GENERAL DESCRIPTION OF EIGHT PLANS Although the present study is concerned only with maternity benefits, 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 for weekly cash payments for disability, whereas production workers are covered for all benefits; plan 6 covers production workers only. The 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 subject 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 months; plans 5 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. For employees 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. For 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. 740055-47-2 5 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 hospitalization 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. Employers pay full costs of the insurance in six of the plans. Workers pay part of the costs in plans 7 and 8, approximately 1/4 and 1/2, respectively. In addition, workers pay in full for the benefits provided 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 the 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. 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 benefits 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. The women's ages ranged from 17 to 44 and averaged 28 years. The following shows the percent distribution: 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 (See All but six claimants had received the full 6 weeks of benefits. 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. The distribution of benefits for the 83 women claimants under plan 1 is as follows: AMOUNT OF TIME LOST FROM WORK The total amount of time lost from work because of maternity cannot 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: Number of weeks between worker's last day of work and date of child's birth All women 1. 5 or less 6-10 11-15 16-20 21-25 26-30 Over 30.. 1 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 remained at work until the very day of a premature birth. Standards for the employment of women during pregnancy require a prenatal leave of absence. The Women's Bureau recommends a leave of 6 weeks before and 2 months after childbirth, with additional time upon the physician's recommendation. Many employers have put into practice this or a similar policy. Unions have recommended 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, because 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 experience 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, |