Laserfiche WebLink
2 <br />ITEM IV <br />SPECIFIC HEALTH STOP LOSS INSURANCE for benefits paid under the Health Contract <br />is either: <br />(a) 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 />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 />inc u ed as an Incurred Health Benefit. This amount is <br />guaranteed for the indicated Contract Year. <br />or <br />(c) not applied for. <br />ITEM V <br />The HOME BANK is identified as: <br />LIBERTY NATIONAL BANK <br />Name <br />305 LAMAR <br />-Address <br />PARIS, TE W 75460 <br />City State Zip <br />ITEM VI <br />The total HEALTH CONTRACT ADMINISTRATION CHARGE for the Contract Year shall be <br />calculated monthly by multiplying, respectively, the number of Health <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 />Employee Only $ 5.23 <br />Employee and Children) $ 9.14 <br />Employee and Spouse $13:65 <br />Employee and Family $16.86 <br />