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APPLICATION FOR GROUP COVERAGE FOR POLICY #359620 & 50703 - (BENEFIT YEAR 2010) PLAN #50703, EFFECTIVE 1/1/2010, TERMINATE OF MELLON HSA EMPLOYER SPONSORED ACCOUNT ACCESS FOR EARLY RETIREES & DEPENDENTS OF MSB MEMBERS, PLAN #359620, EFFECTIVE 1/1/2010, GREAT-WEST NOW PART OF CIGNA WILL PAY CLAIMS FOR HOSPITAL INDEMNITY PLAN