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Premium Rate Schedule & Contract Summary Quote Effective: 01/01/2014 03/31/2014 Version Updated: 10/17/2013 Plan ID: 78124NY098013800 Plan Name: SimplyBlue Plus Gold 5 Rating Region: Rochester Enrollment

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1. Start by entering the current date (October 17, 2013) in the designated field.
2. Review any updates or changes made since the previous version and update the relevant sections accordingly.
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5. Double-check for any spelling or grammatical errors and correct them.
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