Health Insurer, Aetna Inc is expecting in forth quarter of 2009 to shell out about $60 to $65 million as the cost associated with job cuts and restructuring. Earlier, 1,000 positions were axed in December 2008.

In November this year, the health insurer had reduced its work force by 1.8 percent and also revealed its plan for the similar reduction again at the end of first quarter.

The fourth quarter charges included $40 million for reduction of 625 workers and real-estate consolidation and $20 to $25 million is expected in first quarter for similar reduction.

After completion of all job cuts, Aetna is expected to have 34,000 employees.

In recent pre-market trading, the shares fell by 1.9 percent, closing at $32.22, though on Tuesday, stock rose by 15 percent.

The complete industry is fighting with reduction in enrollment in commercial plans, and final outcome of the government's step of overhauling the health care policy is still awaited.

This year, Aetna is going through a period of negative gap between rise in medical costs and growth of premiums. The company is trying to reverse that with a high risk of losing the customers that are not willing to pay higher premiums.