May Insurance Services, Inc.

CENTRAL RESERVE LIFE (CRL)

NOTE: Due to the age of these forms - we did not split the group and individual forms.

Administrative Manual (group) PRO-0456 8/28/03
Application (group 2-50) Employee APL-0547 9/05
Application (group 51+) Employee APL-0548 9/05
Application (group) Employer Participation Request/Agreement PRQ-GPT2 3/05
Application Advantage Products (individual) APL=0549 2/05
Authorization - Release Medical Information AEF-0583 12/04
Change Request Form (group) SEF-0092 10/03
Checklist - HSA (group)
Checklist - Partnership Plan (group)
Checklist - PMOP (group)
Checklist - Submitted New Business (individual) SEF-0138 12/05
Checklist (group) SEF-0031 4/05
Claim Form Dental CEF-GRP32 10/97
Claim Form Prescription - Express Scripts
COBRA Election Form AEF-Cobra2 11/05
COBRA Notice AEF-Cobra4 10/04
Dental Smile Protector Employer Application (group) APC-0069 5/01
Dental Smile Protector Employee Application (group) APC-0067 4/01
Dental Smile Protector Brochure (group) PRB-0369 4/01
Eagle Consumer Association Application/Brochure PRO-0033 10/03
EFT Form (individual) AEF-0303 3/03
Eligible Individual Application APL-GRP48B 7/99
Eligible Individual Brochure PRB-0158 6/03
Elite Advantage Application APL-0549 2/05
Elite Advantage Brochure PRB-0496 1/06
HIPAA & Employers AEF-0590 3/04
HSA - ABCs of your Heatlh Savings Account PRO-0626 2/05
HSA - Application My Health Savings Bank APL-0557 9/04
HSA Enhancement 2006 (grp-indiv) PRB-0350 12/05
HSA Plus Certificate Booklet CEB-0820 4/05
HSAdvantage Brochure (group) PRB-0388 5/04
HSAdvantage Plus Application (individual) APL-0549 2/05
HSAdvantage Plus Brochure (individual) PRB-0485 9/05
LabOne PRO-0354 3/01
Licensing Agent Contract/Application Form APL-0104 1/06
Licensing Agent Direct Deposit Form SEF-0128 5/05
Non-Profit Organization Questionnaire AEF-0191 6/96
Ohio Mandate Insert PRB-0085 6/05
Optional Employee Deductible AEF-F046 9/94
Partnership Western Reserve Administrative Service Agreement AEF-W017
Partnership Western Reserve Administrative Service Monthly Cap AEF-W015 4/03
Partnership Brochure PRB-0165 2/02
Partnership Brochure Supplement PRB-0472 5/04
Partnership Enhancements 2006 (group) PRB-0350 12/05
Payroll Deduction Authorization AEF-T068 3/05
PMOP Brochure PRB-463 4/03
PMOP Enhancements 2006 (group) PRB-0350 12/05
Prescription Claim Form (see above under CLAIM FORM)
Producer Guide (small group) MAN-0029 5/02
Producer Guide (individual) HSA MAN-0043 12/04
Producer Guide (individual) MAN-0030 12/03
Product Grid Advantage Plans (MIS form) 2/06
Select Advantage Application APL-0549 2/05
Select Advantage Brochure PRB-0486 8/05
Short Term Medical Application PRO-0541 8/05
Short Term Ohio Mandates Insert PRI-0161OH 8/05
Term - Employer Instructions AEF-GPT1-4 9/99
Term - Continuation/Conversion AEF-GPT102 1/04
Term - Notice of Conversion AEF-GPT36 10/93
Underwriting Guidelines (individual) MAN-0044 6/05
Verification Guidelines PRO-0552 4/04
Vision - VSP PRO-0535 6/04