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Premium Rate Schedule Quote Effective: 01/01/2016 03/31/2016 Version Updated: 10/22/2015 Plan ID: 78124NY099000900Plan Name: SimplyBlue Plus Standard SilverRating Region: RochesterSmall GroupEnrollment

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Individuals who are applying for the SimplyBlue Plus Silver 16 health insurance plan without pediatric dental coverage in Q4 of the UTCPDF enrollment period.

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