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<br />The remaining 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 Health Contract Underwritten Calculation Schedule <br />provided to the Employer after the end of each Accounting Period. <br /> <br />ITEM VII <br /> <br />The SPECIFIC HEALTH OOIlTRACT S'l'OP LOSS PREMIllH for the Contract Year shall he <br />calculated monthly by multiplying, respectively, the number of Health Certificates <br />exposed for a particular month by $4.63 for each single Health Certificate, $8.09 <br />for each Health Certificate with child (ren), $12.09 for each Health Certificate with <br />spouse, and $14.93 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 HINIHllH BALANCE to be maintained by the Employer in the Employer's Account at <br />The Bank is $10,193 for November I, 1986 through October 31, 1987. <br /> <br />ITEM IX <br /> <br />The HEALTH COIlTRACT UHDERWRITl'EN PRBIUlJK 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 />Signature of the Employer's Group Executive <br /> <br />Date <br /> <br />Date <br /> <br />Signature of Representative of <br />Blue Cross and Blue Shield of Texas, Inc. <br /> <br /> <br />.v <br /> <br />