MATERNITY-BENEFITS UNDER UNION- 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 included in union agreements as well as the women who filed maternity claims and received benefits under these plans. It presents the number 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 themselves 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 economic 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 frequently cut off. Thus a major need is the maintenance of income during 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 necessities must be provided, whether or not the pay check comes in. Secondly, the special demands of illness must be met: doctors' services, 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 unpre 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 meeting the problem. These plans vary widely in their functions, coverage, 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 regularly 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 medical 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 policies, 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. Whatever 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 themselves 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. 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 maintenance 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 governed 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. În plans which provide weekly cash payments, such benefits run for a shorter time in maternity cases than in otherstypically for a 6-week period compared with a 13-week period in general cases of illness or injury. Plans providing cash benefits for hospitalization 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 periods 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 services may be offered, or a special fee may be required. To have a reasonably full picture of the part such plans play in providing 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 benefits and which are included in union agreements. The growth of union-contract health insurance plans has been confined 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 following 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 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 Department 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 requested 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. |