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Maternity Benefits
UNDER UNION CONTRACT
Health Insurance Plans
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UNITED STATES DEPARTMENT OF LABOR
WOMEN’S BUREAU
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BULLETIN 214
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Letter
of transmittal
United States Department of Labor,
Women’s Bureau,
Washington, April 15, 19Ip.
Sir: I have the honor to present a report on maternity benefits
received by women workers under health insurance plans established
by union-management agreement. The study analyzes the experience
of women under eight plans and tries to evaluate the benefits they
received in relation to the costs they incurred. The field work and
the writing of the report were done by Jennie Mohr of the Bureau’s
Research Division.
Respectfully submitted.
_
Frieda S. Miller, Director.
Hon. L. B. Sciiwellenbach,
Secretary of Labor.
CONTENTS
Letter of Transmittal
m
Introduction___________________________________________i
General Description of EightPlans"’]]]”
The Experience of Claimants’
Number, Occupation, and Age ofClaimantsIII
Income MaintenanceI
Benefits for Payment ofMedical Services
10
Benefits for Miscarriage
Payment of Premiums by Workers
What the Records Show
15
hi
5
7
7
8
13
14
MATERNITY-BENEFITS UNDER UNIONCONTRACT HEALTH INSURANCE PLANS
INTRODUCTION
The purpose of this study is to examine the experience of a group
of women workers who received maternity benefits under unioncontract health insurance plans, to find out how much and what kind
of assistance such plans offer, how extensively the plans were used
for maternity needs, and, as far as possible, the extent to which the
plans compensated the workers for economic losses they incurred by
not working because of maternity.
The report considers eight industrial health insurance plans in
cluded in union agreements as well as the women who filed maternity
claims and received benefits under these plans. It presents the num
ber of maternity claims filed, the types of benefits allowed, and the
amount of money received in benefits. Some evaluation is given of
the relation between benefits received and wage losses incurred by the
workers.
THE BROAD PROBLEM OF MEDICAL CARE
It seems advisable, before discussing individual plans, to indicate
their place within the field of medical care for workers. Over a period
of years workers in this country have become increasingly aware of
the problems involved in obtaining adequate medical care for them
selves and their families. They have been learning what is meant by
“adequate medical care” and the relationship between medical care
and economic status. They have learned also that, regardless of eco
nomic status, there are specific needs that must be met if they are
to have “adequate medical care.” What are these needs, and how can
they be satisfied ?
A worker’s standard of living is determined largely by his earnings.
When disabling illness occurs, those earnings are threatened and fre
quently cut off. Thus a major need is the maintenance of income dur
ing periods of disability. There is usually little or no financial backlog
to provide maintenance for the worker who has temporarily lost his
wages through illness. Food, clothing, shelter, and the other necessi
ties must be provided, whether or not the pay check comes in.
Secondly, the special demands of illness must be met: doctors’ serv
ices, hospital and nursing care, medicines, and special treatments.
These are an additional drain on a family’s limited financial resources.
It is an old story that such needs are often not satisfied because there
is no money to pay for them.
Illness comes irregularly, often suddenly. It is unpredictable, not
only in terms of when it strikes, but also in terms of how long-lasting,
how serious, and how expensive it will be. Because illness is unpre1
2
MATERNITY BENEFITS
dictable, it cannot be planned for in a family budget in the same way
in which other more regular items can be anticipated. A way must
therefore be found to regularize the provision for medical care and
to protect the worker and his family from the loss of earnings when
the wage earner is disabled.
The establishment of prepayment health plans is one way of meet
ing the problem. These plans vary widely in their functions, cover
age, and costs. But they are all alike in providing illness or accident
benefits in exchange for regular weekly or monthly payments of a
specified amount. Costs for these benefits can thus be budgeted reg
ularly over a period of time, thereby reducing, if not eliminating, the
sudden financial demands of unexpected disablement.
The two basic needs—maintenance of income and provision of medi
cal care—may be met by prepayment plans. For the former, many
plans issue health insurance policies which provide cash benefits over
a specified number of weeks for each case of disability. These poli
cies, issued to groups of employed persons, usually establish the
amount of the weekly benefits in relation to the wages of the workers.
Frequently the benefits are scheduled according to a scale of wages
within the group and generally amount to something less than the
weekly wage.
There are, two main types of prepayment plans for medical care.
One is a health insurance indemnity plan, which pays specified sums
of money to the worker to be used for specified medical services.
Services covered by such payments may include one or more of the
following: hospitalization, extra hospital expenses, doctors’ visits,
surgeons’ fees, or special services. Schedules of payments indicate
the amounts that will be made available for each of these services:
the maximum daily amount for hospital room and board, the number
of doctors’ visits that will be paid for and the amount per visit, the
maximum sum in payment of particular surgical operations, and
either a flat amount or a percentage of the daily hospital benefit that
will be paid for hospital extras. These payments are sent directly
to the worker, who is responsible for the full medical costs whether
or not they exceed the amount of the benefits.
The second type of prepaid medical-care plan provides the actual
medical services rather than the money with which members pay for
services. The organization supplying the services may be created by
doctors, by consumers of medical services, or by employers. What
ever form the plan takes, it offers specified types of medical care in
exchange for regular prepayments by members.
Thus, in answering the question of how workers may protect them
selves from the financial drain accompanying illness or accident, one
finds that prepayment health plans offer:
(1) Weekly cash benefits in partial recompense for wage loss;
(2) Provision for medical care in either of two forms:
(a) Cash benefits for certain types and amounts of medi
cal care,
or
(b) Medical services in the form of medical and hospital
care, rather than money with which to pay medical
bills.
MATERNITY BENEFITS
3
THE INCLUSION OF MATERNITY BENEFITS IN HEALTH
INSURANCE PLANS
This study concerns the maternity benefits provided under certain
types of health insurance indemnity plans. Many plans exclude
maternity cases from coverage, although clearly the woman worker
who is an expectant mother faces problems, both of income main
tenance and of medical care, just as surely as does the ill or injured
worker. The economic demands of maternity, unlike those of many
illnesses or accidents, can of course be anticipated to some extent. At
the same time, unpredictable costs frequently arise, and the problems
of meeting wage loss, medical bills, and added expenses in the home
make it particularly necessary to include maternity cases in plans
covering working women.
Even when maternity benefits are provided, they usually are gov
erned by special regulations not applicable to other benefits. A large
proportion of plans which do include maternity benefits require a
waiting period of 9 months before a member is eligible for them;
general waiting periods for all other benefits, if they are required, are
much shorter. In plans which provide weekly cash payments, such
benefits run for a shorter time in maternity cases than in others—
typically for a 6-week period compared with a 13-week period in gen
eral cases of illness or injury. Plans providing cash benefits for hos
pitalization limit the number of payable hospitalization-days for
maternity cases to 10,12, or 14, whereas for other disabilities 3 weeks,
a month, or sometimes longer periods are allowed. Such longer pe
riods of hospitalization are generally not needed for maternity unless
complications arise. Similarly, plans providing medical care directly
often allow more limited benefits for maternity cases; limited serv
ices may be offered, or a special fee may be required.
I o have a reasonably full picture of the part such plans play in pro
viding some measure of economic security and health service for
women workers during periods of maternity, it would be desirable to
examine samples of all types of plans. The present study, however,
is confined to health insurance plans which provide maternity bene
fits and which are included in union agreements.
The growth of union-contract health insurance plans has been con
fined almost entirely to recent years. Wartime conditions were a
predominant factor in bringing health insurance plans under union
agreements, although there is also a general growing concern on the
part of unions for the health of their members. Both union officials
and employers have indicated their expectation that such plans will
continue to be included in contracts.
SELECTION OF PLANS FOR STUDY
The eight plans selected for study are believed to be, on the whole,
typical. No generalizations can or will be made, however, because of
the small number of claims involved.
Before selecting the health insurance plans to be studied, the fol
lowing requirements were decided upon as a basis for selection:
(1) Because the proportion of maternity claims to all claims is
small, the plans should cover a large number of women workers.
(2) Some plans require the insured worker to wait 9 months to 1
4
MATERNITY BENEFITS
year before she is eligible for maternity benefits. Therefore the plans
either should have been in effect long enough for workers to be eligible
for such benefits or should require no waiting period.
(3) Records of individual claims must be available.
(4) Both the unions and the employers, and in certain instances
the insurance companies, must be willing to cooperate by making
available both information about the plans and actual records of
claims.
A list of union-agreement health insurance plans was obtained from
various sources, including other branches of the United States De
partment of Labor, a consultant health insurance agency, research
departments of national unions, and trade-union publications. When
possible, information was obtained also on provisions of the plans,
specifically on maternity benefits and on administrative procedures,
to determine where records of individual claims could be obtained.
The plans varied widely in coverage, some having been established by
agreements between individual plants and local unions; others, by
agreements of unions with trade associations having many company
members.
In all, 256 plans in union agreements were listed, of which 137. were
known to include maternity benefits. From these, 8 plans, covering
20,000 eligible women workers, were chosen for examination.
Administration of the insurance rests variously with the union, the
employer, and the insurance company. Access to records was re
quested of officials having charge of them. From these records data
were obtained concerning (1) the amounts of money paid to individual
claimants for specific benefits, such as weekly allowances, hospital
expenses, or surgical benefits, (2) the worker’s age, wage rate, and,
if possible, occupation, (3) the elapsed time between the worker’s last
day of work and childbirth, and, in some instances, (4) the actual
amount of the hospital or doctor’s bill for the maternity case.
GENERAL DESCRIPTION OF EIGHT PLANS
Although the present study is concerned only with maternity bene
fits, a summary of the general provisions of the eight plans surveyed
will be given, in order to show the place of maternity care within the
total coverage for all disabilities. The number of women covered the
number of maternity claims, and the period included in the survey are
listed for the eight plans on page 7. The plans will be referred to
hereafter by number, as shown on this list. For each provision, the
following description presents, first, the general terms covering all
claims, second, special terms relating to maternity claims if such
qualifications exist.
ELIGIBILITY
Qualifications for coverage are specified in three plans: Plan 1
covers all employees who are union members in good standing: plan 3
covers office workers for hospitalization and surgical benefits but not
tor weekly cash payments for disability, whereas production workers
are covered for all benefits; plan 6 covers production workers only.
1 he remaining plans state merely that they cover “employees ”
Maternity benefits are provided under plans 7 and 8 only if the
woman worker is insured under a “husband-and-wife” or “family”
type of contract. In practice, however, maternity benefits were given
to some women who were insured under individual contracts.
WAITING PERIOD
Employees hired after a plan becomes effective are generally subiect
to a waiting period before they are eligible for benefits. Plans 4 and
7 require new employees to wait 1 month; plans 2 and 6. 3 monthsplans o and 8 6 months; and plan 3, 6 months for half benefits and
12 months for full benefits. Plan 1 covers new employees immediately
upon union affiliation.
J
For empioyees who had been hired before the effective date of the
plan, the waiting period was usually waived, or time of employment
prior to inauguration of the plan was counted as waiting time.
ter maternity benefits, a waiting period of 9 months after initial
enrollment is required under plans 1, 2, 4, 5, and 6. Plan 3 requires
12 months, as for general eligibility; plan 7 requires no waiting period
for maternity benefits; and plan 8 requires 11 months for eligibility for
hospitalization in maternity cases, although in some instances this
requirement seems to have been waived.
DEPENDENTS
Dependents are eligible for certain benefits under three of the plans
Plans 5 and 8 provide hospitalization only; and plan 7, hospitalization
and surgical benefits. Plan 5 carries the cost as part of the premium
paid by the employer. Workers under plans 7 and 8 may elect to
cover their dependents, provided the worker pays full costs of such
coverage.
LIFE AND ACCIDENT INSURANCE
Life insurance: Six out of eight plans include life insurance. Two
of them grant $1,000 and four grant $500.
740055'
5
6
MATERNITY BENEFITS
Accidental death and dismemberment: This benefit is carried by six
plans. Five pay a maximum sum of either $1,000 or $500, and one
provides payment based on the employee’s prior average earnings.
WEEKLY CASH BENEFITS
Weekly payments are provided by all plans. Benefits are paid at
a flat rate for all employees, or as a given percentage of the individual
worker’s earnings, or are scaled according to wage brackets. Amounts
of weekly benefits range from $10 to $35; in most instances, however,
in which a scaled rate is provided, women’s wages restrict benefits to
the lowest or two lowest rates. Except in one plan which carries
benefits for 52 weeks, benefits continue for 13 weeks per disability.
Injury and illness compensable under Workmen’s Compensation laws
are excluded.
■
Weekly cash benefits for maternity are paid, under all the plans, in
the same amount as for other claims, but for a period of only 6 weeks.
HOSPITALIZATION
Hospital care is covered in all plans. Two plans furnish hospitali
zation by arrangements with the Associated Hospital Service (Blue
Cross). Benefits of $4 or $5 per day are payable for from 21 to 50
days per disability. The Blue Cross plans provide hospital care for
21 days per contract year.
>
Four plans specify a payment up to $20 or $25 for miscellaneous
or special hospital expenses not covered by the hospitalization services.
A fifth plan provides similar benefits, though the maximum amount
could not be ascertained.
Hospitalization for maternity is provided for from 10 to 14 days,
rather than for longer periods as in other types of cases.
SURGICAL BENEFITS
Six plans provide surgical benefits on a scale of payments for
specified operations or treatments (plans 1, 3, 4, 5, 7, 8). Maximum
payments range from $112.50 to $175 for individual operations.
Surgical benefits for maternity, provided by five plans, are usually
$25 for miscarriage, $50 for delivery, and $100 for Caesarean surgery
or for operation for ectopic pregnancy.
OTHER BENEFITS
Plan 1 provides payments for a doctor’s services at home, at the
doctor’s office, or in a hospital. Fifty visits per disability, with a
maximum of three visits per week, are paid for at the rate of $2 for
office and $3 for home calls. Plan 2 provides the services of the local
Visiting Nurses Association.
The plan providing payment for doctors’ visits excludes pregnancy
cases from this benefit and also from surgical benefits for delivery.
PAYMENT OF PREMIUMS
Employers pay full costs of the insurance in six of the plans.
Workers pay part of the costs in plans 7 and 8, approximately (4 and
y2, respectively. In addition, workers pay in full for the benefits pro
vided their dependents under these two plans.
THE EXPERIENCE OF CLAIMANTS
The following analysis relates to women receiving maternity benefits
as insured individuals. It is based on records of maternity claims
paid under tlie insurance policies to individual workers covered by
the selected plans. The analysis does not include dependents of
workers, who are not employees under the terms of the contracts. The
following sections will discuss:
Number, occupation, and age of claimants.
Income maintenance.
Benefits for payment of medical and hospital expenses.
Benefits received when miscarriage occurs.
Premium payments made by women workers under two plans.
NUMBER, OCCUPATION, AND AGE OF CLAIMANTS
The number of women covered and the number of maternity claims
paid differ considerably from one plan to another. Because of the
small number of claims, records were obtained covering as long a period
as possible rather than for a uniform period under all plans. The
following tabulation shows, for each plan, the approximate average
number of women workers eligible for benefits during the period
surveyed, the number of maternity claims, and the length of time
covered by the records.
Plan number
All plans.
1.
2.
3.
45.
6.
7.
8.
Number of
women eli
gible (ap
proximate)
Number of
maternity
claims
20,470
251
15,000
590
100
250
1,480
600
1,500
950
149
10
6
6
9
4
32
35
Period
covered
(months)
12
26
23
13
26
18
18
12
The total number of claims actually considered is 185 rather than
251. Sixty-six of the claims under plan 1, included in the tabulation,
have been omitted from the analysis because they were open cases on
which information was not yet available. Twenty-five other open
cases, under various plans, are, however, included in the section of the
report on income maintenance, because on these cases weekly cash bene
fits had been paid in full; but because records on hospital and surgical
benefits were incomplete in these twenty-five cases, they are excluded
from the sections on these latter benefits.
Of the 185 women, 144, or over three-fourths, were factory workers.
Nine were office workers. Occupations of 32 women were not recorded,
though probably most, if not all, were also factory workers.
7
8
MATERNITY BENEFITS
The women’s ages ranged from 17 to 44 and averaged 28 years.
The following shows the percent distribution:
Percent
distribution
All claimants.
100
20 years and under
21-25 years_______
26-30 years_______
31-35 years_______
Over 35 years_____
8
30
26
24
12
INCOME MAINTENANCE
Weekly cash benefits are designed to provide income maintenance
by compensating partially for wages lost through disability. To
determine how effectively this purpose is achieved, three factors must
be taken into account: the actual amount of benefits, the length of time
lost from work, and the relation of benefits to wages.
WEEKLY CASH BENEFITS
All but six claimants had received the full 6 weeks of benefits. (See
p. 13.) The cash benefits ranged, with few exceptions, from $10 to
$20 per week. As indicated earlier, any one of three methods was
used for determining the amount of weekly benefits. The following
tabulation for the 185 women who received benefits shows the three
plans which provide a flat amount for all workers, the four with
benefits based on scaled series of wage brackets, and the one plan
which pays benefits equal to 60 percent of the individual worker’s
average earnings during the month immediately preceding the month
in which she left work.
Plan number
Basis for determining benefits
1_________________________________________
2............................ ................ ..................
3........... .. .................. ......................... Flat rate___________________ _______________
4
5..........................................................
6...................................................... .. ..........................
7.................................................................................
Flat rate........................................... ............................................
8.............................................................. .....................
Weekly
benefit
rate
Number of
women who
received
benefits
i $16. 59
10. 50
10.00
20.00
16.50
17.00
14.00
10. 50
15.00
10.00
20.00
15.00
6
2
17
14
34
1 Represents average amount received.
The distribution of benefits for the 83 women claimants under
plan 1 is as follows:
Benefit rate
Number of women
Less than $10__
$10, less than $15
$15, less than $20.
$20, less than $25.
$25 and over____
________
8
_______
_______
_______
_______
28
24
18
5
MATERNITY BENEFITS
9
AMOUNT OF TIME LOST FROM WORK
The total amount of time lost from work because of maternity can
not be determined from an examination of the maternity-claims
records. In many instances the workers had not yet returned to work;
in some the date of return had not been recorded; in others the workers
had given up their jobs. Fifteen records indicate the date work was
resumed. Seven showed the women had suffered miscarriages and
had returned to work after being out from 12 days to 3 months. The
remaining eight cases, which show periods of absence ranging from
almost 2 months to about 1 year and 8 months, are too few to be
significant.
The elapsed time between the worker’s last day of work and the
date of the child’s birth (or miscarriage) is more frequently known,
however, since both dates are available for 156 of the 185 claims.
For each of the 156 claims the number of weeks between these two
dates was recorded, and the average number of weeks then computed.
The elapsed time, ranging from less than 1 week to 33 weeks, averaged
17 weeks when miscarriage cases were included and 18 weeks when
they were excluded.
A distribution of the elapsed time follows:
Women claimants
Number of weeks between worker’s last day of work and date of child’s birth
Number
Percent
j_
All women'.................... ........................................
5 or less_____ __________ ______ ______ ____________
6-10_______________________________________________
11-15_______ ___________________________________________________
16-20_____________ _____________________________
21-25___________ ___________________________ ______ ______________ _
26-30.......... ................ .................................................................................. .. ..................
Over 30............................................................................................................................
10
20
i Excludes miscarriage cases.
One case is on record of a birth occurring 1 day after the woman
stopped working; another, 2 days afterward. One woman had re
mained at work until the very day of a premature birth.
Standards for the employment of women during pregnancy re
quire a prenatal leave of absence. The Women’s Bureau recommends
a leave of 6 weeks before and 2 months after childbirth, with addi
tional time upon the physician’s recommendation. Many employers
have put into practice this or a similar policy. Unions have recom
mended this policy for inclusion in their contracts. Six States have
passed laws prohibiting the employment of women for specified
periods, before and after childbirth, ranging from 2 weeks to 4 months
before birth and from 3 to 6 weeks after birth. Unfortunately, be
cause only eight plans are involved, one cannot say whether the present
records, according to which over five-sixths of the women took more
than 10 weeks’ leave before childbirth, are representative of the ex
perience of all women workers who stop working because of maternity.
RELATION OF WAGE LOSS TO TOTAL WEEKLY BENEFITS
The relation between maternity benefits paid and wages lost by
the women claimants cannot be determined for two reasons: first,
10
MATERNITY BENEFITS
the total time lost from work is not known; second, where compensa
tion is based on wages, the methods of defining the wages do not yield
exact or comparable figures.
In five of the eight plans the amount of weekly cash benefits paid
is determined by the workers’ wages. No generalizations can be
made, however, concerning these wages because of the small number
of plans and of workers involved, the uneven distribution of workers
among the plans, and the differences in methods of recording wages
for purposes of settling claims. Wages are sometimes computed
as average weekly earnings and sometimes as basic rates. One plan,
in which benefits ai’e based on the individual’s average earnings, uses
as a base the month immediately preceding the month in which the
worker left. Whatever the method used, however, in few instances was
the reported wage over $40 a week, and often it was under $30.
It may be pointed out, however, that the 6-week period covered
by weekly benefits is one-third the average length of time the claim
ants lost before their children were born. And, as shown above, over
90 percent were out for longer than 6 weeks before childbirth (for
only 1 woman was this period exactly 6 weeks). How much longer
after childbirth the wage loss continued or what proportion of the
women returned to their employment is not known. It must also
be considered that, regardless of whether the weekly benefits are a
flat amount, or are based on average earnings, on base rates of pay,
or otherwise computed, they are less than the full amount of wages.
These two factors taken together—the length of time of unemploy
ment in relation to number of weeks compensated, and the relation
of benefits to wages—show that for these women, as for all workers
disabled over a comparable period of time, the weekly benefits fall
considerably below the actual wage loss.
BENEFITS FOR PAYMENT OF MEDICAL SERVICES
HOSPITALIZATION 1
Among the women who received weekly maternity benefits, 87 also
received hospitalization benefits under six of the plans. Hospitali
zation benefits for 8 miscarriage cases are discussed on page 13.
Among the 79 other women for whom the amount in hospitalization
benefits is known, benefits ran as follows: $20-$30, 5; $31-$40, 21;
$41-$50, 43; $51-$60, 10. Thirty-two women, 40 percent of the total
number, received $50, 6 of them under plans providing $5 a day for
14 days and 26 under one providing $5 a day for 12 days.
Special questions of eligibility for hospitalization benefits arise in
the two other plans, which are under the Blue Cross and in which part
of the premium is paid by the worker. In plans 7 and 8 a woman
may elect to come under either a single or a family plan. Hospitali
zation for maternity cases is not included under the former type of
plan. For this reason 13 women covered by plan 7 were not eligible
for hospitalization, although 4 of them were probably eligible as de
pendents of their husbands who were employed in the same plant and
covered under the same plan. Nineteen women were eligible for
'Excludes miscarriage cases.
See separate presentation on p. 13.
MATERNITY BENEFITS
11
hospital benefits under the terms of their own family-type contracts
under plan 7.
( Under plan 8 an 11-month waiting period is required by the Blue
Cross plan in use. Because of this requirement, together with the
election of the single-coverage plan in some instances, 19 women did
not receive hospitalization benefits. Of the remaining 16 women who
did receive these benefits, 5 had transferred to individual policies
after leaving work. The inference is that these 5 women were also
ineligible for hospital care under the group plan, though it was not
possible to obtain further records on these individuals.
Aside from ineligibility under the terms of plans 7 and 8, the most
frequent known cause of failure to receive hospitalization benefits
appears to be failure to send in a hospital bill. A summary of reasons
for not receiving these benefits, under all plans except 7 and 8, follows.
No hospital bill received
ig
Known to be not hospitalizedI___
Received Emergency Maternity and Infant Care___ II_______
Reason unknown__________________
1
a2
22
1 May include some cases that were not hospitalized.
* One not certainly known to have received E. M. 1. C.
Although records give the maximum rate allowed per day and the
total amount paid for hospitalization benefits, it is not possible to
determine the actual number of days for which the women were
hospitalized. Three of the plans provide hospitalization at $4 per
day for a maximum of 14 days for maternity; two provide $5 per
day for 14 days; one provides $5 per day for 12 days; and the two
plans using the Blue Cross provide 10 days. A patient using a hospital
in which the daily rate charged exceeds that allowed by the plan must
herself pay the difference for each day of hospitalization, whether or
not she remains hospitalized for the maximum time allowed. A patient
using a hospital which charges less than the plan’s maximum daily
rate is allowed only the actual charge. The records indicate the total
amount paid for hospitalization but not the number of days the worker
was hospitalized. Thus, for example, under a plan allowing $5 a day
for 12 days, a record of $40 for hospital benefits does not show whether
the woman spent 10 days in a hospital charging $4 or 8 days in one
charging $5.
HOSPITAL EXTRAS
The five plans which allow lump sums for payment of extra hospital
charges covered 35 of the 185 women claimants. Twenty women re
ceived benefits for extras, most of them in amounts ranging from $10
to $15. One woman received a $25 benefit, four received $20, and one
woman received the minimum amount of $3. Five cases were still
open at the time the records were obtained.
RELATION OF HOSPITAL BENEFITS TO HOSPITAL COSTS
From the records of two plans the actual hospital costs as shown
in hospital bills were available for 72 cases. As the following tabula
tions indicate, most of the bills were between $50 and $100, whereas
most of the benefits amounted to $50 or less. In 75 percent of the cases
12
MATERNITY BENEFITS
the benefits were $50 or less, whereas in only 4 percent of the cases
were the bills this low.
Hospital costs
Hospital benefits J
Number
of cases
Amount
All cases.................................. ............
72
Under $51.................... ................... ..............
$51-$75._____________ ___________
$76-$100__________________
$101—$125........... .......................... .................
$126-$150-................... ....................................
$151-$175............................................
3
40
18
4
5
2
Amount
Number
of cases
72
$21-$25 ...
$26-$30..............
$31-$35.............................................
$36-$40......................
$41-$45__
$46-$50___________ _________________
$51-$55................................................... .
$56-$60........ .......... ................................... .
$61-$65........................................................
$66-$70______ _______________ ______
1
1
1
7
8
10
26
3
11
2
2
1 Under one plan, covering 9 cases, these benefits included payments, ranging from $10 to $25, for hos
pital extras.
Three women who received hospitalization benefits under their
union plans also received benefits from the Blue Cross Service to which
presumably they had independently subscribed:
One woman, with a $55 hospital benefit and an $84 bill, re
ceived also $60 for hospitalization under the Blue Cross.
One woman, with a $50 benefit and an $80.36 bill, received the
difference of $30.36 from Blue Cross.
One woman with a $45 benefit and a $58.50 bill, received $58.50
for hospital expenses from Blue Cross.
SURGICAL BENEFITS !
A customary scale of benefits for surgical services for maternity
cases, followed by four of the five plans covering this item, allows
a maximum payment of $25 for miscarriage, $50 for ordinary delivery,
and $100 for Caesarean operation or ectopic pregnancy. The fifth
plan pays, respectively, $18.75, $37.50, and $75.
Like hospitalization benefits, the surgical benefits listed are the
maximum amount, paid in full only if the charges are equal or higher.
For only three of the deliveries, however, was less than the maximum
benefit paid. As will be seen later, the actual charge was sometimes
considerably higher than the benefit.
Again it was found that not all women claimed the benefits for
which they were eligible. Among 58 closed cases covered by surgical
benefits, 13 women who had not filed claims failed to receive benefits.
One of these women, and possibly two more, received benefits from
the Government’s Emergency Maternity and Infant Care program
(E.M.I.C.) and did not get insurance payments. Another did not
receive surgical benefits because she was delivered at home by a
midwife.
SURGICAL BENEFITS AND DOCTORS’ BILLS
Few records indicated the amount of physicians’ fees. Informa
tion was available on 9 cases under one plan which provides a $50
surgical benefit and on 27 cases under another plan which provides
1 Excludes miscarriage cases.
See separate presentation on p. 14.
13
MATERNITY BENEFITS
no surgical benefits. Among the former, the doctors’ bills ranged in
amount from $65 to $100; four were for $75, and three for $100.
The physicians’ bills submitted by 27 claimants, despite the fact
that their plan did not provide benefits either for surgical care or for
physicians’ visits on maternity cases, called for the following fees:
under $50,5; $50-$74,11; $75-99,6; $100 or over, 5.
BENEFITS FOR MISCARRIAGE
Of the 185 women who received maternity benefits, 16 3 had mis
carriages. In one instance miscarriage occurred on the day the
worker left the job, in two others it occurred the following day. Six
miscarriages occurred within 1 month after leave was taken, and one
not until 21 weeks later. In six cases the date of miscarriage is
pot known.
CASH BENEFITS
Ten of the sixteen women received the full 6-week disability benefit,
in amounts ranging from $37.80 to $175.98. The distribution of these
benefits is included in the distribution of weekly benefits for all
maternity cases, shown on page 8.
Payments to six women receiving less than 6 weeks’ benefits were
as follows:
Plan number
Case
number
45
5
8
12
14
25
Weekly
benefit
rate
$15. 84
10.50
10.50
15.00
15.00
15.00
Total cash
Total length of time away from
benefits
work
paid
$70. 06
3.00
7.50
40. 71
64.29
17.14
Unknown.
Terminated employment.
12 days.
3 weeks, 6 days.
5 weeks, 3 days.
2 weeks, 2 days.
Benefit payments to eligible workers generally do not begin until
the second week of disability (except in case of accident). This
requirement may account for the fact that the total benefits paid do
not cover the total length of time away from work, when this is less
than the maximum allowance of 6 weeks.
Case 5 in plan 2, listed above, was recorded as “either miscarriage
or not pregnant.” Disability, for which only $3 was received in
benefits, was ended 9 days after leave was taken. Case 72 in plan 1,
covering a worker who received the full 6 weeks’ benefits and $40 for
hospitalization, was recorded as “threatened miscarriage.”
HOSPITALIZATION BENEFITS
Thirteen women were eligible for such benefits under the terms of
their policies. Eight received benefits varying in total amount from
$12 to $60. Among the remaining 'five women were two who, for
undetermined reasons, received no benefits, two for whom informa
tion was not available, and one who did not go to the hospital.
The $60 benefit went to a woman who had an ectopic pregnancy.
Aside from the hospitalization benefit this worker, under plan 1,
received a 6-week cash benefit as well as a $60 surgical benefit for the
3 Includes one ectopic pregnancy.
14
MATERNITY BENEFITS
necessary operation. The latter payment, despite the plan’s exclusion
of maternity cases from surgical benefits, was apparently made under
the general provisions for surgical care. (For the one Caesarean
operation recorded, however, the plan did not make a surgical
allowance.)
SURGICAL BENEFITS
Of the six women eligible for benefits, only two received them; three
women, again for undetermined reasons, failed to receive them; and
one woman’s case was still open.
PAYMENT OF PREMIUMS BY WORKERS
Under six plans premiums are paid in full by the employers. Plans
7 and 8 require the workers to pay 25 and 50 percent, respectively, of
the costs of their own insurance and also the full premiums for hospi
talization of dependents. Premium rates vary within each of these
plans. Rates are determined in part by elected coverage—the worker
herself, the worker and her husband, or the worker, her husband, and
children; in part, rates are determined by the worker’s wage bracket.
Special wartime provisions had been made in one plan for women
whose husbands were serving in the armed forces.
Amounts actually paid by the women claiming maternity benefits
varied in one plan from 16 to 49 cents a week, in the other from $1.97
to $3.22 a month. Approximately two-thirds of the women had each
paid a total of $20 or less in premiums, from the time they originally
were covered by the plan to the time they stopped working. Under
one plan 35 women had paid total premiums averaging $16.71 each
and received maternity benefits averaging $123 each, which repre
sented weekly cash benefits paid to all 35 women and surgical benefits
claimed by 27 of them. In addition the women received hospitaliza
tion benefits, the value of which could not be ascertained. Under the
other plan 31 women had paid average total premiums of $15.65. A
comparison of premiums paid with maternity benefits received, avail
able for only 11 of these women, showed total premiums averaging
$13.52 4 and benefits in weekly payments and in surgical fees averaging
$96.82, plus hospitalization benefits of unreported value.
Costs to workers who pay part of their premiums should be con
sidered in relation to all benefits received, not to maternity benefits
alone. Records on such total benefits were available for one of these
two plans. It was found that benefits for other disabilities had been
paid, within the period studied, to 7 of the 35 women who received
maternity benefits. Amounts ranged from $22.86 to $252.14.
* Premium payments by these 11 women, among the first to receive such beneijts under
the plan, were of shorter duration than those by the total group of 31 women ; hence, prob
ably, the difference in average total premium payments between $13.52 and $15.65.
STATE COLLEGE LIBRARY
WHAT THE RECORDS SHOW
Because this study covers only eight plans, it does not permit of
general conclusions. The eight^plans all show, however, a fair sim
ilarity in the maternity benefits offered. Weekly cash benefits run
ning for 6 weeks and furnishing partial compensation for wage loss
are found in all the plans studied. Hospitalization benefits are more
or less comparable in all the plans, but payment may be hedged about
by eligibility qualifications not applicable to weekly cash benefits. Sur
gical benefits may be excluded entirely; most of the plans in which
they do occur use the same standard schedule of payment for maternity
cases.
The following paragraphs summarize the information obtained
from the records:
.
1. Of the 20,000 women covered by these plans, 251 received bene
fits for maternity.
2. There is no doubt that the aid afforded to women through
maternity benefits lifts some part of the economic load from their
shoulders. Under most of the plans the workers did not pay pre
miums. Several women who did share costs with employers also re
ceived benefits for other disabilities, in addition to the maternity
benefits. It should be remembered, however, that these women were
among the first to receive maternity benefits under the plans and
therefore had paid relatively few premiums before receiving these
benefits.
3. The average 18-week period of absence from work before child
birth seems long in comparison with the 6-week period for which
weekly cash benefits are paid. Moreover, the duration of postnatal ab
sence from work has not been taken into account. It would be desirable
to discover whether the average 18-week prenatal leave is charac
teristic of a larger and more representative group of women workers.
4. The actual relation of benefits to wages cannot be shown, largely
because of the variety of methods used to define wages for the purpose
of determining benefits. Whatever the method, however, because
most of the women came within either the lowest or next to the lowest
wage bracket, they did not receive the maximum cash benefits per
missible under the various plans.
5. According to the records examined, hospitalization and surgical
benefits were less widely received than were weekly cash benefits.
Many women, apparently, did not avail themselves of hospitalization
and surgical benefits to which they were entitled.
The failure on the part of women to claim hospital and surgical
benefits for which they are eligible is of considerable interest. Prob
ably m some unrecorded instances other arrangements, such as use of
the Federal program for Emergency Maternity and Infant Care or of
community facilities, had been made to insure proper care. But it
may be that further education on the subject is needed to give workers
15
16
MATERNITY BENEFITS
a clear knowledge of what benefits their policies entitle them to and
why it is important to get those benefits.
6. Where hospital costs are known, they are almost always higher
than the amount paid in benefits. This situation may arise from a
number of factors: the limitations on the daily rate permitted and the
services included under this rate, the wartime shortage of hospital
space and personnel which may have shortened the hospital stay, or
the provision in the plan for a longer period of hospitalization than
was generally found necessary. Because of the limitations on daily
rate and on services covered, a woman may incur an additional hospital
bill without having exhausted the total hospitalization benefit.
7. To evaluate the benefits received under health insurance plans,
a number of questions require exploration. Among them are the
following:
(а) Are the experiences of the women under these eight plans
representative of circumstances found elsewhere;
(б) What actual wage losses are incurred, in comparison with
benefits received, and how much time is actually lost from work;
(c) What are the total maternity costs, including hospital and
medical costs;
(d) To what extent can the economic needs of the women be recon
ciled with insurance practice requirements, in determining amounts
and periods of benefits.
These questions require a broad study of programs for maternity
care, including both indemnity plans and direct medical service plans.
X
PUBLICATIONS OF THE WOMEN’S BUREAU
For complete list of publications, write the Women’s Bureau.
Single copies of these publications—or a small supply for special educational
purposes may be secured through the Women’s Bureau without charge, as long
as the free supply lasts. These bulletins may be purchased direct from the
Superintendent of Documents, Washington 25, D. 0., at prices listed. A discount
of 25 percent on orders of 100 or more copies is allowed. Leaflets may be
secured from the Women’s Bureau.
BULLETINS AVAILABLE FOR DISTRIBUTION, PUBLISHED SINCE 1940
No.
157. ihe Legal Status of Women in the United States of America, January 1938,
United States Summary. 1941. 89 pp. 15<#. No. 157-A. Cumulative
Supplement, 1938-1945. 31 pp. 1946, 100. Leaflet—Women’s Eligi
bility for Jury Duty. July 1945.
175. Earnings in the Women’s and Children’s Apparel Industry in the Spring of
1939. 91 pp. 1940. 150.
176. Application of Labor Legislation to the Fruit and Vegetable Canning and
Preserving Industries. 162 pp. 1940. 200.
177. Earnings^and Hours In Hawaii Woman-Employing Industries. 53 pp.
178. Women’s Wages and Hours in Nebraska. 51pp. 1940. 100.
180. Employment in Service and Trade Industries in Maine. 30 pp. 1940. 100.
182. Employment of Women in the Federal Government, 1923 to 1939 60 pp
1941. 100.
183. Women Workers in Their Family Environment. (City of Cleveland State
of Utah.) 82 pp. 1941. 150.
185. The Migratory Labor Problem in Delaware. 24 pp. 1941. 100.
186. Earnings and Hours in Pacific Coast Fish Canneries. 30 pp. 1941. 100.
187. Labor Standards and Competitive Market Conditions in the Canned-Goods
Industry. 34 pp. 1941. 100.
188. Office Work in 5 Cities in 1940 :
1. Houston (100) ; 2. Los Angeles (100) ; 3. Kansas City (150) : 4 Rich-ico t,
. tJ‘?,od (1?0) : 5- Philadelphia (150) ; Chart, Salary Rates in 5 Cities.
189. Part 1. Women s Factory Employment in an Expanding Aircraft Production
Program. 12 pp. 1942. 50. (See Bull. 192-1.)
Part 4. Employment of and Demand for Women Workers in the Manufac
ture of Instruments—Aircraft, Optical and Fire-Control, and Surgical and
Dental. 20 pp. 1942. 50.
190. Recreation and Housing for Women War Workers: A Handbook on Stand
ards. 40 pp. 1942. 100. (See also Special Bulls. 11 and 17 )
191. State Minimum-Wage Laws and Orders, 1942: An Analysis. 52 pp and 6
folders. 1942. 200. Supplements through 1946. Mimeo. Progress of
Minimum-Wage Legislation, 1943-1945.
192. Reports on employment of women in wartime industries:
1. Aircraft Assembly Plants (100) ; 2. Artillery Ammunition Plants
(50) ; 3. Manufacture of Cannon and Small Arms (100) ; 4 Machine
Tool Industry (100) ; 5. Steel (100) ; 6. Shipyards (200) ; 7. Found
ries (100) ; 8. Army Supply Depots (100) ; 9. Cane-Sugar Refineries
(100).
195. Women Workers in Argentina, Chile, and Uruguay. 15 pp. 1942. 50.
196. “Equal Pay” for Women in War Industries. 26 pp. 1942. 100.
197. Women Workers in Some Expanding Wartime Industries—New Jersey. 1942
44 pp. 1943. 100.
’
198. Employment and Housing Problems of Migratory Workers in New York and
New Jersey Canning Industries, 1943. 35 pp. 1944. 100.
199. Successful Practices in the Employment of Nonfarm Women on Farms in
the Northeastern States. 44 pp. 1944. 100.
17
18
PUBLICATIONS OF THE WOMEN’S BUREAU
No.
200. British Policies and Methods in Employing Women in Wartime. 44 pp.
1944. 10^.
201. Employment Opportunities in Characteristic Industrial Occupations of
Women. 50 pp. 1944. 100.
202. State Labor Laws for Women with Wartime Modifications, Dee. 15,1944.
Part I. Analysis of Hour Laws. 110 pp. 1945. 150.
Part II. Analysis of Plant Facilities Laws. 43 pp. 1945. 100.
Part III. Analysis of Regulatory Laws, Prohibitory Laws, Maternity
Laws. 12 pp. 1945. 50.
Part IV, Analysis of Industrial Home-Work Laws. 26 pp. 1945. 100.
Part V. Explanation and Appraisal. 66 pp. 1946. 150.
203. The Outlook for Women in Occupations in the Medical and Other Health
Services.
No. 1—Physical Therapists. 14 pp. 1945. 100.
No. 2—Occupational Therapists. 15 pp. 1945. 100.
No. 3—Professional Nurses. 66 pp. 1946. 150.
No. 4—Medical Laboratory Technicians. 10 pp. 1945. 100.
No. 5—Practical Nurses and Hospital Attendants. 20 pp. 1945. 100.
No. 6—Medical Record Librarians. 9 pp. 1945. 100.
No. 7—Women Physicians. 28 pp. 1945. 100.
No. 8—X-Ray Technicians. 14 pp. 1945. 100.
No. 9—Women Dentists. 21 pp. 1945. 100.
No. 10—Dental Hygienists. 17 pp. 1945. 100.
No. 11—Physicians’ and Dentists’ Assistants. 15 pp. 1946. 100.
No. 12—Trends and Their Effect Upon the Demand for Women Workers.
55 pp. 1946. 150.
204. Women’s Emergency Farm Service on the Pacific Coast in 1943. 36 pp.
1945. 100.
205. Negro Women War Workers. 23 pp. 1945. 100.
206. Women Workers in Brazil. 42 pp. 1946. 100.
207. The Woman Telephone Worker. 38 pp. 1946. 100.
207-A. Typical Women’s Jobs in the Telephone Industry. (In press.)
208. Women’s Wartime Hours of Work—The Effect on their Factory Perform
ance and Home Life. 187 pp. 1947. 350.
209. Women Workers in Ten War Production Areas and Their Postwar Employ
ment Plans. (Springfield-Holyoke, Baltimore. Dayton-Springfield, Detroit-Willow Run, Kenosha, Wichita, Mobile, Seattie-Tacoma, San Francisco-Oakland, and Erie County, N. Y.) 56 pp. 1946. 150.
210. Women Workers in Paraguay. 16 pp. 1946. 100.
211. Employment of Women In the Early Postwar Period, with Background of
Prewar and War Data. 14 pp. 1946. 100.
212. Industrial Injuries to Women. (In press.)
213. Women Workers in Peru. (In press.)
214. Maternity-Benefits Under Union-Contract Health Insurance Plans. (In
press.)
215. Women Workers in Power Laundries. (In press.)
216. Women Workers After VJ-Day in One Community—Bridgeport, Conn. (In
press.)
217. International Work for Status of Women. (In press.)
218. Women’s Occupations Through Seven Decades. (In press.)
219. Earnings for Women Factory Workers, 1946. (In press.)
SPECIAL BULLETINS
No.
2. Lifting and Carrying Weights by Women in Industry.
3.
4.
10.
13.
14.
15.
19.
Rev. 1946. 12 pp.
50.
Safety Clothing for Women in Industry. 11 pp. 1941. 100. Supplements:
Safety Capa for Women Machine Operators. 4 pp. 1944. 50. Safety
Shoes for Women War Workers. 4 pp. 1944. 50.
Washing and Toilet Facilities for Women War Workers. 11 pp. 1942. 50.
Women’s Effective War Work Requires Good Posture. 6 pp. 1943. 50.
Part-Time Employment of Women in Wartime. 17 pp. 1943. 100.
When You Hire Women. 16 pp. 1944. 100.
Community Services for Women War Workers. 11 pp. 1944. 50.
The Industrial Nurse and The Woman Worker. 47 pp. 1944. 100.
PUBLICATIONS OF THE WOMEN’S BUREAU
19
No.
20. Changes in Women’s Employment During the War. 29 pp
„ (Chart based on statistical data also available.)
Bibliography on Night Work for Women. 1946. Multilith.
1944
10<i
LEAFLETS
Standards for Employment of Women. Leaflet No. 1, 1946.
Training for Jobs—For Women and Girls. Leaflet No 1 1947
Equal Pay for Women. Leaflet No. 2,1947.
Wornen White-Collar Workers, “Retool Your Thinking for Your Job Tomorrow.”
1*140.
Protect Future Wage Levels Now (on minimum-wage legislation) 1946
Unemployment Compensation—How It Works for Working Women 1945
Why Women Work, 1946. Multilith.
The Women’s Bureau—Its Purpose and Functions. 1946.
Your Job Future After College. 1947.
0. S. GOVERNMENT PRINTING OFFICE: 1947
For sale by the Superintendent of Documents, U. S. Sovernment Printing Office, Washington 25 D C
Price 10 cents
STATE COLLSRE LIBRARY
@FedFRASER