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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 __________________________________________________________________

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T a b le s :
1.
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5.

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8.

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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 ____________________________________________




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Contents-— Continued
Page
T a b l e s :— C on tin u ed
13.

14.
15.
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19.
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21.

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23.

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25.
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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 _______________________________________________________




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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 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

-

W ork ers

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

R e t ir e d
w ork ers

P la n s

298

D e p e n d e n ts
o f a c t iv e
w orkers

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 __________ __ _______

4 , 69 9. 1

179

3 ,3 7 7 .4

205

3 ,3 7 7 . 1

145

2 , 55 8. 3

272

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

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 < m p lo y e r
e

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
P la n s

A ll p lan s stu d ied

---

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 _

-

37
1
2
1

25
26
10
13
1
6
2
14

___

_

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
.
... .

6 1 0 .2
6 .3
4 0 .8
1 .3

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

W ork ers

D ep en d en ts

P la n s
A ll p lan s p ro v id in g b e n e fits

_ __

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

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

M edical benefits

Active workers

Retired workers

Plans

2

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 ______________

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

A ctive worker s and R etired w ork ers and
their dependents
their dependents
Plans

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 ______________________

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
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

-

_

_

-

1

-

-

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 ________________

-

638. 9

11

3

37. 1

_
-

_
8
1

_
583. 8
18. 0

$200

1
6
o

3

103.0

8.2
72.0

2

35. 1

9

_
_
1

_
31. 8

_
_
-

-

1
-

3. 3
-

7
-

62. 9
-

_

12

_
-

O v e r $175
and un der
$2 00

$1 75

_

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

Children 2

Plans
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

____

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

86.0

38
4

26
6
5
441

1
60

11
18

16
13

1
$49

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

4

10

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

M e d ic a l b e n e fits

D ep en d en ts

W ork ers

D ep en d en ts

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

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

A l l p lan s p r o v id in g b e n e f i t s ___________
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 S ee fo o tn o te s

1 and 2,

-

-

_

-

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

W ork ers

1

626. 8

3. 0
606. 3

2
1

5. 7
6. 0

1

35.
10.
84.
10.

1
1
12
2

5 23

1
18

141. 0

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
65

1 ,2 6 5 . 6

15

1 3 6 .4

14

1 0 1 .4

64

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 —

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
P la n 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 --------------------------------------

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

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 2

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
C ash

T o ta l

L o c a tio n

W ork ers

35

635. 0

21

4 8 2 .9

3 14

152. 1

5

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

P la n s

S e r v ic e

P la n s

W ork ers 2

P la n s

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
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C ollective Bargaining C lauses: Company Pay for Time Spent on
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