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1966 May f2y Legislation approving the Ontario Medical Services Insurance Plan--OMSIP for short-----was passed in the Ontario Legislature on Feb. 18th of this year. Coverage commenced April Ist for social assistance recipients. Coverage will begin July 1st for those who have already enrolled, or who enroll now before oe ee Vth. OMSIP PROVIDES COVERAGE REGARDLESS OF AGE, INCOME OR HEALTH OMSIP has been estab- lished to provide adequate insurance coverage for the payment of doctors' bills, and to make this coverage available to all Ontario resi- dents regardless of their age, income or state of health. Enrollment in OMSIP is voluntary. The Plan is intended for individuals and their fam- ilies and does not provide group coverage. (Group coy- erage is where a number of individuals collectively pur- chase insurance through their place of employment, union, etc.) Everyone who has lived in Ontario for the past 3 months is eligible to join, except those who are enti- tled to physicians' services under another Act. Members are free to choose their own doctor. If a member travels outside the Province, and requires care, OMSIP will still pay the doctors' bills up to OMSIP established rates. People who find they can- not continue to pay for all or part of their OMSIP con- tract because of unemploy- ment, illness or disability, may apply for temporary assistance in paying their fees. _ THE NEWS - Many qualify for full or Page 9 partial assistance Since the aim of OMSIP leg- islation is to provide adequate medical insurance for Ontario residents, full or partial pre- mium assistance is available for those who require it. Automatic fully-paid coverage Many residents and their dependants have automatic- ally received fully paid cover- age under OMSIP. These are people who are already re- ceiving benefits under the fol- lowing Acts: ® The Blind Persons' Allowances Act © The Disabled Persons' Allowances Act The General Welfare Assistance Act The Mothers' Allowances Act The Old Age Assistance Act The Rehabilitation Services Act Automatic fully-paid cover- age is also provided for old age security pensioners and their dependants declared eli- gible for coverage by the Ontario Department of Public Welfare. Fully-paid coverage on application People resident in Ontario for the past 12 months and who had no taxable income in 1965 get full assistance. This means if these people make out their application form now, before May 16th, they will get OMSIP protec- tion, fully paid for by the government, starting this July 1st. In addition, many who have been resident in Ontario for the past 12 months will be eligible for partial assistance, depending on their taxable income and number of de- pendants. (See below). DO YOU QUALIFY FOR PARTIAL ASSISTANCE? Yes, if you are a single person and your taxable income in 1965 was $500 or less. Complete cost....... $60.00 Government pays... 30.00 MOUDAY 248 Noss neti a 30.00 ($7.50 every 3 months) Yes, if you have one depen- dant, and if together your total taxable income in 1965 was $1,000 or less. Complete cost..... $120.00 Government pays.. 60.00 Wewipay st. a 60.00 ($15.00 every 3 months) What is taxable income? Yes, if you have a family of 3 or more, and if your family's total taxable income in 1965 was $1,300 or less. Complete cost..... $150.00 Government pays.. 90.00 You pay 60. 60.00 ($15.00 every 3 months) Taxable income is the amount of your income upon which you pay tax after exemptions for dependants and other allowances have been deducted. HERE'S YOUR APPLICATION FORM--Please use BALL POINT PEN. Cut out form carefully. Mail today! INSTRUCTIONS 9. Print the first names of your wife or husband (spouse) in the first box. PARTIALLY ASSISTED PREMIUMS . If you have a Social Insurance Number write it in the Then print the first names of all your eligible dependant children, FO pn eee ee a at ge ts squares provided starting with the first number in starting with the oldest, in the following boxes. If you have more than Cost for those eligible for Complete Government You the first square. If you do not have a number, place five eligible dependant children continue your list in the section on this premium assistance IRE ieee am av mark in the square marked NO. side of the form. If you have more than 10 eligible dependant children, (a) The single person .........eceeeenees $ 60.00 $30.00 $30.00 2. Print your last or Family Name in the box. (Example: list them separately and return with your application form. (covering only the member) ($7.80 ' ; : with a taxable income in 1965 mth Smith, Jones, Brown, etc.). Under BIRTH DATE, write the number of the day of birth, print the of $800 oF less Simone 3. Print your firstand second Given Names in the boxes, month and write the number of the year of birth. (Example: 18 Sept. 1954). (uh Tietamlipel mole ee $120.00 $00.00 saiion (Example: John, Harry, Mary, etc.). If you have a ($15.00 Under SEX, write M if the child is male, F if the child is female. (covering the head of the family nickname or are commonly known by another name : : and one eligible dependant) sont for mailing purposes, please indicate in the box 10. Sign your name on the line marked SIGNATURE OF APPLICANT and with a total taxable income in 1965 3 months) marked OTHER. write in the date and year. of $1,000 or less 4. Print your address in the first box; your City, Town, 11. IF YOU ARE APPLYING FOR PREMIUM ASSISTANCE (c) The family of three or more........... $150.00 $90.00 $60.00 Village or Post Office in the next box; and your Read this section very carefully and complete either the section marked icoverio gee head Port ae County or District in the last box. 'A' or the one marked 'B' (not both). wiheh ict Reals resend 3 months) 5. Write the number of the day on which you were born 12. Remember, if you receive benefits under any of the Acts listed under of $1,300 or less in the box marked DAY. Print the name of the month #5(1) in the folder entitled "omsip,.. WHAT 11 MEANS AND WHAT IT CAN DO FOR YOU", (or its abbreviation) in the box marked MONTH. you should not complete an application form. You will be provided FULL PREMIUMS 5; in th 4 : : . eee ee a veen oon ere 9. Mahe automatically.with folly pald coverage: Cost for those not eligible for premium assistance COST 6. Men should place a V/ mark inthe box marked MALE. (a) The single person ........+...seeeeee eee eeeeeees $60.00 a year Women should place a V mark in the box marked (covering only the member) ($15.00 every 3 months) FEMALE. (b) The family of tWO........cceeeeesecreeveeeceoens $120.00 a year (covering the head of the family and one eligible dependant) 7. If you are single place a v/ mark in the box marked ($30.00 every 3 months) SINGLE. If you are married place a V/ mark in the box marked MARRIED. If your status is other than single or married (Example: separated, divorced or widow- ed) write your status on the line marked OTHER. 8. Write your occupation and the kind of business or industry in which you work (Example: Carpenter-- Building Trade; Farmer--Agriculture; Salesman-- (c) The family of three or more..........eeeeeeeeeeee $150.00 a year (covering the head of the family and all eligible dependants) ($37.50 every 3 months) SEND YOUR COMPLETED APPLICATION FORM TO: Bakery). FOR ADDITIONAL CHILDREN ATTACH A SEPARATE SHEET OMSIP, P.O. Box 1700, Terminal A, Toronto, Ontario. wy ONTARIO MEDICAL SERVICES INSURANCE PLAN OMSIP, PLEASE READ INSTRUCTIONS ABOVE APPLICATION FORM [ ityes, insert) Social Insurance Number No O Last or Family Name APPLICATION FOR PREMIUM ASSISTANCE 11. | have lived in Ontario for the past 12 months. | am not covered for total medical care by government. | agree to allow the Medical Services Insurance Division to verify all statements made by me on this application. (SIGN A OR B ONLY) A.NO TAXABLE INCOME | hereby apply for full premium assistance | and my eligible dependants had no taxable in- come for the 12 months ended December 31st last. | state that the information given by me is correct. BEFORE COMPLETING 4. Your Address | RR # or P.O. Box or Street & Number City or Town or Village or Post Office County or District Please print Birth Date 7. Marital Status 8. Occupation & Nature of Business or Industry O oO Male Female Other (specify) Month 9. LIST DEPENDANTS Spouse and/or children (children must be under 21 and unmarried). Other dependants and fully employed children must apply for separate coverage. Given Names Only Birth Date Given Names Only Birth Date Month Day Month 1. Do you have a Social Insurance Number? For office use only 2. Your Name Please print bay Gaeta Single Married Signature of Applicant Date 19 B. TAXABLE INCOME OF $1,300.00 OR LESS | hereby apply for partial premium assistance My taxable income and the taxable income of my eligible dependants was in total $. for the 12 months ended December 31st last. | state that the information given by me is correct. | Day Year Spouse Ez child Pee ee er Ta Fs SAR a? List additional dependant children in space provided above. ist child (oldest eligible) 2nd child 10. In applying for coverage under The Ontario Medical Services Insurance Act, 1965, | confirm that | have lived in Ontario for the past 90 days, | am not covered for total medical care by government and that the information given by me is correct. For office use only Signature of Applicant Date. a Signature of Applicant Date 19