Preferred Maketing Associates (PMA)
Monday - Thursday:
8 am - 4:45 pm
Friday:
8 am - 12:30 pm
Supplies
2017 Master Group Application
            2017 Master Group Application  (900 kb)
2017 BCBS ACA Group RateBook
            2017 BCBS ACA Group RateBook  (426 kb)
2017 BCBS ACA Group Options
            2017 BCBS ACA Group Options  (24975 kb)
2017 BCBS Underwriting Guidelines
            2017 BCBS Underwriting Guidelines  (173 kb)
2017 Formulary (6 Tier)
      To be used for 1-50 group ACA products with effective or renewal date of 1-1-17 or after.
            2017 Formulary (6 Tier)  (2906 kb)
2017 Tier 1 Pharmacies List
      Tier 1 Pharmacies list for 2017 ACA products in Alphabetical city order
            2017 Tier 1 Pharmacies List  (79 kb)
Tier 1 Pharmacies List
      Tier 1 Pharmacies list for 2017 ACA products in Alphabetical pharmacy name order
            Tier 1 Pharmacies List  (79 kb)
            2016 Master Group Application  (599 kb)
            Small Group Employee Application  (325 kb)
            2016 Small Group Rate Book  (981 kb)
            2016 Plan Options  (6616 kb)
2017 BlueFreedom Options at a Glance
            2017 BlueFreedom Options at a Glance  (11573 kb)
      Amendment Form - Amendment to be used to change options or make any changes on the group level once the group is active.
            Amendment Form  (46 kb)
      Group EFT Authorization - Allows BCBS groups to pay via EFT.
            EFT Authorization Form  (17 kb)
            2015 SelectBlue Three-Tier Options Brochure  (7826 kb)
            2015 BluePride Brochure  (5814 kb)
            2014 BluePridePlus Plan Options  (7373 kb)
      BluePride Brochure - Health plans for employer groups of 2-50 eligible employees.
            Form 4727 Rev. 6/8/12  (5034 kb)
      BluePride Options At a Glance - Health plans for employer groups of 2-50 eligible employees.
            Form 4728 Rev. 6/20/12   (1382 kb)
      BlueFreedom Brochure - Health plans for employer groups of 51-99 eligible employees.
            Form 8901 Rev. 12/22/10  (970 kb)
      BlueFreedom Options At A Glance - Health plans for employer groups of 51-99 eligible employees.
            Form 8906 Rev. 12/22/10   (671 kb)
      BlueFreedom Master Group Application
            From 30-015 Rev. 1/12  (108 kb)
      BlueFreedom Employee Enrollment Form
            Form 31-072 Rev. 9/1/10   (38 kb)
      Fremont BlueChoice Brochure
            Form 36-093 (05-02-11)  (4915 kb)
      Fremont BlueChoice FAQs
            Form 36-123 (04-27-12)  (530 kb)
            Agent of Record Change Request Form  (136 kb)
Return to Top


Copyright © 2017 Preferred Marketing Associates. All rights reserved.
Website created by Web Solutions Omaha