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<br />The rema1n1ng Health Contract Administration Charge amount as calculated above. if <br />any. will be carried forward each Contract Year. The cumulative remaining Health <br />Contract Administration Charge amount deferred from prior accounting periods. if <br />any. is shown in the Remaining Heal th Contract Underwritten Calculation Schedule <br />provided to the Employer after the end of each Accounting Period. <br /> <br />ITKK VII <br /> <br />The SPECIl!'IC HEALTH COllTRACT STOP LOSS PRBKIUM for the Contract Year shall be <br />calculated monthly by mu1 tiplying. respectively. the number of Health Certificates <br />exposed for a particular month by $3.94 for each single Health Certificate. $6.89 <br />for each Health Certificate with child(ren). $10.28 for each Health Certificate with <br />spouse. and $12.70 for each Health Certificate with family. These amounts are <br />guaranteed for the indicated Contract Year and are included in the Health Contract <br />Underwritten Premium. <br /> <br />ITEM VIII <br /> <br />The KINIHDH BALANCE to be maintained by the Employer in the Employer's Account at <br />The Bank is $6.035 for November 1, 1985 through April 30. 1986. and $9,847 for May <br />1. 1986 through October 31. 1986 <br /> <br />ITKK IX <br /> <br />The HEALTH COllTRACT UNDERWRITTEN PRBKIUM rates for the Contract Year shall be: <br /> <br /> Employee Employee & Employee & Employee & <br /> Only Child (ren) Spouse Family <br />Hospitalization: $32.93 $ 57.55 $ 85.92 $106.12 <br />OME: $21. 96 $ 38.36 $ 57.28 $ 70.75 <br />TOTAL : $54.89 $ 95.91 $143.20 $176.87 <br /> <br />z).~_.(!~ <br /> <br />S1gnature of the Employer's Group Executive <br /> <br />//- j-- 37 <br />Date <br /> <br />-~'__ / f <br /> <br />Signature of Represeqta ive of <br />Blue Cross and Blue sl1 Id of Texas. Inc. <br /> <br />/1. S" - ,g7 <br />Date <br /> <br /> <br />., <br /> <br />