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<br />ITEK V <br /> <br />The EMPLOYER'S BANK is identified as <br /> <br />LIBERTY NATIONAL BANK <br />Name <br /> <br />305 LAMAR <br />Address <br /> <br />PARIS, <br />City <br /> <br />TEXAS <br />State <br /> <br />75460 <br />Zip <br /> <br />ITEM VI <br /> <br />The HEALTH CONTRACT ADMINISTRATION CHARGE for the Contract Year shall be calculated <br />monthly by multiplying, respectively, the number of Health Certificates exposed for <br />a particular month by the rates for the category of the Certificate as indicated <br />below and totaling the results thus obtained: <br /> <br />Employee Only <br />Employee and Child(ren) <br />Employee and Spouse <br />Employee and Family <br /> <br />Heal th <br />$ 4.30 <br />$ 7.50 <br />$11.19 <br />$13.83 <br /> <br />Of that total charge, an amount to be calculated by applying the following portion <br />of the above rates is to be paid monthly to Blue Cross and Blue Shield of Texas, <br />Inc. : <br /> <br />Employee Only <br />Employee and Cbild(ren) <br />Employee and Spouse <br />Employee and Family <br /> <br />Heal th <br />$ 3.44 <br />$ 6.00 <br />$ 8.96 <br />$11.07 <br /> <br />The rema1n1ng Health Contract Administration Charge amount as calculated by applying <br />the remaining portion of each rate as follows, is to be held by the employer and <br />paid to Blue Cross and Blue Shield of Texas, Inc. within ten (10) days after the end <br />of the final Accounting Period as provided in Article III, Section D of this <br />agreement: <br /> <br />Employee Only <br />Employee and Child(ren) <br />Employee and Spouse <br />Employee and Family <br /> <br />Heal th <br />$ .86 <br />$ 1.50 <br />$ 2.23 <br />$ 2.76 <br /> <br />These amounts are guaranteed for the indicated Contract Year and are included in the <br />Health Contract Underwritten Premium. <br /> <br /> <br />., <br /> <br />