

1

2
2
1
1
2
1
2
7
1
1
1
1
3
1
1
1
2
1

A m o u n t r e q u ir e d u n d er S ta te t e m p o r a r y d is a b ilit y la w .

In the 61 plans under which the amount of payment was geared to earnings
c la ssific a tio n s, the low er and upper earnings categories established the m inim um
and m axim um amounts provided under the plan. F or exam ple, under the following
schedule, w ork ers could receive no le s s than $ 1 4 and no m ore than $ 3 5 :




B a s ic w e e k ly e a r n in g s
U n d e r $ 2 8 __________________________________________________
$ 2 8 b u t l e s s th a n $ 3 6 __________________________________
$ 3 6 b u t l e s s th a n $ 4 8 __________________________________
$ 4 8 b u t l e s s th a n $ 6 0 __________________________________
$ 6 0 a n d o v e r ______________________________________________

W e e k ly a c c id e n t and
s ic k n e s s b e n e fit
$14
17
21
28
35

36
T A B L E D - 3 . — A c c i d e n t and s i c k n e s s ; B a s is f o r d e t e r m in i n g n o n o c c u p a t i o n a l b e n e f i t a m o u n t
b y t y p e o f b a r g a in in g u n it, la t e 195 5
T y p e o f b a r g a i n i n g u nit
A l l p la n s
S in g le e m p l o y e r

B a s is f o r d e t e r m in i n g a m o u n t

( 0 0 0 ‘ s)

(000* s)

B ecau se

( 0 0 0 ‘ s)

300

A l l p la n s p r o v i d i n g n o n o c c u p a t io n a l
a c c id e n t and s i c k n e s s b e n e f i t s
F la t a m o u n t ______________________________________
U n if o r m a m o u n t _____________________________
W ith s t ip u la t e d m a x im u m p e r c e n t a g e
o f e a r n i n g s _________________________________
G r a d u a t e d a c c o r d i n g to e a r n in g s ____________
W ith s t ip u la t e d m in im u m and
m a x i m u m ___________________________________
W ith s t ip u la t e d m a x i m u m ________ _______
W ith s t ip u la t e d m in im u m _________________
W ith n o s t ip u la t e d m in im u m o r
m a x im u m
O th e r
____________________________________________

NOTE:

W orkers
P la n s

P la n s

N um ber

A ll p la n s s t u d ie d

M u ltie m p lo y e r

W ork ers

W orkers

o f r o u n d in g ,

sum s

4 , 981

200

2 , 822

100

2, 159

237
134
130

3, 675
1, 876
1 ,8 3 2

167
86
86

2, 540
1 ,0 8 1
1 ,0 8 1

70
48
44

1, 135
795
751

4
97

44
1, 657

-

-

78

1 ,4 4 6

4
19

44
212

71
19
2

1 ,4 5 2
i4 0
7

63
13
-

1, 369
69
-

8
6
2

84
72
7

5
6

58
144

2
3

8
14

3
3

49
130

o f i n d iv id u a l i t e m s

T A B L E D - 4 . — A c c i d e n t a n d s i c k n e s s : D is t r ib u t io n
o f p la n s p r o v i d i n g a g r a d u a t e d n o n o c c u p a t io n a l
b e n e f i t b y a m o u n t p r o v i d e d w o r k e r s e a r n in g
$ 4 , 0 0 0 y e a r l y , la t e 1955 1

d o n ot n e c e s s a r i l y e q u a l t o t a l s .

T A B L E D - 5 . — A c c i d e n t a n d s i c k n e s s : D is t r ib u t io n
o f p la n s p r o v i d i n g a fla t a m o u n t b y a m o u n t o f w e e k ly
n o n o c c u p a t i o n a l b e n e f i t , la t e 195 5 1
W orkers

A m o u n t o f w e e k ly b e n e f i t f o r
$ 4 , 0 0 0 -a -y e a r w o rk e r 2

A l l p la n s p r o v i d i n g
a n a m o u n t b a s e d on
e a r n i n g s a lo n e

$ 2 5 ________________________________
$ 2 5 .0 1 b u t l e s s th a n $ 3 0 ______
$ 3 0 __________________________________
$ 3 0 .0 1 b u t l e s s th a n $ 3 5
$ 3 5 ___________________ ____ __
$ 3 5 .0 1 b u t l e s s th a n $ 4 0 ______
$40
.... ....................... ..
$ 4 0 .0 1 b u t l e s s th a n $ 4 5 ______
$45
____ .
$ 4 5 .0 1 b u t l e s s th a n $ 5 0
$ 5 0 _ _ ______________ _____ ____
$ 5 0 .0 1 b u t l e s s th a n $ 5 5 ______
$ 5 5 _____
_____ _ _______ ___ ______

W ork ers

P la n s
(0 0 0 ‘ s )

( 0 0 0 ‘ s)
A l l p la n s p r o v i d i n g a fla t
a m o u n t b e n e f i t __________________
3 95

3 1 ,6 2 6

3
4
11
7
7
17
21
7
3
9
2
3
1

12
9
106
61
35
300
163
84
134
273
17
17
415

1 B a s e d on a s tu d y o f 3 0 0 h e a lt h a n d i n s u r a n c e
p la n s u n d e r c o l l e c t i v e b a r g a i n i n g c o v e r i n g a p p r o x i ­
m a t e l y 5 m i l l i o n w o r k e r s ; 237 o f t h e s e p r o v i d e d f o r
n o n o c c u p a t i o n a l a c c id e n t a n d s i c k n e s s b e n e f i t s .
E x­
c lu d e d a r e 2 p la n s u n d e r w h ic h th e w e e k ly b e n e f i t
p r o v i d e d d u r in g th e f i r s t p a r t o f th e b e n e f i t p e r i o d
w a s h i g h e r th an th a t p r o v i d e d d u r in g th e la t t e r p a r t
o f the b e n e f i t p e r i o d .
2 W e e k ly e q u iv a le n t — $ 7 6 . 9 2 .
3 2 p la n s c o v e r i n g 5 , 0 0 0 w o r k e r s p r o v i d e d a
lo w e r b e n e fit fo r w o m e n .




A m o u n t o f w e e k ly b e n e f i t

P la n s

________
U nder $15
_
$ 1 5 __________________________________
$ 1 5 .0 1 b u t l e s s th a n $ 2 0
$20
_ ...
$ 2 0 .0 1 b u t l e s s th a n $ 2 5 _______
$ 2 5 __________________________________
$ 2 5 .0 1 b u t l e s s th a n $ 3 0 _
$30
____
... .
$ 3 0 .0 1 b u t l e s s than $ 3 5
$ 3 5 .0 1 h u t l e s s than $ 4 0 .
$40
_______
_______
$45
. _____________
$50

____

2 133

2 1 ,8 7 3

3
4
2
8
6
15
7
27
6
12
2
33
6
1
1

90
55
6
434
33
103
23
193
42
91
21
74 4
28
3
9

1 B a s e d on a s tu d y o f 3 0 0 h e a lt h a n d i n s u r a n c e
p la n s u n d e r c o l l e c t i v e b a r g a i n i n g c o v e r i n g a p p r o x i ­
m a t e ly 5 m i l l i o n w o r k e r s ; 237 o f t h e s e p r o v i d e d f o r
n o n o c c u p a tio n a l a c c id e n t and s ic k n e s s b e n e fit s .
2 11 p la n s c o v e r i n g 1 8 7 ,0 0 0 w o r k e r s p r o v i d e d
a l o w e r b e n e f i t f o r w o m e n . E x c l u d e d i s 1 p la n u n d e r
w h ic h th e w e e k ly b e n e f i t p r o v i d e d d u r in g th e f i r s t p a r t
o f th e b e n e f i t p e r i o d w a s h i g h e r th a n th a t p r o v i d e d
d u r in g th e la t t e r p a r t o f th e b e n e f i t p e r i o d .

it e m s

N O T E : B e c a u s e o f r o u n d in g , s u m s
do n ot n e c e s s a r ily equ a l t o t a ls .

o f i n d iv id u a l

37
A con siderably la rg er proportion of m ultiem ployer plans provided flat
benefits than did sin g le -e m p lo y e r plan s.
Slightly m ore than half of the sin g le ­
em p loyer plans made available a flat am ount, as contrasted with n early th re e fourths of the m u ltiem p loyer plan s.
Am ount of B e n e fits. — A m uch d iscu ssed aspect of accident and sick n ess
plans concerns the ratio of benefits to norm al w ages.
It is com m only argued
that too high a benefit le v e l fo ste rs m a lin gerin g, i. e. , the reliance upon benefit
paym ents during periods when the w orker is not actually ill or the continuation
of benefits beyond that point when the w orker has recovered sufficiently to return
to the jo b .
On the other hand, it is argued that to fix benefit lev els so low as
to elim inate any p o ssib ility of m alingering would not only be unfair to the valid
claim ants but would, in e ffe ct, com p rom ise the ba sic purpose of accident and
sick n ess plans— to provide a reasonable incom e during periods wren the w orker
m ay need it m o st.
A s pointed out p rev io u sly , a number of plans regulated or
controlled the proportion of wage replacem ent through the establishm ent of a
m a xim u m , either in the form of a specified percentage of earnings or a fixed
dollar amount.
F o r a w orker earning $ 4 ,0 0 0 a year 19 (an a rb itra rily selected earnings
le v e l), w eekly benefits provided by graduated plans ranged from $2 5 to $55
(table D -4 ). The m o st frequently provided amount was $ 4 0 , which was app roxi­
m a te ly the m edian amount provided by a il graduated plan s.
This benefit lev el
provided slightly m o re than 50 percent of g ro ss weekly wages before deductions
fo r w ork ers paid at the rate of $ 4 ,0 0 0 y e a rly .
Under plans providing flat am ounts, the paym ents ranged from le s s than
$ 1 5 to $ 55 w eekly (table D -5 ).
The m o st frequently provided amount was $ 4 0 ,
found in about a fourth of the plans stipulating a uniform benefit. Slightly few er
plans provided $30 w eekly, which was a lso the m edian amount provided under ail
fla t type plan s. 0 Only 8 plans provided a w eekly benefit in e xcess of $ 4 0 ; for
the m o st p art, these plans covered w orkers whose expected level of earnings was
c h a ra cte ristica lly high.
V ariations in Am ount Based on Sex. — In g en eral, both m en and wom en
w ork ers w ere entitled to the sam e amount of nonoccupational accident and s ic k ­
ness b e n e fit s .21
Under 13 pla n s, how ever, different benefit levels w ere p r o ­
vided and in each case wom en received a le s s e r amount.
M ost of these plans
w ere in industries in which em ploym ent of women was rela tiv ely high.
A s shown
below , for w orkers earning $ 3 ,0 0 0 y ea rly (an a rb itra ry earnings le v e l), in only

W ork ers
P e r c e n t o f b e n e fit le v e l p r o v id e d m e n a v a ila b l e t o w o m e n e a r n i n g $ 3 , 0 0 0 a y e a r ______
A l l p la n s p r o v id in g d iffe r e n t a m o u n ts f o r
m e n a n d w o m e n ______________________________________
60
75
78
80
83

lo

p e r c e n t __
p e r c e n t __
p e r c e n t __
p e r c e n t __
p e r c e n t __

P la n s

(0 0 0 * 3 )

_______ 13

19 2

1
7
1
3
1

20
13 6
7
28
1

W eekly equivalent— $ 7 6 .9 2 .
20 The relationsh ip of this median or of the different benefit le v e ls to arbitrarily s e le c t earnings le v e ls c a n , of c o u r se , be readily com­
puted; how ever, the ben efit amount under many flat plans is geared to the exp ected le v e l of earnings of workers covered by the plan . In
many c a s e s , th ese le v e ls may vary con sid erab ly from an arbitrarily se le c te d on e, and the relation sh ip s mentioned above would be u n rea listic.
For exam ple, if workers covered by a flat plan are exp ected to earn $ 6 ,0 0 0 a year (or at this rate) the le v e l o f ben efits provided by the plan
would tend to reflect this exp ectan cy. R elatin g this le v e l of b en efits to a $ 4 ,0 0 0 -a -y e a r w age would exaggerate the ratio of earnings pro­
vided by the plan . T h e opposite would be true if earnings were su b sta n tially below $ 4 ,0 0 0 .
21 Th e ava ila b ility of b en efits in the maternity c a s e s is d isc u sse d in a separate sectio n of this study.







CO

T A B L E D - 6 . — A cc id e n t and s ic k n e s s : D is trib u tio n of plan s by am ount of w ee kly n o n o ccu p atio n a l b e n e fit p ro vid e d w o rk e rs
e a rn in g $ 4 , 000 y e a r ly and d u ra tio n of b e n e fit p e rio d , late 1 9 5 5 1

00

M a x im u m d u ratio n of b en efit p e rio d
O th e r
W ork ers

A l l p la n s p r o v i d i n g n o n o c c u p a t i o n a l
a c c id e n t a n d s i c k n e s s b e n e f i t s -----------------

_

A l l p la n s p r o v i d i n g f la t a m o u n t o r
a m o u n t b a s e d o n e a r n in g s a lo n e ______ _
U nder $15
.................
...................................
$15
________________________________________
$ 1 5 .0 1 b u t l e s s th an $ 2 0 _______________
$ 2 0 __________________________________________
$ 2 0 .0 1 b u t l e s s than $ 2 5 -----------------------$ 2 5 ________ _____ ____________________________
$ 2 5 .0 1 b u t l e s s than $ 3 0 _______________
$ 3 0 _______________________________________ .
$ 3 0 .0 1 b u t l e s s th an $ 3 5 -----------------------$ 3 5 __________________________________________
$ 3 5 .0 1 b u t l e s s th an $ 4 0 _______________
$ 4 0 _______________________________________ _
$ 4 0 .0 1 b u t l e s s th an $ 4 5 _______________
$ 4 5 __________________ _____________________
$ 4 5 .0 1 b u t l e s s than $ 5 0 _______________
$ 5 0 __________________________________________
$ 5 0 .0 1 b u t l e s s th an $ 5 5 _______________
$ 5 5 __________________________________ _______

52 w e e k s
P la n s

P la n s

W orkers

W orkers
P la n s

( 0 0 0 1s )

( 0 0 0 's )

(0 0 0 's )

13 w e e k s 3

W orkers

W orkers

W orkers
P la n s

( 0 0 0 ‘ s)

1
2
3
4
p a rt of

26 w eeks

13 w e e k s
N um ber

A l l p la n s p r o v i d i n g an a m o u n t b a s e d o n
f a c t o r s o t h e r th an e a r n in g s ------------------

P er year

P e r d is a b ilit y

A l l p la n s
A m o u n t o f w e e k ly b e n e f i t f o r
$ 4 , 0 0 0 -a -y e a r w o rk e r 2

P la n s
( 0 0 0 ' s)

(0 0 0 ‘ s)

237

4

3 ,6 7 5

86

769

120

2 ,2 5 0

9

142

9

463

13

53

9

177

1

9

4

44

2

37

1

85

1

2

228
3
4
2
8
6
18
11
38
13
19
19
54

3 ,4 9 9
90
55
6
434
33
114
32
299
102
126
321
907
84
162
273
20
17
424

85
3
4
2
6

761
90
55
6
153
19
106
8
118
26
43
20
66
_
10
13
15

116

2 ,2 0 6
_
_
-

7
_
_
_
_
1
_
_

105
_
5
-

8
_
-

37 8
.
281
-

12
_

50
_
14
5
_
5
5
6
-

7
9
9
3
3

2

4

15
4

15
3
4

6
11
_

2
2
2
1
1

4

9

_
_
1
6
19

7
14
8
43

7
6

2
1
1
1

4

22
122
61
79
260
841
84
150
158
5

7
415

2

7

-

_
93
_

~

~

4

2
1
1
3
_
1
_
~

2
2

2

_

50
16
_

2

29

2

_

1
1
1

"

-

_
1

2
9
6

B a s e d on a study of 300 h ealth and in s u ra n c e plans under c o lle c tiv e b a rg a in in g co v e rin g a p p ro x im a te ly 5 m illio n w o rk e rs .
W ee kly e q u iva len t— $ 7 6 .9 2 . 13 p lan s c o v e rin g 192,000 w o rk e rs p ro vid e d a lo w e r b e n efit fo r w om en.
In c lu d e s 4 p la n s c o v e rin g 2 8 6 ,0 0 0 w o rk e rs that p rovid e d s e p a ra te ly fo r 13 w eeks p e r y e a r fo r a c cid e n ts and 13 w eeks p er y e a r fo r s ic k n e s s .
In clu d e d a re 3 plans u n de r w hich the w eekly am ount p ro vid e d d u rin g the f i r s t p a rt of the b en efit p e rio d was h ig h e r than that p ro vid e d d u rin g the la tte r
the b e n efit p e rio d .

N O TE:

B e c a u s e of ro u n d in g , su m s of in d iv id u a l ite m s do not n e c e s s a r ily equal to ta ls .

39
1 plan was the amount provided women le s s than 75 percent
Inasmuch as flat amounts fo r m en and w om en, re g a rd le ss of
provided by 11 of the 13 p lan s, the relationship between
m en and wom en under these plans would gen erally be the
le v e ls .

of that provided m en .
earnings le v e ls , w ere
the amounts provided
sam e at other incom e

Duration of B e n e fits .— P rovision s lim iting the number of weekly benefit
paym ents available to w orkers were included in a ll but 2 of the 237 plans p r o ­
viding nonoccupational accident and sick n ess ben efits. P redom inantly, the s p e c i­
fied num ber of w eekly paym ents was available to the w orker for each separate
disability (table D - 6 ) . aa About half of the p la n s, accounting for about 6 out of
10 w orkers with accident and sick n ess benefit cov era g e, made payments available
to incapacitated w orkers fo r up to 26 weeks per disability. M ost of the rem aining
plans provided benefits for a m axim um of 13 weeks per disability. The duration
of weekly benefits was uniform fo r a ll w orkers covered by the plan, re g a rd le ss
of sex or earnings le v e ls , except fo r certain m odifications based on age (see
below ). Only 1 plan varied the benefit period on the b a sis of length of s e r v ic e .
G en erally, under plans providing benefits for 26 weeks or m o r e , the
amount of the w eekly paym ent was greater than the amount specified under plans
with a shorter benefit period. M ore than half of the plans with a 2 6 -w e e k dura­
tion paid $40 a week or m o re to a $ 4 , 0 0 0 -a -y e a r w o rk er. In con trast, the great
m a jo rity of those with a 13-w ee k duration provided $30 or le s s (table D -6 ).
Reduction of Benefits During A ctive E m ploym ent. — Under 55 p lan s, a
m odification was made in accident and sickness benefits provided w ork ers upon
attainment of a specified age (table A - 13).
W ith two exception s, these plans
specified age 60 as the tim e when the benefit provisions w ere changed. In only
one instance was the benefit discontinued. With this exception, the change in no
case affected the amount of w eekly paym ent; rath er, it consisted of shifting the
benefit payments from a "p e r -d is a b ilit y " basis to a M e r -y e a r ,f ba sis (table D -7 ) .
p
In 2 out of 3 of these pla n s, both accident and sick n ess benefits were affected ; in
the rem aining plan s, only the sick ness benefit was affected .
T A B L E D - 7 . — A c c id e n t and s ic k n e s s :

C h a n g e in b a s is of w e e k ly n o n o c c u p a tio n a l b e n e fit p a y m e n t
due to a g e , la te 1955 1
W o rk e rs

P r o v is io n

P la n s
(O O P

1s)

A l l p la n s p r o v id in g fo r a ch a n g e in b a s is of p a y m e n t at s p e c if ie d age

_55

41 9

C h a n g e a ffe c te d both a c c id e n t an d s ic k n e s s b e n e fit s

__________________

36

281

A fte r age 60:
13 w e e k s p e r y e a r
2 6 w e e ks p e r y e a r

17

B e fo r e age 6 5 :
13 w e e k s p e r d is a b ilit y

A f t e r ag e 6 5 :
13 w e e k s p e r y e a r

1

13

B e f o r e ag e 7 0 :
20 w e e k s p e r d is a b ilit y

A fte r age 70:
D is c o n t in u e d

1

5

19

138

8
1
10

85
3
50

B e fo r e age 6 0 :
13 w e e k s p e r d is a b ilit y
26 w e e k s p e r d is a b ilit y

Change

________________
________________

a ffe c te d s ic k n e s s b e n e fit o n ly

B e f o r e ag e 6 0 :
13 w e e k s p e r d is a b ilit y
20 w ee ks p e r d is a b ilit y
26 w e e k s p e r d is a b ilit y

A fte r
13
20
26

a g e 60:
w eeks per y e a r
w eeks p er y e a r
w eeks p er year

17

62

201

1
B a s e d on a stu d y of 300 h e a lth and in s u r a n c e p la n s u n d e r c o lle c t iv e b a r g a in in g ; of th e s e , 23 7 p la n s p ro v id e d a
w e e k ly n o n o c c u p a tio n a l a c c id e n t an d s ic k n e s s b e n e f it s .
N O TE:
^

B e c a u s e of ro u n d in g , s u m s of in d iv id u a l it e m s do not n e c e s s a r ily e q u a l t o t a ls .

Under these p la n s, the number of w eek ly paym ents a worker c o lle c te d from the plan for previous d isa b ilitie s had no bearing on the

number available to him in c a se of future d isa b ilitie s so long as the d is a b ilitie s were due to unrelated c a u s e s and were separated b y a
return to work, usu ally for a sp e cified period.




40
Qccupational Benefits
H isto ric a lly , w eekly accident and sick n ess b e n e fits, with few exception s,
w ere designed to recom pense em ployees prevented from working by o ff-th e -jo b
inju ries or illn e s s e s , since partial wage paym ent in case of d isability incurred
on the job was provided through w o rk m e n ^ com pensation law s.
H ow ever, as
accident and sick n ess plans developed, the paym ents m ade under these state laws
w e re , in m any in sta n ces, le ss than the worker would have received fo r o ff-th e -jo b
in ju rie s. To c o r re c t this situation, an increasing num ber of accident and s ic k ­
n ess plans in recent years have included a guarantee that the w orker who is
injured on the job w ill receive an incom e at lea st equal to the amount provided
for o ff-th e -jo b d isa b ilitie s.

About 1 out of 5 plans (52) with accident and sick n ess b e n e fits, covering
a substantially higher proportion of w o rk e rs, provided paym ents in case of o ccu ­
pational d isabilities (table D - l ) .
M ost of these plans m ade available a w eekly
occupational benefit equal to the difference between the amount of the nonoccupational paym ent and the w o rk m e n ^ com pensation paym ent (table D - 8 ). F o r e x ­
a m p le, assu m in g that the amount of the nonoccupational disability benefit was $ 4 0
w eek ly, and that the disabled w orker received $30 w eekly under w o rk m e n ^ c o m ­
pensation, the w orker would thus be entitled to the difference of $ 1 0 w eekly from
the private plan, gen erally fo r the sam e period he would have drawn benefits in
case of a nonoccupational disability.

TABLE D - 8 .— Accident and sickness: Relationship between amount
of weekly nonoccupational and occupational benefits provided
workers earning $ 4 ,0 0 0 yearly, late 1955 1
Workers
Amount of weekly occupational benefit

Plans
(000's)

A ll plans providing nonoccupational and
occupational accident and
sickness benefits _____________________________ _

50

1,695

Difference between W orkm en's Compensation
benefit and nonoccupational benefit___________
Same as nonoccupational b en efit_____________ _
50 percent of nonoccupational benefit __________
25 percent of nonoccupational benefit ____ __
Other

39
4
2
2
3

1,563
60
44
17
11

1 Based on a study of 300 health and insurance plans under col­
lective bargaining covering approximately 5 m illion w orkers.

With few exceptions, the period during which paym ents w ere made for
occupational disabilities was of the sam e duration as that provided for nonoccupa­
tional d isa b ilitie s.
As indicated below , nearly th ree-fo u rth s of the plans p r o ­
viding occupational benefits did so for up to 26 weeks per d isability.




W orkers
Maximum duration of occupational benefit period_____

Plans

(000*s)

A ll plans providing occupational benefits

52_________1 ,7 1 4

13 weeks per d isa b ility __________________________
26 weeks per d isa b ility __________________________
52 weeks per d isa b ility __________________________
26 weeks per year _______________________________
U n lim ite d __________________________________________
Other ______________________________________________

10
35
2
1
1
3

84
1, 510
85
9
10
17

NOTE: Because of rounding, sums of individual items do not nec­
e ssarily equal totals.

41
H o sp ita l B e n e fits

V irtu ally all plans in this study providing hospital benefits made these
benefits available through c o m m e r c ia l insurance c a r r ie r s or through prepaym ent
plans o ffered by nonprofit organizations such as Blue C r o s s .
A few p ro g ra m s
w ere s e lf-in s u r e d , that i s , the benefits were paid directly by the fund to which
contributions were made or by the em p loy er.
G en erally , plans underwritten by
c o m m e r c ia l c a r r ie r s provided fo r fixed cash allowances to be applied toward
expenses n orm ally incurred in the hospital.
These are usually re fe rre d to as
cash or indem nified p la n s.
Benefits made available through plans operated by
nonprofit organizations were usually of a serv ice type; i . e. , sp ecified benefits
were assu red rather than cash allow ances toward the cost of those ben efits.
S e lfinsured program s made use of both m ethods.
H ospital benefits are generally described in te rm s of two m a jo r c o m ­
ponents: (l) R oom and board benefits and (2) "e x t r a " or ancillary hospital s e rv ice
allow an ces.
The fo rm e r covers allowances for ro o m , m e a ls , special diets on
o cc a sio n , and general nursing c a r e ; the latter applies to allow ances for such
se rv ic e s or charges as use of operating and cystoscopic r o o m s , supplies (e. g. ,
bandages, sp lin ts, anesthetic m a te r ia ls ), p rescrib e d laboratory exam ination s,
specified drugs and m ed ica tio n s,
various types of X -r a y exam ination s, etc.
Under virtu ally all pla n s, a m axim um number of days of hospitalization
was provided.
U su a lly, the daily benefit allow ances or se rv ice s rem ained the
sam e throughout this entire period. H ow ever, under som e plans low er or lim ited
benefits were provided during the latter part of the period, re fe rre d to in this
report as the "e x te n d e d -c o v e r a g e ” period. The time during which the higher or
full benefits were provided is designated as the M ll-b e n e fit" period.
fu
Types of Plans
Of the 300 plans studied, 293 provided hospital benefits for active w orkers
and 278 for the w o r k e r s 1 dependents. M ore than half of the plans provided cash
benefits (table E - l ) . 23
H ow ever, a somewhat la rg er number of w orkers w ere
covered by se rv ice p la n s. Slightly m ore than a tenth of the plans w ere com bin a­
tion plans (cash and se rv ic e ); m o st of these plans provided cash daily room and
board allow ances but made available specified hospital extras on a fu ll-c o s t or
se rv ice b a s is .
No significant variation was noted in the extent to which single
and m ultiem ployer plans utilized c a sh - or s e rv ice -ty p e p rog ram s.
Duration of Benefits
Although full daily room and board allow ances were available to both
w orkers and their dependents for periods ranging fro m le s s than 2 1 to m o re than
120 days per hospital stay, the m a jo rity of plans provided 70 days or m ore fo r
each group (table E - 2 ) . 24
The m o st frequent durations specified were 31 and
70 days.
When com bined with the next m o st prevalent fu ll-b e n e fit period (120
days), these 3 benefit periods accounted for over tw o-thirds of the plans.
G en era lly , s e rv ic e -ty p e plans stipulated longer fu ll-b e n e fit periods than
plans providing cash allow an ces. This was true for both workers and dependents.
Although the duration of the fu ll-b e n e fit period under se rv ic e -ty p e plans varied
con siderably, plans providing 1 2 0 days covered approxim ately tw o-th irds of the
w orkers under all plans with se rv ic e -ty p e room and board benefits (table E -2 ).

Plans were classified according to the type of room, board, and extra hospital benefits provided during the full-benefit period.
24 Frequently, limitations were placed on the number of days benefits were available in case of a tonsillectomy, poliomyelitis, and
mental and nervous disorders; these limitations are not described in this study. The benefits for maternity care are described in a subse­
quent section of this study.




42
A slightly s m a lle r
fying 1 2 0 -d a y benefit
of w orkers or their
periods of 1 2 0 days

proportion of w orkers w ere under s e rv ice plans s p e c i­
periods fo r dependents. In con trast, only a s m a ll proportion
dependents under cash plans w ere provided with fu ll-b e n e fit
or m o re .

T A B L E E - l . — H o s p it a liz a t io n :

T y p e s o f p l a n s f o r w o r k e r s a n d d e p e n d e n t s b y t y p e o f b a r g a i n i n g u n it , l a t e 1 9 5 5
A l l p la n s

T y p e o f p la n s a n d g r o u p c o v e r e d 1

S in g le e m p lo y e r

W ork ers
P la n s

M u ltie m p lo y e r

W ork ers
P la n s

W ork ers
P la n s

(0 0 0 *s)

(0 0 0 fs)

(0 0 0 * s j

300

A l l p la n s s tu d ie d

4 ,9 8 1

200

2 ,8 2 2

100

2 ,1 5 9

293
158
102
33

4 ,9 0 8
1 ,8 8 2
2 ,2 7 5
751

199
102
72
25

2 ,8 1 3
1 ,0 0 1
1 ,6 1 2
201

94
56
30
8

2 ,0 9 5
881
663
551

278
150
99
29

4 ,2 7 9
1 ,8 1 0
2 ,2 5 5
213

193
97
71
25

2 ,7 8 1
971
1 ,6 1 0
201

85
53
28
4

1 ,4 9 8
840
645
13

W orkers
A l l p l a n s p r o v i d i n g h o s p i t a l b e n e f i t s ____________
C ash
_
__ _
S e r v ic e
C a sh and s e r v ic e
__
_
_ _ _
D e p e n d e n ts
A l l p la n s p r o v id in g h o s p it a l b e n e fits
C ash
_ _

Sftrvire
C a sh and s e r v ic e

____________

1 P la n s w e r e c l a s s i f i e d a c c o r d in g t o ty p e o f b e n e f it s p r o v id e d d u r in g th e f u ll - b e n e f it p e r i o d .
F u ll-b e n e fit
p e r i o d o n t h i s a n d s u b s e q u e n t t a b l e s in t h i s s e c t i o n o f t h e b u l l e t i n r e f e r s t o t h e p e r i o d d u r i n g w h ic h t h e m a x i m u m
d a ily r o o m an d b o a r d b e n e fit is p r o v id e d .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls . A l l c o v e r a g e d a ta s h o w n
in t h is stu d y r e la t e to n u m b e r o f a c t iv e w o r k e r s c o v e r e d b y p la n s .
S e e fo o tn o te 3 , p . 1.

Dependents received benefits for the sam e period as w ork ers under a
large m a jo rity of the 2 72 plans providing hospitalization to both groups (table
E - 3 ) . W here there was a d ifferen ce, a shorter period was specified fo r depend­
ents in virtu ally a ll c a s e s .
Under three p lan s, the number of days in the fu ll-b e n e fit period in creased
according to the length of tim e a w orker participated in a plan.
F o r exam ple,
under 1 plan, this period in creased from 21 to 25 days after 1 year of p a r tic i­
pation, and then to 31 days a fter the second y ea r.
Extended coverage p e rio d s, at reduced allow an ces, w ere provided under
55 plans fo r w orkers and dependents. F or each group, m o re than half of these
plans provided a fu ll-b e n e fit period of 2 1 days and an extended coverage period
of 180 days (table E - 4 ) .
Of the 51 plans with extended coverage provisions for
both w orkers and dependents, the duration was identical in a ll c a s e s , and only
1 plan provided a low er lev e l of daily room and board allow ances fo r dependents
(table E - 3 ) .
N ea rly 95 percent of the plans coveiin g both w orkers and dependents
provided hospital benefits on a "p e r -d is a b ilit y M b a s is , that i s , benefits w ere p a y ­
able for each separate d isability or period of hospital confinem ent. 25 The num ber
of tim es the individual received benefits under the plan for previous disa b ilities
had no bearing on the benefits available to him in case of future illn e s s e s . Under
the few plans providing benefits on a " p e r - y e a r " b a s is , the amount available to
the insured for a second or third period of hospital confinem ent during any 1
benefit year was the unused portion of the benefits sp ecified .

A separate disability or a separate period of hospital confinement was usually described, in relation to a previous use of hospital
facilities, as being due to a different or unrelated cause, or separated by a return to work or a specified period of time.







TABLE E - 2 . — Hospitalization:

Distribution of plans by duration of full-benefit period for workers and dependents and type of room and board benefit, late 1955
Type of room and board benefit for—
Dependents

Workers
Duration of full-benefit period

All plans

Cash

Workers
Number

Plans

A ll plans providing hospital benefits

___

Under 21 days __________________________ __
21 days ___________________________________
22 but less than 31 days ________________
31 days ____________________________________
32 but less than 70 days --------------------------70 days _________________________________ __
71 but less than 120 d ays_________________
120 days -------------- --------------- ------- -------------121 days and over ______________________ __
Other 3 --------------------------------------------------------

Plans

Plans

2 2 93

24 , 908

186

2 ,0 7 6

3
30
3
72
17
78
14
56
10
10

48
325
10
833
176
679
206
2 ,0 7 3
364
193

3
1
3
70
16
54
9
16
8
6

48
3
10
816
161
433
158
201
85
162

2, 833

107

322

29
2
1
24
5
40
2
4

-

18
15
246
49
1 ,872
279
31

Service

Workers
Plans

( 0 0 0 's)

( 0 0 0 's )

( 0 0 0 's)

Cash

Workers

Workers

Workers

(000 1s)

All plans

Service

Workers
Plans

(0 0 0 's )

278

4 ,2 7 9

175

1 ,9 6 6

1
30
6
80
11
66
13
55
7
9

4
325
37
1 ,0 3 7
54
595
144
1 ,5 6 8
346
167

1
1
6
77
9
44
10
16
6
5

4
3
37
1 ,0 0 9
40
361
109
196
69
137

(0 0 0 1s)
103

2 ,3 1 3

29

322
28
14
234
35
1,372
277
31

_
-

3
2
22
3
39
1
4

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 m illion w orkers.
2 2 plans covering 2 5 ,0 0 0 workers provided a shorter duration for women.
3 Include plans with no specified duration and plans for which the full-benefit period increased according to the length of time a worker participated in
the plan.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals.
workers covered by the plans.
See footnote 3, p. 1.

TABLE E - 3 . — Hospitalization:

All coverage data shown in this study relate to number of active

Relationship of provisions for workers and dependents, late 1955 1
Benefits during—

A ll plans providing benefit for
workers and dependents
----------------

_

Tfr variation in provision
\i
Variation in provision ___________________

1

Maximum room and
board benefit

Extended coverage period

Full-benefit period
Daily room and
board benefit
Workers
Plans
( 0 0 0 's)

Provision

Duration
Workers
Plans
( 0 0 0 's)

Daily room and
board benefit
Workers
Plans
( 0 0 0 's)

Hospital extra
service benefit

Duration
Workers

Workers

Workers
Plans

Plans

Plans
(000* s)

(000* s)

(000* s)

272

4 ,215

272

4 ,2 1 5

51

479

51

479

272

4, 215

271

4, 210

224
48

3,6 9 6
519

251
21

3 ,9 2 0
295

50
1

455
24

51

479
-

218
54

3, 629
586

221
50

3 ,6 2 9
581

Based on a study of 300 health and insurance plans under collective bargaining; of these, 272 plans provided hospitalization to both workers and dependents.

NOTE:

All coverage data shown in this study relate to number of active workers covered by the plans.

See footnote 3, p. 1.
CO




TABLE E - 4 . — Hospitalization:

Distribution of plans by duration of full-benefit and extended coverage periods for workers and dependents, late 1955
D u r a t io n o f e x t e n d e d c o v e r a g e p e r i o d
A l l p la n s 2

D u r a t io n o f f u l l - b e n e f i t p e r i o d

L e s s than
90 d a y s

90 d a y s

(0 0 0 » s )

(0 0 0 » s )

(0 0 0 * s )

(0 0 0 * s )

(0 0 0 »s)

(000 *s)

W orkers

W orkers
P la n s

P la n s

P la n s

246 d a y s
and o v e r

245 d ays

W orkers

W orkers
P la n s

P la n s

P la n s

P la n s

181 bu t l e s s
th a n 2 4 5 d a y s

180 d a y s

W ork ers

W orkers

W ork ers

W orkers
N um ber

91 bu t l e s s
th a n 180 d a y s

(0 0 0 * s )

(0 0 0 * s )

W orkers

A l l p la n s w ith e x t e n d e d c o v e r a g e
p r o v i s i o n s ...
U n d e r 21 d a y s
21 d a y s
_____ _____
22 but l e s s th a n 60 d a y s
.... .........
60 d a y s
61 bu t l e s s th an 120 d a y s ___________
120 d a y s ........... ...........................
O th e r 3 ___
_________

55

529

5

52

3
30
4
6
4

48
325
22
43
18

35
-

6
2

55

1
4
-

18

-

55

567

8

7

53

16
21
-

~

2
3
1
_
1

105

7

53

17
_

3
_
13

5

39

2
1
2
-

13
1
25
_

■

30

323

2

8

5

48

1

6

28
_
_
1
1
"

309
-

1
_

-

_
-

1
-

-

■

1

5

5
■

_
48
“

“

-

30

323

1

3

5

48

1

6

28
_
1
1

309
_
_

_
_
1
_

_
_
_
3
_

_
_
_

_
_
_
48

_

_
_

1

6

6
8

3
_

6
_

D ep en d en ts

A l l p la n s w ith e x t e n d e d c o v e r a g e
p r o v is io n s _
U n d e r 21 d a y s
_
21 d a y s
22 but l e s s th a n 60 d a y s
60 d a y s ....
61 bu t l e s s th an 120 d a y s
120 d a y s
_______ _
O th e r 4
____

... ......

l

4

4
325
120
31
18

2
6
-

6

55

_

1

13

30
7

6
_

___

_

_
74
31
_

2
3
_
1
_
1

16
21
_
3
_
13

3

29

1
_

4
.
25
_
_

2
_

_

6
8

5

_

* Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 m illion workers; of these, 293 and 278 plans
provided hospital benefits for workers and dependents, respectively.
2 The difference in worker coverage figures for plans providing extended coverage for each group is accounted for by the fact that the 55 plans in each
group were not identical.
3 Under 1 plan covering 13,000 w orkers, full-benefit period increased according to the length of time a worker participated in the plan; under the other
plan the full-benefit period was 183 days.
4 This plan provided a full-benefit period of 183 days.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals.
workers covered by the plans.
See footnote 3, p. 1.

A ll coverage data shown in this study relate to number of active

45
Room and Board Allow ances
Service P la n s .— Under virtu ally a ll plans providing s e rv ic e -ty p e room
and board ben efits, w orkers and dependents were eligible for sem ip rivate a c c o m ­
modations during the fu ll-b e n e fit period without extra cost for the hospital s e rv ic e s
provided. Sem iprivate accom m odations w ere gen erally described as room s having
2 beds or 2 and not m ore than 4 bed s.
If the patient occupied a private ro o m ,
a specified cash allowance or the amount charged by the hospital for the a c c o m ­
modations to which the patient was entitled was allow ed toward the cost of the
private room ; the patient was respon sible for the differen ce.
Extended coverage periods w ere included in 39 of the 107 plans providing
s e r v ic e -ty p e room and board benefits for w o rk ers. Under 30 of these 39 c a s e s ,
the plan paid half the cost of the hospital accom m odations during this p eriod .
M o st of the rem aining plans provided a fixed daily cash allowance to be applied
toward a ll hospital ch arges.
E sse n tia lly the sam e p ractices existed among the
41 se rv ice plans under which dependents w ere covered by extended coverage
p r o v isio n s.
Cash P la n s. — P ra c tica lly a ll of the plans with cash room and board b en e­
fits provided a fixed daily allowance (table E - 5 ) . Under these p r o g r a m s , r e im ­
bu rsem ent was made toward the charge for hospital accom m odations up to the
stipulated daily m axim um . Any charge in ex c e ss of this m axim um was paid for
by the w ork er.
D aily cash room and board allow ances fo r w orkers and dependents ranged
fro m le s s than $ 8 to m ore than $ 1 6 .
The average allowance for w orkers was
$ 1 1 .1 2 and for dependents, $ 1 0 .3 1 .
N early 1 out of 3 plans specifying cash
daily allow ances for both w orkers and their dependents provided a lower amount
fo r dependents.
G en erally , plans with low daily allow ances a lso tended to provide benefits
fo r re la tiv ely short fu ll-b e n e fit p e rio d s. F o r exam ple, daily allow ances of le s s
than $ 1 2 for w orkers and dependents w ere provided under a substantially la rg e r
proportion of plans specifying fu ll-b e n e fit periods of le s s than 70 days than those
specifying 70 days or m ore (table E - 5 ) .
L e ss than 1 0 percent of the cash plans covering w orkers and dependents
provided for extended coverage.
W here such p rovisions w ere m ade, the daily
allow ance during the extended coverage period was half that provided during the
fu ll-b e n e fit period in virtu ally a ll c a s e s .
M axim um A llo w a n ce. — The m axim um room and board allowance is the
product of the daily cash allowance tim es the m axim um number of days of hospital
stay provided under the plan.
O bviously, this allow ance can be calculated only
for cash plan s, since ba sic to the definition of a se rv ice plan is the prov isio n
that the daily benefit is provided in the form of specified hospital a ccom m od ation s,
i. e . , sem ip rivate or w ard.
Thus, to a w orker who m ay have to utilize the
benefits under a se rv ice plan for an extended period of tim e, the m axim um dura­
tion of the hospital stay provided would be his chief concern. In the sam e c i r ­
cu m sta n ces, under a cash plan, both the daily room and board allow ance and the
duration would be of particu lar sign ifican ce.
H ow ever, w orkers whose hospital
stay is of a rela tiv ely short duration would be chiefly concerned with the amount
of the daily room and board allow ance, i. e. , whether it covers the charge for
the accom m odation provided. * 6

^ The average hospital stay in nongovernmental general hospitals was somewhat less than 8 days in 1953. Only about 4 percent of
all hospitalized persons remained in the hospital longer than 30 days; less than 1 percent were hospitalized longer than 60 days.







T A B L E E - 5 . — H o s p it a liz a t io n :

D is t r ib u t io n o f p la n s b y d a ily r o o m a n d b o a r d a l lo w a n c e f o r w o r k e r s an d d e p e n d e n t s
and d u r a t io n o f f u l l - b e n e f it p e r i o d , la t e 195 5 1

O
N

Maximum number of days in full-benefit period
A ll plans

71 but less
32 but less
120
121 and over
Other 2
70
than 70
than 120
Workers
Workers
Workers
W orkers
Workers
Workers
Workers
Workers
Workers
Plans
Plans
Plans
Plans
Number
Plans
Plans
Plans
Plan's
(000 *s)
(000* s)
(000* s)
(000* s)
(000‘ s)
(000* s)
(000* s)
(000* s)
(000* s)

Maximum daily room and
board allowance

31

Under 31

Worker 3
A ll plans providing cash
room and board b e n e fi t s __
Under $8 ______ _____________
$8 but less than $ 9 __________
$ 9 but less than $ 10 ________
$ 10 but le s s than $ 11 _______
$ 11 but le s s than $ 1 2 _______
$ 12 but le s s than $ 1 3 _____
$ 13 but less than $ 1 4 _______
$ 14 but le ss than $ 1 5 _______
$ 15 but le s s than $ 1 6 _______
$ 16 and over _________________
Daily allowance not
specified ----------------------------Average maximum
daily allowance4 ____________

186

2 ,0 7 6

11
27
19
38
10
43
6
8
16
5

55
143
351
483
74
388
72
127
163
88

3

131

7

61

70

816

2
8
13
_
3
_
_
_
35

9
17
7
14
5
6
1
4
5
1

49
113
287
227
35
29
4
38
24
2

1

1
2
2
_
1
_
_
_
1

.16

161

54

433

9

158

16

201

8

7

18
43
75
24
229
10
21
12
2

2
1
_
4
_
1
1
-

85

6

.

8

162

_
_
1

3
14
107
_
12
_
_
_
24

6
9
10
3
18
2
2
3
1

-

_
17
_
51
_
64
19
-

1
_
_
_
6
2
1
6
-

3
_

.
4
-

-

_
44
50
4
100
-

43
16
18
8

1
1
-

-

-

-

1
1

9
25

2

1
1
7
_
6

123

69

5

137

-

-

_
1

.
4

4

43

-

-

-

4
2
1
1
_
-

-

-

1
-

$1] L 12
.

Dependents
A ll plans providing cash
room and board benefits __
Under $8 _________ ___________
$8 but less than $ 9 __________
$ 9 but le s s than $10 ________
$10 but less than $ 11 _______
$11 but less than $ 1 2 _______
$ 12 but less than $ 1 3 _____
$ 13 but less than $ 1 4 _______
$ 14 but le s s than $ 15 _ _____
$15 but less than $ 1 6 _______
$ 16 and o v e r __________________
Daily allowance not
sp e c ifie d ____________________
Average maximum
daily allowance4 __________

175

1 ,966

8

44

77

1 ,0 0 9

9

40

21
31
15
35
10
39
5
6
10
1

129
353
335
284
79
414
56
37
130
25

1
1
1
4

4
2
4
31

13
19
8
13
6
12
1
3
1
1

84
288
296
88
48
150
4
23
2
25

3
1

19
3

1

11

2

1

3

_

_

_

_

_
_

4

7

_

_

8
6
10
3
12
2
2
1
-

361

52
36
89
20
144
10
10
1
-

10

109

4
_
_
1
_
4

22
_
_
17
_
51
_
_
19
-

16

196

123

_

44

1

3

-

2
1
4
1
1
6
-

-

4
11
40
34
, 4
100
-

6

-

-

1
1
-

18
8
-

-

-

1

1

_

-

_

_

-

-

_
1
-

-

-

-

1
~

9

2

_

-

_

_

123

$10i.31

1 B a s e d o n a s tu d y o f 300 h e a lth and i n s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a i n i n g c o v e r i n g a p p r o x i m a t e l y 5 m i l l i o n w o r k e r s ; o f t h e s e , 29 3 a n d 2 7 8 p la n s
p r o v i d e d h o s p i t a l b e n e f i t s f o r w o r k e r s and d e p e n d e n t s , r e s p e c t i v e l y .
2 I n c lu d e s p la n s u n d e r w h ic h f u l l - b e n e f i t p e r i o d w as n ot s p e c i f i e d an d p la n s f o r w h ic h the f u l l - b e n e f i t p e r i o d i n c r e a s e d a c c o r d i n g to th e le n g t h o f t im e a
w o r k e r s p a r t i c i p a t e d in the p la n .
3 2 p la n s c o v e r i n g 2 5 , 0 0 0 w o r k e r s p r o v i d e d a s h o r t e r d u r a t io n f o r w o m e n .
4 A r i t h m e t i c a l a v e r a g e : A m o u n t o f b e n e f i t p r o v i d e d to w o r k e r and d e p e n d e n t b y e a c h p la n w a s w e ig h t e d b y t o t a l n u m b e r o f w o r k e r s c o v e r e d b y that p la n .
NOTE:

A ll c o v e r a g e

d a ta s h o w n in th is

s tu d y r e la t e to n u m b e r o f a c t iv e w o r k e r s

c o v e r e d b y the p l a n s .

S ee fo o tn o te

3,

p . 1.

47

Considerable variation existed in the m axim um room and board allow ances
provided per hospital stay under the 176 and 167 plans covering w orkers and
dependents, re sp e ctiv ely (table E - 6 ) . * 7
N ea rly a fourth of the plans allow ed a
m axim um of $ 1 , 0 0 0 or m o re to the w orker; a lm o st a fifth of the plans extending
benefits to dependents provided a m axim um of $ 1 ,0 0 0 or m o r e . On the a v era g e ,
the m axim um room and board allow ance available to w orkers per hospital stay
was $ 7 8 1 .
Dependents* m axim um coverage amounted to an average of $ 6 7 3 .
Of the plans specifying a m axim um room and board benefit for both w orkers and
dependents, identical benefits w ere provided both groups under the large m a jo rity
of the plans (table E - 3 ) .
T A B L E E - 6 . — H o s p it a liz a t io n : D is t r ib u t io n o f p la n s b y m a x im u m r o o m a n d b o a r d a llo w a n c e
f o r w o r k e r s an d d e p e n d e n ts , la te 1955 1
P la n s c o v e r in g
M a x im u m r o o m and b o a r d a llo w a n ce p e r h o s p ita l sta y 2

D ep en d en ts

W orkers

W orkers

W ork ers
N um ber

N um ber
(0 0 0 « s)

( 0 0 0 's )
A l l p la n s w it h m a x i m u m r o o m a n d
b o a r d a l l o w a n c e _________________________________

_

U n d e r $ 1 5 0 _________________________________ „
__ _
$ 1 5 0 b u t l e s s t h a n $ 2 0 0 _________________________ _
$ 2 0 0 b u t l e s s th a n $ 2 5 0 _________________________ _
$ 2 5 0 b u t l e s s t h a n $ 3 0 0 _________________________ _
$ 3 0 0 b u t l e s s th a n $ 3 5 0 ____________________________
$ 3 50 b u t l e s s th a n $ 4 0 0 ____________________________
$ 4 0 0 b u t l e s s th a n $ 4 5 0 ____________________________
$ 4 5 0 b u t l e s s th a n $ 5 0 0
$ 5 0 0 b u t l e s s t h a n $ 5 5 0 ____________________________
$ 5 5 0 b u t l e s s th a n $ 6 0 0 ____________________________
$ 6 0 0 b u t l e s s th a n $ 6 5 0
$ 6 5 0 b u t l e s s t h a n $ 7 0 0 ____________________________
$ 7 0 0 b u t l e s s t h a n $ 7 5 0 ___ __________ ____________
$ 7 5 0 b u t l e s s t h a n $ 8 0 0 _____________________ ____
$ 8 0 0 b u t l e s s th a n $ 8 5 0
_
_ _
$ 8 5 0 b u t l e s s th a n $ 9 0 0
_ __________________ _
$ 9 0 0 b u t l e s s th a n $ 9 5 0 ____________________________
$ 9 5 0 b u t l e s s t h a n $ 1 , 0 0 0 _________________________
$ 1 , 0 0 0 b u t l e s s th a n $ 1 , 2 0 0 ____
. ______
$ 1 , 2 0 0 b u t l e s s th a n $ 1 , 4 0 0
_ _
$ 1 , 4 0 0 b u t l e s s t h a n $ 1 , 6 0 0 ______________________
$ 1 , 6 0 0 b u t l e s s th a n $ 1 , 8 0 0 _________________ __ .
$ 1 , 8 0 0 b u t l e s s th a n $ 2 , 0 0 0 _______________ ____
$ 2 , 0 0 0 a n d o v e r ___________________________________ _
A v e r a g e m a x im u m r o o m and b o a r d
a l l o w a n c e 3 _______________________ _________________

176

1 ,8 4 8

4
21
10
20
8
6
5
3
6
10
2
14
3
17
_
4
3
8
4
11
1
12
4

17
142
297
276
33
49
24
42
18
45
39
87
17
227
_
38
24
32
39
180
4
189
29

1 ,8 1 3

167
1
7
27
9
20
12
4
2
1
8
7
1
13
5
9
1
6
3
5
5
7
1
11
2

$781

1

2
19
370
300
131
96
27
27
1
52
37
4
102
87
128
5
64
13
18
52
96
4
165
13

$673

1 B a s e d o n a s t u d y o f 3 0 0 h e a l t h a n d i n s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a i n i n g c o v e r i n g a p p r o x i m a t e l y 5 m i l ­
lio n w o r k e r s ; o f t h e s e , 293 and 27 8 p la n s p r o v id e d h o s p it a l b e n e fit s f o r w o r k e r s and d e p e n d e n ts , r e s p e c t iv e l y .
W h e r e th e m a x i m u m r o o m a n d b o a r d a l l o w a n c e w a s n o t s p e c i f i e d it w a s c o m p u t e d b y m u l t i p l y i n g th e m a x i m u m d a i l y
a l l o w a n c e b y th e n u m b e r o f d a y s o f h o s p i t a l s t a y p r o v i d e d . E x c l u d e d f r o m t h i s t a b l e a r e a l l s e r v i c e - t y p e p la n s a n d
a f e w c a s h o r c a s h a n d s e r v i c e t y p e p l a n s u n d e r w h ic h m a x i m u m r o o m a n d b o a r d a l l o w a n c e w a s n o t c o m p u t a b l e .
2 2 p la n s c o v e r in g 2 5 ,0 0 0 w o r k e r s p r o v id e d a l e s s e r a m o u n t f o r w o m e n .
3 A r i t h m e t ic a l a v e r a g e c o m p u t e d b y w e ig h t in g a m o u n t o f m a x im u m r o o m an d b o a r d a llo w a n c e e a c h p la n p r o ­
v id e d b y t o ta l n u m b e r o f w o r k e r s c o v e r e d b y p la n .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
i n t h i s s t u d y r e l a t e to n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s . S e e f o o t n o t e 3 , p . 1 .

A ll c o v e r a g e d a t a

show n

H ospital Extra Allow ances
Allow ances fo r hospital charges other than fo r room and board w ere
provided in a il except one of the plans covering w orkers and dependents.
V arious
methods w ere used in providing these ben efits.
H ow ever, the large m a jo rity

27

Where the maximum room and board allowance was not specified, it was computed by multiplying the maximum daily allowance by the
number of days of hospital stay provided. Included in this computation were the allowances provided during the full-benefit period and the
extended coverage period. Excluded from table E-6 were all plans providing service benefits and those plans with cash or a combination
cash and service benefit under which the maximum amount was not computable.




48
of plans called for the payment during the entire benefit period of ( l ) charges
up to a fixed m axim um or (2) the full cost of specified se rv ic e s (table E - 7 ) .
Some plans provided full paym ent up to a certain lev e l but made allow ance fo r
further reim b u rsem en t on a percentage ba sis if the stipulated level was exceeded;
fo r exam ple, a plan m ay reim b u rse the insured individual for a ll extra charges
up to $24 0 plus 75 percent of charges in e x ce ss of that amount up to a specified
m a xim u m .
Under the se rv ice type, som e plans paid the full cost of specified
se rv ic e s during part of the benefit period (the fu ll-b e n e fit period) and provided
reim b u rsem en t on a percentage b a s is , u su ally 50 p ercen t, during the rem ain der
of the benefit period (extended c o v era g e).

T A B L E E - 7 . — H ospitalization: Method of specifying allow ance for hospital e xtras
for w orkers and dependents, late 1955 1
P lans covering—
D ep en d en ts

W ork ers

M eth od

W ork ers

W ork ers
N um ber

N um ber
(0 0 0 *s)

A l l p la n s p r o v id in g b e n e fit f o r e x t r a h o s p it a l s e r v i c e s

_
_

A llo w a n ce p r o v id e d fo r e x p e n s e s in c u r r e d :
T p t o a fiv e d a m o u n t
T
....
_ __ _ .
_
U p t o a f i x e d a m o u n t w it h a d d i t i o n a l r e i m b u r s e m e n t o n a
p e rce n ta g e b a s is
_
_
________________
U p to d iff e r e n c e b e tw e e n r o o m a n d b o a r d c h a r g e s a n d a
fiv e r ! a m o u n t
_
_ ___ ______ „
O th e r
____
_ _____ __
_________
B e n e fits p r o v id e d on a s e r v ic e b a s is :
_
______________ _____ ___ _
_
‘F o r e n t i r e b e n e f i t p e r i o d
_
_
F o r p a r t o f b e n e fit p e r io d an d r e im b u r s e m e n t o f p e r c e n t a g e
o f o o ^ t o f ^ s e r v ic e s f o r r e m a i n d e r o f p e r i o d
F o r p a rt o f b e n e fit p e r io d and r e im b u r s e m e n t o f d iffe r e n c e
b e tw e e n r o o m an d b o a r d c h a r g e s an d a fix e d a m o u n t fo r
-r e m a i n d e r o f b e n e f i t p e r i o d
....
O th e r
_ ____________________________________________________________________ _ _
_

(0 0 0 » s )

292

4 ,9 0 4

277

4 ,2 7 4

120

1 ,3 6 5

112

1 ,3 6 4

31

844

33

364

8
4

99
130

5
4

21
130

90

2 ,0 4 7

81

1 ,9 6 5

32

358

34

367

6
2

50
10

6
2

53
10

1 B ased on a study of 300 health and insurance plans tinder collec tiv e bargaining covering approxim ately
5 m illion w ork e rs; of th e se , 293 and 278 plans provided hospital benefits for w ork ers and dependents, re sp e c tiv e ly .
N O T E : B ecause of rounding, sum s of individual item s do not n e c e s s a rily equal to ta ls.
A ll coverage data shown
in this study relate to number of active w orkers covered by the plans.
See footnote 3 , p. 1.

Plans providing benefits in the form of s e rv ic e s rather than cash allow ance
typ ically listed those benefits fo r which the cost was covered (in fu ll or in p a rt),
and those excluded.. The specified se rv ic e s varied considerably among p lan s.
In a ll c a s e s , use of operating or cysto sco p ic room and supplies (such as band­
a g e s , sp lin ts, m a te ria l for casts and anesthetic m a teria l) w ere covered in fu ll.
The plans a lso paid for certain laboratory se rv ic e s v a rio u sly defined. R e im b u rse ­
m ent fo r fu ll cost of certain drugs was com m on; this specification gen erally in ­
cluded a ll m edications listed in the latest editions of The United States P h a rm a ­
copeia, The National F o rm u la ry , and New and N onofficial R em ed ies.
L e ss f r e ­
quently included w ere diagnostic and therapeutic X -r a y , and blood for tran sfu sion .
The 120 plans stipulating a m axim um cash allowance fo r w orkers varied
w idely in the amounts provided, ranging fro m le s s than $50 to m o re than $ 600
(table E - 8 ) .
The m edian amount provided under these plans was between $12 5
and $15 0 fo r w o rk e rs. On the w hole, dependents* allow ances w ere slightly lo w er.




49

T A B L E E - 8 . — Hospitalization: D istribution of plans providing full reim b ursem ent
of charges for hospital extras up to a fixed m axim um
by amount provided w ork ers and dependents, late 1955 1
Plans covering—
Dependents

W orker s

M axim um amount

W orker s

W ork ers
Num ber

Num ber

(000 *3 )

(000 *s)
A ll plans providing allow ance for full reim b u rsem en t of hospital
extras up to a fixed m a x im u m _______________________________________________

120

1 ,3 6 5

Under $50 ________________________________________________________________________
$50 but le s s than $75 ___________________________________________________________
$ 7 5 but le s s than $10 0
___
_____ _______________________________
$100 but le s s than $12 5 ________________________________________________________
$12 5 but le s s than $150 _ _____________________________________________________
$15 0 but le s s than $175 ________________________________________________________
$ 1 7 5 but le s s than $200 ______________________________________________________ *
$ 2 0 0 but le s s than $225 ________________________________________________________
$22 5 but le s s than $250 ________________________________________________________
$250 but le s s than $300 __________ _______________ _________________________ _
$ 3 0 0 but le s s than $400 ________________________________________________________
$400 but le s s than $500 _____________ _______________________________ _________
$ 5 0 0 but le s s than $600 ___________________ ___________________ __ _____ __
_______ ___________ .____
$ 6 0 0 and over
_
_ _ _

7
12
11
25
8
15
2
12
4
3
11
2
5
3

27
316
41
262
83
67
7
258
59
44
52
15
62
73

112
6
16
10
26
6
12
2
10
5
1
7
2
7
2

1 ,3 6 4
30
319
73
238
101
184
5
94
88
13
75
65
57
23

1 B ased on a study of 300 health and insurance plans under co llec tiv e bargaining covering approxim ately
5 m illion w o rk ers; of th e se , 293 and 278 plans provided hospital benefits for w ork ers and dependents, re sp ectiv ely..
N O T E : Because of rounding, sum s of individual item s do not n e c e s s a r ily equal to ta ls.
A ll coverage data shown
in this study rela te to number of active w orkers covered by the plans.
See footnote 3 , p. 1.

P l a n s p r o v i d i n g a c a s h a l l o w a n c e t o c o v e r e x p e n s e s i n c u r r e d u p to a f i x e d
l e v e l , p l u s a d d i t i o n a l r e i m b u r s e m e n t o n a p e r c e n t a g e b a s i s , p a i d 75 p e r c e n t o f
th e c h a r g e s in e x c e s s o f the f u l l - r e i m b u r s a b l e a m o u n t in a l l e x c e p t 1 c a s e ( t a b l e
E -9 ).
H o w e v e r , u n d e r m o s t p l a n s h a v i n g th is f e a t u r e , a l i m i t w a s p l a c e d o n th e
a m o u n t th a t w a s r e i m b u r s a b l e .
T h e s e l i m i t s r a n g e d f r o m $ 3 7 5 to $ 3 , 7 5 0 .
M ore
th a n t w o - t h i r d s o f th e p l a n s c o v e r i n g w o r k e r s a n d d e p e n d e n t s s t i p u l a t e d a m a x i ­
m u m o f l e s s th a n $ 2 , 5 0 0 .
F c p u r - f i f t h s o f the 2 71 p l a n s p r o v i d i n g e x t r a h o s p i t a l a l l o w a n c e s f o r b o t h
w o r k e r s and d ep e n d e n ts s p e c i f i e d id e n t ic a l b e n e fit s f o r b o th g ro u p s (ta b le E - 3 ) .
U n d e r o n l y o n e p l a n w h e r e b e n e f i t s d i f f e r e d w a s th e d e p e n d e n t s * a l l o w a n c e m o r e
l i b e r a l th a n th a t p r o v i d e d th e w o r k e r .
R e d u c t i o n in B e n e f it s

D u rin g A c t iv e

E m p loy m en t

A s s h o w n in t a b l e A - 1 3 , th e h o s p i t a l b e n e f i t w a s r a r e l y m o d i f i e d o n th e
b a s is o f a g e d u rin g a c t iv e e m p lo y m e n t .
O n ly s ix p la n s r e d u c e d b e n e fits w h en
th e w o r k e r a t t a i n e d a s p e c i f i e d a g e . U n d e r 3 o f t h e s e , th e d u r a t i o n o f th e b e n e f i t
f o r the w o r k e r a n d h i s d e p e n d e n t s w a s r e d u c e d f r o m o v e r 120 da.ys t o 2 0 d a y s
p e r y e a r w h e n the a c t i v e w o r k e r r e a c h e d a g e 7 0 .
O f the r e m a i n i n g 3 p l a n s ,
2 p l a c e d a l i m i t o n th e t o t a l a m o u n t o f h o s p i t a l , s u r g i c a l , a n d / o r m e d i c a l b e n e ­
f i t s p a y a b l e t o b o t h th e w o r k e r a n d h i s d e p e n d e n t s a f t e r the w o r k e r a t t a i n e d
a g e 6 5 ; a n d 1 p l a n p l a c e d the b e n e f i t a v a i l a b l e to e a c h g r o u p o n a " p e r - y e a r ”
r a t h e r th a n a " p e r - d i s a b i l i t y " b a s i s w h e n th e w o r k e r r e a c h e d a g e 6 0 .
B e n e fits

for

p ro v id e d

T h i r t y - n i n e o f th e 67 p l a n s e x t e n d i n g h o s p i t a l b e n e f i t s t o r e t i r e d w o r k e r s
the s a m e b e n e f i t s , i n a l l r e s p e c t s , a s t h o s e a v a i l a b l e t o th e w o r k e r




R e tire d

W orkers

and th eir

D ependents

50
i m m e d i a t e l y p r i o r t o r e t i r e m e n t ® 28
A s li g h t ly l a r g e r p r o p o r t i o n (36 out o f 5 6)
o f p la n s e x te n d in g b e n e fit s to d e p e n d e n ts o f r e t i r e d w o r k e r s m a in t a in e d the s a m e
p r o v i s i o n s th a t w e r e p r o v i d e d d e p e n d e n t s o f a c t i v e w o r k e r s ®
T A B L E E - 9 - — H ospitalization: D istribution of plans providing full reim b u rsem en t of charges for hospital extras
up to a fixed amount with additional reim b u rsem en ts on a percentage basis
by amount for w orkers and dependents, late 1 9 5 5 1
Plans covering—
Dependents

W ork ers

Amount

W ork ers

W ork ers
Plans

Plans
(0 0 0 1s)
A ll plans providing for full reim b ursem ent of hospital
extras up to a fixed m axim um with additional r e im b ursem ent on a percentage basis _______________________

(000« s)

_

230

2 838

z 32

235 8

B a sic
amount

Plus 75 percent
of next—

$ 7 5 ____________________________
$100
_______
______________
$120
____ ___________________
$ 1 2 0 _________________________
$ 1 5 0 ______ _ _ _____
_
$ 1 5 0 __________________________
$ 1 6 0 __________________________
__________
$180
_
$ 2 0 0 _____________
_____
$ 2 0 0 _____________ _________
$ 2 0 0 ________________________
$ 2 0 0 _________________ _____
$ 2 2 0 ________________________
$ 2 2 0 ________________________
$ 2 2 5 __________________________
$ 2 4 0 __
____ ____________
$ 2 4 0 __________________________
$ 2 4 0 ______________________
$24 0 _________
__
_ ____
$ 2 5 0 __________________________
$ 2 5 0 __________________________
$ 2 5 0 __________________________
$ 2 60
_______________________
$2 80 __________ _____________
$ 2 8 0 __________________________
$ 2 9 0 __________________________
$ 3 0 0 __________________________
$ 3 0 0 ________________________
$ 3 1 0 _____ ____ ________________
$ 3 2 0 __________________________
$ 5 0 0 __________________________

$ 1 ,2 0 0 ____________________
$ 3 ,9 0 0 ____________________
$ 1 ,2 0 0 ____________________
$ 1 ,8 8 0 ____________________
$ 1 ,8 5 0 ____________________
_
_
$ 2 ,0 0 0
__________
$ 1 ,0 0 0 ____________________
$ 1 ,6 2 0 ____________________
$ 1 ,0 0 0
__________________
$ 1 ,8 0 0 ____________________
$ 2 ,4 0 0 ____________________
$ 5 ,0 0 0 ________ ____________
$ 1 ,0 0 0 ____________________
_
E x c e ss ____________________ _
$ 4 ,0 0 0 ____________________
$ 5 0 0 _______________________
$ 1 ,0 0 0 ____________________ __
$ 2 ,0 0 0 ____________________
E x c e ss
________
__ _
$ 2 ,0 0 0 ____________________
$ 4 ,0 0 0 ______________ ____
E x c e ss
__ __ -------- __ _
$ 4 ,0 0 0 __________________ .
$ 9 6 0 _______________________
$ 2 ,0 0 0 ________ ____________
$ 2 ,0 0 0 ____________________
_
$ 1 ,7 3 3 __________ _______ _
$ 4 ,0 0 0 ____________________ _
$ 2 ,2 5 3 ____________________
$ 1 ,0 0 0 ____________________
E x c e ss ____________________

1
1
1
1
3
1
1
1
4
1
2
1
1
1
_
1
1
1
1
1
1
1
1
1
1

7
18
35
_
12
88
4
25
6
21
9
11
3
8
3
_
5
50
3
14
2
5
6
2
2
500

1
1
1
1
_
3
1
1
1
4
1
2
1
1
1
2
1
1
1
1
1
1
1
1
1
1
-

7
18
35
12
_
88
25
4
6
21
9
11
11
3
8
8
5
3
2
5
50
3
4
14
5
2
-

■

1 B ased on a study of 300 health and insurance plans under collective bargaining covering approxim ately 5 m il­
lion w o rk e rs; of th e se , 293 and 278 plans provided hospital benefits for w orkers and dependents, re sp e c tiv e ly .
2 Excludes 1 plan, covering 6 ,0 0 0 w orkers that provided $ 500 b asic amount plus 50 p ercent of the next $ 1 ,5 0 0
of ch a rg e s.
N O T E : B ecause of rounding, sum s of individual item s do not n e c e s s a r ily equal to ta ls. A ll coverage data shown
in this study relate to number of active w orkers covered by the p la n s.
See footnote 3 , p . 1.

B e n e f i t s f o r e a c h g r o u p u n d e r th e r e m a i n i n g p l a n s w e r e r e d u c e d i n s e v e r a l
w a y s®
P l a n b e n e f i t s w e r e m a d e l e s s l i b e r a l b y r e d u c i n g o n e o r m o r e o f th e
b e n e f i t p r o v i s i o n s , i® e ® , r o o m a n d b o a r d a l l o w a n c e , e x t r a s e r v i c e a l l o w a n c e ,
d u ra tio n , e tc .
F r e q u e n t l y , th e s a m e b e n e f i t s c h e d u l e w a s p r o v i d e d , b u t th e
m a x im u m a m ou n t p a y a b le f o r e a c h d is a b ilit y p r io r to r e t ir e m e n t r e p r e s e n t e d
th e t o t a l p a y m e n t u n d e r th e p l a n d u r i n g th e e n t i r e p e r i o d o f r e t i r e m e n t ®
O nce
t h e s e b e n e f i t s w e r e e x h a u s t e d , c o v e r a g e u n d e r th e h o s p i t a l p l a n c e a s e d ®
To
illu s t r a t e , a p la n p r o v id e d a d a ily r o o m and b o a r d a llo w a n c e o f $1 0 a d a y f o r
70 d a y s w i t h a n a l l o w a n c e o f $ 2 0 0 f o r e x t r a h o s p i t a l e x p e n s e s .
T h e s e b e n e fits
w e r e a v a il a b le p r i o r to r e t i r e m e n t f o r e a c h s e p a r a t e d is a b i lit y .
H o w e v e r , th e
r e t i r e d w o r k e r a n d d e p e n d e n t r e c e i v e d t h e s e b e n e f i t s o n l y o n c e d u r i n g th e e n t i r e
p e riod of retirem en t.
28

For this a n a ly s is , b en efits available to the worker retiring at age 65 were compared with those available to him im m ediately prior to
retirement (i. e . , at age 6 4 ). It has been previously noted that b en efits for the active worker may have been reduced as he reached a certain
advanced age.




51
A f e w p l a n s w h i c h p r o v i d e d th e s a m e b e n e f i t s c h e d u l e th a t w a s a v a i l a b l e
b e f o r e r e t i r e m e n t , s p e c i f i e d a m a x i m u m a m o u n t d u rin g r e t i r e m e n t to b e a p p lie d
n o t o n l y to h o s p i t a l e x p e n s e s b u t a l s o to s u r g i c a l a n d m e d i c a l e x p e n s e s .
For
e x a m p le , a p la n p r o v id e d f o r s e m i p r iv a t e a c c o m m o d a t io n s and f u l l x o s t o f s p e c i ­
f i e d e x t r a s e r v i c e s p e r d i s a b i l i t y p r i o r to r e t i r e m e n t .
D uring r e t ir e m e n t , r e i m ­
b u r s e m e n t fo r a ll h o s p ita l, s u r g ic a l, and m e d ic a l e x p e n se s c o m b in e d w as lim ite d
to $ l , 0 0 0 o
A n o t h e r t y p e o f r e d u c t i o n i n v o l v e d s h i f t i n g th e m e t h o d o f p a y m e n t f r o m
a " p e r - d i s a b i l i t y 1 to a " p e r - y e a r " b a s i s . U n d e r t h is a p p r o a c h , th e s a m e s c h e d u l e
1
o f b e n e f i t s w a s a v a i l a b l e to b o t h th e a c t i v e a n d r e t i r e d w o r k e r ; - h o w e v e r , th e l a t t e r
w a s e l i g i b l e f o r th e b e n e f i t s o n l y o n c e a y e a r , w h e r e a s the f o r m e r c o u l d u s e th e
fu ll-b e n e fit sch ed u le fo r ea ch d isa b ility .
T h e l e n g t h o f th e f u l l - b e n e f i t p e r i o d a v a i l a b l e t o r e t i r e d w o r k e r s a n d t o
t h e i r d e p e n d e n t s w a s m o s t f r e q u e n t l y 120 d a y s , p r o v i d e d in a b o u t a t h i r d o f th e
p la n s c o v e r i n g e a c h g r o u p (ta ble E - 1 0 ) o
S lig h tly fe w e r p la n s g ra n te d a 7 0 -d a y

T A B L E E - 1 0 . — H ospitalization: D istribution of plans by duration of full-benefit period for retired w orkers
and their dependents and type of ro om and board benefit, late 19 55 1
Type of room and board benefits provided
Dependents of retired w ork ers

R etired w orkers
Duration of fu llbenefit period

Service

Cash

A ll plans

Workers

W orkers
Plans

Plans
(000*s)

(000*s)

A ll plans extending
hospital b e n e fit s _________

67

1, 784

32

21 days
22 but le s s than 31 d a y s ___
31 days _ __ ___________ __
32 but le s s than 70 d a y s ___
70 d a y s ____________ ________
71 but le s s than 120 d a y s __
120 days ____________________
121 days and over
__ ____
Other 2 _
_ _ _

5
1
7
3
15
5
20
4
7

56
3
34
28
114
49
964
300
235

_
-

5
2
11
3
3
2
6

383

-

18
25
57
27
16
21
217

W ork ers

Workers

(000*s)

(000*s)

S ervice
W orkers

W orkers
Plans

Plans

Plans

C ash

A ll plans

Plans
(000*3)

(000*s)

35

1 ,4 0 1

56

1 ,7 2 9

23

332

33

1 ,3 9 6

5
1
2
1
4
2
17
2
1

56
3
16
3
57
22
948
279
18

5
1
4
2
13
5
19
3
4

56
3
24
17

_

_

-

-

5
1
1
1
4
2
17
1
1

56
3
13
3
57
22
948
277
18

10 3
49
962
298
220

3
1
9
3
2
2
3

11
14
45
27
13
21
202

1 B ased on a study of 300 health and insurance plans under collective bargaining covering ap p roxim ately
5 m illion w o rk e rs. See p. 50 for a d iscu ssion of provisions affecting the frequency and duration of benefit paym ents to
retired w orkers and dependents.
2 Includes plans with no specified duration and plans for which the fu ll-b e n e fit period in creased according
to the length of time a w orker participated in the plan.
N O T E : Because of rounding, sum s of individual item s do not n e c e s s a r ily equal to ta ls.
A ll
shown in this study relate to number of active w ork ers covered by the plans. See footnote 3 , p . 1.

c overage

data

fu ll-b en efit p e rio d .
T h e m o s t c o m m o n d u r a t i o n f o u n d in p l a n s p r o v i d i n g c a s h
r o o m a n d b o a r d b e n e f i t s w a s 70 d a y s , a s a g a i n s t 120 d a y s in s e r v i c e - t y p e p l a n s .
E x t e n s i o n o f h o s p i t a l b e n e f i t s t o r e t i r e d w o r k e r s w a s m o r e c o m m o n l y f o u n d in
p la n s p r o v id in g s e r v i c e r o o m and b o a r d b e n e fit s to a c t i v e w o r k e r s .




52
U n d e r c a s h p l a n s c o v e r i n g r e t i r e d w o r k e r s a n d d e p e n d e n t s , th e dailyr o o m a n d b o a r d a l l o w a n c e s w e r e th e s a m e a s t h o s e p r o v i d e d p r i o r t o r e t i r e m e n t
i n th e l a r g e m a j o r i t y o f c a s e s 0
T h e a m o u n ts r a n g e d f r o m l e s s than $ 8 to $ 1 5 ,
w i t h a b o u t t w o - t h i r d s o f the p l a n s c o v e r i n g r e t i r e d w o r k e r s a n d d e p e n d e n t s p r o ­
v id in g $ 1 0 to $ 1 3 d a ily (ta b le E - l l ) .
U n der v ir t u a lly a ll p la n s p r o v id in g a d a ily
b e n e f i t o f $ 1 0 o r m o r e to r e t i r e d w o r k e r s a n d d e p e n d e n t s , th e f u l l - b e n e f i t p e r i o d
w a s 70 d a y s o r m o r e .
O n ly th re e p lan s s p e c if ie d a l o w e r d a ily a llo w a n c e f o r
t h e d e p e n d e n t t h a n f o r th e r e t i r e d w o r k e r .
T A B L E E - l l . — H ospitalization: D istribution of cash plans by daily room and board allowance
for retired w orkers and their dependents, late 1955 1
Plans covering—
R etired w orker

M axim um daily room and board allowance

W orker s
N um ber
(000 fs )

Dependents of
re tire d worker
W ork ers
Num ber
(000 ls )

A ll plans extending cash benefit

32

38 3

23

332

Under $8
___ __
.
.......... .
_ __
............................
$8 but le s s than $9
.
.
.
.
__
....... .
. _
_
$9 but le s s than $10 __
$10 but le s s than $11 ....
.......... ...................... .......................
$11 but le s s than $12 ___________________________________________________________
$12 but le s s than $ 1 3
......... .
........................
$ 1 3 but le s s than $ 14
$ 14 but le s s than $ 15
$15
Daily allow ance not specified
_ _

3
1
3
9
2
10
1

20
3
27
52
14
136
3
4
4
120

3

14

3
7

18
47

1
1
1

_

7
1
1
_

1

_

126
3
4
_

120

1 B a sed on a study of 300 health and insurance plans under c o llec tiv e bargaining covering approxim ately
5 m illion w o rk e rs; of th e se , 67 and 56 plans extended hospital benefits to re tire d w ork ers and dependents, r e s p e c ­
tiv e ly .
See p. 50 for a d iscu ssion of p rovision s affecting the le v e l and amount of benefit payments to retired
w orkers and dependents.
N O T E : B ecause of rounding, sum s of individual item s do not n e c e s s a r ily equal to ta ls.
A ll coverage data
shown in this study relate to number of active w orkers covered by the p la n s.
See footnote 3, p. 1.

E le v e n p lan s in c lu d e d ex ten d ed c o v e r a g e p e r io d s f o r r e t i r e d w o r k e r s
and th eir d e p en d en ts.
In a l l e x c e p t t w o p l a n s , c o v e r a g e w a s o f th e s e r v i c e t y p e
( s e m i p r i v a t e a c c o m m o d a t i o n s ) . U n d e r th e 9 p l a n s p r o v i d i n g s e r v i c e - t y p e b e n e f i t s ,
th e f u l l - b e n e f i t p e r i o d w a s m o s t f r e q u e n t l y 21 d a y s ; th e e x t e n d e d c o v e r a g e p e r i o d
w a s u s u a l l y 180 d a y s o r m o r e .
D u r i n g the e x t e n d e d c o v e r a g e p e r i o d , th e w o r k e r
r e c e i v e d a n a l l o w a n c e g e n e r a l l y e q u a l to 50 p e r c e n t o f th a t p r o v i d e d d u r i n g th e
fu ll-b en efit p erio d .
U n d e r th e 4 p l a n s p r o v i d i n g f o r d i s c o n t i n u a n c e o f b e n e f i t s d u r i n g th e r e ­
t ir e m e n t p e r i o d (table A - 9 ) ,
th e b e n e f i t s r e m a i n e d i n e f f e c t f o r n o t m o r e th a n
1 y e a r a f t e r the w o r k e r r e t i r e d .




53
Surgical Benefits

O f the 30 0 p l a n s s t u d i e d , 2 9 4 a n d 263 p l a n s p r o v i d e d s u r g i c a l b e n e f i t s
for w o r k e r s and d ep en d en ts, r e s p e c t iv e ly .
T h ese b en efits w e re g e n e r a lly p r o ­
v id e d under g ro u p c o n tr a c ts p u r c h a s e d fr o m in su ra n ce c o m p a n ie s or n o n p ro fit o r ­
g a n i z a t i o n s s u c h a s B l u e S h i e l d . In a f e w p l a n s , th e b e n e f i t s w e r e s e l f - i n s u r e d .
S u r g ic a l b e n e fit s w e r e a v a ila b le fo r v ir t u a lly a ll ty p e s o f o p e r a t io n s i n c i ­
d e n t t o n o n o c c u p a t i o n a l d i s a b i l i t i e s p e r f o r m e d in th e h o s p i t a l a n d , in th e o v e r ­
w h e l m i n g m a j o r i t y o f p l a n s , in th e d o c t o r ls o f f i c e o r in th e h o m e a s w e l l ( t a b l e
F -l).
B e n e f i t s f o r o p e r a t i o n s p e r f o r m e d o u t s i d e th e h o s p i t a l , h o w e v e r , w e r e
s o m e t i m e s l i m i t e d to s u r g e r y in s p e c i a l i s t s 1 o f f i c e s o r t o c a s e s i n v o l v i n g m i n o r
s u r g e r y , such as a t o n s ille c t o m y , r e m o v a l of ce rta in types of c y s t s , and e m e r ­
gen cy treatm en t fo r in ju r ie s .
T A B L E F - l . — Surgical:

Types of plans covering w orkers and dependents, late 1 9 5 5 1
Plans covering—
Dependents

W orkers

P ro vision

W ork ers

W ork ers
Plans

Plans

( 0 0 0 's )

( 0 0 0 's)
A ll plans providing benefit ___________________

_

B enefits provided for operations in:
H o sp ita l, d o c to r 's o ffic e , and home _______
Hospital and d o c to r 's office _________________
Hospital only
_________________________________
B enefits provided in fo rm of:
................... ...
Cash
S erv ice _________________________________________

1 Based on a study of
5 m illion w o rk e rs.

300

294

4 , 917

2 63

4 , 190

273
12
9

3 ,8 0 6
1 ,0 3 4
78

236
7
20

3 ,0 3 9
316
835

2 80
14

4 , 405
512

252
11

3 , 721
469

health and insurance plans

under collective

bargaining

covering approxim ately

N O T E : Because of rounding, sum s of individual item s do not n e c e s s a rily equal tota ls.
A ll coverage data
shown in this study relate to num ber of active w orkers covered by the p lans.
See footnote 3, p. 1.

Types

o f P la n s

T w o t y p e s o f s u r g i c a l b e n e f i t s w e r e a v a i l a b l e u n d e r th e p l a n s s t u d i e d
s e r v i c e p la n s and c a s h p la n s .
U n d e r the s e r v i c e p l a n th e f u l l c o s t o f a n o p ­
e r a t i o n w a s c o v e r e d , th a t i s , n o m a x i m u m w a s s e t . 29 U n d e r th e c a s h p l a n
the
c o m m o n p r o c e d u r e w a s t o p r o v i d e c a s h s u r g i c a l b e n e f i t s , th a t i s , s t i p u l a t e d
a l l o w a n c e s w e r e p r o v i d e d t o a p p l y t o w a r d the s u r g e o n ls c h a r g e .
U n lik e h o s p i ­
t a l iz a t i o n , s u r g i c a l b e n e f it s w e r e s e l d o m p r o v i d e d on a s e r v i c e b a s i s (ta b le F - l ) .
Cash

P la n s

E a c h c a s h p la n t y p i c a l l y p r o v i d e d a l i sting settin g f o r t h the m a x i m u m
a llo w a n c e s p a y a b le fo r s p e c if ie d s u r g ic a l p r o c e d u r e s . T h is lis tin g w a s c o m m o n l y
r e f e r r e d t o in th e p l a n a s th e " s c h e d u l e o f s u r g i c a l a l l o w a n c e s . "
U nder these
p l a n s , th e i n d i v i d u a l w a s r e i m b u r s e d o n l y f o r th e a c t u a l s u r g i c a l f e e c h a r g e d , i f
th e c h a r g e w a s l e s s th a n th e m a x i m u m s t i p u l a t e d in th e s c h e d u l e .
If th e s u r ­
g e o n ' s f e e w a s h i g h e r t h a n t h e a l l o w a n c e p r o v i d e d in th e s c h e d u l e , th e i n d i v i d u a l
w a s l i a b l e f o r th e d i f f e r e n c e »
U n d e r 40 p l a n s u t i l i z i n g B l u e S h i e l d , h o w e v e r ,
p a r t i c i p a t i n g d o c t o r s a g r e e d t o a c c e p t the s c h e d u l e a l l o w a n c e a s f u l l p a y m e n t
f o r s u r g e r y p e r f o r m e d i f th e w o r k e r ' s i n d i v i d u a l o r f a m i l y i n c o m e d i d n o t e x c e e d
^
Under some service p la n s, certain minor su rgical procedures were not cov ered , e . g ., t o n sille c to m ie s; in oth e rs, a nominal charge
w as made in connection with certain minor surgical procedures. Among the organizations providing b en efits on a service b a s is were the
Health Insurance P lan of Greater New York, the K aiser Foundation Health P la n , the United Mine Workers Welfare and Retirem ent F u n d , and
the St. L o u is Labor Health Institute.




54
a s p e c i f i e d a m o u n t ( t a b l e F - 2 ) . U n d e r t h e s e p r o g r a m s , i f th e i n c o m e f e l l w i t h ­
in the l i m i t a t i o n s s p e c i f i e d , w o r k e r s a n d d e p e n d e n t s w e r e , in e f f e c t , g i v e n a
s e r v i c e b e n e f i t , th a t i s , th e w o r k e r w a s a s s u r e d t h a t th e e n t i r e s u r g e o n * s f e e
f o r a l i s t e d o p e r a t i o n w o u l d b e p a i d b y th e p l a n .
TA B L E F - 2 . — Surgical: Cash plans with income
limitation features, late 1955 1
W orkers
Provision

Plans
(000*s)

A ll cash surgical plans under which schedule
allowance was accepted as full payment if
annual income was under ______________________
Individual
coverage
$ 2 , 000
$ 2 , 000
$ 2 , 000
$ 2 ,4 0 0
$ 2 ,4 0 0
$ 2 ,4 0 0
$ 2 , 500
$ 3 , 000
$ 3 , 000
$ 3 , 000
$ 3 , 600
$ 3, 750
$ 5 , 000
$ 6 , 000

F am ily of 2
$ 2 , 500
$ 2 , 500
$ 3, 000
$ 3 ,2 0 0
$ 3 ,6 0 0
$ 4 , 000
$ 4 , 000
$ 4 , 000
$ 4 , 500
$ 5 ,5 0 0
$ 4 ,2 0 0
$ 5 , 000
$ 5 , 000
$ 6 , 000

240

928

2
1
5
1
1
1
6
3
1
3
1
6
8
1

10
3
27
5
9
7
26
40
11
9
13
691
72
5

F am ily of 3
or more
$ 2 , 500
$ 3, 000
$ 4 ,0 0 0
$ 4 ,0 0 0
$ 3 ,6 0 0
$ 4 ,0 0 0
$ 4 ,0 0 0
$ 5 , 000
$ 6 , 000
$ 5 ,5 0 0
$ 4 ,2 0 0
$ 5 ,0 0 0
$ 5 ,0 0 0
$ 6 , 000

__________

___________

___________
___________
___________
___________
___________
___________

1 Based on a study of 300 health and insurance plans under c o l­
lective bargaining covering approximately 5 m illion w ork ers; of these
294 and 263 plans provided surgical benefits for w orkers and depend­
ents, respectively.
2 A ll 40 plans cover dependents as w ell as w ork ers.

A m o u n t o f B e n e f it s .— S u r g ic a l fee s c h e d u le s , w h ich
are
ty p ica lly set
f o r t h in g r e a t d e t a i l , a r e u s u a l l y c l a s s i f i e d a c c o r d i n g t o th e a l l o w a n c e p r o v i d e d
f o r th e m o s t e x p e n s i v e o p e r a t i o n l i s t e d .
T h i s a m o u n t i s r e f e r r e d t o a s th e
" m a x i m u m s c h e d u l e - a l l o w a n c e . " In a d d i t i o n t o th e m a x i m u m s c h e d u l e a l l o w a n c e ,
a l l o w a n c e s p r o v i d e d f o r a n a p p e n d e c t o m y a n d a t o n s i l l e c t o m y , t w o o f th e m o r e
c o m m o n s u r g i c a l p r o c e d u r e s , w e r e t a b u l a t e d f o r t h i s s t u d y to p r o v i d e s o m e i n ­
d i c a t i o n o f th e v a r i a t i o n a m o n g p l a n s in s c h e d u l e a l l o w a n c e s .
The m a x im u m sch e d u le a llo w a n c e r a n g e d f r o m $ 1 0 0 to $ 565 fo r w o r k e r s
and f r o m $ 75 to $ 5 6 5 fo r d e p e n d e n ts (ta b le F - 3 ) .
The m o s t c o m m o n am ou n ts
s p e c i f i e d u n d e r the 2 8 0 a n d 2 5 2 p l a n s p r o v i d i n g c a s h b e n e f i t s t o w o r k e r s a n d
d ep e n d e n ts, r e s p e c t i v e ly , w e r e $ 2 0 0 , $ 2 5 0 , and $ 3 0 0 .
The a v e r a g e m a x im u m
s c h e d u le a llo w a n c e s w e r e $263 fo r w o r k e r s and $256 fo r d e p e n d e n ts .
A l l b u t 31 o f t h e 24 6 p l a n s w i t h c a s h b e n e f i t s f o r b o t h w o r k e r s a n d d e ­
p en den ts p r o v id e d id e n tica l m a x im u m sch ed u le a llo w a n c e s fo r e a ch g r o u p . W h e re
a l o w e r a m o u n t w a s a v a i l a b l e f o r d e p e n d e n t s , it w a s in n o c a s e l e s s th a n 50 p e r ­
c e n t o f th e a m o u n t p r o v i d e d w o r k e r s , a s i n d i c a t e d b e l o w :




Percent of m aximum schedule allow ance provided w orkers that
_______ was provided dependents_______
A ll plans providing a lower m aximum allow ­
ance for dependents than for w o r k e r s _______
50
60
70
80

but
but
but
but

le s s
le ss
le s s
le ss

than
than
than
than

60p e r c e n t_____________________
70p e r c e n t_____________________
80p e r c e n t_____________________
90 percent______________________

W orkers
Plans

(000 *sj

_____ 31____________247
4
10
5
12

18
80
58
91




TABLE F - 3 .— Surgical: Distribution of plans by maximum schedule and appendectomy allowance for workers and dependents, late 1955
Maximum allowance for appendectomy
All plans
Maximum schedule
allowance 2

Under $100
Workers

Workers
Plans

Numbe r
(0 0 0 's)

(0001s)

More than $100
$100
but less than
$125
Workers
Workers
Plans
Plans
(0 0 0 's)
(000's)

More than $125
but less than
$150
Workers
Workers
Plans
(000‘ s)
(0001s)

$150

$125
Plans

Other

Workers
Plans

Workers
Plans

(000 «s)

(000's)

Workers
All plans providing cash
benefits
______________________ _
$100 ____________________________ _
.
$150 __________________________
$200 ____________________________ .
$225 ______________________________
$240 ........................ ............... ..............
$250 ______________________________
$300 ______________________________
$350 __________________ ____ ___
Over $350 ________________________
Other4_____________________________
Average maximum schedule
allowance 5
__ __ __ ____
Average allowance for
___________________
appendectomy 5

280
3
21
80
27
6
50
76
6
3
8

4,405
61
118
1,061
207
28
675
1,923
69
108
156

7

75

101

1,196

11

82

59

1,331

28

76

1,350

320

3 343

3
_
3

_
6
.
_
_
22

_
1
19
1
54
1

_
4
151
15
1,117
64

_
4
6
5
2
3

_
69
36
63
44
131

5

59

58

781

612

6225

-

1
-

20
3
8
40
23
131

6
.

3
2
2
_
_
_
_
_

61
8
6
_
_
_
_
_
_

19
70
6
5
1
_

110
1,027
37
19
3
_
-

_
3
_
6
1
_
1
_

_
11
_
28
37
7
-

_
1
2
39
15
2

97

1,187

12

56

57

1,301

99
1,015
37
19
13

4
6
_

18
29
.

7
20
505
767

7
20
535
767
2

$2 63
$1 28

Dependents
All plans providing cash
benefits
___________________
$100
_ __________________________
$150 ______________________________
$200 _____ _______________________
$225 _____ _________ _____________
$240 ___ _ _ _____ ___ _ _
$250 ________________________ ____
$300
__________________________
$350 .. ...................................... .
.
Over $350 ____ ___ ______
Other4 .................................................
Average maximum schedule
allowance 5
Average allowance for
appendectomy 5 ___

252

3,721

11

112

1
24
74
20
6
43
65
3
3
13

12
181
1,082
175
29
527
1,387
47
87
194

1
5
2
_

12
82
6
_
_

_

_

19
64
6
5
2

_

_
1
2
37
15

-

-

12
45

-

_

_

-

1

7

-

-

-

-

-

-

_

_

-

_

-

-

-

-

-

1

1

4

1

4

2

2

3

3

13

_

-

-

-

2
-

17
-

42

-

118
599
-

64

3
2
2
3

$2 56
$i;22

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 million workers; of these, 294 and 263 plans provided sur­
gical benefits for workers and dependents, respectively.
2 Refers to the surgical fee allowance for the most expensive operation listed in the surgical schedule.
3 4 plans covering 69,000 workers provided an allowance of more than $150 but less than $175, 14 plans covering 151,000 workers provided an allowance of $175
or m ore, and 2 plans covering 123,000 workers did not not provide a specific allowance.
4 Includes amounts other than those exact amounts specified.
5 Arithmetical average computed by weighting amount of allowance for most expensive operation and amount of appendectomy allowance each plan provided by total
number of workers covered by plan.
6 1 plan covering 3,000 workers provided an allowance of more than $150 but less than $175, 9 plans covering 99,000 workers provided an allowance of $175 or
more, and 2 plans covering 123,000 workers did not provide a specific allowance.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals. All coverage data shown in this study relate to number of active workers cov­
ered by the plans. See footnote 3, p. 1.

cn
Cn

56
The appendectomy allowance provided w orkers and dependents ranged
fr o m le s s than $10 0 to m ore than $175 and averaged $ 1 2 8 and $ 122 for each
group, re sp e ctiv ely (table F - 3 ) . In the 31 plans providing a low er appendectomy
allowance fo r dependents than for the w ork er, the m axim um schedule allowance
was also le s s for dependents.
The relationship between the appendectomy a l­
lowance and the m axim um schedule allow ance, as shown in table F - 3 , presents
a m ore revealing picture of the differences among plans in the lib e ra lity of s u r ­
gical benefits than either allowance taken separately. With the exception of plans
with a m axim um schedule allowance of le s s than $ 2 0 0 , the amount provided for
an appendectomy was usually about half of the m axim um schedule allowance p ro ­
vided by the plan.
F o r both w orkers and dependents, the amount allowed for a ton sillecto m y
ranged fro m le s s than $25 to m ore than $60 (table F - 4 ) .
The average to n s il­
lecto m y allowance provided w orkers was $ 4 3 . On the a v erage, an adult dependent
receiv ed a slightly higher allowance than a child ($ 4 2 and $ 3 8 , re sp e ctiv e ly ).
A different allowance was provided to adult and child dependents under 55 plans,
each of which stipulated a reduced amount for dependents under a certain age,
usually 12 y e a r s .
H ow ever, in no case did the m axim um schedule allowance
fo r a child differ fro m that provided an adult dependent.
T A B L E F - 4 . — Surgical:

Distribution of plans by ton sillecto m y allow ance for w ork ers and dependents, late 1955 1
P la n s c o v e r in g —
D ep en d en ts
W ork ers

A llo w a n ce fo r t o n s ille c to m y

A d u lt

(0 0 0 * s )

L e s s t h a n $ 2 5 _________________________________________
$ 2 5 _______________________________________________________
$ 2 5 . 01 b u t l e s s t h a n $ 3 0 ___________________________
$ 3 0 _______________________________________________________
$ 3 0 . 0 1 b u t l e s s t h a n $ 3 5 ___________________________
$ 3 5 ______ „
__________________________________________
$ 3 5 . 0 1 b u t l e s s t h a n $ 4 0 ______________________ ___
........_________ __ ____ __________________
$40 _
_
$ 4 0 . 01 b u t l e s s t h a n $ 4 5 ___________________________
$ 4 5 _______________________________________________________
$ 4 5 . 0 1 b u t l e s s t h a n $ 5 0 ___________________________
$50
________________________
____ ____
$ 5 0 . 0 1 b u t l e s s t h a n $ 6 0 ___________________________
$ 6 0 _______________________________________________________
O v e r $ 6 0 ___ _______________________________________
A l l o w a n c e n o t s p e c i f i e d --------------------------------------------A v e r a g e t o n s i l l e c t o m y a l l o w a n c e 2 ______________

4 ,4 0 5

280
1
19
1
58
2
15
28
19
12
36
1
53
12
14

1
121
4
631
5
66
218
506
80 9
884
18
589
106
181
143
123

7
2
$43

W ork ers
P la n s

P la n s

P la n s

A l l p l a n s p r o v i d i n g c a s h b e n e f i t __________________

C h il d

W ork ers

W orkers

(0 0 0 »s)

(0 0 0 *s)
2 52

3, 72 1

252

3 ,7 2 1

6
19
1
54
1
15
23
18
8
29
1
49

57
142
4
650
4
91
200
421
712
361
18
568
93
154
L25
123

8
26
1
85
1
15
25
15
10
29

66
162
4
1, 0 4 9
4
201
210
427
730
361

8
13

5
2
$42

-

-

21

182
122
39
43
123

8
4
2
2
$38

1 B ased on a study of 300 health and insurance plans under collective bargaining covering approxim ately
5 m illio n w o rk e r s; of their 294 and 263 plans provided su rg ical benefits for w ork e rs and dependents, re sp e c tiv e ly .
2 A rith m e tic a l average computed by weighting amount of ton sillecto m y allow ance each plan provided by total
num ber of w ork e rs covered by plan.
N O T E : B ecause of rounding, sum s of individual item s do not n e c e s s a rily equal to ta ls .
A ll coverage data
shown in this study relate to number of active w ork ers covered by the plans.
See footnote 3, p. 1.

Reduction of B enefits During A ctive Em ploym ent
Surgical benefits were ra re ly m odified during active em ploym ent on the
b a sis of age (table A - 13).
Of the 3 plans that reduced benefits after a worker
attained a specified a g e , 1 lim ited the total amount of su rgical benefits payable
to w orkers to $200 a y e a r .
The other two plans placed a lim it on the total
amount payable under the plans for surgical and other benefits during the r e ­
m ainder of the w orker 1 active em ploym ent.
s
These p rovision s relating to r e ­
duction of benefits were a lso applicable to dependents of active w ork ers attain­
ing the specified a g e s.




57
T ABL E F - 5 . — Surgical:

Distribution of plans by the maximum schedule and appendectomy allowance
for retired workers and dependents, late 1955 1
Maximum allowance for appendectomy
A ll plans

Maximum schedule
allowance 2

$100
Workers
Number

$125

W orkers
Plans

(000 *s)

$150

W orkers
Plans

(000»s)

Other 3

W orkers
Plans

(000 *s)

W orkers
Plans
(000 *s)

(000 *s)

Retired workers

A ll plans providing
cash benefit

____

53

1 ,415

10

69

7
9
16
17
4

57
71
343
811
134

7
2
1
_

57
9
3
_

“

A ll plans providing
cash benefit
_ ___

44

1 ,363

$200
_
$225 _____
$250
$300
Other 3

5
7
15
13
4

52
57
334
788
132

$200
_
$225 ____ _
$250
....
$300
O th er3

...

.

22

1,058

17

154

4

11
340
708
-

6
11
-

51
_
103
-

_

-

1
15
6
-

_
4

_
134

9

66

20

1 ,039

12

129

3

129

5
2
1

52
9
3

_
14
6

_
331
708

5

_

48

_

7

80

_

_

134
_

_

Dependents

...

.

.....

_

_

1

3

_

_

_

3

_

_
_
129

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately
5 m illion w orkers; of these 58 and 48 plans provided surgical benefits for retired workers and their dependents,
respectively. See p. 57 for a discussion of provisions affecting the amount of benefit payments to retired w orkers
and dependents.
Refers to the surgical fee allowance for the most expensive operation listed in the surgical schedule.
3 Includes amounts other than those exact amounts specified.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals.
A ll coverage data
shown in this study relate to number of active w orkers covered by the plans.
See footnote 3, p. 1.




58

B enefits for R etired W orkers and Their Dependents
Of the 58 and 48 plans extending su rgical benefits to retired w orkers and
to their dependents, re sp e ctiv e ly , the sam e provision s that were available to them
im m ed ia tely prior to the w o rk er’ s retirem en t were m aintained in about 2 out of 3
of these p la n s . 30 Under the rem aining plans— all of the cash type— reduced s u r ­
gical benefits were available to each group. This reduction was effected by m ak ­
ing le s s lib e ra l one or m o re of the provisions pertaining to the benefit. Under
all of these p la n s, the schedule of surgical fee allow ances available to active
w ork ers and dependents was also applicable after the worker re tire d . H ow ever,
under som e plans the m axim um schedule allowance was the m axim um amount of
su rg ica l benefits each group could r e c e iv e .
T h u s, one operation could exhaust
this c o v e ra g e.
Other plans stipulated a m axim um amount which was applicable
to su r g ic a l, h o sp ital, and m ed ical expenses where provided . 31

Under the 53 and 44 plans providing cash su rg ica l benefits to retired
w orkers and to their dependents, re sp e c tiv e ly , the m axim um su rg ica l schedule
allow ance ranged fro m $ 200 to $30 0 (table F - 5 ) .
In about 1 out o f 5 p la n s, the
m axim um schedule allowance was also the total amount of su rg ica l coverage
available to each group during the entire retirem en t p erio d . The benefit allowed
fo r an appendectom y varied fro m $100 to $ 15 0 and was usually 50 percent of the
m axim um schedule allow ance.

In all but one of the plans extending coverage to the dependents of retired
w o rk e rs, the allow ances provided dependents were the sam e as those fo r retired
w o rk e rs. The one plan which provided le s s lib e ra l allow ances fo r retired w ork­
ers* dependents also specified low er allow ances for the dependents of active
w ork ers.

Under the 4 plans providing for discontinuance of benefits during the
retirem en t p erio d (table A - 9), the benefits rem ained in effect for not m ore than
1 year after the worker retired .

For this analysis, benefits available to the worker retiring at age 65 were compared with those available to him immediately prior to
retirement (i. e., at age 64).
31 See Hospital Benefits, p. 51, for a description of this type of provision.




59
M ed ical B e n e fit s

A s previously explained (p. 3 ), m ed ical benefits d iscu ssed in this s e c ­
tion are allow ances for physicians* v is its .
Such allow ances are provided in the
fo rm of cash or s e r v ic e .
O f the 300 plans studied, m ed ical benefits were available under 193 and
145 plans covering w orkers and dependents, re sp e ctiv e ly . Like hospital and s u r ­
gical b e n e fits, m ed ical benefits were gen erally provided through group contracts
purchased fro m insurance com panies or nonprofit organizations such as Blue
Shield; under a few plans the benefits were se lf-in s u r e d by the fund to which con­
tributions were made or by the em p loyer.

se rv ic e s
provided
1 out of
m ed ical

In virtually all c a s e s , m ed ical benefits w ere provided for the doctor* s
received in the hospital (table G - l ) .
Slightly le s s than half of the plans
m ed ical benefits to w orkers for treatm ents outside of the hospital. About
6 plans providing benefits for dependents made available o u t-o f-h o sp ita l
care.

T A B L E G - l . — M e d ic a l:

T y p e s o f p la n s c o v e r i n g w o r k e r s a n d d e p e n d e n t s , la te 1955*

l

P la n s c o v e r i n g —
W ork ers

P r o v is io n

D e p e n d e n ts
W ork ers

W ork ers
N um ber

N um ber
(0 0 0 * s)
193

3 ,6 8 3

145

2 , 774

99
a 76

1 ,6 1 0
1 ,2 2 7

121
10

1 ,8 1 5
2 18

9
5
4

171
349
326

7
4
3

293
287

17**
19

2 ,8 2 2

A l l p la n s p r o v id in g m e d ic a l b e n e f i t s -----------------B e n e fits p r o v id e d f o r tr e a tm e n t in :
H o s p it a l o n l y -----------------------------------------------------H o s p it a l, d o c t o r * s o f f i c e , and h o m e -----------H o s p it a l, d o c t o r * s o f f i c e , h o m e , and
H ea lth o r M e d ic a l c e n t e r -----------------------------H e a lth o r M e d ic a l C e n t e r o n l y -----------------------------O th er3 - B e n e fits p r o v id e d in f o r m o f:
C a s h --------------------------------------------------------------------S e r v i c e ------------- ---------------------------------------------------

(0 0 0 »s )

4

861

4

130
15

162

2,012
762

1 B a s e d on a s tu d y o f 300 h e a lth and in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r i n g a p p r o x im a t e ly
5 m il l i o n w o r k e r s .
a I n c lu d e s 1 p la n that p r o v id e d b e n e fit s f o r h o m e , o f f i c e , and h o s p it a l tr e a tm e n t f o r s ic k n e s s and p r o v id e d
b e n e fit s f o r tr e a tm e n t o f a c c i d e n t d i s a b i li t i e s o n ly in the h o s p it a l.
3 I n c lu d e s 1 p la n that p r o v id e d b e n e fit s f o r t r e a tm e n t o n ly f o r d is a b i li t i e s c a u s e d b y a c c i d e n t s .
4 I n c lu d e s 1 p la n that p r o v id e d b e n e fit s f o r tr e a tm e n t a t h o s p it a l and in s p e c i a l i s t ^ o f f i c e .
#
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e data
s h o w n in th is s tu d y r e la t e to n u m b e r o f a c t iv e w o r k e r s c o v e r e d b y the p la n s .
S ee fo o t n o t e 3. p. 1.

An insured worker becam e eligible for benefit coverage after com pleting
the eligibility re qu irem en ts, if any, specified under the plan (table A - 12).
Upon
com pletion of these re q u irem en ts, a sick or injured w orker, or his dependent,
qualified for benefits either im m ediately or after a specified number of tr e a t­
m ents or days of d isability.
Cash Plans
Nine out of 1 0 m ed ical benefit plans provided cash allow ances for w orkers
and dependents (table G - l ) .
A s in the case of su rgical b en efits, these benefits
were p rim a rily provided through group insurance contracts purchased fro m c o m ­
m e r c ia l insurance com panies or nonprofit organizations such as Blue Shield. Each
contract contained a schedule of m ed ical fee allow ances for physicians* v isits and
the m axim um amount payable under the plan for m ed ical c a r e .
If, fo r exam p le,




60

the doctor*s charge for a v isit exceeded the allow ance, or if he made m ore v isits
than the m axim um number sp ecified , the insured individual was respon sible for
the d ifferen ce.
H ow ever, under 30 plans utilizing Blue Shield, participating d o c­
tors agreed to accept the allow ances sp ecified under the plan, for s e rv ic e s c o v ­
ered by the plan, as full paym ent if the w o rk er's individual or fa m ily incom e did
not exceed a specified amount (table G -2 ) . The m axim um annual incom e specified
varied among p la n s, ranging fro m $ 2 , 0 0 0 and $ 2 ,5 0 0 for individual and fa m ily
co v e ra g e, re sp e c tiv e ly , to $ 6 , 0 0 0 fo r either type of cov era g e.
T A B L E G - 2 . — M e d ic a l: C ash plan s w ith in c o m e lim ita tio n
fe a t u r e s , late 1955 1
W ork ers
P la n s

P r o v is io n

(0 0 0 *s)
A il c a s h m e d ic a l plan s u n d er w h ich s ch e d u le
a llo w a n ce w as a c c e p t e d as fu ll p a ym en t if
annual in c o m e w as u n d er ----------------------------------Ind ivid u a l
coverage
$ 2 ,0 0 0
$ 2 ,0 0 0
$ 2 ,0 0 0
$ 2 ,4 0 0
$ 2 ,4 0 0
$ 2 ,4 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 3 ,0 0 0
$ 3 ,6 0 0
$ 3 ,7 5 0
$ 5 , 000
$ 6 ,0 0 0

F a m ily o f 2
$ 2 ,5 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 3 ,2 0 0
$ 3 , 600
$ 4 , 000
$ 4 ,0 0 0
$ 4 , 000
$ 4 ,5 0 0
$ 4 ,2 0 0
$ 5 , 000
$ 5 , 000
$ 6 , 000

*30

743

F a m ily o f 3
or m ore
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 4 ,0 0 0
$ 4 ,0 0 0
$ 3 ,6 0 0
$ 4 ,0 0 0
$ 4 ,0 0 0
$ 5 ,0 0 0
$ 6 ,0 0 0
$ 4 ,2 0 0
$ 5 ,0 0 0
$ 5 , 000
$ 6 ,0 0 0

----------------------- ----------------- - ------------------------------------------------ -------------------------------------------------------------------------------------------------------------------- —

2
2
4

1
1
1
3
3

1
1
4

6
1

10
14

22
5
9
7
7
40

11
13
545
58
5

1 B a s e d on a stu dy o f 300 h e a lth and in s u r a n c e p lan s u n d er
c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly 5 m illio n w o r k e r s ; o f
th ese 193 and 145 p lan s p r o v id e d m e d ic a l b e n e fits f o r w o r k e r s and
d ep en d en ts r e s p e c t iv e ly .
2 A ll 30 p lan s c o v e r d ep en d en ts as w e ll as w o r k e r s .
N O T E : B e ca u s e o f rou n d in g ,
n e c e s s a r il y eq u a l t o ta ls .

su m s

o f in d iv id u a l

ite m s d o not

Location of T re a tm e n ts. — Of the 174 plans providing cash benefits for
w o rk e rs, all except 1 specified an allowance for in -h o sp ita l treatm ent (table G -3 ) .
About 2 out of 5 plans provided allow ances for home and office treatm ent. A l ­
though all plans providing cash benefits for dependents stipulated an allowance
for treatm ent in the h osp ita l, le s s than 1 out of 1 0 covered v isits in the d o c to rrs
office and home c a lls .

Waiting P e r io d . — The waiting period for cash benefits varied according
to the type of disability (accident or sick n ess) and in som e c a s e s , according to
where the treatm ent was adm inistered (in the h osp ital, d o cto rls o ffic e , or h o m e).
P ro v isio n s governing payment of benefits for disabilities caused by accidents w e re ,
for the m ost part, fa r le s s re stric tiv e than those governing benefit payments for
disabilities resulting fro m sic k n e ss.
U su a lly, paym ent began im m ed iately for
treatm ent of disabilities due to accidents, re g a rd le ss of where the treatm ent was
given (h ospital, d o c to r 's o ffic e , or hom e).

Under the 173 plans providing in -h o sp ita l care for w o rk e rs, benefits in
case of sick ness began im m ed iately under 7 out of 10 plans.
Under the large
m a jo rity of plans which did not m ake benefits available im m ediately to w orkers
upon being h o sp italized , the waiting period did not exceed 3 days or the third
v isit. M o re o v e r, a third of the plans which specified a longer waiting period made
benefits retroactive to the fir s t day or fir s t v isit after a specified period of




61
TABLE G -3 .— Medical:

Distribution of cash plans by allowance provided for doctor's treatment
for workers and dependents, late 19 55 1

o
o
o
(0

o
©
o
C
O

Plans covering workers
Plans covering dependents
Allowance arovided for treatment in—
Allowance provided for treatment inHome
Hospital *
Home
Hospitala
Doctor's office
Doctor1 office
s
Workers
Workers
Workers
Workers
Workers
Workers
Number
Number
Number
Number
Number
Number
(000*s)
(000's)
(000's)
(000*s)

Maximum allowance
per treatment

All plans providing cash
benefit-----------------------------

173

2 ,817

$ 2 __________________________
$ 3 — -------------------------$ 3 .5 0 --------------------------------$4 -------------------------------------$4. 50 -------------------------- —
$ 5 --------------------------------------£ 6 ---- ---------------------------------Other 3 --------- ----------------------

_
95
2
29
4
36
1
o

_
814
33
1,330
31
43 7
5
168

74

1,209

74

185
2 74
27
590
_
3
_
131

_
28
2
4
6
21
9
4

23
33
2
11
_
1
_
4

1,232

130

2,012

196
19
51
36
680
79
170

_
74
2
24
25
1
4

_
686
33
793
_
346
5
150

11
3
5
1
2

203

9

193

46
21
13
124

_
4
1
2
2

_
50
2
9
133

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 million
workers; of these, 193 and 145 plans provided medical benefits for workers and dependents, respectively.
1 In a number of plans the payment was based on a , daily allowance for eacn day hospitalized rather than on a per
treatment basis.
For a discussion of this type of benefit see p. 62.
In a few plans a higher allowance was available for
the first few visits; the lower amounts which applied subsequently were used in this table.
Some plans made higher allow­
ances available for an extended number of visits and then reduced the amount; under the few such plans, the higher amount
was used in this table.
3 Includes amounts other than those exact amounts specified.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals.
study relate to number of active workers covered by the plans. See footnote 3, p. 1.

All coverage data shown in this

TABLE G -4 .— Medical: Distribution of cash plans according to when payments begin for
doctor's treatment in office and home, for workers and dependents, late 1955 1

Payment for treatment

Allowance providedTor‘"treatmenTTt£
Doctor's office
Home
Workers
Workers
Plans
Plans
(000's)
(000*8)

Workers
All plans providing allowance for treatment
by doctor in office and home -----------------------For sickness-----------------------------------------------Immediately-------------------------------------------After:
First v i s i t -----------------------------------------Second v i s i t --------------------------------------Third v is it -----------------------------------------Seventh v i s i t ----------------------- --------------First day of disability----------------------Second day of disability--------------------Third day of disability---------------------Seventh day of disability------------------For accident-----------------------------------------------Immediately--------------------------------------------After:
Second v i s i t ---------------------------------------Third v is it-----------------------------------------Third day of disability---------------------Seventh day of disability-------------------

2 74
73
11

1,209
1,204
235

74
74
11

1,232
1,232
259

12
22
9
1
6
2
2
8
73
60

599
122
106
4
34
46
5
55
1,208
617

12
22
9
1
6
2
3
8
73
59

599
122
106
4
34
46
8
55
1,230
636

4
5
2
2

33
531
8
18

4
5
3
2

33
531
12
18

11
11
3

203
203
128

9
9
3

193
193
128

1
5
1
1
11
10
1

5
33
2
35
203
199
4

1
3
1
1
9
8
1

5
23
2
35
193
189
4

Dependents
All plans providing an allowance for
by doctor in office and h o m e -----------------------For sickness-----------------------------------------------Immediately--------------------------------------------After:
First v i s i t -----------------------------------------Second v i s i t ---------------------------------------First day of disability----------------------Second day of disability--------------------For accident-----------------------------------------------Immediately ------------------------------------------After third v i s i t -------------------------------------

1 Based on a study of 300 health and insurance plans under collective bargaining covering approx­
imately 5 million workers; of these, 193 and 145 plans provided medical benefits for workers and de­
pendents, respectively.
1 plan provided benefit for treatment in tlie doctor's office for sickness only; 1 plan provided
benefits for treatment in the doctorts office for accidental injuries only.
NOTE: Because of rounding, sums of individual items do not necessarily equal totals. All cov­
erage data shown in this study relate to number of active workers covered by the plans. See foot­
note 3, p. 1.




62

hosp italization .
O f the 130 plans covering dependents, 9 out o f 10 provided im ­
m ediate b e n e fits . 32
The waiting period did not exceed 3 days in any plan r e ­
quiring a waiting period for dependents.
Under a large m a jo rity of the plans covering w orkers and dependents,
paym ents in case of sic k n e ss, if given in the doctor*s office or h o m e, w ere not
available until after a specified number of v isits o r days of disability (table G -4 ) ;
m o st frequently payments began after the second v is it.

B a sis of P a y m e n ts. — The b a sis of paym ent of m ed ical care allow ances
varied not only among plans but a lso within p la n s. Am ong the m ore com m on b a se s
on which paym ents were made w ere "p e r v i s i t " (also specified as "p e r c a l l " or
"p e r tr e a tm e n t"), "p e r d a y ," and "p e r day of hospital c o n fin e m e n t." Under plans
providing coverage in hom e, o ffic e , and h osp ital, allow ances fo r o u t-o f-h o sp ita l
treatm ent w ere often made on a p e r -v is it b a s is , while allow ances for in -h o sp ita l
treatm ent w ere on a p e r -d a y -o f-c o n fin e m e n t b a s is .
P lans providing an allow ance on a " p e r - v i s i t " b a sis usually lim ited the
paym ents to one v isit per day. A ll of the plans covering home and office care
and the m a jo rity of those covering in -h o jpital care that based the allowance on
a " p e r -d a y " b a sis provided payments only for days during which the doctor visited
the patient.
H ow ever, o n e-th ird of the plans (58) providing in -h o sp ita l m ed ical
benefits fo r w orkers made available an allowance for each day of hospital con­
finem ent rather than for each day the doctor treated the w o rk er.
N ea rly half
(59) the plans covering dependents provided in -h osp ital benefits on a "p e r -d a y o f-c o n fin e m e n t" b a s is .
The allowance provided fo r home and office treatm ent typically rem ained
the sa m e , re g a rd le ss of the number of treatm ents receiv ed during any period of
disa b ility . H ow ever, variations in hospital care allow ances were found in a sub­
stantial num ber of plans. Some plans allow ed a higher allowance for p h y s ic ia n s
c a lls during the fir s t day or two of hospitalization than for the rem ainder of the
insured in d iv id u a ls period of hospital confinem ent.
F o r exa m p le, a plan m ay
allow up to $ 1 0 for all v isits made by a doctor during the fir s t day of hospital
confinem ent, up to $5 fo r visits made during the second day, and up to $3 for
v isits made on each day th erea fter. Under a few p la n s, the allowance was p ro ­
vided on a " p e r - v i s i t " b a sis fo r the fir s t or fir s t and second day of hospitalization;
th ereafter payments w ere made on a "p e r -d a y " b a s is . A pian utilizing this m ethod
m ight provide up to $ 5 for each v isit during the fir s t day of hospitalization (the
m axim um num ber of v isits payable per day was usually stipulated) and up to $3
per day for v isits made during the rem ainder of the period of hospital confinem ent.

Am ount of A llo w a n ce . — The amount norm ally available to w orkers per
treatm ent in the hospital and in the home ranged fro m $3 to $ 6 , and fo r tr e a t­
m ent in the d o c to r 1 s o ffic e , fro m $2 to $5 (table G - 3 ) . 33
M o re than half of the plans allow ed up to $3 for a hospital treatm en t,
but a la rg e r proportion of w orkers were covered by plans providing $ 4 or m o r e .
M o st plans allow ed $2 or $3 fo r treatm ent in the doctor* s o ffic e .
A llow ances
fo r a hom e v isit were typically high er.
Under plans providing allow ances for all
treatm ent lo ca tio n s, the allow ances fo r hospital and home v isits were usually
higher than the amount provided for an office v is it.

^
In-hospital sickness benefits became available at the same time to both workers and dependents under all except 4 of the 126 plans
covering both groups.
33
For plans making available a higher allowance for the first few visits, the lower amounts which applied subsequently were used for
this study; for the plans providing a higher allowance for an extended number of visits and then a reduced amount, the higher amount was used.




63
A few plans providing benefits for home treatm ent granted an additional
allow ance if the care was receiv ed at night, if m ore than one m em b er of the
fa m ily was taken care of during the sam e v is it, or if the v isit was m ore than a
stipulated num ber of m ile s fro m the d o c to r's o ffic e .
F o r exam ple, 1 plan paid
up to $ 3 .5 0 per v is it, plus up to $2 fo r each additional fa m ily m em b er treated
by the doctor during the sam e v isit; if the home v isit occu rred between 1 1 p. m .
and 7 a . m . or was over 5 m ile s fro m the d o c to r 's o ffic e , the plan paid up to
$ 4 per v isit.

M axim um A llo w a n c e . 34— The m axim um amount available for m ed ical care
is of p articu lar in terest to w orkers required to be under the d o c to r's care for an
extended p e rio d . It p e rm its the w orker to evalu ate, in p a rt, his m axim um p ro ­
tection under the plan. On the other hand, a w orker whose disability is of a r e ­
la tively short duration would be m o re concerned with the allowance per treatm ent
o r per day, i . e . , whether or not it is large enough to cover the d o c to r's ch a rg e.

A large m a jo rity of the plans applied the m axim um allowance on a " p e r d isa b ility " b a s is , that i s , fu ll benefits were available for each separate disability
(table G -5 ) . 35
The num ber of tim es the individual has received benefits under
the plan had no bearing on the benefits available to him in case of future i l l ­
n e s s e s . Under the plans that made available the m axim um allowance on a "p e r
y e a r " or "p e r 6 -m o n th " b a s is , the amount available fo r separate disa b ilities fo l­
lowing the fir s t disability during any 1 benefit year or 6 -m onth period was the
unused portion of the benefits specified for that year or period.

A few plans stipulated separate m axim um allow ances for treatm ent in the
hom e or d o cto r's office and fo r care in the hosp ital.
F o r e xa m p le, 1 plan a l­
lowed up to $ 31 0 per year for home and office treatm ent and $ 2 1 0 per year fo r
hospital treatm ent.
Under such plans, the highest allowance p ossible would be
the sirm of the 2 separate a llow an ces, e . g . , $ 52 0 in this c a s e .
Under a few
p la n s, the m axim um allowed for home and office treatm ent was ex p re ssed on a
" p e r - y e a r " b a sis and that for hospital c a r e , on a "p e r -d is a b ilit y " b a s i s . 36
The
m axim um allow ances under these plans are determ ined in the sam e m anner as
fo r the exam ple cited above.

Considerable variation existed in the m axim um allow ances payable under
the 174 and 130 cash plans covering w orkers and dependents, re sp e ctiv ely (table
G -5 ) .
About a fourth of the p lan s, covering alm o st 60 percent of the w o rk e rs,
allowed a m axim um of $ 300 or m ore to the w orker; a lm ost a fifth pf the plans
extending benefits to dependents, accounting for half the total w orker co v e ra g e ,
provided a m axim um of $ 30 0 or m o r e . On the a v era g e , the m axim um allowance
provided w orkers was $ 4 5 9 . D ependents' m axim um allowance averaged $ 3 2 4 .37

34 Where the maximum allowance was not specified, it was computed by multiplying the allowances provided per treatment by the number
of treatments for which benefits are payable. Under plans providing different allowances for hospital, office, and home treatments, the most
liberal allowance was used in computing the maximum allowance.
35 A separate disability was usually described as one that was due to a different or unrelated cause or separated by a return to work
or a specified period of time.
36 These types of plans are included in the “ Other** category in table G-5.
37 The substantial difference in average maximum allowances for workers and dependents was attributable to several factors. A num­
ber of large plans (in terms of workers covered) with high maximum allowances did not provide benefits for dependents. Many plans pro­
vided more comprehensive coverage for workers than dependents; under 72 plans, workers were provided allowances for treatment in the
hospital, doctor's office, and home, whereas only 9 plans covering dependents made available this comprehensive coverage. In a few plans,
benefits were available to workers for a longer period than for dependents. In some plans, the allowance per visit for workers was greater
than that specified for dependents.







TABLE G - 5 .— Medical:

Distribution of plans providing cash allowance for doctorfs treatment for workers and dependents
by maximum amount provided and basis of payment, late 1955®

On

Basis of payment
All plans
Per disability

Maximum allowance

Per year

Workers

W orkers

Plans

Plans

Number

(000*s)

(000*s)

Other

Workers

Workers
Plans

(000*s)

(000*s)

Workers
A ll plans providing cash benefits -----------------------

174

2, 822

131

1,412

25

765

2 18

644

Under $10Q _______________________________________

19
15
37
26
25
9
13
13
4
5
8

107
151
322
224
252
82
313
606
30
570
165

17
9
33
22
16
4
12
6
4
8

100
88
234
199
195
41
298
24
70
165

2
6
3
3
2
1
5
3
-

7
64
60
24
5
3
578
24
-

1
1
7
4
1
2
1
1
-

_
29
1
52
37
15
4
6
500
-

$100 but less than $150 --------------------------------------$150 but less than $200 --------------------------------------$200 bu. less than $250 -----------------------------------—
$250 but less than $300 --------------------------------------$300 but less than $350 --------------------------------------$350 but less than $400 --------------------------------------$400 but less than $500 --------------------------------------$500 but less than $600 ---------------------------- ---------$600 and over -------------------------------------------------------Not specified --------------------------------------------------------Av rage maximum allowance 3

--------------------------

$459

Dependents
A ll plans providing cash benefits -----------------------

130

2 ,0 1 2

99

1 ,090

21

737

4 10

185

Under $100 -----------------------------------------------------------$100 but less than $150 --------------------------------------$150 but less than $200 --------------------------------------$200 but less than $250 --------------------------------------$2 50 but less than $300 --------------------------------------$300 but less than $350 --------------------------------------$350 but less than $400 --------------------------------------$400 but less than $500 ---------------------------------------$500 but less than $600 --------------------------------------$600 and o v e r -------------------------------------------------------Not specified ---------------------------------------------------------

22
16
21
28
13
3
10
9
1
2
5

124
160
182
266
120
35
300
595
26
52
150

19
9
16
25
10
3
10
4
1
2
-

107
107
108
239
99
35
300
17
26
52
-

2
5
4
3
2
5
-

7
49
64
28
10
578
-

!

10
4
10
11
.
.
.
150

Average maximum allowance 3 ---------------------------

2
1
.
1
.
.
.
5

$324

1 B ased on a study of 300 health and in su ra n ce plans under c o lle c t iv e b a rg a in in g c o v e r in g a p p ro x im a te ly 5 m illio n w o r k e r s ; o f t h e s e , 193 and 145 plans
p ro v id e d m e d ic a l b en efits fo r w o r k e r s and dependents, r e s p e c tiv e ly .
2 Includes 7 plans under w h ich m axim um applied to a 6 -m on th p e r io d .
3 A r ith m e tica l a v e ra g e ; am ount o f b en efit during a s p e c ifie d p e r io d p ro v id e d w o r k e r o r dependent b y ea ch plan was w eig h ted b y total n u m b er o f w o r k e rs
co v e r e d b y that in su ra n ce plan.
4 Inclu des 4 plans under w h ich m axim u m applied to a 6-m on th p e r io d .
NOTE: B eca u se of rou n d in g, sum s of individual item s do not n e c e s s a r ily equal to ta ls .
w o r k e rs co v e r e d b y the plans * See footn ote 3, p. 1.

A ll c o v e r a g e data show n in this study r e la te to n u m b er o f a ctiv e

65

In -H osp ital Consultation A llo w a n ce . — About 1 out of 10 plans providing
cash m ed ica l benefits to w ork ers and dependents included an allow ance for sp e ­
c ia list consultation during hospital confinem ent, if requested by the attending phy­
sicia n .
M ost frequently 1 consultation was sp ecified , with an allow ance of up to
$10.
Under som e plans Which provided fo r 2 in -h o sp ita l consultations, the m a x i­
mum amounts payable w ere $15 and $10 for the fir s t and second con sultations,
re sp e ctiv ely .

Service Plans
Service benefits w ere available under 19 and 15 plans covering w orkers
and dependents, re sp e ctiv e ly . In m o st c a s e s , the benefits w ere provided through
group practice prepaym ent a rran gem en ts; a few plans made available benefits on
a se lf-in su r e d b a s is — that i s , the fund to which contributions w ere made paid the
cost of the m ed ical benefits provided the covered m em b e r.
V irtually a ll of the plans provided for general m ed ica l and s p e c ia lis ts *
se rv ic e s to am bulatory patients in health or m ed ica l centers to the extent such
se rv ic e s needed.
A m a jo rity of plans a lso covered doctors* v isits in the h o s ­
pital and hom e.
Unlike cash p lan s, under plans providing s e rv ic e benefits the type o'*
d isability (accident and sick n e ss) or place where the m ed ica l treatm ent was a d ­
m in istered had no effect on the availability of ben efits.
Benefits under these
plans w ere available beginning with the fir s t day of disability.
Under a few plans,
w ork ers and dependents w ere charged a nom inal amount for the fir s t home v isit;
how ever, no charge was made for followup v is its .
In a few other p lan s, tre a t­
m ent in the doctor *s office was provided w orkers without co st, but dependents w ere
charged a nom inal amount (e. g. , $ l ) per office v is it.

Reduction of Benefits During A ctive E m ploym ent
M edical benefits w ere ra re ly m odified during active em ploym ent on the
b a sis of age (table A - 13).
Of the 9 plans that reduced b en efits, 8, covering
w ork ers only, reduced them at age 60 by shifting the allow ance at that age from
a "p e r -d is a b ilit y " basis to a " p e r -y e a r 1 b a s is .
’
F or exam ple, a plan providing
$2 for each office treatm ent and $3 for hospital treatm ent stipulated a m axim um
of $ 150 for a ll treatm ents during any 1 disability until age 6 0, after which the
total of such payments was lim ited to $ 150 in any calendar y ea r.

Benefits for R etired W o rk ers and Their Dependents
Under 25 of the 35 plans extending m ed ica l benefits to retired w o rk e rs,
the benefits provided were the sam e in all resp ects as those available to w orkers
im m ediately p rior to retirem en t (table A - 8 ) . 38 A slightly la rg er proportion of
the plans (23 out of 31) extending benefits to dependents of retired
w orkers
m aintained the sam e benefits provided dependents of active w o rk e rs.
The r e ­
m aining plans extended le ss lib era l benefits to each group.
Under the one se rv ice program that provided le s s lib era l benefits for
retired w o rk e rs, m ed ica l benefits for retired w orkers w ere available only for
treatm ent in the health cen ter, w hereas before retirem en t, benefits w ere a lso
available for treatm ent in the hospital.

^ F or this a n a ly sis, b e n e fits a vailable to a worker retiring at age 65 were com pared with those available to him im m ediately before
retirement (i. e ., at age 64).




66

V irtu ally a ll of the cash plans that made available le s s lib era l benefits
to retired w orkers provided the sam e schedule allow ances available p rior to r e ­
tirem en t.
H ow ever, under a few p lan s, the m axim um amount payable fo r each
d isability p rior to retirem en t represented the total paym ent under the plan during
the entire retirem en t period.
Once these benefits w ere exhausted, plan coverage
cea se d .
F o r exam ple, 1 plan provided allow ances fo r h osp ital, doctor*s o ffic e ,
and home treatm ent of $ 5 , $ 3 , and $ 5 , re sp e c tiv e ly , with a m axim um allow ance
of $ 1 5 5 .
These benefits w ere available p rior to retirem en t fo r each separate
d isability.
H ow ever, for retired w orkers and dependents, the m axim um a llo w ­
ance was applicable to the entire retirem en t p eriod.
Other plans extended the
sam e benefit schedule available p rior to retirem en t but specified a m axim um
amount during retirem en t to be applied not only to m ed ica l expenses but a lso to
hospital and su rg ica l exp en ses.
F o r exam ple, one plan specified that re im b u r s e ­
m ent for h osp ital, su r g ic a l, and m ed ica l benefits would be lim ited to $ 3 ,9 7 0 .
One plan that made available cash allow ances fo r h osp ital, d o cto rfs o ffic e , and
home treatm ents before retirem en t provided only in -h o sp ita l care fo r retired
w o r k e r s.

Two out of 3 plans extending benefits to retired w ork ers lim ited the
benefit coverage to treatm ent received in the hospital (table G -6 ) . A la rg e r p r o ­
portion of plans extending benefits to dependents lim ited the coverage to hospital
treatm ent.

TABLE G -

6. —

M e d ic a l:
T y p e s o f d o c t o r 's t r e a t m e n t f o r w h ic h b e n e fit s w e r e e x t e n d e d
to r e t i r e d w o r k e r s an d d e p e n d e n ts , la te

19551

P la n s c o v e r in g —
R e tir e d w o r k e r s

B e n e f it p r o v i d e d f o r t r e a t m e n t in —

D ep en d en ts o f r e t ir e d w o r k e r s

W ork ers
N um ber
(
A l l p la n s e x te n d in g m e d ic a l b e n e fit s

35
22
7
4
22

_ _ _ _ _ _

H o s p ita l o n ly
__ __ __ ------------ ------------- __
H o s p i t a l , d o c t o r ' s o f f i c e , a n d h o m e _____________
H o s p ita l, d o c t o r 's o f f i c e , h o m e , an d
h e a l t h o r m e d i c a l c e n t e r ___ — ____ ____ — _
O th er
____ __ __ __________
— ----------------------------------

000* s )
1,491
866
13
6
135
327

W ork ers
N um ber
(

3
1
25
2
3
31

000* s )
1,346
886
133
5
0
277

1 B a s e d o n a s t u d y o f 300 h e a l t h a n d i n s u r a n c e p l a n s u n d e r c o l l e c t i v e b a r g a i n i n g c o v e r i n g a p p r o x i m a t e l y 5
w ork ers.
2 1 p la n p r o v id e d b e n e f it s f o r t r e a t m e n t a t th e h o s p it a l a n d in th e s p e c i a l i s t 's o f f i c e a n d 1 o n ly a t th e h e a lt h
cen ter.
3 T h is p la n p r o v i d e s b e n e fit s a t th e h o s p it a l a n d th e s p e c i a l i s t 's o f f i c e .

m illio n

NOTE:
fo o tn o te

3
.,

A ll

p.

1.

covera ge

d a ta

sh ow n

in

t h is

stu d y

r e la te to

num ber

of

a c tiv e

w ork ers

covered

by

th e

p la n s .

See

M ore than half the cash plans covering retired w orkers and dependents
allow ed them a m axim um of $3 for each hospital treatm ent (table G -7 ) .
About
40 percen t of the plans provided m axim um allow ances of $30 0 or m o re to retired
w ork ers and dependents (table G -8 ).
Under four plan s, the m axim um allow ance
was a lso the total amount of m ed ica l coverage (excluding su rg ica l) available to
each group during the retirem en t period.
Under the 3 plans providing for discontinuance of benefits during the r e ­
tirem ent period (table A - 9 ) , the benefits rem ained in effect for not m o re than
1 year a fter the w orker re tire d .







T A B L E G - 7 . — M e d i c a l:

D is t r ib u t io n o f c a s h p la n s b y a l lo w a n c e

P la n s c o v e r i n g r e t i r e d w o r k e r s
A llo w a n c e ; p r o v i d e d f o r t r e a t m e n t in —
H o s p it a l 2
D o c t o r ' s o ffic e
H om e
W orkers
W orkers
W orkers
N um ber
N um ber
N um ber
(000« s)
( 0 0 0 1s )
( 0 0 0 's )

M a x im u m a llo w a n c e
p er trea tm en t

A l l p la n s e x t e n d in g c a s h b e n e fit s ____
$ 2 ______
S3
$4
$5
O th e r

—

28

1 ,0 2 7

—

......

p r o v i d e d f o r d o c t o r 's t r e a t m e n t f o r r e t i r e d w o r k e r s an d d e p e n d e n t s , la te 1955

17
8
2
1

245
573
89
120

6

161

1
4

3
37

1

120

P la n s c o v e r i n g d e p e n d e n t s o f r e t i r e d w o r k e r s
A l l o w a n c e p r o v i d e d f o r t r e a t m e n t in —
H osip ita l 2
D o c t o r 1s o f f i c e
H om e
W orkers
W orkers
W ork ers
N um ber
N um ber
N um ber
( 0 0 0 's )
(000* s)
( 0 0 0 1s )

6

161

27

1 ,0 1 9

2

133

2

133

4
1

24
17

13

1

13

120

237
573
89
120

1

1

16
8
2
1

1

120

1

120

1 B a s e d o n a s tu d y o f 300 h e a lth and in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r i n g a p p r o x i m a t e ly 5 m i l l i o n w o r k e r s ; o f t h e s e , 35 an d 31 p la n s e x ­
t e n d e d m e d i c a l b e n e f i t s to r e t i r e d w o r k e r s and d e p e n d e n t s , r e s p e c t i v e l y .
2 In s o m e o f the p la n s p a y m e n t w a s b a s e d o n a d a ily a llo w a n c e f o r e a c h d a y h o s p i t a l i z e d r a t h e r th an o n a p e r t r e a t m e n t b a s i s . F o r a d i s c u s s i o n o f th is ty p e o f
b e n e f i t s e e p. 62.
In a fe w p la n s a h ig h e r a llo w a n c e w a s a v a i l a b l e f o r the f i r s t f e w v i s i t s ; th e l o w e r a m o u n ts w h ic h a p p lie d s u b s e q u e n t ly w e r e u s e d in th is t a b l e .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s
w o r k e r s c o v e r e d b y the p la n s .
S e e f o o t n o t e 3, p. 1.

T A B L E G - 8 . — M e d i c a l:

do n o t n e c e s s a r i l y

eq u a l to t a ls .

A ll c o v e r a g e

d a ta s h o w n in th is

s tu d y r e l a t e

to n u m b e r o f

a c t iv e

D is t r ib u t io n o f c a s h p la n s e x t e n d in g b e n e f i t s to r e t i r e d w o r k e r s an d d e p e n d e n ts
b y m a x im u m a m o u n t p r o v i d e d , la t e 1955 1
P la n s c o v e r i n g —
D ep en d en ts o f r e t ir e d w o r k e r s

R e tir e d w o rk e rs
M a x im u m a llo w a n c e

W orkers

W ork ers
N um ber

N um ber

( 0 0 0 's)

( 0 0 0 1s)
A l l p la n s e x te n d in g c a s h b e n e f it to
r e t i r e d w o r k e r s __________________________________

28

1 ,0 2 7

27

1 ,0 1 9

U nder $150
„ __________________________________
$ 1 5 0 bu t l e s s than $ 2 0 0 __________________________
$ 2 0 0 bu t l e s s than $ 2 5 0 ____________________ ____
$ 2 5 0 bu t l e s s than $ 3 0 0
$ 3 0 0 b u t l e s s than $ 3 5 0 __________________________
$ 3 5 0 but l e s s than $ 4 0 0
$ 4 0 0 b u t l e s s than $ 5 0 0
$ 500 and o v e r
O th e r _________ __ _______
__ __ __ ____________

2
3
6
5
2
6
2
1
1

47
38
63
29
17
123
540
50
120

1
3
7
4
2
6
2
1
1

39
38
65
26
17
123
540
50
120

1
B a s e d o n a stu d y o f 300 h e a lt h and i n s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r i n g a p p r o x i m a t e ly 5 m i l ­
l i o n w o r k e r s ; o f t h e s e , 35 and 31 p la n s e x t e n d e d m e d i c a l b e n e f i t s to r e t i r e d w o r k e r s an d d e p e n d e n t s , r e s p e c t i v e l y .
S e e p . 66 f o r a d i s c u s s io n c o n c e r n in g l im i t a t io n s o n b e n e f i t s p a y a b le d u r in g p e r i o d o f r e t i r e m e n t .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l i t e m s d o n o t n e c e s s a r i l y e q u a l t o t a l s .
A ll c o v e r a g e
s h o w n in th is stu d y r e la t e to n u m b e r o f a c t iv e w o r k e r s c o v e r e d b y the p l a n s .
S e e fo o t n o t e 3, p . 1.

d a ta

Os
<1




69
Maternity Benefits

Benefits were available to women w ork ers and dependent w ives for d is ­
a bilities resulting fro m pregnancy in about 90 percent of the plans studied.
Gen­
e r a lly , this coverage was in the fo rm of specific allow ances or s e rv ic e s under
the various individual plan b en efits, i. e . , accident and s ic k n e s s , hospitalization,
su rg ic a l, and m e d ica l.
H ow ever, under som e plans, a gen eral lu m p -s u m a llo w ­
ance was provided for m aternity c a r e , usually in lieu of the separate benefit
allow ances provided by the plan.
M ost plans providing m aternity benefits lim ited the a v a ilability, am ount,
or duration of benefits to lev els below those provided for other types of d isa b ilitie s.
B enefits available for a disability resulting fro m pregnancy w ere provided
in 272 and 263 plans covering w ork ers and dependents, re sp e c tiv e ly (tables H - 1
and H - 2 ) . 39
M ore than half of the plans (150) provided a com bination of accident
and sick n e ss, hosp ital, and su rgical benefits for w ork ers in m aternity c a s e s ;

T A B L E H - l . — M a te r n ity :

B e n e fits p r o v id e d w o m e n w o r k e r s , la te 1 9 5 5 1

( x i n d i c a t e s b e n e f i t s p r o v i d e d u n d e r p la n ; d a s h e s , n o b e n e f i t s p r o v i d e d )
B e n e fits p r o v id e d
W e e k ly
a c c id e n t and
s ic k n e s s

W ork ers 2

H o s p it a l

S u r g ic a l

M e d ica l

X
X
_

X
X
_

_
_

X
X
X

X
X
-

X
X
-

_

_

G en eral
lu m p - s u m
a llo w a n c e

P la n s
(0 0 0 * s )

2 72
X
_
_
X
_
X
X
_
X
X

_

-

_

-

X
X
_

_
_
X

-

-

_

_

_
X
X
X

-

-

-

X
-

_
X
X
_
X
X

4 ,7 9 9

150
65
22
8
7
6
4
3
2
1
1
1
1
1

2 ,3 6 1
953
728
414
129
74
34
39
25
3
13
10
9
9

1 B a s e d o n a s tu d y o f 3 0 0 h e a lt h a n d i n s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v ­
a p p r o x im a t e ly 5 m illio n w o r k e r s .
2 N u m b e r o f w o r k e r s c o v e r e d b y p l a n s m a y n o t r e f l e c t an i n d i c a t i o n o f u s e o f p r o ­
v is io n s s in c e p r o p o r t io n o f w o m e n c o v e r e d v a r ie d s u b s ta n tia lly a m o n g p la n s .
e r in g

NOTE:

B ecau se

of

ro u n d in g ,

su m s

o f in d iv id u a l it e m s

do

n ot n e c e s s a r ily

e q u a l t o t a ls .

65 plans provided only hospital and surgical benefits for such disa b ilities stable
H - l ) . M edical benefits in conjunction with other plan benefits were provided under
16 plans.
Under 30 plans, a general lu m p -su m allow ance was provided.
This
allowance was provided in lieu of all other plan benefits under 22 plans, and in
addition to 1 other benefit under 8 plans.

In the accompanying tables dealing with maternity benefits, as in other sections of this study, the numbers of workers covered by
the plans are shown in order to reflect the relative size of plans in the various categories studied. Far more significant figures, if they
were available, would be the number of women covered by the plans. Obviously, maternity benefits become more important and more costly
in relation to the proportion of women covered. Under some of the plans studied, women comprised the greater part of the labor force. On
the other hand, in some cases where maternity benefits were provided, the employment of women was relatively uncommon. Thus, the
number of workers covered by plans may not reflect an indication of use of the maternity benefits.




70
A com bination of hospital and su rgical benefits was provided dependent
w ives under 195 plans (table H -2 ). M edical as w ell as hospital and su rgical bene­
fits w ere available to dependents under 14 plans. T h irty -tw o plans gave depend­
ents a general lu m p -su m allow ance in lieu of all other plan benefits.

T A B L E H - 2 . — M a te r n ity :

B e n e fits p r o v id e d w o r k e r s *

d e p e n d e n t s , la t e 195 5 1

(x in d ic a te s b e n e fits p r o v id e d u n d e r p la n ; d a s h e s , n o b e n e fits p r o v id e d )
B e n e fits p r o v id e d
H o s p ita l

S u r g ic a l

X

X

X
X
X

X

M e d ic a l

W ork ers
P la n s

G en eral
lu m p -s u m
a llo w a n c e

(0 0 0 * s)

2 63

-

_

-

X

-

X

-

X

1 B a s e d o n a s tu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s
a p p r o x im a t e ly 5 m illio n w o r k e r s .

2 ,6 8 8
783
141
510
25
9

19
14
2
1

X

e r in g

4 , 156

195
32

under

c o lle c t iv e b a r g a in in g

cov­

Accident and Sickness Benefits

Under the 166 plans providing weekly accident and sick n ess benefits for
d isa b ilities resultin g fro m pregnancy, the sam e p r o v isio n s, with the exception of
those relating to the qualification for benefits (when benefits becam e available)
and duration of the benefits, w ere applicable to m aternity and nonm aternity d is ­
a b ilitie s. The basis for determ ining the benefits (flat or graduated) and the amount
of the w eekly paym ents provided were identical for both types of d isa b ilitie s.

Qualifying P e r io d .40— Once w ork ers com pleted the eligibility requirem ents
to be covered (insured) by the plan (table A - 12), under 66 plan s, benefits were
payable only for a d isability caused by a pregnancy which began after the worker
had becom e insured (table H -3 ). P regnancy d isability benefits becam e available
im m ed ia tely , under 53 plans.
The rem aining plans requ ired the w orker to be
insured for a specified period, usually 9 m onths, in order to be eligible for bene­
fit paym en ts.

Am ount of B e n e fits. — Under plans providing uniform (flat) amounts to
com pensate for lo st w a g e s, the paym ents to women in pregnancy c a s e s ranged
fro m $ 1 0 to $55 weekly (table H -4 ).
The m o st com m on amount was $ 4 0 , found
in a third of the plans stipulating a uniform amount.
A som ewhat sm a lle r p ro ­
portion specified $ 3 0 .
M ore than $40 was provided in only 5 plans.

Qualifying period as used here and throughout this section refers to the period of time, if any, that the individual must be insured
by the plan in order to receive benefits.







T A B L E H - 3 . — M aternity: A v a ila b ilit y o f b e n e fits to n ew ly in s u r e d w o rk e rs and dependents, late 1955
B e n e fit p ro v id e d
W e e k ly a c c id e n t
and s ick n e s s
W orkers
P la n s
(0 0 0 * s )

A v a il a b i l it y o f b e n e f it s

H o s p it a l

M e d ic a l

S u r g ic a l

W orkers
P la n s

W orkers

W orkers
P la n s

P la n s
(000 »s)

(0 0 0 * s )

(0 0 0 * s )

G e n e r a l lu m p -s u m
a llo w a n c e
W orkers
P la n s
(0 0 0 * s )

W ork ers 2

A l l p la n s p r o v i d i n g b e n e f it

____

______

B e n e fi t s b e c o m e a v a i l a b l e im m e d i a t e l y
I f p r e g n a n c y c o m m e n c e s w h ile i n s u r e d
A f t e r b e in g i n s u r e d f o r :
8 m o n t h s _____________________________________ _
9 m o n t h s ______________________________________
10 m o n t h s ______________________________________
12 m o n t h s _
O th e r _ ______________
___________ ___________

166

2 ,5 7 9

239

3 ,9 5 9

233

3 ,8 8 8

16

551

30

80 5

53
66

817
1 ,2 0 9

42
72

721
1 ,2 1 6

40
79

696
1 ,2 7 3

8

468

10
11

346
345

1
37
3
1
5

12
418
45
13
64

10
88
18
5
4

126
1 ,7 0 1
126
30
40

8
85
11
6
4

110
1 ,6 8 1
48
41
40

1
4
1
2

15
22
3
44

5
3

64
42

1

9

_

_

230

3 ,3 6 4

210

3 ,2 0 7

14

510

34

80 9

_

_

35
62

665
613

28
63

584
657

5

422

13
16

362
413

-

-

11
94
18
6
4

127
1 ,7 4 7
140
35
37

8
88
11
7
5

110
1 ,7 0 0
62
46
49

-

-

_

_

1
4
2
2

15
22
8
44

3
2

8
25

-

-

_

_

D e p e n d e n ts

A l l p la n s p r o v i d i n g b e n e f it

________

B e n e fit s b e c o m e a v a i l a b l e i m m e d ia t e ly
I f p r e g n a n c y c o m m e n c e s w h ile i n s u r e d
A f t e r b e in g in s u r e d f o r :
__ ___ __ ____ _____ __ ____________
_
_
_
8 m o n th s
9 m o n th s
_____________ ______ __ _____ ___ _____ __
10 m o n t h s ________________________________________
12 m o n t h s ________________________________________
O th e r
_
_____

_

_

_

_

1 B a s e d on a study of 300 health and in su ra n c e p lan s under c o lle c t iv e b a rg a in in g c o v e rin g a p p ro x im a te ly 5 m illio n w o rk e rs .
2 N u m b er of w o rk e rs co v e re d by p lan s m ay not re fle c t an in d ic a tio n o f u se of p ro v is io n s s in c e p ro p o rtio n o f w om en co v e re d v a r ie d s u b s ta n tia lly am ong p la n s.
N O T E : B e c a u se of rounding, su m s of in d iv id u a l ite m s do not n e c e s s a r ily equal to ta ls .
w o rk e rs co v e re d by the p la n s.
See footnote 3, p. 1.

A l l co v e ra g e data shown in th is study re la te to n u m b er o f a c tiv e

72
The amount of weekly benefits provided by graduated plans for a b sen ces
due to pregnancy ranged fro m $15 up to $45 for women w o rk ers earning $ 3 ,0 0 0
yea rly — an a rb itra rily selected earnings lev el (table H - 5 ) .
The amounts m ost
frequently specified were m ore than $2 5 but le s s than $ 4 0 .
T A B L E H - 4 . — M a t e r n i t y : D i s t r i b u t i o n o f p la n s p r o ­
v id in g a fla t a c c id e n t and s ic k n e s s b e n e fit
b y a m ou n t p r o v id e d w o m e n w o r k e r s ,
la t e 1 9 5 5 1
A m ou n t o f b e n e fit fo r w om en
e a r n in g $ 3 ,0 0 0 a y e a r
A l l p la n s p r o v id in g a fla t
am ount
_____________________

_

U n d e r $ 1 5 _____________ _____ _
$ 1 5 __________ _________________ $ 1 5 . 0 1 b u t l e s s th a n $ 2 0 _____
$ 2 0 _________________________________
$ 2 0 . 0 1 b u t l e s s th a n $ 2 5 _____
$ 2 5 __________________________ _______
$ 2 5 . 0 1 b u t l e s s th a n $ 3 0 _____
$30
$ 3 0 . 0 1 b u t l e s s th a n $ 3 5 _____
$ 3 5 ______________________ ________
$ 3 5 . 0 1 b u t l e s s th a n $ 4 0 _____
$40
...................
$ 4 0 . 0 1 b u t l e s s th a n $ 4 5 _____
$ 4 5 a n d o v e r __________ _____ _

W orkers 2
P la n s
( 0 0 0 ' s)

94

2
2
2
6
4
7

-

22
5
5
3
31

-

5

1 ,3 1 6

41
45
6
146
46
61
_
172
12
35
31
695
_
23

1 B a s e d o n a s tu d y o f 300 h e a lth a n d in s u r a n c e
p la n s u n d e r c o ll e c t iv e b a r g a in in g c o v e r in g a p p r o x i­
m a t e ly 5 m illio n w o r k e r s ; 166 o f th e s e p r o v id e d an
a c c id e n t and s ic k n e s s b e n e fit f o r m a t e r n it y c a s e s .
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t
r e fl e c t an in d ic a tio n o f u s e o f b e n e fit s in c e p r o p o r t io n
o f w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .

T A B L E H - 5 . — M a t e r n i t y : D i s t r i b u t i o n o f p la n s p r o ­
v id in g a g r a d u a te d a c c id e n t a n d s i c k n e s s b e n e f it
b y am ou n t p r o v id e d w o m e n w o r k e r s
e a r n in g $ 3 ,0 0 0 y e a r l y , la te 1 9 5 5 1
A m ou n t o f b e n e fit f o r w om en
e a r n in g $ 3 ,0 0 0 a y e a r 2
A l l p la n s p r o v i d i n g an a m o u n t
b a s e d o n e a r n i n g s a l o n e ____
$ 1 5 ...
........................ ....
$ 1 5 . 0 1 b u t l e s s th a n $ 2 0 _____
.....
$ 2 0 ............................................. .....
$ 2 0 . 0 1 b u t l e s s th a n $ 2 5 _____
$ 2 5 ___ ____________________________
$ 2 5 . 0 1 b u t l e s s th a n $ 3 0 _____
$ 3 0 _________________________________
$ 3 0 . 0 1 b u t l e s s t h a n $ 3 5 _____
$ 3 5 _________________________________
$ 3 5 . 0 1 b u t l e s s th a n $ 4 0 _____
$ 4 0 _________________________________
$ 4 0 . 0 1 b u t l e s s t h a n $ 4 5 _____

W ork ers 3
P la n s
( 0 0 0 1s )

70

1 ,2 5 0

1

9
11
16
99
62
92
141
218
567
37

-

5
2
16
14
7
13
6
4
2

1 B a s e d o n a s tu d y o f 300 h e a lth an d in s u r a n c e
p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x i ­
m a t e ly 5 m illio n w o r k e r s ; 166 o f th e s e
p r o v i d e d an
a c c id e n t and s ic k n e s s b e n e fit f o r m a t e r n it y
cases.
E x c l u d e d a r e 2 p l a n s u n d e r w h ic h th e w e e k l y b e n e f i t
p r o v i d e d w a s g r a d u a t e d o n f a c t o r s o t h e r th a n e a r n i n g s .
2 W e e k ly e q u iv a le n t— $ 5 7 .7 0 .
3 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t
r e f l e c t an in d ic a tio n o f u s e o f b e n e fit s in c e p r o p o r t io n
o f w o m e n c o v e r e d v a r ie d s u b s t a n t ia lly a m o n g p la n s .

Duration of B e n e fits. — W eekly benefit payments fo r m aternity c a se s under
a ll but a few plans were provided for a shorter period of tim e than for other
d isa b ilitie s. F or a disability caused by pregnancy, weekly accident and sick n ess
benefits w ere provided for a m axim um of 6 weeks under a ll except 7 plan s, as
shown in the tabulation below . The six plans that provided benefits for a longer
period allow ed the sam e number of weekly paym ents for a b sen ces which were due
to other types of d isa b ilitie s.
W ork ers
D u r a t io n
A l l p la n s p r o v i d i n g w e e k ly a c c i d e n t a n d
s i c k n e s s b e n e f i t s f o r m a t e r n i t y c a s e s _______
4

w eeks

______________________________________________

13 w e e k s _______________________________________________
2 6 w e e k s _______________________________________________

P lq n s

(OOP1s)

166

2 , 579

1
159
4
2

5
2 ,5 2 4
17
32

N O T E : B e c a u s e o f r o u n d i n g , s u m s o f i n d i v id u a l i t e m s do n o t
n e c e s s a r il y eq u a l t o t a ls .
N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y
n o t r e f l e c t an i n d i c a t i o n o f u s e o f b e n e f i t s i n c e p r o p o r t i o n o f w o m e n
c o v e r e d v a r i e d s u b s t a n t i a l ly a m o n g p l a n s .

H ospital Benefits
B enefits available for expenses incurred during hospital confinem ent for
m aternity c a se s usually w ere le s s liberal than those provided for other types of




73
d is a b ilitie s .41 M ost of the plans providing service benefits for nonm aternity c a se s
provided se rv ice or cash benefits for m aternity ca se s for fewer days.
Under
plans providing cash benefits for both nonmaternity and m aternity confinem ents,
a few provided lower allow ances for m aternity c a s e s ; m ore frequently, the number
of days for which benefits w ere payable was reduced for m aternity c a s e s .
Ex­
tended coverage periods were ra re ly provided for m aternity c a s e s .

Types of P la n s . — H ospital benefits for m aternity care were provided in
2 39 and 230 plans for w orkers and dependents, re sp e c tiv e ly .
M ore than tw othirds of these plans provided cash benefits (table H -6 ). Only a few plans p r o ­
vided com bination cash and se rv ice benefits; the m ajority of these plans provided
cash room and board allow ances but made available specified hospital extras on
a full cost or se rv ice b a s i s .42

T A B L E H - 6 . — M a te r n ity :

T y p e s o f h o s p it a l p la n s f o r w o r k e r s an d d e p e n d e n ts ,

la te

1955

P la n s c o v e r in g —
D e p e n d e n ts

W orkers
T y p e o f p la n

W orkers

W ork ers 2
N um ber

N um ber

(0 0 0 * s )

(0 0 0 * s )
A ll p la n s p r o v id in g h o s p it a l b e n e ­
f i t s f o r m a t e r n i t y c a s e s ________

239

3 ,9 5 9

230

3, 364

C a s h _______________________________________
S e r v i c e ___________________________________
C a s h a n d s e r v i c e _____________________

166
61
12

1, 5 2 1
1, 8 3 1
607

16 0
59
11

1 ,4 4 2
1, 8 0 6
117

1 B a sed on a
in g a p p r o x i m a t e l y 5
2 N um ber of
s in c e p r o p o r t io n o f

stu d y o f 3 0 0 h e a lth and in s u r a n c e p la n s u n d e r c o ll e c t iv e b a r g a in in g c o v e r ­
m illio n w o r k e r s .
w o r k e r s c o v e r e d b y p la n s m a y n ot r e f l e c t a n in d ic a t io n o f u s e o f b e n e fit
w o m e n c o v e r e d v a r ie d s u b s t a n t ia lly a m o n g p la n s .

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n ot n e c e s s a r i l y e q u a l t o t a ls .
A l l c o v e r a g e d a t a s h o w n in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y t h e
p la n s .
S e e f o o t n o t e 3 , p . 1.

N early half the cash plans covering w ork ers and m ore than tw o-th ird s
of those covering dependents made available a flat amount (e. g. , $ 1 0 0 ) for all
expenses incurred in the hospital. Separate allow ances for daily room and board
charges and for hospital extra or an cillary se rv ice s w ere provided under m ore
than tw o-fifth s of the cash plans covering w o rk ers; le s s than a fifth of the cash
plans covering dependents used this method of providing hospital benefits.
The
rem aining plans specified a m axim um daily allowance for ro o m and board charges
with an ov erall m axim um amount available for all m aternity expen ses incurred
in the hospital.
Under these p lan s, the difference between the total ro o m and
board charges and the ov erall m axim um was used to defray the cost of extra
hospital se rv ic e s required.

Under se rv ice plan s, specified benefits were a ssu r e d w ork ers and depend­
ents rather than allow ances toward the cost of ben efits.
Under a few plans,
w orkers had to pay an initial m aternity charge (e. g. , the fir s t $60 of ail h osp i­
tal, su rg ica l, and m ed ical expenses incurred); th erea fter, fu ll-s e r v ic e benefits
wero provided.

^ Under some plans, lower benefits were available for all types of maternity cases (normal delivery, caesarean section, ectopic preg­
nancy, miscarriage, etc.); under other plans, less liberal benefits were provided for normal delivery cases only. The discussion in this
section covers benefits provided in normal delivery cases only.
42 For a discussion of cash, service, and combination cash and service plans, see the Hospital Benefits section of this study.




74
Qualifying P e r io d . — M ore than half of the plans covering w ork ers and
dependents required that the individual be insured for a sp ecified period (usually
9 m onths) in order to be eligible for hospital benefits (table H -3 ).
The next m ost
com m on e lig ib ility requirem ent for each group was that pregnancy m ust have
com m en ced while insured. The rem aining plans made benefits available im m e d i­
ately to newly insured w ork ers and dependents.
R oom and B oard A llo w a n c e s. — Full daily room and board allow ances
w ere payable to both w ork ers and dependents for periods ranging fro m le s s than
8 to m ore than 120 days per hospital stay under those plans specifying a m axim um
duration (table H -7 ).
The m a jo rity of these plans provided 14 days or le s s for
each group.
Dependent w ives receiv ed benefits for the sam e period as w ork ers under
a ll except 4 of the 95 plans that specified a duration for both group s. Under 3 of
the 4 plans providing different coverage p erio d s, w o rk ers receiv ed benefits for
up to 14 d ays, while dependents w ere covered for only 10 days.
G en erally , s e rv ic e -ty p e plans stipulated longer fu ll-b e n e fit periods than
plans providing cash a llow an ces. A fu ll-b en efit period of m ore than 14 days was
provided under the m a jo rity of the plans with se rv ice ben efits.
The fu ll-b e n e fit period provided in m aternity c a se s was shorter than that
specified for nonm aternity c a se s under m ore than tw o-th ird s of the plans covering
w o rk e rs. About th re e -fifth s of the plans covering dependents provided a shorter
fu ll-b e n e fit period for m aternity c a s e s .
Extended coverage p e rio d s, at reduced
allow an ces, were provided under four plans for w o rk e rs .
Two of these plans
a lso provided an extended coverage period for dependents.
Under virtu ally all plans with s e rv ic e -ty p e room and board b e n e fits, w ork­
e rs and dependents w ere eligible for sem iprivate accom m odation s during the fu llbenefit period without extra cost for the hospital se rv ic e s p r o v id e d .43 If the patient
occupied a private ro o m , the amount charged by the hospital for accom m odations
to which the patient was entitled, or a specified cash allow ance, was allowed
toward the cost of the ro o m ; the patient was respon sib le fo r the d ifferen ce.
The
one se r v ic e -ty p e plan with an extended coverage period provided a cash allow ance
($ 5 a day) to be applied toward all hospital ch a rg es.
N in ety -fou r and 57 plans with cash room and board benefits for w orkers
and dependents, re sp e ctiv e ly , provided a fixed daily allow ance (table H - 8 ).
Under
these p r o g r a m s, reim b u rsem en t was made toward the charge for hospital a c c o m ­
m odations up to the stipulated daily m axim u m .
Any charge in e x c e ss of this
m axim um was paid for by the insured.
The daily cash allow ance provided for m atern ity confinem ent was le s s
than that specified for nonm aternity c ase s under rela tiv ely few plans— 10 covering
w ork ers and 4 covering dependents.
Daily cash room and board allow ances for
w ork ers ranged fro m le s s than $7 to m ore than $ 1 6 . The average amount p r o ­
vided under the 94 plans with cash allow ances was $ 1 1 . 17; for dependents, the
average was $ 1 0 .4 8 under the 57 plans specifying a daily a llo w a n c e .44 About a
tenth o f the plans providing a room and board allow ance for both w ork ers and
dependent w ives specified a lower amount for dependents.
O f the 3 cash plans with extended coverage for w o rk e rs, 2 provided a
daily allow ance of $10 during the fu ll-b en efit period and $6 during the extended
coverage period; the third plan, which provided up to $ 1 2 daily during the fu llbenefit period, paid a third of the cost of a sem iprivate ro o m during the extended
coverage period.
43

Semiprivate accommodations were generally described as rooms having 2 beds or 2 and not more than 4 beds.
Average was computed by weighting amount of daily room and board allowance each plan provided by total number of workers covered.







TABLE H - 7 .— Maternity: Distribution of plans providing hospital benefits by duration of full-benefit period
and type of room and board benefits for workers and dependents, late 1955 1
Type of room and board benefit for—
Dependents

W orkers 2
Duration of full-benefit period

All plans

Cash

Worker s
Number

W orkers
Number

All plans providing hospital benefits
for maternity cases

Under 8 days
_ _
8 days
.
..
10 days
. _
11 days but less than 14 days
14 days
15 days but less than 70 days
70 days
71 days but less than 120 days
120 days
.
..........
Over 120 days
Duration not specified3

_

Number

Cash

Workers

W orkers

(000 «s)

(000 *s)

A ll plans

Service

Number
(000 *s)

Service
W orkers

Workers
Number

Number
(000 *s)

(000 »sj

(000 »s)

239

3,959

173

1,559

66

2 ,4 0 0

230

3, 364

168

1,503

62

1,861

3
8
35
2
59
5
10
2
21
4
90

11
60
1,069
41
417
28
138
22
903
308
963

2
3
12
2
57
4
1
2

6
9
85
41
400
26
9
22

1
5
23

5
51
984

2
3
12
1
12
3
1
3

6
9
90
4
70
25
9
31

5
51
484

17
3
129

1
1
7

3
3
104

21
4

903
308

11
60
573
4
72
27
113
31
903
308
1,262

1
5
22

2
1
9

3
8
34
1
13
4
8
3
21
4
131

21
4

903
308

-

90

-

-

-

963

-

-

_
-

131

-

-

-

-

_

1,262

1 Based on a study of 300 health and insurance plans under collective bargaining covering approximately 5 m illion workers.
2 Number of workers covered by plans may not reflect an indication of use of benefit since proportion of women covered varied substantially among plans.
3 Included are plans that provided a flat amount for room , board, and hospital extra charges.
NOTE: Because of rounding, sums of individual items do not n ecessarily equal totals.
workers covered by the plans.
See footnote 3, p. 1.

A ll coverage data shown in this study relate to number of active

<1
Cn




■1
<
On

T A B L E H - 8 . — M a t e r n it y : D is t r ib u t io n o f p la n s p r o v i d i n g h o s p i t a l b e n e f it s by d a i l y r o o m a n d b o a r d a l lo w a n c e an d
d u r a t io n o f f u l l - b e n e f i t p e r i o d f o r w o r k e r s a n d d e p e n d e n t s , la t e 1955 1
M a x im u m n u m b e r o f d a y s in f u l l - b e n e f i t p e r i o d
10 d a y s

U n d e r 10 d a y s

D a ily r o o m a n d b o a r d a l lo w a n c e

P la n s

N um ber

P la n s

O v e r 14 d a y s

P la n s

O th e r 2

W orkers

W ork er s

(000 * s )

(000 *s)

(0 0 0 * s )

14 d a y s

W ork ers

W ork ers

W ork ers

W orkers
P la n s

P la n s
(0 0 0 «s)

(000 *s)

(000 *s)

W ork ers 3

A l l p la n s p r o v i d i n g c a s h r o o m a n d b o a r d
a l lo w a n c e f o r m a t e r n it y c a s e s 4

94

775

U n d e r $ 7 ______________________________________
$ 7 but l e s s th an $8
$8 bu t l e s s th an $ 9
$ 9 but l e s s th a n $ 1 0
_
$ 1 0 but l e s s th an $11
$ 1 1 but l e s s than $ 1 2 .
..........
$ 12 but le s s th a n $ 13
$ 1 3 but l e s s than $ 1 4
$ 1 4 but l e s s than $ 1 5
$>15 but l e s s th an $ 1 6
......
. .
$ 16 a n d o v e r
_ _ ._

4
3
17
13
22
3
20
4
1
5
2

56
19
104
59
219
19
121
62
4
64
49

A l l p la n s p r o v i d i n g c a s h r o o m a n d b o a r d
a llo w a n c e f o r m a t e r n it y c a s e s 4

57

530

U n d e r $ 7 _ ___________________________________
$ 7 but l e s s th an $ 8
$ 8 but l e s s th a n $9
$9 but l e s s than $ 1 0
$ 1 0 but l e s s th a n $11
$11 but l e s s th a n $ 1 2
$ 1 2 but l e s s th an $ 1 3
$ 1 3 but l e s s th a n $ 1 4
$ 1 4 but l e s s th an $ 1 5
$15

3
2
13
8
13
3
8
2
1
4

14
21
197
40
81
20
49
42
4
63

5

15

12

85

_
1
4
_
_
-

_
2
13
_

-

-

57

400

7

57

13

220

19
19
86
30
63
5
94
38
_
21
25

_
2
1
1
_
2
_
_
1

_
11
14
1
_
12
_
_
19

1
_
1
1
2
1
3
1
1
2

37
.
2
3
128
9
5
8
4
24

70

7

65

_

1
1
2

9
14
11

1

24

3
3
12
7
13
1
13
2
2
1

11

73

12

5
_
13
40
5
10

-

_

_
_

-

1
_
6
1
2
1
_

-

-

-

3
-

27
5
10
16
-

D ep en d en ts

5

15

_

_

2
_
_
1
5
1
2

3

27

2

12

_

_

_

_

_

_

_

_

_

_

_

_

_

_

_

_
1
4

2
13

_

_

_

_

_
4
1
4

17
4
22

_

_

_

_

_

_

_

_

1

_

19

22

309

1
6
2
4
2
1
2
1
3

7
168
11
19
15
1
42
4
44

1 B a s e d o n a s tu d y o f 300 h e a lt h an d in s u r a n c e p la n s u n d er c o l l e c t i v e b a r g a in in g c o v e r i n g a p p r o x i m a t e ly 5 m i l l i o n w o r k e r s .
2 I n c lu d e s p la n s p r o v i d i n g a s in g le a llo w a n c e f o r r o o m a n d b o a r d , a n d h o s p i t a l e x t r a s ; d u r a t io n o f th e f u l l - b e n e f i t p e r i o d c o u l d n o t be d e t e r m in e d f o r
th e se p la n s .
3 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d i c a t i o n o f u s e o f b e n e fit s i n c e p r o p o r t i o n o f w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .
4 E x c lu d e d f r o m th is t a b le a r e 79 an d 111 p la n s that p r o v i d e d a f la t a l lo w a n c e f o r r o o m a n d b o a r d a n d h o s p i t a l e x t r a c h a r g e s f o r w o r k e r s a n d d e p e n d e n t s ,
r e s p e c t iv e ly .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y
w o r k e r s c o v e r e d b y th e p la n s .
S e e fo o t n o t e 3, p . 1.

eq u a l t o t a ls .

A ll c o v e r a g e

d a ta

s h o w n in th is

s tu d y r e la t e to n u m b e r o f a c t iv e

77

M a x i m u m r o o m a n d b o a r d a l l o w a n c e s 45 p r o v i d e d p e r h o s p i t a l s t a y u n d e r
72 c a s h p l a n s c o v e r i n g w o r k e r s a n d 26 p l a n s c o v e r i n g d e p e n d e n t s r a n g e d f r o m
l e s s t h a n $ 1 0 0 t o m o r e th a n $ 2 5 0 ( t a b l e H - 9 ) . M o r e t h a n 8 o u t o f 10 p l a n s g r a n t e d
w o r k e r s a n d d e p e n d e n ts l e s s than $ 1 7 5 a s a m a x i m u m .
T A B L E H - 9 . — M a t e r n it y :

D is t r ib u t io n o f p la n s p r o v id in g h o s p it a l b e n e f it s b y m a x im u m r o o m a n d b o a r d a llo w a n c e
fo r w o r k e r s and d e p e n d e n ts , la te 1955 1
P la n s c o v e r in g —

M a x im u m r o o m and
b o a r d a llo w a n c e

W ork er s

D ep en d en ts
W orkers

W orkers 2
N um ber

N um ber
(0 0 0 ‘ s )

( 0 0 0 ‘ s)

A l l p la n s p r o v id in g m a x im u m r o o m a n d
b o a r d a llo w a n c e f o r m a t e r n it y c a s e s

72

522

26

179

U n d e r $ 1 0 0 _____________________________________________
$ 1 0 0 bu t l e s s th an $ 1 2 5 _
$ 1 2 5 but l e s s th an $ 1 5 0
$ 1 5 0 b u t l e s s t h a n $ 1 7 5 ____________________________
$ 1 7 5 b u t l e s s t h a n $ 2 0 0 ____________________________
$ 2 0 0 b u t l e s s th a n $ 2 2 5 ____________________________
$ 2 2 5 b u t l e s s t h a n $ 2 5 0 ____________________________
$ 2 5 0 a n d o v e r _________________________________________

8
17
23
13
3
2
3
3

66
110
115
115
41
21
12
41

3
9
6
3
-

9
62
29
27
-

3
2

24
28

-

1 B a s e d on a stu d y o f 3 0 0 h e a lth a n d in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly
5 m il l io n w o r k e r s ; o f t h e s e , 239 a n d 230 p la n s p r o v id e d h o s p it a l b e n e fit s f o r m a t e r n it y c a s e s f o r w o r k e r s a n d
d e p e n d e n ts, r e s p e c t iv e ly .
W h e r e th e m a x i m u m r o o m a n d b o a r d a l l o w a n c e w a s n o t s p e c i f i e d it w a s c o m p u t e d b y
m u l t i p l y i n g t h e m a x i m u m d a i l y a l l o w a n c e b y th e n u m b e r o f d a y s o f h o s p i t a l s t a y p r o v i d e d .
E x c lu d e d f r o m th is
t a b l e a r e a l l s e r v i c e p l a n s a n d a l l c a s h p l a n s p r o v i d i n g a f la t a m o u n t f o r r o o m , b o a r d , a n d h o s p i t a l e x t r a c h a r g e s
a s w e l l a s a f e w c a s h o r c a s h a n d s e r v i c e t y p e p l a n s u n d e r w h ic h n o m a x i m u m r o o m a n d b o a r d a l l o w a n c e w a s
s p e c ifie d .
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d ic a tio n o f u se o f b e n e fit s in c e p r o p o r t io n o f
w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .

sh ow n

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e
in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S e e f o o t n o t e 3 , p . 1.

d a ta

H o s p i t a l E x t r a A l l o w a n c e s . — - A l l o w a n c e s f o r h o s p i t a l c h a r g e s o t h e r th a n
f o r r o o m a n d b o a r d w e r e s p e c i f i c a l l y p r o v i d e d f o r in 160 a n d 119 o f t h e p l a n s
c o v e r i n g w o r k e r s a n d d e p e n d e n t s , r e s p e c t i v e l y ( t a b l e H - 1 0 ) . 46 T h e v a r i o u s m e t h ­
o d s u s e d in p r o v i d i n g t h e s e b e n e f i t s w e r e th e s a m e f o r m a t e r n i t y a n d n o n m a t e r n i t y
c a s e s . T h e l a r g e m a j o r i t y o f p l a n s c a l l e d f o r th e p a y m e n t d u r i n g th e e n t i r e b e n e ­
f i t p e r i o d o f (1 ) c h a r g e s up t o a f i x e d m a x i m u m o r (2 ) th e f u l l c o s t o f s p e c i f i e d
s e rv ice s.
U n d e r s l i g h t l y m o r e th a n a t e n t h o f th e p l a n s , th e a m o u n t a l l o w e d
w o r k e r s f o r e x t r a s e r v i c e s w a s th e d i f f e r e n c e b e t w e e n the t o t a l h o s p i t a l c h a r g e s
f o r r o o m a n d b o a r d a n d th e m a x i m u m a m o u n t s p e c i f i e d u n d e r t h e p l a n s .
One
out o f 4 p la n s c o v e r i n g d e p e n d e n ts u s e d th is m e t h o d .
F o u r p lan s c o v e r i n g w o r k ­
e r s a n d 3 c o v e r i n g d e p e n d e n t s p r o v i d e d f u l l r e i m b u r s e m e n t o f c h a r g e s up t o a
c e r t a i n l e v e l but m a d e a n a l l o w a n c e f o r f u r t h e r r e i m b u r s e m e n t s o n a p e r c e n t a g e
b a s i s (75 p e r c e n t ) i f t h e s t i p u l a t e d l e v e l w a s e x c e e d e d .

P l a n s p r o v i d i n g b e n e f i t s in th e f o r m o f p a y m e n t f o r s e r v i c e s r a t h e r t h a n
c a s h a l l o w a n c e s t y p i c a l l y l i s t e d t h o s e b e n e f i t s f o r w h i c h c o s t w a s c o v e r e d (in f u l l
o r in p a r t ) a n d t h o s e e x c l u d e d .
U n d e r v i r t u a l l y a l l p l a n s , th e s a m e s e r v i c e s

45

Maximum room and board allow ance is the product o f the daily ca sh a llow an ce tim es the maximum number o f days of h ospital sta y
provided under plan s. F or the s ig n ific a n c e of this a llo w a n ce , s e e the H ospital B e n e fits s e c tio n o f this study. T h is a llow an ce co u ld not
be com puted for s e rv ice -ty p e pla n s, ca sh plans providing a flat amount for room , board, and h o sp ita l extra ch a rg e s , and for th ose with a
daily room and hoard allow an ce that s p e c ifie d a maximum allow an ce to be applied to all h ospital ch a rge s, as w ell as the fe w ca sh or cash
and serv ice-ty p e plans under w hich no maximum room and board allow an ce w as s p e c ifie d .
46 Not included in these groups are 79 and 111 plans that provided a fla t allo w a n ce for room and board, and h o sp ita l extra ch arges for
workers and depen dents, r e s p e c tiv e ly . T h e se plans are d e s crib e d under the s e c t io n on lump-sum allow an ce for h o sp ita l care.




78

p r o v i d e d f o r n o n m a t e r n i t y c a s e s w e r e p r o v i d e d f o r m a t e r n i t y c a s e s . 47
A n a d d i­
t i o n a l s e r v i c e c o v e r e d u n d e r s o m e p l a n s w a s th e c o s t o f n u r s e r y c a r e f o r th e
n e w b o r n in fa n t.
T A B L E H - 1 0 . — M a t e r n it y : M e th o d o f s p e c ify in g a llo w a n c e f o r h o s p it a l e x t r a s
fo r w o r k e r s and d e p e n d e n ts , la te 1955 1
P la n s c o v e r in g —
W orkers

M eth od

D ep en d en ts
W ork ers *

N um ber

W ork ers
N um ber

(0 0 0 * s )
A l l p la n s p r o v id in g e x t r a h o s p it a l b e n e fit
a llo w a n c e s f o r m a t e r n it y c a s e s 3
A llo w a n ce p r o v id e d fo r e x p e n s e in c u r r e d :
Up to a fix e d a m ou n t
U p t o a f i x e d a m o u n t w it h a d d it i o n a l
r e i m b u r s e m e n t o n a p e r c e n t a g e b a s i s ____
Up to d iff e r e n c e b e tw e e n r o o m an d
b o a r d c h a r g e s and a fix e d a m ou n t
O th e r
B e n e fit p r o v id e d on a s e r v ic e b a s is fo r
e n t i r e b e n e f i t p e r i o d ______________________________

( 0 0 0 's )

16 0

3 ,1 7 5

119

2 ,3 9 1

65

474

17

112

4

556

3

56

19
4

231
25

29
4

346
13

68

1 ,8 9 0

66

1 ,8 6 5

1 B a s e d on a s tu d y o f 300 h e a lth a n d in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly
5 m illio n w o r k e r s .
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d ic a tio n o f u s e o f b e n e fit s in c e p r o p o r t io n o f
w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .
3 E x c l u d e d f r o m t h i s t a b l e a r e 79 a n d 111 p l a n s th a t p r o v i d e d a f l a t a l l o w a n c e f o r r o o m , b o a r d , a n d h o s p i t a l
e x tra c h a r g e s fo r w o r k e r s and d e p e n d e n ts, r e s p e c t iv e ly .

show n

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y t h e p l a n s .
S ee fo o tn o te 3,

A ll c o v e r a g e
p . 1.

d a ta

A m o u n t s a llo w e d w o r k e r s and d e p e n d e n ts u nder p la n s p r o v id in g an a l l o w ­
a n c e f o r f u l l r e i m b u r s e m e n t o f e x t r a h o s p i t a l c h a r g e s up t o a f i x e d l e v e l r a n g e d
f r o m l e s s th a n $ 5 0 t o m o r e th a n $ 2 7 5 ( t a b l e H - l l ) .
M o r e than h a lf th e p la n s
a l l o w e d l e s s th a n $ 1 2 5.
T A B L E H - l l . — M a t e r n it y : D is t r ib u t io n o f p la n s p r o v id in g fu ll r e im b u r s e m e n t o f c h a r g e s f o r h o s p it a l e x t r a s up to
a f ix e d m a x im u m b y a m o u n t p r o v i d e d w o r k e r s a n d d e p e n d e n t s , la te 1 95 5 1
P l a n s c o v e r i n g ----W orkers

M a x im u m a m ou n t

D ep en d en ts
W ork ers 2

N um ber

W ork ers
N um ber

(0 0 0 ‘s)

(0 0 0 ‘s)

A l l p l a n s p r o v i d i n g a l l o w a n c e f o r f u ll
r e im b u r s e m e n t o f h o s p ita l e x t r a s up
to a fix e d m a x im u m

65

474

17

112

U nder $50
$ 5 0 b u t l e s s th a n $ 7 5
$ 7 5 b u t l e s s th a n $ 1 0 0
$ 1 0 0 b u t l e s s t h a n $ 1 2 5 ____________________________
$ 1 2 5 b u t l e s s th a n $ 1 5 0
$ 1 5 0 b u t l e s s t h a n $ 1 7 5 ____________________________
$ 1 7 5 b u t l e s s th a n $ 2 0 0
$ 2 0 0 b u t l e s s th an $ 2 2 5
$ 2 2 5 b u t l e s s th an $ 2 5 0
________
$ 2 5 0 b u t l e s s th a n $ 2 7 5
$ 2 7 5 a n d o v e r _________________________________________

6
6
10
15
8
6
1
6
3
1
3

61

3
1
2
5

9
3
9
30

16

52
103
85
30
1
44
36
13
35

_

_

1

5

_

_

2
1

15
11

-

2

-

33

1 B a s e d on a stu d y o f 3 0 0 h e a lt h a n d in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly
5 m il l io n w o r k e r s ; o f t h e s e , 239 a n d 230 p la n s p r o v id e d h o s p it a l b e n e fit s fo r m a t e r n it y c a s e s fo r w o r k e r s a n d
d ep en d en ts, r e s p e c t iv e ly .
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d ic a t io n o f u s e o f b e n e fit s s in c e p r o p o r t io n o f
w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .
N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e
s h o w n in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S e e f o o t n o t e 3 , p . 1.

47 For a description of services usually covered, see the Hospital Benefits section of this study, p. 48.




d a ta

79
L u m p -S u m A llo w a n c e fo r H osp ita l C a r e . — A c o m m o n m e th o d o f p ro v id in g
f o r h o s p it a l m a t e r n i t y b e n e fit s w a s the e s t a b l is h m e n t o f a fla t a l l o w a n c e to b e
a p p lie d t o w a r d a ll c h a r g e s i n c u r r e d , i. e. , r o o m and b o a r d and e x t r a s e r v i c e s .
T h i s a p p r o a c h w a s u s e d in 79 p l a n s c o v e r i n g w o r k e r s a n d 111 p l a n s c o v e r i n g
d e p e n d e n ts (table H - 1 2 ) .
U n d er th is m e th o d , no m a x im u m s w e r e s p e c i f i e d fo r
d a i l y r o o m a n d b o a r d o r e x t r a s e r v i c e s ; th e a l l o w a n c e c o u l d b e a p p l i e d t o a n y
p a r t o f the h o s p it a l b il l.
T he a m o u n ts p r o v id e d u nder t h e s e p la n s r a n g e d f r o m
$50 to m o r e than $ 1 7 5 f o r e a c h g r o u p .
A b o u t 3 ou t o f 4 p l a n s c o v e r i n g w o r k e r s
a n d d e p e n d e n t s p r o v i d e d b e t w e e n $ 7 5 a n d $ 1 2 5.
O n th e a v e r a g e , a m o u n t s f o r
w o r k e r s w e r e s lig h t ly l a r g e r than th o s e p r o v i d e d d e p e n d e n ts .
.T A B L E H - 1 2 . — M a t e r n i t y :

D is t r ib u t io n o f p la n s s p e c ify in g a fla t a m o u n t f o r r o o m , b o a r d , a n d h o s p it a l e x t r a s
f o r w o r k e r s an d d e p e n d e n t s , la t e 1955 1
P la n s c o v e r in g —
D ep en d en ts

W orkers

A m oun t

W orkers

W ork ers 2
N um ber

N um ber

(0 0 0 «s)

(OOO’ s )
A l l p la n s p r o v id in g a fla t a m o u n t f o r r o o m ,
b o a r d , an d h o s p it a l e x t r a s fo r m a t e r n it y
cases

79

784

111

973

$ 5 0 b u t l e s s th a n $ 7 5
$ 7 5 b u t l e s s t h a n $ 1 0 0 _____________________________
$ 1 0 0 b u t l e s s th a n $ 1 2 5 ____________________________
$ 1 2 5 b u t l e s s th a n $ 1 5 0
$ 1 5 0 b u t l e s s th a n $ 1 7 5
_ ^ . ....
$ 1 7 5 a n d o v e r _________________________________________

8
29
31
6
3
2

43
32 6
334
58
14
10

18
45
37
8
2
1

115
415
368
65
8
3

1 B a s e d on a stu d y o f 3 0 0 h e a lth a n d in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g a p p r o x im a t e ly
5 m illio n w o r k e r s .
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d ic a t io n o f u s e o f b e n e fit s in c e p r o p o r t io n o f
w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .

sh ow n

N O T E : B e c a u s e o f r o u n d i n g , s u m s o f i n d i v id u a l i t e m s d o n o t n e c e s s a r i l y e q u a l t o t a l s .
A ll c o v e r a g e
in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S e e f o o t n o t e 3, p . 1.

d a ta

S u rg ica l B e n e fits
S u r g i c a l b e n e fit s f o r m a t e r n i t y c a s e s w e r e p r o v i d e d u n d e r 233 a n d 210
p la n s c o v e r in g w o r k e r s and d ep e n d e n ts, r e s p e c t i v e ly .
U n d e r th e o v e r w h e l m i n g
m a jo r it y o f p la n s,
b e n e f i t s w e r e p r o v i d e d in th e f o r m o f a c a s h a l l o w a n c e . ^
O n l y 11 a n d 9 p l a n s m a d e a v a i l a b l e s e r v i c e b e n e f i t s f o r w o r k e r s a n d d e p e n d e n t s ,
re sp ectiv ely .
U n d e r a l l p l a n s , th e t y p e o f b e n e f i t ( c a s h o r s e r v i c e ) w a s th e s a m e a s
th a t p r o v i d e d i n n o n m a t e r n i t y c a s e s .
H o w e v e r , o f the 40 c a s h p la n s w h i c h had
an i n c o m e li m it a t io n p r o v i s i o n a p p li c a b le to n o n m a t e r n it y s u r g i c a l p r o c e d u r e s ,
12 d i d n o t e x t e n d t h i s p r o v i s i o n t o m a t e r n i t y c a s e s . 49
Q u a l i f y i n g P e r i o d . — W o r k e r s a n d d e p e n d e n t s h a d t o be i n s u r e d f o r a s p e c ­
if i e d p e r i o d o f t i m e , u s u a lly 9 m o n t h s , b e f o r e b e c o m i n g e li g ib le f o r the o b s t e t r i c a l
p o r t i o n o f th e s u r g i c a l b e n e f i t s u n d e r 114 p l a n s c o v e r i n g w o r k e r s a n d 119 p l a n s
c o v e r i n g d e p e n d e n ts (ta b le H - 3 ) .
U n d e r the n e x t m o s t c o m m o n p r o v i s i o n fo u n d
in 79 a n d 63 p l a n s c o v e r i n g w o r k e r s a n d d e p e n d e n t s , r e s p e c t i v e l y , b e n e f i t s w e r e
a v a i l a b l e s o l o n g a s p r e g n a n c y c o m m e n c e d a f t e r th e i n d i v i d u a l w a s i n s u r e d .
Under
th e r e m a i n i n g p l a n s , th e o n l y r e q u i r e m e n t w a s p l a n c o v e r a g e — n o c o n d i t i o n s
or
w aitin g p e r io d s w e r e s p e c if ie d .

The allowances referred to in this report apply to those provided for normal delivery. Usually, different amounts were specified for
caesarean section, ectopic pregnancy, etc. These allowances were not tabulated for this study.
F o r an e x p la n a t io n o f th e in c o m e lim it a t io n p r o v is i o n , s e e th e S u r g ic a l B e n e f it s s e c t i o n o f t h is s t u d y , p .




53.

80

A m o u n t o f B e n e f i t . — U n d e r th e p l a n s p r o v i d i n g s e r v i c e b e n e f i t s f o r w o r k ­
e r s a n d d e p e n d e n t s , th e f u l l c o s t o f o b s t e t r i c a l c a r e w a s c o v e r e d b y t h e p l a n .
H o w e v e r , a s n o t e d p r e v i o u s l y , u n d e r a f e w s e r v i c e p l a n s , w o r k e r s h a d to p a y
a n i n i t i a l m a t e r n i t y c h a r g e ( e . g . , the f i r s t $ 6 0 o f a l l h o s p i t a l , s u r g i c a l , a n d
m e d ic a l e x p e n s e s in c u r r e d ); th e r e a ft e r , f u l l - s e r v i c e b en efits w e r e p r o v id e d .
C a s h s u r g ic a l p la n s s p e c i f i e d c e r t a i n a ll o w a n c e s p a y a b le fo r s u r g i c a l
p r o c e d u r e s r e la t in g to p r e g n a n c y .
U s u a l l y , th e a m o u n t a v a i l a b l e f o r " n o r m a l
d e l i v e r y ” w a s g r e a t e r th a n th a t s p e c i f i e d f o r a m i s c a r r i a g e o r a n a b o r t i o n but
l e s s th a n th a t p r o v i d e d f o r a c a e s a r e a n s e c t i o n o r a n e c t o p i c p r e g n a n c y .
T h e " n o r m a l d e l i v e r y ” a l l o w a n c e p r o v i d e d u n d e r th e c a s h p l a n s r a n g e d
f r o m l e s s th a n $ 5 0 t o $ 1 2 5 ( t a b l e H - 1 3 ) .
The m o s t fre q u e n t a llo w a n c e s w e r e
$ 5 0 a n d $ 7 5 . T h e s e t w o a m o u n t s a c c o u n t e d f o r a p p r o x i m a t e l y t w o - t h i r d s o f th e
c a s h p la n s.

T A B L E H - 1 3 . -----M a t e r n i t y :

D is t r ib u t io n o f p la n s b y s u r g i c a l a llo w a n c e s p e c i f i e d f o r d o c t o r ’s fe e f o r d e l iv e r y ,
f o r w o r k e r s and d e p e n d e n ts , la te 1955 1
P la n s c o v e r in g —
W orkers

A llo w a n ce fo r d e liv e r y fe e

D ep en d en ts
W ork ers 2

W ork ers
N um ber

N um ber

(0 0 0 ’ s)

( 0 0 0 's )
___

222

3 ,4 0 3

201

2 ,7 6 3

U nder $50 .
__ _________ _______
_ _
$50
.................................. ..........
_ __________ _______
$ 5 0 . 0 1 b u t l e s s t h a n $ 6 0 _ ________________________
$ 6 0 _______________________________________________________
$ 6 0 . 0 1 b u t l e s s th a n $ 7 5
$ 7 5 _______________________________________________________
$ 7 5 . 0 1 b u t l e s s th a n $ 1 0 0 _________________________
$100
__________________________
$ 1 0 0 . 0 1 b u t l e s s th a n $ 1 2 5
$ 1 2 5 _____________________________________________ _______
O t h e r _____________________________________________________

2
68
1
25
18
72
20
5
4
6
1

13
454
4
475
820
80 0
676
36
68
55
3

2
75
2
23
18
55
13
3
2
7
1

40
619
12
469
832
572
130
9
18
59
3

A l l p la n s p r o v i d i n g a c a s h b e n e f i t

1 B a s e d on a s tu d y o f 3 00 h e a lth a n d in s u r a n c e p la n s u n d e r c o l l e c t i v e b a r g a in in g c o v e r in g
5 m illio n w o r k e r s .
A llo w a n c e r e f e r s to am ou n t s p e c ifie d on s c h e d u le o f a llo w a n c e s fo r a n o r m a l
2 N u m b e r o f w o r k e r s c o v e r e d b y p la n s m a y n o t r e f l e c t an in d ic a t io n o f u s e o f b e n e fit s in c e
w o m e n c o v e r e d v a r i e d s u b s t a n t ia lly a m o n g p la n s .

show n

a p p r o x im a te ly
d e liv e r y c a s e .
p r o p o r t io n o f

N O T E : B e c a u s e o f r o u n d i n g , s u m s o f i n d i v id u a l i t e m s d o n o t n e c e s s a r i l y e q u a l t o t a l s .
A ll c o v e r a g e
in t h i s s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S e e f o o t n o t e 3, p . 1.

d a ta

N i n e - t e n t h s o f th e p l a n s w i t h c a s h s u r g i c a l b e n e f i t s f o r b o th w o r k e r s
and dependen ts p r o v id e d id e n tica l n o r m a l d e liv e r y a llo w a n c e s fo r e a ch g ro u p .
W h e r e a l o w e r a m o u n t w a s a v a i l a b l e f o r d e p e n d e n t s , it w a s in n o c a s e l e s s th a n
50 p e r c e n t o f th e a m o u n t p r o v i d e d w o r k e r s , a s i n d i c a t e d b e l o w . In 16 p l a n s p r o ­
v i d i n g a l o w e r n o r m a l d e l i v e r y a l l o w a n c e f o r d e p e n d e n t s t h a n f o r w o r k e r s , th e
m a x im u m s u r g ic a l sch ed u le a llo w a n ce w as a ls o le s s fo r dep en d en ts.




P e r c e n t o f n o r m a l d e l i v e r y a l lo w a n c e p r o v i d e d w o r k e r s that w as
________ p r o v i d e d d e p e n d e n ts _________
A l l p la n s p r o v id in g a l o w e r n o r m a l d e l i v e r y
a llo w a n c e f o r d e p e n d e n ts than f o r w o r k e r s —
50
60
70
80

bu t
but
but
but

le s s
le s s
le s s
le s s

than 60p e r c e n t
than 70 p e r c e n t
than 80 p e r c e n t
than 90 p e r c e n t

----------------------------------------------------------------------_______________________
------------------------------------

W orkers
P la n s

( 000 1s)

______ 18____________ 28 7
1
10
1
6

15
205
8
59

81

M e d ic a l B en efits
M e d ic a l b e n e fits w e r e s e ld o m a v a ila b le du rin g a d is a b ilit y c a u s e d by
p r e g n a n c y . 50
O n l y 16 a n d 14 o f th e p l a n s s t u d i e d p r o v i d e d s u c h b e n e f i t s f o r
w o r k e r s an d d e p e n d e n ts , r e s p e c t i v e l y (table H - 1 4 ).
T o th e e x t e n t th a t p r e n a t a l
a n d p o s t n a t a l c a r e w e r e m e n t i o n e d in th e p l a n s , it w a s u s u a l l y s p e c i f i e d t h a t t h e y
w e r e c o v e r e d b y the s u r g i c a l a ll o w a n c e .
M e d ic a l b e n e fit s fo r m a t e r n it y c a r e w e r e a v a ila b le im m e d i a t e l y upon
b e c o m i n g in s u r e d u nder 8 p la n s c o v e r i n g w o r k e r s and u nder 5 p lan s w ith b e n e fit s
f o r d e p e n d e n ts (table H - 3 ) .
T he r e m a in in g p lan s r e q u ir e d w o r k e r s and d e p e n d e n ts
to be in s u r e d fo r a s p e c if ie d p e r io d .
B e n e f i t s in th e f o r m o f s e r v i c e s r a t h e r th a n c a s h a l l o w a n c e s w e r e p r o ­
v i d e d u n d e r 12 a n d 10 p l a n s f o r w o r k e r s a n d d e p e n d e n t s , r e s p e c t i v e l y .
Under
th e m a j o r i t y o f t h e s e p l a n s , b e n e f i t s w e r e a v a i l a b l e r e g a r d l e s s o f w h e r e t h e c a r e
w a s p r o v i d e d (ta b le H - 1 4 ) .
T w o p la n s c o v e r i n g both w o r k e r s and d e p e n d e n ts p r o ­
v i d e d c a r e o n l y in th e h o s p i t a l , a n d 1 m a d e it a v a i l a b l e o n l y in th e h e a l t h c e n t e r .
U n l i k e th e m a j o r i t y o f th e s e r v i c e p l a n s , b e n e f i t s u n d e r t h e 4 c a s h p l a n s
w e r e p r o v i d e d o n l y in th e h o s p i t a l (3 p l a n s ) a n d in the d o c t o r * s o f f i c e (1 p l a n ) .
T w o p l a n s p r o v i d e d th e s a m e i n - h o s p i t a l b e n e f i t th a t w a s s p e c i f i e d f o r i n - h o s p i t a l
c a r e o f n on m a tern ity d is a b ilit ie s .
In th e o t h e r t w o p l a n s , s p e c i a l a l l o w a n c e s ,
w h i c h d i f f e r e d f r o m t h o s e a v a i l a b l e in n o n m a t e r n i t y c a s e s , w e r e p r o v i d e d .

G en era l L u m p -S u m A llow a n ce
A s p e cifie d su m o f m o n e y , h e re in ca lle d a lu m p -s u m a llo w a n ce , w as
p r o v i d e d w o r k e r s a n d d e p e n d e n t s f o r a m a t e r n i t y d i s a b i l i t y u n d e r 30 a n d 34 p l a n s ,
r e s p e c t i v e l y (ta ble H - 1 5 ).
T h i s l u m p - s u m b e n e f i t w a s p r o v i d e d in l i e u o f a i l
o t h e r p l a n b e n e f i t s f o r w o r k e r s u n d e r 22 p l a n s .
The re m a in in g p la n s a llo w e d
th e w o r k e r a l u m p - s u m a l l o w a n c e in a d d i t i o n to o n e o t h e r p l a n b e n e f i t , e . g . ,
a c c id e n t and s ic k n e s s o r h o s p it a l b e n e fit s (ta b le H - l ) .
D ependents w e r e p r o v id e d
a l u m p - s u m a l l o w a n c e in l i e u o f a l l o t h e r p l a n b e n e f i t s u n d e r 32 p l a n s ; 2 p l a n s
g r a n t e d t h i s a l l o w a n c e to d e p e n d e n t s in a d d i t i o n t o a ' h o s p i t a l b e n e f i t ( t a b l e H - 1 5 ) .
A s w ith the s e p a r a t e b e n e f it s , a w a itin g p e r i o d w a s u s u a lly s p e c i f i e d (ta b le H - 3 ) .
T h e l u m p - s u m a ll o w a n c e p r o v i d e d w o r k e r s r a n g e d f r o m $ 5 0 to $ 1 7 5 ; the
a m ou n t p r o v id e d d ep e n d e n ts r a n g e d f r o m $50 to $200 (tab le H - 1 5 ) . T he a m ou n t
m o s t c o m m o n ly s p e c if ie d fo r w o r k e r s and d ep en d en ts w a s $150 and $ 1 0 0 , r e s p e c ­
t i v e l y , f o u n d in a t h i r d o f t h e p l a n s f o r e a c h g r o u p .

A s used in the M edical B e n e fits s e c tio n of this study, the term
the doctor performing the surgical p rocedures.




'm edical b e n e fits * ’1 a pp lies to doctors* v is it s other than th o se o f

82
T A B L E H - 1 4 . — M a te r n ity ; T y p e s o f d o c t o r 's tr e a tm e n t f o r w h ich m e d ic a l b e n e fits w e r e p r o v id e d
to w o r k e r s and d e p e n d e n ts , b y typ e o f b e n e f i t s , la te 1 9 5 5 1
T y p e o f m e d ic a l b e n e fits
W orkers 2
B e n e fit p r o v id e d f o r
tr e a tm e n t in—

W orkers
N um ber

H o s p ita l o n ly ____________________
H o s p it a l, d o c t o r 's o f f i c e ,
h o m e , and h ealth c e n t e r _____
H o s p ita l and h ealth c e n t e r ____
H ealth c e n t e r o n ly _ _____ __ _
D o c t o r 's o f f i c e o n ly ____________

A ll p la n s

S e r v ic e
W orkers

W orkers
P la n s

P la n s
(000* s)

A l l plan s p r o v id in g m e d ic a l
b e n e fit f o r m a te r n ity c a s e s __

D epen den ts

C a sh

A ll p la n s

N um ber
(000* s)

( 0 0 0 's)

C a sh

W orkers

S e r v ic e

W ork ers
P la n s

W ork ers
P la n s

( 0 0 0 's)

(000* s)

( 0 0 0 's )

16

551

4

58

12

494

14

510

4

58

10

453

5

337

3

55

2

282

5

337

3

55

2

282

8
1
1
1

168
35

168
35

162

7

162

_

_

_

_

_

9

_

8
1
1

7

_
_

9

_

1

9

3

1

3

1
1

_

3

1

3

9

_

* B a s e d on a study o f 300 h ealth and in s u r a n c e p la n s u n d e r c o ll e c t iv e b a r g a in in g c o v e r in g a p p r o x im a t e ly 5 m illio n w o r k e r s .
N u m b er o f w o r k e r s c o v e r e d by plans m a y n o t r e f l e c t an in d ic a tio n o f u s e o f b e n e fit s in c e p r o p o r t io n o f w o m e n c o v e r e d
v a r ie d s u b s ta n tia lly a m o n g p la n s .
N O T E : B e c a u s e o f r o u n d in g , su m s o f in d iv id u a l ite m s do n o t n e c e s s a r i l y eq u a l t o t a ls .
stu dy r e la te to n u m b e r o f a c tiv e w o r k e r s c o v e r e d b y the p la n s .
S ee fo o tn o te 3, p . 1.

A ll c o v e r a g e data show n in

T A B L E H - 1 5 . — M a te r n ity : D is t r ib u t io n o f p la n s p r o v id in g lu m p -s u m a llo w a n c e
b y a m ou n t f o r w o r k e r s and d e p e n d e n ts , la te 1 9 5 5 1
L u m p -s u m a llo w a n c e
A ll p lan s
A m ou n t

O nly m a t e r n it y
b e n e fit p r o v id e d

W orkers
N um ber

W orkers
P la n s

( 0 0 0 's)

(000* s)

P r o v id e d in a d d i­
tio n to a n oth er
b e n e fit2
W orkers
P la n s
(000* s)

W ork ers 3
A ll plan s p r o v id in g lu m p -s u m
a llo w a n c e f o r m a te r n ity c a s e s __

30

805

22

728

$ 5 0 _ _____ __ ____________ __
_
$75
..................................................... ........
$1 0 0 _________________________________
$ 1 2 5 ........................
.........
$ 1 3 0 ___
................................. . _
$ 1 5 0 ......................................... . ..............
$175
„ „ __ ________________

4
6
6
2
1
10
1

286
64
94
54
2
2 98
7

4
4
4
1
1
8

286
39
66
49
2
285

8

78

2
2
1
_
2
1

25
28
5
_
13
7

2

25

2

25

D epen den ts
A ll plans p r o v id in g lu m p -s u m
a llo w a n c e f o r m a te r n ity c a s e s __

34

809

32

783

$ 5 0 _ ___________ ___________ ___ „ _
$ 7 5 .................... ...... ............ .....................
$ 100
$ 1 2 0 ___________________________ ____
$ 1 2 5 ________________ _______________
$ 130 _________________________________
$ 1 5 0 _________________________________
$ 20 0 ______ „ _____________ ________

5
4
11
1
1
1
8
3

351
34
140
5
5
2
223
49

5
2
11
1
1
1
8
3

351
9
140
5
5
2
223
49

1
m a te ly
2
3
p o r t io n

-

-

-

-

-

-

_

_

B a s e d on a study o f 300 h e a lth and in s u r a n c e p la n s un d er c o ll e c t iv e b a r g a in in g c o v e r in g a p p r o x i­
5 m illio n w o r k e r s .
See ta b le s H - l and H -2 f o r b e n e fit p r o v id e d in a d d itio n t o lu m p -s u m a llo w a n c e .
N u m b e r o f w o r k e r s c o v e r e d b y p lan s m a y not r e fl e c t an in d ic a tio n o f use o f b e n e fit s in c e p r o ­
o f w o m e n c o v e r e d v a r ie d s u b s ta n tia lly a m o n g p la n s .

N O T E : B e c a u s e o f ro u n d in g , su m s o f in d iv id u a l it e m s d o not n e c e s s a r il y equ a l t o t a ls . A ll c o v e r a g e
data show n in th is study r e la te to n u m b e r o f a c t iv e w o r k e r s c o v e r e d by the p la n s . See fo o tn o te 3, p. 1.




this

83
Other Medical Care Benefits

In a d d i t i o n to th e b e n e f i t s d e s c r i b e d in th e p r e v i o u s s e c t i o n s o f t h i s r e p o r t ,
a n u m b e r o f p la n s m a d e a v a ila b le s p e c ia l b e n e fit s c o v e r in g e x te n d e d i l l n e s s , c e r t a i n
types o f d is a b ility , o r e x p e n s e s in c u r r e d fo r c e r ta in typ es o f s e r v i c e s . G e n e r a lly ,
t h e s e b e n e f i t s s u p p l e m e n t e d the h o s p i t a l , s u r g i c a l , a n d m e d i c a l c a r e a l l o w a n c e s o r
s e r v i c e s p r o v i d e d u n d e r the b a s i c p l a n . A m o n g t h e s e b e n e f i t s w e r e m a j o r m e d i c a l
b e n e f i t s , a l s o r e f e r r e d to a s e x t e n d e d m e d i c a l c a r e o r c a t a s t r o p h e m e d i c a l b e n e f i t s ;
p o lio m y e lit is in s u r a n c e ; m t-p a tie n t la b o r a t o r y and X - r a y b e n e fit s and su p p le m e n ta l
a ccid en t b e n e fits.
M a jo r

M ed ica l E xp en se

B e n e fits

M a jo r m e d ic a l e x p e n se b en efits w e r e o r ig in a lly d e v e lo p e d b y c o m m e r c i a l
i n s u r a n c e c o m p a n i e s to s u p p l e m e n t the p r o t e c t i o n p r o v i d e d u n d e r t h e r e g u l a r o r
b a s i c h o s p it a l , s u r g i c a l , an d m e d i c a l p r o g r a m s in c a s e o f e x te n d e d p e r i o d s o f
i l l n e s s . 51
R e c e n t ly , a p r o g r a m h as b e e n d e v e lo p e d w h ich has no u n d e rly in g c o v ­
e r a g e i n th e f o r m o f a b a s i c p l a n .
T h i s i s c o m m o n l y r e f e r r e d to a s a " c o m ­
p r e h e n s i v e m e d i c a l " o r " i n t e g r a t e d " p la n .
A l t h o u g h t h is t y p e a p p e a r e d to b e r e ­
c e i v i n g i n c r e a s e d a t t e n t i o n , th e s u p p l e m e n t a l p l a n — th a t p r o v i d e d i n c o n n e c t i o n w i t h
a b a s i c p l a n — w a s m o r e p r e v a l e n t at the t i m e o f t h i s s t u d y .
A lth ou gh p r o v i s i o n s o f m a j o r m e d i c a l p r o g r a m s v a r y c o n s i d e r a b l y , th ey
have th ree b a s ic c h a r a c t e r is t ic s : (l) A m a x im u m d olla r lim it on b en efits p a y a b le ,
(2 ) a c a s h d e d u c t i b l e w h i c h m u s t b e m e t b y the b e n e f i c i a r y b e f o r e b e n e f i t s u n d e r th e
m a j o r m e d i c a l p r o v i s i o n s a r e a v a i l a b l e , a n d (3) a c o - i n s u r a n c e p r o v i s i o n u n d e r
w h i c h th e b e n e f i c i a r y a s s u m e s a p e r c e n t a g e o f th e i n c u r r e d e x p e n s e s w i t h i n th e
m a x i m u m l i m i t s o f th e p l a n . T h e f o l l o w i n g e x a m p l e i l l u s t r a t e s h o w th e t y p e s u p p l e ­
m e n tin g a b a s ic h o s p it a l, s u r g ic a l , and m e d i c a l plan o p e r a t e s .
A w o r k e r in cu rs
to ta l m e d i c a l c a r e e x p e n s e s o f $ 3 , 0 0 0 d u rin g a p e r i o d o f e x te n d e d i l l n e s s .
The
b a s i c p l a n c o v e r s $ 9 0 0 o f t h is a m o u n t . T h e m a j o r m e d i c a l i n s u r a n c e p l a n f u r t h e r
p r o v i d e s th a t th e w o r k e r w i l l b e a r th e n e x t $ 1 0 0 o f c h a r g e s ( c o m m o n l y r e f e r r e d to
a s the " d e d u c t i b l e " o r " c o r r i d o r " u n d e r the p l a n ) .
O f th e r e m a i n i n g $ 2 , 0 0 0 o f
e x p e n s e s ( $ 3 , 0 0 0 l e s s / $ “900 + $ 1 0 0 7 ) , th e p l a n p a y s 75 p e r c e n t . T h u s , u n d e r th e
c o m b i n e d b a s i c a n d m a j o r m e d i c a l p r o g r a m s , the w o r k e r i s r e i m b u r s e d f o r $ 2 , 4 0 0
out o f a total c h a rg e o f $ 3 ,0 0 0 .
V i r t u a l l y a l l t y p e s o f d i s a b i l i t i e s w e r e c o v e r e d b y th e m a j o r m e d i c a l p l a n s
s t u d i e d . 52 G e n e r a l l y , a l l t y p e s o f e x p e n s e s i n c u r r e d in c o n n e c t i o n w i t h a d i s a b i l ­
ity w e r e a ls o c o v e r e d , in clu d in g a ll d o c t o r b i l l s , s e r v i c e s o f r e g i s t e r e d n u r s e s ,
h o s p it a l e x p e n s e s , and o t h e r m e d i c a l it e m s s u ch as d r u g s , a m b u la n c e s e r v i c e ,
a r t ific ia l lim b s , d ia g n o stic la b o r a t o r y p r o c e d u r e s , X - r a y tr e a tm e n ts , o x y g e n , b lo o d
t r a n s fu s io n s (in clu d in g c o s t o f b l o o d ) , and r e n ta l o f ir o n lu n g s o r o th e r d u r a b le
t h e r a p e u t i c e q u i p m e n t . M o s t p l a n s p l a c e d a m a x i m u m o n th e d a i l y r a t e o f h o s p i t a l
r o o m c h a r g e s t h a t w o u l d b e r e i m b u r s a b l e s o a s to e x c l u d e p a y m e n t f o r " l u x u r y "
a cco m m o d a tio n s.
P r e v a l e n c e . — F o u r t e e n o f th e 3 0 0 h e a l t h a n d i n s u r a n c e p l a n s s t u d i e d p r o ­
v i d e d m a j o r m e d i c a l e x p e n s e b e n e f i t s f o r w o r k e r s (1 2 s i n g l e - e m p l o y e r p l a n s a n d 2
m u ltie m p lo y e r p la n s).
T h e s e p l a n s c o v e r e d n e a r l y a f i f t h o f th e w o r k e r s i n th e
s t u d ' . U n d e r 13 p l a n s , th e m a j o r m e d i c a l e x p e n s e b e n e f i t s s u p p l e m e n t e d t h o s e p r o ­
v id e d by a b a s ic h o sp ita l and s u r g ic a l-m e d ic a l p r o g r a m . M a jo r m e d ic a l e x p en se
b e n e f i t s w e r e m a d e a v a i l a b l e to d e p e n d e n t s u n d e r e i g h t o f t h e s e p l a n s ; n o n e e x t e n d e d

Some Blue C ro ss-B lu e Shield plans have o ffered con tracts providing sim ilar b e n e fits . Substantial and com prehensive p ro te ctio n is
a ls o afforded by many o f the s e rv ice -ty p e m edical care programs included in this study. T h is s e c t io n , h ow ever, r e la te s o n ly to m ajor medi­
c a l expen se covera ge provided by com m ercial insurance com pan ies.
52
Among the ty p e s o f d is a b ilitie s and b e n e fits com m only exclu ded were those due to pregn an cy, e x ce p t for s e r io u s co m p lic a tio n s ;
dental care and co s m e tic surgery, u n less required b e c a u s e o f an a ccid en t occurring w hile the insurance w as in e ffe c t ; and eye g la s s e s and
hearing aid ex p e n s e s .
T h e plans u su ally s p e c ifie d that the ex p e n se s must be “ r e a s o n a b le * and must be p re scrib e d b y a lic e n s e d p h y s ic ia n .
*




84
b e n e f i t s to r e t i r e d w o r k e r s a n d t h e i r d e p e n d e n t s . In the r e m a i n i n g p l a n , b e n e f i t s
c o m m o n l y a v a i l a b l e u n d e r a b a s i c p la n a n d t h o s e p r o v i d e d u n d e r a m a j o r m e d i c a l
p r o g r a m w e r e c o m b i n e d in t o o n e “ c o m p r e h e n s i v e m e d i c a l p l a n . n
T y p e a n d A m o u n t o f D e d u c t i b l e . — U n d e r 11 o f th e 13 p l a n s s u p p l e m e n t i n g
a b a s i c p r o g r a m , th e d e d u c t i b l e w a s a f l a t a m o u n t , u s u a l l y $ 1 0 0 .
S even of these
11 p l a n s s p e c i f i e d th a t th e d e d u c t i b l e w a s a p p l i c a b l e to e x p e n s e s i n c u r r e d f o r a l l
d i s a b i l i t i e s o c c u r r i n g w i t h i n a s p e c i f i e d p e r i o d , g e n e r a l l y the c a l e n d a r y e a r ; the
o t h e r 4 a p p l i e d i t to e a c h s e p a r a t e d i s a b i l i t y .
T h e d e d u c t i b l e v a r i e d w i t h th e i n ­
s u r e d i n d i v i d u a l s i n c o m e u n d e r the 2 r e m a i n i n g p l a n s , 1 o f w h i c h a p p l i e d th e d e ­
d u c t i b l e o n a p e r - d i s a b i l i t y b a s i s , an d the o t h e r o n a p e r - y e a r b a s i s .
N o n e o f th e 8 p l a n s s u p p l e m e n t i n g a b a s i c p r o g r a m a n d e x t e n d i n g c o v e r a g e
to d e p e n d e n t s i n c l u d e d a “ f a m i l y d e d u c t i b l e " w h i c h r e c o g n i z e d th e p o s s i b i l i t y o f th e
o c c u r r e n c e o f m o r e th a n 1 m a j o r i l l n e s s in th e f a m i l y at th e s a m e t i m e . H o w e v e r ,
a m a j o r i t y o f th e p l a n s c o v e r i n g w o r k e r s a n d d e p e n d e n t s p r o v i d e d th a t w h e n t w o o r
m o r e m e m b e r s o f a f a m i l y i n c u r r e d c o v e r e d m e d i c a l e x p e n s e s as th e r e s u l t , o f the
s a m e a c c i d e n t , th e a m o u n t o f the d e d u c t i b l e a p p l i e d to th e e x p e n s e s o f a l l i n j u r e d
m e m b e r s in s te a d o f e a c h in d iv id u a l s e p a r a t e ly .
B e n e f i t A m o u n t s . — S e v e n t y - f i v e p e r c e n t o f c o v e r e d e x p e n s e s in e x c e s s o f
th e b a s i c p l a n b e n e f i t s a n d th e d e d u c t i b l e w a s p a y a b l e u n d e r 8 o f the m a j o r m e d i ­
c a l p l a n s u p to a s p e c i f i e d m a x i m u m ; 4 o f th e r e m a i n i n g p l a n s p a i d 80 p e r c e n t o f
c o v e r e d c h a r g e s ; 1 p a i d 90 p e r c e n t . T h e m a x i m u m a m o u n t p a y a b l e u n d e r th e p la n s
r a n g e d f r o m $ 3 , 0 0 0 p e r i n d i v i d u a l , p r o v i d e d u n d e r 1 p l a n , to $ 1 0 , 0 0 0 p e r i n d i ­
v id u a l, p r o v i d e d u n d e r 2 p la n s . T e n p la n s p r o v id e d a m a x i m u m o f $ 5 , 0 0 0 .
B en efit P e r i o d . — T he s p e c ifie d m a x im u m a llo w a n ce was p ro v id e d fo r ea ch
d i s a b i l i t y u n d e r 8 o f the 13 p l a n s .
U n d e r 5 o f t h e s e p l a n s , r e i m b u r s e m e n t u p to
th e s p e c i f i e d m a x i m u m w a s a v a i l a b l e a s l o n g a s the d i s a b i l i t y l a s t e d . T h e 3 r e ­
m a i n i n g p l a n s p l a c e d a r e s t r i c t i o n o n th e l e n g t h o f t i m e b e n e f i t s w e r e a v a i l a b l e f o r
any 1 d isa b ility .
F i v e o f th e 13 p l a n s s p e c i f i e d a m a x i m u m p a y a b l e f o r a l l d i s a b i l i t i e s .
U n d e r 1 p la n , p a y m e n ts c o v e r e d e x p e n s e s i n c u r r e d w ith in a p e r i o d o f 2 y e a r s f r o m
th e d a t e o f th e f i r s t m e d i c a l c a r e o r t r e a t m e n t o f a d i s a b i l i t y . A n o t h e r p l a n r e ­
q u i r e d the r e a p p l i c a t i o n o f th e d e d u c t i b l e at th e e n d o f e a c h 1 2 - m o n t h p e r i o d e v e n
t h o u g h the d i s a b i l i t y w a s the s a m e . O n e p la n th a t p r o v i d e d a m a x i m u m b e n e f i t o f
$ 1 0 , 0 0 0 f o r a l l d i s a b i l i t i e s l i m i t e d the a m o u n t p a y a b l e f o r a l l c o v e r e d e x p e n s e s i n ­
c u r r e d d u r i n g a n y o n e 1 2 - m o n t h p e r i o d to $ 5 , 0 0 0 .
U n d e r t h is p l a n , h o w e v e r ,
th e p e r i o d d u r i n g w h i c h the p la n c o n t i n u e d to p a y b e n e f i t s w a s e x t e n d e d , up to
12 m o n t h s , i f the w o r k e r w a s t o t a l l y d i s a b l e d o r i f th e d e p e n d e n t w a s i n c a p a b l e o f
c a r r y in g on n o r m a l a c tiv itie s .
U n d e r th e 8 p l a n s p r o v i d i n g b e n e f i t s f o r e a c h s e p a r a t e d i s a b i l i t y — a n d 2 o f
t h e 13 p l a n s th a t s p e c i f i e d a m a x i m u m f o r a l l d i s a b i l i t i e s , p r o v i s i o n w a s m a d e f o r
th e r e i n s t a t e m e n t o f th e m a x i m u m a m o u n t , u s u a l l y a f t e r th e i n s u r e d i n d i v i d u a l h a d
c o ll e c t e d a s p e c ifie d am ou n t (e . g . , $ 1 ,0 0 0 ) and had p r o v id e d s a t is fa c t o r y e v id e n ce
o f g o o d h e a lth .

P o lio m y e litis

B en efits

A l t h o u g h p o l i o m y e l i t i s w a s o f t e n c o v e r e d b y th e b a s i c h o s p i t a l , s u r g i c a l ,
a n d m e d i c a l p l a n s s t u d i e d , s o m e p r o g r a m s p l a c e d l i m i t a t i o n s o n th e b e n e f i t s p r o ­
v id e d fo r th is i l l n e s s . F o r e x a m p le , u n d er s o m e h o s p it a l p la n s w ith a fu ll - b e n e f it
p e r i o d o f 21 d a y s a n d a n e x t e n d e d c o v e r a g e p e r i o d o f 180 d a y s , h o s p i t a l i z a t i o n f o r
p o l i o m y e l i t i s w a s l i m i t e d t o 21 f u l l - b e n e f i t d a y s a n d o n l y 9 e x t e n d e d c o v e r a g e d a y s .
A fe w p r o g r a m s p r o v id e d on ly d ia g n o s tic s e r v i c e s .




85
In recognition of the often costly and prolonged nature of p o lio , specia l
allow ances w ere provided in about a sixth of the health and insurance plans studied.
In addition to h osp ital, su r g ic a l, and m ed ical se rv ice s (including nursing c a r e ),
these allow ances gen erally covered physiotherapeutic s e r v ic e s , use of iron lung,
b ra c es and other equipment, m edications and su p p lies, and transportation e xp en ses.
Although m o st of the plans provided com plete reim b u rsem en t, subject only to a
m axim um amount (e. g . , $ 5 ,0 0 0 ) for expenses incurred within a stated period
(e . g. , within 2 years after the fir s t treatm ent), som e plans paid only a specified
percent of charges (e. g. , 75 percent) incurred within a specified p erio d .
A few
plans lim ited the polio benefit to rehabilitation and treatm ent at sp ecified reh a b ili­
tation cen ters after the acute and contagious stage had pa ssed , for up to 1 year or
up to a fixed m oney allow ance, whichever o ccu rred fir s t .

Of the 300 health and insurance plans studied, 48 provided a cash polio
benefit allowance fo r active w orkers and 50 covered dependents (table I - l ) .
Plans
making the benefit available to both active w orkers and dependents provided identical
benefits to each group.
T A B L E 1 - 1 . — O th e r m e d ic a l :a r e b e n e fit s :
D i s t r i b u t i o n o f p la n s p r o v i d i n g c a s h poli< ( m y e l i t i s b e n e f i t t o w o r k e r s
a n d d e p e n d e n t s b y a m o u n t p r o v i d e d a n d p e r i o d o f t im e d u r in g w h ic h e x p e n s e s i n c u r ■ed w e r e c o v e r e d , l a t e 1 9 5 5 1
B e n e fit c o v e r s e x p e n s e s in c u r r e d d u r in g —
A l l p la n s
A m ou n t p r o v id e d

W orkers

W orkers
P la n s

N um ber

1st 3 y e a r s o f
trea tm en t

1st 2 y e a r s o f
trea tm en t

W orkers

W orkers
P la n s

P la n s
( 0 0 0 's)

( 0 0 0 's)

(0 0 0 « s )

O th e r

( 0 0 0 's)

W orkers
________

48

1 ,0 1 5

12

116

31

869

5

29

_
__
__________________________________

6
3
5
1
33

37
28
33
2
916

2

12

_

_

4
2
2

25
20
13

1
3

1
9

2
102

23

812

1

8
20
2

A l l p la n s p r o v id in g b e n e fit
$ 1 ,5 0 0
$ 2 ,0 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 5 ,0 0 0

________________________________
............ _ .

_

_

_

-

D ep en d en ts
_____

_

50

52 9

14

12 6

30

369

6

33

_________________

_

6
4
5
1
34

37
32
33
2
42 6

2

12

4
2
2

25
20
13

2
3

12
20

_

_

_

_

22

31 2

1

2

A l l p la n s p r o v id in g b e n e fit
$ 1 ,5 0 0
$ 2 ,0 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 5 ,0 0 0

___

___

.... .
________________________________
__________________________________

1 B a s e d on a stu d y o f
5 m illio n w o r k e r s .

300 h e a lth

and in s u r a n c e

_

_

_

_

2
112

1
11

p la n s

under

c o lle c t iv e

b a r g a in in g

c o v e r in g

a p p r o x im a te ly

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s do n o t n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e
s h o w n in t h is s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S e e f o o t n o t e 3 , p . 1.

d a ta

Com plete reim b u rsem en t, up to the specified m a xim u m s, was provided for
all expenses incurred within a specified period under all except three pla n s, which
paid 75 percent of the incurred ch a rg e s. E xpenses incurred during the fir s t 3 years
of treatm ent were covered under m ore than 6 out of 10 plans (table 1 -1 ).
The
m ajority of the rem aining plans lim ited payments to expenses incurred within the
fir s t 2 years of treatm ent.

The m axim um amounts payable under the plans ranged fr o m $ 1 ,5 0 0 to
$ 5 ,0 0 0 with over tw o-th irds of the plans providing a m axim um benefit of $ 5 ,0 0 0 .
Under a m a jo rity of the p la n s, these m axim um allow ances were payable in lieu of
all other plan benefits (table 1 -2 ).




86

Under a few plans with both polio and m a jo r m ed ical b en efits, benefits
provided under m a jo r m ed ica l were available after the m axim um provided under the
polio benefit was exhausted.
T A B L E 1 - 2 . — O th e r m e d i c a l c a r e b e n e f i t s : D is t r ib u t io n o f p la n s p r o v id in g c a s h p o l io m y e l i t i s b e n e fit to w o r k e r s
an d d e p e n d e n ts b y a m o u n t p r o v id e d an d it s r e la t io n to o t h e r b e n e f i t s , la t e 1 95 5 1
B e n e fit p r o v id e d —
A l l p la n s
A m ou n t p r o v id e d

In a d d it i o n to o t h e r
p la n b e n e fit s

W orkers
P la n s

P la n s

P la n s

( 0 0 0 1s )

( 0 0 0 ‘ s)

( 0 0 0 ‘ s)

(0 0 0 * s )

N ot s p e c ifie d

W orkers

W orkers

W orkers
N um ber

In l i e u o f o t h e r
p la n b e n e f i t s

W orkers
_

A l l p l a n s p r o v i d i n g b e n e f i t ________

48

1 ,0 1 5

17

223

31

792

_

$ 1 ,5 0 0
$ 2 ,0 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 5 ,0 0 0

6
3
5
1
33

37
28
33
2
916

3

14

_

_

-

_

-

-

1
13

2
206

23
28
33
710

-

_

3
3
5
20

-

-

-

-

A l l p l a n s p r o v i d i n g b e n e f i t ________

50

52 9

17

223

32

302

1

4

$ 1 ,5 0 0
$ 2 ,0 0 0
$ 2 ,5 0 0
$ 3 ,0 0 0
$ 5 ,0 0 0

6
4
5
1
34

37
32
33
2
426

3

14

3
3
5

23
28
33

1

4

-

-

_

_

_

_

21

220

__________________________________
___ _________________________ .
____ ___________________________
________________________________
_________________ _________ _
D ep en d en ts

_
_____________ _____ _
______________________ _________
__ ___ _________
____________
____
_______________________
__________________________________

1 B a s e d on a stu d y o f
5 m illio n w o r k e r s .

300 h e a lth

and in s u r a n c e

_

_

_

_

2
206

1
13

p la n s

under

c o lle c t iv e

b a r g a in in g

c o v e r in g

a p p r o x im a t e ly

N O T E : B e c a u s e o f r o u n d in g , s u m s o f in d iv id u a l it e m s d o n o t n e c e s s a r i l y e q u a l t o t a ls .
A ll c o v e r a g e
s h o w n in t h is s t u d y r e l a t e t o n u m b e r o f a c t i v e w o r k e r s c o v e r e d b y th e p l a n s .
S ee fo o tn o te 3 , p . 1.

d a ta

O u t-P a tien t D iagnostic X -r a y and L aboratory Benefits
An increasing num ber of health and insurance plans are providing a s e p ­
arate benefit for out-patient diagnostic X -r a y and laboratory procedures— that i s ,
those p erfo rm ed in the home or in the ph y sicia n 's o ffic e , as distinct fro m hospital
treatm en t. F o r hospitalized patients, these procedures are usually covered by the
1
'hospital e x tr a s M a llow an ces. & T h ese out-patient benefits are gen erally available
3
only when the procedures are requested by a doctor in connection with a diagnosis;
they are seldom available for routine ph ysical exam inations where no disability
is susp ected.
N ea rly a third of the plans studied (90) provided som e coverage fo r out­
patient diagnostic laboratory and X -r a y p ro ce d u res. 54 Of th ese , 87 provided b en e­
fits for w orkers and 65 covered dependents. T hese benefits were provided in the
fo r m of required se rv ic e s or through a specified cash allow ance.
Under a few
plans with serv ice benefits fo r w o rk e rs, dependents were required to pay part of
the c o st of the se rv ic e s provided.
About 9 out of 10 plans provided a cash allow ance, up to a specified
m a xim u m , for these b en efits. T his allowance was usually provided for all covered
expen ses incurred during each separate disability or for all disa b ilities occurring

53 For a description of these allowances, see p. 47 of the Hospital Benefits section of this study.
54 Excluded from these figures are those plans which provided benefits only for a specific type of X-ray or laboratory procedure.




87
during a specified p eriod , com m only 6 months or a y e a r . Under som e p la n s, how­
e v e r, the allowance was provided on a p e r-d isa b ility ba sis for accident c a se s and
on a tim e basis for sick n ess c a s e s .
The m axim um diagnostic X -r a y and laboratory allowance provided w orkers
ranged fro m $10 to over $ 1 0 0 .
M ost frequently, how ever, the m axim um amount
specified was $ 5 0 (35 plans); the next m o st com m on allowance was $ 2 5 (23 plan s).
The m axim um allowance available for dependents was the sam e as that provided
w orkers under a ll except six of the plans with a cash benefit for each group. Under
5 of the 6 plans that specified a different allowance for dependents than for w o rk e rs,
the m axim um allowed dependents was $ 2 5 , as against $50 fo r w o rk ers.

Supplemental Accident Benefits
L e s s than 10 percen t (2 4), of the 300 plans studied covering a slightly
sm a lle r proportion of w o rk e rs, provided w orkers and dependents with a supple­
m ental cash allowance in case of accidental injury; an additional 3 plans covered
dependents only. This allowance was available fo r payment of doctors* and hospital
charges over and above those reim b u rsed under other plan p rovision s. F o r e x a m ­
p le , the hospitalized individual could use the allowance to pay the difference between
the actual hospital room and board charge and the amount norm ally provided under
the plan.
A ll except one of the plans provided full reim b u rsem en t of covered e x ­
penses incurred within a specified period up to a stipulated dollar m axim u m . The
one exception reim b u rsed the individual on a percentage b a s is , i. e. , 75 percen t.
V irtually all plans lim ited payments under the supplem ental accident p rovision to a
period of 3 months following the date of the accident. A few plans provided benefit
periods of 6 or 7 months following the date of injury.
Under all except 2 plans
covering w o r k e r s , the m axim um benefit payable was $ 3 0 0 . One of the rem aining 2
plans specified $ 15 0 and the o th er, $ 3 7 5 . F o r dependents, the m axim um payable
was $ 300 under 22 p la n s, $ 15 0 in 4 p lan s, and $ 375 in 1 plan.




*

U. S. G O V E R N M E N T P R IN T IN G O F F IC E :

<5 0—4 3 2
97 4 8 1


Federal Reserve Bank of St. Louis, One Federal Reserve Bank Plaza, St. Louis, MO 63102