Laserfiche WebLink
<br />ITEM IV <br /> <br />SPECIFIC HEALTH STOP LOSS INSURANCE for benefits paid under the Health Contract <br />is either: <br /> <br />(a) <br /> <br />applied for and all Health Contract benefits paid in excess of <br />$ per Health Certificate per Contract Year shall not <br />be included as an Incurred Health Benefit. This amount is <br />guaranteed for the indicated Contract Year, <br /> <br />or <br /> <br />(b) <br /> <br />x <br /> <br />applied for and all Health Contract benefits paid in excess of <br />$30.000 per Participant per Contract Year shall not be <br />included as an Incurred Health Benefit. This amount is <br />guaranteed for the indicated Contract Year. <br /> <br />or <br /> <br />(c) <br /> <br />not applied for. <br /> <br />ITEM V <br /> <br />The HOKE BANK is identified as: <br /> <br />LIBERTY NATIONAL BANK <br />Name <br /> <br />305 LAHAR <br />Address <br /> <br />PARIS. <br />City <br /> <br />TEXAS <br />Sta te <br /> <br />75460 <br />Zip <br /> <br />ITEM VI <br /> <br />The total HEALTH CONTRACT ADMINISTRATION CHAllGE for the Contract Year shall be <br />calculated monthly by multiplying, respectively. the number of Heal th <br />Certificates exposed for a particular month by the rates for the category of the <br />Certificate as indicated below and totaling the results thus obtained: <br /> <br />Employee Only <br />Employee and Child(ren) <br />Employee and Spouse <br />Employee and Family <br /> <br />HEALTH <br />$ 5.23 <br />$ 9.14 <br />$13.65 <br />$16.86 <br /> <br /> <br />., <br /> <br />