NEW YORK 65
REGULAR BASIC

($10 a Month)

Pays Benefits Up to 31 Days For
• Hospital room/board up to $18 a day

• Miscellaneous hospital charges up to
$150

• Doctors fees in hospital (non-surgical) up to $145

$6 per day, first week-$5 per day,
second week-$4 per day, thereafter
Convalescent nursing home charges up
to $7.50 a day following at least 5
days hospital confinement

PLUS: Surgery, in or out of a hospital, and
Radiation Therapy for Malignancy according
to a schedule, up to $250.

Same plan available on Optional basis at
a cost of $8 per month with room and board
benefits limited to $12 per day.

The important benefits and limitations of
New York 65 are presented in this folder.
Complete details are given in the Certificate
Booklet you will receive shortly after you
enroll.

NEW YORK 65 MAJOR MEDICAL BENEFITS ($9 a Month)

Pays Hospital and Convalescent Nursing Home Benefits
(Maximum Benefit $3600 FOR ANY ONE CONFINEMENT)

■ Hospital room and board benefits up to $18 a day after the first 31 days of
confinement

■ Benefits for other hospital services and supplies at 80% of the amount by which
expenses exceed $150

■Convalescent nursing home benefits up to $7.50 per day for a maximum of 60
days following at least 5 days hospital confinement

(NOTE: After you've been out of a hospital or convalescent nursing home for 90
days, you're entitled to a new maximum benefit of $3600 for any future
confinement.)

Pays Other Medical Expense Benefits

(Maximum Benefit $10,000 DURING YOUR LIFETIME)

Pays benefits for the following medical expenses at 80% of the amount by which
expenses exceed $75 in a calendar year:

Doctor's medical and surgical services for home, office or in-hospital care — with
maximum expense equal to the excess of:

the established Blue Shield fees in your community
for families with maximum yearly income of $6,000,

over

the benefits payable under other plans for these services.

If you have no basic coverage for surgery or doctor fees in hospital, you
should be prepared to meet the equivalent of New York 65 Basic benefits out
of your own pocket.

■ Private duty nursing services by registered professional nurses, registered visit-
ing nurses, or licensed practical nurses, not in excess of charges of $1,000 in
any calendar year

Drugs and medicines which require a doctor's prescription

■ Diagnostic x-ray and laboratory examination and out-patient diagnostic services Physiotherapy artificial limbs and eyes... trusses and crutches

Rental of a wheel-chair, hospital-type bed, iron sung, or other equipment for the treatment of respiratory paralysis

Local ambulance service to or from a hospital or convalescent nursing home

Benefits under New York 65 are subject to reduction if you have other hospital, surgical or medical insurance

Who is Eligible for New York 65

You are eligible — during any open enrollment period – to join New York 65 if you are 65 or over and reside in New York State. Your spouse (regardless of age) may also enroll if you are enrolled. Protection begins upon receipt by New York 65 of your first premium payment.

If you became 65 after the close of an open enrollment, or retire and are already over 65, you may enroll within 31 days of reaching 65 or your retirement.

If you were confined in a hospital or convalescent nursing home on or during the 31 days prior to the date your coverage in New York 65 would otherwise become effective, your protection will begin 31 days after you are no longer so confined.

How to Enroll in New York 65

It's easy to enroll in New York 65- no complicated forms no long list of questions. Your Agent or Broker will gladly give you specific answers concerning New York 65- will offer you any assistance you want in enrolling. There is no additional charge for his services. So see him today - or, if you prefer, fill in, tear off and mail the convenient application form printed inside.

Expenses not Covered

Under New York 65

Expenses during the first 6 months of your insurance—or during any period of hospital confinement commencing in the first 6 months-for any condition for which you received treatment or diagnosis during the 90 days before your New York 65 insurance became effective.

Other principal exclusions are: injuries and diseases covered by Workmen's Compensation; care for mental and nervous conditions outside a hospital; dental care; eye examinations and glasses; hearing aids; diseases or injuries arising out of any war; expenses for services and supplies furnished without charge by any government; expenses which you would have no legal obligation to pay if you did not have insurance.

Benefits under New York 65 are subject to reduction if you have benefits under other hospital, surgical or medical plans.

NEW YORK 65 HEALTH INSURANCE ASSOCIATION 101 WEST 51st STREET, NEW YORK 19, NEW YORK

New York 65 Certificate Booklet-Basic and Major Medical Expense Benefits