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lOV'A STATE TEACHERS COLLEGE FEB 15 1961 LI BRARY Surgical and Medical Benefits « • L a te S u m m e r 1 9 5 9 Bulletin No. 1280 UNITED STATES DEPARTMENT OF LABOR James P. Mitchell, Secretary ..Jsp iw a n C la g u a , B U R EA U OF Commissioner LA B O R STATISTICS HEALTH AND INSURANCE PLANS UNDER COLLECTIVE BARGAINING Surgical and Medical Benefits Late Summer 1959 Bulletin No. 1280 November I960 UNITED STATES DEPARTMENT OF LABOR James P. Mitchell, Secretary BU R EA U O F LA B O R STATISTICS Ew a n C la g u e , Com m issioner For sale by the Superintendent of Documents, U.S. Government Printing Office, W ashington 25, D.C. Price 3 0 cents Preface T h is stu d y o f the s u r g ic a l an d m e d i c a l b e n e fit fe a t u r e s o f 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 , b a s e d o n an a n a l y s i s o f 3 0 0 s e l e c t e d p la n s , is the t h ir d in a s e r i e s o f b u lle t in s d e a lin g s e p a r a t e l y w ith the v a r io u s c o m p o n e n t s o f h e a lth and in s u r a n c e p la n s . T h e f i r s t b u lle t in d e s c r i b e d a c c id e n t an d s i c k n e s s b e n e fit s in e f f e c t in the f a l l o f 1958 (B L S B u ll. 12 50, June 1 9 5 9 ), and the s e c o n d b u lle t in d e s c r i b e d h o s p it a l b e n e fit s in e f f e c t in e a r l y 1959 (B L S B u ll. 1274, M a r c h I 9 6 0 ). S u b s e q u e n t r e p o r t s w ill d e a l w ith m a j o r m e d i c a l b e n e fi t s , and w ith l i f e in s u r a n c e and a c c id e n t a l d e a th an d d i s m e m b e r m e n t b e n e fi t s . A s a w h o le , th is s e r i e s b r in g s up to d ate the B u r e a u o f L a b o r S t a t is t ic s e a r l i e r b u lle t in , A n a ly s is o f 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 lle c t iv e B a r g a in in g , L a te 1955 (B L S B u ll. 1221, N o v e m b e r 19 57). E a c h o f the 300 p la n s a n a ly z e d w a s in e f f e c t in the la te s u m m e r o f 1959 an d c o v e r e d at le a s t 1 ,0 0 0 w o r k e r s . In t o t a l, the s e le c t e d p la n s p r o v i d e d b e n e fit c o v e r a g e to a lm o s t 5 m i ll i o n w o r k e r s , o r a b ou t t w o - f i f t h s o f the e s t i m a t e d c o v e r a g e o f a ll 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 . S u m m a r y a r t i c l e s o f th is stu d y a p p e a r e d in the June an d Ju ly I9 6 0 i s s u e s o f the M o n th ly L a b o r R e v ie w . A fe w d i f f e r e n c e s in the d a ta r e p o r t e d , d u e to l a t e r r e v is i o n s , w ill b e fou n d in th is fin a l b u lle tin . T h is stu d y v /a s c o n d u c te d an d the r e p o r t w a s p r e p a r e d in the B u r e a u 's D i v i s i o n o f W a g e s an d I n d u s t r ia l R e la t io n s b y D o r o t h y R . K ittn e r an d H a r r y E . D a v is , u n d e r the d i r e c t i o n o f D o n a ld M . L a n d a y . Contents Page I n t r o d u c t i o n ____________________________________________________________________________ S c o p e o f s t u d y __________________________________________________________________________ P r e v a le n c e o f b e n e fits ________________________________________________________________ F in a n c in g _______________________________________________________________________________ E li g i b i li t y r e q u ir e m e n t s _____________________________________________________________ C o n tin u a n c e o f c o v e r a g e d u r in g l a y o f f _________________________________________ S u r g ic a l b e n e fits ______________________________________________________________________ A c t iv e w o r k e r s ’ and d epen d en ts* n o n m a te r n ity b e n e fits ____________________ R e d u c tio n of b e n e fits d u r in g a c t iv e e m p lo y m e n t ______________________________ 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 ___________ ______________________________ M e d ic a l b e n e fits _______________________________________________________________________ A c t iv e w o r k e r s * and d e p e n d e n ts ' n o n m a te r n ity b e n e fits ____________________ R e d u c tio n o f b e n e fits d u r in g a c t iv e e m p lo y m e n t ______________________________ 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 ________________________________________ M a te r n ity b e n e fits _______________________________________________________________ S u r g ic a l b e n e fits __________________________________________________________________ M e d ic a l b e n e fits __________________________________________________________________ 1 2 2 8 11 12 12 14 21 22 25 25 32 32 33 33 39 T a b le s : 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. H ea lth and in s u r a n c e p la n s s tu d ie d b y s i z e , in d u s tr y d iv is io n , and typ e o f b a r g a in in g unit ____________________________________ H e a lth and in s u r a n c e p la n s s tu d ie d b y in d u s tr y and g r o u p s e lig ib le f o r s u r g i c a l b e n e fits _____________________________________ H ea lth and in s u r a n c e p la n s s tu d ie d b y in d u s tr y and g r o u p s e lig ib le f o r m e d ic a l b e n e fits _____________________________________ C l a s s i f i c a t i o n o f p la n s p r o v id in g s u r g i c a l and m e d ic a l b e n e fits b y e lig ib le g r o u p s ______________________________________ R e la tio n s h ip o f n o n m a te r n ity s u r g ic a l and m e d ic a l b e n e fits p r o v id e d a c t iv e w o r k e r s and th e ir d e p e n d e n ts , a c tiv e and r e t i r e d w o r k e r s , r e t i r e d w o r k e r s and th e ir d e p e n d e n ts , and d e p e n d e n ts o f a c t iv e and r e t ir e d w o r k e r s _____________________________________________________________ M eth od o f fin a n c in g s u r g i c a l b e n e fits b y g r o u p s e l ig i b l e and typ e o f b a r g a in in g unit ________________________________________________ M e th o d o f fin a n c in g m e d ic a l b e n e fits b y g r o u p s e lig ib le and typ e o f b a r g a in in g unit ___ R e la tio n s h ip o f m e th o d o f fin a n c in g s u r g i c a l and m e d ic a l b e n e fits f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts , r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts , and a c t iv e and r e t i r e d w o r k e r s ________________________________________________________ E li g i b i li t y r e q u ir e m e n t s f o r s u r g i c a l and m e d ic a l b e n e fits ___________ E ff e c t o f a g e w h en c o v e r a g e c o m m e n c e s on a v a ila b ilit y o r l e v e l o f s u r g i c a l and m e d ic a l b e n e fit f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts ____________________________________________ T y p e s o f s u r g i c a l b e n e fits and l o c a t io n o f s u r g i c a l c a r e o f n o n m a te r n ity d is a b il i t ie s b y g r o u p s e l ig i b l e ----------------------------------In c o m e lim it s o f s e r v i c e b e n e fit s u r g i c a l p la n s and s e r v i c e b e n e fit m e d ic a l p la n s ____________________________________________ v 3 4 5 6 8 9 10 11 13 13 15 15 Contents-— Continued Page T a b l e s :— C on tin u ed 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. C h a r t: R e la tio n s h ip o f s u r g i c a l b e n e fits p r o v id e d a c t iv e w o r k e r s and th e ir d e p e n d e n ts , 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 , and a c t iv e and r e t ir e d w o r k e r s ___________________________________________ A p p e n d e c to m y a llo w a n c e b y m a x im u m s c h e d u le a llo w a n c e f o r a c t iv e w o r k e r s _________________________________________________________ A p p e n d e c to m y a llo w a n c e b y m a x im u m s c h e d u le a llo w a n c e f o r d e p en d en ts o f a c t iv e w o r k e r s ________________________________________ T o n s il l e c t o m y a llo w a n c e f o r a c t iv e w o r k e r s and th e ir d ep e n d e n ts ____________________________________________________________ M a in te n a n ce o f s u r g i c a l and m e d ic a l b e n e fits d u rin g a c t iv e e m p lo y m e n t f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts ________ A p p e n d e c to m y a llo w a n c e b y m a x im u m s c h e d u le a llo w a n c e f o r r e t ir e d w o r k e r s _________________________________________________________ A p p e n d e c to m y a llo w a n c e b y m a x im u m s c h e d u le a llo w a n c e f o r d e p e n d e n ts o f r e t ir e d w o r k e r s _______________________________________ T y p e s o f m e d ic a l b e n e fits and lo c a t io n o f m e d ic a l c a r e o f n o n m a te r n ity d is a b il i t ie s b y g r o u p s e lig ib le ________________________ R e la tio n s h ip o f m e d ic 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 and th e ir d e p e n d e n ts , 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 , and a c tiv e and r e t ir e d w o r k e r s ____________________________________ W a itin g r e q u ir e m e n t s f o r n o n m a te r n ity m e d ic a l b e n e fits f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts b y l o c a t io n o f m e d ic a l c a r e _____________________________________________________________ C a s h a llo w a n c e s f o r n o n m a te r n ity m e d ic a l c a r e p r o v id e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts b y lo c a t io n o f m e d ic a l c a r e _________________________________________________________________ M a x im u m c a s h a llo w a n c e f o r n o n m a te r n ity m e d ic a l c a r e f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts b y b a s is o f p a y m e n t _______ W a itin g r e q u ir e m e n t s f o r m e d ic a l b e n e fits f o r 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 b y l o c a t io n o f m e d ic a l c a r e _________ C a s h a llo w a n c e f o r in -h o s p ita l m e d ic a l c a r e f o r r e t i r e d w o r k e r s and th e ir d e p e n d e n ts _____________________________________________ M a x im u m c a s h a llo w a n c e f o r m e d ic a l c a r e f o r r e t i r e d w o r k e r s and th e ir d e p e n d e n ts b y b a s is o f p a y m e n t ---------------------------T y p e s o f s u r g i c a 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 and d ep en d en t w i v e s ______________________________________________ A v a ila b ilit y o f s u r g i c a l b e n e fits f o r n o r m a l d e li v e r y m a te r n ity c a s e s to n e w ly in s u r e d w o m e n w o r k e r s and d ep en d en t w iv e s _____________________________________________________________ N o r m a l d e l i v e r y m a te r n ity s u r g i c a l a llo w a n c e s f o r w o m e n w o r k e r s and d e p e n d e n t w iv e s ____________________________________ L o c a t io n o f m e d ic a l c a r e f o r w h ich b e n e fits f o r n o r m a l d e l i v e r y m a te r n ity c a s e s w e r e p r o v id e d w o m e n w o r k e r s and d e p en d en t w iv e s _____________________________________________ A v a ila b ilit y o f m e d ic a l b e n e fits f o r m a te r n ity c a s e s t o n e w ly in s u r e d w o m e n w o r k e r s and d e p e n d e n t w iv e s __________________ P e r c e n t o f h e a lth and in s u r a n c e p lan s p r o v id in g s u r g i c a l and m e d ic a l b e n e fits to a c t iv e and 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 _______________________________________________________ vi 17 18 19 20 21 23 24 26 27 28 30 31 34 34 35 36 37 38 38 39 7 Health and Insurance Plans Under Collective Bargaining Surgical and M edical Benefits, Late Summer 1959 In tr o d u c tio n S u r g ic a l and m e d ic a l b e n e fit s in p r iv a t e h e a lth and in s u r a n c e p la n s d e f r a y , in w h o le o r in p a r t, p h y s i c i a n s 1 c h a r g e s f o r s u r g ic a l p r o c e d u r e s (in c lu d in g o b s t e t r i c s ) and f o r m e d ic a l c a r e not in v o lv in g s u r g e r y . T h e s e b e n e fit s a r e a lm o s t in v a r ia b ly p r o v id e d f o r n o n o c c u p a tio n a l d is a b il i t ie s o n ly s in c e e x p e n s e s in c u r r e d a s a r e s u lt o f o c c u p a t io n a l d i s a b il i t ie s a r e c o v e r e d b y w o r k m e n ’ s c o m p e n s a t io n b e n e fit s . S u r g ic a l and m e d ic a l b e n e fits take the f o r m o f c a s h a llo w a n c e s o r s e r v i c e s p r o v id e d at lit t le o r no c h a r g e . P la n s p r o v id in g c a s h b e n e fit s r e im b u r s e c o v e r e d p e r s o n s f o r the p h y s ic ia n 1s c h a r g e s up to stip u la te d m a x im urns. Th e in d i v id u a l is r e s p o n s ib le f o r the d i f f e r e n c e , i f a n y , b e tw e e n the d o c t o r ’ s c h a r g e s and the a m ou n t p a id b y the p la n . T h is typ e o f b e n e fit is u s u a lly m a d e a v a ila b le th ro u g h g ro u p c o n t r a c t s p u r c h a s e d f r o m c o m m e r c i a l in s u r a n c e c a r r i e r s . S e r v ic e b e n e fit s , u n d er s o m e p la n s , a r e p r o v id e d a ll s u b s c r i b e r s , r e g a r d le s s o f t h e ir i n c o m e . T h e s e s e r v i c e - w i t h o u t - i n c o m e - l i m i t p la n s c o v e r v i r t u a lly th e e n tir e c o s t o f the p h y s ic ia n ’ s s e r v i c e s . O th e r s e r v i c e p la n s , the s e r v i c e w i t h - i n c o m e - l i m i t p la n s , r e s t r i c t s e r v i c e b e n e fit s to w o r k e r s and d e p e n d e n ts w h o s e i n c o m e s a r e l e s s than a s p e c if ie d a m ou n t (e . g. , $ 4 ,0 0 0 a y e a r f o r a s in g le p e r s o n and $ 6 , 000 f o r f a m ily c o v e r a g e ) ; th o s e w ith h ig h e r i n c o m e s get c a s h b e n e f it s . S e r v i c e - w i t h o u t - i n c o m e - l i m i t p la n s , w ith fe w e x c e p t io n s , u t iliz e g r o u p p r a c t i c e p r e p a y m e n t p r o g r a m s s u ch a s the H e a lth In s u r a n c e P la n o f G r e a t e r N ew Y o r k and the K a is e r F o u n d a tio n H ea lth P la n , o n the W e s t C o a s t . 1 S e r v i c e - w i t h i n c o m e - l i m i t p la n s p u r c h a s e g r o u p in s u r a n c e c o n t r a c t s f r o m l o c a l B lu e S h ie ld o r g a n iz a tio n s and o th e r n o n p r o fit g r o u p s , c o m m o n ly r e f e r r e d to a s in d iv id u a l p r a c t ic e p r e p a y m e n t p la n s . 2 S om e p la n s p r o v id e s e lf - i n s u r e d c a s h o r s e r v i c e b e n e fit s , that i s , b e n e fit s a r e p r o v id e d by the e m p lo y e r o r f r o m a fund to w h ic h c o n t r i b u tio n s a r e m a d e . s e le c t e d su m m er in e f fe c t m a d e in T h e m a in c h a r a c t e r i s t i c s o f s u r g ic a l and m e d ic a l b e n e fit s p r o v id e d b y c o l l e c t i v e l y b a r g a in e d h e a lth and in s u r a n c e p r o g r a m s in e f f e c t in la te 1959 a r e d e s c r i b e d in th is r e p o r t . A s im i la r s t u d y ,3 b a s e d on p la n s in la te 1955, p r o v id e s a b a s is f o r in d ic a tin g the c h a n g e s that h a v e b e e n s u r g ic a l and m e d ic a l b e n e fit s o v e r the p a s t fe w y e a r s . 1 P h y s ic ia n s p a r tic ip a t in g in th e s e p r o g r a m s p r a c t i c e a s a g ro u p in a c o m m o n c e n t e r o r c e n t e r s . H o w e v e r , u n d er s o m e p r o g r a m s , su ch a s G ro u p H ealth I n s u r a n c e , In c . (N ew Y o r k C ity ) and S pokane (W a sh . ) C ou n ty M e d ic a l B u r e a u , that p r o v id e s e r v i c e b e n e fit s to a ll m e m b e r s r e g a r d l e s s o f in c o m e , p a r tic ip a t in g p h y s ic ia n s p r a c t i c e on an in d iv id u a l b a s is . 2 D o c t o r s p a r tic ip a t in g in th e s e p r o g r a m s m a in ta in in d iv id u a l p r a c t i c e s . T h e a llo w a n c e s u n d er th e s e p la n s a r e p r o v id e d in a c c o r d a n c e w ith a fe e s c h e d u le a p p r o v e d b y p a r t ic ip a t in g d o c t o r s . B lu e S h ie ld p la n s a r e s p o n s o r e d by State o r l o c a l m e d ic a l s o c i e t i e s . 3 A n a ly s is o f H ea lth and I n s u r a n c e P la n s U n d er C o ll e c t i v e B a r g a in in g , L a te 1955 (B L S B u ll. 1221, 1957). 2 T h is r e p o r t d o e s not d e s c r i b e the s u p p le m e n ta r y b e n e fit s that a r e in c lu d e d in s o m e h e a lth and in s u r a n c e p r o g r a m s , s u ch a s m a jo r m e d ic a l ( a ls o r e f e r r e d to a s e x te n d e d m e d ic a l o r c a t a s t r o p h e ) b e n e f it s , p o li o m y e l it i s in s u r a n c e , o u t-p a tie n t l a b o r a t o r y and X - r a y b e n e f it s , and s u p p le m e n ta l a c c id e n t b e n e f it s . G e n e r a lly , w h e r e p r o v id e d , s u ch b e n e fit s w e r e in a d d itio n to the b a s i c h o s p it a ls u r g i c a l - m e d i c a l b e n e f it s . S c o p e o f Study T h e 300 s e le c t e d p la n s s tu d ie d w e r e in e f f e c t in la te s u m m e r 1 9 5 9 .4 T h e y ra n g e d in c o v e r a g e f r o m 1, 000 to a h a lf m i l l i o n w o r k e r s , and, in to ta l, p r o v id e d h e a lth a n d in s u r a n c e b e n e fit s to 4 . 9 m i l l i o n w o r k e r s (ta b le 1) o r a b o u t 40 p e r c e n t o f the e s t im a t e d n u m b e r o f w o r k e r s u n d e r a ll 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 i v e b a r g a in in g a g r e e m e n t s . V ir t u a lly e v e r y m a jo r m a n u fa c tu rin g and n o n m a n u fa c tu rin g in d u s tr y w a s r e p r e s e n t e d in the s a m p le stu d ie d (ta b le s 2 and 3). A lm o s t 3 out o f 4 p la n s (2 1 9 ), c o v e r i n g t w o - t h i r d s o f the w o r k e r s , w e r e in m a n u fa c tu r in g i n d u s t r ie s . A b o u t a th ir d o f the p la n s (9 5 ), c o v e r i n g m o r e th an 4 0 p e r c e n t o f the w o r k e r s , w e r e n e g o tia te d b y m u l t ie m p lo y e r g r o u p s . U n d er s o m e o f the p la n s o p e r a t e d b y m u lt ie m p lo y e r g r o u p s o r m u ltip la n t c o m p a n ie s c o v e r in g w id e g e o g r a p h ic a r e a s , the ty p e s and a m o u n ts o f b e n e fits v a r ie d f r o m a r e a to a r e a . W h e re s u ch v a r ia t io n s o c c u r r e d , the b e n e fit s c o v e r in g the l a r g e s t g r o u p o f w o r k e r s w e r e a n a ly z e d f o r th is stu dy and a s s ig n e d the w e ig h t ( i . e . , the c o v e r a g e ) o f a ll w o r k e r s c o v e r e d b y the p la n . P r e v a le n c e o f B e n e fits O f the 300 p la n s s tu d ie d , s u r g ic a l b e n e fit s w e r e p r o v id e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts 5 b y 293 and 282 p la n s , r e s p e c t i v e l y (ta b le 2 ). 6 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 r e c e i v e d s u r g i c a l b e n e fit s u n d er 103 and 100 p la n s , 4 T h e s a m e s a m p le o f p la n s w a s u s e d in H e a lth and I n s u r a n c e P la n s U n d er C o ll e c t i v e B a r g a in in g : A c c id e n t and S ic k n e s s B e n e fit s , F a ll 1958 (B L S B u ll. 1250, 1959); and H o s p it a l B e n e fit s , E a r ly 1959 (B L S B u ll. 1274, I9 6 0 ). T h e c u r r e n t s a m p le w a s c o m p r is e d o f 271 p la n s a l s o c o v e r e d in the B u reau* s 1955 stu dy and 29 s u b s titu te s that w e r e r e q u ir e d f o r the fo llo w in g r e a s o n s : D e c r e a s e in p la n c o v e r a g e to f e w e r than 1, 000 w o r k e r s ; m e r g e r o r c o m p a n y sh u t d ow n ; o r la c k o f s u ffic ie n t c u r r e n t d ata. A ll c o v e r a g e data r e p o r t e d in th is stu d y 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 (m e n and w o m e n ) c o v e r e d b y the p la n s . F o r e x a m p le , w h en r e f e r e n c e i s m a d e to d ep en d en t c o v e r a g e , the e x te n t o f s u ch c o v e r a g e is e x p r e s s e d in t e r m s o f the n u m b er 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 w h ic h e x te n d o r p r o v id e the s p e c if ie d b e n e fits f o r d e p e n d e n ts . No a tte m p t w a s m a d e to d e te r m in e the n u m b e r o f w o m e n w o r k e r s , d e p e n d e n ts , r e t ir e d w o r k e r s , o r d e p e n d e n ts o f r e t ir e d w o r k e r s c o v e r e d b y the p la n s . 5 D e p e n d e n ts in c lu d e the w o r k e r * s s p o u s e and c h ild r e n u n d er a sta te d a g e , u s u a lly 19 y e a r s . ® F iv e o f the s e v e n p la n s that d id not p r o v id e b e n e fit s f o r the a c t iv e w o r k e r c o v e r e d w o r k e r s in the m a r it im e in d u s tr y w h o r e c e i v e f r e e c a r e in U. S. P u b lic H ea lth S e r v ic e h o s p it a ls and o u t-p a tie n t f a c i l i t i e s , u n d er the U n ited S ta te s m a r it im e la w . H o w e v e r , a ll o f th e s e p la n s c o v e r e d t h e ir d e p e n d e n ts and th r e e c o v e r e d r e t i r e d w o r k e r s and t h e ir d e p e n d e n ts . 3 T a b le 1. H ea lth and in s u r a n c e p la n s stu d ied b y s iz e , in d u s tr y d iv is io n , and type o f b a rg a in in g u n it, la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) A ll in d u s tr ie s W ork ers cov ered M u it ie m p lo y e r S in g le e m p lo y e r T o ta l P la n s W ork ers P la n s W ork ers P la n s W ork ers A l l p lan s stu d ie d ------------------------------------ 300 4 ,9 3 3 .2 205 2 ,8 0 6 .7 95 2 ,1 2 6 .5 1 ,0 0 0 and u n d e r 5, 000 w o r k e r s ---------5, 000 and u n d e r 10, 000 w o r k e r s ------1 0 ,0 0 0 and u n d e r 1 5 ,0 0 0 w o r k e r s -----1 5 ,0 0 0 and u n d e r 2 5 ,0 0 0 w o r k e r s -----2 5 ,0 0 0 and u n d e r 5 0 ,0 0 0 w o r k e r s -----50, 000 and u n d e r 100, 000 w o r k e r s ----1 0 0 ,0 0 0 w o r k e r s and o v e r --------------------- 137 59 34 26 28 5 11 3 5 1 .7 41 9. 1 3 8 7 .0 4 7 2 .0 9 2 8 .8 3 0 6 .6 2 ,0 6 8 .0 102 39 20 17 17 4 6 2 6 2 .4 2 7 2 .0 224. 6 3 0 2 .9 5 3 2 .0 2 5 0 .8 9 6 2 .0 35 20 14 9 11 1 5 8 9 .3 1 4 7 .1 1 6 2 .4 1 6 9 .1 3 9 6 .8 5 5 .8 1, 1 0 6 .0 M a n u fa ctu rin g S in g le e m p lo y e r N on m a n u fa ctu rin g M u lt ie m p lo y e r S in gle e m p lo y e r M u lt ie m p lo y e r P la n s W ork ers P la n s W ork ers P la n s W ork ers P lan s W ork ers A l l p lan s stu d ied ------------------------------------ 179 2 ,6 5 0 .4 40 672 .5 26 1 5 6 .3 55 1 ,4 5 4 .0 1 ,0 0 0 and u n d e r 5, 000 w o r k e r s ---------5, 000 and u n d e r 1 0 ,0 0 0 w o r k e r s --------1 0 ,0 0 0 and u n d e r 1 5 ,0 0 0 w o r k e r s -----1 5 ,0 0 0 and u n d e r 2 5 , 000 w o r k e r s -----2 5 ,0 0 0 and u n d e r 5 0 ,0 0 0 w o r k e r s -----5 0 ,0 0 0 and u n d e r 100, 000 w o r k e r s ----100, 000 w o r k e r s and o v e r -------------------- 86 34 17 16 16 4 6 218. 6 240. 7 188. 6 2 8 7 .9 5 0 1 .8 250. 8 9 6 2 .0 14 11 8 1 3 1 2 39. 5 7 7 .6 9 0 .8 1 8 .0 109. 8 5 5 .8 2 8 1 .0 16 5 3 1 1 4 3 .8 3 1 .3 36. 0 15. 0 3 0 .2 21 9 6 8 8 4 9 .8 6 9 .5 7 1 .6 1 5 1 .1 2 8 7 .0 8 2 5 .0 - - - - _ 3 1 A ll c o v e r a g e data r e p o r t e d in th is study r e la t e to the n u m b er o f a c t iv e w o r k e r s (m en and w o m e n ) c o v e r e d b y the p la n s . N o a ttem p t w a s m a d e to d e te r m in e the n u m b er o f w o m e n w o r k e r s , d e p e n d e n ts , r e t ir e d w o r k e r s , o r d e p en d en ts o f r e t ir e d w o r k e r s c o v e r e d b y the p la n s . r e s p e c t i v e l y , c o v e r i n g a bou t 4 0 p e r c e n t o f a ll w o r k e r s in the 300 p la n s s t u d ie d .7 B e n e fit s f o r r e t ir e d p e r s o n s w e r e p r o v id e d b y a b ou t tw o out o f fiv e o f the s in g le e m p lo y e r p la n s s tu d ie d and b y a b ou t on e ou t o f fiv e o f the m u lt ie m p lo y e r p la n s (ta b le 6 ). M e d ic a l b e n e fit s w e r e p r o v id e d by 7 out o f 10 o f the p la n s stu d ie d (2 1 3 ). B o th a c t iv e w o r k e r s and t h e ir d e p e n d e n ts r e c e i v e d th e s e b e n e fit s u n d er 179 p la n s (ta b le 4 ). A n a d d itio n a l 31 p la n s p r o v id e d m e d ic a l b e n e fit s to w o r k e r s o n ly , and 3 p la n s p r o v id e d c o v e r a g e f o r th e ir d e p e n d e n ts o n ly . 8 R e t ir e d w o r k e r s and t h e ir d e p e n d e n ts r e c e i v e d m e d ic a l b e n e fits u n d e r 74 and 71 p la n s , r e s p e c t i v e l y , c o v e r in g o v e r 30 p e r c e n t o f the w o r k e r s in the s a m p le . 7 T h e t e r m " r e t i r e d w o r k e r " a s u s e d in th is r e p o r t d o e s not n e c e s s a r i l y c o v e r a ll p e n s io n e r s . W o r k e r s r e t ir e d b e f o r e the e x t e n s io n o f b e n e fit s to p e n s io n e r s a r e s o m e t im e s not c o v e r e d . See E x t e n s io n o f H ealth B e n e fits to P r i o r P e n s io n e r s (in M on th ly I ja b o r R e v ie w , A u g u st I9 6 0 ). A l s o e x c lu d e d f r o m p la n c o v e r a g e a r e r e t ir e d w o r k e r s w h o d id not m e e t p r e s c r i b e d e l ig i b i l it y r e q u ir e m e n t s . T h e data in th is r e p o r t d o not r e f l e c t the i n c r e a s e in the n u m b e r o f p la n s that h a v e e x te n d e d b e n e fit s to 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 s in c e la te s u m m e r 1959. 8 W o r k e r s u n d er th e s e th r e e p la n s a r e in the m a r it im e in d u s tr y . See fo o tn o te 6. 4 T a b le 2. H ealth and in s u r a n c e p la n s stu d ied b y in d u s tr y and g ro u p s e l ig ib le f o r s u r g ic a l b e n e fit s , la te s u m m e r 1959 1 (W o r k e r s in th ou san d s) A ll p la n s p r o v id in g s u r g ic a l b e n e fit s fo r ---T o ta l D ep en d en ts o f a c t iv e w ork ers A c tiv e w orkers In d u stry D ep en d en ts o f r e t ir e d w orkers R e tir e d w orkers P la n s W ork ers P la n s W ork ers P la n s W ork ers P la n s W ork ers P la n s W ork ers A l l p la n s stu d ied _________________ 300 4 ,9 3 3 .2 2 293 4,8 3 7 . 0 282 4 .7 5 9 . 1 M a n u fa c t u r in g _________________ 219 3,3 22. 9 219 3,3 22. 9 208 F o o d and k in d r e d p r o d u c t s ______ T o b a c c o m a n u fa c t u r e s ----------------T e x tile m i ll p r o d u c t s --------------A p p a r e l and o th e r fin is h e d p r o d u c t s _________________________ L u m b e r and w o o d p r o d u c t s , e x c e p t fu rn itu re ------------------------F u r n itu r e and fix t u r e s --------------P a p e r and a llie d p r o d u c ts ---------P rin tin g , p u b lish in g , and a llie d in d u s tr ie s ----------------------C h e m ic a ls and a llie d p r o d u c t s _________________________ P e tr o le u m re fin in g and r e la t e d in d u s tr ie s _____________ R u b b e r and m is c e lla n e o u s p la s t i c s p r o d u c t s ---------------------L e a th e r and le a th e r p r o d u c t s ___ Stone, c la y , and g la s s p r o d u c t s -------------------------------------P r i m a r y m e ta l in d u s tr ie s ---------F a b r ic a t e d m e ta l p r o d u c t s ______ M a c h in e r y , e x c e p t e l e c t r i c a l __ E l e c t r i c a l m a c h in e r y , e q u ip m en t, and su p p lie s _____________ T r a n s p o r ta tio n equ ip m en t ______ In s tru m e n ts and r e la te d p r o d u c t s -------------------------------------M is c e lla n e o u s m a n u fa ctu rin g in d u s tr ie s ______________________ 17 3 11 168. 1 24. 0 44. 7 17 3 11 168. 1 24. 0 44. 7 6 395. 1 6 3 5 13 44. 5 68. 1 49. 5 3 5 13 6 21. 7 10 109. 4 N on m an u fa ctu rin g ------------------ M ining, c r u d e p e tr o le u m , and n a tu ra l g a s p r o d u c tio n ------------T r a n s p o r t a t i o n ____________________ C o m m u n ic a t io n s __________________ U t ilit ie s : E l e c t r i c and g a s ______ W h o le s a le and r e ta il t r a d e --------H o te ls and r e s ta u r a n ts --------------S e r v ic e s ---------------------------------------C o n s tr u c tio n --------------------------------M is c e lla n e o u s n on m a n u fa c tu r in g in d u s tr ie s ------------------ 103 2,0 07. 2 100 1 ,9 9 7 .2 3 ,2 4 9 .9 75 1,644. 8 72 1,6 34. 8 16 3 7 161. 3 24. 0 32. 2 5 - 31. 6 _ - 5 _ _ 31. 6 _ 395. 1 5 383. 1 44. 5 68. 1 49. 5 3 5 13 44. 5 68. 1 49. 5 - - 1 2 6 21. 7 5 19. 2 10 109. 4 10 109. 4 - 2 281. 0 2 281. 0 1. 3 8. 8 1 2 1. 3 8. 8 3 16. 0 1 9. 0 6 79. 6 6 79. 6 8 92. 7 8 92. 7 7 71. 5 4 48. 3 4 48. 3 8 11 108. 3 68. 7 8 11 108. 3 68. 7 8 8 108. 3 50. 7 6 1 105. 8 7. 3 6 1 105. 8 7. 3 10 21 11 22 76. 499. 98. 147. 8 2 1 0 10 21 11 22 76. 499. 98. 147. 8 2 1 0 10 21 11 22 76. 499. 98. 147. 8 2 1 0 7 3 2 12 16 23 330. 2 902. 0 16 23 330. 2 902. 0 16 23 330. 2 902. 0 8 33. 4 8 33. 4 8 7 41. 4 7 41. 4 81 1,610. 3 4 22 2 11 12 5 9 15 1 4 5 0 2 7 3 2 11 7 9 268. 8 598. 0 7 9 268. 8 598. 0 33. 4 4 16. 5 4 16. 5 7 41. 4 1 1. 7 1 1. 7 74 1,514. 1 74 1 ,5 0 9 .2 28 362. 4 28 362. 4 1 9 4 .9 870. 7 38. 3 35. 2 60. 4 67. 1 140. 1 196. 4 4 16 1 11 12 5 9 15 9 7 1 2 4 1 1 4 4 21 1 11 11 4 7 14 194. 864. 8. 35. 59. 58. 89. 192. 3 8 193. 6 69. 4 3 8 9 2 193. 6 69. 4 26. 6 22. 5 7. 2 1 7. 2 1 194. 804. 8. 35. 60. 67. 140. 196. 46. 17. 6. 110. 46. 17. 6. 107. 4 5 0 2 9 7 1 2 2 2 1 6 9 2 3 2 39. 0 4. 1 3 2 39. 0 4. 1 7. 2 1 7. 2 1 7. 2 - - - 26. 6 22. 5 - - _ _ 1 See fo o tn o te 1, table 1. E x clu d e s s u p p le m e n ta ry b e n e fits su ch a s m a jo r m e d ic a l. 2 2 p la n s did n o t p r o v id e s u r g ic a l b e n e fit s . 5 p la n s did n ot p r o v id e s u r g ic a l b e n e fits fo r a c t iv e w o r k e r s ; th e s e p la n s c o v e r e d w o r k e r s in the m a r it im e in d u s try w ho r e c e i v e c a r e in U. S. P u b lic H ealth S e r v ic e H o sp ita ls and o u t-p a tie n t f a c i l i t i e s fr e e o f c h a r g e . H o w e v e r, a ll o f th e se 5 p la n s c o v e r e d the d ep en d en ts o f a c t iv e w o r k e r s and 3 o f th em c o v e r e d r e t ir e d w o r k e r s and th e ir d ep en d en ts. 5 T a b le 3. H ealth and in s u r a n c e p la n s stu d ied b y in d u s try and g r o u p s e lig ib le f o r m e d ic a l b e n e fit s , la te su m m e r 1959 1 (W o r k e r s in th ou san d s) A ll p la n s p ro v id in g m e d ic a l b e n e fit s fo r — T o ta l D ep end ents o f a c t iv e w orkers A c tiv e w orker s In d u stry g ro u p D ep en d en ts o f r e t ir e d w orkers R e tir e d w orkers P la n s W o rk e rs P la n s W ork ers P la n s W ork ers P la n s W ork ers P la n s W ork ers A ll p la n s s tu d ie d _______________ M a n u fa c t u r in g _________________ F o o d and k in d re d p r o d u c t s ______ T o b a c c o m a n u fa c t u r e s ___________ T e x tile m ill p r o d u c ts ____________ A p p a r e l and o th e r fin ish e d p r o d u c ts -----------------------------------L u m b e r and w o o d p r o d u c t s , e x c e p t fu rn itu re ________________ F u rn itu re and fix t u r e s --------------P a p e r and a llie d p r o d u c ts ______ P rin tin g , p u b lish in g , and a llie d i n d u s t r i e s --------------- — C h e m ic a ls and a llie d p ro d u c ts -------------------------------------P e tr o le u m re fin in g and r e la te d in d u s tr ie s --------------------R u b ber and m is c e lla n e o u s p la s t ic s p r o d u c t s _______________ L e a th e r and le a th e r p r o d u c t s ----S tone, c la y , and g la s s p r o d u c t s ---------------------------------P r im a r y m e ta l in d u s tr ie s ______ F a b r ic a t e d m e ta l p ro d u c ts --------M a c h in e r y , e x c e p t e l e c t r i c a l ----E l e c t r i c a l m a c h in e r y , equ ipm en t and s u p p l i e s ---------T ra n s p o r ta tio n equ ipm en t ---------In stru m en ts and r e la te d p r o d u c ts _________________________ M is c e lla n e o u s m a n u fa ctu rin g in d u s tr ie s _____________________ N o n m an u fa ctu rin g ------------------ M in in g, c r u d e p e tr o le u m , and n a tu ra l g a s p ro d u c tio n ________ T r a n s p o r ta tio n _________________ C o m m u n ica tio n s ----------------------U t ilit ie s : E le c t r i c and g a s ______ W h o le s a le and r e t a il tra d e -----H o te ls and r e sta u r a n ts S e r v ic e s ---------------------------------------C o n s tr u c tio n -----------------------------M is c e lla n e o u s n on m anu fa ctu r in g in d u s tr ie s ------------------ 300 4,9 3 3 . 2 210 3,6 84. 2 182 3 ,4 3 1 .4 74 1, 6 7 5 .4 71 1 ,5 7 9 .5 219 3,3 22. 9 152 2,4 87. 3 130 2,305. 5 52 1 ,3 4 2 .7 50 1, 248. 1 17 3 11 168. 1 24. 0 44. 7 14 2 6 157. 6 22. 5 31. 5 12 2 2 144. 6 22. 5 19. 0 5 31. 6 5 31. 6 - - - - - - - - 6 395. 1 5 383. 1 5 383. 1 4 375. 6 3 5 13 44. 5 68. 1 49. 5 3 5 6 44. 5 68. 1 23. 2 3 2 5 44. 5 3. 3 21. 1 1 1 1. 3 5. 5 6 21. 7 3 8. 8 2 4. 3 - - 10 109. 4 9 96. 2 8 93. 0 4 60. 0 4 60. 0 8 92. 7 6 73. 5 5 52. 3 3 33. 3 3 33. 3 8 11 108. 3 68. 7 8 7 108. 3 54. 0 8 5 108. 3 39. 0 6 - 105. 8 - 6 - 105. 8 - 10 21 11 22 76. 499. 98. 147. 8 2 1 0 4 9 7 17 40. 58. 75. 125. 0 0 3 3 4 8 7 15 40. 51. 75. 123. 0 2 3 3 2 2 1 8 18. 6. 3. 86. 0 0 0 2 2 2 1 8 18. 6. 3. 86. 16 23 330. 2 902. 0 11 18 1 8 5 .8 868. 1 9 17 178. 0 841. 7 2 8 9. 0 589. 2 2 8 9 .0 589. 2 8 33. 4 7 31. 8 7 31. 8 4 16. 5 4 16. 5 7 41. 4 5 31. 7 4 29. 2 1 1. 7 1 1. 7 81 1,610. 3 58 1 ,1 9 6 .9 52 1,125. 9 22 332. 7 21 331. 4 4 22 2 11 12 5 9 15 194. 870. 38. 35. 60. 67. 140. 196. 9 7 3 2 4 1 1 4 4 13 1 10 9 5 4 11 1 9 4 .9 614. 7 8. 1 32. 6 53. 2 67. 1 83. 7 135. 4 4 14 1 10 9 4 2 7 194. 653. 8. 32. 53. 58. 32. 85. 9 4 1 6 2 2 7 6 3 7 7 2 1 1 193. 6 6 6 .9 22. 1 22. 5 18. 0 2. 4 3 6 7 2 193. 6 65. 6 22. 1 22. 5 1 1 18. 0 2. 4 7. 2 1 7. 2 1 7. 2 1 7. 2 1 7. 2 1 - 2 - 1 1 - - 281. 0 1. 3 5. 5 - 0 0 0 2 - 1 S ee fo o tn o te 1, t a b le s 1 and 2. 87 p la n s d id not p r o v id e m e d ic a l b e n e fit s . 3 p la n s did n ot p r o v id e m e d ic a l b e n e fits f o r a c t iv e w o r k e r s ; h o w e v e r , d ep en d en ts o f a c t iv e w o r k e r s w e r e c o v e r e d b y th e se p la n s (s e e fo o tn o te 2, t a b l e .2). 6 T a b le 4. C l a s s i f i c a t i o n o f p la n s p r o v id in g s u r g i c a l an d m e d ic a l b e n e fit s 1 b y e l i g i b l e g r o u p s , la t e s u m m e r 1959 2 (W o r k e r s in th o u s a n d s) E lig ib le g r o u p A c t iv e w ork ers D e p e n d e n ts o f a c t iv e w orkers R e t ir e d w ork ers D e p en d en ts o f r e tir e d w orkers T o ta l w ith s u r jj i c a l b e n e f i t s -----X X X X X X _ - - X X X - X - - X X X - X “ X — X - T o ta l w ith m e d i c a l b e n e fit s ____ X X X X X X X - - - X X X - - X X X - X - - X X P la n s W ork ers 298 4, 8 9 7 . 0 178 97 15 33 32 2 1 2, 733. 9 1, 95 7. 7 135. 4 39. 5 20. 5 7. 5 2. 5 213 3, 738. 2 *108 * 69 30 2 42 41 1 * 1 ,7 4 0 . 3 * 1 , 5 4 2 .5 305. 5 94. 6 37. 0 17. 0 1. 3 1 E x c lu d e s s u p p le m e n ta r y b e n e fit s , su ch as m a jo r m e d ic a l and p o lio m y e lit is b e n e fit s . 2 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 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 ll i o n w o r k e r s . A ll c o v e r a g e data 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 (m e n and w o m e n ) c o v e r e d b y the p la n s w h ich p r o v id e d the s p e c if ie d b e n e fit . No a tte m p t w a s m a d e to d e te r m in e the n u m b e r o f w o m e n 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 , o r 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 c o v e r e d b y the p la n s . 3 P la n s d id n o t p r o v id e s u r g i c a l b e n e fits f o r a c t iv e w o r k e r s b e c a u s e th ey c o v e r e d w o r k e r s in the m a r it im e in d u s tr y w h o a r e e n title d to m e d ic a l c a r e in U .S . P u b lic H ealth S e r v ic e h o s p it a ls and o u t -p a t ie n t fa c i l i t i e s fr e e o f c h a r g e . 4 P la n s d id n o t p r o v i d e m e d i c a l b e n e fit s f o r a c t iv e w o r k e r s . S e e fo o t n o t e 3. * P r e l i m i n a r y d a ta p u b lis h e d in the J u ly I960 is s u e o f the M o n th ly L a b o r R e v ie w (p . 71 1, t a b le 1) h a v e b e e n r e v is e d . S in ce 1955, the n u m b e r o f p la n s p r o v id in g s u r g ic a l c o v e r a g e f o r r e t ir e d w o r k e r s i n c r e a s e d f r o m 19 p e r c e n t o f a ll p la n s s tu d ie d to 34 p e r c e n t , and c o v e r a g e f o r t h e ir d e p e n d e n ts r o s e f r o m 16 p e r c e n t to 33 p e r c e n t o f the p la n s ( s e e c h a r t ). A lth o u g h the p r o p o r t io n o f p la n s p r o v id in g m e d ic a l b e n e fit s f o r a c t iv e w o r k e r s i n c r e a s e d b y o n ly 6 p e r c e n t a g e p o in ts , a c t iv e w o r k e r s * d ep en d en ts* c o v e r a g e r o s e f r o m 48 p e r c e n t o f the p la n s stu d ie d to 61 p e r c e n t . C o v e r a g e o f r e t i r e d w o r k e r s b y m e d ic a l b e n e fit s i n c r e a s e d f r o m 12 p e r c e n t to 25 p e r c e n t o f the p la n s s tu d ie d and f o r t h e ir d e p e n d e n ts , f r o m 10 p e r c e n t to 24 p e r c e n t . U n d er m o s t p la n s , id e n t ic a l s u r g ic a l and m e d ic a l b e n e fit s w e r e p r o v id e d a ll e l ig i b l e g r o u p s (ta b le 5 ). A c t iv e w o r k e r s a n d t h e ir d e p e n d e n ts (b o th c h i ld r e n a n d a d u lts ) h ad the s a m e s u r g ic a l and m e d ic a l b e n e fit s in a b o u t 3 out o f 4 o f the p la n s c o v e r in g b o th g r o u p s ; m o r e than 9 ou t o f 10 p la n s g a v e a c t iv e w o r k e r s a n d t h e ir a d u lt d e p e n d e n ts ( e . g . , s p o u s e ) id e n t ic a l s u r g i c a l b e n e f it s . R e t i r e d and a c t iv e w o r k e r s r e c e i v e d id e n t ic a l s u r g ic a l b e n e fit s u n d er 70 o f the 100 p la n s c o v e r in g b oth g r o u p s , and id e n t ic a l m e d ic a l b e n e fit s u n d e r 49 o f the 72 p la n s . 7 Percent o f Health and Insurance Plans Providing Surgical and M edical Benefits to Active and Retired W ork ers and Their Dependents Late 1955 and Late Summer 1959 Based on 300 plans under collective bargaining studied, in late 1955 and late summer 1959. (See text footnote 4.) 8 T a b le 5. R e la t io n s h ip o f n o n m a te r n ity s u r g ic a l and m e d ic a l b e n e fit s p r o v id e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , a c t iv e and r e t ir e d w o r k e r s , r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts , and d e p e n d e n ts o f a c t iv e and r e t ir e d w o r k e r s , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) S u r g ic a l b e n e fits M e d ic a l b e n e fits G r o u p s c o v e r e d and b e n e fit l e v e l P la n s W ork ers P la n s W ork ers A c t iv e w o r k e r s and t h e ir d e p e n d e n ts A l l p la n s p r o v id in g b e n e fit s f o r a c t iv e w o r k e r s and d e p e n d e n t s __________ __ _______ B e n e fit s f o r d e p e n d e n ts : S am e a s b e n e fit f o r a c t iv e w o r k e r s D iff e r e n t f r o m a c t iv e w o r k e r s * b e n e fit in one o r m o r e r e s p e c t s 277 4 , 69 9. 1 179 3 ,3 7 7 .4 205 3 ,3 7 7 . 1 145 2 , 55 8. 3 272 1, 3 2 2 .0 34 81 9. 1 100 1 ,9 6 7 .7 72 1, 6 3 8 .4 70 1, 5 6 5 .4 49 1, 312. 7 30 402. 3 23 3 2 5 .7 100 1 ,9 9 7 .2 71 1 ,5 7 9 .5 91 1, 8 1 8 .7 65 1 ,5 3 9 .9 9 1 7 8 .5 6 3 9 .6 100 1, 9 9 7 .2 71 1 ,5 7 9 .5 72 1 ,7 2 6 .5 50 1, 317. 3 28 2 7 0 .7 21 2 6 2 .2 A c t iv e an d r e t i r e d w o r k e r s A l l p la n s p r o v id in g b e n e fit s f o r a c t iv e w o r k e r s and r e t i r e d w o r k e r s ___________ ____ B e n e f it s f o r r e t i r e d w o r k e r s : S a m e a s b e n e fit f o r a c t iv e w o r k e r s D iff e r e n t fr o m a c t iv e w o r k e r s * b e n e fit in one o r m o r e r e s p e c t s ___________________ R e t ir e d w o r k e r s and t h e ir d e p e n d e n ts A l l p la n s p r o v id in g b e n e fit s 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 B e n e fit s f o r d e p e n d e n ts : S a m e a s b e n e fit f o r r e t i r e d w o r k e r s _______ D iff e r e n t fr o m r e t i r e d w o r k e r s * b e n e fit in one o r m o r e r e s p e c t s ___________________ D e p e n d e n ts o f a c t iv e land r e t i r e d w o r k e r s A l l p la n s p r o v id in g b e n e fit s f o r d e p e n d e n ts o f a c t iv e and r e t i r e d 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 r e t i r e d w o r k e r s : S a m e a s b e n e fit f o r d e p e n d e n ts o f a c t iv e w o r k e r s ----- ----------------------------------- _ D iff e r e n t fr o m b e n e fit f o r d e p e n d e n ts o f a c t iv e w o r k e r s in on e o r m o r e r e s p e c t s ________________________ ______________ 1 See fo o t n o t e s 1 an d 2 , ta b le 4 . 293 and 2 1 0 p la n s p r o v id e d s u r g ic a l and m e d ic a l b e n e fit s , r e s p e c t i v e l y , f o r a c t iv e w o r k e r s ; 282 and 182 p la n s p r o v id e d s u r g ic a l and m e d ic a l b e n e fit s , r e s p e c t i v e l y , to d e p e n d e n ts o f a c t iv e w o r k e r s ; 103 and 74 p la n s p r o v id e d s u r g ic a l an d m e d i c a l b e n e fit s , r e s p e c t i v e l y , to r e t ir e d w o r k e r s ; and 100 and 71 p la n s p r o v id e d s u r g i c a l an d m e d i c a l b e n e fit s , r e s p e c t i v e l y , 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 . 2 In c lu d e s 49 p la n s w h ic h p r o v id e d the s a m e a llo w a n c e f o r a c t iv e w o r k e r s and d ep en d en t a d u lts but a l e s s l i b e r a l a llo w a n c e f o r d ep en d en t c h ild r e n u n d er a s p e c if ie d a g e . F in a n c in g 9 T h e e m p lo y e r p a id the fa ll c o s t o f the a c t iv e w o r k e r ’ s s u r g ic a l and m e d ic a l in s u r a n c e u n d er m o r e than th r e e out o f fiv e o f the p la n s w ith th e s e b e n e fit s (ta b le s 6 and 7 ). J o in tly fin a n c e d b e n e fit s w e r e p r o v id e d u n d e r the r e m a in in g p la n s . 10 9 Th e m e th o d o f fin a n c in g b e n e fit s f o r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts h as ch a n g e d in s o m e p la n s s in c e la te s u m m e r 1959. T h e s e r e v i s i o n s , o c c u r r i n g p r i m a r il y in the p la n s n e g o tia te d b y the s t e e l w o r k e r s 1 u n ion , w h ich ch a n g e d f r o m a c o n t r ib u t o r y to a n o n c o n tr ib u to r y b a s is , a r e not r e f l e c t e d in the data in c lu d e d in th is r e p o r t . 10 I f the w o r k e r c o n tr ib u te d to w a rd the c o s t o f a h e a lth and in s u r a n c e pro g r a m a s a w h o le (w ith the e m p lo y e r p a y in g the r e m a in in g c o s t ) , e a c h b e n e fit w a s c l a s s i f i e d a s jo in t ly fin a n c e d . 9 T a b le 6. M e th o d o f fin a n c in g s u r g ic a l b e n e fit s b y g r o u p s e lig ib le an d typ e o f b a r g a in in g unit, la te s u m m e r 1959 1 (W o r k e r s in th o u s a n d s) T y p e o f b a r g a in in g unit T o ta l G r o u p s c o v e r e d and m e th o d o f fin a n c in g 2 S in g le e m p lo y e r M u lt ie m p lo y e r P la n s W ork ers P la n s W ork ers P la n s W ork ers 293 3 183 110 4 , 8 3 7 .0 3, 000. 1 1, 8 3 6 .9 203 94 109 2, 7 7 0 .5 9 4 2 .6 1, 8 2 7 .9 90 89 1 2 , 0 6 6 .5 2, 0 5 7 .5 9 .0 282 4 127 5 123 32 4 ,7 5 9 . 1 2 , 391. 1 2 , 0 4 9 .4 318. 6 198 50 119 29 2 ,7 3 6 .8 437. 3 2, 0 2 1 .7 2 7 7 .8 84 77 4 3 2 , 0 2 2 .3 1, 9 5 3 .8 2 7 .7 40. 8 103 47 6 28 1 27 2 ,0 0 7 .2 1, 071. 8 2 0 4 .5 18. 0 7 1 2 .9 84 30 27 1 ,4 0 1 . 3 4 8 9 .9 1 9 8 .5 27 7 1 2 .9 19 17 1 1 - 60 5. 9 5 8 1 .9 6. 0 18. 0 - 100 38 6 28 1 ,9 9 7 .2 1, 0 0 4 .2 23 8. 6 18. C 7 3 6 .4 83 24 27 1, 398. 3 436. 6 232. 6 17 14 5 9 8 .9 5 6 7 .6 6. 0 18. 0 A c t iv e w o r k e r s A l l p la n s p r o v id in g b e n e f i t s __ E m p lo y e r o n ly ___________________ E m p lo y e r and w o r k e r D e p e n d e n ts o f a c t iv e w o r k e r s A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n ly ___________________ E m p lo y e r and w o r k e r ___________ W o r k e r o n ly ______________________ R e t ir e d w o r k e r s A l l p la n s p r o v id in g b e n e f i t s ________ E m p lo y e r o n ly ___________________ E m p lo y e r and r e t i r e d w o r k e r __ E m p lo y e r and a c t iv e w o r k e r ___ R e t ir e d w o r k e r o n l y _____________ - - 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 A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n ly ___________________ E m p lo y e r and r e t i r e d w o r k e r __ E m p lo y e r and a c t iv e w o r k e r ___ R e t ir e d w o r k e r o n l y _____________ 1 33 - 32 - 729. 1 1 1 1 7.3 1 See fo o t n o t e s 1 and 2 , ta b le 4 . 2 I f the w o r k e r c o n t r ib u t e d to w a r d the c o s t o f the h e a lth and in s u r a n c e p r o g r a m a s a w h o le (w ith the e m p lo y e r p a y in g the r e m a in in g c o s t ) , the b e n e fit w a s c l a s s i f ie d a s jo in t ly fin a n c e d . 3 In c lu d e s 1 p la n u n d e r w h ic h the b e n e fit f o r w o r k e r s w ith l e s s than 1 y e a r * s s e r v i c e w a s fin a n c e d s o l e l y b y the w o r k e r . 4 In c lu d e s 1 p la n u n d er w h ic h the b e n e fit f o r d e p e n d e n ts o f w o r k e r s w ith l e s s than 1 y e a r * s s e r v i c e w a s fin a n c e d s o l e l y b y the w o r k e r . 5 I n c lu d e s 1 p la n u n d er w h ic h the b e n e fit fo r d e p e n d e n ts o f w o r k e r s w ith l e s s than 1 y e a r * s s e r v i c e w a s fin a n c e d s o l e l y b y the w o r k e r ; and 1 p la n u n der w h ic h the b e n e fit f o r the f i r s t d e p en d en t w a s fin a n c e d s o l e l y b y the e m p lo y e r an d the b e n e fit f o r a ll o th e r d ep e n d e n ts w a s fin a n c e d b y the e m p lo y e r an d the w o r k e r . 6 In c lu d e s 1 p la n u n d er w h ic h the b e n e fit w a s fin a n c e d b y the e m p lo y e r and the l o c a l union.. D e p e n d e n ts 1 s u r g ic a l and m e d ic a l b e n e fit s w e r e fin a n c e d b y the e m p lo y e r in a b ou t 45 p e r c e n t o f the p la n s w ith d e p e n d e n ts 1 c o v e r a g e . A lm o s t a s m a n y p la n s p r o v id e d f o r jo in t fin a n c in g . W o r k e r s p a id the e n tir e c o s t o f b e n e fits u n d er the r e m a in in g p la n s ; u n d er th e s e p la n s , d e p e n d e n ts h ave the a d va n ta ge o f g ro u p i n s u r a n c e that m ig h t o t h e r w is e not h ave b e e n a v a ila b le to th e m . 11 B e n e fits f o r r e t ir e d w o r k e r s w e r e p a id f o r b y the e m p lo y e r u n der a b ou t 45 p e r c e n t o f the p la n s w ith s u r g ic a l and m e d ic a l b e n e fit s f o r th is g r o u p (ta b le s 11 It i s g e n e r a lly r e c o g n i z e d that g ro u p in s u r a n c e c o n t r a c t s h ave the lo w in g a d v a n ta g e s o v e r in d iv id u a l in s u r a n c e p o l i c i e s : L o w e r p r e m iu m s ; the a b s e n c e o f m e d ic a l, a g e , and o th e r r e s t r i c t i o n s on c o v e r a g e ; and the r a r it y o f c o n t r a c t c a n c e lla tio n s . fo l 10 6 and 7 ). R e t ir e d w o r k e r - f i n a n c e d s u r g i c a l and m e d ic a l b e n e fit s w e r e p r o v id e d b y abou t a fo u r th o f the p l a n s . 12 T h e r e m a in in g p la n s h ad jo in t ly fin a n c e d b e n e f it s . T a b le 7. M e th o d o f fin a n c in g m e d ic a l b e n e fit s b y g r o u p s e lig ib le an d typ e o f b a r g a in in g unit, la te s u m m e r 1959 1 (W o r k e r s in t h o u s a n d s ) T y p e o f b a r g a in in g unit T o ta l G r o u p s c o v e r e d and m e th o d o f fin a n c in g 2 S in g le <e m p lo y e r M u lt ie m p lo y e r P la n s P la n s W ork ers P la n s W ork ers 21 0 3 138 72 3 ,6 8 4 .2 2 ,4 0 2 .5 1 ,2 8 1 .7 142 70 72 1 ,9 5 9 .4 6 7 7 .7 1 ,2 8 1 .7 68 68 - 1 ,7 2 4 .8 1, 7 2 4 . 8 - 182 4 84 76 22 3 ,4 3 1 .4 1, 8 7 0 .2 1, 31 0. 6 2 5 0 .6 128 35 73 20 1, 8 6 4 .2 3 5 5 .2 1 ,2 9 1 9 217. 1 54 49 3 2 1, 5 6 7 .2 1, 5 1 5 .0 1 8 .7 33. 5 74 36 5 16 1 21 1, 6 7 5 .4 88 3. 6 1 3 0 .4 18. 0 6 4 3 .4 59 23 15 1 ,0 0 2 .4 23 4. 6 1 2 4 .4 15 13 1 1 - 67 3. 649. 6. 18. - 71 29 5 16 1 25 1, 57 9. 5 738. 7 166. 1 18. 0 6 5 6 .7 13 11 1 1 - 5 7 8 .4 5 5 4 .4 6. 0 18. 0 - W ork ers A c t iv e w o r k e r s A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n ly ___________________ E m p lo y e r and w o r k e r D e p e n d e n ts o f a c t iv e w o r k e r s A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n l y ____________________ E m p lo y e r an d w o r k e r ___________ W o r k e r o n ly ______________________ R e t ir e d w o r k e r s A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n ly E m p lo y e r and r e t i r e d w o r k e r __ E m p lo y e r and a c t iv e w o r k e r ___ R e t ir e d w o r k e r o n l y _____________ - - 21 6 4 3 .4 58 18 15 1, 00 1. 1 184. 3 160. 1 0 0 0 0 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 A l l p la n s p r o v id in g b e n e f i t s _______ E m p lo y e r o n l y ____________________ E m p lo y e r and r e t i r e d w o r k e r __ E m p lo y e r and a c t iv e w o r k e r ___ R e t ir e d w o r k e r o n l y _____________ 1 S ee fo o t n o t e s 1 2 See fo o tn o te 2 , 3 S ee fo o tn o te 3, 4 S ee fo o tn o te 4 , 5 S ee fo o tn o te 6, - 25 - 6 5 6 .7 and 2 , ta b le 4 . ta b le 6. ta b le 6. ta b le 6. ta b le 6. D e p e n d e n ts o f r e t ir e d w o r k e r s r e c e iv e d e m p lo y e r - f i n a n c e d s u r g ic a l and m e d ic a l b e n e fit s u n d er abou t tw o ou t o f fiv e p la n s , w h ile the r e t ir e d w o r k e r p aid the fu ll c o s t u n d er on e ou t o f th r e e p la n s . U n d er a ll e x c e p t one o f the r e m a in in g p la n s , the r e t ir e d w o r k e r p a id a p o r t io n o f the c o s t . A lm o s t a ll m u lt ie m p lo y e r p la n s p r o v id e d e m p lo y e r - f i n a n c e d b e n e fit s f o r a ll c o v e r e d g r o u p s ; in c o n t r a s t , the m a jo r it y o f s in g le - e m p lo y e r p r o g r a m s r e q u ir e d the w o r k e r s (a c tiv e and r e t i r e d ) to p ay a p a r t o r a ll o f the c o s t o f c o v e r a g e f o r t h e m s e lv e s and th e ir d e p e n d e n ts . 12 W h ere the r e t i r e d e m p lo y e e p a y s the e n tir e p r e m iu m , he s t ill h a s a d v a n ta g e s o f r e m a in in g u n d er g r o u p c o v e r a g e . U s u a lly he is a ls o g iv e n the a d va n ta g e o f a lo w ra te d e t e r m in e d b y the a v e r a g e c o s t o f p r o v id in g b e n e fit s f o r a c t iv e e m p lo y e e s and th e ir d e p e n d e n ts a s w e ll a s f o r r e t ir e d e m p lo y e e s and th e ir d e p e n d e n ts . S in ce the a c t iv e w o r k e r s , b e in g on the w h o le m u ch y o u n g e r , h a v e l o w e r u tiliz a tio n r a t e s than r e t ir e d w o r k e r s , the c o m b in e d ra te i s p a r t ic u la r ly a d v a n ta g e o u s to the la t t e r . the 11 S u r g ic a l and m e d ic a l b e n e fit s o f d e p e n d e n ts w e r e g e n e r a lly fin a n c e d in the sa m e m a n n e r a s th o s e f o r a c t iv e and r e t ir e d w o r k e r s (ta b le 8 ). H ow ever, r e t ir e d w o r k e r s 1 b e n e fits w e r e o fte n fin a n c e d d if fe r e n t ly than a c t iv e w o r k e r s 1 b e n e f it s . F o r e x a m p le , o v e r a fifth o f the p la n s that p r o v id e d e m p lo y e r - fi n a n c e d b e n e fit s to a c tiv e w o r k e r s r e q u ir e d the w o r k e r to p a y the fu ll c o s t o f h is b e n e fits a ft e r r e t ir e m e n t , and a b ou t a fo u r th o f the p la n s p r o v id in g jo in t ly fin a n c e d b e n e fits f o r a c t iv e w o r k e r s p r o v id e d e m p lo y e r - f i n a n c e d b e n e fit s a ft e r r e t ir e m e n t . X a b le 8. R e la tio n s h ip o f m e th o d o f fin a n cin g s u r g ic a l and m e d ic a l b e n e fit s fo r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , r e t ir e d w o r k e r s and th e ir d e p en d en ts, and a c t iv e and r e t ir e d w o r k e r s , la te s u m m e r 1959 1 (W o r k e r s in th o u s a n d s) G r o u p s c o v e r e d and m e th o d o f fin a n cin g 2 S u r g ic a l b e n e fit s P la n s W ork ers M e d ic a l b e n e fit s P la n s W ork ers A c t iv e w o r k e r s and t h e ir d e p e n d e n ts 3 A l l p la n s p r o v id in g b e n e fit s f o r a c t iv e w o r k e r s and th e ir d ep en d en ts _____ 277 4 , 699. 1 179 3, 3 7 7 .4 B e n e fit f o r a c t iv e w o r k e r fin a n c e d by B e n e fit fo r d e p en d en ts fin a n c e d : B y By By B e n e fit f o r a c t iv e w o r k e r fin a n c e d b y B e n e fit fo r d e p en d en ts fin a n c e d : B y By 167 122 19 26 110 104 6 2 ,8 6 2 .2 2, 331. 1 29 3. 0 238. 1 1, 8 3 6 .9 1 ,7 5 6 .4 80. 5 111 81 12 18 68 64 4 2 ,1 0 6 .1 1, 8 1 6 .2 114. 0 1 7 5 .9 1 ,2 7 1 .3 1, 1 9 6 .6 7 4 .7 A ll p la n s p ro v id in g b e n e fit s f o r r e t ir e d w o r k e r s and t h e ir d e p e n d e n t s ____ 100 1 ,9 9 7 .2 71 1 ,5 7 9 .5 B e n e fit f o r r e t ir e d w o r k e r fin a n c e d b y e m p l o y e r _____________________________ B e n e fit fo r d epen den ts fin a n ce d : B y e m p l o y e r ______________________________ B y r e t ir e d w o r k e r s and e m p lo y e r By r e tir e d w o rk e r B e n e fit f o r r e t ir e d w o r k e r fin a n c e d by r e t ir e d w o r k e r and e m p lo y e r B e n e fit fo r d e p en d en ts fin a n c e d : B y r e t i r e d w o r k e r and e m p l o y e r _______ B y r e t ir e d w o r k e r _______________________ B e n e fit fo r r e t ir e d w o r k e r fin a n c e d by a c t iv e w o r k e r and e m p l o y e r ______ B e n e fit f o r d e p en d en ts fin a n c e d : B y a c t iv e w o r k e r and e m p l o y e r ________ B e n e fit f o r r e t ir e d w o r k e r fin a n c e d by r e t ir e d w o r k e r ______________________ B e n e fit fo r d e p en d en ts fin a n c e d : B y r e t ir e d w o r k e r ________________________ 44 38 1 5 28 27 1 1 1 27 27 1, 061. 8 1, 0 0 4 .2 37. 0 20. 6 2 0 4 .5 20 1. 6 2 .9 18. 0 18. 0 71 2. 9 7 1 2 .9 34 29 1 4 15 15 789. 0 738. 7 37. 0 1 3 .3 129. 1 129. 1 1 1 21 21 18. 0 18. 0 6 4 3 .4 6 4 3 .4 1 ,9 6 7 .7 72 1, 6 3 8 .4 95 0. 0 845. 8 20 . 5 18. 0 6 5 .7 1, 0 1 7 .7 186. 5 184. 0 6 4 7 .2 39 27 2 1 9 33 7 14 12 8 4 5 .4 79 2. 1 7 .6 18. 0 2 7 .7 793. 0 5 4 .5 1 2 2 .8 6 1 5 .7 e m p lo y e r e m p lo y e r w o r k e r and e m p l o y e r ________________ w o r k e r _________________________________ w o r k e r and e m p l o y e r ________________ w o r k e r and e m p lo y e r ______ ______ w orker R e t ir e d w o r k e r s and t h e ir d e p e n d e n ts 3 - - A c t iv e w o r k e r s and r e t ir e d w o r k e r s 3 A ll p la n s p r o v id in g b e n e fit s fo r a c t iv e w o r k e r and r e t ir e d w o r k e r ________ B e n e fit f o r a c tiv e w o r k e r fin a n c e d b y e m p lo y e r ______________________________ B e n e fit fo r r e t ir e d w o r k e r 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 and e m p l o y e r ___ B y a c t iv e w o r k e r and e m p lo y e r _____ B y r e t i r e d w o r k e r ____________________ B e n e fit f o r a c tiv e w o r k e r fin a n c e d b y w o r k e r and e m p lo y e r __________ ___ B e n e fit fo r r e t ir e d w o r k e r 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 and e m p l o y e r ___ B y r e t i r e d w o r k e r ____________________ 100 49 32 4 1 12 51 12 24 15 1 See fo o t n o t e s 1 an d 2, ta b le 4. 2 See fo o tn o te 2, ta b le 6. 3 S ee fo o tn o te 1, ta b le 5. E li g i b i li t y R e q u ir e m e n t s A s in the c a s e o f o th e r h e a lth and in s u r a n c e b e n e fit s , the w o r k e r g e n e r a lly had to b e on the jo b f o r a s p e c if ie d tim e b e fo r e n e w ly h ir e d s u r g ic a l o r 12 m e d ic a l b e n e fits b e c a m e a v a ila b le to h im o r h is d e p e n d e n ts (ta b le 9). 13 A b o u t a fifth o f the p la n s c o m m e n c e d c o v e r a g e e ith e r im m e d ia t e ly on h ir in g o r w ith in a m on th a ft e r h ir in g , but a b o u t fo u r out o f fiv e p la n s p r o v id e d c o v e r a g e b y the end o f 4 m o n th s o f e m p lo y m e n t. P r e s u m a b ly f o r a c c o u n tin g r e a s o n s , s u r g ic a l o r m e d ic a l c o v e r a g e w a s d e f e r r e d b y a lm o s t 3 out o f 10 p la n s u n til the f i r s t o f the m on th fo llo w in g the c o m p le t io n o f the s p e c if ie d p e r i o d o f e m p lo y m e n t. V ir tu a lly a ll o f the p la n s w ith s u r g i c a l and m e d ic a l b e n e fit s m a d e th e s e b e n e fit s a v a ila b le w ith ou t r e g a r d to the w o r k e r 's o r d e p e n d e n t's a g e w h en c o v e r a g e b e g a n (ta b le 10). O n ly th r e e p la n s p r o v id e d n e w ly h ir e d o ld e r w o r k e r s l e s s l i b e r a l s u r g ic a l b e n e fit s than th o s e p r o v id e d y o u n g e r w o r k e r s b e c o m in g in s u r e d at the s a m e tim e . U n d er th e s e p la n s and on e o th e r , d e p e n d e n ts e n te rin g the p la n at an a d v a n ce d a g e w e r e a l s o p r o v id e d r e d u c e d b e n e fit s . R e d u c e d m e d ic a l b e n e f it s w e r e p r o v id e d w o r k e r s c o m m e n c in g c o v e r a g e at an a d v a n ce d a g e u n d e r s e v e n p la n s and d ep e n d e n ts u n d e r on e p la n . O n ly th r e e s u r g i c a l and fo u r m e d ic a l p la n s w ith h eld c o v e r a g e e n t ir e ly f r o m n e w ly h ir e d o ld e r w o r k e r s and d e p e n d e n ts e n t e r ing the p la n at an a d v a n c e d a g e . N one o f the p la n s lim it e d o r w ith h e ld c o v e r a g e b e c a u s e o f the s e x o f w o r k e r s o r d e p e n d e n ts. C on tin u a n ce o f C o v e r a g e D u rin g L a y o f f . — If the w o r k e r 's e m p lo y m e n t s to p p e d ow in g to la y o f f o r o th e r r e a s o n s , h is b e n e fit s te r m in a te d im m e d ia t e ly o r at the end o f the m on th in w h ich e m p lo y m e n t c e a s e d , u n le s s a g r e e m e n t had b e e n r e a c h e d on c o n tin u a n c e o f g r o u p c o v e r a g e b e y o n d that d a te. 14 L a i d - o f f w o r k e r s con tin u e d to b e c o v e r e d b y a b o u t h a lf o f the 293 p la n s p r o v id in g s u r g i c a l b e n e fit s and b y a b ou t the s a m e p r o p o r t i o n o f p la n s p r o v id in g m e d ic a l b e n e fit s . T h e p e r io d o f c o v e r a g e a ft e r la y o f f ra n g e d f r o m 14 d a y s to 2 y e a r s . A bout a th ird o f the p la n s p r o v id e d c o v e r a g e f o r 7 m o n th s o r m o r e . M o s t fr e q u e n tly , h o w e v e r , c o v e r a g e w a s co n tin u e d f o r 1 m on th fo llo w in g the m on th in w h ich the la y o f f o c c u r r e d . A fe w p la n s (5) m a in ta in e d b e n e fit s f o r an in d e fin ite p e r i o d at the w o r k e r s ' e x p e n s e . B e n e fits f o r l a i d - o f f w o r k e r s w e r e fin a n c e d b y the s a m e m e th o d a s f o r a c t iv e w o r k e r s in a b ou t th r e e out o f fiv e o f the p la n s co n tin u in g s u r g i c a l and m e d ic a l b e n e fit s fo llo w in g la y o ff. A l l e x c e p t a fe w o f the p la n s that e x te n d e d c o v e r a g e f o r l e s s than 6 m o n th s fo llo w in g d ate o f l a y o f f fin a n c e d the b e n e fit s f o r l a i d - o f f w o r k e r s b y the s a m e m e th o d u s e d to fin a n c e the b e n e fit s f o r a c t i v e l y e m p lo y e d w o r k e r s . H o w e v e r , m o s t o f the p la n s that p r o v id e d f o r the e x te n s io n o f b e n e fit s to l a i d - o f f w o r k e r s f o r 6 m o n th s o r m o r e r e q u ir e d the l a i d - o f f w o r k e r to a s s u m e the fu ll c o s t o f h is b e n e fit s im m e d ia t e ly u pon b e in g la id o f f o r at the f i r s t o f the fo llo w in g m on th . S u r g ic a l B e n e fits S u r g ic a l b e n e fit s in v ir t u a lly a ll o f the p la n s w e r e r e s t r i c t e d to o p e r a tio n s in c id e n t to n o n o c c u p a tio n a l d i s a b il i t ie s — o n ly th r e e p la n s c o v e r e d p r o c e d u r e s 13 E lig ib ilit y r e q u ir e m e n t s a s d is c u s s e d in th is s e c t io n r e f e r o n ly to the p e r io d o f e m p lo y m e n t r e q u ir e d o f the w o r k e r b e f o r e he is e lig ib le to p a r t ic ip a t e in the p la n . U n d er s o m e p la n s , in a d d itio n to s p e c if y in g an e m p lo y m e n t r e q u ir e m e n t, a p e r i o d o f u n ion m e m b e r s h ip w a s a ls o r e q u ir e d . T h is p e r i o d r a r e l y e x c e e d e d the e m p lo y m e n t r e q u ir e m e n t . T h e w a itin g r e q u ir e m e n t s f o r the n o n m a te r n ity m e d ic a l b e n e fit s and the m a te r n ity s u r g i c a l and m e d ic a l b e n e fit s a r e d is c u s s e d in the a p p lic a b le s e c t io n s o f th is r e p o r t . 14 W o r k e r s u s u a lly h a v e the r ig h t u n d e r B lu e S h ield p la n s and s o m e c o m m e r c i a l in s u r a n c e p o l i c i e s to c o n v e r t , at th e ir ow n e x p e n s e , to an in d iv id u a l p o l i c y w ith ou t p r o v in g in s u r a b ilit y . 13 T a b le 9 . E lig ib ility r e q u ir e m e n t s fo r s u r g ic a l and m e d ic a l b e n e f i t s ,1 la te su m m e r 19592 (W o r k e r s in th ou sa n d s) M e d ic a l b e n e fits S u r g ica l b e n e fits E ffe c t iv e date o f c o v e r a g e A ll p lan s stu d ied --- P la n s W ork ers P la n s W ork ers 300 4 ,9 3 3 .2 300 4 ,9 3 3 .2 3 298 4 ,8 9 7 .0 42 1 3 3 ,7 3 8 .2 42 34 21 60 3 7 2 6 .6 2 9 1 .9 1 2 7 .7 5 6 9 .5 7 8 .0 30 25 12 46 6 3 4 .3 2 6 1 .4 6 6 .8 3 7 5 .9 - 1 24 1 2 - 3 5 .0 5 4 7 .8 6 .3 4 0 .8 - 13 22 8 9 1 6 1 9 1 .1 3 4 4 .9 8 7 5 .2 8 9 .3 1 3 .3 9 3 .2 ----- A ll p lans p ro v id in g b e n e f i t s ___________ A fte r e m p lo y m e n t f o r ----U nder 1 m o n t h _______________________ 1 and u n der 2 m o n t h s _______________ 2 and un der 3 m on th s ___ _ _ 3 and un der 4 m on th s _ _ _ 4 and un der 5 m on th s _ _ 5 and un der 6 m o n t h s ______________ 6 and un der 7 m on th s _ _ 8 and u n der 9 m o n t h s ______________ 12 an d u n d « r 13 m o n t h s 13 m onths o r m o r e _ - ___ _ F ir s t day o f m onth fo llo w in g c o m p le tio n o f e m p lo y m e n t fo r ---U nder 1 m onth ____ ____ _ _ 1 and un der 2 m onths 2 and u n d er 3 m o n th s 3 and un der 4 m o n t h s ______________ 4 and u n der 5 m on th s 6 an d u n d e r 7 m o n t h s 12 and u n der 13 m o n t h s ____________ O ther . ... . 37 1 2 1 6 1 0 .2 6 .3 4 0 .8 1 .3 25 26 10 13 1 6 2 14 596. 1 3 8 5 .5 1 ,0 3 1 .7 124. 1 1 3 .3 9 3 .2 5 .9 1 9 4 .9 - - - - 13 1 6 2 .9 1 See fo o tn o te 1, ta b le 4 . 2 See fo o tn o te 1, ta b le 1. 3 In clu d es 5 p lan s w h ich p r o v id e d b e n e fits fo r d epen den ts o f a c tiv e w o r k e r s but not fo r a c tiv e w o r k e r s (s e e fo o tn o te 2, table 2 ). 4 In clu d es 3 p la n s w h ich p r o v id e d b e n e fits fo r d epen den ts o f a c t iv e w o r k e r s but not fo r a c t iv e w o r k e r s (s e e fo o tn o te 1, table 3). T a b le 10. E ffe c t o f ag e w hen c o v e r a g e c o m m e n c e s on a v a ila b ility o r le v e l o f s u r g ic a l and m e d ic a l b e n e fit fo r a c t iv e w o r k e r s and th e ir d ep en d en ts, la te su m m e r 1 9 591 (W o r k e r s in th ou san d s) S u r g ic a l b e n e fits P r o v is io n A ll p lan s p ro v id in g b e n e fits W ork ers _ __ A v a ila b ility o r le v e l o f b e n e fit not a ffe c te d b y a g e w hen c o v e r a g e c o m m e n c e s ______________ R e d u c e d b e n e fit p r o v id e d i f cov era ge com m en ces a fte r a g e ----60 _ 65 B e n e fit not a v a ila b le i f cov era ge com m en ces a fte r a g e ----55 _ _ _____ 65 ____ 70 M e d ic a l b e n e fits D ep en d en ts P la n s W ork ers P la n s 293 4 ,8 3 7 .0 282 287 4 ,7 8 0 .3 23 5 1 .3 - _ 1 1 1 1. 0 3 .1 1 .3 W ork ers W ork ers D ep end ents P la n s W ork ers 4 ,7 5 9 .1 210 3 ,6 8 4 .2 182 3 ,4 3 1 .4 275 4 ,6 9 4 .7 199 3 ,6 0 9 .6 177 3 ,4 1 1 .7 23 1 5 1 .3 7 .7 26 1 6 1 .6 2 .5 1 2 .5 1 1 1 1.0 3 .1 1 .3 1 3 - 1.0 9 .5 _ 4 1 7 .2 P la n s W o r k e r s _ 1 S ee fo o tn o te s 1 and 2, ta b le 4 . In clu d e s I p lan w h ich p r o v id e d w o r k e r s h ir e d a fte r ag e 60 and th e ir d epen den ts w h o w e r e o v e r a g e 60 w h en f i r s t in s u r e d a r e d u c e d b e n e fit d uring the f ir s t 36 m on th s o f c o v e r a g e . 14 r e s u lt in g f r o m o c c u p a tio n a l d is a b il i t ie s . 15 B e n e fits f o r the o b s t e t r i c a l p r o c e d u r e r e q u ir e d in n o r m a l d e li v e r y m a te r n ity c a s e s w e r e p r o v id e d b y a ll but 17 p la n s c o v e r i n g w o m e n w o r k e r s and 13 c o v e r in g d e p e n d e n t w iv e s , a s sh ow n in the f o l lo w in g ta b u la tion : W om en w o r k e r s D is a b ilit ie s c o v e r e d A ll p la n s p r o v id in g s u r g i c a l b e n e fits ---------------------------------N o n m a te r n ity and m a t e r n i t y ____________________ N o n m a te r n ity o n ly ___________ P la n s W ork ers (th o u s a n d s ) D ep en d en t w iv e s P la n s W ork ers (th o u s a n d s ) 293 4, 837. 0 282 4, 759. 1 276 17 4, 510. 6 326. 4 269 13 4, 544. 1 215. 0 A c t iv e W o r k e r s 1 and D e p e n d e n ts 1 N o n m a te r n ity B e n e f i t s . ---- C a sh s u r g ic a l b e n e fit s f o r n o n m a te r n ity d is a b il i t ie s w e r e p r o v id e d a c t iv e w o r k e r s and th e ir d e p e n d e n ts in 223 and 215 p la n s , r e s p e c t i v e l y (ta b le 11). 16 U su a lly , u n d e r th e s e p la n s , c o v e r e d p e r s o n s w e r e r e im b u r s e d f o r the c o s t o f o p e r a t io n s up to a m a x i m u m s c h e d u le d a llo w a n c e f o r e a c h p r o c e d u r e . T h e in d iv id u a l w a s r e s p o n s i b l e f o r the d if f e r e n c e , i f any, b e tw e e n the a m o u n t the s u r g e o n c h a r g e d and the a l lo w a n c e p r o v id e d in the s c h e d u le . H o w e v e r , s ix p la n s c o v e r in g w o r k e r s and fiv e p la n s c o v e r in g d e p e n d e n ts p r o v id e d the c a s h b e n e fit s on a c o - i n s u r a n c e b a s is . T h e s e p la n s p a id a p e r c e n t a g e (u s u a lly 75 to 80 p e r c e n t ) o f the in s u r e d ’ s " o u t - o f p o c k e t " s u r g ic a l, m e d ic a l, and h o s p it a l e x p e n s e s that e x c e e d e d a s p e c if ie d a m ou n t, c o m m o n ly r e f e r r e d to a s the " d e d u c t ib le . 1,17 15 T h e th r e e p la n s w h ich c o v e r e d s u r g ic a l p r o c e d u r e s in c id e n t to o c c u p a tio n a l d is a b il i t ie s p a id the d if f e r e n c e b e tw e e n the w o r k m e n 's c o m p e n s a t io n b e n e fit and the a m ou n t p r o v id e d b y the p la n . M o s t p la n s s p e c i f i c a l l y e x c lu d e d on e o r m o r e s u r g i c a l p r o c e d u r e s , su ch a s c o s m e t i c and d e n ta l s u r g e r y , and p r o c e d u r e s f o r the tr e a tm e n t o f s e l f in flic t e d i n ju r ie s . 16 P la n s w e r e c l a s s i f i e d s o le l y a c c o r d in g to typ e o f b e n e fit s ( c a s h o r s e r v i c e ) p r o v id e d , w ith ou t r e g a r d to the p a r t y (th e d o c t o r o r th e in s u r e d ) to w h o m p a y m e n t w a s m a d e , o r to th e typ e o f in s u r e r ( c o m m e r c i a l in s u r a n c e c a r r i e r s o r n o n p r o fit p r e p a y m e n t o r g a n iz a t io n s s u ch a s B lu e S h ie ld ). T h e d e fin itio n o f c a s h and s e r v i c e b e n e fit s u s e d f o r c l a s s if y i n g p la n s in c lu d e d in th is r e p o r t d i f f e r s f r o m the d e fin it io n u s e d in the 1955 s u r v e y ; h e n c e , n o c o m p a r is o n b e tw e e n the p r e v a le n c e o f c a s h o r s e r v i c e b e n e fit s in 1955 and 1959 sh ou ld b e m a d e . F o r the 1955 stu dy, p la n s p r o v id in g c a s h b e n e fit s to a ll c o v e r e d p e r s o n s , r e g a r d l e s s o f in c o m e , and p la n s that p r o v id e d c a s h b e n e fit s to w o r k e r s w h o s e ann u al in c o m e w a s o v e r a s p e c if ie d lim it w e r e c l a s s i f i e d as " c a s h " p la n s . F o r th is r e p o r t , i f c a s h b e n e fit s w e r e a p p lic a b le to in d iv id u a ls w ith annual in c o m e s e x c e e d in g a s p e c if ie d lim it and s e r v i c e b e n e fit s a p p lie d to w o r k e r s w ith in c o m e l e s s than th is a m ou n t, the p la n w a s c l a s s i f i e d a s a " s e r v i c e - w i t h - i n c o m e l im i t " p la n . 17 T h is ty p e o f b e n e fit is u s u a lly c a lle d a " c o m p r e h e n s i v e b e n e fit. " It d i f f e r s f r o m the " m a jo r m e d ic a l e x p e n s e b e n e f it " p r o v id e d on a c o - i n s u r a n c e b a s is to c o v e r e x p e n s e s n ot c o v e r e d b y the " b a s i c " h o s p ita l, s u r g ic a l, and m e d ic a l b e n e fit s , in that a ll o r v ir t u a lly a ll b e n e fit s a r e on a c o - i n s u r a n c e b a s i s . T h is r e p o r t in c lu d e s c o m p r e h e n s iv e b e n e fit s but n ot m a jo r m e d ic a l b e n e fit s . 15 T a b le 11. T y p e s o f s u r g ic a l b e n e fits and lo c a t io n o f s u r g ic a l c a r e o f n on m a tern ity d is a b ilit ie s b y g r o u p s e lig ib le , late su m m e r 1959 1 D ep en d en ts o f a c t iv e w orkers A c tiv e w orkers T y p e and lo c a t io n P la n s W ork ers D ep en d en ts o f r e t ir e d w orkers R e tir e d w orkers P la n s W ork ers P la n s W ork ers P la n s W ork ers A ll p lans p ro v id in g b e n e f i t s _______ 293 4,*837. 0 282 4 ,7 5 9 . 1 103 2, 0 0 7 .2 100 1, 9 9 7 .2 B e n e fit p r o v id e d in fo r m o f — C a sh ______________________________ S e r v ic e ___________________________ W ith in c o m e lim it s W ithout in c o m e lim it s 223 70 44 26 3, 4 4 4 .3 1, 3 9 2 .7 9 2 9 .5 4 6 3 .2 215 67 44 23 3 ,3 8 5 .3 1, 373. 8 9 2 9 .5 444. 3 71 32 23 9 1, 0 8 0 .7 9 2 6 .5 684. 9 241. 6 69 31 23 8 1, 0 7 2 .7 924. 5 684. 9 239. 6 B e n e fit p r o v id e d fo r o p e r a tio n s in— H o sp ita l, d o c t o r 's o f f i c e , and h o m e 2_______________________ H o sp ita l and d o c t o r 's o ff ic e 2 __ H o sp ita l o n ly ____________________ 272 14 7 4 ,0 0 1 .7 776. 8 58. 5 262 14 6 3 ,9 2 5 .8 776. 8 5 6 .5 87 12 4 1, 190. 8 7 6 7 .8 48. 6 85 12 3 1, 1 8 2 .8 7 6 7 .8 46 . 6 S ee fo o tn o te 1 and 2, ta b le 4. F o r th is ta b le " m e d i c a l " o r "h e a lth " c e n t e r was c o n s id e r e d " d o c t o r 's o f f ic e . ' T a b le 12. In c o m e lim it s o f s e r v i c e b e n e fit s u r g ic a l p lan s and s e r v ic e b e n e fit m e d ic a l p lan s 1 (W o r k e r s in th ou san d s) Surgical benefits Annual income lim its 2 Retired workers Plans Plans W orkers 1 ,3 9 2 .7 32 9 2 6 .5 3 70 1, 6 6 4 .3 4 6 3 .2 9 2 9 .5 9 23 2 4 1 .6 684. 9 30 s40 764. 5 8 9 9 . 8 1 .5 2 3 .4 - - ___ 70 Service plans without income lim its ________________ ___ Service plans with income lim it s __ 44 4 A ll service p la n s ______________ M edical benefits Active workers 26 W orkers Active w orkers Plans W orkers Retired w orkers Plans W orkers 35 1, 303. 9 3 15 6 3 7 .7 2 0 6 6 6 .2 Income lim its for— Individual F am ily of— 2 persons 3 or more persons $ 2 , 000 ___ $ 2 , 500 ____ $ 3 , 000 ____ $ 2 , 4 0 0 ____ $ 3 ,2 0 0 ____ $ 4 ,0 0 0 ____ $ 2 ,4 0 0 ___ $ 3 ,6 0 0 ____ $ 3 ,6 0 0 ____ $ 2 ,4 0 0 ___ $ 4 , 000 ____ $ 4 , 000 ____ $ 2 , 500 ___ $ 4 , 000 ____ $ 4 , 000 ____ $ 2 ,9 9 0 ___ $ 4 ,4 9 8 ____ $ 5 , 9 8 0 _____ $ 3 ,0 0 0 __ $ 4 ,0 0 0 ___ $ 5 , 0 0 0 _____ $ 3 , 000 $ 4 , 800 ___ $ 4 , 800 $ 3 , 000 ___ $ 5 , 000 ____ $ 5 , 000 ____ $ 3 , 000 ___ $ 5 , 500 ____ $ 5 , 500 ____ $ 3 ,7 5 0 ___ $ 5 , 000 ____ $ 5 , 000 ____ $ 4 , 0 0 0 ___ $ 6 , 0 0 0 ____ $ 6 , 0 0 0 $ 5 , 000 ___ $ 5 , 000 ____ $ 5 , 000 ____ $ 5 , 000 ___ $ 6 , 000 ____ $ 7 , 500 ____ $ 5 , 000 ___ $ 7 , 500 ____ $ 7 , 500 ____ $ 6 , 000 ___ $ 6 , 000 ____ $ 6 , 000 ____ $ 7 ,5 0 0 ___ $ 7 ,5 0 0 ____ $ 7, 5 0 0 7 . . . 1 1 1 6 8 1 3 1 2 1 1 4 1 6 6 4 1 8 6 .5 1 0 . 0 6 .6 139. 0 1 1 . 0 4 6. 0 3. 8 1 1 .4 2 . 6 1. 3 .8 1 . 0 27. 3 48. 0 4 .4 5 8 3 .8 2 6 1 4 - 1 6 1 1 0 1 5 1 3 - - 1 2 1 1.4 1 2 . 6 2 - 1 1. 3 14. 0 1 . 0 5 .8 4 6 .6 2 1 1 3 - 7 - 5 7 7 .3 1 4 1 6 4 1 8 .5 .0 6 .6 . 9 .0 46. 0 3. 8 1 1 .4 1. 3 2 6 . 8 1 . 0 2 7 .3 48. 0 4 .4 583. 8 1 - 1 1 1 2 1 1 - 2 1 2 1 1 3 - 7 1. 5 7. 3 - 1 1 .4 1. 3 14. 0 1 . 0 5. 8 46. 6 - 5 7 7 .3 1 See fo o tn o te s 1 and 2, ta b le 4 . 293 and 103 p lan s p r o v id e d s u r g ic a l b e n e fits f o r a c tiv e and r e t ir e d w o r k e r s , r e s p e c t iv e ly ; 210 and 74 p la n s p r o v id e d m e d ic a l b e n e fit s , f o r a c tiv e and r e t ir e d w o r k e r s , r e s p e c t iv e ly , 2 F o r w o r k e r s w ith fa m ily c o v e r a g e , the lim it s w e r e a p p lic a b le to the e n tir e fa m ily in c o m e . 3 In c lu d e s 1 p la n w h ich p r o v id e s s e r v i c e b e n e fits fo r h o s p ita l tre a tm e n ts and c a s h b e n e fits fo r h om e and o ff i c e t r e a tm e n t s . 4 In c lu d e s 34 p lan s w h ich a ls o p r o v id e th is type o f b e n e fit fo r m a te r n ity d is a b ilit ie s . 5 T h e se p lan s do not p r o v id e m e d ic a l b e n e fit s fo r m a te r n ity c a s e s . 6 In c o m e l im it s un der 5 o f th e se p la n s w e r e not a p p lic a b le to m a te r n ity d is a b ilit ie s ; under th ese 5 p la n s a ll w o m e n w o r k e r s and depen den t w iv e s , r e g a r d le s s o f in c o m e , r e c e iv e d a c a s h a llo w a n c e fo r d is a b ilit ie s r e s u ltin g fr o m p r e g n a n c y . 7 A p p lic a b le o n ly to w o r k e r 's in c o m e . 16 S e r v ic e b e n e fit s w e r e p r o v id e d w o r k e r s and d e p e n d e n ts b y 70 and 67 p la n s , r e s p e c t i v e l y . M o r e than a th ird o f th e s e p la n s p r o v id e d fu ll s e r v i c e b e n e fit s . 18 T h e r e m a in in g 44 s e r v i c e p la n s u t iliz e d B lu e S h ie ld and p r o v id e d s e r v i c e - w i t h i n c o m e - l i m i t b e n e f it s . T h e in c o m e lim it s s p e c if ie d in th e s e 44 p la n s f o r s in g le a c t iv e w o r k e r s and f o r th o s e w ith 3 o r m o r e p e r s o n s in th e ir f a m ily a r e s u m m a r i z e d b e lo w . 19 M o s t o f the 11 p la n s w h ich r e s t r i c t e d s e r v i c e b e n e fit s to f a m i l i e s w ith in c o m e s o f $ 4 , 000 o r l e s s c o v e r e d w o r k e r s in in d u s t r ie s w h e r e ann u al e a r n in g s w e r e r e la t iv e ly lo w (e . g. , w o m e n 's g a r m e n ts , t o b a c c o p r o d u c t s , t o y s , p a p e r p r o d u c t s , and b u ild in g s e r v i c e ) . H o w e v e r , s o m e o f the p la n s w ith lo w l im i t s c o v e r e d w o r k e r s in in d u s tr ie s w ith r e l a t iv e ly h igh ann u al e a r n in g s , s u ch a s p u b lic u t ilit ie s and the m a n u fa c tu r e o f in s tr u m e n ts and a u to m o tiv e p a r t s . A n n u a l in c o m e l i m i t 1 A ll s e r v i c e - w i t h - i n c o m e - l i m i t p la n s ----------------------------------------------U n d er $ 3 , 000 ______________________ $ 3 , 000 th rou g h $ 3 , 750 ___________ $ 4 , 000 ______________________________ $ 4 , 800 th rou g h $ 5 , 000 ___________ $ 5 , 500 th rou g h $ 6 , 000 ___________ $ 7 , 500 ______________________________ F a m ily S in g le (3 o r m o r e person s) in d iv id u a ls 44 12 8 4 11 1 8 44 0 1 10 8 7 18 1 E x c e p t f o r 8 p la n s w h ich c o n s id e r e d o n ly the w o r k e r 's in c o m e , the f a m ily lim it s a p p lie d to the in c o m e o f the e n tir e fa m ily , in c lu d in g the e a r n in g s o f d e p e n d e n ts. T h e s a m e ty p e o f and th e ir d e p e n d e n ts in a ll g r o u p s (ta b le 13). U n d er w o r k e r and c a s h b e n e fit s b e n e fit (c a s h o r s e r v i c e ) w a s fu r n is h e d b o th w o r k e r s but 2 o f 277 p r o g r a m s w ith s u r g i c a l b e n e fit s f o r b o th th e s e tw o p la n s , s e r v i c e b e n e fit s w e r e p r o v id e d the w e r e p r o v id e d h is d e p e n d e n ts. S u r g ic a l b e n e fit s w e r e a lw a y s a v a ila b le f o r p r o c e d u r e s p e r f o r m e d in the h o s p it a l and u s u a lly f o r th o s e in the d o c t o r 's o f f i c e o r at h o m e (ta b le 11). H ow e v e r , s o m e p la n s s p e c i f i c a l l y lim it e d b e n e fit s f o r c a r e o u ts id e o f the h o s p ita l to "m in o r" p ro ce d u re s. 18 U n d er s o m e o f th e s e r v i c e - w i t h o u t - i n c o m e - l i m i t p la n s , c e r t a in m in o r s u r g i c a l p r o c e d u r e s w e r e n ot c o v e r e d , e. g. , t o n s i l l e c t o m i e s ; in o t h e r s , a n o m in a l c h a r g e w a s m a d e in c o n n e c t io n w ith c e r t a in m in o r p r o c e d u r e s . A m o n g the o r g a n i z a tio n s that p r o v id e d s e r v i c e s u r g i c a l and m e d ic a l b e n e fit s r e g a r d l e s s o f in c o m e w e r e the H ealth I n s u r a n c e P la n o f G r e a t e r N ew Y o r k , the K a is e r F o u n d a tio n H ealth P la n , the U n ited M in e W o r k e r s W e lfa r e and R e t ir e m e n t Fund, G ro u p H ealth In s u r a n c e , In c. , and th e St. L o u is L a b o r H ealth In s titu te . F or a su m m ary d e s c r ip t io n o f s o m e o f th e s e p r o g r a m s , s e e the a p p e n d ix e s o f D ig e s t o f O ne H u n d red S e le c t e d H ealth and I n 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 , E a r ly 1958 (B L S B u ll. 1236, O c t o b e r 1958). w F o r m o r e d e t a ils , s e e ta b le 12. 17 T a b le 13. R e la t io n s h ip o f s u r g ic a l b e n e fit s p r o v id e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , r e t i r e d w o r k e r s a n d t h e ir d e p e n d e n ts , and a c t iv e and r e t i r e d w o r k e r s , la te s u m m e r 1959 1 (W o r k e r s in th o u s a n d s ) P r o v i s i o n s p e c if ie d fo r b o th — P rovision Type of benefit (cash or service) ___ No variation ______________________ V ariation _________________________ Benefit provided for: M ost expensive o p e ra tio n _______ No variation __________________ V ariation ______________________ A p p e n d e cto m y ____________________ No variation __________________ V ariation ______________________ T o n s ille c to m y ____________________ No variation __________________ V ariation ______________________ A ctive worker s and R etired w ork ers and their dependents their dependents Plans W ork e rs Plans 277 275 10 0 2 4 ,6 9 9 . 1 4 , 6 8 9 .1 1 0 . 0 277 253 24 277 253 24 2276 204 4 72 4, 6 9 9 .1 4, 000. 9 6 9 8 .2 4, 699. 1 4, 0 0 0 .9 6 9 8 .2 4 ,5 1 9 . 1 3, 197. 1 1, 322. 0 100 99 1 96 4 100 196 4 (3 ) (3 ) (3 ) A ctive and retired w orkers W ork ers Plans W ork ers 1 ,9 9 7 .2 1 ,9 9 5 .2 2 . 0 100 100 1 ,9 6 7 .7 1 ,9 6 7 .7 - 1 ,9 9 7 .2 1 , 9 8 6 .5 1 0 .7 1 ,9 9 7 .2 1 ,9 8 6 .5 1 0 .7 (3 ) (3 ) (3 ) 100 91 9 100 93 7 (3 ) (3) (3 ) 1 ,9 6 7 .7 1 ,9 1 8 .2 4 9 .5 1 ,9 6 7 .7 1, 9 3 1 .2 3 6 .5 (3 ) (3 ) (3 ) 1 See fo o t n o t e s 1 and 2, ta b le 4 . 29 3, 2 8 2 , 103, and 100 p la n s p r o v id e d s u r g ic a l b e n e fi t s f o r a c t iv 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 ir e d w o r k e r s , and d e p en d en ts o f r e tir e d w o r k e r s , r e s p e c t iv e ly . 2 E x c lu d e s 1 p la n w h ic h did not p r o v id e t o n s ille c t o m y b e n e fit s . 3 D ata on the t o n s i l l e c t o m y b e n e fit s f o r r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts w e r e not a n a ly z e d . 4 I n c lu d e s 49 p la n s w h ic h p r o v id e d l e s s l i b e r a l a llo w a n c e s f o r d ep en d en t c h ild r e n , u s u a lly th o s e u n d e r ag e 12, than f o r a c t iv e w o r k e r s and ad u lt d e p e n d e n ts . F o r th is stu dy, s u r g i c a l f e e s c h e d u le s , w h ich a r e u s u a lly s e t fo r t h in d e ta il in p la n s w ith c a s h b e n e fit s and in th o s e p r o v id in g s e r v i c e b e n e fit s w ith in c o m e lim it s , w e r e c l a s s i f i e d a c c o r d in g to the a llo w a n c e p r o v id e d f o r the m o s t e x p e n s iv e o p e r a t io n lis t e d , c o m m o n ly c a lle d the "m a x im u m s c h e d u le a llo w a n c e . " A llo w a n c e s s p e c if ie d f o r an a p p e n d e c to m y and a t o n s ille c t o m y , tw o o f the 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 a ls o ta b u la te d to in d ic a te the v a r ia t io n in s c h e d u le a llo w a n c e s fou n d a m o n g p la n s . 20 T h e a llo w a n c e p r o v id e d f o r the m o s t e x p e n s iv e o p e r a tio n ra n g e d f r o m $ 1 0 0 to $ 6 0 0 f o r w o r k e r s and f r o m $ 1 2 8 to $ 6 0 0 f o r d e p e n d e n ts (t a b le s 14 and 15). A b o u t tw o out o f f iv e p la n s s p e c if ie d a m a x im u m s c h e d u le a llo w a n c e o f $ 3 0 0 — the a m ou n t p r o v id e d b y the m e d ia n p la n . T h e m a x im u m a llo w a n c e a v e r a g e d $ 3 0 7 f o r w o r k e r s and $ 2 9 8 f o r d e p e n d e n ts. Th e a llo w a n c e s p r o v id e d f o r an a p p e n d e c to m y ra n g e d f r o m $ 6 6 . 50 to $ 2 0 2 . 50 f o r w o r k e r s and f r o m $ 5 8 . 65 to $ 2 0 0 f o r d e p e n d e n ts. H o w e v e r , the a m ou n t m o s t fr e q u e n t ly s p e c if ie d f o r e a ch g r o u p w a s $ 1 5 0 . The a v e ra g e a l lo w a n c e w a s $ 1 4 4 f o r w o r k e r s and $ 1 3 8 f o r d e p e n d e n ts . In the m a jo r i t y o f p la n s , the a m ou n t p r o v id e d f o r an a p p e n d e c to m y w a s o n e -h a lf the a llo w a n c e f o r the m o s t 20 T h e a llo w a n c e s d e s c r i b e d a r e the m a x im u m a m o u n ts p a y a b le u n d e r the c a s h p la n s and s e r v i c e - w i t h - i n c o m e lim it p la n s f o r e a ch p r o c e d u r e . T h e s e p la n s p a y o n ly w h at the d o c t o r c h a r g e s if l e s s than the m a x im u m a llo w e d b y the p la n . T h e a m o u n ts p a y a b le u n d er the p la n s p r o v id in g c a s h b e n e fit s on a c o - i n s u r a n c e b a s is w e r e n ot c o m p u ta b le and, t h e r e f o r e , w e r e e x c lu d e d f r o m th is s e c t io n . 18 T a b le 14. A p p e n d e c to m y a llo w a n c e by m a x im u m sch ed u le a llo w a n c e fo r a c t iv e w o r k e r s , late s u m m e r 1959 1 (W o r k e r s in thousands M aximum allowance for appendectomy Maxim um schedule allowance 2 Total $ Over $ 125 and under $150 $ 125 100 $ 150 Plans Workers Plans Workers Plans Workers Plans Workers Plans W orkers A ll plans providing cash allow an ces 3 __________________ _ $ 1 5 0 _______________________________ $ 2 0 0 _______________________________ $ 2 2 5 _______________________________ $ 2 4 0 _______________________________ $ 2 5 0 _______________________________ $ 2 7 5 _______________________________ $ 3 0 0 _______________________________ $ 3 5 0 _______________________________ $ 3 6 0 ___________________________________________________ $ 3 7 5 _ _______________________________________________ $ 4 0 0 _______________________________ $ 4 5 0 ___________________________________________________ $ 5 0 0 ___________________________________________________ $ 6 0 0 ___________________________________________________ Other 7 _________________________________________________ A verage maximum schedule allowance 8 _________ ________________________ A verage allowance for appe nde ctomy 8 _______________________________ 261 8 46 16 4 36 2 6 110 7 2 5 3 9 7 2 4 4 ,1 6 8 .0 458 4 34. 6 7 .7 2 9 7 .9 97. 3 2 0 . 1 7 9 7 .7 1 2 . 6 1 ,9 1 5 .2 78. 0 94. 6 2 0 . 8 47. 0 5 8 6 .2 4 0 .2 27. 3 65. 4 6 7 .7 285. 2 26. 4 8 43 3 8 - - 2 9. 3 - - $150 $200 $225 $240 $250 $275 $300 $350 $360 $375 $400 $450 $500 $600 O ther 1 3 27 789. 1 _ 7. 2 _ 1 1 . 1 664. 0 1 6 .6 6 7 .7 6 . 0 - - 9 - - 1 - - - - - - - - 5 _ 32. 5 _ 1 108 1 ,9 3 6 .6 _ 1 4 .5 70. 9 9. 0 18. 0 _ 1 ,69 9 . 8 1 .0 _ 1 1 .5 6 . 0 13. 0 - _ _ - - 2 _ 1 1 1 1 13 1 1 _ 6 86 _ 1 . 0 - - - - - - - - - - - - 1 - - 5 _ _ 1 - - - - 1 - - - - 2 4 6 .2 25. 3 - 1 1 . 2 1 _ 9 4 .6 _ 19.3 2 .4 8 . 1 1 0 . 0 - $307 $ 144 1 Over $ 150 and under $175 A ll p lan s p ro v id in g c a s h a l l o w a n c e s 3 ____________ s48 _ 13 664. 9 Over $ 175 and under $200 $ 175 11 103. 0 38. 9 $ 2 0 0 '15 16 8 .2 ______________________ ______________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ 7 _____________________ 31. 8 63. 1 8. 2 3. 3 1 2 3 .2 72. 0 16. 0 3. 8 2 7 .7 583. 8 6. 8 17. 3 18. 0 1 See fo o tn o te s 1 and 2, ta b le 4. 293 p lan s p r o v id e d s u r g ic a l b e n e fits f o r a c t iv e w o r k e r s . 2 R e f e r s to the s u r g ic a l fe e a llo w a n c e fo r the m o s t e x p e n s iv e o p e r a tio n o f a ll o p e r a tio n s lis t e d in the s u r g ic a l sc h e d u le . 3 In c lu d e s 44 s e r v i c e p la n s w ith in c o m e lim it s ; the a llo w a n c e s under th e se p la n s w e r e a p p lic a b le to w o r k e r s w ith in d iv id u a l o r fa m ily in c o m e o f m o r e than s p e c if ie d lim it s . E x clu d e s 6 p la n s w h ich p r o v id e d the c a s h b e n e fits on a c o -in s u r a n c e b a s is . 4 In c lu d e s 4 p lan s w h ich p r o v id e d an a llo w a n c e o f l e s s than $ 100. 5 In clu d e s 4 p la n s w h ich p r o v id e d an a llo w a n c e o f $ 1 2 0 . 6 In clu d e s 2 p la n s w h ich p r o v id e d a l e s s e r am oun t d u rin g the f ir s t y e a r o f c o v e r a g e . 7 In c lu d e s 4 p la n s w h ich p r o v id e d m a x im u m sc h ed u le a llo w a n c e s , r e s p e c t iv e ly , o f $ 1 0 0 , $ 1 7 5 , $ 2 1 3 , and $ 4 3 0 . 8 A m ou n t p r o v id e d by e a c h p lan w e ig h ted by n u m b er o f w o r k e r s c o v e r e d . 9 In clu d e s 1 p lan w h ich p r o v id e d an a llo w a n c e o f $ 2 0 2 . 50. 19 Table 15. Appendectomy allowance by maximum schedule allowance for dependents of active w orkers, late sum m er 1959 1 (W orkers in thousands) M a x im u m a llo w a n c e f o r a p p e n d e cto m y O v e r $ 125 and u n der $ 1 50 T o ta l M a x im u m sch e d u le a llo w a n c e 2 $ 125 $ 100 $1 5 0 P la n s W o rk e r s P la n s W o rk e r s P la n s W o rk e r s P la n s W o rk e r s P la n s W o r k e r s A ll p lan s p r o v id in g c a sh a llo w a n c e s 3 ____________________ 254 4 ,1 3 0 .2 4 63 513. 3 5 52 1,305.5 6 67. 5 99 1, 360. 3 $ 1 5 0 ______________________________ $2 00 ______________________________ $225 ______________________________ $ 2 40 ______________________________ $ 2 5 0 ______________________________ $275 $ 3 0 0 _______________________ _____ $ 3 50 ______________________________ $ 3 60 ______________________________ $ 3 75 ...................................................... $ 4 00 ______________________________ $ 4 50 $5 00 $ 6 00 ................................ ..................... O th er 7 __________ _______________ 12 44 17 5 38 2 6 98 7 2 4 2 9 7 2 5 89 .2 329.1 96.9 22.1 1,298.1 12.6 1,3 18.5 78.0 94 .6 17.0 45 .7 58 6.2 4 0 .2 27.3 74.7 12 43 3 2 1 - 89. 2 321. 9 26. 4 9 .3 17. 0 - 1 4 30 1 9 1 - 7.2 13.1 1,178.4 6.6 67.7 6.0 - 2 1 1 1 41. 5 6. 0 13. 0 1. 0 14 1 6 78 2 1 1 1 1 - 70. 5 9. 0 1, 1 4 6 .4 94. 6 1 9 .3 2 .4 8. 1 10. 0 - 2 - 49. 5 - 5 $ 1 5 0 _______________________________ $ 2 0 0 _______________________________ $ 225 ______________ ________________ $ 240 ............ ......................... ................... $ 2 50 _______________________________ $ 275 $3 0 0 _______________________________ $ 3 5 0 ............... ......................................... $ 3 6 0 _____________________ _________ $ 375 $ 4 0 0 ........................................ ............... $ 4 5 0 ____________________ _________ $ 5 0 0 ______________ _______ ________ $ 6 00 .......... ............ .............................. O t h e r 7 - ....................... — _ ________ 25.3 1.2 - 1 - 1 - 6. 0 $ 2 98 O ve r $ 15 0 and u n d er $175 A ll p la n s p r o v id in g c a sh a llo w a n c e s 3 _____________________ - -e# u> 00 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 8 _____________________ A v e r a g e a llo w a n c e f o r a p p e n d e cto m y 8 ________________ - 12 638. 9 11 3 37. 1 _ - _ _ 8 1 _ 583. 8 18. 0 O v e r $175 and un der $2 00 $1 75 1 6 o 3 103.0 8.2 72.0 $200 2 35. 1 9 _ _ 1 _ 31. 8 _ _ - - 1 - 3. 3 - 7 - 62. 9 - _ _ 1 1 2 6 .4 17. 3 106. 6 I O .U - - - - 1 - 6.8 - - - See footnotes 1 and 2, table 4. 282 plans provided surgical benefits for dependents of active w orkers. See footnote 2, table 14. 3 Includes 44 service plans with income lim its; the allowances under these plans were applicable to dependents with fam ily incomes which exceeded the specified lim its. Excluded 5 plans which provided the cash benefits on, a co-insurance b a sis. 4 Includes 5 plans which provided an allowance of le ss than $ 10 0 . 5 See footnote 5, table 14. 6 See footnote 6 , table 14. 7 Includes 5 plans which provided m aximum schedule allowances, respectively, of $ 1 2 8 , $ 1 3 3 , $ 17 5 , $ 2 6 0 , and $ 43 0 . 8 See footnote 8 , table 14. 1 2 20 T a b le 16. T o n s i l l e c t o m y a llo w a n c e f o r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) Dependents yf orkers Adults T on sillectom y allowance A ll plans providing cash allo w a n c es3 ___ Under $ 2 5 __________________________________ $ 2 5 ___________________________________________ $ 3 0 __________________________________________ $ 30. 01 and under $ 35 ________ __________ $ 35 ___________________________________________ $ 3 5 .0 1 and under $ 4 0 ____________________ $ 40 ___________________________________________ $ 4 0 .0 1 and under $ 4 5 ____________________ $ 4 5 ___________________________________________ $ 4 5 .0 1 and under $ 5 0 ____________________ $ 50 ___________________________________________ $ 5 0 . 01 and under $ 6 0 ____________________ $ 60 ___________________________________________ $ 6 0 . 01 and under $ 7 0 -----------------------------$ 7 0 and under $ 8 0 _________________________ $ 80 and over _______________________________ A verage ton sillectom y allowance 5 ____ Children 2 Plans Workers Plans Workers Plans Workers 261 4, 168. 0 254 4, 130. 2 254 4 ,1 3 0 .2 1 1.2 7 38 61. 6 284. 2 46. 0 53. 3 397. 1 4 4 .4 71. 7 985. 1 15. 8 945. 4 141. 0 252. 6 665. 5 1 9 4 .9 8. 2 2 6 22 6 6 4 48 1 60 12 21 16 13 2 $50 1 4 10 38 4 26 6 5 441 1 60 11 18 16 13 1 $49 86.0 4 86.0 58. 6 3 2 0 .9 36. 8 911. 7 4 4 .4 45. 7 421. 1 15. 8 964. 5 116. 0 2 4 3 .9 665. 5 1 9 4 .9 4. 4 11 59. 8 643. 4 57 - - 10 175. 6 976. 3 65. 6 49. 7 436. 8 700. 5 8 7 .4 7 3 .4 622. 2 153. 5 - 30 8 6 444 - 47 12 6 13 6 $45 ______ 1___________ _________ 1_______ 1 S e e fo o t n o t e s 1 and 2, ta b le 4. 293 and 282 p la n s p r o v id e d s u r g ic a l b e n e fit s f o r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , r e s p e c t i v e l y . 2 T h e data r e f l e c t s lo w e r a llo w a n c e s p r o v id e d b y 49 p la n s f o r you n g c h ild r e n , u s u a lly th o s e ag e 12 o r u n d e r. 3 In c lu d e s 44 s e r v i c e p lan s w ith in c o m e l im it s ; the a llo w a n c e s u n d er t h e s e p la n s w e r e a p p lic a b le to a c t iv e w o r k e r s and t h e ir d ep en d en ts w ith in d iv id u a l o r fa ifrily in c o m e s o f m o r e than s p e c if i e d l i m i t s . E x c lu d e s 6 p la n s c o v e r in g a c t iv e w o r k e r s and 5 p la n s c o v e r in g d e p e n d en ts w h ic h p r o v id e d the c a s h b e n e fit s on a c o - i n s u r a n c e b a s is . 4 S e e fo o tn o te 6, ta b le 14. 5 S e e fo o tn o te 8, ta b le 14. e x p e n s iv e o p e r a tio n . H o w e v e r , p la n s w ith h ig h m a x im u m s c h e d u le a llo w a n c e s ( o v e r $ 3 5 0 ) had a p p e n d e c to m y a llo w a n c e s that ra n g e d f r o m 25 p e r c e n t to 47 p e r ce n t, bu t m o s t fr e q u e n t ly 35 p e r c e n t , o f the m a x im u m s c h e d u le a llo w a n c e . C o n v e r s e l y , u n d er p la n s w ith a lo w m a x im u m s c h e d u le a llo w a n c e (u n d e r $ 2 0 0 ) the a p p e n d e c to m y a llo w a n c e w a s at le a s t t w o - t h ir d s o f the a llo w a n c e f o r the m o s t e x p e n s iv e o p e r a tio n . T o n s il l e c t o m y a llo w a n c e s f o r w o r k e r s r a n g e d f r o m $ 1 6 . 50 to $ 9 3 . 75; f o r a d u lt d e p e n d e n ts , f r o m $ 2 0 . 40 to $ 9 1 ; and f o r c h ild d e p e n d e n ts, f r o m $ 2 0 . 40 to $ 7 8 . T h e m e d ia n p la n p r o v id e d $ 4 5 f o r w o r k e r s and d e p e n d e n ts (ta b le 16). A ll e x c e p t 10 o f the 44 p la n s p r o v id in g s e r v i c e b e n e fit s w ith in c o m e lim it s had t o n s i l l e c t o m y a llo w a n c e s w ith in the ra n g e o f $ 5 0 to $ 6 7 . 50. In 49 p la n s , c h ild r e n u n d er a sta ted a g e (e . g. , 12 y e a r s ) w e r e p r o v id e d s m a lle r a llo w a n c e s than o th e r d e p e n d e n ts . W ith fe w e x c e p t io n s , th e s e p la n s p r o v id e d a d u lt d e p e n d e n ts $ 5 0 o r m o r e and d e p e n d e n t c h ild r e n l e s s than $ 5 0 . T h e a v e r a g e a llo w a n c e f o r w o r k e r s w a s $ 5 0 ; f o r a d u lt d e p e n d e n ts , $ 4 9 ; and f o r c h ild d e p e n d e n ts (1 2 y e a r s o r u n d e r in m o s t p la n s ), $ 4 5 . T h e a llo w a n c e s p a id b y s e r v i c e p la n s w ith in c o m e lim it w e r e h ig h e r , on the a v e r a g e , than th o s e p a id b y the c a s h b e n e fit p la n s . F o r e x a m p le , the a v e r a g e a p p e n d e c to m y a llo w a n c e p r o v id e d b y the s e r v i c e p la n s w a s 5 p e r c e n t m o r e f o r w o r k e r s and 10 p e r c e n t m o r e f o r d e p e n d e n ts than the a v e r a g e p a id b y the c a s h b e n e fit p la n s . T h e d if f e r e n c e s b e tw e e n the a llo w a n c e s f o r the m o r e c o m p lic a t e d p r o c e d u r e s w e r e s u b s ta n tia lly g r e a t e r . F o r e x a m p le , the m a x im u m a llo w a n c e p r o v id e d b y the s e r v i c e p la n s a v e r a g e d a b ou t 50 p e r c e n t m o r e than that p r o v id e d b y the c a s h b e n e fit p la n s . 21 I d e n tic a l a llo w a n c e s f o r a ll s u r g ic a l p r o c e d u r e s w e r e p r o v id e d w o r k e r s a n d a d u lt d e p e n d e n ts in 226 o f the 248 p r o g r a m s w ith c a s h a llo w a n c e s f o r b o th grou ps. W h e re a l o w e r b e n e fit w a s m a d e a v a ila b le f o r the a d u lt d e p e n d e n t, it w a s u s u a lly at le a s t 60 p e r c e n t o f the a m ou n t p r o v id e d the w o r k e r . T h e m a x im u m s c h e d u le a llo w a n c e p r o v id e d b o th w o r k e r s and d e p e n d e n ts i n c r e a s e d b y a bou t 17 p e r c e n t , on the a v e r a g e , s in c e la te 1955. The a p p en d ec to m y a llo w a n c e s r o s e b y 13 p e r c e n t on the a v e r a g e , and t o n s il le c t o m y a llo w a n c e s f o r w o r k e r s and a d u lt d e p e n d e n ts b y a p p r o x im a t e ly 17 p e r c e n t . A s lig h tly l a r g e r i n c r e a s e o c c u r r e d in the t o n s il le c t o m y a llo w a n c e p r o v id e d d e p e n d e n t c h ild r e n . 21 R e d u c tio n o f B e n e fit s D u rin g A c t iv e E m p lo y m e n t . — S u r g ic a l b e n e fit s p r o v id e d w o r k e r s and d e p e n d e n ts w e r e m o d ifie d b y o n ly fo u r s m a ll p la n s d u r in g a w o r k e r ‘ s a c t iv e e m p lo y m e n t (ta b le 17). T w o p la n s r e d u c e d b e n e fit s w h en the in s u r e d in d iv id u a l (w o r k e r o r s p o u s e ) r e a c h e d a g e 60. U n d e r one o f th e s e p la n s , T a b le 17. M a in te n a n ce o f s u r g ic a l and m e d ic a l b e n e fits d u rin g a c t iv e e m p lo y m e n t f o r a c t iv e w o r k e r s and th e ir d e p e n d e n ts , la te s u m m e r 1959 1 (W o r k e r s in th ousand s) S u r g ic a l b e n e fits P r o v is io n W ork ers W ork ers D ep en d en ts W ork ers P la n s W ork ers P la n s W ork ers P la n s W ork ers 293 4 ,8 3 7 .0 282 4 ,7 5 9 . 1 210 3, 684. 2 182 3 ,4 3 1 .4 289 4, 826. 3 278 4, 748. 4 203 3, 662. 0 180 3 ,4 2 5 . 8 2 6. 3 2 6. 3 - - - - 5 1 16. 6 2. 5 _ 1 2. 5 1 1 3. 1 1. 3 1 1 3. 1 1. 3 1 3. 1 ~ 1 3. 1 M ain tain ed at co n sta n t le v e l r e g a r d le s s o f a g e _____________________ R e d u c e d at ag e — 6 0 --------------------------------------------------------6 5 --------------------------------------------------------D is c o n tin u e d at a g e — 65 _____________________________________ 7 0 ______________________________________ 1 and 2, D ep en d en ts P la n s A l l p lan s p r o v id in g b e n e f i t s ___________ 1 S ee fo o tn o te s M e d ic a l b e n e fits - - _ - table 4. in d iv id u a ls o v e r a g e 60 c o u ld r e c e i v e o n ly h a lf o f the b e n e fit s a v a ila b le to th e m p r i o r to that a g e . U n d e r the o th e r p la n , the m a x im u m a m o u n t p a y a b le w a s r e d u c e d f r o m $ 2 0 0 p e r d is a b ilit y b e f o r e a g e 60 to $ 2 00 p e r y e a r f o r in d iv id u a ls o v e r 60. S u r g ic a l b e n e fit s w e r e d is c o n tin u e d b y on e p la n at a g e 65, and b y a n o th e r at a ge 7 0. 21 T h e s e i n c r e a s e s c o m p a r e w ith a 6 - p e r c e n t i n c r e a s e f r o m D e c e m b e r to S e p te m b e r 1959 in the B u r e a u o f L a b o r S t a t is t ic s in d e x o f su rg e o n s * f e e s f o r an a p p e n d e c to m y and w ith a 1 2 - p e r c e n t i n c r e a s e f o r a t o n s ille c t o m y (s e e B L S C o n s u m e r P r i c e In d e x : P r i c e In d e x e s f o r S e le c t e d Ite m s and G r o u p s , S e p te m b e r 1959 and F e b r u a r y I9 6 0 i s s u e s ) . 1955 22 R e t ir e d W o r k e r s and T h e ir D e p e n d e n ts . 22— I d e n tic a l s u r g i c a l b e n e fit s w e r e p r o v id e d a c t iv e and r e t ir e d w o r k e r s b y 70 o f the 100 p la n s w ith b e n e fit s f o r b oth g r o u p s (ta b le 5 ). A b o u t the sa m e n u m b e r o f p la n s (7 2 ) p r o v id e d d e p e n d e n ts o f r e t ir e d w o r k e r s w ith b e n e fit s id e n t ic a l to th o s e a v a ila b le to a c t iv e w o r k e r s * d e p e n d e n ts . T h e r e m a in in g p la n s r e d u c e d b e n e fit s b y e ith e r o f tw o m eth od s. One m e th o d , the on e m o s t fr e q u e n tly u s e d , lim it e d the a m o u n t o f b e n e fit s p r o v id e d d u r in g the e n t ir e r e t ir e m e n t p e r i o d . F o r e x a m p le , a ft e r r e t ir e m e n t , the m a x im u m s c h e d u le a llo w a n c e u n d er s o m e p la n s b e c a m e the lif e t im e l im i t on the a m ou n t the r e t i r e e o r h is s p o u s e c o u ld r e c e i v e ; th u s, on e e x p e n s iv e o p e r a t io n m ig h t ex h a u st s u r g i c a l c o v e r a g e f o r a p e r s o n . O th e r p la n s s p e c if ie d a m a x im u m a m ou n t a p p lic a b le to a ll s u r g i c a l, h o s p it a l, and w h e r e p r o v id e d , m e d ic a l e x p e n s e s . S o m e p la n s a p p lie d th e s e r e s t r i c t i o n s to the b e n e fit s a v a ila b le to a r e t ir e d w o r k e r * s e n tir e f a m ily r a th e r than to e a c h in d iv id u a l. The s e c o n d m e th o d w a s to r e d u c e b e n e fit l e v e l s d i r e c t l y , i . e . , the s c h e d u le o f a l lo w a n c e s w a s lo w e r than that p r o v id e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts . R e t ir e d w o r k e r s and t h e ir d e p e n d e n ts co n tin u e d to b e c o v e r e d b y the s a m e typ e o f b e n e fit s — c a s h o r s e r v i c e — that w a s a v a ila b le to th e m d u rin g a c t iv e e m p lo y m e n t (ta b le 13). A lm o s t a th ir d o f the s e r v i c e - w i t h o u t - i n c o m e - l i m i t p la n s a n d o v e r h a lf o f the 4 4 s e r v i c e - w i t h - i n c o m e - l i m i t p la n s that c o v e r e d a c t iv e w o r k e r s and t h e ir d e p e n d e n ts e x te n d e d th e s e ty p e s o f b e n e fit s to 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 (ta b le 11). A s sh ow n b e lo w , in c o m e l im i t s in the 2 3 s e r v i c e w i t h - i n c o m e - l i m i t p la n s c o v e r in g r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts w e r e , w ith o n ly one e x c e p t io n , $ 4 ,0 0 0 o r h ig h e r f o r a p e n s io n e r and h is s p o u s e — p r o b a b ly h ig h en ou g h to p r o v id e m o s t r e t ir e d w o r k e r s and th e ir s p o u s e s w ith s e r v i c e b e n e f it s (ta b le 12). A n n u a l in c o m e lim it A ll s e r v i c e - w i t h - i n c o m e l im i t p la n s _________________________ U n d e r $ 3, 000 _______________________ $ 3, 000 th ro u g h $ 3 ,7 5 0 ____________ $ 4 , 0 0 0 _______________________________ $ 4 ,8 0 0 th ro u g h $ 5 ,0 0 0 ____________ $ 5 ,5 0 0 th ro u g h $ 6 ,0 0 0 ____________ $ 7 , 5 0 0 _______________________________ S in g le F a m ily in d iv id u a ls (2 p e r s o n s ) 23 5 4 2 5 - 7 23 1 - 4 4 4 10 m o s t e x p e n s iv e m a x im u m s c h e d u le a llo w a n c e ) r a n g e d f r o m $ 1 5 0 to $ 5 0 0 in the 90 p la n s that p r o v id e d c a s h a llo w a n c e s f o r r e t ir e d w o r k e r s and the 88 p la n s c o v e r i n g t h e ir d e p e n d e n ts (ta b le s 18 and 19). 23 T h e m a x im u m a llo w a n c e a v e r a g e d a b o u t $ 3 2 5 f o r e a c h g r o u p . 24 T h e a p p e n d e c to m y a llo w a n c e p r o v id e d r e t ir e d w o r k e r s v a r ie d f r o m $ 7 5 to $ 2 0 0 and f r o m $ 7 5 to $ 1 7 5 f o r t h e ir d e p e n d e n ts — a v e r a g in g $ 1 3 8 f o r ea ch group. 22 S ee fo o tn o te 7. 23 T h e a llo w a n c e s d e s c r i b e d h e r e a r e the a m o u n ts p a y a b le u n d er the c a s h p la n s a n d the s e r v i c e - w i t h - i n c o m e - l i m i t p la n s . T h e a m o u n ts p a y a b le b y the fo u r p la n s p r o v id in g c a s h b e n e fits on a c o - i n s u r a n c e b a s is w e r e n ot co m p u ta b le and, t h e r e fo r e , w e r e e x c lu d e d . 24 T h e 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 f o r r e t ir e d w o r k e r s w e r e g r e a t e r than f o r a c t iv e w o r k e r s b e c a u s e b e n e fit s w e r e e x te n d e d to r e t ir e d w o r k e r s b y a h ig h e r p r o p o r t io n o f the h ig h b e n e fit p la n s than o f the lo w b e n e fit p la n s . 23 T a b le 18. A p p e n d e c to m y a llo w a n c e b y m a x im u m sch e d u le a llo w a n c e f o r r e t ir e d w o r k e r s , late su m m e r 1959 1 (W o r k e r s in th ou san d s) M a x im u m a llo w a n c e f o r a p p e n d e cto m y T ota l M ax im u m sch e d u le a llo w a n ce 2 $1 00 P la n s W ork ers A ll p la n s p r o v id in g c a s h a llo w a n c e s 3 ------------------------------------------------------ 90 1, 635. 9 $1 5 0 $ 1 80 $200 $2 25 $240 $ 2 50 $27 5 $5 00 $5 50 $ 3 75 $400 $450 $500 1 1 13 7 1 19 1 34 2 2 1 7 1 35. 10. 87. 48. 3. 617. 6. 213. 10. 3. 19. 577. 5. _____________________________________________ __________________________ ________ __________ _____________________________________________ _____________________________________________ _____________________________________________ ........ ........... ......... . _ __ .... . ........ .. ................ . _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ A v e r a g e m a x im u m sch e d u le ^ lln ^ a n rp ^ . .... ... .... __ A v e r a g e a llo w a n c e fo r a p p e n d e cto m y 6 ______________________________ 0 0 1 5 0 8 0 1 0 0 3 3 8 P la n s $1 25 W ork ers 4 17 P la n s 141. 0 35. 10. 84. 10. 1 1 12 2 1 W ork ers 5 23 626. 8 1 18 3. 0 606. 3 2 1 5. 7 6. 0 1 5 .8 0 0 1 4 1. 5 $3 25 $1 38 ______ 1____________ M a x im u m a llo w a n c e f o r a p p en d ectom y ---- C ontinued O v er $125 and un der $1 50 A ll p la n s p ro v id in g c a s h a llo w a n c e s 3 _________________________________ $150 $ 1 80 $200 $2 2 5 $2 4 0 $250 $275 $3 0 0 $3 5 0 $3 7 5 $4 0 0 $450 _____________________________________________ ______________ _____________________________ _ __ _ _ _ _ _ _____________________________________________ _____________________________ ______________ __________________________________________ ___________________________________________ __________________________________________ ___________________________________________ _____________________________________________ _____________________________________________ _____________________ ______________________ 3 18. 5 _ - _ _ - _ 1 1 - 1 - O v er $ 1 5 0 $1 50 - _ 11. 5 6. 0 - 1. 0 - - 37 265. 3 10 _ 1 5 _ - _ 3. 0 38. 1 _ _ _ - _ - - - - - 30 1 - 204. 9 19. 3 - - 71 81 81 _ 97 584. 3 _ _ 1. 0 4. 0 2. 0 - 577. 3 1 S ee fo o tn o te s 1 and 2, ta b le 4. 103 p la n s p r o v id e d s u r g ic a l b e n e fits f o r r e t ir e d w o r k e r s . 2 S ee fo o tn o te 2, ta b le 14. 3 In clu d e s 23 s e r v i c e p la n s w ith in c o m e lim it s ; the a llo w a n c e s u n der th e se p la n s w e r e a p p lic a b le to r e t ir e d w o r k e r s w ith in d iv id u a l o r fa m ily in c o m e o f m o r e than s p e c ifie d lim it s . E x clu d e s 4 p la n s w h ich p r o v id e d the c a s h b e n e fits on a c o -in s u r a n c e b a s is . 4 I n c lu d e s 3 p la n s w h ich p r o v id e d an a llo w a n c e o f un der $1 00. 5 In clu d e s 1 p la n w h ich p r o v id e d an a llo w a n c e o f $1 20. 6 S ee fo o tn o te 8, table 14. 7 P la n p r o v id e d an a llo w a n c e o f $2 00. 8 P la n p r o v id e d an a llo w a n c e o f $1 7 5 . 9 P la n s p r o v id e d an a llo w a n c e o f $ 1 5 7 . 50. 24 T a b le 19. A p p e n d e c to m y a llo w a n c e b y m a x im u m sc h e d u le a llo w a n c e fo r d ep en d en ts o f r e t ir e d w o r k e r s , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) 1 S ee fo o tn o te s 1 and 2 , ta b le 4. 100 p la n s p r o v id e d s u r g ic a l b e n e fit s fo r d ep en d en ts o f r e t ir e d w o r k e r t. 2 S ee fo o tn o te 2 , ta b le 14. 3 In clu d e s 23 s e r v i c e p la n s w ith in c o m e lim it s ; the a llo w a n c e s u n der th e se plans^ w e r e a p p lic a b le to r e t ir e d w o r k e r s ' d e p en d en ts w ith fa m ily in c o m e o f m o r e than s p e c ifie d lim it s . E x c lu d e s 4 p lan s w h ich p r o v id e d the c a s h b e n e fit s on a c o -in s u r a n c e b a s is . 4 S ee fo o tn o te 4, ta b le 18. 5 S ee fo o tn o te 5, ta b le 18. 6 S ee fo o tn o te 8, ta b le 14. 7 See fo o tn o te 8, ta b le 18. 8 S e e fo o tn o te 9» ta b le 18. 25 V ir t u a lly a ll o f the p la n s p r o v id e d s u r g ic a l b e n e fit s f o r the e n tir e r e t ir e m e n t p e r io d . O f the s ix p la n s c o v e r in g r e t ir e d w o r k e r s and fiv e c o v e r in g t h e ir d e p e n d e n ts that d id n ot p r o v id e b e n e fit s d u r in g the e n tir e r e t ir e m e n t p e r io d , fo u r o f th e m p r o v id e d b e n e fit s o n ly d u rin g the f i r s t y e a r . M e d ic a l B e n e fits S o m e m e d ic a l b e n e fit s — u s u a lly o n ly d o c to r s * v i s it s in the h o s p it a l— w e r e p r o v id e d b y 7 out o f 10 o f the 300 p la n s a n a ly z e d . W ith on e e x c e p t io n , e v e r y p la n r e s t r i c t e d m e d ic a l b e n e fit c o v e r a g e to n o n o c c u p a tio n a l d is a b i l i t i e s . 25 O n ly 35 p la n s p r o v id e d m e d ic a l b e n e fit s f o r m a te r n ity a s w e ll a s n o n m a te r n ity c a s e s . 2° W ork ers D is a b ilit ie s c o v e r e d A ll p la n s p r o v id in g m e d ic a l b e n e fits ________________________ N o n m a te r n ity and m a t e r n i t y __ N o n m a te r n ity o n l y ______________ P la n s 210 35 175 W ork ers (th o u sa n d s) 3, 6 8 4 .2 635. 0 3 ,0 4 9 . 2 D e p e n d e n ts P la n s 182 35 147 W ork ers (th o u sa n d s) 3 ,4 3 1 . 4 732. 5 2, 6 9 8 .9 A c t i v e W o r k e r s * and D e p e n d e n ts 1 N o n m a te r n ity B e n e f i t s . — C o v e r a g e f o r p h y s ic ia n s * c a r e d u r in g h o s p it a l c o n fin e m e n t w a s p r o v id e d b y a lm o s t a ll p la n s (ta b le 2 0 ). D o c to r s * s e r v i c e s u s e d b y w o r k e r s o u ts id e o f the h o s p it a l, e it h e r at the d o c t o r 's o f f i c e , a t the h e a lth c e n t e r , o r at h o m e , w e r e c o v e r e d b y s lig h tly l e s s than h a lf o f the p la n s (1 0 0 ). O n ly 1 out o f 4 p la n s (4 6 ) p r o v id e d o u t - o f h o s p it a l m e d ic a l b e n e fit s f o r d e p e n d e n ts . C a s h m e d ic a l b e n e fit s w e r e p r o v id e d w o r k e r s u n d e r 140 p la n s and th e ir d e p e n d e n ts u n der 115 p la n s (ta b le 2 0 ). 27 U s u a lly the plan s p e c if ie d the m a x im u m a m ou n t p a y a b le p e r v i s it f o r m e d ic a l c a r e b y a g e n e r a l p r a c t it io n e r o r s p e c ia lis t ( e . g . , up to $ 5 ) , and the m a x im u m a llo w a n c e p e r d is a b ilit y (e . g. , up to $ 3 0 0 ). 28 H o w e v e r , a s in the c a s e o f s u r g i c a l b e n e f it s , s ix p la n s c o v e r in g w o r k e r s and fiv e p la n s c o v e r i n g th e ir d e p e n d e n ts p r o v id e d the c a s h m e d ic a l b e n e fits on a co -in s u r a n c e b a s is . 25 T h e p la n w h ic h p r o v id e d m e d ic a l b e n e fits f o r o c c u p a t io n a l d is a b ilit ie s p a id the d if fe r e n c e b e tw e e n the w o r k m e n 's c o m p e n s a tio n b e n e fit and the b e n e fit p r o v id e d u n d e r the p la n . 26 M a n y p la n s p r o v id e d o n ly h o s p ita l m a te r n ity b e n e fit s and b e n e fit s f o r o b s te tr ic a l p r o c e d u r e s . T h e h o s p it a l b e n e fit s a r e d e s c r i b e d in H ea lth and In s u r a n c e P la n s U n d er C o ll e c t i v e B a r g a in in g : H o s p ita l B e n e fit s , E a r ly 1959 (B L S B u ll. 1274, I9 6 0 ); and the o b s t e t r i c a l a s w e ll a s m e d ic a l m a te r n ity b e n e fits a r e d e s c r i b e d in th is r e p o r t , pp. 33—39). *7 S ee fo o tn o te 16. 28 A lth o u g h m o s t p la n s lim it e d r e im b u r s e m e n t s to c h a r g e s m a d e b y l ic e n s e d p h y s ic ia n s , s o m e p la n s p r o v id e d the s a m e o r d iffe r e n t a llo w a n c e s f o r tr e a tm e n t r e n d e r e d b y c h i r o p r a c t o r s o r C h r is t ia n S c ie n c e p r a c t i t io n e r s . T h e s e a llo w a n c e s a r e n ot d is c u s s e d in th is r e p o r t . 26 T a b le 20. T y p e s o f m e d ic a l b e n e fit s and lo c a t io n o f m e d ic a l c a r e o f n o n m a te r n ity d i s a b ilit ie s b y g r o u p s e lig ib le , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) D ep en d en ts o f a c t iv e w ork ers T y p e and lo c a t io n P la n s W ork ers P la n s D ep en d en ts o f r e t ir e d w ork ers R e tir e d w orkers A c tiv e w orkers W ork ers P la n s W ork ers P la n s W ork ers A ll p la n s p r o v id in g b e n e f i t s ---------- 210 3, 684. 2 182 3, 431. 4 *74 *1, 6 7 5 .4 *71 * 1 ,5 7 9 .5 B e n e fit p r o v id e d in fo r m o f— C a sh ______________________________ S e r v ic e ---------------------------------------W ith in c o m e lim it s _________ W ithout in c o m e l i m i t s ______ 140 270 40 2 30 2, 0 1 9 .9 1, 664. 3 8 9 9 .8 764. 5 115 2 67 40 2 27 1, 786. 0 1 ,6 4 5 .4 899. 8 745. 6 *39 2 35 20 2 15 * 3 7 1 .5 1, 3 0 3 .9 666. 2 637. 7 *39 2 32 20 2 12 * 93 1, 6 3 0 .8 37 603. 0 16 112. 7 9 7 1 .8 4 136 45 2 39. 0 2, 476. 7 309. 7 B e n e fit p r o v id e d f o r m e d ic a l c a r e in— H o sp ita l, d o c t o r 's o f f i c e , and h o m e 3 ______________________ H o sp ita l and d o c t o r 's o f f i c e 3 ---------------------------------------H o s p ita l and h o m e --------------------H o s p ita l o n ly -----------------------------D o c t o r 's o f f i c e o n ly 3 ----------------- 1 1 110 45 10. 2. 1, 731. 309. 0 7 0 7 42. 0 1 - 35. 0 - 51 46 - 1, 131. 6 396. 1 372. 1, 207. 666. 541. - 56 44 2 3 2 1 - 1, 1 6 7 .2 301. 5 1 S ee fo o t n o t e s 1 and 2, ta b le 4. 2 In c lu d e s 1 p la n w h ich p r o v id e d s e r v i c e b e n e fit s f o r h o s p it a l v is it s and c a s h b e n e fits f o r h o m e and o f fic e v is its . 3 F o r th is ta b le " m e d i c a l " o r " h e a lt h " c e n te r w a s c o n s id e r e d " d o c t o r 's o f f ic e . " 4 T h e s e p la n s p r o v id e d b e n e fit s o n ly f o r v is it s to the m e d ic a l c e n t e r . * P r e l i m i n a r y data p u b lis h e d in the J u ly is s u e o f the M on th ly L a b o r R e v ie w (p . 712, ta b le 2) h a v e b e e n r e v is e d . O f the 7 0 and 67 p la n s that p r o v id e d s e r v i c e b e n e fit s to w o r k e r s and d e p e n d e n ts , r e s p e c t i v e l y , 40 u sin g B lu e S h ie ld p r o g r a m s p r o v id e d s e r v i c e - w i t h i n c o m e - l i m i t b e n e fit s f o r a s p e c if ie d n u m b e r o f t r e a t m e n t s . T h e p a tien t w as r e s p o n s i b l e f o r the c o s t o f a d d itio n a l t r e a t m e n t s . T h e s e p la n s , lik e c a s h p la n s , c o v e r e d g e n e r a l p r a c t it io n e r s ’ o r s p e c i a l i s t s ’ v i s i t s , and lim it e d the m a x im u m a llo w a n c e p a y a b le f o r e a c h v i s it and fo r a ll v i s i t s d u rin g a s in g le d is a b ilit y . The in c o m e l im i t s s p e c if ie d f o r s in g le a c tiv e w o r k e r s and f o r w o r k e r s w ith th r e e o r m o r e p e r s o n s in t h e ir f a m ily a r e s u m m a r iz e d b e lo w . 29 A n n u a l in c o m e l i m i t 1 A ll s e r v ic e - w it h -in c om e -lim it p l a n s _____________ _______________ U n d er $ 3, 000 _ _ $ 3 , 000 th ro u g h $ 3 , 750 __________ $ 4 , 000 _____________________________ $ 4 , 800 th ro u g h $ 5 , 000 _ _______ $ 5 , 500 th ro u g h $ 6 , 000 __________ $ 7 , 500 _____________________________ S in g le in d iv id u a ls 40 9 7 4 11 1 8 F a m ily (3 o r m o r e p erson s) 40 - 1 7 8 6 18 1 E x c e p t f o r 8 p la n s w h ich c o n s i d e r e d o n ly the w o r k e r ’ s in c o m e , the fa m ily lim it s a p p lie d to the in c o m e o f the e n tir e fa m ily , in c lu d in g the e a r n in g s o f d e p e n d e n ts . 29 F o r m o r e d e t a ils , s e e ta b le 12. 27 T a b le 21. R e la tio n sh ip o f m e d ic a l b e n e fit s p ro v id e d a c t iv e w o r k e r s and th e ir d ep en d en ts, r e t ir e d w o r k e r s and th e ir d epen den ts, and a c t iv e and r e t ir e d w o r k e r s , late su m m e r 1959 1 (W o r k e r s in thousan d s) P r o v is io n s p e c ifie d fo r both— P r o v is io n A c tiv e w o r k e r s and th eir d e p en d en ts R e tir e d w o r k e r s and th eir d e pendents A c tiv e and r e t ir e d w o r k e r s P la n s W ork ers P la n s W ork ers P la n s T y p e o f p lan (c a s h o r s e r v ic e ) _______________ N o v a r ia t io n ___________________________________ V a r ia tio n ---------------------------------------------------------- 179 178 1 3, 377. 4 3, 375. 4 2. 0 72 71 1 1, 695. 5 1, 693. 5 2. 0 73 71 2 1, 754. 4 1, 659. 8 94. 6 L o c a tio n o f v is it s c o v e r e d _____________________ No v a r ia t io n ___________________________________ V a r ia tio n ---------------------------------------------------------- 179 149 30 3, 377. 4 2, 617. 7 759. 7 72 66 6 1, 695. 5 1, 655. 9 39. 6 73 66 7 1, 754. 4 1, 634. 5 1 1 9 .9 W aitin g r e q u ir e m e n t f o r s ic k n e s s b e n e fits in the: H o sp ita l ----------------------------------------------------------No v a r ia t io n ----------------------------------------------V a r ia tio n ___________________________________ D o c t o r 's o ff ic e 2 ______________________________ No v a r ia t io n _______________________________ V a r ia tio n ___________________________________ H om e ___________________________________________ No v a r ia t io n _______________________________ V a r ia tio n ___________________________________ 174 171 3 44 43 1 37 36 1 3, 067. 7 3, 0 3 7 .2 30. 5 917. 7 891. 7 26. 0 603. 0 577. 0 26. 0 68 68 12 12 10 10 - 1, 394. 0 1, 394. 0 226. 8 226. 8 187. 8 187. 8 - 67 66 1 16 16 16 16 - 1, 3 5 8 .3 1, 351. 0 7. 3 221. 4 221. 4 221. 4 221. 4 - 174 174 68 68 1, 394. 0 1, 394. 0 44 44 37 37 - 3, 067. 7 3, 067. 7 917. 7 917. 7 603. 0 603. 0 - 12 12 10 10 - 226. 8 2 2 6 .8 _ 187. 8 1 8 7 .8 - 67 66 1 16 15 1 16 15 1 1, 3 5 8 .3 1, 351. 0 7. 3 221. 4 220. 1 1. 3 221. 4 220. 1 1. 3 174 165 9 44 44 3, 067. 7 2, 501. 5 566. 2 917. 7 917. 7 68 67 1 12 12 1, 394. 0 1, 392. 0 2. 0 226. 8 226. 8 67 66 1 16 16 1, 358. 3 1, 351. 0 7. 3 221. 4 221. 4 W aiting r e q u ir e m e n t fo r a c c id e n t b e n e fits in the: H o sp ita l _______________________________________ No v a r ia t io n _______________________________ V a r ia tio n ___________________________________ D o c t o r 's o ff ic e 2 _____________________________ N o v a r ia t io n _____________________________ V a r ia tio n __________________________________ H o m e __________________________________________ N o v a r ia t io n ------------------------------------- ------V a r ia tio n ___________________________________ B e n e fit p r o v id e d f o r e a ch v is it o r day o f v i s it s in the: H o sp ita l ----------------------------------------------------------No v a r ia t io n _______________________ ______ V a r ia tio n ___________________________________ D o c t o r 's o ff ic e 2 _________________________ ___ No v a r ia t io n ----------------------------------------------V a r ia tio n ___________________________________ H om e ______________________________ ______ __ No v a r ia t io n _____________________________ _ V a r ia tio n _________________________________ M a x im u m b e n e fit p r o v id e d d u rin g a s p e c if ie d p e r io d ----------------------------------N o v a r ia t io n ___________________________________ V a r ia tio n ____________ __________ __________ - - - - _ - - _ 37 37 - 603. 0 603. 0 - 10 10 - 187. 8 187. 8 - 16 16 - 221. 4 221. 4 - 179 151 28 3, 377. 4 2, 633. 9 743. 5 72 71 1 1, 695. 5 1, 693. 5 2. 0 73 69 4 1, 754. 4 1, 642. 5 111. 9 1 S ee fo o tn o te s 1 and 2, ta b le 4, and fo o tn o te 1, ta b le 5. 2 F o r th is ta b le " m e d i c a l ” o r " h e a lth " c e n te r w a s c o n s id e r e d " d o c t o r 's o ff ic e . " - W ork ers 28 T a b le 22 . W aiting r e q u ir e m e n t s fo r n on m a te rn ity m e d ic a l b e n e fits fo r a c t iv e w o r k e r s and th e ir d ep en d en ts b y lo c a t io n o f m e d ic a l c a r e , la te su m m e r 1959* (W o r k e r s in th ou san d s) M e d ic a l c a r e in— H osp ita l W hen b e n e fits b e g in D o c to r *s o ff ic e H om e P la n s W ork ers P la n s W ork ers P la n s W ork ers 199 3 ,1 6 8 .7 88 1 ,4 3 5 .0 88 1 ,4 2 7 .7 161 2 ,7 8 3 .8 36 4 4 3 .9 34 4 2 9 .9 10 8 4 5 2 .6 83. 8 8 0 .9 2 27. 6 5 8 1 3 3 .3 8 5 .7 2 1 .0 15 19 9 1 2 1 5 1 2 9 .2 188. 5 598. 7 1 2 .0 2 7 .6 1 .8 3 3 .3 15 19 11 1 2 1 5 1 2 9 .2 1 8 8 .5 6 0 5 .4 12. 0 2 7 .6 1 .8 3 3 .3 187 3 ,0 4 8 .4 77 8 6 6 .6 75 8 5 2 .6 2 28 . 2 1 1 8 4 .9 1 .5 85. 7 1 4 3 1 1 1 5 0 0 .0 3 3 .6 1 6 .4 1 2 .0 4 .9 1 .5 1 4 5 1 1 1 500. 0 3 3 .6 23 . 1 12. 0 4 .9 1 .5 172 2 ,9 3 7 . 1 36 4 6 0 .4 32 4 1 8 .4 156 2 ,7 6 0 .5 24 3 2 6 .0 22 3 2 1 .0 2 4 1 8 1 1 9 .7 4 8 .7 1 .5 8 5 .7 2 1 .0 2 8 1 1 - 1 6 .4 115. 1 1 .4 1 .5 - 2 6 1 1 - 1 6 .4 7 8 .1 1 .4 1 .5 - 163 2 ,8 4 9 .9 33 4 5 3 .5 29 4 1 1 .5 - 1 .5 8 5 .7 2 1 5 .4 1 .5 2 1 5 .4 1 .5 A c tiv e W o r k e r s A ll p lan s p ro v id in g m e d ic a l b e n e fit s 2 __ __ ... ________ ______ F o r s ic k n e s s — I m m e d ia te ly A ft e r — F ir s t v is it S e c o n d v is it _____ — ________ ____ T h ir d v i s i t ________________________ _ F o u rth v is it ________ - _________ _ F i r s t d a y o f d is a b ility S e c o n d day o f d is a b ilit y ___________ S e v e n th d a y o f d i s a b i l i t y T h ir d day o f h o s p it a liz a tio n _ __ F o u rth day o f h o s p i t a l i z a t i o n _____ F o r a c c id e n ts — I m m e d ia te ly ____________________________ A ft e r — F i r s t v is it ----— — ------- -----S e co n d v is it -------------------------------------T h ir d v i s i t __________________________ F m ir t b v i s i t . — T h ir d day o f d i s a b i l i t y ------------------Seventh day o f d is a b ilit y ------- T h ir d day o f h o s p i t a l i z a t i o n ---------- D ep end ents A ll p la n s p ro v id in g m e d ic a l b e n e fit s 2 __ — — — ------- — — - F o r s ic k n e s s — I m m e d ia te ly - --------------- ---- ---A fte r— F ir s t v is it — ------- ------------------ S e c o n d v i s i t _________________ ______ T h ir d v i s i t __________________________ Seventh day o f d is a b ilit y — ------T h ir d d ay o f h o s p it a liz a tio n _ __ F o u rth day o f h o s p i t a l i z a t i o n -------F o r a c c id e n ts — I m m e d ia te ly ______ _____ — ---------- A ft e r — S e c o n d v i s i t -------------------------------------S eventh day o f d i s a b i l i t y ---------------T h ir d day o f h o s p it a liz a tio n - — - 1 8 1 S ee fo o tn o te s 1 and 2, ta b le 4 . 210 and 182 p la n s p r o v id e d m e d ic a l b e n e fit s fo r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts, r e s p e c t iv e ly . 2 E x clu d e s p lan s w h ich p r o v id e d b e n e fits on ly fo r tre a tm e n t in the m e d ic a l o r h ea lth c e n te r and p la n s u n d e r w h ich the w aitin g p e r io d w as not d ir e c t ly r e la t e d to the n u m b er o f v is it s o r d ay s o f d i s a b ilit y , i . e . , p la n s that p r o v id e d the c a s h b e n e fits on a c o -in s u r a n c e b a s is . 29 M o s t s i n g l e - e m p l o y e r s e r v i c e b e n e fit p la n s w e r e s e r v i c e - w i t h - i n c o m e l im i t p la n s , but m o s t m u lt ie m p lo y e r s e r v i c e b e n e fit plan s w e r e s e r v i c e - w i t h o u t i n c o m e - l i m i t plans,, T h e s e a l l - s e r v i c e p la n s p r o v id e d g e n e r a l m e d ic a l and s p e c i a l i s t s e r v i c e s in the d o c t o r * s o f f i c e o r at h e a lth c e n t e r s and , w ith fe w e x c e p t io n s , in the h o s p it a l o r at the h o m e a s w e l l* 30 I n s u r e d in d iv id u a ls w e r e e n c o u r a g e d to u s e the h e a lth c e n t e r s f o r p r e v e n tiv e c a r e . W ith on e e x c e p t io n , the 179 p la n s p r o v id in g b e n e fit s to b o th w o r k e r s and d e p e n d e n ts c o v e r e d b o th g r o u p s w ith the s a m e typ e o f b e n e fit (ta b le 2 1 ). A lth o u g h p la n s that p r o v id e d s e r v i c e b e n e fit s to a ll m e m b e r s , r e g a r d l e s s o f in c o m e , m a d e th e s e b e n e fit s a v a ila b le im m e d ia t e ly , p la n s p r o v id in g c a s h a l lo w a n c e s (c a s h and s e r v i c e - w i t h - i n c o m e - l i m i t b e n e f it s ) stip u la te d the n u m b e r o f v i s it s o r d a y s a ft e r the o n s e t o f e a c h d is a b ilit y f o r w h ich no b e n e fit s w e r e p a y a b le . G e n e r a lly , the r e q u ir e m e n t s f o r a c c id e n t b e n e fit s w e r e m o r e l i b e r a l than f o r s ic k n e s s b e n e fit s , and th o s e f o r in - h o s p it a l c a r e m o r e l ib e r a l than th o s e a p p ly in g to h o m e and o f f i c e v is its * O n ly a s m a ll p r o p o r t io n o f p a tie n ts r e c e i v e d th e s e p r e f e r e n c e s , h o w e v e r , b e c a u s e o f the lo w f r e q u e n c y o f a c c id e n t and in h o s p it a l c a s e s * M o r e than 9 out o f 10 o f the p la n s m a d e i n - h o s p it a l b e n e fit s a v a ila b le im m e d ia t e ly i f the d is a b ilit y w a s the r e s u lt o f an a c c id e n t (ta b le 22)* I n - h o s p it a l m e d ic a l b e n e fit s f o r w o r k e r s u n d er 8 out o f 10 p la n s w e r e im m e d ia t e ly a v a ila b le i f t h e ir c o n fin e m e n t w a s c a u s e d b y i l l n e s s ; but o n ly 2 out o f 5 p la n s p r o v id e d im m e d ia te c o v e r a g e o f i l l n e s s tr e a t e d in the h o m e o r o ffic e * W ith fe w e x c e p t io n s , the w a itin g r e q u ir e m e n t s f o r d epen d en ts* b e n e fit s w e r e the s a m e a s f o r w o r k e r s (ta b le 2 1 ). A lth o u g h m e d ic a l b e n e fit s w e r e , in g e n e r a l, b a s e d on the n u m b e r o f v i s it s m a d e b y the p h y s ic ia n o r the p a tie n t, m a n y c a s h p la n s r e s t r i c t e d b e n e fit s to on e c a ll a d ay. T h e y u s u a lly a c c o m p lis h e d th is b y b a s in g the m a x im u m p a y m e n t on the n u m b e r o f days* tr e a tm e n t o r n u m b e r o f d a y s the p a tie n t w a s in the h o s p it a l. In a ll p la n s p r o v id in g c a s h o r s e r v i c e - w i t h - i n c o m e - l i m i t b e n e f it s , the a llo w a n c e p e r v is it o r p e r d ay f o r h o m e and o f f i c e c a r e r e m a in e d the sa m e th ro u g h o u t the e n tir e p e r io d o f d i s a b i l i t y .31 H o w e v e r , in s o m e p la n s , the a l lo w a n c e f o r h o s p it a l v i s it s w a s g r e a t e r in the f i r s t 1 to 10 d a y s than s u b s e q u e n tly . A fe w p la n s p a id the a llo w a n c e on a p e r v i s it b a s is d u r in g the f i r s t 1 o r 2 d a y s o f c o n fin e m e n t; t h e r e a f t e r , the b e n e fit w a s p a y a b le on a p e r day b a s is * P la n s u sin g th is m e th o d s tip u la te d the m a x im u m n u m b e r o f v i s it s that w o u ld b e c o v e r e d on a p e r v is it b a s is . A lth o u g h the m a x im u m ca s h a l l o w a n c e 32 f o r e a c h h o s p ita l v is it o r d ay o f tr e a tm e n t in the h o s p it a l v a r i e d c o n s id e r a b ly , ra n g in g f r o m $ 2 . 5 0 to $ 7 . 5 0 , a l m o s t 60 p e r c e n t o f the p la n s p a id $ 4 o r m o r e and a b ou t h a lf that p r o p o r t io n p r o v id e d $ 5 o r m o r e (ta b le 2 3 ). 33 T h e a v e r a g e i n - h o s p it a l a llo w a n c e p r o v id e d u n d er 30 S ee fo o tn o te 18* 31 A s e p a r a te d is a b ilit y w a s u s u a lly d e s c r i b e d a s b e in g due to a d iffe r e n t o r u n r e la te d ca u s e o r s e p a r a te d b y a r e t u r n to w o r k o r b y a s p e c if ie d p e r io d o f tim e* 32 T h e p la n s p a y o n ly w hat the d o c t o r c h a r g e s i f l e s s than the m a x im u m a llo w e d b y the p la n . T h e a m o u n ts p a y a b le by the fe w p la n s that p r o v id e d the b e n e f it s on a c o - i n s u r a n c e b a s is w e r e n ot co m p u ta b le and , t h e r e f o r e , w e r e n ot in c lu d e d . 33 F o r p la n s p r o v id in g h ig h e r a llo w a n c e s f o r the f i r s t fe w v i s it s o r d a y s , the 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 tly w e r e u se d f o r th is stu dy; f o r p la n s p r o v id in g a h ig h e r a llo w a n c e f o r an e x te n d e d n u m b e r o f v i s it s o r d a y s and then a r e d u c e d a m ou n t, the h ig h e r a m o u n ts w e r e used* 30 T a b le 2 3 . C a s h a llo w a n c e s f o r n o n fn a te r n ity m e d ic a l c a r e p r o v id e d a c t iv e w o r k e r s and th e ir d e p e n d e n ts b y l o c a t io n o f m e d ic a l c a r e , la te s u m m e r 1959 1 __________________________________ (W o r k e r s in th o u s a n d s) M e d ic a l c a r e p r o v id e d in — M a x im u m a llo w a n c e p e r tr e a tm e n t o r p e r d a y 2 D o c t o r •s o f f i c e H o s p ita l P la n s W ork ers P la n s W ork ers H om e P la n s W ork ers A c tiv e w o r k e r s A l l p la n s p r o v id in g c a s h a llo w a n c e s 3 ——---- ----- --------- — --------— — $2 $ 3 -----— ----- ---------------------- -------------- -- -----$ 3 .5 0 ..................................- ........... $ 4 -- ----- --------------------- ---------- ---------------- ------$ 4 .5 0 - $ 5 ---------------- ------------- ---------------------------------$6 $ 7 .5 0 - ........................... — ................................................. O th er4 A v e r a g e a llo w a n c e 5------------ ----------------------- 174 2 ,7 1 3 .9 _ 67 2 37 4 47 11 2 4 6 3 8 .6 3 1 .0 8 8 3 .2 4 1 .4 4 3 9 .6 5 9 8 .0 1 5 .3 6 6 .8 66 1, 1 7 4 .5 66 1 0 3 .3 3 5 4 .9 18. 1 645. 1 _ 13 31 2 16 - - 2 - 4 .3 _ 4 8 .8 - 2 $ 4 .3 3 1 ,1 6 7 .2 . 9 8 .6 1 6 .0 4 1 .4 3 1 .4 8 5 4 .5 7 5 .5 4 9 .8 15 1 6 3 29 9 - 3 $3 .4 3 $ 4 . 73 D ep en d en ts A l l p la n s p r o v id in g c a s h a llo w a n c e s 3 ------------------------------------ — — $2 $ 3 ------------— -------------------- --------------------------$ 3 . 5 0 ------------------------ --------------- — $ 4 --------------------- — ----------- — — -------$ 4 . 5 0 ---------------- -------- -- ------------ — $ 5 ----------------------------- ---------------------------------$6 ....................... .............. - $ 7 . 5 0 ......... .............................. - ...................... O th er4 - - -------------------------- A v e r a g e a llo w a n c e 5 --------- -------------------- — 150 _ 59 2 37 1 37 10 2 2 2 ,5 0 1 .2 _ 1 ,0 8 9 .8 3 1 .0 4 1 1 .5 1 0 .0 3 4 1 .6 5 9 4 .2 1 5 .3 7 .8 $ 4 .2 0 _________ 1____________ 18 2 2 6 .5 2 10 1 4 3 8 .9 1 5 2 .8 7. 5 2 4 .0 3 .3 - 1 - - - _ $2 .9 8 1 15 1 8 5 .5 _ 2 3 8 .9 _ - 3 11. 1 - _ 1 1 4 .0 21. 5 - 8 2 - _ $ 4 .6 4 ________ 1___________ 1 S ee fo o t n o t e s 1 and 2, ta b le 4. 210 and 182 p la n s p r o v id e d m e d ic a l b e n e fit s f o r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts , r e s p e c t i v e l y . 2 F o r p la n s p r o v id in g h ig h e r a llo w a n c e s f o r the f i r s t fe w v is it s o r d a y s , the lo 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 f o r the p u r p o s e s o f th is ta b u la tio n ; f o r p la n s p r o v id in g a h ig h e r a llo w a n c e f o r an e x te n d e d n u m b e r o f v is it s o r d a y s and then a r e d u c e d a m o u n t, the h ig h e r a m o u n ts w e r e u s e d . 3 In c lu d e s the a llo w a n c e s p r o v id e d u n d er the 40 s e r v i c e - w i t h - i n c o m e - l i m i t p la n s ; e x c lu d e s 6 p la n s c o v e r in g w o r k e r s and 5 p la n s c o v e r in g d e p en d en ts w h ic h p r o v id e d the c a s h b e n e fit s on a c o - i n s u r a n c e b a s i s . 4 In c lu d e s p la n s w ith am o u n ts o th e r than the e x a c t a m ou n ts s p e c if ie d a b o v e . s S e e fo o t n o t e 8, ta b le 14. th e s e p la n s w a s $ 4 .3 3 f o r w o r k e r s and $ 4 .2 0 f o r d e p e n d e n ts . A llo w a n c e s f o r o f f i c e v i s it s w e r e u s u a lly l e s s than the a m ou n t p r o v id e d f o r in - h o s p i t a l c a r e ; the a ll o w a n c e f o r o f f i c e v i s it s a v e r a g e d $ 3 .4 3 f o r w o r k e r s and $ 2 .9 8 f o r t h e ir d e p e n d e n ts . T h e a m ou n t p a y a b le f o r e a c h v i s it to the p atien t*s h o m e w as g e n e r a lly h ig h e r than that p r o v id e d f o r tr e a tm e n t in the d o c t o r f s o f f i c e o r , l e s s o fte n , in the h o s p it a l. A b o u t 3 ou t o f 5 o f the 66 p la n s p r o v id in g a llo w a n c e s f o r h o m e c a r e f o r w o r k e r s p a id $ 5 o r m o r e f o r e a c h h o m e tr e a tm e n t. The a v era g e a l lo w a n c e f o r w o r k e r s w a s $ 4.73 p e r h o m e v i s it ; f o r d e p e n d e n ts , u n d e r o n ly 15 p la n s , it w a s s lig h t ly l e s s . A d d itio n a l a llo w a n c e s w e r e p r o v id e d b y s o m e p la n s f o r n ig h t c a l l s , o r i f m o r e than on e m e m b e r o f the f a m ily w as tr e a t e d d u rin g the s a m e v i s it , o r i f the h o m e v i s i t to o k p la c e m o r e than a g iv e n d is ta n c e f r o m the d o c t o r s o f f i c e . A n e v a lu a tio n o f the m a x im u m p r o t e c t io n f o r le n g th y d is a b il i t ie s as p r o v id e d b y c a s h a llo w a n c e p la n s m a y be b a s e d , in p a r t , on the m a x im u m a m ou n t 31 p a y a b le d u r in g a s in g le d is a b ilit y o r a s p e c if ie d p e r i o d . 34 A lth o u g h c a s h a ll o w a n c e p la n s u s u a lly p r o v id e a m a x im u m a m o u n t f o r e a c h d is a b ilit y , 23 p la n s c o v e r in g w o r k e r s and 19 p la n s c o v e r i n g d e p e n d e n ts a p p lie d m a x im u m a llo w a n c e s to a ll tr e a tm e n ts r e c e iv e d d u r in g a 6 - o r 1 2 -m o n th p e r i o d (ta b le 2 4 ). U n d e r th e s e p la n s , the a m ou n t a v a ila b le a ft e r the f i r s t d is a b ilit y w as the u n u se d p o r t io n o f T a b le 2 4 . M a x im u m c a s h a llo w a n c e fo r n o n m a te r n ity m e d ic a l c a r e fo r a c t iv e w o r k e r s and th e ir d e p e n d e n ts b y b a s is o f p a y m e n t, la te s u m m e r 1 9 5 9 x (W o r k e r s in th ou sa n d s) B a s is o f p a y m en t T o ta l M a x im u m a llo w a n c e f o r a ll v is it s P e r d is a b ilit y P er year P la n s W ork ers P la n s W ork ers P la n s 3 174 2 ,7 1 3 .9 141 1 ,8 5 5 .8 12 9 26 23 20 13 18 12 6 21 9 5 7 2 .9 1 7 9 .0 2 3 6 .3 2 4 0 .8 2 0 7 .9 7 1 .4 1 7 4 .8 1 2 8 .4 6 8 .5 6 8 1 .7 5 3 9 .0 1 1 3 .2 12 7 23 19 14 7 17 9 4 19 5 5 O th er W ork ers P la n s W ork ers 16 1 9 6 .5 4 17 6 6 1 .6 7 2 .9 1 4 9 .0 1 5 4 .0 2 0 3 .7 1 4 7 .4 4 0 .2 1 6 0 .1 7 3 .4 5 1 .5 6 6 3 .8 2 6 .6 1 1 3 .2 2 2 4 1 2 _ 2 1 _ 2 - 3 0 .0 54. 3 37 . 1 1 .7 1 1 .4 _ 4 3 .0 1 0 .6 _ 8 .4 - _ 1 5 4 1 1 1 2 2 - _ 2 8 .0 _ 5 8 .8 1 9 .8 1 4 .7 1 2 .0 6 .4 1 7 .9 5 0 4 .0 - A c tiv e w o r k e r s A ll p la n s p r o v id in g ca sh a llo w a n c e s 2 _ U n d er $ 1 0 0 __________________________ $ 1 0 0 and u n d er $ 1 50 $ 1 5 0 and u n d e r $ 2 0 0 _______________ $ 2 0 0 and u n d er $ 2 5 0 __ _ $ 2 5 0 and u n d er $ 3 0 0 $ 3 0 0 and u n d er $ 3 5 0 $ 3 5 0 and u n d er $ 4 0 0 $ 4 0 0 and u n d e r $ 5 0 0 _______________ $ 5 0 0 a n d u n d e r $6 00 $ 6 0 0 and u n d e r $ 7 00 $ 7 0 0 and o v e r _______________________ O th er __ _ _ A v e r a g e m a x im u m a l l o w a n c e 5 $ 517 D ep en d en ts A ll p lan s p ro v id in g c a s h a llo w a n c e s 2 ________________________ 3 150 2 ,5 0 1 .2 127 2 ,2 3 2 .3 17 2 1 3 .6 66 5 5 .3 U n d er $ 1 0 0 ................... ............................ $ 1 0 0 and u n d er $ 1 5 0 __ __ — $ 1 5 0 and u n d e r $ 2 00 $ 2 0 0 and u n d e r $ 2 5 0 __ __ __ $ 2 5 0 and u n d e r $ 3 0 0 _______________ $ 3 0 0 and u n d e r $ 3 5 0 _______________ $ 3 5 0 and u n d e r $ 4 0 0 __ __ __ $ 4 0 0 and u n d e r $ 5 0 0 _______________ $ 5 0 0 and u n d e r $ 6 0 0 _______________ $ 6 0 0 a n d u n d e r $ 7 00 — $ 7 0 0 and o v e r __ _______ _ __ O t h e r -------------------------------------------------- 14 12 15 22 15 8 18 14 4 19 5 4 9 0 .2 6 6 6 .0 1 4 6 .1 241. 7 1 6 3 .3 6 0 .3 1 8 2 .8 140. 1 2 7 .9 6 5 4 .7 2 4 .9 1 0 3 .2 13 10 12 18 12 5 17 11 4 18 3 4 6 7 .1 6 4 8 .0 8 2 .2 2 1 0 .5 1 2 4 .6 3 8 .3 168. 1 9 0 .7 2 7 .9 652.8 1 8 .9 1 0 3 .2 1 2 4 3 3 3 1 - . 1 6 .0 5 4 .3 3 1 .2 3 8 .7 2 2 .0 4 9 .4 2 .0 - 1 1 1 1 1 1 - 2 3 .1 2 .0 9 .6 1 4 .7 1 .9 4 .0 - A v e r a g e m a x i m u m a llo w a n c e 5 ___ $332 1_____________ 1 S ee fo o tn o te s 1 and 2, ta b le 4 . 210 and 182 p la n s p r o v id e d m e d ic a l b e n e fits fo r a c t iv e w o r k e r s and t h e ir d e p e n d e n ts, r e s p e c t i v e l y . 2 S ee fo o tn o te 3, ta b le 2 3. 3 E x c lu d e s 1 p lan w h ich p r o v id e d s e r v i c e b e n e fits fo r h o s p ita l v is it s and c a s h b e n e fits fo r h o m e and o ffic e v is its . 4 In clu d e s 7 p la n s u n der w h ich the b a s is o f p a y m en t w a s a 6 -m o n th p e r io d . 5 See fo o tn o te 8 , ta b le 14. 6 In clu d e s 2 p lan s u n d er w h ich the b a s is o f p a y m en t w a s a 6 -m o n th p e r io d . 34 W h ere the m a x im u m a llo w a n c e w as n ot s p e c i f i e d it w a s c o m p u te d m u ltip ly in g the a llo w a n c e s p e r v i s it o r p e r d a y b y the n u m b e r o f v i s it s o r d a y s f o r w h ich b e n e fits w e r e p a y a b le . U n d e r p la n s p r o v id in g d iffe r e n t a llo w a n c e s f o r h o s p it a l, o f f i c e , and h o m e c a r e , th e m o s t l ib e r a l a llo w a n c e w a s u s e d in co m p u tin g the m a x im u m a llo w a n c e . by 32 the m a x im u m a llo w a n c e p r o v id e d f o r the y e a r o r 6 -m o n th p e r i o d . A fe w p la n s s p e c i f i e d s e p a r a t e m a x im u m a llo w a n c e s f o r h o s p it a l v is it s and f o r h o m e and o f f i c e v i s i t s . U n d er th e s e p la n s the to ta l a llo w a n c e f o r h o s p it a l c a r e w a s p a y a b le on a p e r d is a b ilit y b a s i s , and the m a x im u m a m ou n t f o r h o m e and o f f i c e tr e a tm e n t on a p e r y e a r o r 6 -m o n th b a s i s . 35 T h e m a x im u m a llo w a n c e (p e r d is a b ilit y , y e a r , o r h a lf y e a r ) in the 174 p la n s p r o v id in g c a s h a llo w a n c e s f o r w o r k e r s ra n g e d f r o m $ 51 to $ 2 ,5 0 0 . T h e ra n g e f o r d e p e n d e n ts w as a bou t the s a m e . A b o u t o n e ou t o f f iv e p la n s , i n clu d in g a fe w c o v e r in g a la r g e n u m b e r o f w o r k e r s , p a id $ 5 0 0 o r m o r e . The a v e r a g e m a x im u m a llo w a n c e f o r w o r k e r s w as $ 5 1 7 and f o r d e p e n d e n ts , $ 3 3 2 . 36 T h ir ty p la n s that p r o v id e d b e n e fits f o r w o r k e r s , r e g a r d l e s s o f the l o c a tio n o f v i s i t s , c o v e r e d o n ly the i n - h o s p it a l tr e a tm e n t o f d e p e n d e n ts (ta b le 21). A l s o , n in e p la n s p a id d e p e n d e n ts s m a l le r b e n e fits f o r i n - h o s p it a l m e d ic a l t r e a t m e n t. B o th o f th e s e ty p e s o f r e d u c t io n s u s u a lly , a lth ou gh n ot a lw a y s , r e d u c e d the m a x im u m b e n e fit. A lt o g e t h e r , m a x im u m b e n e fits w e r e l o w e r f o r d e p e n d e n ts than f o r a c t iv e w o r k e r s in 28 p la n s . W ith th e s e e x c e p t io n s , w o r k e r s and d e p en d e n ts w e r e u s u a lly p r o v id e d id e n t ic a l m e d ic a l b e n e fits (ta b le 5) ju s t as th e y u s u a lly r e c e iv e d id e n t ic a l h o s p it a l and s u r g i c a l b e n e fit s . A n a llo w a n c e f o r s p e c i a l i s t c o n s u lt a tio n , if r e q u e s t e d b y the a tten d in g p h y s ic ia n , w as p r o v id e d w o r k e r s b y 34 p la n s , and d e p e n d e n ts b y 32 p la n s . M o s t o f the p la n s c o v e r e d o n ly on e s u ch c o n s u lt a tio n p e r d is a b ilit y and p a id $ 1 0 o r $ 1 5 to w a r d the s p e c i a l i s e s c h a r g e . R e d u c tio n o f B e n e fits D u r in g A c t i v e E m p lo y m e n t . ---- W o r k e r s * m e d ic a l b e n e fits w e r e r e d u c e d in o n ly s ix p la n s d u r in g a c t iv e e m p lo y m e n t (ta b le 17). F iv e p la n s lim it e d w o r k e r s o v e r 60 to the s a m e n u m b e r o f tr e a tm e n ts in a y e a r as w as p r e v i o u s l y a v a ila b le f o r e a c h d is a b ilit y , and on e p la n r e d u c e d f r o m 70 to 31 the m a x im u m n u m b e r o f d a y s o f b e n e fits w h en the in d iv id u a l r e a c h e d a g e 65. O n ly on e p la n d is c o n tin u e d b e n e fits f o r w o r k e r s and t h e ir d e p e n d e n ts w hen th e y r e a c h e d an a d v a n ce d a ge— a g e 65 in th is c a s e . R e t ir e d W o r k e r s and T h e ir D e p e n d e n ts . 37---- R e t ir e d w o r k e r s and t h e ir d e p e n d e n ts w e r e e x te n d e d b e n e fits b y 74 and 71 p la n s , r e s p e c t i v e l y (ta b le 3 ). A b o u t t w o -t h ir d s o f th e s e p la n s p r o v id e d id e n t ic a l b e n e fits f o r b o th a c t iv e and r e t ir e d w o r k e r s and to the d e p e n d e n ts o f a c t iv e and r e t ir e d w o r k e r s (ta b le 5 ). T h e r e m a in in g p la n s r e d u c e d b e n e fits f o r r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts b y on e o r m o r e o f the fo llo w in g m e th o d s : (1) R e s t r ic t in g the lo c a t io n o f t r e a t m e n t s ; (2) n a r r o w in g the b a s is o f p a y m e n t; o r (3) p la c in g an o v e r a l l m a x im u m on the a m ou n t p a y a b le f o r m e d ic a l , s u r g i c a l, and h o s p ita l e x p e n s e s i n c u r r e d d u r in g the r e t ir e m e n t p e r i o d . P la n s u tiliz in g th e f i r s t m e th o d g e n e r a lly lim it e d b e n e fits to i n - h o s p it a l c a r e . T h o s e u s in g the s e c o n d m e th o d u s u a lly p r o v id e d the s a m e s c h e d u le a llo w a n c e s a v a ila b le p r i o r to r e t ir e m e n t , but r e s t r i c t e d the to ta l a m ou n t p a y a b le d u r in g the r e t ir e m e n t p e r i o d to the m a x im u m p r e v io u s ly 35 F o r th is r e p o r t , the m a x im u m a llo w a n c e u n d e r e a c h o f th e s e p la n s w as the s u m o f the tw o s e p a r a t e a llo w a n c e s . 36 T h e s u b s ta n tia l d i f f e r e n c e in a v e r a g e m a x im u m a llo w a n c e s f o r w o r k e r s and d e p e n d e n ts is a ttr ib u ta b le to s e v e r a l f a c t o r s . A fe w o f the la r g e p la n s (in t e r m s o f w o r k e r s c o v e r e d ) d id n ot p r o v id e b e n e fits f o r d e p e n d e n ts . M a n y p la n s p r o v id e d m o r e c o m p r e h e n s iv e c o v e r a g e f o r w o r k e r s than d e p e n d e n ts . In a fe w p la n s , b e n e fits w e r e a v a ila b le to w o r k e r s f o r a l o n g e r p e r i o d o f tim e than f o r d e p e n d e n ts . In s o m e o t h e r s , th e a llo w a n c e p e r v i s it w as g r e a t e r f o r w o r k e r s than f o r d e p e n d e n ts . *7 S ee fo o tn o te 7. 33 p a y a b le f o r e a c h d is a b ilit y . F o r e x a m p le , o n e p la n that w o u ld p a y a c t iv e w o r k e r s up to $3 f o r e a c h d a y o f h o s p it a l c o n fin e m e n t w ith a m a x im u m a llo w a n c e o f $ 9 3 f o r e a c h d is a b ilit y , a llo w e d p e n s io n e r s a m a x im u m o f $ 9 3 f o r the r e s t o f t h e ir l i v e s . P la n s u tiliz in g the th ir d m e th o d o f c u r t a ilin g m e d ic a l b e n e fit s , lik e th o s e u s in g the s e c o n d m e th o d , p r o v id e d the s a m e a llo w a n c e s f o r r e t ir e d as f o r a c t iv e w o r k e r s , but a d d ed an o v e r a l l lif e t im e lirh it f o r a ll h e a lth b e n e f it s . One p la n , f o r e x a in p le , w ou ld p a y r e t ir e d w o r k e r s no m o r e than $ 1 ,5 0 0 f o r a ll m e d i c a l c a r e e x p e n s e s (h o s p ita l, s u r g i c a l, and m e d ic a l) i n c u r r e d a ft e r r e t ir e m e n t . C a sh b e n e fits w e r e p r o v id e d b y m o r e than h a lf o f the 74 and 71 p la n s w ith b e n e fits f o r r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts , r e s p e c t i v e l y (ta b le 2 0). A ll e x c e p t th re e o f th e s e p la n s p a id s p e c if ie d a llo w a n c e s f o r d o c to r s * tr e a t m e n t s . 8 S e r v ic e b e n e fits w e r e p r o v id e d r e t ir e d w o r k e r s b y the r e m a in in g 35 p la n s , and t h e ir d e p e n d e n ts b y the r e m a in in g 32 p la n s ; 20 o f th e s e p la n s p r o v id e d s e r v i c e w i t h - i n c o m e - l i m i t b e n e fits f o r b oth r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts . A s in the c a s e o f s u r g i c a l b e n e fit s , th e s e lim it s a p p e a r e d , on the w h o le , to b e h ig h r e la t iv e to the r e d u c e d in c o m e s o f r e t ir e d w o r k e r s (ta b le 12). O n ly in - h o s p it a l c a r e w as p r o v id e d r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts b y 51 and 56 p la n s , r e s p e c t i v e l y . U n d e r a ll but o n e p la n , a llo w a n c e s f o r v i s it s to r e t ir e e s and d e p en d en ts c o n fin e d to the h o s p ita l w e r e p a y a b le b e g in n in g w ith the d o c t o r 1s f i r s t v i s it (ta b le 2 5). M o s t fr e q u e n t ly , the m a x im u m a m ou n ts p r o v id e d b y p la n s s p e c ify in g c a s h a llo w a n c e s f o r h o s p it a l v is it s w e r e $ 3 and $ 5 p e r v i s it o r d a y (ta b le 2 6). S ix o f the n in e p la n s p r o v id in g r e t ir e d w o r k e r s a c a s h a llo w a n c e f o r o f f i c e tr e a tm e n ts p a id $ 3 f o r e a c h o f f i c e c a l l. T h r e e o f the e ig h t p la n s c o v e r in g h o m e v is it s f o r r e t ir e d w o r k e r s p a id a m a x im u m o f $ 5 p e r v i s it ; a ll e x c e p t on e o f the re m a in in g p la n s p a id l e s s than th is a m ou n t. T h e m a x im u m a llo w a n c e p r o v id e d r e t ir e d w o r k e r s and t h e ir d e p e n d e n ts f o r a s p e c if ie d p e r i o d (u s u a lly p e r d is a b ilit y ) ra n g e d f r o m $ 6 3 to $ 2 ,2 5 0 (ta b le 27). A b o u t t h r e e ou t o f fiv e p la n s p r o v id e d $ 3 5 0 o r m o r e . M a te r n ity B e n e fits O b s t e t r ic a l p r o c e d u r e s w e r e c o v e r e d b y n e a r ly a ll o f th e p la n s p r o v id in g s u r g i c a l b e n e fits f o r o th e r ty p e s o f o p e r a t io n s . S o m e o f the s u r g i c a l p la n s a ls o in c lu d e d m e d ic a l c a r e r e q u ir e d p r i o r to o r a ft e r the te r m in a tio n o f a p r e g n a n c y in the b e n e fit p r o v id e d f o r the o b s t e t r i c a l p r o c e d u r e . In c o n t r a s t , f e w e r than a fifth o f the p la n s w ith m e d ic a l b e n e fits f o r n o n m a te r n ity d is a b il i t ie s c o v e r e d p r e n a ta l and p o s tn a ta l c a r e in the d o c t o r 's o f f i c e , at the p a t ie n t 's h o m e , o r in the h o s p ita l. T h is s e c t i o n d e s c r i b e s the s u r g ic a l and m e d ic a l b e n e fits p r o v id e d f o r " n o r m a l d e l i v e r y " m a t e r n it y c a s e s . D iffe r e n t b e n e fits w e r e g e n e r a lly a v a ila b le f o r m i s c a r r i a g e s and f o r c o m p lic a t e d c a s e s , s u c h as th o s e in v o lv in g a C a e s a r e a n s e ctio n o r e c to p ic p re g n a n cy . Th e c a s h a llo w a n c e s f o r n o r m a l d e li v e r y w e r e u s u a lly l a r g e r than f o r a m i s c a r r i a g e , but s m a l l e r than th o s e p r o v id e d f o r a C a e s a r e a n s e c t i o n o r an e c t o p i c p r e g n a n c y . S u r g ic a l B e n e fi t s . — S u r g ic a l b e n e fits f o r o b s t e t r i c a l p r o c e d u r e s w e r e p r o v id e d w o m e n w o r k e r s b y 276 o f the 293 p la n s w ith n o n m a t e r n it y s u r g i c a l b e n e fits and f o r d ep e n d e n t w iv e s b y 269 o f the 282 p la n s . M o s t o f the 17 p la n s that d id n ot p r o v id e s u c h b e n e fits f o r w o r k e r s w e r e in in d u s t r ie s (s u c h as c o n s t r u c tio n and tr a n s p o r ta t io n ) w h e r e fe w w o m e n w o r k e r s a r e e m p lo y e d . 38 C a sh b e n e fits w e r e p r o v id e d o n a c o - i n s u r a n c e b a s is b y the t h r e e p la n s that d id n ot p r o v id e a c a s h a llo w a n c e . 34 T a b le 25. W aiting r e q u ir e m e n t s fo r m e d ic a l b e n e fits f o r r e t ir e d w o r k e r s and th e ir d epen den ts b y lo c a t io n o f m e d ic a l c a r e , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s)____________________________________ B e n e fit p r o v id e d fo r m e d ic a l c a r e in— W hen b e n e fits b e g in H o sp ita l __________________________ P la n s W ork ers D o c to r 's s o ff ic e P la n s H om e W ork ers P la n s W ork ers R e tir e d w o r k e r s A ll plans p ro v id in g m e d ic a l F o r s ic k n e s s — I m m e d ia t e ly _______________________ A ft e r — F i r s t v is it ______ _______ S e c o n d v i s i t -----------------------------T h ir d v is it ___________ _____ _ F o u r th v is it _____ _____ T h ir d day o f h o s p it a liz a tio n __ F o r a c c id e n ts — I m m e d ia t e ly _______________________ A ft e r — S e c o n d v i s i t ------------------------- _ T h ir d v is it ------------------------------F o u r th v i s i t -------------------------- --T h ir d day o f h o s p it a liz a tio n — 65 1 ,2 6 5 . 6 15 1 3 6 .4 14 1 0 1 .4 64 1 ,2 5 9 - 6 10 82. 5 9 78. 5 1 .3 3 9 .3 1 .3 1 2 .0 - 1 1 2 1 - 1 .3 4 .3 5 .3 1 2 .0 - 1 - 6 .0 1 2 1 1 - 64 1 ,2 5 9 . 6 12 1 1 8 .8 10 7 9 .8 - 1 6 .0 1 1 1 4 .3 1 .3 1 2 .0 1 2 1 4 .3 5 .3 1 2 .0 64 1 ,2 6 4 .3 9 9 9 .5 7 60. 5 63 1 ,2 5 8 .3 7 6 0 .2 6 5 6 .2 1 6. 0 2 - 3 9 .3 - 1 - 4 .3 - 63 1 ,2 5 8 . 3 8 9 5 .2 6 5 6 .2 1 6 .0 1 •* 4 .3 - 1 - 4 .3 - D ependents A ll p lans p ro v id in g m e d ic a l b e n e fits 2 __ _____________________ _ F o r s ic k n e s s — TmmAHiatply A ft e r — S e co n d v i s i t ____________________ T h ir d day o f h o s p it a liz a tio n — F o r a c c id e n ts — ___ _ I m m e d ia te ly _____ _____ A ft e r — S e c o n d visit ------------— — T h ir d day o f h o s p it a liz a tio n __ 1 S ee fo o tn o te s 1 and 2, table 4 . and th e ir d e p e n d e n ts, r e s p e c t iv e ly . 2 S ee fo o tn o te 2 , table 22 . 74 and 71 plans p r o v id e d m e d ic a l b e n e fits f o r r e t ir e d w o r k e r s T a b le 26 . C a sh a llo w a n c e fo r in -h o s p ita l m e d ic a l c a r e f o r r e t ir e d w o r k e r s and th e ir d ep en d en ts, late s u m m e r 1959 1 (W o r k e r s in th ou san d s) M a x im u m c a s h a llo w a n c e p er v is it o r p e r day in h o s p ita l 2 D ep en d en ts R e tir e d w o r k e r s P la n s W ork ers P la n s P la n s p ro v id in g c a s h a llo w a n c e s 3__ 56 1 ,0 2 4 .0 56 ,, 20 8 15 8 5 1 9 8 .8 4 0 .1 1 5 9 .0 5 8 3 .3 4 2 .8 19 9 15 8 5 $4 -----1..................................................... $ 6 ~ ............................................................. O th er4 — ----- — — W ork ers 1 ,0 2 4 .7 1 9 7 .5 42. 1 1 5 9 .0 5 8 3 .3 4 2 .8 1 S ee fo o tn o te s 1 and 2, ta b le 4 . 74 and 71 plans p ro v id e d m e d ic a l b e n e fits f o r 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, r e s p e c t iv e ly . 2 S ee fo o tn o te 2 , table 23 . 3 In clu d e s the a llo w a n c e s p r o v id e d u n der the 20 s e r v i c e - w i t h - i n c o m e - l i m i t p la n s; e x c lu d e s the 3 plans c o v e r in g r e t ir e d w o r k e r s and th e ir d epen den ts w h ich p r o v id e d the c a s h b e n e fit s on a c o -in s u r a n c e b a s i s . 4 In clu d e s plans p ro v id in g c a s h a llo w a n c e s in am ou n ts n ot sh ow n s e p a r a t e ly . 35 T a b le 27. M a x im u m c a s h a llo w a n c e f o r m e d ic a l c a r e f o r r e t i r e d w o r k e r s and t h e ir d e p e n d e n ts b y b a s is o f p a y m e n t, la te s u m m e r 1 9 5 9 1 (W o r k e r s in th o u s a n d s) B a s is o f p a y m en t i M a x im u m a llo w a n c e f o r a ll v is it s P e r d is a b ilit y P la n s W ork ers O th er P la n s W ork ers P la n s W ork ers A l l p lan s p r o v id in g c a s h a llo w a n c e s 2 _ _______ 56 1, 0 2 4 .0 43 900. 8 3 13 123.2 U n d e r $ 1 0 0 . __ _____ __________ $ 1 0 0 and u n d e r $ 1 5 0 ----------------- ----$ 1 5 0 and u n d e r $ 2 0 0 . _______ __ $ 2 0 0 and u n d e r $ 2 5 0 ___________ $2 50 and u n d e r $ 3 0 0 ------------------------$ 3 0 0 and u n d e r $ 3 5 0 _______ ____ $ 3 5 0 and u n d e r $ 4 0 0 ______ ________ $ 4 0 0 and u n d e r $ 5 0 0 _________________ $ 5 0 0 and u n d e r $ 6 0 0 _________________ $ 6 0 0 and u n d e r $ 7 0 0 _____________ $ 7 0 0 and o v e r __ ________ — 2 3 5 4 8 1 9 4 3 13 4 14. 6 46. 6 48. 9 13. 5 79. 5 10 .0 117. 1 35. 7 11 .5 635. 7 10. 9 2 3 2 2 5 _ 9 3 3 12 2 14. 6 46. 6 11.3 6. 4 32. 5 117. 1 23. 7 11. 5 6 3 3.8 3 .3 3 2 3 1 1 _ 1 2 _ 37. 6 7. 1 47 .0 10.0 12.0 1 .9 7. 6 A l l p lan s p r o v id in g c a s h a llo w a n c e s 2 ________________________ 56 1, 0 2 4 .7 44 913. 5 3 12 111.2 U n d e r $ 1 0 0 .............................................. $ 1 0 0 and u n d e r $ 1 5 0 ___________ ___ $ 1 5 0 and u n d e r $ 2 0 0 _________________ $ 2 0 0 and u n d e r $ 2 5 0 ------------------------$ 2 5 0 and u n d e r $ 3 0 0 __ _______ __ $ 3 0 0 and u n d e r $ 3 5 0 . ____________ $ 3 5 0 and u n d e r $ 4 0 0 ________ $ 4 0 0 and u n d e r $ 5 0 0 ____________ $ 5 0 0 and u n d e r $ 6 0 0 _________________ $ 6 0 0 and u n d e r $ 7 0 0 ________ _ ____ $ 7 0 0 and o v e r ___________ _____ 2 3 4 5 9 1 10 4 2 13 3 14. 6 46. 6 47. 6 25. 5 8 1 .5 10.0 118. 1 25 .0 10. 5 635. 7 9. 6 2 3 1 3 6 _ 10 4 2 12 1 14. 6 46. 6 10 .0 1 8 .4 34. 5 _ 1 1 8 .1 2 5 .0 10. 5 63 3.8 2 .0 _ 3 2 3 1 _ _ _ 37. 6 7. 1 47 .0 10.0 _ 1 .9 7. 6 R e t ir e d w o r k e r s D e p e n d e n ts 1 2 1 S e e fo o t n o t e s 1 and 2 , ta b le 4 . 74 and 71 p la n s p r o v id e d m e d ic a l b e n e fit s f o r r e t i r e d w o r k e r s and t h e ir d e p e n d e n ts , r e s p e c t i v e l y . 2 S e e fo o tn o te 3, ta b le 2 6 . 3 In c lu d e s 4 p lan s w h ic h p r o v id e d the a llo w a n c e on a " p e r y e a r " b a s is , and 6 p lan s w h ich p r o v id e d it o n a " r e t i r e m e n t p e r i o d " b a s i s . T h e s a m e ty p e o f b e n e fit (c a s h o r s e r v i c e ) w as a v a ila b le f o r b o th m a t e r n ity and n o n m a te r n ity c a s e s in a ll e x c e p t 15 p la n s . T h e s e 15 p la n s p r o v id e d c a s h b e n e fits f o r o b s t e t r i c a l and s e r v i c e b e n e fits f o r o t h e r s u r g i c a l p r o c e d u r e s . W ith on e e x c e p t io n , b o th w o m e n w o r k e r s and d e p e n d e n t w iv e s w e r e c o v e r e d b y the s a m e ty p e o f b e n e fit. C a sh m a t e r n it y b e n e fits w e r e a v a ila b le to w o m e n w o r k e r s and d e p e n d e n t w iv e s in 223 and 217 p la n s , r e s p e c t i v e l y ; s e r v i c e b e n e fits w e r e p r o v id e d in the r e m a in in g p la n s (ta b le 2 8). H o w e v e r , s e r v i c e b e n e fits w e r e r e s t r i c t e d to s u b s c r i b e r s w ith in c o m e s b e lo w s p e c if ie d lim it s b y 34 s e r v i c e p la n s ; th o s e w ith i n c o m e s a b o v e the lim it s r e c e iv e d c a s h b e n e fit s . 36 T a b le 2 8 . T y p e s o f s u r g i c a l m a te r n ity b e n e fit s p r o v id e d w o m e n w o r k e r s and d ep e n d e n t w iv e s , la te s u m m e r 1959 1 (W o r k e r s in th o u s a n d s) T y p e o f b e n e fit and grou p c o v e r e d A l l p la n s p r o v id in g s u r g i c a l b e n e fit s f o r m a te r n ity c a s e s -------------------------------- Cagh S p e c ifie d o b s t e t r i c a l a l l o w a n c e --------G e n e r a l lu m p -s u m a l l o w a n c e -----------C o -in s u r a n c e ---------------------------------------S e r v i c e --------------------------------------------------------W ith in c o m e l i m i t s ------------------------------W ith ou t in c o m e l i m i t s -------------------------- W om en w o rk e rs D e p en d en t w iv e s P la n s W ork ers 2 P la n s W ork ers 276 4 , 510. 6 269 4 ,5 4 4 .1 223 190 32 1 53 34 19 3, 52 4. 5 2 ,5 4 9 .2 971. 1 4 .2 986. 1 795. 7 1 9 0 .4 217 179 37 1 52 34 18 3 ,3 9 4 .9 2 ,4 3 3 .6 957. 1 4 .2 1 ,1 4 9 .2 7 9 5 .7 3 5 3 .5 1 S ee fo o t n o t e s 1 and 2 , ta b le 4 . 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 ot in d ic a t e the r e la t iv e fr e q u e n c y o f u s e o f m a t e r n it y b e n e fit s s in c e the 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 . A s tip u la te d a m ou n t f o r n o r m a l d e li v e r y w as p r o v id e d w o m e n w o r k e r s and d e p e n d e n t w iv e s in 190 and 179 o f th e p la n s , r e s p e c t i v e l y , w ith c a s h b e n e f i t s . 39 A g e n e r a l lu m p -s u m a llo w a n c e that c o u ld b e u s e d to w a r d o b s t e t r i c a l and o t h e r e x p e n s e s w as a v a ila b le in a ll e x c e p t o n e o f the r e m a in in g c a s h b e n e fit p la n s . 40 M a te r n ity b e n e fits w e r e a v a ila b le im m e d ia t e ly to n e w ly in s u r e d w o m e n w o r k e r s u n d e r 48 p la n s and to d e p e n d e n t w iv e s u n d e r 45 p la n s (ta b le 2 9). A l m o s t a ll o f th e r e m a in in g p la n s h ad w a itin g p e r i o d s th at c o v e r e d th e d u r a tio n o f n o r m a l p r e g n a n c ie s . A b o u t o n e - f i f t h o f th e p la n s p r o v id e d s e r v i c e b e n e fit s in m a t e r n it y c a s e s , 41 c o m p a r e d w ith o n e - f o u r t h in n o n m a t e r n it y c a s e s . H o w e v e r , m o r e than th r e e ou t o f f iv e h ad in c o m e lim it s on s e r v i c e b e n e f i t s . 42 39 E x c lu d e s 34 s e r v i c e p la n s p a y in g c a s h b e n e fits to th o s e o v e r the in c o m e lim it s and 1 p la n w h ich p r o v id e d m a t e r n it y b e n e fits on a c o - i n s u r a n c e b a s is . 40 T h e s e g e n e r a l lu m p - s u m a llo w a n c e s w h ich a r e p r o v id e d in lie u o f a ll o r s o m e o f the b a s i c p la n b e n e fits a r e d e s c r i b e d in H ea lth and In s u r a n c e B e n e fits U n d e r C o lle c t iv e B a r g a in in g : H o s p ita l B e n e fit s , E a r ly 1959 (B L S B u ll. 1274, p p . 36 and 37). 41 U n d e r a fe w p la n s , the p a tie n t w a s r e q u ir e d to p a y an in itia l m a t e r n it y f e e (e . g. , the f i r s t $ 6 0 o f h o s p ita l, s u r g i c a l, and m e d ic a l e x p e n s e s ) ; t h e r e a f t e r , b e n e fits w e r e a v a ila b le w ith ou t fu r t h e r c o s t . 42 In a d d itio n to p a y in g f o r o b s t e t r i c a l s e r v i c e s , p r e n a t a l c a r e w as p r o v id e d b y m o s t g r o u p p r a c t i c e p r e p a y m e n t p la n s , but w as o n ly r a r e l y in c lu d e d in the s e r v i c e b e n e fits p r o v id e d b y the in d iv id u a l p r a c t i c e p la n s , s u c h as B lu e S h ie ld . 37 T a b le 2 9 . A v a ila b ilit y o f s u r g i c a l b e n e fit s f o r n o r m a l d e liv e r y m a t e r n it y c a s e s to n e w ly in s u r e d w o m e n w o r k e r s and d ep en d en t w iv e s , la te s u m m e r 1959 1 (W o r k e r s in th o u s a n d s) W om en w o rk e rs D ep en d en t w iv e s A v a ila b ilit y o f b e n e fit s A l l p la n s p r o v id in g s u r g i c a l b e n e fit f o r n o r m a l d e l i v e r y m a t e r n it y c a s e s ------ B e n e fits b e c o m e a v a ila b le im m e d ia t e ly If p r e g n a n c y c o m m e n c e s w h ile in s u r e d A ft e r b e in g in s u r e d f o r — L e s s than 8 m o n th s ----------------------------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 v e r 12 m on th s -------------------------------------- P la n s W ork ers 2 P la n s W ork ers 276 4 ,5 1 0 .6 269 4 ,5 4 4 . 1 48 118 1 ,0 0 1 .3 2 ,3 6 0 . 8 45 118 1 ,1 0 4 .2 2 ,3 8 2 .4 3 8 82 14 1 2 3 1 .3 1 0 5 .0 8 1 8 .9 1 6 5 .8 1 1 .0 16. 5 2 8 80 13 1 2 2 6 .3 1 0 5 .0 7 4 2 .4 156. 3 1 1 .0 16. 5 1 S ee fo o t n o t e s 1 and 2 , ta b le 4 . 2 S ee fo o t n o t e 2 , ta b le 2 8 . T h e ’ ’n o r m a l d e l i v e r y ” a llo w a n c e p r o v id e d w o m e n w o r k e r s and d e p e n d e n t w iv e s v a r i e d f r o m l e s s than $ 5 0 to $ 1 2 5 (ta b le 30). The a m ou n ts m o s t f r e q u en tly s p e c if ie d w e r e $ 5 0 , $ 7 5 , and $ 9 0 . Th e a v e r a g e a llo w a n c e f o r w o m e n w o r k e r s w as $ 8 1 ; f o r d e p en d en t w iv e s , $ 7 4 . H ig h e r o b s t e t r i c a l a llo w a n c e s w e r e g e n e r a lly fou n d in p la n s p r o v id in g s e r v i c e b e n e fits w ith in c o m e lim it s than in p la n s p r o v id in g c a s h b e n e fits w ith no in c o m e lim i t s . F o r e x a m p le , o v e r h a lf o f the p la n s w ith the f o r m e r typ e o f b e n e fit s p e c i f i e d a n o r m a l d e li v e r y a llo w a n c e o f $ 9 0 o r m o r e as a g a in s t a th ir d o f th o s e p r o v id in g c a s h b e n e fit s . Id e n tic a l a m ou n ts w e r e p r o v id e d w o m e n w o r k e r s and d e p e n d e n t w iv e s in 188 o f the 202 p la n s w ith a " n o r m a l d e l i v e r y ” a llo w a n c e f o r b oth g r o u p s . W h e re a d iffe r e n t a m ou n t w as s p e c if ie d f o r d e p e n d e n ts , it w as u s u a lly at le a s t 70 p e r ce n t o f the a llo w a n c e p r o v id e d w o m e n w o r k e r s . Th e p e r c e n t o f the n o r m a l d e l i v e r y a llo w a n c e p r o v id e d w o m e n w o r k e r s that w as p r o v id e d d e p e n d e n t w iv e s is sh ow n in the fo llo w in g ta b u la tio n : P ercen t A ll p la n s w ith n o r m a l d e li v e r y a llo w a n c e s f o r b oth w o m e n w o r k e r s and d ep en d en t w iv e s _______________________________ 100 p e r c e n t . ___ 80 and u n d e r 90 p e r c e n t 70 and u n d e r 80 p e r c e n t 60 and u n d e r 70 p e r c e n t 50 and u n d e r 60 p e r c e n t P la n s 202 188 2 8 1 3 W ork ers (th o u s a n d s ) 2, 983. 6 2 ,3 5 2 . 9 502. 5 78. 2 1. 0 4 9. 0 A ll o f the p la n s w ith a l o w e r n o r m a l d e li v e r y a llo w a n c e f o r d e p e n d e n t w iv e s a ls o p r o v id e d a l o w e r m a x im u m s c h e d u le a llo w a n c e f o r d e p e n d e n ts than fo r w o rk e rs. 38 T a b le 30. N o r m a l d e liv e r y m a te r n ity s u r g ic a l a llo w a n c e s f o r w o m e n w o r k e r s and d epen den t w i v e s , late s u m m e r 1959 1 _________________________________ (W o r k e r s in th ou sa n d s) W om en w o r k e r s D ep en d en t w iv e s N o r m a l d e liv e r y a llo w a n c e W ork ers 2 P la n s A l l p lan s p ro v id in g a n o r m a l d e liv e r y a llo w a n c e 3 ----------------------------- U nder $ 5 0 ------------------------------------------ ------$ 5 0 ------------------------------------------------------------$ 6 0 ------------------------------------------------------------$ 6 0 .0 1 and u n d e r $ 7 5 ----------------------------$ 7 5 ------------------------------------------------------------$ 7 5 .0 1 and u n d e r $ 9 0 ----------------------------$ 9 0 ------------------------------------------------------------$1 0 0 ------------------ ---------------------------------------$1 05 ------------------------------ ---------------------------$ 1 2 5 ....................................................................A v e r a g e s u r g ic a l a llo w a n c e 4 —------------- P la n s W ork ers 3 ,2 2 9 .3 224 3 ,3 4 4 .9 213 5 45 10 11 76 10 38 15 4 10 2 1 7 .2 2 9 8 .2 5 6 .0 87. 1 628. 7 78. 7 1 ,6 8 3 .2 1 4 1 .4 79. 1 75.3 3 49 9 14 68 9 37 11 2 11 1 $81 205. 0 828. 6 5 3 .0 124. 1 523. 1 7 8 .2 1 ,1 8 3 .2 109. 7 19. 1 105. 3 • $74 1 See fo o tn o te s 1 and 2 , ta b le 4. 2 76 and 269 plans p r o v id e d m a te r n ity s u r g ic a l b e n e fits f o r w o m e n w o r k e r s and depen den t w iv e s , r e s p e c t iv e ly . 2 See fo o tn o te 2 , ta b le 28 . 3 In clu d es the 34 s e r v i c e p lan s w ith in c o m e lim it s ; the a llo w a n c e s u n d er th ese plans w e r e a p p lic a b le to w o r k e r s and depen den ts w ith in d iv id u a l o r fa m ily in c o m e s o f m o r e than a s p e c if ie d am ou n t. E x clu d e s 32 and 37 p lan s w h ich p r o v id e d a g e n e r a l lu m p -s u m a llo w a n c e f o r w o m e n w o r k e r s and depen den t w iv e s , r e s p e c t iv e ly . 4 B e n e fit p r o v id e d b y e a c h p la n w eig h ted b y n u m b er o f w o r k e r s c o v e r e d . T a b le 31 . L o c a tio n o f m e d ic a l c a r e f o r w h ich b e n e fits f o r n o r m a l d e liv e r y m a te r n ity c a s e s w e r e p r o v id e d w o m e n w o r k e r s and depen den t w iv e s , la te s u m m e r 1959 1 (W o r k e r s in th ou sa n d s) W om en w o r k e r s A l l p la n s p r o v id in g m e d ic a l b e n e fits f o r n o r m a l d e liv e r y m a te r n ity c a s e s ---------------------------------- C ash T o ta l L o c a tio n P la n s S e r v ic e P la n s W ork ers W ork ers 2 P la n s 35 635. 0 21 4 8 2 .9 3 14 152. 1 5 29. 8 4 2 2 .0 1 7. 8 29 1 5 9 7 .0 8 .2 17 4 6 0 .9 12 1 136. 1 8 .2 W ork ers 2 M e d ic a l b e n e fit f o r d o c t o r 's c a r e in— H o s p ita l, d o c t o r 's o f f i c e , and h o m e ----------------------------------------D o c t o r 's o ff ic e o n l y ------------------------- - - D ep en d en t w iv e s A l l p lan s p r o v id in g m e d ic a l b e n e fits f o r n o r m a l d e liv e r y m a te r n ity c a s e s ---------------------- --------— 35 7 3 2 .5 M e d ic a l b e n e fit f o r d o c t o r 's c a r e in— H o s p ita 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 ----------------------------------------D o c t o r 's o ff i c e o n l y ------------------------ 7 2 3 2 .8 27 1 4 9 1 .5 8 .2 20 4 0 0 .5 3 15 5 45 . 1 2 187. 7 15 3 5 5 .4 ~ 12 1 136. 1 8 .2 - S ee fo o tn o te s 1 and 2 , ta b le 4. S ee fo o tn o te 2 , ta b le 2 8 . A ll o f th e se p lan s p r o v id e d s e r v i c e b e n e fits r e g a r d le s s o f in c o m e . 3 3 2 .0 39 M e d ic a l B e n e fit s . — In a d d itio n to p r o v id in g o b s t e t r i c a l b e n e f it s , 35 p la n s p r o v id e d w o m e n w o r k e r s and d ep en d e n t w iv e s w ith m e d ic a l b e n e fits f o r p r e n a t a l and p o s tn a ta l c a r e (ta b le 3 1 ) . 43 U s u a lly o u t - o f - h o s p i t a l as w e ll as in - h o s p it a l tr e a tm e n ts w e r e c o v e r e d . B e n e fits in the f o r m o f s e r v i c e s r a th e r than c a s h w e r e p r o v id e d b y a bou t t w o -fift h s o f the p la n s . C a sh b e n e fits ---- w ith fe w e x c e p t io n s , g e n e r a l lu m p -s u m a llo w a n c e s ---- w e r e p r o v id e d b y the re m a in in g p la n s . M a te r n ity m e d ic a l b e n e fits w e r e a v a ila b le im m e d ia t e ly to n e w ly in s u r e d w o m e n w o r k e r s and d e p en d en t w iv e s u n d e r 13 p la n s (ta b le 32). T h e re m a in in g p la n s c o v e r e d p r e g n a n c ie s c o m m e n c in g a ft e r in d iv id u a ls b e c a m e in s u r e d . T a b le 3 2 . A v a ila b ilit y o f m e d i c a l b e n e fit s f o r m a te r n ity c a s e s to n e w ly in s u r e d w o m e n w o r k e r s and d ep en d en t w iv e s , la te s u m m e r 1 9 5 9 1 (W o r k e r s in th ou sa n d s) W om en w o rk e rs D ep en d en t w iv e s C o n d itio n s g o v e r n in g a v a ila b ilit y o f b e n e fit s P la n s W ork ers 2 P la n s P la n s p r o v id in g m e d i c a l b e n e fit s f o r m a te r n ity c a s e s -------------------— -------- 35 6 3 5 .0 35 7 3 2 .5 B e n e fits b e c o m e a v a ila b le im m e d ia t e ly o n b e c o m in g i n s u r e d ----------------------------- 13 2 5 9 .8 13 3 6 2 .2 16 2 7 6 .9 16 2 7 6 .8 4 2 2 5 .5 7 2 .8 4 2 2 0 .7 7 2 .8 P r e g n a n c y c o m m e n c e s w h ile in s u r e d — A ft e r b e in g in s u r e d f o r — 9 m o n t h s -----------------------------------------------10 m o n th s — — — - ----- ------ W ork ers 1 S e e fo o t n o t e s 1 and 2 , ta b le 4 . 2 S e e fo o t n o t e 2 , ta b le 2 8 . 43 in c lu d e d w ith th e p la n . In o t h e r p la n s , th e s e p r e n a t a l and p o s tn a ta l tr e a tm e n ts w e r e o c c a s i o n a l l y the o b s t e t r i c a l b e n e fit p r o v id e d u n d e r the s u r g i c a l p r o v i s io n s o f ☆ U. S. GOVERNMENT PRINTING OFFICE: I960 O - 577202 Recent BLS Industrial Relations Studies B u ll. N o . T it le P r ic e A greem en t P r o v is io n s 1272 Union Security and Checkoff Provisions in Major Union Contracts , 1958-59. 20 cents 1266 C ollective Bargaining C lauses: Company Pay for Time Spent on Union Business. October 1959. 35 cents 1251 Premium Pay for Night, Weekend, and Overtime Work in Major Union Contracts, 1958. 30 cents 1248 Paid Holiday Provisions in Major Union Contracts, 1958. 25 cents 1233 Paid Vacation Provisions in Major Union Contracts, 1957. 30 cents 1216 C ollective Bargaining C lauses: Dismissal Pay. August 1957. 25 cents 1209 Analysis of Layoff, R ecall, and Work-Sharing Procedures in Union Contracts. March 1957. 30 cents E m p l o y e e -B e n e f i t P l a n s 1274 Health and Insurance Plans Under C ollective Bargaining: Hospital Benefits, Early 1959* 30 cents 1259 Pension Plans Under C ollective Bargaining: Part I. Vesting Provisions and Requirements for Early Retirement Part II. Involuntary Retirement Provisions, Late 1958. 25 cents 1250 Health and Insurance Plans Under C ollective Bargaining: Accident and Sickness Benefits, Fall 1958. 25 cents 1236 Digest of One Hundred Selected Health and Insurance Plans Under C ollective Bargaining, Early 1958. $1.25 1232 Digest of One Hundred Selected Pension Plans Under C ollective Bargaining, Winter 1957-58. 45 cents U n io n A c t i v i t i e s 1267 Directory of National and International Labor Unions in the United States, 1959. 45 cents 1263 Union Constitution Provisions: 30 cents 1239 Union Constitution Provisions: Election and Tenure of National and International Union O fficers, 1958. Trusteeship. November 1959. 30 cents Work S to p p a g e s 1278 Analysis of Work Stoppages, 1959. 40 cents G eneral 1225 1225-1 1225-2 A Guide to Labor-Management Relations in the United States. April 1958. Supplement No. 1. November 1958. Supplement No. 2. July 1959* (Punched for standard binders.) $2.00 45 cents 45 cents
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