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let us help you pry for 1 surgical 2 major medical 3 in hospital medical care 4 doctors services the coop 41 package plan includes all the following services 1 surgical benefits arc paid at the latcs i ccommcndcd by the onuiio medical association as shown in the general section 1962 schedule of fees for the following surgical operations fractures and dislocations services of anaesthetists cystoscopic and bronchoscope examination burns and lacerations confinements including picnatal and postnatal caie k diagnostic xrays up to 2500 per contract yeai each member and dependent except when covered by the ontario hospital services commission tonsils and adenoids hernia pregnancy aie subject to a tenmonth waiting period exceptions care undci the surgical contiact docs not cover redactions innoculations vacci nations or injections 3 in hospital care benefits 1 one hospital visit per day when confinement to a hospital is due to a medical illness 2 one consultation withicgaid to each- confinement irrhospital limit of sixty days foi each eligible member or dependent duiing any contiact ycai 2 major medical benefits aie paid at latcs iccommendcd by the ontario medical association in 1962 schedule of fees guaranteed plan to pay 80 of all eligible expenses from 10000 to a maximum of 500000 incurred in any twelvemonth period doctors office or house calls differential between specialists and general rates k drugs ordered on prescription or given by the doctoi ambulance charges appliances k therapy or related sci vices oidcicd by the doctor as ncccssaiy tieatnient of an illness or injury nursing care except in hospital medically ncccssaiy care by a lcgisteicd nurse laboratory services foi outpatients it is ncccssaiy to submit receipts foi a major medical claim 4 doctors services at home in the office limited number of injections medical benefits subject to a limit of 200 00 pci pcison each contract ycai aftci one full years membership medical checkup k eyetest for correction of vision ho medical examination no enrollment fee no age limit for adults one low rate includes husband wife and semiannual premtum limited opportunity family dependent children a aa un 19 years of age aoutuu single semiannual premium 3000 this enrollment ends february 15 1964 or economy 3 1 n 1 includes benefits under 1 surgical 2 major medical 3 in hospital medical care semiannual premium single 1500 family 3000 here is all you do to join 1 fill out application attach cheque for first 6 months premium 2 mail or deliver to york cooperative medical services 31 yonge st north richmond hill ontario effective date of your medical insurance is march 1 1964 and your policy will be mailed to you for further informition writ or call on york cooperative medical services 31 yonge st n richmond hill licensed by the ontario depirtment of insurance r application for membership york cooperative medical services 31 yonge st north richmond mill ont name date of birth print name in full miiname first address occupation employed by name of wife or husband dale of birth dependent children under 38 years of age names date of birth i agree thai the fatuity of any statement in thin application shall bar all right fo benefits if such statement materially affect either the acceptance of my application or the risk assumed by the cooperative enclosed my cheque or money order for the first six months premium payable to york cooperative medical services jl understand my coverage will begin march 1 1964 signature of applicant si liigi only one application form necessary for each family single persons age 19 and over must rrake a separate application application for membership york cooperative medical services i 31 yonge st north richmond hill ont name date of birth print name in full surname first address i occupation employed by name of wife or husband date of birth dependent children under 19 years ok age names date of birth i agree thai the falsity of any statement in this application shall bar all right to benefits if such statement materially affects either the acceptance of my application or the risk assumed by the cooperative enclosed my cheque or money order for the first six months premium payable to york cooperative medical services i understand my coverage will begin march 1 1964 signature of applicant si j