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MMIBIT <br />for <br />CITY OF PARIS <br />G roup Name <br />25724 <br />Group Number <br />ITKH I <br />These specifications are for the CONTRACT YEAR which shall commence on November 1, <br />1985 and end on October 31, 1986. <br />ITEH II <br />The ACCOUNTING PERIOD shall commence on November 1, 1985 and end on October 31, <br />1986. <br />ITEM III <br />The DRAFT AUTHORITY (Column C)shall be calculated monthly and be equal to the sum of <br />the products obtained by multiplying respectively the number of Health Certificates <br />exposed for a particular month by $36.50 for each single Health Certificate, $63.78 <br />for each Health Certificate with child(ren), $95.24 for each Health Certificate with <br />spouse, and $117.62 for each Health Certificate with family. <br />ITEM ID <br />SPECIFIC STOP LOSS INSURANCE for benefits paid under the Health Contract is either: <br />(a) applied for and all Health Contract benefits paid in excess of <br />$ per Health Certificate per Contract Year shall not be <br />included as an Incurred Health Benefit. This amount is guaranteed <br />for the indicated Contract Year, <br />or <br />(b) _ X 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 guaranteed <br />for the indicated Contract Year, <br />or <br />(c) not applied for. <br />27(' <br />�L <br />