Evening star. [volume] (Washington, D.C.) 1854-1972, 1959-04-15

lpital expenses. The plan then
would pay all Of the next $500
lof expenses and 80 per cent Of
costs in excess Of this $3.50.
without limit on the number
Iof days Of disqualification.
Medical expenses-The en-
Iploye would pay the FIRST $50
and the plan would pay 80 per
cent Of the remainder.
although the hospital and
medical sections of the plan
each would call Tor employe
payment Of the first $50 Of ex-
penses. this is actually a total
Of $50 for both. Even II both
kinds OF costs were incurred,
the combined cost Of the de-
ductible to the employee would
mot exceed $50 in any calendar
year. Hospital and medical
benefits together could not ex-
coed $500 in any calendar
year. There would be a SIS
900 general limitation on life
time benefits, but there would
be provisions for reinstatement
Of the maximum benefits under
certain conditions)
Maternity Benefits-The
plan would pay the full cost
Of disqualification and obstetrf-
cal treatment for female en-
ployes Of wives Of employees up
to a maximum Of 5000 for nor
NAL delivery.
An employee who did not
want to enroll for the COM
prehensive plan might instead
receive Government contribu-
ton to the cost Of an approved
employe organization plan or
an approved group practice
prepayment plan.
The plan would provide free
coverage for employees who re-
tire and their dependents. with
the same level Of benefits as
before retirement.
For the most part. it could
be expected that coverage of
the comprehensive plan would
be Nationwide. However. there
would be provision for the use
Of local plans covering sub
stantial numbers of Federal
employees las in the DISTRICT |
If such plans agreed to provide
protection in all respects iden-
tical to the comprehensive plan
at the same or lower cost.
The criteria against which |
the commission said any plan
should be measured include the
following:
l. The Government should |
provide for its employees, as a
group, a plan which they. as
individuals, cannot obtain for
themselves. If the Government
merely helped to pay for health
insurance already available to
employees. it would be falling to
take advantage of a funda-
mental group insurance prin-
ciple:: that, with a wide spread
ing of the risk, more liberal
benefits can be provided at a
lower cost than can be pro-
vided any individual.
Other Plans Permitted
2. Enrolment in approved
employe association-sponsored
plans and group practice pre-
payment plans should be per-
mitted. Strong considerations
of equity dictate that existing
plans of the types mentioned
should be permitted to par
ticipate if they can meet the
standards Of eligibility that
would be prescribed.
3. The high cost of catas-
trophic or prolonged Illness
should be covered. The bank
costs of catastrophe or
prolonged illnesses make them
contingencies against which in
Surance is essential.
4. With some limitations,
free" coverage should be pro-
vided for certain groups OF In
dividualS. The free-coverage
groups should include employees
who retire, go on leave without
pay or are in receipt of Fed
eral employees compensation
benefits. If feasible, it would
also be desirable to include
annuitants.
5. Provision should be made
for funding the cost for the
group during the
active working life.
Properly designed advance
is essential to a stable
premium rate and benefit