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a ~ . aS a TOE erenn ae ys ‘ to. : Blue C ‘ é ue Cross iF no of Northern California yt } ky 1950 trankha Steet, Oakland, Californin 214659 t : Side IDENTIFICATION CARD ol sutncrher and en: otled tamuly members ti. vite ISUBSERIBER'S NAME EFFECTIVE “75 | oj] MULHOLLANO PATRICK J) 3-01-75 | bo: - F IDENTIFICATION NO. GROUP OR ACCOUNTNO. ae | [Mel mab~ 6196 lr-co0et b16eE OP na nehetan tal alin te ieebebe sone’ 1 1{GROUP OF ACCOUNT NAME |twoivrova ENROLLMENT PLAN THIS SUMMARY D@CS NOTACTER ATT ACHEOCONIRACT subject to waiver | SPITAL 365 DAYS, AT 80 PERCENT ORVERAGE SBED ROOM, 80 PCT OF ERAGE 2BED TOWARD HIGHER ROOM, |f HER HOSPITAL SERVICES, SPECIAL |i ITS PAID AT GO PCTs AMBULANCE t. E MAJOR MEDICAL. EXTENDED CARE |! CILITY COVERED AT 80 PCT. in ROFESSIONAL SERVICES COVERED beac DER MAJOR MEDICAL. if |) MATERNITY CARE SEE CONTRACT. | MAJOR MEDICAL AO PERCENT : “OF REASONABLE FEE AFTER $100 (DEDUCTIBLE PER CALENDAR YEAR» . ete cae gla eR a ALE RAERSU Nes, Sar cts ; ‘ THE BQUITABLE LIFE ASSYAANCE SOCIETY OF THE UNITED STATES "#3 Group Hospital Expense Cord This Is do cortily that the employes whose slynature cppecte bolow hos hean insured os on employes of a périlepating momber firm fer group hoapliat expense beonolils under a master gover Jnaudd by Thé Equitable Lite Assurance Socioty of the United States, $200 Avenue of the Amacizas, Now York, N. ¥., 10019, to the Trusteas of Califomia bond Title Assotintion Jasutonce fund. Policy Ne. 14967 H — Cestifieaty No. ‘<n Fot further Informotion ov te ihe daptite of thie tovernyy, oF if opplies ie ikis employes, o¢ hls thet) depondoatlet piace tommunicate wilh ihe employer of Ibe Insvred of wlth Imperleal Indyattlas, Administrator, 701 South Atlantis Boulevard, Moniarey Park, Collfornia 91744, 1213) 289-2174. Rofer to the nama of the Imured, ond the policy and totilitete mumbats given above, “Weve D thrtlan L. Slgnoture of Imployas CLIA—GR 91S Printod tn U.S.A, i : { i 7 i | i Neer Raper rvtitpepts gen meer se sdeetade tate aak-heeenan ee ted fue - Ve toe af peodh. t, oe eos + a4 - ¥ * . X. 4 a a we eure hte er . cath Soe ee i 4715200 PF 02129 a Notas re ae? int 3 + wn SS Ay PEASE fe eT Fe A Shea Reet “evs ua oP ye ee 1 eel Ds PRE od gi .* : . . a n eres - ww oN, a= shoe . + . . Ne te ®t 4 ew aa rats Me ae pe beled ens - as re st _™, w as . Reval at am ate So ae + ate Seat trial wh Mei ante ep Oe age welt “ert FO ey. er Ye pen” AF 2, ae aS mg, **a Te eo, . a . my f . oe = ‘<r ad 4 - - * Far oF ae Oe war af 22 “ nd tty ta or a ~ PP. ii, Be we ws. An cot ae a, aw ~~ os : Saar . . . A 4 . _ 4 vy .