Supplies Individual Application       New Application for 2010             GR-67466-33 (2-10)  (430 kb) Rates Effective 7-1-10 through 9-30-10             NE Rates Effective 7-1-2010  (415 kb) PPO Value $2500 Option             NE Value PPO 2500 (10/10)  (75 kb) PPO $5000 Option             NE PPO 5000 (10/10)  (77 kb) PPO $5000 HSA Option             NE HD 5000 (10/10)  (75 kb) Preventive & Hospital Care $3000 Option             NE P&H 3000 (10/10)  (75 kb) Dental Option             NE PPO Dental (10/10)  (72 kb) Underwriting Guide             13.02.002.1 CP (6/10)  (268 kb) Dental Election Form       Dental Election or Dental Change form for existing members             GR-68184 (6-07)  (37 kb)

Preferred Marketing Associates, Ltd. 3530 North 163rd Plaza (163rd & Maple) Omaha, NE 68116 (402)397-9787 Toll Free 1-800-777-0723