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I <br />27J <br />ITMv <br />The EMPLOYER'S BANK is identified as <br />LIBERTY NATIONAL BANK <br />Name <br />305 LAMAR <br />Address <br />PARIS, TERAS 75460 <br />City State Zip <br />ITBli VI <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 />Health - <br />Employee Only T +. 5 0 <br />Employee and Children) $ 7.50 <br />Employee and Spouse $11.19 <br />Employee and Family $13.83 <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 />Heal th <br />Employee Only T 3.44 <br />Employee and Children) $ 6.00 <br />Employee and Spouse $ 8.96 <br />Employee and Family $11.07 <br />The remaining 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 />Health <br />Employee Only .86 <br />Employee and Children) $ 1.50 <br />Employee and Spouse $ 2.23 <br />Employee and Family $ 2.76 <br />These amounts are guaranteed for the indicated Contract Year and are included in the <br />Health Contract Underwritten Premium. <br />p �, <br />