Document:

<PAGE>   1
                                                                   Exhibit 10.49

                        AMENDED AND RESTATED STATE INCOME

                            TAX ALLOCATION AGREEMENT

         THIS AMENDED AND RESTATED STATE INCOME TAX ALLOCATION AGREEMENT (this
"Agreement") is made and entered into as of November 30, 2000, by and among
RIGHTCHOICE MANAGED CARE, INC., a Delaware corporation ("Parent"), and
DIVERSIFIED LIFE INSURANCE AGENCY OF MISSOURI, INC. ("DLIAM"), HMO MISSOURI,
INC. ("HMO Missouri"), HEALTHLINK, INC. ("HealthLink"), PREFERRED HEALTH PLANS
OF MISSOURI, INC. ("PHPMo"), FORTY-FOUR FORTY-FOUR FOREST PARK REDEVELOPMENT
CORPORATION ("Forest Park"), R & P REALTY, INC. ("R & P") and C & S PROPERTIES,
INC. ("C & S") (hereinafter referred to individually as a "Subsidiary" or
collectively as "Subsidiaries").

                                   WITNESSETH:

         WHEREAS, RightCHOICE Managed Care, Inc., a Missouri corporation
("RightCHOICE"), DLIAM, HMO Missouri, HealthLink and PHPMo entered into that
certain State Income Tax Allocation Agreement dated September 30, 1999 (as the
same may have been amended from time to time, the "Original Agreement");

         WHEREAS, RightCHOICE and its parent, Blue Cross and Blue Shield of
Missouri ("BCBSMo"), entered into that certain State Income Tax Allocation
Agreement dated September 30, 1999 (as the same may have been amended from time
to time, the "BCBSMo Agreement");

         WHEREAS, BCBSMo, Forest Park, R & P and C & S entered into that certain
State Income Tax Allocation Agreement dated June 10, 1999 (as the same may have
been amended from time to time, the "BCBSMo Subsidiary Agreement");

         WHEREAS, BCBSMo merged into Parent on the effective date of this
Agreement and, subsequent to that merger, RightCHOICE also merged into Parent;

         WHEREAS, as a result of the merger of BCBSMo into Parent and
RightCHOICE into Parent, the successor-in-interest to BCBSMo, the parties desire
to terminate and replace the BCBSMo Agreement and the BCBSMo Subsidiary
Agreement, to add Forest Park, R & P and C & S as parties to the Original
Agreement and to amend and restate the Original Agreement as hereinafter
provided;

         WHEREAS, to the extent this Agreement conflicts or is inconsistent with
any term or condition of the Original Agreement, the terms and conditions of
this Agreement shall supersede such term or condition in the Original Agreement;

         WHEREAS, Parent and Subsidiaries are members of an affiliated group of
corporations within the meaning of section 1504(a)(1) of the Internal Revenue
Code of 1986 (the "Code") for which Parent is the parent corporation;

         WHEREAS, Parent and its eligible subsidiaries (the "Consolidated
Group") have elected and consented to file and do file consolidated state income
tax returns; and

         WHEREAS, the parties to this Agreement wish to agree on the payment of
tax liabilities between Parent and the Subsidiaries in a manner pursuant to
which each Subsidiary pays Parent an amount of state income tax based upon the
amount of state income taxes which would be payable by the Subsidiary if it
filed a separate state income tax return, which includes the income, gain, loss
and deductions of Subsidiary;

         NOW, THEREFORE, Parent and each Subsidiary hereby agrees as follows:
<PAGE>   2
I.       Consolidated Return.

         Parent and its includible subsidiaries, including the Subsidiaries,
         have elected to file consolidated state income tax returns for the
         taxable period ending December 31, 2000, and for any subsequent taxable
         period for which the Consolidated Group is permitted to file a
         consolidated state income tax return. Each of the Subsidiaries agree to
         file such consents and other documents and to take such action as may
         be necessary to carry out the purposes and provisions of this
         paragraph.

II.      Calculation of Separate Company State Income Tax Liability.

         A.       Beginning with the period ended December 31, 2000, and for
                  each tax year thereafter, each Subsidiary will calculate the
                  state income tax liability for each Subsidiary (for the period
                  during which such Subsidiary was a direct or indirect
                  subsidiary of Parent), as if such Subsidiary were to file a
                  separate state income tax return for such period.

III.     Liability for Tax Payments - State.

         A.       If a Subsidiary would be subject to state income tax liability
                  resulting from the calculation required by Paragraph II,
                  above, such Subsidiary shall pay such liability to Parent.

         B.       If a Subsidiary has a net operating loss for the period, such
                  Subsidiary will be entitled to a refund from the Parent at
                  such time as the Subsidiary can utilize the net operating loss
                  if it filed a separate state income tax return.

         C.       Parent agrees to be the sole agent for Subsidiary and to act
                  in its own name in all matters relating to the corporation
                  state income tax liability, including payment of such
                  liability, for any year in which it elects or is required to
                  file a consolidated state income tax return.

IV.      Method and Time of Payment.

         Any amount to be paid by a Subsidiary to Parent or by Parent to a
         Subsidiary by reason of paragraph III shall be paid quarterly based on
         Subsidiary's estimated tax liability. The quarterly payment shall be
         made in time to reasonably permit Parent to make required estimated
         payments or final settlements with the state.

V.       Adjustment of Tax Liability.

         In the event of any adjustment of the tax liability as to the
         consolidated state income tax return of the Consolidated Group, by
         reason of the filing of an amended return, a tentative loss carryback
         refund application, claim for refund, or arising out of a federal or
         state audit, the liability of the Parent and Subsidiary hereunder shall
         be redetermined after fully giving effect to any such adjustment as if
         such adjustment had been a part of the original computation, including
         any interest and penalties attributable to any such adjustment.

VI.      Successors, Assign.

         The provisions and terms of this Agreement shall be binding on and
         inure to the benefit of any successor, by merger, acquisition of assets
         or otherwise, to any of the parties hereto.

                                       2
<PAGE>   3
VII.     Duration.

         With respect to each Subsidiary, unless earlier terminated by mutual
         agreement of the parties, this Agreement shall remain in effect with
         respect to all taxable years for which consolidated state income tax
         return are filed by the Consolidated Group and such Subsidiary is
         included as a member of the Consolidated Group. Earnings and Profits
         Adjustments.

         This Agreement is not intended to establish the method by which the
         earnings and profits of each member of the Consolidate Group will be
         determined.

VIII.    Miscellaneous.

         This Agreement contains the entire agreement among the parties hereto,
         and supersedes any prior written or oral understanding or agreement
         among the parties with respect to the settlement of state income taxes.
         No modification, extension, renewal, recession, termination or waiver
         of any of the provisions contained herein shall be binding upon any
         party unless made in writing and signed on its behalf by one of its
         officers.

IX.      GOVERNING LAW.

         THE PROVISIONS OF THIS AGREEMENT SHALL BE GOVERNED AND INTERPRETED IN
         ACCORDANCE WITH THE LAWS OF MISSOURI.

                                       3
<PAGE>   4
         IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by their duly authorized officer, and the amendment and restatement of
the Original Agreement is effective as of November 30, 2000.

<TABLE>
<S>                                              <C>
PREFERRED HEALTH PLANS OF MISSOURI, INC.         RIGHTCHOICE MANAGED CARE, INC., a
                                                 Delaware corporation

By:  /s/ John A. O'Rourke                        By:  /s/ John A. O'Rourke
    --------------------------------------           --------------------------------------
     John A. O'Rourke                                 John A. O'Rourke
     Chairman                                         President and Chief Executive Officer

DIVERSIFIED LIFE INSURANCE AGENCY                HMO MISSOURI, INC.
OF MISSOURI, INC.

By:  /s/ John A. O'Rourke                        By:  /s/ John A. O'Rourke
    --------------------------------------           --------------------------------------
     John A. O'Rourke                                 John A. O'Rourke
     Chairman                                         Chairman and President

HEALTHLINK, INC.                                 FORTY-FOUR FORTY-FOUR FOREST PARK
                                                 REDEVELOPMENT CORPORATION

By:  /s/ John A. O'Rourke                        By:  /s/ John A. O'Rourke
    --------------------------------------           --------------------------------------
     John A. O'Rourke                                 John A. O'Rourke
     Chairman                                         President

R & P REALTY, INC.                               C & S PROPERTIES, INC.

By:  /s/ John A. O'Rourke                        By:  /s/ John A. O'Rourke
    --------------------------------------           --------------------------------------
     John A. O'Rourke                                 John A. O'Rourke
     President                                        President
</TABLE>

                                       4<PAGE>   1

                                                                   EXHIBIT 10.10

                                                         Translation from French

                               EMPLOYMENT CONTRACT

BETWEEN THE UNDERSIGNED:

               Insituform Europe, a French societe par actions simplifiee with
sole shareholder with a capital of 38,200 euros, having its registered office
located at 30 boulevard de Bellerive - 92500 Rueil Malmaison, registered with
the Registry of Commerce and Companies of Nanterre under number 433 960 242
(hereinafter referred to as "Insituform Europe"), represented by Mr. Robert
Kelley, duly empowered for the purpose hereof,

                                                                on the one hand,

AND:

               Mr. Antoine Menard, residing at 15 rue Charles-Rhone - 78100
Saint-Germain-en-Laye,

                                                                  on other hand,

IT HAS BEEN AGREED AS FOLLOWS:

                                    ARTICLE 1
                                     HIRING

                  1.1 Subject to the results of the hiring medical check-up,
Insituform Europe shall hire Mr. Menard, who accepts it, as Manager (Directeur)
as from February 1, 2001. This employment is governed by the terms hereof, by
the collective bargaining agreement of public works - engineers and executives
(convention collective nationale des travaux publics - ingenieurs et cadres)
(n(Degree) 3005) of August 31, 1955, including its annexes and amendments
(hereinafter the "Collective Bargaining Agreement"), as well as all other
current or future provisions, instructions, or any regulations of Insituform
Europe.

<PAGE>   2

               Mr. Menard, who accepts this hiring, formally represents that as
from the above-mentioned date, he will not be bound to any other company and
will be free of any commitment with any company whatsoever.

                  1.2 The seniority of Mr. Menard within Insituform Europe will
be calculated as from May 1, 1995.

                  1.3 For the purpose of this employment contract, the term
"Affiliated Company" shall mean any company which, directly or indirectly,
through one or more intermediaries, controls Insituform Europe or is under the
same control as Insituform Europe. A company shall be deemed to control another
when it meets one of the criteria referred to in Article L. 233-3 of the French
Commercial Code.

                                    ARTICLE 2
                                     DUTIES

                  2.1 Mr. Menard shall exercise the duties as Manager
(Directeur), hierarchic coefficient 162, reference position C, 2nd grade, of the
Collective Bargaining Agreement.

                  2.2 In his capacity as Manager (Directeur), Mr. Menard shall
exercise the following duties:

                    -    Supervision and follow-up of all European subsidiaries
                         of Insituform Technologies, Inc. (hereinafter referred
                         to as "ITI"), in particular setting-up and follow-up of
                         the productivity enhancement and costs reduction plans
                         in these subsidiaries, setting-up and follow-up of the
                         sales policies targeted per country, creation and
                         analysis of the various reports and management charts
                         of the various subsidiaries, possible recruitment of
                         senior managers of these subsidiaries and their career
                         management.

                  He will exercise his duties under the authority and in the
context of the instructions given by the Chairman of Insituform Europe to whom
he will report on his activity.

                                       2

<PAGE>   3

                  2.3 Mr. Menard will exercise his duties at the registered
office of Insituform Europe, it being however specified that he will have to
frequently travel in the context of his duties.

                  2.4 Mr. Menard undertakes to devote the time, efforts, and
attention appropriate to his position at Insituform Europe, and may not exercise
any other position, on his behalf or on behalf of a third party, except in
respect of the activities to be exercised for another company affiliated to ITI.

                                    ARTICLE 3
                                  COMPENSATION

                  3.1 Mr. Menard shall receive (i) a gross annual salary of
eight hundred and fifty four thousand (854,000) francs, payable in thirteen (13)
equal installments, the thirteenth installment being fully paid in December of
the corresponding year. Insituform Europe shall proceed with an annual review of
this salary (anniversary date March).

                  3.2 In addition to this gross salary, Mr. Menard shall be
entitled to receive a non-guaranteed annual bonus of a target amount of 50% of
the salary referred to in Article 3.1 above. The actual amount of the bonus, if
any, shall be calculated according to the allocation rules provided for by ITI.

                  3.3 A company car (type Safrane or equivalent) shall be made
available to Mr. Menard who may use it for professional and personal purposes,
under the conditions in force within Insituform Europe and specified by
memorandum. The portion corresponding to the use of the car for personal
purposes, assessed at the gross amount of eight hundred and fifty (850) francs,
shall be considered as a benefit in kind and in this respect shall be subject to
social contributions. The transport expenses incurred by Mr. Menard for
professional purposes will be reimbursed to him pursuant to the rules applicable
within Insituform Europe.

                                    ARTICLE 4
                              TERM AND TERMINATION

                  4.1 This contract will come into force on February 1, 2001 for
an indefinite term. It shall not be subject to a trial period.

                  4.2 This contract may be terminated by either party, by
registered mail with return receipt requested indicating the prior notice
period, which shall be three (3) months.

                                       3

<PAGE>   4

There will be no prior notice period in case of dismissal for gross or willful
misconduct (faute grave ou lourde).

                  4.3 For any dismissal other than for gross or willful
misconduct, Mr. Menard shall receive, with respect to all indemnities to which
he may be entitled, an indemnity amounting to:

                  (i)  one year of gross salary, within the meaning of Article
3.1 hereof only, or

                  (ii) the amount that is due to him under the provisions
falling within either the regulations regarding labor law, or the Collective
Bargaining Agreement, if this amount is higher than the amount referred to in
(i) above,

                  it being however understood that Mr. Menard shall bear all
social contributions that could be payable due to the payment of the indemnity
referred to in this Article.

                                    ARTICLE 5
                                  WORKING HOURS

                  The parties remind that the nature of the duties entrusted to
Mr. Menard and his level of responsibility imply a large degree of independence
in the organization of his work schedule excluding any fixed standard working
hours. Therefore, due to the responsibilities that Mr. Menard assumes in the
context hereof and the freedom he has in the organization of his work, he will
not be submitted to the rules on overtime hours and compensating day-off.

                                    ARTICLE 6
                              PROFESSIONAL EXPENSES

                  Upon evidence of supporting documents, Insituform Europe will
reimburse to Mr. Menard all reasonable expenses incurred in the context of his
professional activity. This reimbursement shall be made in accordance with the
rules and procedures applicable within Insituform Europe.

                                       4

<PAGE>   5

                                    ARTICLE 7
                           PAID VACATION AND BENEFITS

                  7.1 Mr. Menard shall be entitled each year to paid vacation
calculated in accordance with the law and the Collective Bargaining Agreement.
The dates of this vacation shall be mutually agreed with Insituform Europe
considering the needs of Insituform Europe.

                  7.2 Mr. Menard will be entitled to the benefits provided for
by the law in force and the rules and procedures applicable within Insituform
Europe.

                                    ARTICLE 8
                            CONFIDENTIAL INFORMATION

                  Mr. Menard hereby undertakes to scrupulously comply with,
during the term of this contract and for a five-year period following its
termination, the rules applicable regarding confidentiality and inventions set
forth in Annex A attached hereto.

                                    ARTICLE 9
                                 NON-COMPETITION

                  For two years following the termination of Mr. Menard's
employment contract, for any reason whatsoever, the latter undertakes not to,
directly or indirectly, as principal, agent, employee, distributor,
representative, partner, shareholder or other, compete with, in any way
whatsoever, Insituform Europe, or any Affiliated Company for which Mr. Menard
will have been in charge of the follow-up and supervision in respect hereof, as
far as the activities of cleaning and renovating of pipes on the territory of
the French Republic are concerned.

                                   ARTICLE 10
                          GOVERNING LAW OF THE CONTRACT

                  10.1 This contract shall be construed according to, and
governed by, French law, and any dispute arising out of the performance hereof
shall be governed by French law. The French courts will have exclusive
jurisdiction.

                  10.2 The clauses of Insituform Europe's internal rules
(reglement interieur), that Mr. Menard will comply with when such regulations
will be adopted, will be applied to determine the rights and obligations of Mr.
Menard and Insituform Europe that will not be specifically contemplated in this
contract.

                                       5

<PAGE>   6

                                   ARTICLE 11
                            ENTIRETY OF THE CONTRACT

                  This contract, with its Annex A, constitutes the entirety of
the contract entered into between Mr. Menard and Insituform Europe, and cancels
all uses and practices, arrangements, conventions, undertakings or statements of
intent (whether written or oral) that have occurred between Mr. Menard and
Insituform Europe in connection with the conditions of employment of Mr. Menard
by Insituform Europe or any Affiliated Company. In particular, this contract
cancels and supersedes the employment contract entered into between Mr. Menard
and Insituform France on March 24, 1995 as well as any amendment thereto.

A FRENCH VERSION OF THIS CONTRACT WILL SUPERSEDE THIS ENGLISH VERSION.

                  The parties entered into this contract in two original
counterparts in Rueil Malmaison, on January 31, 2001.

Insituform Europe

by        *                                                         *
   -----------------                                         -----------------
     Robert Kelley                                             Antoine Menard

* THIS DOCUMENT WAS EXECUTED IN FRENCH.

This document is a fair and accurate English translation of the Employment
Agreement executed by Robert Kelley, on behalf of Insituform Europe, and Antoine
Menard.

                                                      /s/ Thomas A. A. Cook
                                             -------------------------------
                                             Thomas A. A. Cook
                                             Vice President - General Counsel

                                       6

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