PROOF & PAYMENT OF CLAIMS - Continued possible to give proof within such time, provided such proof is furnished as soon as reasonably possible. Payment of Claim. — All benefits payable under this Plan will be paid as they accrue immediately upon receipt of due written proof of claim. All benefits (except benefits which you have assigned) will be paid to you provided you are able to sign a valid release for such benefits. If in the opinion of the Association you are either physically or mentally incompetent to give a valid release for any benefit which becomes payable to you, or if any benefit becomes payable to your estate, the Association reserves the right, at its own option, either to pay such benefits directly to the hospital or other person or persons on whose charges payment of such benefit is based, or to pay such benefit to any of your relatives by blood or adoption or connection by marriage deemed by the Association to be equitably entitled thereto. Any payment made by the Association in good faith pursuant to this provision shall fully discharge the obligations of the Association to the extent of such payment. Physical Examination. The Association at its own expense shall have the right and opportunity to have a doctor examine any individual whose injury or sickness is the basis of a claim when and as often as it may reasonably require during pendency of a claim. Assignment. You may assign (a) Benefits for hospital expenses to the hospital. (b) Benefits for nursing home expenses to the nursing home. (c) Benefits for fees charged by an operating surgeon to the surgeon. (d) Benefits for in-hospital medical expenses to the doctor. No assignment of any other benefits will be accepted by the Association. No assignment will be binding upon the Association unless made in writing and until filed with the Association. The Association assumes no responsibility for the validity of any assignment. Legal Actions. - No action at law or in equity shall be brought to recover on this Plan prior to the expiration of sixty days after written proof of claim has been furnished in accordance with the requirements of this Plan. No such action shall be brought after the expiration of three years after the time written proof of claim is required to be furnished. Index For Basic and Major Medical Benefits Page 1. Cover 2. Introduction and Association Address 10-Day Free Examination 3. Highlights of Your New York 65 Plan 4. Eligibility, Effective Date of Insurance 5. Monthly Premiums 6. Basic Plan-Description of Benefits 7. Basic Plan-Description of Benefits 8. Basic Plan-Description of Benefits 9. Schedule of Procedures 10. Schedule of Procedures (continued) 11. Schedule of Procedures (continued) 12. Major Medical Plan-Description of Benefits 13. Major Medical Plan-Description of Benefits 14. Major Medical Plan-Description of Benefits 15. Major Medical Plan-Description of Benefits 16. Exclusions 17. Exclusions (continued) 18. Definitions 19. Definitions (continued) 20. Termination and Modification of Insurance Temporary Extension of Coverage 21. Proof, and Payment of Claims 22. Proof, and Payment of Claims (continued) HERE ARE SOME HELPFUL ANSWERS TO GENERAL QUESTIONS Sometimes people find that insurance claim forms are complicated and difficult to fill out. We have WHO MAY MAKE A CLAIM? You, the Insured, must personally make claim for your New York 65 benefits. If you are unable to do so, the claim form may be completed by a near relative (not a minor), with an explanation of the reason you did not sign it personally. WHEN SHOULD A CLAIM BE FILED? You may send in Part One of the claim form as Suggestion: Keep bills for prescribed medications and other small covered expenses that are incurred during the early part of each calendar year so that you can file a claim after your total covered expenses exceed the deductible amounts described in your Certificate Booklet. WHERE MAY I GET CLAIM FORMS? A claim form is included in this initial enroll- SHOULD I ASSIGN MY BENEFITS? The only difference between assigning and not assigning a benefit is in the name of the payee on the benefit check. In either case, the check will be mailed to you. If you have assigned the benefit by signing your name by the appropriate arrow on the claim form, IMPORTANT Be sure to read your CERTIFICATE BOOKLET carefully. It contains a detailed description of the maximum benefits and the specific kinds of charges that are covered by New York 65 plans, and it is the ONLY official and authoritative description of those benefits and charges. the check will be payable to the hospital, nursing home or doctor, as the case may be. Many people find it convenient to have the check made payable to the institution or doctor to whom money is owed so that it may easily be forwarded by mail. WHERE SHOULD I MAIL THE CLAIM FORM? Send your completed claim forms to the following address: NEW YORK 65 BOX 6565, GENERAL POST OFFICE NEW YORK 1, N. Y. You should also use that address when you write to New York 65 in regard to any claims question. WHERE SHOULD I CALL THE NEW YORK 65 OFFICE? If you would like to discuss claims questions by telephone with the New York 65 office, you may call the following number in New York City: LT 1-6500 AREA CODE 212 If you wish to call personally at the New York 65 office in New York City, the street address is: 101 W. 51st STREET NEW YORK 19, N. Y. THE NEW YORK 65 OFFICE IS ON THE 15th FLOOR 101 W. 51st Street is located between the Avenue of the Americas (Sixth Avenue) and Seventh Avenue. |