Type of benefits: Services of medical group practice in the center with 75 parttime physicians Enrollment-1952: 30,000 Eligibility for enrollment: Group enrollment only through union locals Definition of eligible dependent: Wives of union members who agree to pay $10 per year Benefits: Hospital care: Included Surgical care: Limited minor surgery performed in center General medical care: Included Specialists' care: Included only in center Maternity care: Not included Care of newborn: Not included Preventive care: Included (provides for periodic health examination, im munizations, etc.) Home nursing care: Not included Dental care: Not included Refractions: Included X-rays, diagnostic and therapeutic: Included Laboratory and other diagnostic tests: Included Drugs and medicines: Included when used in center. At a nominal cost when used outside center Appliances: Not included Physical therapy: Included Ambulance service: Not included Other benefits: None Exclusions: Care for injuries and illnesses as a result of employment Psychiatric treatment Cost: $10 per year for each union member and each wife, plus employer contribution of one-fourth of 1 percent of payroll Conversion privileges: None Provisions for conditions of coverage for (a) Persons above age of 65-by paying $10 per year. (b) Periods of unemployment-membership in center entitles member to full coverage for service at center during fiscal year. (c) Employees retired for age, disability, or other reasons-$10 per year. About 55,000 persons are covered by the Amalgamated Insurance Fund for hospitalization, surgical care, and medical care in the center. Very truly yours, MORRIS BRAND, M.D., Medical Director THE AMALGAMATED INSURANCE FUND (CLOTHING INDUSTRY)—AMENDED REGULATIONS INSURANCE BENEFITS 1. Employee benefits-Effective October 1, 1951 Weekly disability benefit: Increased for males and females to $20. Hospitalization benefits: Increased from $6 per day to $9 per day. (No change in the rate of incidentals, which remains at a maximum of $50.) Surgical benefits: Increased from $150 maximum schedule to a new $200 maximum schedule. 2. Dependent benefits-Effective March 1, 1953 Nine dollars per day, 31 days, plus $50 incidental charges. Surgical benefits: $10 to $200, depending on nature of operation. Maternity (dependent wife only): $25 to $100, depending on nature of termination. Eligible dependents: Unmarried children from 2 weeks to 19 years of age. Unemployed husband or wife. 3. Eligibility Disability: Employees who do not have 6 months' covered employment are eligible after 4 weeks' employment by a "contributing employer." All other coverage, life, hospitalization, surgical, and maternity, including dependent coverage: Employees having 6 months' covered employment—prior regulations apply. 4. Terminations Disability: Employee's insurance terminates automatically on the first day on which the employee accepts employment from a "noncontributing employer," but such coverage will terminate in any event not later than 6 months following the last date of employment with a 'contributing employer." All other coverage, life, hospitalization, surgical, and maternity, including dependent coverage: Prior regulations continue with respect to extended coverages. INSURANCE PLAN OF THE AMALGAMATED INSURANCE FUND Effective February 1, 1944, as amended to April 1, 1948 DEFINITIONS In order to simplify the explanation of the insurance plan, the following names will be used in this booklet: Union means the Amalgamated Clothing Workers of America. Fund means the Amalgamated Insurance Fund. Employer means a manufacturer or contractor of men's and boys' clothing who has signed an agreement to make contributions to the fund and has made such contributions. The word "employer" also includes the contractor of such manufacturers. Insurance company means the insurance company from which you will receive certificates of group insurance in accordance with the plan of insurance. This plan of insurance applies to you only if you are a member of the union and work for an employer in connection with the manufacture of men's and boys' clothing. SECTION 1. BENEFITS PROVIDED 1. Group life insurance: $500 payable to your designated beneficiary. 2. Weekly accident and sickness benefits: Male, $15 per week; female, $10 per week. These weekly disability benefits are payable while you are unable to work due to sickness or accident not covered by workmen's compensation or unemployment insurance. 3. Hospitalization benefits: Room and board-not to exceed $6 for each day confined. Incidentals-not to exceed $50. 4. Surgical benefits: Not to exceed $150. Payment is made according to a schedule of surgical operations, ranging from $10 to $150. Obstetrical benefits range from $25 for miscarriage to $50 for normal delivery and $100 for an operation. You do not pay any premiums for these benefits as all cost is carried by the fund. You do not have to pass an examination to be insured. The insurance under this plan has no surrender or loan value. SECTION II. WHEN DOES MY GROUP INSURANCE START? You will be eligible for group insurance on the first day of the month after you meet the following requirements: (a) Are a member of the union; and (b) Have been employed by an employer or employers for 6 successive months and for not less than 500 hours in the preceding period of not more than 12 months. SECTION III. PERIOD OF DISABILITY AND PAYMENTS OF WEEKLY BENEFITS You must be under the care of a doctor and unable to go to work. However, you need not be confined to bed or to your home. 1. Accident benefits: If you are continuously disabled for 7 or more days, payment will be made as of the first day. You cannot receive more than 13 weeks benefits on account of 1 or more accidents during any 12 consecutive months. 2. Sickness benefits: If you are continuously disabled for a period of 14 or more days, payments will be made beginning with the eighth day. No benefits will be paid for the first 7 days of disability due to sickness. You cannot receive more than 13 weeks of benefits on account of 1 or more sicknesses in any 12 consecutive months. 3. You cannot receive more than 13 weeks of benefits in any 1 period of disability. SECTION IV. ARE ALL ACCIDENTS AND SICKNESSES COVERED? Benefits are payable for all sicknesses and accidents except the following: 1. Disability for which you are eligible to receive workmen's compensation benefits. 2. Disability due to intentionally self-inflicted injury, while sane or insane. 3. Disability caused by or resulting from pregnancy, including childbirth. 4. Disability incurred outside the United States and Canada in North America. 5. Disability incurred before the date the employee became insured under this plan. As indicated in section III, you must be under the care of licensed physician in order to receive benefits. SECTION V. HOSPITALIZATION BENEFITS You must be confined in a hospital for at least 18 hours. 1. Rate per day: You are paid for each day of confinement at a rate not to exceed $6 per day for a period of not more than 31 days for disability due to sickness nor separately for more than 31 days for disability due to accident during any 12 consecutive months. 2. Hospital incidentals: During any 1 continuous confinement of not less than 18 hours, you can receive benefits not to exceed $50 for services such as the use of operating rooms, laboratory examinations, services and tests, etc., in connection with such confinement. In connection with this benefit, no indemnity is provided for surgeons', physicians', and nurses' fees or charges. All hospitalization confinements are covered except those due to the following: 1. Disability for which you may be entitled to workmen's compensation benefits. 2. Intentionally self-inflicted injury, while sane or insane. 3. Confinement before the day your group insurance goes into effect. 4. Disability caused by or resulting from pregnancy, including childbirth. The hospital must be a legally constituted hospital in the United States. No benefits are provided if you are an outpatient, treated in a clinic or if you visit the hospital for several hours each day. The insurance company will pay the hospital charges in accordance with this plan. Examples 1. Hospital bill, $4 per day for 10 days. Incidentals, operating room, $30. You will be paid in accordance with the charges made; i. e., $70. 2. Hospital bill, $8 per day for 40 days. X-days, $25; drugs, $20. Total, $80. Incidentals, operating room, $35; You will be paid as follows: $6 for 31 days and $50 for incidentals. SECTION VI. SURGICAL BENEFITS (FIRST PROVIDED AS OF APRIL 1, 1948) You need not be confined to a hospital to receive surgical benefits. The surgical procedure may be performed in the doctor's office, as an outpatient in a hospital. in a clinic or at home. A surgical claim blank will be furnished by the insurance company upon notification that surgery was performed. This surgical claim blank must be completed by you and your surgeon. Surgical fees: Payable in accordance with our schedule of operations, ranging from $10 to $150. If 2 or more operative procedures are performed during 1 single operation, payment will be made on the basis of the operative procedure which is the highest payable according to the schedule. Obstetrical (maternity) benefits range from $25 for miscarriage to $50 for normal delivery and $100 for an operative procedure. You cannot receive weekly disability benefits or hospitalization benefits for any disability caused by or resulting from pregnancy, including childbirth. The insurance company will pay the surgical charge in accordance with the schedule. SCHEDULE OF OPERATIONS Maximum limit of payment: The maximum limit of payment for surgical fees for all operations performed after cessation of active employment and before returning to active employment shall be $150. Maximum amount of payment Abdomen: Cutting into abdominal cavity for diagnosis or treatment of or- Thigh Leg, entire foot, arm, forearm, or entire hand_ Fingers or toes, each_ Blood transfusions, each_ Breast: Amputation Abscess, deep (furuncles excepted) Chest: Complete thoracoplasty, or removal of portion of lung-- Other cutting into thoracic cavity for diagnosis or treatment (tapping excepted) Initial induction of artificial pneumothorax. Dislocation: Reduction of hip or knee joint (patella excepted). Shoulder, elbow, or ankle joint-- Lower jaw--- Collar bone or wrist-- For dislocations requiring an open operation, the basic amount will be twice the amount shown above. cepted) Diseased portion of bone, including curettage (alveolar processes ex Ear, nose, or throat: Mastoidectomy: 1 side.. Eye: Both sides-- Tonsillectomy, or tonsillectomy and adenoidectomy--. Sinus operation by cutting (puncture of antrum excepted). Tracheotomy Bronchoscopy for removal of foreign body or biopsy-. Any other cutting operation (tapping excepted) _. Any cutting operation into the eyeball (through the cornea or sclera)__ 50 Removal of eyeball---- Any other cutting operation on eyeball__ Fracture: Treatment of thigh, leg, kneecap, upper arm, vertebra or vertebrae, or pelvis (coccyx excepted) _- 50 Lower jaw (alveolar process excepted), collar bone, shoulder blade or forearm__ The amounts shown above under "Fracture" are for simple fractures. For compound fractures the basic amount will be one and one-half times the amount shown above for the corresponding simple fracture. For fractures requiring an open operation, the basic amount will be twice the amount shown above for the corresponding simple fracture. Genito-Urinary tract: Removal of kidney--- 150 Cutting into or fixation of kidney. 100 Removal of tumors or stones in kidney, ureter or bladder by cutting operation____ 100 By crushing, cauterization or endoscopic means-- 25 39087-54-pt. 6-35 Maximum amount Genito-Urinary tract-Continued Stricture of urethra, open operation__ Intraurethral cutting operation_-_ Removal of entire prostate by open operation (complete procedure). Removal of part of prostate by endoscopic means.. By other cutting operation_. Varicocele, cutting operation on__ of payment 50 25 150 40 75 25 Hydrocele, excision, or incision and treatment of sac (tapping excepted) _ 25 Complete removal of uterus, tubes and ovaries__ Other operations on uterus and its appendages: Goitre: 35 150 100 50 25 Thyroidectomy (complete procedure, including ligation of thyroid arteries, to be treated as 1 operation) __ 150 Ligation of thyroid arteries not followed by thyroidectomy, 1 or more at 1 operation----. 50 2-or-more-stage operation--- 75 (Complete procedure to be treated as one operation.) Obstetrical procedure: Delivery of child or children__. Caesarean section, including delivery---. Abdominal operation for extrauterine pregnancy Miscarriage__. Paracentesis, tapping of: Abdomen, chest, or bladder (other than catheterization). Rectum : Cutting operation or injection treatment for radical cure of hemorrhoids (complete procedure) ---- Cutting operation for prolapsed rectum or fistula in ano_. Skull, cutting into cranial cavity Cutting operature for fissure__ Spine or spinal cord: 150 Operation with removal of portion of vertebra or vertebrae (except coccyx)--. 150 Removal of part or all of coccyx--. Tumors: Cutting operation for removal of malignant tumors, except those of face, lip, or skin_____. 100 Malignant tumors of face, lip, or skin___ Benign tumors requiring hospital confinement. 25 25 10 Varicose veins, cutting operation or injection treatment (complete procedure on all veins) --- 40 The company will, subject to the limitations applicable to surgical benefits contained in the policy, pay the employee for any cutting operation not specified in the above schedule performed while the person insured is confined, other than as an outpatient, in a legally constituted and operated hospital; but the company reserves the right to determine the amount of any such payment to be made. SECTION VII. WHAT SHOULD I DO IN THE CASE OF ACCIDENT OR SICKNESS? If you become disabled, notify your union office immediately. Be sure to give your name, social security number, home address, name of employer and last date of employment. If it is not physically possible for you to notify the union |