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2017
Instructions for Form 8941
Department of the Treasury
Internal Revenue Service
Credit for Small Employer Health Insurance Premiums
DRAFT AS OF
November 22, 2017
Partnerships, S corporations, cooperatives,
Section references are to the Internal Revenue Code
unless otherwise noted.
TIP estates, trusts, and tax-exempt eligible small
Future Developments
For the latest information about developments related to
Form 8941 and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
Form8941.
What’s New
Employers in Hawaii cannot claim this credit for insurance
premiums paid for health plan years beginning after 2016.
For more information, see Waiver for Hawaii in the Line A
instructions.
General Instructions
Purpose of Form
Eligible small employers (defined below) use Form 8941
to figure the credit for small employer health insurance
premiums for tax years beginning after 2009. For tax
years beginning after 2013, the credit is only available for
a 2-consecutive-tax-year credit period. The maximum
credit is generally a percentage of premiums the employer
paid during the tax year for certain health insurance
coverage the employer provided to certain employees
enrolled in a qualified health plan offered through a Small
Business Health Options Program (SHOP) Marketplace.
But the credit may be reduced by limitations based on the
employer's full-time equivalent employees, average
annual wages, adjusted average premiums, and state
premium subsidies and tax credits.
For information about insurance plans offered
TIP through a SHOP Marketplace, visit
Healthcare.gov.
For tax-exempt eligible small employers, the
maximum credit is 35% of premiums paid, is limited to the
amount of certain payroll taxes paid, and is claimed as a
refundable credit on Form 990-T, Exempt Organization
Business Income Tax Return. A tax-exempt eligible small
employer is an eligible small employer described in
section 501(c) that is exempt from taxation under section
501(a). A tax-exempt employer not described in section
501(c) is generally not eligible to claim this credit.
However, a tax-exempt farmers' cooperative subject to tax
under section 1381 may be able to claim the credit as a
general business credit as discussed next.
For all other eligible small employers, the maximum
credit is 50% of premiums paid, can be taken against both
regular and alternative minimum tax, and is claimed as
part of the general business credit on Form 3800.
Nov 22, 2017
employers must file this form to claim the credit.
All other taxpayers must not complete or file this form if
their only source for this credit is a partnership, S
corporation, cooperative, estate, or trust. Instead, they
must report this credit directly on line 4h in Part III of Form
3800, General Business Credit.
Eligible Small Employers
You are an eligible small employer for the tax year if you
meet the following three requirements.
1. You paid premiums for employee health insurance
coverage under a qualifying arrangement. A
qualifying arrangement is generally an arrangement that
requires you to pay a uniform percentage (not less than
50%) of the premium cost for each enrolled employee's
health insurance coverage (defined later). However, an
arrangement that requires you to pay a uniform premium
for each enrolled employee (composite billing) and offers
different tiers of coverage (for example, employee-only,
dependent, and family coverage) can be a qualifying
arrangement even if it requires you to pay a uniform
percentage that is less than 50% of the premium cost for
employees not enrolled in employee-only coverage.
In addition, an arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) can be a qualifying arrangement
even if it requires you to pay a uniform percentage that is
less than 50% of the premium cost for some employees.
For details, see Employer Premiums Paid, Health
Insurance Coverage, and Qualifying Arrangement, later.
2. You had fewer than 25 full-time equivalent employees (FTEs) for the tax year. You may be able to meet
this requirement even if you had 25 or more employees.
For details, see Worksheets 1 and 2.
Although the term "eligible small employer" is
TIP defined in the Internal Revenue Code to include
employers with "no more than" 25 FTEs, the
phase out of the credit amount operates in such a way
that an employer with exactly 25 FTEs is not in fact
eligible for the credit.
3. You paid average annual wages for the tax year of
less than $53,000 per FTE. For details, see Worksheets
1 and 3.
If you had more than 10 FTEs and average
annual wages of more than $26,000, the FTE and
CAUTION average annual wage limitations (discussed later)
will separately reduce your credit. This may reduce your
credit to zero even if you had fewer than 25 FTEs and
average annual wages of less than $53,000.
!
Cat. No. 55222U
Wellness programs. A wellness program is generally an
insurance program of health promotion or disease
prevention. If you pay part or all of the cost of an
employee's participation in a wellness program, use the
amount you paid to figure your employer premiums paid.
Employers treated as a single employer. Treat the
following employers as a single employer to figure the
credit.
Employers who are corporations in a controlled group
of corporations.
Employers who are members of an affiliated service
group.
Employers who are partnerships, proprietorships, etc.,
under common control. See Regulations sections
1.414(c)-2, 1.414(c)-3, and 1.414(c)-4.
Tax-exempt employers under common control. See
Regulations section 1.414(c)-5.
For details, see section 45R(e)(5)(A) and Regulations
section 1.45R-2(b).
Tobacco surcharges. A tobacco surcharge is generally
an additional amount charged for insurance for a tobacco
user. If you pay part or all of an employee's tobacco
surcharge, you can’t use the amount you paid to figure
your employer premiums paid.
DRAFT AS OF
November 22, 2017
Dependent coverage. Dependent coverage is generally
coverage offered separately to an individual who is or may
become eligible for coverage under the terms of a group
health plan because of a relationship to a
participant-employee, whether or not a dependent of the
participant-employee. Dependent coverage doesn’t
include coverage, such as family coverage, which
includes coverage of the participant-employee. If you pay
part or all of the cost of an employee's dependent
coverage, use the amount you paid to figure your
employer premiums paid.
No more than one Form 8941 can be filed with a
TIP tax return, unless the exception described in
Example 2 below applies.
Example 1. You are a sole proprietor with two
separate businesses and you file a separate Schedule C
(Form 1040) for each business. You must treat both
businesses as a single employer to figure the credit. You
will file one Form 8941 for both businesses.
Portion of premiums paid. If you pay only a portion of
the premiums and your employees pay the rest, only the
portion you pay is taken into account. For this purpose,
any premium paid through a salary reduction arrangement
under a section 125 cafeteria plan isn’t treated as an
employer paid premium. For more information on cafeteria
plans, see section 1 of Pub. 15-B, Employer's Tax Guide
to Fringe Benefits.
Example 2. You and your spouse are both sole
proprietors and file a separate Schedule C (Form 1040)
for each of your separate businesses. Neither spouse was
an employee of the other spouse or participated in the
management of the other spouse's business at any time
during the tax year. No more than 50% of the gross
income of either business was derived from royalties,
rents, dividends, interest, and annuities and you otherwise
meet the requirements listed in Regulations section
1.414(c)-4(b)(5)(ii). Don’t treat both businesses as a
single employer to figure the credit. If you and your
spouse are both eligible small employers, you can file two
Forms 8941 with a jointly filed Form 1040.
Example 3. You offer health insurance coverage to
employees under a qualifying arrangement that requires
you to pay 60% of the premium cost for employee-only
coverage for each employee enrolled in any health
insurance coverage you provide to employees. The total
premium for each employee enrolled in employee-only
coverage is $5,200 per year or $100 ($5,200 ÷ 52) for
each weekly payday. The total premium for each
employee enrolled in family coverage is $13,000 per year
or $250 ($13,000 ÷ 52) for each weekly payday.
Each payday you contribute $60 (60% of $100) toward
the premium cost of each employee enrolled in
employee-only coverage and withhold the remaining $40
from the employee's paycheck to obtain the $100 total
weekly premium. Each payday you contribute $60 (the
same amount you pay toward the premiums of employees
enrolled in employee-only coverage) toward the premium
cost of each employee enrolled in family coverage and
withhold the remaining $190 from the employee's
paycheck to obtain the $250 total weekly premium.
To determine the premiums you paid during the tax
year, multiply the number of pay periods during which the
employee was enrolled in the health insurance coverage
by $60. For example, you would have paid $3,120 ($60 ×
52) for an employee who was enrolled for the entire tax
year. You would have paid $600 ($60 × 10) for an
employee who was only enrolled for 10 pay periods. You
will need an additional set of calculations if the premium
amounts changed during the tax year.
Credit Period
For tax years beginning after 2013, the credit period
during which the credit can be claimed is a
2-consecutive-tax-year period beginning with the first tax
year in which:
An eligible small employer (or any predecessor) files an
income tax return with an attached Form 8941 with line A
checked “Yes” and a positive amount on line 12, or
A tax-exempt eligible small employer (or any
predecessor) files Form 990-T with an attached Form
8941 with line A checked “Yes” and a positive amount on
line 12.
Employer Premiums Paid
Only premiums you paid for health insurance coverage
under a qualifying arrangement (discussed later) for
individuals considered employees are counted when
figuring your credit.
State premium subsidy or tax credit. If you are entitled
to a state tax credit or a state premium subsidy paid
directly to you for premiums you paid, don’t reduce the
amount you paid by the credit or subsidy amount. Also, if
a state pays a premium subsidy directly to your insurance
provider, treat the subsidy amount as an amount you paid
for employee health insurance coverage.
-2-
Instructions for Form 8941 (2017)
Health Insurance Coverage
requirement. Amounts you or your employee pay to cover
a tobacco surcharge aren’t considered premiums paid for
health insurance coverage when figuring this credit.
For tax years beginning after 2013, health insurance
coverage generally means coverage provided to
employees enrolled in a qualified health plan offered
through a Small Business Health Options Program
(SHOP) Marketplace. For an exception that applies to
certain employers in Wisconsin, see the Line A
instructions, later. If this exception applies, health
insurance coverage means coverage as defined under
Health Insurance Coverage in the 2013 Instructions for
Form 8941.
Dependent coverage. Premiums you pay for dependent
coverage aren’t subject to the uniform percentage
requirement. You aren’t required to pay a uniform
percentage (not less than 50%) for dependent coverage.
DRAFT AS OF
November 22, 2017
Arrangements with composite billing. An
arrangement that requires you to pay a uniform premium
for each enrolled employee (composite billing) and offers
different tiers of coverage can be a qualifying arrangement
even if it requires you to pay a uniform percentage that is
less than 50% of the premium cost for employees not
enrolled in employee-only coverage. It is a qualifying
arrangement (assuming employee-only coverage is the
least expensive tier of coverage) if it requires you to pay
the following amounts.
A uniform percentage (not less than 50%) of the
premium cost for each employee (if any) enrolled in
employee-only coverage.
A uniform amount that is no less than the amount you
would have paid toward employee-only coverage for each
employee (if any) enrolled in family coverage.
A uniform amount that is no less than the amount you
would have paid toward employee-only coverage for each
employee (if any) enrolled in any other tier of coverage
(figured separately for each tier).
A stand-alone dental plan offered through a
TIP SHOP exchange will be considered a qualified
health plan for purposes of the credit.
Employer premiums paid for health insurance
coverage can be counted in figuring the credit
CAUTION only if the premiums are paid under a qualifying
arrangement.
!
Qualifying Arrangement
A qualifying arrangement is generally an arrangement that
requires you to pay a uniform percentage (not less than
50%) of the premium cost for each enrolled employee's
health insurance coverage (defined earlier). An
arrangement that offers different tiers of coverage (for
example, employee-only and family coverage) is generally
a qualifying arrangement if it requires you to pay a uniform
percentage (not less than 50%) separately for each tier of
coverage you offer. However, an arrangement can be a
qualifying arrangement even if it requires you to pay a
uniform percentage that is less than 50% of the premium
cost for some employees.
Arrangements with list billing and only employee-only coverage. An arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) that only provides employee-only
coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for some employees. It is a
qualifying arrangement if it requires you to pay either of
the following amounts.
A uniform percentage (not less than 50%) of the
premium charged for each employee enrolled in the
employee-only coverage.
A uniform percentage (not less than 50%) of your
employer-computed composite rate (defined later) for
your employee-only coverage for each employee enrolled
in the employee-only coverage.
For more information about the following exceptions,
see Regulations section 1.45R-4.
State or local law. You will be treated as satisfying the
uniform percentage requirement if your failure to
otherwise satisfy the requirement was solely attributable
to additional contributions you made to certain employees
to comply with state or local law.
Wellness program. If a plan of an employer provides a
wellness program, for purposes of meeting the uniform
percentage requirement any additional amount of the
employer contribution attributable to an employee's
participation in the wellness program over the employer
contribution with respect to an employee that doesn’t
participate in the wellness program is not taken into
account in calculating the uniform percentage
requirement, whether the difference is due to a discount
for participation or a surcharge for nonparticipation. The
employer contribution for employees who don’t participate
in the wellness program must be at least 50% of the
premium (including any premium surcharge for
nonparticipation). However, for purposes of figuring the
credit, the employer contributions are taken into account,
including those contributions attributable to an employee's
participation in a wellness program.
Arrangements with list billing and other tiers of coverage. An arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) that provides other tiers of
coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for some employees. It is a
qualifying arrangement (assuming employee-only
coverage is the least expensive tier of coverage) if it
requires you to pay the following amounts.
A uniform percentage (not less than 50%) for each
employee enrolled in employee-only coverage as
discussed under Arrangements with list billing and only
employee-only coverage above.
A uniform amount that is either equal to the amount you
would have paid toward employee-only coverage (as
discussed above), a uniform percentage (not less than
50%) of the premium charged, or a uniform percentage
(not less than 50%) of your employer-computed
Tobacco surcharge. Any additional amount you or your
employee pay to cover a tobacco surcharge isn’t taken
into account in figuring the uniform percentage
Instructions for Form 8941 (2017)
-3-
beginning in 2017, payroll taxes, for this purpose, mean
only the following taxes.
Federal income taxes the tax-exempt employer was
required to withhold from employees' wages in calendar
year 2017.
Medicare taxes the tax-exempt employer was required
to withhold from employees' wages in calendar year 2017.
Medicare taxes the tax-exempt employer was required
to pay for calendar year 2017.
composite rate (defined below) for your family coverage,
for each employee (if any) enrolled in family coverage.
A uniform amount that is either equal to the amount you
would have paid toward employee-only coverage (as
discussed above), a uniform percentage (not less than
50%) of the premium charged, or a uniform percentage
(not less than 50%) of your employer-computed
composite rate (defined below) for any other tier of
coverage, for each employee (if any) enrolled in any other
tier of coverage (figured separately for each tier).
DRAFT AS OF
November 22, 2017
Premium Deduction Reduced
Employer-computed composite rate. The
employer-computed composite rate for a tier of coverage
is the average rate determined by adding the premiums
for that tier of coverage for all employees eligible to
participate in the health insurance plan (whether or not
they actually receive coverage under the plan or under
that tier of coverage) and dividing by the total number of
such eligible employees.
You must reduce your deduction for the cost of providing
health insurance coverage to your employees by the
amount of any credit for small employer health insurance
premiums allowed with respect to the coverage.
More Information
For more information about this credit, see the following.
Section 45R.
Regulations sections 1.45R-0 through 1.45R-5.
IRS.gov/Affordable-Care-Act/Employers/SmallBusiness-Health-Care-Tax-Credit-and-the-SHOPMarketplace.
More than one plan. Different types of health insurance
plans are generally not aggregated for purposes of
meeting the qualifying arrangement requirement. For
example, if you offer a major medical insurance plan and a
stand-alone vision plan, you generally must separately
satisfy the requirements for a qualifying arrangement with
respect to each type of coverage. For exceptions, see
Regulations section 1.45R-4(c).
Specific Instructions
Partnerships, S corporations, cooperatives,
TIP estates, trusts, and tax-exempt eligible small
State subsidies and credits. For this purpose, if you
are entitled to a state tax credit or a state premium
subsidy paid directly to you for premiums you paid, don’t
reduce the amount you paid by the credit or subsidy
amount. Also, if a state pays a premium subsidy directly to
your insurance provider, treat the subsidy amount as an
amount you paid for employee health insurance coverage.
employers must file this form to claim the credit.
All other taxpayers must not complete or file this form if
their only source for this credit is a partnership, S
corporation, cooperative, estate, or trust. Instead, they
must report this credit directly on line 4h in Part III of Form
3800.
State Premium Subsidy and Tax
Credit Limitation
Use Worksheets 1 through 7 to figure the amounts to
report on various lines of Form 8941.
Use Worksheets 1, 2, and 3 to figure the amounts to
report on lines 1, 2, and 3 of Form 8941.
Use Worksheet 4 to figure the amounts to report on
lines 4, 5, and 13 of Form 8941.
Use Worksheets 5, 6, and 7 to figure the amounts to
report on lines 8, 9, and 14 of Form 8941.
Your credit may be reduced if you are entitled to a state
tax credit or a state premium subsidy for the cost of health
insurance coverage you provide under a qualifying
arrangement to individuals considered employees. The
state tax credit may be refundable or nonrefundable and
the state premium subsidy may be paid to you or directly
to your insurance provider.
Although a state tax credit or premium subsidy paid
directly to you doesn’t reduce the amount of your
employer premiums paid, and although a state premium
subsidy paid directly to an insurance provider is treated as
an employer premium you paid, the amount of your credit
can’t be more than your net premium payments.
Net premium payments are employer premiums paid
(discussed earlier) minus the amount of any state tax
credits you received or will receive and any state premium
subsidies paid either to you or directly to your insurance
provider for premiums for health insurance coverage you
provide under a qualifying arrangement to individuals
considered employees.
Line A
Answer "Yes" if one of the following applies.
You paid premiums for employee health insurance
coverage you provided through a SHOP Marketplace or
through a direct enrollment process, if available in your
state.
You qualify for an exception to this requirement as
discussed below.
If you answer "Yes" because you paid premiums for
employee health insurance coverage you provided
through a SHOP Marketplace, enter the Marketplace
identifier, if any.
If you answer "No," don’t file Form 8941 unless you are
filing it for a partnership, S corporation, cooperative,
estate, trust, or tax-exempt eligible small employer that
received from another entity a credit that must be reported
on line 15. For more information, see the instructions for
line 15.
Payroll Tax Limitation for Tax-Exempt
Eligible Small Employers
The credit for tax-exempt eligible small employers can’t
exceed the amount of certain payroll taxes. For tax years
-4-
Instructions for Form 8941 (2017)
Worksheet 1. Information Needed To
Complete Line 1 and Worksheets 2
and 3
Waiver for Hawaii. Hawaii has received a 5-year State
Innovation Waiver under section 1332 of the Affordable
Care Act. Employers in Hawaii cannot participate in the
SHOP Marketplace or claim the credit for insurance
premiums paid for health plan years beginning after 2016.
However, certain employers with a 2016 health plan year
that continues into 2017 can claim the credit for part of
their tax year beginning in 2017. For more information on
the waiver, visit CMS.gov.
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.
DRAFT AS OF
November 22, 2017
(a)
Individuals
Considered
Employees
Exception for certain employers in Wisconsin. For
calendar year 2016, SHOP Marketplaces in certain
counties of Wisconsin did not have qualified health plans
available for employers to offer to employees. Transition
relief allows employers with a principal business address
in the counties listed below to claim the credit for their tax
year beginning in 2016. Certain employers with a 2016
health plan year that continues into 2017 can claim the
credit for part of their tax year beginning in 2017. For
details, see Notice 2016-75, 2016-51 I.R.B. 832, available
at IRS.gov/IRB/2016-51_IRB/ar12.html.
(b)
Employee
Hours of
Service
(c)
Employee
Wages
Paid
1.
2.
3.
4.
5.
6.
Wisconsin: Pierce, Polk, and St. Croix counties.
7.
Line C
8.
Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning in 2014 or 2015 included a Form
8941 with line A checked “Yes” and line 12 showing a
positive amount. For more information, see Credit Period,
earlier.
9.
If you answer “Yes,” do not file Form 8941 unless you
are filing it for a partnership, S corporation, cooperative,
estate, trust, or tax-exempt eligible small employer that
received from another entity a credit that must be reported
on line 15. An entity that qualifies for this exception should
not report any amount on line 12 . For more information,
see the instructions for line 15.
13.
10.
11.
12.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Totals:
Column (a), Individuals Considered
Employees
Enter the name or other identifying information for all
individuals considered employees for purposes of this
credit.
In general, all employees who perform services for you
during the tax year are taken into account in determining
your FTEs, average annual wages, and premiums paid.
Rules that apply to certain types of employees are
discussed below.
Instructions for Form 8941 (2017)
-5-
discussed above. A sole proprietor must include both
business and nonbusiness employees to determine FTEs,
average annual wages, and premiums paid.
Excluded employees. The following individuals aren’t
considered employees when you figure this credit. Hours
and wages of these employees and premiums paid for
them aren’t counted when you figure your credit.
The owner of a sole proprietorship.
A partner in a partnership.
A shareholder who owns (after applying the section 318
constructive ownership rules) more than 2% of an S
corporation.
A shareholder who owns (after applying the section 318
constructive ownership rules) more than 5% of the
outstanding stock or stock possessing more than 5% of
the total combined voting power of all stock of a
corporation that is not an S corporation.
A person who owns more than 5% of the capital or
profits interest in any other business that isn’t a
corporation.
Family members or a member of the household who is
not a family member but qualifies as a dependent on the
individual income tax return of a person listed above.
Family members include a child (or descendant of a
child), a sibling or step-sibling, a parent (or ancestor of a
parent), a step-parent, a niece or nephew, an aunt or
uncle, or a son-in-law, daughter-in-law, father-in-law,
mother-in-law, brother-in-law, or sister-in-law. A spouse of
any owner or family member listed above is also
considered a family member for this purpose.
Ministers. A minister performing services in the exercise
of his or her ministry is treated as self-employed for social
security and Medicare purposes. However, for credit
purposes, whether a minister is an employee or
self-employed is determined under the common law test
for determining worker status. Self-employed ministers
aren’t considered employees.
DRAFT AS OF
November 22, 2017
Column (b), Employee Hours of
Service
Enter the total hours of service for the tax year for each
employee listed in column (a). Don’t enter more than
2,080 hours for any employee. But enter -0- for seasonal
employees who worked 120 or fewer days during the tax
year.
Employee hours of service. An employee’s hours of
service for a year include the following.
Each hour for which the employee is paid, or entitled to
payment, for the performance of duties for the employer
during the employer’s tax year.
Each hour for which an employee is paid, or entitled to
payment, by the employer on account of a period of time
during the employer's tax year during which no duties are
performed due to vacation, holiday, illness, incapacity
(including disability), layoff, jury duty, military duty, or
leave of absence (except that no more than 160 hours of
service are required to be counted for an employee on
account of any single continuous period during which the
employee performs no duties).
To figure the total number of hours of service you must
take into account for an employee for the year, you can
use any of the following methods.
Actual hours worked method. Determine actual
hours of service from records of hours worked and hours
for which payment is made or due (payment is made or
due for vacation, holiday, illness, incapacity, etc., as
described above).
Days-worked equivalency method. Use a
days-worked equivalency whereby the employee is
credited with 8 hours of service for each day for which the
employee would be required to be credited with at least
one hour of service under the rules described above.
Weeks-worked equivalency method. Use a
weeks-worked equivalency whereby the employee is
credited with 40 hours of service for each week for which
the employee would be required to be credited with at
least one hour of service under the rules described above.
Former employees. Premiums paid on behalf of a
former employee with no hours of service may be treated
as paid on behalf of an employee for purposes of figuring
the credit provided that, if so treated, the former employee
is also treated as an employee for purposes of the uniform
percentage requirement.
Leased employees. Don’t use premiums paid by the
leasing organization to figure your credit. Also, a leased
employee who isn’t a common law employee is
considered an employee for credit purposes if he or she
does all the following.
Provides services to you under an agreement between
you and a leasing organization.
Has performed services for you (or for you and a
related person) substantially full time for at least 1 year.
Performs services under your primary direction or
control.
But don’t use hours, wages, or premiums paid with
respect to the initial year of service on which leased
employee status is based.
Seasonal employees. Employees who perform labor or
services on a seasonal basis and perform labor or
services for you 120 or fewer days during the tax year
aren’t considered employees in determining FTEs and
average annual wages. But premiums paid on their behalf
are counted in determining the amount of the credit.
Seasonal workers include retail workers employed
exclusively during holiday seasons. Seasonal workers
also include workers employed exclusively during the
summer.
Column (c), Employee Wages Paid
!
CAUTION
Complete Worksheet 2 before you complete
column (c) of Worksheet 1. Do not complete
column (c) if Worksheet 2, line 3, is 25 or more.
Enter the total wages paid for the tax year for each
employee listed in column (a). But enter -0- for seasonal
employees who worked 120 or fewer days during the tax
year.
Household and other nonbusiness employees.
Household employees and other employees who aren’t
performing services in your trade or business are
considered employees if they otherwise qualify as
-6-
Instructions for Form 8941 (2017)
Worksheet 4. Information Needed To
Complete Lines 4, 5, and 13 and
Worksheet 7
Wages, for this purpose, mean wages subject to social
security and Medicare tax withholding determined without
considering any wage base limit.
Worksheet 2. Information Needed To
Complete Line 2 (FTEs)
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.
DRAFT AS OF
November 22, 2017
Your credit is reduced if you had more than 10 full-time
equivalent employees (FTEs) for the tax year. If you had
25 or more FTEs for the tax year, your credit is reduced to
zero.
1. Enter the total employee hours of
service from Worksheet 1, column
(b) . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Hours of service per FTE . . . . . . . . .
2.
3. Full-time equivalent employees.
Divide line 1 by line 2. If the result is not
a whole number (0, 1, 2, etc.),
generally round the result down to
the next lowest whole number. For
example, round 2.99 down to 2.
However, if the result is less than one,
enter 1. Report this number on Form
8941, line 2 . . . . . . . . . . . . . . . . . .
(a)
Enrolled
Individuals
Considered
Employees
(c)
Adjusted
Average
Premiums
(d)
Enrolled
Employee
Hours of
Service
1.
2.
2,080
3.
4.
5.
6.
7.
8.
9.
3.
10.
Worksheet 3. Information Needed To
Complete Line 3 (Average Annual
Wages)
11.
12.
13.
14.
Your credit is reduced if you paid average annual wages
of more than $26,000 for the tax year. If you paid average
annual wages of $53,000 or more for the tax year, your
credit is reduced to zero.
1. Enter the total employee wages paid
from Worksheet 1, column (c) . . . . . .
1.
2. Enter FTEs from Worksheet 2,
line 3 . . . . . . . . . . . . . . . . . . . . . . .
2.
3. Average annual wages. Divide line 1
by line 2. If the result is not a multiple of
$1,000 ($1,000, $2,000, $3,000, etc.),
round the result down to the next
lowest multiple of $1,000. For example,
round $2,999 down to $2,000. Report
this amount on Form 8941, line 3 . . .
(b)
Employer
Premiums
Paid
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
3.
Totals:
Column (a), Enrolled Individuals
Considered Employees
Enter the name or other identifying information for each
individual listed in column (a) of Worksheet 1 who was
enrolled in health insurance coverage you provided to
employees during the tax year under a qualifying
arrangement. For details, see Health Insurance Coverage
and Qualifying Arrangement, earlier.
Instructions for Form 8941 (2017)
-7-
Column (b), Employer Premiums Paid
was enrolled for the entire tax year. You would have paid
$570 ($57 × 10) if the employee was only enrolled for 10
pay periods. You will need an additional set of
calculations if the premium amounts changed during the
tax year.
Enter the total employer premiums paid for the tax year for
each employee listed in column (a). For details, see
Employer Premiums Paid, earlier.
Column (c), Adjusted Average
Premiums
Column (d), Enrolled Employee Hours
of Service
DRAFT AS OF
November 22, 2017
Your credit is reduced if the employer premiums paid are
more than the employer premiums that would have been
paid if individuals considered employees were enrolled in
a plan with a premium equal to the average premium for
the small group market in the rating area in which the
employee enrolls for coverage.
!
Don’t complete column (d) of Worksheet 4 if
Form 8941, line 12, is zero.
CAUTION
Enter the amount from column (b) of Worksheet 1 for
each employee listed in column (a) of Worksheet 4.
The rating area in which an employee enrolls for
coverage is generally the rating area where your business
is located (based on your primary business address). You
will generally have selected a plan in your rating area that
covers all employees located within or outside your rating
area. However, if you have multiple businesses or
operations in multiple states, and have set up plans in
more than one SHOP Marketplace, the average premiums
may be different for employees enrolled in each SHOP
Marketplace.
Worksheet 5. Information Needed To
Complete Line 8 (If Line 2 is More
Than 10)
1. Enter the amount from Form 8941,
line 7 . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Enter the number from Form
8941, line 2 . . . . . . . . . . . .
2.
Enter, for each employee listed in column (a), the
premiums you would have paid if the employee had
enrolled in a plan or plans with a total premium equal to
the average premium for the small group market in the
rating area in which the employee enrolls for coverage.
3. Subtract 10 from line 2 . . . . .
3.
4. Divide line 3 by 15. Enter the
result as a decimal (rounded to
at least 3 places) . . . . . . . .
4.
To find the average premium for the small group market
in a rating area for tax years beginning in 2017, see the
average premium tables at the end of these instructions.
Family coverage includes any coverage other than
employee-only coverage.
5. Multiply line 1 by line 4 . . . . . . . . . . . . . .
5.
6. Subtract line 5 from line 1. Report this
amount on Form 8941, line 8 . . . . . . . . .
6.
Worksheet 6. Information Needed To
Complete Line 9 (If Line 3 is More
Than $26,000)
Example 4. Assume the same facts that were used in
Example 3. The $60 you contribute each payday toward
employee health insurance coverage is 60% ($60 ÷ $100)
of the weekly premium for each employee enrolled in
employee-only coverage and 24% ($60 ÷ $250) of the
weekly premium for each employee enrolled in family
coverage.
In this situation, the total average premium limitation
amounts that apply are 60% of the applicable average
premium amounts for each employee enrolled in
employee-only coverage and 24% of the applicable
average premium amounts for each employee enrolled in
family coverage.
You have an employee enrolled in employee-only
coverage who enrolled for coverage in your local rating
area. The applicable employee-only average premium
amount for the rating area is $4,940 or $95 ($4,940 ÷ 52)
for each weekly payday. The amount you would have paid
toward this employee's health insurance coverage based
on the average premiums is $57 (60% of $95) each
payday.
To determine the premiums you would have paid for
this employee during the tax year if the employee had
enrolled in an average premium plan, multiply the number
of pay periods during which your employee was enrolled
in the health insurance coverage by $57. For example,
you would have paid $2,964 ($57 × 52) if the employee
1. Enter the amount from Form 8941,
line 8 . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Enter the amount from Form
8941, line 7 . . . . . . . . . . . . .
2.
3. Enter the amount from Form
8941, line 3 . . . . . . . . . . . . .
3.
4. Subtract $26,200 from
line 3 . . . . . . . . . . . . . . . . . .
4.
5. Divide line 4 by $26,200. Enter
the result as a decimal (rounded
to at least 3 places) . . . . . . . .
5.
1.
6. Multiply line 2 by line 5 . . . . . . . . . . . . . .
6.
7. Subtract line 6 from line 1. Report this
amount on Form 8941, line 9 . . . . . . . . .
7.
Line 10
Enter the total amount of any state premium subsidies
paid and any state tax credits available to you for
premiums included on line 4. For details, see State
Premium Subsidy and Tax Credit Limitation, earlier.
-8-
Instructions for Form 8941 (2017)
Worksheet 7. Information Needed To
Complete Line 14 (If Line 12 is More
Than Zero)
its tax liability. Therefore, to figure the unused amount of
the credit allocated to patrons, the cooperative must first
figure its tax liability. While any excess is allocated to
patrons, any credit recapture applies as if the cooperative
had claimed the entire credit.
If the cooperative is subject to the passive activity rules,
include on line 15 any credit for small employer health
insurance premiums from passive activities disallowed for
prior years and carried forward to this year. Complete
Form 8810, Corporate Passive Activity Loss and Credit
Limitations, to determine the allowed credit that must be
allocated to patrons. For details, see the Instructions for
Form 8810.
1. Enter the total enrolled employee hours of
service from Worksheet 4, column
(d) . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
DRAFT AS OF
November 22, 2017
2. Hours of service per FTE . . . . . . . . . .
2.
2,080
3. Divide line 1 by line 2. If the result is not a
whole number (0, 1, 2, etc.), generally
round the result down to the next
lowest whole number. For example,
round 2.99 down to 2. However, if the
result is less than one, enter 1. Report
this number on Form 8941, line 14 . . .
3.
Estates and trusts. Allocate the credit on line 16
between the estate or trust and the beneficiaries in the
same proportion as income was allocated and enter the
beneficiaries' share on line 17.
If the estate or trust is subject to the passive activity
rules, include on line 15 any credit for small employer
health insurance premiums from passive activities
disallowed for prior years and carried forward to this year.
Complete Form 8582-CR, Passive Activity Credit
Limitations, to determine the allowed credit that must be
allocated between the estate or trust and the
beneficiaries. For details, see the Instructions for Form
8582-CR.
Line 15
Enter any credit for small employer health insurance
premiums from:
Schedule K-1 (Form 1065), box 15 (code P);
Schedule K-1 (Form 1120S), box 13 (code P);
Schedule K-1 (Form 1041), box 13 (code G); and
Form 1099-PATR, Taxable Distributions Received
From Cooperatives, box 10, or other notice of credit
allocation.
Line 19
Partnerships, S corporations, cooperatives,
TIP estates, trusts, and tax-exempt eligible small
employers always must report the above credits
on line 15. All other filers figuring a separate credit on
earlier lines also must report the above credits on line 15.
All others not using earlier lines to figure a separate credit
must report the above credits directly on Form 3800, Part
lll, line 4h.
Enter the total amount of certain payroll taxes. Payroll
taxes, for this purpose, mean only the following taxes.
Federal income taxes the tax-exempt employer was
required to withhold from employees' wages in calendar
year 2017.
Medicare taxes the tax-exempt employer was required
to withhold from employees' wages in calendar year 2017.
Medicare taxes the tax-exempt employer was required
to pay for calendar year 2017.
Line 17
Cooperatives. A cooperative described in section
1381(a) must allocate to its patrons the credit in excess of
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the
United States. You are required to give us the information. We need it to ensure that you are complying with these laws
and to allow us to figure and collect the right amount of tax.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by section 6103.
h
The time needed to complete and file this form will vary depending on individual circumstances. The estimated burden
for individual and business taxpayers filing this form is approved under OMB control number 1545-0074 and 1545-0123
and is included in the estimates shown in the instructions for their individual and business income tax return. The
estimated burden for all other taxpayers who file this form is shown below.
Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learning about the law or the form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparing and sending the form to the IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 hr., 51 min.
1 hr., 23 min.
2 hr., 46 min.
If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler,
we would be happy to hear from you. See the instructions for the tax return with which this form is filed.
Instructions for Form 8941 (2017)
-9-
Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4
The following tables list the average
premiums for the small group market
in each rating area generally listed by
county for each state for tax years
beginning in 2017.
Limestone
6,238
15,623
Petersburg
10,239
24,784
Lowndes
6,604
16,608
Prince of Wales-Hyder 10,239
24,784
Macon
6,149
15,693
Sitka
10,239
24,784
Madison
6,238
15,623
Skagway
10,239
24,784
Marengo
6,149
15,693
Southeast Fairbanks
10,434
26,154
Marion
6,149
15,693
Valdez Cordova
9,537
26,194
DRAFT AS OF
November 22, 2017
Alabama
Employee- Dependent,
Only
Family, etc.
Marshall
6,149
15,693
Wade Hampton
10,434
26,154
County
Mobile
5,864
16,050
10,239
24,784
Autauga
6,604
16,608
Monroe
6,149
15,693
Wrangell City and
Borough
Baldwin
6,149
15,693
Montgomery
6,604
16,608
Yakutat
10,434
26,154
Barbour
6,149
15,693
Morgan
7,490
17,986
Yukon Koyukuk
10,434
26,154
Bibb
6,351
17,224
Perry
6,149
15,693
Blount
6,351
17,224
Pickens
6,149
15,693
Bullock
6,149
15,693
Pike
6,149
15,693
Butler
6,149
15,693
Randolph
6,149
15,693
Calhoun
6,031
16,936
Russell
7,030
16,447
Chambers
6,149
15,693
Shelby
6,351
17,224
Cherokee
6,149
15,693
St. Clair
6,351
17,224
Chilton
6,351
17,224
Sumter
6,149
15,693
Choctaw
6,149
15,693
Talladega
6,149
15,693
Clarke
6,149
15,693
Tallapoosa
6,149
15,693
Clay
6,149
15,693
Tuscaloosa
6,530
16,043
Cleburne
6,149
15,693
Walker
6,351
17,224
Coffee
6,149
15,693
Washington
6,149
15,693
Colbert
7,072
16,976
Wilcox
6,149
15,693
Conecuh
6,149
15,693
Winston
6,149
15,693
Coosa
6,149
15,693
Covington
6,149
15,693
Crenshaw
6,149
15,693
Cullman
6,149
15,693
County
Employee- Dependent,
Only
Family, etc.
Dale
6,149
15,693
Aleutians East
10,434
26,154
Dallas
6,149
15,693
Aleutians West
10,434
26,154
DeKalb
6,149
15,693
Anchorage
9,537
26,194
Elmore
6,604
16,608
Bethel
9,537
26,194
Escambia
6,149
15,693
Bristol Bay
10,434
26,154
Etowah
5,448
16,355
Denali
10,434
26,154
Fayette
6,149
15,693
Dillingham
9,537
26,194
Franklin
6,149
15,693
Fairbanks North Star
10,434
26,154
Geneva
6,054
13,847
Haines
10,239
24,784
Greene
6,530
16,043
Hoonah-Angoon
10,239
24,784
Hale
6,530
16,043
Juneau
10,239
24,784
Henry
6,054
13,847
Kenai Peninsula
10,434
26,154
Houston
6,054
13,847
Ketchikan Gateway
10,239
24,784
Jackson
6,149
15,693
Kodiak Island
10,434
26,154
Jefferson
6,351
17,224
Lake and Peninsula
10,434
26,154
Lamar
6,149
15,693
Matanuska Susitna
10,434
26,154
Lauderdale
7,072
16,976
Nome
10,434
26,154
Lawrence
7,490
17,986
North Slope
10,434
26,154
Lee
5,727
13,471
Northwest Arctic
10,434
26,154
Alaska
-10-
Arizona
County
Employee- Dependent,
Only
Family, etc.
Apache
6,048
14,412
Cochise
6,445
16,932
Coconino
6,048
14,412
Gila
6,572
16,544
Graham
6,445
16,932
Greenlee
6,445
16,932
La Paz
7,132
19,568
Maricopa
5,993
16,312
Mohave
6,048
14,412
Navajo
6,048
14,412
Pima
5,732
17,349
Pinal
6,572
16,544
Santa Cruz
5,732
17,349
Yavapai
5,438
16,701
Yuma
7,132
19,568
Arkansas
County
Employee- Dependent,
Only
Family, etc.
Arkansas
5,710
14,595
Ashley
5,710
14,595
Baxter
4,573
13,288
Benton
4,573
13,288
Boone
4,573
13,288
Bradley
5,710
14,595
Calhoun
5,816
15,416
Carroll
4,573
13,288
Chicot
5,710
14,595
Clark
5,127
13,995
Clay
5,683
15,011
Cleburne
5,525
14,527
Cleveland
5,710
14,595
Columbia
5,816
15,416
Conway
5,525
14,527
2017 Average Premium Tables
Craighead
5,683
15,011
Stone
5,683
15,011
Santa Clara
7,125
18,858
Crawford
5,152
15,139
Union
5,816
15,416
Santa Cruz
6,260
14,770
Crittenden
5,683
15,011
Van Buren
5,525
14,527
Shasta
6,161
15,330
Cross
5,683
15,011
Washington
4,573
13,288
Sierra
6,161
15,330
Dallas
5,710
14,595
White
5,525
14,527
Siskiyou
6,161
15,330
Desha
5,710
14,595
Woodruff
5,683
15,011
Solano
6,899
15,884
DRAFT AS OF
November 22, 2017
Drew
5,710
14,595
Faulkner
5,525
14,527
Franklin
5,152
15,139
Fulton
5,683
15,011
Garland
5,127
13,995
County
Grant
5,525
14,527
Yell
5,525
14,527
Sonoma
6,899
15,884
Stanislaus
6,977
14,929
Sutter
6,161
15,330
Employee- Dependent,
Only
Family, etc.
Tehama
6,161
15,330
Trinity
6,161
15,330
Alameda
6,810
17,385
Tulare
6,977
14,929
6,161
15,330
California
Greene
5,683
15,011
Alpine
Tuolumne
6,161
15,330
Hempstead
5,816
15,416
Amador
6,161
15,330
Ventura
5,970
15,430
Hot Spring
5,127
13,995
Butte
6,161
15,330
Yolo
5,930
15,943
6,161
15,330
Yuba
6,161
15,330
Howard
5,816
15,416
Calaveras
Independence
5,683
15,011
Colusa
6,161
15,330
Izard
5,683
15,011
Contra Costa
7,046
17,619
Jackson
5,683
15,011
Del Norte
6,161
15,330
Jefferson
5,710
14,595
El Dorado
5,930
15,943
County
Employee- Dependent,
Only
Family, etc.
Johnson
5,152
15,139
Fresno
6,269
17,056
Adams
6,416
18,805
6,161
15,330
Alamosa
7,088
14,801
Colorado
Lafayette
5,816
15,416
Glenn
Lawrence
5,683
15,011
Humboldt
6,161
15,330
Arapahoe
6,416
18,805
14,595
Imperial
5,644
14,675
Archuleta
7,176
15,918
5,644
14,675
Baca
7,088
14,801
Lee
5,710
Lincoln
5,710
14,595
Inyo
Little River
5,816
15,416
Kern
6,568
15,775
Bent
7,088
14,801
15,139
Kings
6,269
17,056
Boulder
5,578
17,092
6,161
15,330
Broomfield
6,416
18,805
Logan
5,152
Lonoke
5,525
14,527
Lake
Madison
4,573
13,288
Lassen
6,161
15,330
Chaffee
7,088
14,801
13,288
Los Angeles
6,233
16,516
Cheyenne
7,088
14,801
6,269
17,056
Clear Creek
6,416
18,805
Marion
4,573
Miller
5,816
15,416
Madera
Mississippi
5,683
15,011
Marin
6,899
15,884
Conejos
7,088
14,801
14,595
Mariposa
6,977
14,929
Costilla
7,088
14,801
6,161
15,330
Crowley
7,088
14,801
Monroe
5,710
Montgomery
5,127
13,995
Mendocino
Nevada
5,816
15,416
Merced
6,977
14,929
Custer
7,088
14,801
6,161
15,330
Delta
7,176
15,918
Newton
4,573
13,288
Modoc
Ouachita
5,816
15,416
Mono
5,644
14,675
Denver
6,416
18,805
Perry
5,525
14,527
Monterey
6,260
14,770
Dolores
7,176
15,918
6,899
15,884
Douglas
6,416
18,805
Phillips
5,710
14,595
Napa
Pike
5,127
13,995
Nevada
6,161
15,330
Eagle
7,378
18,967
Poinsett
5,683
15,011
Orange
6,346
17,261
El Paso
6,109
16,336
5,930
15,943
Elbert
6,416
18,805
Polk
5,152
15,139
Placer
Pope
5,525
14,527
Plumas
6,161
15,330
Fremont
7,088
14,801
14,527
Riverside
5,704
14,548
Garfield
7,378
18,967
5,930
15,943
Gilpin
6,416
18,805
Prairie
5,525
Pulaski
5,525
14,527
Sacramento
Randolph
5,683
15,011
San Benito
6,260
14,770
Grand
7,176
15,918
14,527
San Bernardino
5,704
14,548
Gunnison
7,176
15,918
6,045
15,354
Hinsdale
7,176
15,918
Saline
5,525
Scott
5,152
15,139
San Diego
Searcy
4,573
13,288
San Francisco
6,636
20,243
Huerfano
7,088
14,801
15,139
San Joaquin
6,977
14,929
Jackson
7,176
15,918
5,970
15,430
Jefferson
6,416
18,805
Sebastian
5,152
Sevier
5,816
15,416
San Luis Obispo
Sharp
5,683
15,011
San Mateo
8,031
20,736
Kiowa
7,088
14,801
15,011
Santa Barbara
5,970
15,430
Kit Carson
7,088
14,801
St. Francis
5,683
2017 Average Premium Tables
-11-
Florida
La Plata
7,176
15,918
Lake
7,176
15,918
Larimer
6,924
15,012
County
Las Animas
7,088
14,801
Lincoln
7,088
Logan
6,204
Pasco
7,222
17,303
Employee- Dependent,
Only
Family, etc.
Pinellas
6,793
17,736
Polk
6,725
18,523
Alachua
6,914
18,526
Putnam
6,547
19,304
14,801
Baker
6,819
18,340
Santa Rosa
6,248
15,409
16,834
Bay
6,087
16,518
Sarasota
6,187
17,419
DRAFT AS OF
November 22, 2017
Mesa
6,200
17,485
Bradford
6,228
18,668
Seminole
6,403
16,459
Mineral
7,088
14,801
Brevard
6,562
19,268
St. Johns
6,230
20,276
Moffat
7,176
15,918
Broward
6,412
19,677
St. Lucie
5,720
15,781
6,436
18,498
Montezuma
7,176
15,918
Calhoun
Sumter
6,343
20,097
Montrose
7,176
15,918
Charlotte
7,602
21,853
Suwannee
5,794
18,191
Morgan
6,204
16,834
Citrus
6,175
16,645
Taylor
7,698
20,766
5,248
18,079
Otero
7,088
14,801
Clay
Union
6,404
18,849
Ouray
7,176
15,918
Collier
5,724
18,249
Volusia
6,502
18,059
Park
6,416
18,805
Columbia
7,619
20,834
Wakulla
6,279
18,762
6,377
19,377
Walton
5,595
15,589
Washington
6,572
19,403
Phillips
6,204
16,834
DeSoto
Pitkin
7,378
18,967
Dixie
5,675
15,282
Prowers
7,088
14,801
Duval
6,680
17,101
Pueblo
6,909
18,542
Escambia
7,011
16,171
Rio Blanco
7,176
15,918
Flagler
7,325
17,746
Rio Grande
7,088
14,801
Franklin
6,390
19,561
County
Employee- Dependent,
Only
Family, etc.
Routt
7,176
15,918
Gadsden
5,640
18,111
Appling
5,981
17,458
Saguache
7,088
14,801
Gilchrist
6,191
18,470
Atkinson
7,013
19,033
15,918
Glades
6,694
21,069
Bacon
5,114
14,189
7,132
18,814
San Juan
7,176
Georgia
San Miguel
7,176
15,918
Gulf
7,505
19,997
Baker
Sedgwick
6,204
16,834
Hamilton
6,289
18,448
Baldwin
7,411
19,119
18,967
Hardee
6,611
15,476
Banks
6,786
14,149
5,344
17,934
Summit
7,378
Teller
6,109
16,336
Hendry
7,605
21,272
Barrow
Washington
6,204
16,834
Hernando
6,794
19,628
Bartow
6,329
16,664
14,791
Highlands
7,233
22,204
Ben Hill
7,286
20,529
7,286
20,529
Weld
Yuma
5,465
6,204
16,834
Connecticut
Hillsborough
6,063
18,134
Berrien
Holmes
6,336
18,530
Bibb
6,078
17,514
Indian River
5,680
15,775
Bleckley
6,078
17,514
5,114
14,189
Jackson
5,706
15,332
Brantley
Jefferson
7,343
17,863
Brooks
7,286
20,529
5,981
17,458
County
Employee- Dependent,
Only
Family, etc.
Fairfield
7,969
20,972
Lafayette
6,707
17,176
Bryan
Hartford
7,443
19,986
Lake
7,418
20,508
Bulloch
5,981
17,458
Litchfield
6,860
18,726
Lee
6,462
18,664
Burke
6,275
18,063
Middlesex
8,289
20,591
Leon
7,004
20,060
Butts
6,329
16,664
New Haven
7,661
19,642
Levy
6,257
19,545
Calhoun
7,132
18,814
New London
6,262
16,977
Liberty
6,502
18,954
Camden
5,114
14,189
Tolland
7,109
15,267
Madison
7,585
19,890
Candler
5,981
17,458
Windham
7,050
24,756
Manatee
6,495
20,547
Carroll
6,471
19,520
Marion
5,381
15,531
Catoosa
6,368
17,701
5,114
14,189
Delaware
County
Employee- Dependent,
Only
Family, etc.
All
7,492
18,236
District of Columbia
County
Employee- Dependent,
Only
Family, etc.
All
6,547
19,479
Martin
6,350
20,401
Charlton
Miami-Dade
6,882
20,551
Chatham
5,981
17,458
Monroe
7,638
21,499
Chattahoochee
5,440
18,095
7,357
18,355
Nassau
7,343
15,187
Chattooga
Okaloosa
6,647
25,545
Cherokee
6,329
16,664
Okeechobee
7,498
20,433
Clarke
5,344
17,934
7,132
18,814
Orange
6,644
17,145
Clay
Osceola
6,558
21,366
Clayton
6,329
16,664
Palm Beach
6,502
19,808
Clinch
7,286
20,529
-12-
2017 Average Premium Tables
Cobb
6,329
16,664
Lanier
7,286
20,529
Towns
6,786
14,149
Coffee
7,013
19,033
Laurens
7,013
19,033
Treutlen
7,013
19,033
Colquitt
7,286
20,529
Lee
7,132
18,814
Troup
5,440
18,095
Columbia
6,275
18,063
Liberty
5,981
17,458
Turner
7,286
20,529
Cook
7,286
20,529
Lincoln
6,275
18,063
Twiggs
6,078
17,514
Coweta
6,329
16,664
Long
5,981
17,458
Union
6,786
14,149
DRAFT AS OF
November 22, 2017
Crawford
6,078
17,514
Lowndes
7,286
20,529
Upson
5,440
18,095
Crisp
7,132
18,814
Lumpkin
6,786
14,149
Walker
6,368
17,701
Dade
6,368
17,701
Macon
5,440
18,095
Walton
6,329
16,664
Dawson
6,786
14,149
Madison
5,344
17,934
Ware
5,114
14,189
Decatur
7,286
20,529
Marion
5,440
18,095
Warren
6,275
18,063
DeKalb
6,329
16,664
McDuffie
6,275
18,063
Washington
7,411
19,119
Dodge
6,078
17,514
McIntosh
5,114
14,189
Wayne
5,114
14,189
Dooly
6,078
17,514
Meriwether
5,440
18,095
Webster
5,440
18,095
Dougherty
7,132
18,814
Miller
7,286
20,529
Wheeler
7,013
19,033
Douglas
6,329
16,664
Mitchell
7,132
18,814
White
6,786
14,149
Early
7,286
20,529
Monroe
6,078
17,514
Whitfield
5,986
15,344
Echols
7,286
20,529
Montgomery
7,013
19,033
Wilcox
6,078
17,514
Effingham
5,981
17,458
Morgan
5,344
17,934
Wilkes
6,275
18,063
Elbert
5,344
17,934
Murray
5,986
15,344
Wilkinson
7,411
19,119
Emanuel
6,275
18,063
Muscogee
5,440
18,095
Worth
7,132
18,814
Evans
5,981
17,458
Newton
6,329
16,664
Fannin
5,986
15,344
Oconee
5,344
17,934
Fayette
6,329
16,664
Oglethorpe
5,344
17,934
Floyd
7,357
18,355
Paulding
6,329
16,664
County
Employee- Dependent,
Only
Family, etc.
Forsyth
6,329
16,664
Peach
6,078
17,514
All
6,207
Franklin
6,786
14,149
Pickens
7,357
18,355
Fulton
6,329
16,664
Pierce
5,114
14,189
Gilmer
7,357
18,355
Pike
6,329
16,664
Glascock
6,275
18,063
Polk
7,357
18,355
Glynn
5,114
14,189
Pulaski
6,078
17,514
Gordon
7,357
18,355
Putnam
6,078
17,514
Grady
7,286
20,529
Quitman
5,440
18,095
Greene
5,344
17,934
Rabun
6,786
14,149
Gwinnett
6,329
16,664
Randolph
7,132
18,814
Habersham
6,786
14,149
Richmond
6,275
18,063
Hall
6,786
14,149
Rockdale
6,329
16,664
Hancock
7,411
19,119
Schley
7,132
18,814
Haralson
6,471
19,520
Screven
5,981
17,458
Harris
5,440
18,095
Seminole
7,286
20,529
Hart
6,786
14,149
Spalding
6,329
16,664
Heard
6,471
19,520
Stephens
6,786
14,149
Henry
6,329
16,664
Stewart
5,440
18,095
Houston
6,078
17,514
Sumter
7,132
18,814
Irwin
7,286
20,529
Talbot
5,440
18,095
Jackson
5,344
17,934
Taliaferro
6,275
18,063
Jasper
6,329
16,664
Tattnall
5,981
17,458
Jeff Davis
7,013
19,033
Taylor
5,440
18,095
Jefferson
6,275
18,063
Telfair
7,013
19,033
Jenkins
6,275
18,063
Terrell
7,132
18,814
Johnson
7,013
19,033
Thomas
7,286
20,529
Jones
6,078
17,514
Tift
7,286
20,529
Lamar
6,329
16,664
Toombs
7,013
19,033
2017 Average Premium Tables
-13-
Hawaii
16,824
Idaho
County
Employee- Dependent,
Only
Family, etc.
Ada
5,018
14,199
Adams
4,899
13,438
Bannock
4,943
13,479
Bear Lake
4,943
13,479
Benewah
5,467
13,147
Bingham
4,943
13,479
Blaine
5,001
13,335
Boise
4,899
13,438
Bonner
5,467
13,147
Bonneville
5,631
13,163
Boundary
5,467
13,147
Butte
4,943
13,479
Camas
5,001
13,335
Canyon
4,899
13,438
Caribou
4,943
13,479
Cassia
5,001
13,335
Clark
5,631
13,163
Clearwater
5,251
15,940
Custer
4,943
13,479
Elmore
4,899
13,438
Franklin
4,943
13,479
Fremont
5,631
13,163
Gem
4,899
13,438
Gooding
5,001
13,335
Fulton
7,117
17,009
Saline
6,335
17,757
Idaho
5,251
15,940
Gallatin
6,335
17,757
Sangamon
6,399
15,963
Jefferson
5,631
13,163
Greene
6,204
16,724
Schuyler
6,399
15,963
Jerome
5,001
13,335
Grundy
7,928
20,078
Scott
6,399
15,963
Kootenai
5,467
13,147
Hamilton
6,335
17,757
Shelby
6,399
15,963
Latah
5,467
13,147
Hancock
5,251
17,388
St. Clair
6,989
17,646
DRAFT AS OF
November 22, 2017
Lemhi
5,631
13,163
Hardin
6,335
17,757
Stark
7,117
17,009
Lewis
5,251
15,940
Henderson
5,251
17,388
Stephenson
6,523
16,617
Lincoln
5,001
13,335
Henry
5,251
17,388
Tazewell
7,117
17,009
Madison
5,631
13,163
Iroquois
6,755
16,857
Union
6,335
17,757
Minidoka
5,001
13,335
Jackson
6,335
17,757
Vermilion
6,755
16,857
Nez Perce
5,251
15,940
Jasper
6,335
17,757
Wabash
6,335
17,757
Oneida
4,943
13,479
Jefferson
6,335
17,757
Warren
5,251
17,388
Owyhee
4,899
13,438
Jersey
6,204
16,724
Washington
6,204
16,724
Payette
4,899
13,438
Jo Daviess
6,523
16,617
Wayne
6,335
17,757
Power
4,943
13,479
Johnson
6,335
17,757
White
6,335
17,757
Shoshone
5,467
13,147
Kane
7,109
19,152
Whiteside
5,251
17,388
Teton
5,631
13,163
Kankakee
7,928
20,078
Will
7,928
20,078
Twin Falls
5,001
13,335
Kendall
7,928
20,078
Williamson
6,335
17,757
Valley
4,899
13,438
Knox
7,117
17,009
Winnebago
6,523
16,617
Washington
4,899
13,438
Lake
6,435
21,690
Woodford
7,117
17,009
LaSalle
7,117
17,009
Lawrence
6,335
17,757
Illinois
Indiana
Employee- Dependent,
Only
Family, etc.
Lee
6,523
16,617
County
Livingston
7,095
22,039
County
Employee- Dependent,
Only
Family, etc.
Adams
6,399
15,963
Logan
6,399
15,963
Adams
7,447
18,455
Alexander
6,335
17,757
15,963
Allen
6,518
16,243
Bond
6,204
16,724
Macoupin
6,204
16,724
Bartholomew
6,875
16,452
Boone
6,523
16,617
Madison
6,989
17,646
Benton
6,839
19,061
Brown
6,399
15,963
17,757
Blackford
7,432
15,566
Bureau
5,251
17,388
Marshall
7,117
17,009
Boone
6,974
19,527
Calhoun
6,204
16,724
Mason
6,399
15,963
Brown
6,293
17,071
Carroll
6,523
16,617
17,757
Carroll
6,908
21,010
6,893
16,758
Macon
Marion
Massac
6,399
6,335
6,335
Cass
6,399
15,963
McDonough
7,117
17,009
Cass
Champaign
6,755
16,857
McHenry
6,435
21,690
Clark
6,454
15,683
Christian
6,399
15,963
McLean
7,095
22,039
Clay
7,068
19,132
Clark
6,755
16,857
Menard
6,399
15,963
Clinton
6,908
21,010
Clay
6,335
17,757
Mercer
5,251
17,388
Crawford
6,454
15,683
Clinton
6,204
16,724
Monroe
6,989
17,646
Daviess
7,393
17,078
Coles
6,755
16,857
Montgomery
6,204
16,724
Dearborn
5,685
18,500
Cook
6,786
18,697
Morgan
6,399
15,963
Decatur
6,875
16,452
Crawford
6,335
17,757
Moultrie
6,399
15,963
DeKalb
7,447
18,455
Cumberland
6,755
16,857
Ogle
6,523
16,617
Delaware
7,432
15,566
DeKalb
6,523
16,617
17,009
Dubois
7,393
17,078
DeWitt
7,095
22,039
Perry
6,335
17,757
Elkhart
7,205
15,931
Douglas
6,755
16,857
Piatt
6,755
16,857
Fayette
5,783
18,932
DuPage
7,109
19,152
15,963
Floyd
6,454
15,683
Edgar
6,755
16,857
Pope
6,335
17,757
Fountain
6,908
21,010
Edwards
6,335
17,757
Pulaski
6,335
17,757
Franklin
5,685
18,500
Effingham
6,335
17,757
17,009
Fulton
6,893
16,758
8,317
19,043
Peoria
Pike
Putnam
7,117
6,399
7,117
Fayette
6,335
17,757
Randolph
6,204
16,724
Gibson
Ford
6,755
16,857
Richland
6,335
17,757
Grant
7,432
15,566
Franklin
6,335
17,757
17,388
Greene
7,393
17,078
Rock Island
5,251
-14-
2017 Average Premium Tables
Hamilton
6,974
19,527
Vanderburgh
8,317
19,043
Guthrie
6,834
16,767
Hancock
5,783
18,932
Vermillion
7,068
19,132
Hamilton
6,380
15,256
Harrison
6,454
15,683
Vigo
7,068
19,132
Hancock
6,302
17,532
Hendricks
6,974
19,527
Wabash
7,447
18,455
Hardin
6,380
15,256
Henry
5,783
18,932
Warren
6,839
19,061
Harrison
6,834
16,767
Howard
6,893
16,758
Warrick
8,317
19,043
Henry
6,020
15,484
DRAFT AS OF
November 22, 2017
Huntington
7,447
18,455
Washington
6,454
15,683
Howard
6,302
17,532
Jackson
6,875
16,452
Wayne
5,783
18,932
Humboldt
6,302
17,532
Jasper
6,839
19,061
Wells
7,447
18,455
Ida
6,043
16,540
Jay
7,432
15,566
White
6,839
19,061
Iowa
6,045
16,431
Jefferson
6,454
15,683
Whitley
7,447
18,455
Jackson
6,045
16,431
Jennings
6,875
16,452
Jasper
6,305
15,095
Johnson
6,293
17,071
Jefferson
6,020
15,484
Knox
7,393
17,078
6,045
16,431
Kosciusko
7,205
15,931
County
Employee- Dependent,
Only
Family, etc.
Johnson
Jones
6,045
16,431
6,834
16,767
Iowa
LaGrange
7,447
18,455
Adair
Keokuk
6,020
15,484
Lake
7,139
17,521
Adams
6,834
16,767
Kossuth
6,302
17,532
LaPorte
7,139
17,521
Allamakee
6,302
17,532
Lee
6,020
15,484
6,020
15,484
Lawrence
6,293
17,071
Appanoose
Linn
6,045
16,431
Madison
5,783
18,932
Audubon
6,834
16,767
Louisa
6,020
15,484
Marion
6,974
19,527
Benton
6,045
16,431
Lucas
6,020
15,484
6,045
16,431
Marshall
7,205
15,931
Black Hawk
Lyon
6,043
16,540
Martin
7,393
17,078
Boone
6,380
15,256
Madison
6,305
15,095
6,302
17,532
Miami
6,893
16,758
Bremer
Mahaska
6,020
15,484
Monroe
6,293
17,071
Buchanan
6,045
16,431
Marion
6,305
15,095
Montgomery
6,908
21,010
Buena Vista
6,043
16,540
Marshall
6,380
15,256
6,302
17,532
Morgan
6,974
19,527
Butler
Mills
6,834
16,767
Newton
6,839
19,061
Calhoun
6,380
15,256
Mitchell
6,302
17,532
Noble
7,447
18,455
Carroll
6,380
15,256
Monona
6,043
16,540
6,834
16,767
Ohio
5,685
18,500
Cass
Monroe
6,020
15,484
Orange
7,393
17,078
Cedar
6,045
16,431
Montgomery
6,834
16,767
Owen
6,293
17,071
Cerro Gordo
6,302
17,532
Muscatine
6,020
15,484
6,043
16,540
Parke
7,068
19,132
Cherokee
O'Brien
6,043
16,540
Perry
7,393
17,078
Chickasaw
6,302
17,532
Osceola
6,043
16,540
Pike
7,393
17,078
Clarke
6,834
16,767
Page
6,834
16,767
6,043
16,540
Porter
7,139
17,521
Clay
Palo Alto
6,043
16,540
Posey
8,317
19,043
Clayton
6,045
16,431
Plymouth
6,043
16,540
Pulaski
6,893
16,758
Clinton
6,045
16,431
Pocahontas
6,043
16,540
6,043
16,540
Putnam
6,908
21,010
Crawford
Polk
6,305
15,095
Randolph
7,432
15,566
Dallas
6,305
15,095
Pottawattamie
6,834
16,767
Ripley
5,685
18,500
Davis
6,020
15,484
Poweshiek
6,380
15,256
6,834
16,767
Rush
6,875
16,452
Decatur
Ringgold
6,834
16,767
Scott
6,454
15,683
Delaware
6,045
16,431
Sac
6,043
16,540
6,020
15,484
Shelby
6,974
19,527
Des Moines
Scott
6,045
16,431
Spencer
7,393
17,078
Dickinson
6,043
16,540
Shelby
6,834
16,767
St. Joseph
7,205
15,931
Dubuque
6,045
16,431
Sioux
6,043
16,540
6,302
17,532
Starke
7,205
15,931
Emmet
Story
6,380
15,256
Steuben
7,447
18,455
Fayette
6,302
17,532
Tama
6,380
15,256
Sullivan
7,068
19,132
Floyd
6,302
17,532
Taylor
6,834
16,767
6,302
17,532
Switzerland
5,685
18,500
Franklin
Union
6,834
16,767
Tippecanoe
6,908
21,010
Fremont
6,834
16,767
Van Buren
6,020
15,484
Tipton
6,908
21,010
Greene
6,380
15,256
Wapello
6,020
15,484
18,932
Grundy
6,380
15,256
Warren
6,305
15,095
Union
5,783
2017 Average Premium Tables
-15-
Washington
6,020
15,484
Hodgeman
6,516
15,988
Stevens
6,516
15,988
Wayne
6,020
15,484
Jackson
5,741
14,107
Sumner
5,446
14,674
Webster
6,380
15,256
Jefferson
5,741
14,107
Thomas
5,999
18,229
Winnebago
6,302
17,532
Jewell
5,210
14,578
Trego
5,999
18,229
Winneshiek
6,302
17,532
Johnson
6,519
16,493
Wabaunsee
5,741
14,107
Woodbury
6,043
16,540
Kearny
6,516
15,988
Wallace
5,999
18,229
DRAFT AS OF
November 22, 2017
Worth
6,302
17,532
Kingman
5,446
14,674
Washington
5,210
14,578
Wright
6,302
17,532
Kiowa
6,516
15,988
Wichita
5,999
18,229
Labette
5,786
18,209
Wilson
5,446
14,674
Lane
5,999
18,229
Woodson
5,786
18,209
6,519
16,493
Wyandotte
6,519
16,493
Kansas
County
Employee- Dependent,
Only
Family, etc.
Leavenworth
Lincoln
5,210
14,578
Allen
5,786
18,209
Linn
5,741
14,107
Anderson
5,741
14,107
Logan
5,999
18,229
Atchison
5,741
14,107
Lyon
5,741
14,107
County
Employee- Dependent,
Only
Family, etc.
Barber
6,516
15,988
Marion
5,446
14,674
Adair
5,488
14,571
5,488
14,571
Kentucky
Barton
5,999
18,229
Marshall
5,741
14,107
Allen
Bourbon
5,786
18,209
McPherson
5,446
14,674
Anderson
5,857
15,664
Brown
5,741
14,107
Meade
6,516
15,988
Ballard
6,016
18,305
Butler
5,446
14,674
Miami
6,519
16,493
Barren
5,488
14,571
Chase
5,446
14,674
Mitchell
5,210
14,578
Bath
6,144
20,621
Chautauqua
5,446
14,674
Montgomery
5,446
14,674
Bell
6,054
17,534
Cherokee
5,786
18,209
Morris
5,210
14,578
Boone
6,339
14,396
Cheyenne
5,999
18,229
15,988
Bourbon
5,857
15,664
Clark
6,516
15,988
Nemaha
5,741
14,107
Boyd
6,144
20,621
Clay
5,210
14,578
Neosho
5,786
18,209
Boyle
5,857
15,664
Cloud
5,210
14,578
18,229
Bracken
6,144
20,621
Coffey
5,741
14,107
Norton
5,999
18,229
Breathitt
6,054
17,534
Comanche
6,516
15,988
Osage
5,741
14,107
Breckinridge
5,511
14,664
Cowley
5,446
14,674
18,229
Bullitt
5,511
14,664
Crawford
5,786
18,209
Ottawa
5,210
14,578
Butler
5,488
14,571
Decatur
5,999
18,229
Pawnee
6,516
15,988
Caldwell
6,016
18,305
Dickinson
5,210
14,578
18,229
Calloway
6,016
18,305
6,339
14,396
Morton
Ness
Osborne
Phillips
6,516
5,999
5,999
5,999
Doniphan
5,741
14,107
Pottawatomie
5,741
14,107
Campbell
Douglas
5,741
14,107
Pratt
6,516
15,988
Carlisle
6,016
18,305
Edwards
6,516
15,988
Rawlins
5,999
18,229
Carroll
5,511
14,664
Elk
5,446
14,674
Reno
5,446
14,674
Carter
6,144
20,621
Ellis
5,999
18,229
Republic
5,210
14,578
Casey
5,488
14,571
Ellsworth
5,210
14,578
Rice
5,446
14,674
Christian
6,622
16,252
Finney
6,516
15,988
Riley
5,210
14,578
Clark
5,857
15,664
Ford
6,516
15,988
Rooks
5,999
18,229
Clay
6,054
17,534
Franklin
5,741
14,107
Rush
5,999
18,229
Clinton
5,488
14,571
Geary
5,210
14,578
Russell
5,999
18,229
Crittenden
6,016
18,305
Gove
5,999
18,229
14,578
Cumberland
5,488
14,571
Graham
5,999
18,229
Scott
5,999
18,229
Daviess
6,622
16,252
Grant
6,516
15,988
Sedgwick
5,446
14,674
Edmonson
5,488
14,571
Gray
6,516
15,988
15,988
Elliott
6,144
20,621
Greeley
5,999
18,229
Shawnee
5,741
14,107
Estill
5,857
15,664
Greenwood
5,446
14,674
Sheridan
5,999
18,229
Fayette
5,857
15,664
Hamilton
6,516
15,988
18,229
Fleming
6,144
20,621
6,054
17,534
Saline
Seward
Sherman
5,210
6,516
5,999
Harper
5,446
14,674
Smith
5,999
18,229
Floyd
Harvey
5,446
14,674
Stafford
6,516
15,988
Franklin
5,857
15,664
Haskell
6,516
15,988
15,988
Fulton
6,016
18,305
Stanton
6,516
-16-
2017 Average Premium Tables
Gallatin
6,339
14,396
Ohio
6,622
16,252
Franklin
7,386
16,842
Garrard
5,857
15,664
Oldham
5,511
14,664
Grant
5,804
13,965
Grant
6,339
14,396
Owen
5,857
15,664
Iberia
6,157
16,311
Graves
6,016
18,305
Owsley
6,054
17,534
Iberville
5,753
16,071
Grayson
5,511
14,664
Pendleton
6,339
14,396
Jackson
7,386
16,842
Green
5,488
14,571
Perry
6,054
17,534
Jefferson
6,221
16,491
DRAFT AS OF
November 22, 2017
Greenup
6,144
20,621
Pike
6,054
17,534
Jefferson Davis
6,575
18,510
Hancock
6,622
16,252
Powell
5,857
15,664
Lafayette
6,157
16,311
Hardin
5,511
14,664
Pulaski
5,488
14,571
Lafourche
6,653
16,751
Harlan
6,054
17,534
Robertson
6,144
20,621
LaSalle
5,804
13,965
Harrison
5,857
15,664
Rockcastle
5,857
15,664
Lincoln
7,386
16,842
Hart
5,488
14,571
Rowan
6,144
20,621
Livingston
5,753
16,071
Henderson
6,622
16,252
Russell
5,488
14,571
Madison
7,386
16,842
Henry
5,511
14,664
Scott
5,857
15,664
Morehouse
7,386
16,842
Hickman
6,016
18,305
Shelby
5,511
14,664
Natchitoches
6,916
17,311
Hopkins
6,622
16,252
Simpson
5,488
14,571
Orleans
6,221
16,491
Jackson
5,857
15,664
Spencer
5,511
14,664
Ouachita
7,386
16,842
Jefferson
5,511
14,664
Taylor
5,488
14,571
Plaquemines
6,221
16,491
Jessamine
5,857
15,664
Todd
6,622
16,252
Pointe Coupee
5,753
16,071
Johnson
6,054
17,534
Trigg
6,622
16,252
Rapides
5,804
13,965
Kenton
6,339
14,396
Trimble
5,511
14,664
Red River
6,916
17,311
Knott
6,054
17,534
Union
6,622
16,252
Richland
7,386
16,842
Knox
6,054
17,534
Warren
5,488
14,571
Sabine
6,916
17,311
LaRue
5,511
14,664
Washington
5,511
14,664
St. Bernard
6,221
16,491
Laurel
6,054
17,534
Wayne
5,488
14,571
St. Charles
6,221
16,491
Lawrence
6,144
20,621
Webster
6,622
16,252
St. Helena
5,753
16,071
Lee
6,054
17,534
Whitley
6,054
17,534
St. James
6,221
16,491
Leslie
6,054
17,534
Wolfe
6,054
17,534
St. John Baptist
6,221
16,491
Letcher
6,054
17,534
Woodford
5,857
15,664
St. Landry
6,157
16,311
Lewis
6,144
20,621
St. Martin
6,157
16,311
Lincoln
5,857
15,664
St. Mary
6,157
16,311
Livingston
6,016
18,305
6,221
16,491
Louisiana
Employee- Dependent,
Only
Family, etc.
St. Tammany
Logan
5,488
14,571
Parish
Tangipahoa
5,753
16,071
Lyon
6,016
18,305
Acadia
6,157
16,311
Tensas
7,386
16,842
Madison
5,857
15,664
Allen
6,575
18,510
Terrebonne
6,653
16,751
5,753
16,071
Magoffin
6,054
17,534
Ascension
Union
7,386
16,842
Marion
5,511
14,664
Assumption
6,653
16,751
Vermilion
6,157
16,311
Marshall
6,016
18,305
Avoyelles
5,804
13,965
Vernon
5,804
13,965
6,575
18,510
Martin
6,054
17,534
Beauregard
Washington
5,753
16,071
Mason
6,144
20,621
Bienville
6,916
17,311
Webster
6,916
17,311
McCracken
6,016
18,305
Bossier
6,916
17,311
West Baton Rouge
5,753
16,071
6,916
17,311
McCreary
5,488
14,571
Caddo
West Carroll
7,386
16,842
McLean
6,622
16,252
Calcasieu
6,575
18,510
West Feliciana
5,753
16,071
7,386
16,842
Winn
5,804
13,965
Meade
5,511
14,664
Caldwell
Menifee
6,144
20,621
Cameron
6,575
18,510
Mercer
5,857
15,664
Catahoula
5,804
13,965
Metcalfe
5,488
14,571
Claiborne
6,916
17,311
5,804
13,965
County
Employee- Dependent,
Only
Family, etc.
Maine
Monroe
5,488
14,571
Concordia
Montgomery
5,857
15,664
DeSoto
6,916
17,311
Androscoggin
6,005
15,419
20,621
East Baton Rouge
5,753
16,071
Aroostook
6,566
18,274
7,386
16,842
Cumberland
5,748
15,578
Morgan
6,144
Muhlenberg
6,622
16,252
East Carroll
Nelson
5,511
14,664
East Feliciana
5,753
16,071
Franklin
6,005
15,419
15,664
Evangeline
6,157
16,311
Hancock
6,566
18,274
Nicholas
5,857
2017 Average Premium Tables
-17-
Kennebec
5,989
16,112
Norfolk
7,448
20,478
Lenawee
6,203
16,491
Knox
5,989
16,112
Plymouth
6,963
19,874
Livingston
6,203
16,491
Lincoln
5,989
16,112
Suffolk
7,448
20,478
Luce
6,851
16,513
Oxford
5,989
16,112
Worcester
6,791
19,812
Mackinac
6,273
19,063
Penobscot
6,005
15,419
Macomb
6,797
18,588
Piscataquis
6,005
15,419
Manistee
5,364
15,855
Michigan
DRAFT AS OF
November 22, 2017
Sagadahoc
5,748
15,578
6,851
16,513
6,005
15,419
County
Employee- Dependent,
Only
Family, etc.
Marquette
Somerset
Mason
5,679
16,367
Waldo
6,005
15,419
Alcona
6,273
19,063
Mecosta
5,679
16,367
6,851
16,513
Washington
6,566
18,274
Alger
Menominee
6,851
16,513
York
5,748
15,578
Allegan
5,731
13,706
Midland
5,561
17,308
Alpena
6,273
19,063
Missaukee
5,364
15,855
Antrim
5,364
15,855
Monroe
6,260
18,710
Arenac
6,331
17,880
Montcalm
5,679
16,367
Baraga
6,851
16,513
Montmorency
6,273
19,063
Maryland
County
Employee- Dependent,
Only
Family, etc.
Allegany
5,979
15,272
Barry
5,731
13,706
Muskegon
5,679
16,367
Anne Arundel
6,283
17,167
Bay
6,331
17,880
Newaygo
5,679
16,367
Baltimore
6,283
17,167
Benzie
5,364
15,855
Oakland
6,797
18,588
Baltimore City
6,283
17,167
Berrien
6,352
18,401
Oceana
5,679
16,367
Calvert
6,172
15,613
Branch
6,070
18,182
Ogemaw
6,273
19,063
Caroline
6,172
15,613
Calhoun
6,070
18,182
Ontonagon
6,851
16,513
Carroll
5,979
15,272
Cass
6,352
18,401
Osceola
5,679
16,367
Cecil
6,172
15,613
Charlevoix
5,364
15,855
Oscoda
6,273
19,063
Charles
6,172
15,613
Cheboygan
6,273
19,063
Otsego
6,273
19,063
Dorchester
6,172
15,613
Chippewa
6,273
19,063
Ottawa
5,679
16,367
Frederick
5,979
15,272
Clare
5,561
17,308
Presque Isle
6,273
19,063
Garrett
5,979
15,272
Clinton
5,872
17,176
Roscommon
6,273
19,063
Harford
6,283
17,167
Crawford
6,273
19,063
Saginaw
6,331
17,880
Howard
6,283
17,167
Delta
6,851
16,513
Sanilac
7,003
18,125
Kent
6,172
15,613
Dickinson
6,851
16,513
Schoolcraft
6,851
16,513
Montgomery
6,615
18,377
Eaton
5,872
17,176
Shiawassee
5,472
16,240
Prince George's
6,615
18,377
Emmet
5,364
15,855
St. Clair
6,605
16,953
Queen Annes
6,172
15,613
Genesee
5,472
16,240
St. Joseph
6,352
18,401
Somerset
6,172
15,613
Gladwin
5,561
17,308
Tuscola
7,003
18,125
St. Marys
6,172
15,613
Gogebic
6,851
16,513
Van Buren
6,352
18,401
Talbot
6,172
15,613
Grand Traverse
5,364
15,855
Washtenaw
6,203
16,491
Washington
5,979
15,272
Gratiot
6,331
17,880
Wayne
6,260
18,710
Wicomico
6,172
15,613
Hillsdale
5,872
17,176
Wexford
5,364
15,855
Worcester
6,172
15,613
Houghton
6,851
16,513
Huron
7,003
18,125
Ingham
5,872
17,176
5,679
16,367
County
Employee- Dependent,
Only
Family, etc.
County
Employee- Dependent,
Only
Family, etc.
Ionia
Iosco
6,273
19,063
Aitkin
5,924
15,282
Barnstable
8,746
22,384
Iron
6,851
16,513
Anoka
6,248
17,649
Berkshire
6,608
17,893
Isabella
5,561
17,308
Becker
6,906
19,857
Bristol
6,963
19,874
Jackson
5,872
17,176
Beltrami
5,924
15,282
Dukes
8,746
22,384
Kalamazoo
6,070
18,182
Benton
6,248
17,649
Essex
7,252
19,601
Kalkaska
5,364
15,855
Big Stone
5,758
16,996
Franklin
6,608
17,893
Kent
5,679
16,367
Blue Earth
5,826
15,721
Hampden
6,608
17,893
Keweenaw
6,851
16,513
Brown
5,519
16,684
Hampshire
6,608
17,893
Lake
5,679
16,367
Carlton
6,247
13,448
Middlesex
7,448
20,478
Lapeer
5,472
16,240
Carver
6,248
17,649
Nantucket
8,746
22,384
Leelanau
5,364
15,855
Cass
5,924
15,282
Massachusetts
-18-
Minnesota
2017 Average Premium Tables
Chippewa
5,758
16,996
Renville
5,758
16,996
Humphreys
5,923
13,739
Chisago
5,924
15,282
Rice
5,826
15,721
Issaquena
5,923
13,739
Clay
6,906
19,857
Rock
5,519
16,684
Itawamba
5,731
14,065
Clearwater
6,247
18,951
Roseau
5,924
15,282
Jackson
6,284
13,749
Cook
6,247
13,448
Scott
6,248
17,649
Jasper
5,923
13,739
Cottonwood
5,519
16,684
Sherburne
6,248
17,649
Jefferson
5,923
13,739
DRAFT AS OF
November 22, 2017
Crow Wing
5,924
15,282
Sibley
5,758
16,996
Jefferson Davis
5,923
13,739
Dakota
6,248
17,649
St. Louis
6,247
13,448
Jones
5,581
13,746
Dodge
6,499
17,785
Stearns
6,248
17,649
Kemper
5,923
13,739
Douglas
6,906
19,857
Steele
6,499
17,785
Lafayette
5,923
13,739
Faribault
5,826
15,721
Stevens
6,906
19,857
Lamar
5,581
13,746
Fillmore
6,499
17,785
Swift
5,758
16,996
Lauderdale
5,923
13,739
Freeborn
6,499
17,785
Todd
5,924
15,282
Lawrence
5,923
13,739
Goodhue
6,499
17,785
Traverse
6,906
19,857
Leake
5,923
13,739
Grant
6,906
19,857
Wabasha
6,499
17,785
Lee
5,731
14,065
Hennepin
6,248
17,649
Wadena
5,924
15,282
Leflore
5,923
13,739
Houston
6,499
17,785
Waseca
5,826
15,721
Lincoln
5,923
13,739
Hubbard
5,924
15,282
Washington
6,248
17,649
Lowndes
5,923
13,739
Isanti
5,924
15,282
Watonwan
5,826
15,721
Madison
5,694
14,427
Itasca
6,247
13,448
Wilkin
6,906
19,857
Marion
5,923
13,739
Jackson
5,519
16,684
Winona
6,499
17,785
Marshall
5,105
14,425
Kanabec
5,924
15,282
Wright
6,248
17,649
Monroe
5,923
13,739
Kandiyohi
5,758
16,996
Yellow Medicine
5,758
16,996
Montgomery
5,923
13,739
Kittson
6,247
18,951
Neshoba
5,923
13,739
Koochiching
6,247
13,448
Newton
5,923
13,739
Lac qui Parle
5,758
16,996
5,923
13,739
Mississippi
Employee- Dependent,
Only
Family, etc.
Noxubee
Lake
6,247
13,448
County
Oktibbeha
5,923
13,739
Lake of the Woods
6,247
13,448
Adams
5,923
13,739
Panola
5,923
13,739
Le Sueur
5,826
15,721
Alcorn
5,923
13,739
Pearl River
5,581
13,746
5,923
13,739
Lincoln
5,519
16,684
Amite
Perry
5,581
13,746
Lyon
5,758
16,996
Attala
5,923
13,739
Pike
5,923
13,739
Mahnomen
6,247
18,951
Benton
5,731
14,065
Pontotoc
5,731
14,065
5,923
13,739
Marshall
6,247
18,951
Bolivar
Prentiss
5,923
13,739
Martin
5,826
15,721
Calhoun
5,923
13,739
Quitman
5,923
13,739
McLeod
5,758
16,996
Carroll
5,923
13,739
Rankin
5,694
14,427
5,923
13,739
Meeker
5,758
16,996
Chickasaw
Scott
5,923
13,739
Mille Lacs
5,924
15,282
Choctaw
5,923
13,739
Sharkey
5,923
13,739
Morrison
5,924
15,282
Claiborne
5,923
13,739
Simpson
5,694
14,427
5,923
13,739
Mower
6,499
17,785
Clarke
Smith
5,923
13,739
Murray
5,519
16,684
Clay
5,923
13,739
Stone
6,284
13,749
Nicollet
5,826
15,721
Coahoma
5,923
13,739
Sunflower
5,923
13,739
5,694
14,427
Nobles
5,519
16,684
Copiah
Tallahatchie
5,923
13,739
Norman
6,247
18,951
Covington
5,923
13,739
Tate
5,105
14,425
5,105
14,425
Olmsted
6,499
17,785
DeSoto
Tippah
5,731
14,065
Otter Tail
6,906
19,857
Forrest
5,581
13,746
Tishomingo
5,923
13,739
Pennington
6,247
18,951
Franklin
5,923
13,739
Tunica
5,105
14,425
6,284
13,749
Pine
5,924
15,282
George
Union
5,731
14,065
Pipestone
5,519
16,684
Greene
5,581
13,746
Walthall
5,923
13,739
Polk
6,247
18,951
Grenada
5,923
13,739
Warren
5,694
14,427
6,284
13,749
Pope
6,906
19,857
Hancock
Washington
5,923
13,739
Ramsey
6,248
17,649
Harrison
6,284
13,749
Wayne
5,923
13,739
Red Lake
6,247
18,951
Hinds
5,694
14,427
Webster
5,923
13,739
16,684
Holmes
5,923
13,739
Wilkinson
5,923
13,739
Redwood
5,519
2017 Average Premium Tables
-19-
Winston
5,923
13,739
Iron
6,066
15,134
St. Francois
5,796
14,803
Yalobusha
5,923
13,739
Jackson
5,861
15,293
St. Louis
5,796
14,803
Yazoo
5,923
13,739
Jasper
5,676
13,318
St. Louis City
5,796
14,803
Jefferson
5,796
14,803
Ste. Genevieve
5,796
14,803
Johnson
6,569
17,998
Stoddard
6,757
14,363
6,905
14,468
Stone
5,334
13,567
Missouri
County
Employee- Dependent,
Only
Family, etc.
Knox
Laclede
5,334
13,567
Sullivan
6,905
14,468
Adair
6,905
14,468
Lafayette
6,569
17,998
Taney
5,334
13,567
Andrew
6,971
14,166
Lawrence
5,334
13,567
Texas
6,066
15,134
Atchison
6,971
14,166
Lewis
6,905
14,468
Vernon
6,569
17,998
Audrain
6,060
16,164
Lincoln
5,796
14,803
Warren
5,796
14,803
Barry
5,334
13,567
Linn
6,905
14,468
Washington
5,796
14,803
Barton
5,676
13,318
Livingston
6,971
14,166
Wayne
6,757
14,363
Bates
6,569
17,998
Macon
6,905
14,468
Webster
5,334
13,567
Benton
6,569
17,998
Madison
6,757
14,363
Worth
6,971
14,166
Bollinger
6,757
14,363
Maries
6,060
16,164
Wright
5,334
13,567
Boone
6,060
16,164
Marion
6,905
14,468
Buchanan
6,971
14,166
McDonald
5,676
13,318
Butler
6,757
14,363
Mercer
6,971
14,166
Caldwell
6,971
14,166
Miller
6,060
16,164
County
Employee- Dependent,
Only
Family, etc.
Callaway
6,060
16,164
Mississippi
6,757
14,363
Beaverhead
7,570
16,232
Camden
6,060
16,164
Moniteau
6,060
16,164
Big Horn
7,570
16,232
Cape Girardeau
6,757
14,363
Monroe
6,060
16,164
Blaine
7,570
16,232
Carroll
6,971
14,166
16,164
Broadwater
6,661
15,663
Carter
6,066
15,134
Morgan
6,060
16,164
Carbon
6,619
15,530
Cass
5,861
15,293
New Madrid
6,757
14,363
Carter
7,570
16,232
Cedar
5,334
13,567
13,318
Cascade
6,661
15,663
Chariton
6,060
16,164
Nodaway
6,971
14,166
Chouteau
6,661
15,663
Christian
5,334
13,567
Oregon
6,066
15,134
Custer
7,570
16,232
Clark
6,905
14,468
16,164
Daniels
7,570
16,232
Clay
5,861
15,293
Ozark
5,334
13,567
Dawson
7,570
16,232
Clinton
6,971
14,166
Pemiscot
6,757
14,363
Deer Lodge
6,661
15,663
Cole
6,060
16,164
14,363
Fallon
7,570
16,232
7,570
16,232
DRAFT AS OF
November 22, 2017
Montgomery
Newton
Osage
Perry
6,060
5,676
6,060
6,757
Montana
Cooper
6,060
16,164
Pettis
6,569
17,998
Fergus
Crawford
6,066
15,134
Phelps
6,066
15,134
Flathead
6,270
14,155
Dade
5,334
13,567
Pike
6,905
14,468
Gallatin
6,661
15,663
Dallas
5,334
13,567
Platte
5,861
15,293
Garfield
7,570
16,232
Daviess
6,971
14,166
Polk
5,334
13,567
Glacier
7,570
16,232
DeKalb
6,971
14,166
Pulaski
6,066
15,134
Golden Valley
7,570
16,232
Dent
6,066
15,134
Putnam
6,905
14,468
Granite
7,570
16,232
Douglas
5,334
13,567
Ralls
6,905
14,468
Hill
7,570
16,232
Dunklin
6,757
14,363
Randolph
6,060
16,164
Jefferson
6,661
15,663
Franklin
5,796
14,803
Ray
6,971
14,166
Judith Basin
6,661
15,663
Gasconade
6,060
16,164
15,134
Lake
6,270
14,155
Gentry
6,971
14,166
Ripley
6,066
15,134
Lewis and Clark
6,661
15,663
Greene
5,334
13,567
Saline
6,569
17,998
Liberty
7,570
16,232
Grundy
6,971
14,166
14,468
Lincoln
7,570
16,232
Harrison
6,971
14,166
Scotland
6,905
14,468
Madison
7,570
16,232
Henry
6,569
17,998
Scott
6,757
14,363
McCone
7,570
16,232
Hickory
5,334
13,567
15,134
Meagher
7,570
16,232
7,570
16,232
Reynolds
Schuyler
Shannon
6,066
6,905
6,066
Holt
6,971
14,166
Shelby
6,905
14,468
Mineral
Howard
6,060
16,164
St. Charles
5,796
14,803
Missoula
6,270
14,155
Howell
6,066
15,134
17,998
Musselshell
6,619
15,530
St. Clair
6,569
-20-
2017 Average Premium Tables
Park
7,570
16,232
Dodge
5,944
15,607
Seward
6,164
17,146
Petroleum
7,570
16,232
Douglas
5,944
15,607
Sheridan
7,612
18,397
Phillips
7,570
16,232
Dundy
7,612
18,397
Sherman
6,371
16,268
Pondera
7,570
16,232
Fillmore
6,164
17,146
Sioux
7,612
18,397
Powder River
7,570
16,232
Franklin
6,371
16,268
Stanton
6,371
16,268
Powell
7,570
16,232
Frontier
7,612
18,397
Thayer
6,164
17,146
DRAFT AS OF
November 22, 2017
Prairie
7,570
16,232
Furnas
6,371
16,268
Thomas
7,612
18,397
Ravalli
7,570
16,232
Gage
6,164
17,146
Thurston
5,944
15,607
Richland
7,570
16,232
Garden
7,612
18,397
Valley
6,371
16,268
Roosevelt
7,570
16,232
Garfield
6,371
16,268
Washington
5,944
15,607
Rosebud
7,570
16,232
Gosper
6,371
16,268
Wayne
6,371
16,268
Sanders
7,570
16,232
Grant
7,612
18,397
Webster
6,371
16,268
Sheridan
7,570
16,232
Greeley
6,371
16,268
Wheeler
6,371
16,268
Silver Bow
6,661
15,663
Hall
6,371
16,268
York
6,164
17,146
Stillwater
6,619
15,530
Hamilton
6,371
16,268
Sweet Grass
6,619
15,530
Harlan
6,371
16,268
Teton
6,661
15,663
Hayes
7,612
18,397
Toole
7,570
16,232
Hitchcock
7,612
18,397
County
Employee- Dependent,
Only
Family, etc.
Treasure
7,570
16,232
Holt
6,371
16,268
Carson City
6,236
14,551
Valley
7,570
16,232
Hooker
7,612
18,397
Churchill
7,586
17,920
Wheatland
7,570
16,232
Howard
6,371
16,268
Clark
6,048
14,672
6,236
14,551
Nevada
Wibaux
7,570
16,232
Jefferson
6,164
17,146
Douglas
Yellowstone
6,619
15,530
Johnson
6,164
17,146
Elko
7,586
17,920
16,268
Esmeralda
7,586
17,920
7,586
17,920
Kearney
Nebraska
6,371
Keith
7,612
18,397
Eureka
Keya Paha
6,371
16,268
Humboldt
7,586
17,920
18,397
Lander
7,586
17,920
7,586
17,920
County
Employee- Dependent,
Only
Family, etc.
Adams
6,371
16,268
Knox
6,371
16,268
Lincoln
Antelope
6,371
16,268
Lancaster
6,164
17,146
Lyon
6,236
14,551
Arthur
7,612
18,397
18,397
Mineral
7,586
17,920
Banner
7,612
18,397
Logan
7,612
18,397
Nye
6,048
14,672
Blaine
6,371
16,268
Loup
6,371
16,268
Pershing
7,586
17,920
Boone
6,371
16,268
16,268
Storey
6,236
14,551
6,501
16,002
7,586
17,920
Kimball
Lincoln
Madison
7,612
7,612
6,371
Box Butte
7,612
18,397
McPherson
7,612
18,397
Washoe
Boyd
6,371
16,268
Merrick
6,371
16,268
White Pine
Brown
7,612
18,397
Morrill
7,612
18,397
Buffalo
6,371
16,268
Nance
6,371
16,268
Burt
5,944
15,607
Nemaha
6,164
17,146
Butler
6,371
16,268
Nuckolls
6,371
16,268
Cass
5,944
15,607
Otoe
6,164
17,146
Cedar
6,371
16,268
Pawnee
6,164
17,146
Chase
7,612
18,397
Perkins
7,612
18,397
Cherry
7,612
18,397
Phelps
6,371
16,268
Cheyenne
7,612
18,397
Pierce
6,371
16,268
Clay
6,371
16,268
Platte
6,371
16,268
Colfax
6,371
16,268
Polk
6,371
16,268
Cuming
6,371
16,268
Red Willow
7,612
18,397
Custer
6,371
16,268
Richardson
6,164
17,146
Dakota
6,371
16,268
Rock
6,371
16,268
Dawes
7,612
18,397
Saline
6,164
17,146
Dawson
6,371
16,268
Sarpy
5,944
15,607
Deuel
7,612
18,397
Saunders
5,944
15,607
Dixon
6,371
16,268
Scotts Bluff
7,612
18,397
2017 Average Premium Tables
-21-
New Hampshire
County
Employee- Dependent,
Only
Family, etc.
All
7,363
19,424
New Jersey
County
Employee- Dependent,
Only
Family, etc.
All
7,632
19,355
New Mexico
County
Employee- Dependent,
Only
Family, etc.
Bernalillo
6,433
17,252
Catron
6,834
19,377
Chaves
6,834
19,377
Cibola
6,834
19,377
Colfax
6,834
19,377
Hamilton
6,450
17,120
Bertie
7,216
19,046
Curry
6,834
19,377
Herkimer
6,450
17,120
Bladen
6,023
19,058
De Baca
6,834
19,377
Jefferson
6,450
17,120
Brunswick
6,642
17,931
Dona Ana
6,860
17,651
Kings
7,839
23,291
Buncombe
6,067
15,600
Eddy
6,834
19,377
Lewis
6,450
17,120
Burke
6,177
17,376
Grant
6,834
19,377
Livingston
5,413
14,888
Cabarrus
6,083
17,324
DRAFT AS OF
November 22, 2017
Guadalupe
6,834
19,377
Madison
6,450
17,120
Caldwell
6,177
17,376
Harding
6,834
19,377
Monroe
5,413
14,888
Camden
7,216
19,046
Hidalgo
6,834
19,377
Montgomery
6,971
17,662
Carteret
6,128
14,519
Lea
6,834
19,377
Nassau
7,535
21,531
Caswell
6,291
15,459
Lincoln
6,834
19,377
New York
7,839
23,291
Catawba
6,177
17,376
Los Alamos
6,834
19,377
Niagara
5,704
16,154
Chatham
6,291
15,459
Luna
6,834
19,377
Oneida
6,450
17,120
Cherokee
6,067
15,600
McKinley
6,834
19,377
Onondaga
6,265
17,359
Chowan
7,216
19,046
Mora
6,834
19,377
Ontario
5,413
14,888
Clay
6,067
15,600
Otero
6,834
19,377
Orange
6,677
17,568
Cleveland
6,055
15,740
Quay
6,834
19,377
Orleans
5,704
16,154
Columbus
6,642
17,931
Rio Arriba
6,834
19,377
Oswego
6,450
17,120
Craven
6,128
14,519
Roosevelt
6,834
19,377
Otsego
6,450
17,120
Cumberland
6,023
19,058
San Juan
6,750
18,216
Putnam
6,677
17,568
Currituck
7,216
19,046
San Miguel
6,834
19,377
Queens
7,839
23,291
Dare
6,128
14,519
Sandoval
6,433
17,252
Rensselaer
6,971
17,662
Davidson
5,946
16,104
Santa Fe
6,155
17,379
Richmond
7,839
23,291
Davie
5,946
16,104
Sierra
6,834
19,377
Rockland
7,839
23,291
Duplin
6,642
17,931
Socorro
6,834
19,377
Saratoga
6,971
17,662
Durham
6,291
15,459
Taos
6,834
19,377
Schenectady
6,971
17,662
Edgecombe
6,238
20,565
Torrance
6,433
17,252
Schoharie
6,971
17,662
Forsyth
5,946
16,104
Union
6,834
19,377
Schuyler
6,265
17,359
Franklin
6,343
18,229
Valencia
6,433
17,252
Seneca
5,413
14,888
Gaston
6,055
15,740
St. Lawrence
6,450
17,120
Gates
7,216
19,046
Steuben
6,265
17,359
Graham
6,067
15,600
7,535
21,531
Granville
5,574
14,369
New York
County
Employee- Dependent,
Only
Family, etc.
Suffolk
Sullivan
6,677
17,568
Greene
6,238
20,565
Albany
6,971
17,662
Tioga
6,265
17,359
Guilford
6,662
16,954
Allegany
5,704
16,154
Tompkins
6,265
17,359
Halifax
7,216
19,046
Bronx
7,839
23,291
Ulster
6,677
17,568
Harnett
6,023
19,058
Broome
6,265
17,359
Warren
6,971
17,662
Haywood
6,067
15,600
Cattaraugus
5,704
16,154
Washington
6,971
17,662
Henderson
6,067
15,600
Cayuga
6,265
17,359
Wayne
5,413
14,888
Hertford
7,216
19,046
Chautauqua
5,704
16,154
Westchester
7,839
23,291
Hoke
6,023
19,058
Chemung
6,265
17,359
Wyoming
5,704
16,154
Hyde
6,128
14,519
Chenango
6,450
17,120
Yates
5,413
14,888
Iredell
6,177
17,376
Clinton
6,450
17,120
Jackson
6,067
15,600
Columbia
6,971
17,662
Cortland
6,265
17,359
Delaware
6,677
17,568
Dutchess
6,677
Erie
North Carolina
Johnston
6,343
18,229
Jones
6,128
14,519
County
Employee- Dependent,
Only
Family, etc.
Lee
6,291
15,459
17,568
Alamance
6,291
15,459
Lenoir
6,128
14,519
5,704
16,154
Alexander
6,177
17,376
Lincoln
6,055
15,740
Essex
6,450
17,120
Alleghany
7,573
20,171
Macon
6,067
15,600
Franklin
6,450
17,120
Anson
6,083
17,324
Madison
6,067
15,600
Fulton
6,971
17,662
Ashe
7,573
20,171
Martin
7,216
19,046
Genesee
5,704
16,154
Avery
6,067
15,600
McDowell
6,067
15,600
Greene
6,971
17,662
Beaufort
6,128
14,519
Mecklenburg
6,083
17,324
-22-
2017 Average Premium Tables
Mitchell
6,067
15,600
Cavalier
7,030
17,297
Auglaize
7,480
16,162
Montgomery
6,207
14,116
Dickey
7,030
17,297
Belmont
7,496
19,458
Moore
6,207
14,116
Divide
7,030
17,297
Brown
7,363
17,363
Nash
6,238
20,565
Dunn
7,030
17,297
Butler
6,812
16,369
New Hanover
6,642
17,931
Eddy
7,030
17,297
Carroll
7,521
18,214
Northampton
7,216
19,046
Emmons
7,030
17,297
Champaign
6,576
18,414
DRAFT AS OF
November 22, 2017
Onslow
6,642
17,931
Foster
7,030
17,297
Clark
6,576
18,414
Orange
6,291
15,459
Golden Valley
7,030
17,297
Clermont
7,363
17,363
Pamlico
6,128
14,519
Grand Forks
6,243
15,522
Clinton
7,363
17,363
Pasquotank
7,216
19,046
Grant
7,030
17,297
Columbiana
7,489
19,976
Pender
6,642
17,931
Griggs
7,030
17,297
Coshocton
7,496
19,458
Perquimans
7,216
19,046
Hettinger
7,030
17,297
Crawford
7,128
18,124
Person
6,291
15,459
Kidder
7,030
17,297
Cuyahoga
7,530
18,227
Pitt
6,238
20,565
La Moure
7,030
17,297
Darke
6,576
18,414
Polk
6,067
15,600
Logan
7,030
17,297
Defiance
7,749
17,269
Randolph
6,662
16,954
McHenry
7,030
17,297
Delaware
6,996
19,040
Richmond
6,023
19,058
McIntosh
7,030
17,297
Erie
7,709
18,253
Robeson
6,023
19,058
McKenzie
7,030
17,297
Fairfield
6,996
19,040
Rockingham
6,662
16,954
McLean
7,030
17,297
Fayette
6,996
19,040
Rowan
6,083
17,324
Mercer
7,030
17,297
Franklin
6,996
19,040
Rutherford
6,067
15,600
Morton
5,944
16,471
Fulton
7,749
17,269
Sampson
6,023
19,058
Mountrail
7,030
17,297
Gallia
8,906
20,656
Scotland
6,023
19,058
Nelson
7,030
17,297
Geauga
7,530
18,227
Stanly
6,083
17,324
Oliver
7,030
17,297
Greene
6,576
18,414
Stokes
5,946
16,104
Pembina
7,030
17,297
Guernsey
7,496
19,458
Surry
5,946
16,104
Pierce
7,030
17,297
Hamilton
6,812
16,369
Swain
6,067
15,600
Ramsey
7,030
17,297
Hancock
7,480
16,162
Transylvania
6,067
15,600
Ransom
7,030
17,297
Hardin
7,480
16,162
Tyrrell
6,128
14,519
Renville
7,030
17,297
Harrison
7,496
19,458
Union
6,083
17,324
Richland
7,030
17,297
Henry
7,749
17,269
Vance
5,574
14,369
Rolette
7,030
17,297
Highland
7,363
17,363
Wake
6,343
18,229
Sargent
7,030
17,297
Hocking
6,280
15,527
Warren
5,574
14,369
Sheridan
7,030
17,297
Holmes
5,810
15,434
Washington
6,128
14,519
Sioux
7,030
17,297
Huron
7,709
18,253
Watauga
7,573
20,171
Slope
7,030
17,297
Jackson
8,906
20,656
Wayne
6,238
20,565
Stark
7,030
17,297
Jefferson
7,496
19,458
Wilkes
7,573
20,171
Steele
7,030
17,297
Knox
6,996
19,040
Wilson
6,238
20,565
Stutsman
7,030
17,297
Lake
7,530
18,227
Yadkin
5,946
16,104
Towner
7,030
17,297
Lawrence
8,906
20,656
Yancey
6,067
15,600
Traill
7,030
17,297
Licking
6,996
19,040
Walsh
7,030
17,297
Logan
6,996
19,040
Ward
7,030
17,297
Lorain
7,530
18,227
Wells
7,030
17,297
Lucas
7,749
17,269
Williams
7,030
17,297
Madison
6,996
19,040
Mahoning
7,489
19,976
Marion
7,654
18,142
North Dakota
County
Employee- Dependent,
Only
Family, etc.
Adams
7,030
17,297
Barnes
7,030
17,297
Benson
7,030
17,297
6,887
16,343
7,030
17,297
County
Employee- Dependent,
Only
Family, etc.
Medina
Billings
Meigs
6,280
15,527
Bottineau
7,030
17,297
Adams
7,363
17,363
Mercer
7,480
16,162
Bowman
7,030
17,297
Allen
7,480
16,162
Miami
6,576
18,414
Burke
7,030
17,297
Ashland
6,887
16,343
Monroe
7,496
19,458
Burleigh
5,944
16,471
Ashtabula
7,530
18,227
Montgomery
6,576
18,414
Cass
6,347
16,007
Athens
6,280
15,527
Morgan
7,496
19,458
2017 Average Premium Tables
Ohio
-23-
Morrow
7,654
18,142
Custer
6,190
16,263
Wagoner
6,499
16,138
Muskingum
7,496
19,458
Delaware
6,190
16,263
Washington
6,190
16,263
Noble
7,496
19,458
Dewey
6,190
16,263
Washita
6,190
16,263
Ottawa
7,709
18,253
Ellis
6,190
16,263
Woods
6,190
16,263
Paulding
7,480
16,162
Garfield
6,190
16,263
Woodward
6,190
16,263
Perry
7,496
19,458
Garvin
6,190
16,263
Oregon
DRAFT AS OF
November 22, 2017
Pickaway
6,996
19,040
Grady
6,540
16,385
Pike
8,906
20,656
Grant
6,190
16,263
Portage
6,887
16,343
Greer
6,190
16,263
County
Employee- Dependent,
Only
Family, etc.
Preble
6,576
18,414
Harmon
6,190
16,263
Baker
6,873
14,004
6,155
18,234
Putnam
7,480
16,162
Harper
6,190
16,263
Benton
Richland
7,128
18,124
Haskell
6,190
16,263
Clackamas
6,401
16,495
16,263
Clatsop
7,722
16,661
7,722
16,661
Ross
8,906
20,656
Hughes
6,190
Sandusky
7,709
18,253
Jackson
6,190
16,263
Columbia
Scioto
8,906
20,656
Jefferson
6,190
16,263
Coos
7,722
16,661
16,263
Crook
6,873
14,004
7,722
16,661
Seneca
7,709
18,253
Johnston
6,190
Shelby
6,576
18,414
Kay
6,190
16,263
Curry
Stark
7,521
18,214
Kingfisher
6,190
16,263
Deschutes
6,083
14,711
6,534
15,058
Summit
6,887
16,343
Kiowa
6,190
16,263
Douglas
Trumbull
7,489
19,976
Latimer
6,190
16,263
Gilliam
6,873
14,004
Tuscarawas
7,496
19,458
Le Flore
5,655
14,002
Grant
6,873
14,004
6,873
14,004
Union
6,996
19,040
Lincoln
6,540
16,385
Harney
Van Wert
7,480
16,162
Logan
6,540
16,385
Hood River
6,873
14,004
16,263
Jackson
6,534
15,058
6,873
14,004
Vinton
8,906
20,656
Love
6,190
Warren
6,812
16,369
Major
6,190
16,263
Jefferson
Washington
6,280
15,527
Marshall
6,190
16,263
Josephine
6,534
15,058
16,263
Klamath
6,083
14,711
6,083
14,711
Wayne
5,810
15,434
Mayes
6,190
Williams
7,749
17,269
McClain
6,540
16,385
Lake
Wood
7,749
17,269
McCurtain
6,190
16,263
Lane
6,155
18,234
16,263
Lincoln
7,722
16,661
6,155
18,234
Wyandot
7,709
18,253
Oklahoma
McIntosh
6,190
Murray
6,190
16,263
Linn
Muskogee
6,190
16,263
Malheur
6,873
14,004
16,263
Marion
6,316
15,761
6,873
14,004
Noble
County
Employee- Dependent,
Only
Family, etc.
Nowata
6,190
16,263
Morrow
Adair
6,190
16,263
Okfuskee
6,190
16,263
Multnomah
6,401
16,495
Alfalfa
6,190
16,263
Oklahoma
6,540
16,385
Polk
6,316
15,761
Atoka
6,190
16,263
Okmulgee
6,499
16,138
Sherman
6,873
14,004
Beaver
6,190
16,263
Osage
6,499
16,138
Tillamook
7,722
16,661
Beckham
6,190
16,263
Ottawa
6,190
16,263
Umatilla
6,873
14,004
Blaine
6,190
16,263
Pawnee
6,499
16,138
Union
6,873
14,004
Bryan
6,190
16,263
Payne
6,190
16,263
Wallowa
6,873
14,004
Caddo
6,190
16,263
Pittsburg
6,190
16,263
Wasco
6,873
14,004
Canadian
6,540
16,385
Pontotoc
6,190
16,263
Washington
6,401
16,495
Carter
6,190
16,263
16,263
Wheeler
6,873
14,004
Cherokee
6,190
16,263
Pushmataha
6,190
16,263
Yamhill
6,401
16,495
Choctaw
6,190
16,263
Roger Mills
6,190
16,263
Cimarron
6,190
16,263
Rogers
6,499
16,138
Cleveland
6,540
16,385
Seminole
6,190
16,263
Coal
6,190
16,263
Sequoyah
5,655
14,002
Comanche
6,039
14,562
Stephens
6,190
16,263
Texas
6,190
16,263
Cotton
6,190
16,263
Pottawatomie
6,190
6,190
Craig
6,190
16,263
Tillman
6,190
16,263
Creek
6,499
16,138
Tulsa
6,499
16,138
-24-
Pennsylvania
County
Employee- Dependent,
Only
Family, etc.
Adams
6,715
17,746
Allegheny
6,766
17,502
Armstrong
6,766
17,502
Beaver
6,766
17,502
2017 Average Premium Tables
Bedford
6,932
16,622
Susquehanna
7,282
18,425
McCormick
7,551
18,307
Berks
6,715
17,746
Tioga
7,282
18,425
Newberry
7,334
17,732
Blair
6,932
16,622
Union
7,272
17,763
Oconee
7,338
18,039
Bradford
7,282
18,425
Venango
5,642
14,336
Orangeburg
6,893
20,724
Bucks
7,839
19,987
Warren
5,642
14,336
Pickens
6,171
16,105
Butler
6,766
17,502
Washington
6,766
17,502
Richland
6,053
18,595
DRAFT AS OF
November 22, 2017
Cambria
6,932
16,622
Wayne
7,282
18,425
Saluda
7,316
17,780
Cameron
6,783
17,813
Westmoreland
6,766
17,502
Spartanburg
5,425
15,339
Carbon
7,282
18,425
Wyoming
7,282
18,425
Sumter
6,464
17,850
Centre
7,272
17,763
York
6,715
17,746
Union
5,364
15,558
Chester
7,839
19,987
Williamsburg
6,083
17,110
Clarion
5,642
14,336
York
6,594
16,640
Clearfield
6,932
16,622
Clinton
7,282
18,425
County
Employee- Dependent,
Only
Family, etc.
Columbia
7,272
17,763
All
7,009
Crawford
5,642
14,336
Cumberland
6,997
18,096
Dauphin
6,997
18,096
Delaware
7,839
19,987
Elk
6,783
17,813
Erie
5,642
14,336
Fayette
6,766
17,502
Forest
5,642
14,336
Franklin
6,997
18,096
Fulton
6,997
18,096
Greene
6,766
17,502
Huntingdon
6,932
16,622
Indiana
6,766
17,502
Jefferson
6,932
16,622
Juniata
6,997
18,096
Lackawanna
7,282
18,425
Lancaster
6,715
17,746
Lawrence
6,766
17,502
Lebanon
6,997
18,096
Lehigh
7,272
17,763
Luzerne
7,282
18,425
Lycoming
7,282
18,425
McKean
5,642
14,336
Mercer
5,642
14,336
Mifflin
7,272
17,763
Monroe
7,282
18,425
Montgomery
7,839
19,987
Montour
7,272
17,763
Northampton
7,272
17,763
Northumberland
7,272
17,763
Perry
6,997
18,096
Philadelphia
7,839
19,987
Pike
7,282
18,425
Potter
6,783
17,813
Schuylkill
7,272
17,763
Snyder
7,272
17,763
Somerset
6,932
16,622
Sullivan
7,282
18,425
2017 Average Premium Tables
Rhode Island
South Dakota
19,512
South Carolina
County
Employee- Dependent,
Only
Family, etc.
Aurora
6,518
16,606
Employee- Dependent,
Only
Family, etc.
Beadle
6,163
16,963
County
Bennett
6,264
16,546
Abbeville
6,937
18,479
Bon Homme
6,518
16,606
Aiken
6,117
14,182
Brookings
6,163
16,963
Allendale
6,207
16,648
Brown
6,163
16,963
Anderson
7,072
18,045
Brule
6,518
16,606
Bamberg
5,453
15,607
Buffalo
6,518
16,606
Barnwell
5,417
15,371
Butte
6,264
16,546
Beaufort
6,876
16,040
Campbell
6,163
16,963
Berkeley
6,494
19,824
Charles Mix
6,518
16,606
Calhoun
5,641
15,642
Clark
6,163
16,963
Charleston
6,104
16,556
Clay
6,104
17,502
Cherokee
5,861
15,821
Codington
6,163
16,963
Chester
6,690
17,240
Corson
6,264
16,546
Chesterfield
6,121
16,963
Custer
6,264
16,546
Clarendon
5,288
17,413
Davison
6,518
16,606
Colleton
6,048
15,837
Day
6,163
16,963
Darlington
7,418
17,664
Deuel
6,163
16,963
Dillon
6,435
16,280
Dewey
6,264
16,546
Dorchester
7,056
14,681
Douglas
6,518
16,606
Edgefield
5,360
15,777
Edmunds
6,163
16,963
Fairfield
6,380
17,156
Fall River
6,264
16,546
Florence
6,547
17,021
Faulk
6,163
16,963
Georgetown
6,771
16,905
Grant
6,163
16,963
Greenville
6,183
16,725
Gregory
6,264
16,546
Greenwood
5,526
15,855
Haakon
6,264
16,546
Hampton
6,829
17,362
Hamlin
6,163
16,963
Horry
6,623
15,869
Hand
6,518
16,606
Jasper
6,165
15,582
Hanson
6,518
16,606
Kershaw
7,411
18,250
Harding
6,264
16,546
Lancaster
6,894
16,792
Hughes
6,518
16,606
Laurens
6,269
16,138
Hutchinson
6,518
16,606
Lee
6,062
16,439
Hyde
6,518
16,606
Lexington
6,284
18,834
Jackson
6,264
16,546
Marion
7,353
18,141
Jerauld
6,518
16,606
Marlboro
6,555
16,871
Jones
6,264
16,546
-25-
Kingsbury
6,163
16,963
DeKalb
5,032
13,081
Robertson
5,459
13,902
Lake
6,104
17,502
Dickson
5,529
12,700
Rutherford
5,459
13,902
Lawrence
6,264
16,546
Dyer
5,004
16,951
Scott
5,151
13,797
Lincoln
6,104
17,502
Fayette
5,491
13,136
Sequatchie
6,003
14,364
Lyman
6,264
16,546
Fentress
5,032
13,081
Sevier
5,151
13,797
Marshall
6,163
16,963
Franklin
6,003
14,364
Shelby
5,491
13,136
DRAFT AS OF
November 22, 2017
McCook
6,104
17,502
Gibson
5,004
16,951
Smith
5,032
13,081
McPherson
6,163
16,963
Giles
5,529
12,700
Stewart
5,529
12,700
Meade
6,264
16,546
Grainger
5,151
13,797
Sullivan
5,214
15,105
Mellette
6,264
16,546
Greene
5,214
15,105
Sumner
5,459
13,902
Miner
6,518
16,606
Grundy
6,003
14,364
Tipton
5,491
13,136
Minnehaha
6,104
17,502
Hamblen
5,151
13,797
Trousdale
5,459
13,902
Moody
6,104
17,502
Hamilton
6,003
14,364
Unicoi
5,214
15,105
Pennington
6,264
16,546
Hancock
5,214
15,105
Union
5,151
13,797
Perkins
6,264
16,546
Hardeman
5,004
16,951
Van Buren
5,032
13,081
Potter
6,163
16,963
Hardin
5,004
16,951
Warren
5,032
13,081
Roberts
6,163
16,963
Hawkins
5,214
15,105
Washington
5,214
15,105
Sanborn
6,518
16,606
Haywood
5,491
13,136
Wayne
5,529
12,700
Shannon
6,264
16,546
Henderson
5,004
16,951
Weakley
5,004
16,951
Spink
6,163
16,963
Henry
5,004
16,951
White
5,032
13,081
Stanley
6,264
16,546
Hickman
5,529
12,700
Williamson
5,459
13,902
Sully
6,518
16,606
Houston
5,529
12,700
Wilson
5,459
13,902
Todd
6,264
16,546
Humphreys
5,529
12,700
Tripp
6,264
16,546
Jackson
5,032
13,081
Turner
6,104
17,502
Jefferson
5,151
13,797
Union
6,104
17,502
Johnson
5,214
15,105
County
Employee- Dependent,
Only
Family, etc.
Walworth
6,163
16,963
Knox
5,151
13,797
Anderson
7,421
16,249
7,421
16,249
Texas
Yankton
6,518
16,606
Lake
5,004
16,951
Andrews
Ziebach
6,264
16,546
Lauderdale
5,491
13,136
Angelina
7,421
16,249
12,700
Aransas
5,649
16,677
8,349
16,667
Lawrence
Tennessee
County
Employee- Dependent,
Only
Family, etc.
5,529
Lewis
5,529
12,700
Archer
Lincoln
5,529
12,700
Armstrong
7,515
16,719
13,797
Atascosa
5,437
14,188
6,665
19,326
Loudon
5,151
Anderson
5,151
13,797
Macon
5,032
13,081
Austin
Bedford
5,529
12,700
Madison
5,004
16,951
Bailey
7,421
16,249
Benton
5,004
16,951
Marion
6,003
14,364
Bandera
5,437
14,188
Bledsoe
6,003
14,364
Marshall
5,529
12,700
Bastrop
5,781
16,200
Blount
5,151
13,797
Maury
5,529
12,700
Baylor
7,421
16,249
Bradley
6,003
14,364
McMinn
6,003
14,364
Bee
7,421
16,249
Campbell
5,151
13,797
McNairy
5,004
16,951
Bell
6,560
16,416
Cannon
5,032
13,081
Meigs
6,003
14,364
Bexar
5,437
14,188
Carroll
5,004
16,951
Monroe
5,151
13,797
Blanco
7,421
16,249
Carter
5,214
15,105
Montgomery
5,459
13,902
Borden
7,421
16,249
Cheatham
5,459
13,902
12,700
Bosque
7,421
16,249
Chester
5,004
16,951
Morgan
5,151
13,797
Bowie
5,450
14,063
Claiborne
5,151
13,797
Obion
5,004
16,951
Brazoria
6,665
19,326
Clay
5,032
13,081
13,081
Brazos
5,510
15,125
Cocke
5,151
13,797
Perry
5,529
12,700
Brewster
7,421
16,249
Coffee
5,529
12,700
Pickett
5,032
13,081
Briscoe
7,421
16,249
Crockett
5,004
16,951
14,364
Brooks
7,421
16,249
7,421
16,249
Moore
Overton
Polk
5,529
5,032
6,003
Cumberland
5,032
13,081
Putnam
5,032
13,081
Brown
Davidson
5,459
13,902
Rhea
6,003
14,364
Burleson
5,510
15,125
Decatur
5,004
16,951
13,797
Burnet
7,421
16,249
Roane
5,151
-26-
2017 Average Premium Tables
Caldwell
5,781
16,200
Freestone
7,421
16,249
Kimble
7,421
16,249
Calhoun
5,501
15,732
Frio
7,421
16,249
King
7,421
16,249
Callahan
7,106
16,443
Gaines
7,421
16,249
Kinney
7,421
16,249
Cameron
6,716
12,301
Galveston
6,665
19,326
Kleberg
7,421
16,249
Camp
7,421
16,249
Garza
7,421
16,249
Knox
7,421
16,249
Carson
7,515
16,719
Gillespie
7,421
16,249
Lamar
7,421
16,249
DRAFT AS OF
November 22, 2017
Cass
7,421
16,249
Glasscock
7,421
16,249
Lamb
7,421
16,249
Castro
7,421
16,249
Goliad
5,501
15,732
Lampasas
6,560
16,416
Chambers
6,665
19,326
Gonzales
7,421
16,249
LaSalle
7,421
16,249
Cherokee
7,421
16,249
Gray
7,421
16,249
Lavaca
7,421
16,249
Childress
7,421
16,249
Grayson
7,707
15,650
Lee
7,421
16,249
Clay
8,349
16,667
Gregg
6,073
18,134
Leon
7,421
16,249
Cochran
7,421
16,249
Grimes
7,421
16,249
Liberty
6,665
19,326
Coke
7,421
16,249
Guadalupe
5,437
14,188
Limestone
7,421
16,249
Coleman
7,421
16,249
Hale
7,421
16,249
Lipscomb
7,421
16,249
Collin
6,518
16,750
Hall
7,421
16,249
Live Oak
7,421
16,249
Collingsworth
7,421
16,249
Hamilton
7,421
16,249
Llano
7,421
16,249
Colorado
7,421
16,249
Hansford
7,421
16,249
Loving
7,421
16,249
Comal
5,437
14,188
Hardeman
7,421
16,249
Lubbock
5,195
14,808
Comanche
7,421
16,249
Hardin
7,483
17,494
Lynn
7,421
16,249
Concho
7,421
16,249
Harris
6,665
19,326
Madison
7,421
16,249
Cooke
7,421
16,249
Harrison
7,421
16,249
Marion
7,421
16,249
Coryell
6,560
16,416
Hartley
7,421
16,249
Martin
7,421
16,249
Cottle
7,421
16,249
Haskell
7,421
16,249
Mason
7,421
16,249
Crane
7,421
16,249
Hays
5,781
16,200
Matagorda
7,421
16,249
Crockett
7,421
16,249
Hemphill
7,421
16,249
Maverick
7,421
16,249
Crosby
5,195
14,808
Henderson
7,421
16,249
McCulloch
7,421
16,249
Culberson
7,421
16,249
Hidalgo
5,702
14,248
McLennan
5,096
12,301
Dallam
7,421
16,249
Hill
7,421
16,249
McMullen
7,421
16,249
Dallas
6,518
16,750
Hockley
7,421
16,249
Medina
5,437
14,188
Dawson
7,421
16,249
Hood
7,421
16,249
Menard
7,421
16,249
Deaf Smith
7,421
16,249
Hopkins
7,421
16,249
Midland
6,019
14,806
Delta
6,518
16,750
Houston
7,421
16,249
Milam
7,421
16,249
Denton
6,518
16,750
Howard
7,421
16,249
Mills
7,421
16,249
DeWitt
7,421
16,249
Hudspeth
7,421
16,249
Mitchell
7,421
16,249
Dickens
7,421
16,249
Hunt
6,518
16,750
Montague
7,421
16,249
Dimmit
7,421
16,249
Hutchinson
7,421
16,249
Montgomery
6,665
19,326
Donley
7,421
16,249
Irion
5,414
14,408
Moore
7,421
16,249
Duval
7,421
16,249
Jack
7,421
16,249
Morris
7,421
16,249
Eastland
7,421
16,249
Jackson
7,421
16,249
Motley
7,421
16,249
Ector
8,055
18,635
Jasper
7,421
16,249
Nacogdoches
7,421
16,249
Edwards
7,421
16,249
Jeff Davis
7,421
16,249
Navarro
7,421
16,249
El Paso
5,982
14,595
Jefferson
7,483
17,494
Newton
7,421
16,249
Ellis
6,518
16,750
Jim Hogg
7,421
16,249
Nolan
7,421
16,249
Erath
7,421
16,249
Jim Wells
7,421
16,249
Nueces
5,649
16,677
Falls
7,421
16,249
Johnson
6,518
16,750
Ochiltree
7,421
16,249
Fannin
7,421
16,249
Jones
7,106
16,443
Oldham
7,421
16,249
Fayette
7,421
16,249
Karnes
7,421
16,249
Orange
7,483
17,494
Fisher
7,421
16,249
Kaufman
6,518
16,750
Palo Pinto
7,421
16,249
Floyd
7,421
16,249
Kendall
5,437
14,188
Panola
7,421
16,249
Foard
7,421
16,249
Kenedy
7,421
16,249
Parker
6,518
16,750
Fort Bend
6,665
19,326
Kent
7,421
16,249
Parmer
7,421
16,249
Franklin
7,421
16,249
Kerr
7,421
16,249
Pecos
7,421
16,249
2017 Average Premium Tables
-27-
Virginia
Polk
7,421
16,249
Webb
6,623
18,329
Potter
7,515
16,719
Wharton
7,421
16,249
Presidio
7,421
16,249
Wheeler
7,421
16,249
County
Employee- Dependent,
Only
Family, etc.
Rains
7,421
16,249
Wichita
8,349
16,667
Accomack
5,731
15,557
Randall
7,515
16,719
Wilbarger
7,421
16,249
Albemarle
5,503
15,071
Reagan
7,421
16,249
Willacy
7,421
16,249
Alexandria City
6,924
18,884
DRAFT AS OF
November 22, 2017
Real
7,421
16,249
Williamson
5,781
16,200
Alleghany
5,731
15,557
Red River
7,421
16,249
Wilson
5,437
14,188
Amelia
6,243
16,308
Reeves
7,421
16,249
Winkler
7,421
16,249
Amherst
5,519
15,132
5,519
15,132
Refugio
7,421
16,249
Wise
6,518
16,750
Appomattox
Roberts
7,421
16,249
Wood
7,421
16,249
Arlington
6,924
18,884
Robertson
5,510
15,125
Yoakum
7,421
16,249
Augusta
5,731
15,557
5,731
15,557
Rockwall
6,518
16,750
Young
7,421
16,249
Bath
Runnels
7,421
16,249
Zapata
7,421
16,249
Bedford
5,519
15,132
Rusk
6,073
18,134
Zavala
7,421
16,249
Bedford City
5,519
15,132
Bland
5,731
15,557
Botetourt
5,948
17,326
6,831
14,350
Sabine
7,421
16,249
San Augustine
7,421
16,249
San Jacinto
6,665
19,326
Utah
Employee- Dependent,
Only
Family, etc.
Bristol City
San Patricio
5,649
16,677
County
Brunswick
5,731
15,557
San Saba
7,421
16,249
Beaver
6,852
18,976
Buchanan
5,731
15,557
Schleicher
7,421
16,249
Box Elder
6,057
15,737
Buckingham
5,731
15,557
6,974
16,940
Scurry
7,421
16,249
Cache
Buena Vista City
5,731
15,557
Shackelford
7,421
16,249
Carbon
6,852
18,976
Campbell
5,519
15,132
16,249
Daggett
6,852
18,976
Caroline
6,243
16,308
5,884
16,949
Shelby
7,421
Sherman
7,421
16,249
Davis
Carroll
5,731
15,557
Smith
6,387
18,155
Duchesne
6,852
18,976
Charles City
6,243
16,308
16,249
Emery
6,852
18,976
Charlotte
5,731
15,557
6,852
18,976
Somervell
7,421
Starr
7,421
16,249
Garfield
Charlottesville City
5,503
15,071
Stephens
7,421
16,249
Grand
6,852
18,976
Chesapeake City
6,718
16,597
16,249
Iron
7,759
16,605
Chesterfield
6,243
16,308
6,852
18,976
Sterling
7,421
Stonewall
7,421
16,249
Juab
Clarke
6,924
18,884
Sutton
7,421
16,249
Kane
6,852
18,976
Colonial Heights City
6,243
16,308
16,249
Millard
6,852
18,976
Covington City
5,731
15,557
6,057
15,737
Swisher
7,421
Tarrant
6,518
16,750
Morgan
Craig
5,948
17,326
Taylor
7,106
16,443
Piute
6,852
18,976
Culpeper
5,731
15,557
6,974
16,940
Terrell
7,421
16,249
Rich
Cumberland
6,243
16,308
Terry
7,421
16,249
Salt Lake
5,884
16,949
Danville City
6,835
15,325
Throckmorton
7,421
16,249
San Juan
6,852
18,976
Dickenson
5,731
15,557
6,852
18,976
Titus
7,421
16,249
Sanpete
Dinwiddie
6,243
16,308
Tom Green
5,414
14,408
Sevier
6,852
18,976
Emporia City
5,731
15,557
Travis
5,781
16,200
Summit
5,884
16,949
Essex
5,731
15,557
5,884
16,949
Trinity
7,421
16,249
Tooele
Fairfax
6,924
18,884
Tyler
7,421
16,249
Uintah
6,852
18,976
Fairfax City
6,924
18,884
18,134
Utah
5,501
15,967
Falls Church City
6,924
18,884
5,884
16,949
Upshur
6,073
Upton
7,421
16,249
Wasatch
Fauquier
6,924
18,884
Uvalde
7,421
16,249
Washington
7,759
16,605
Floyd
5,731
15,557
16,249
Wayne
6,852
18,976
Fluvanna
5,503
15,071
Weber
6,057
15,737
Franklin
5,948
17,326
Franklin City
5,731
15,557
Frederick
5,532
14,279
Fredericksburg City
6,924
18,884
Galax City
5,731
15,557
Giles
5,548
15,322
Val Verde
7,421
Van Zandt
7,421
16,249
Victoria
5,501
15,732
Walker
7,421
16,249
Waller
6,665
19,326
Ward
7,421
16,249
Washington
7,421
16,249
Vermont
County
Employee- Dependent,
Only
Family, etc.
All
6,408
-28-
17,080
2017 Average Premium Tables
Gloucester
6,718
16,597
Radford City
5,548
15,322
Kittitas
6,107
16,053
Goochland
6,243
16,308
Rappahannock
5,731
15,557
Klickitat
6,381
17,857
Grayson
5,731
15,557
Richmond
5,731
15,557
Lewis
6,527
16,846
Greene
5,503
15,071
Richmond City
6,243
16,308
Lincoln
5,603
14,976
Greensville
5,731
15,557
Roanoke
5,948
17,326
Mason
6,527
16,846
Halifax
5,731
15,557
Roanoke City
5,948
17,326
Okanogan
6,107
16,053
DRAFT AS OF
November 22, 2017
Hampton City
6,718
16,597
Rockbridge
5,731
15,557
Pacific
6,527
16,846
Hanover
6,243
16,308
Rockingham
5,092
17,255
Pend Oreille
5,603
14,976
Harrisonburg City
5,092
17,255
Russell
5,731
15,557
Pierce
6,527
16,846
Henrico
6,243
16,308
Salem City
5,948
17,326
San Juan
6,527
16,846
Henry
5,731
15,557
Scott
6,831
14,350
Skagit
6,527
16,846
Highland
5,731
15,557
Shenandoah
5,731
15,557
Skamania
6,381
17,857
Hopewell City
6,243
16,308
Smyth
5,731
15,557
Snohomish
6,527
16,846
Isle of Wight
6,718
16,597
Southampton
5,731
15,557
Spokane
5,603
14,976
James City
6,718
16,597
Spotsylvania
6,924
18,884
Stevens
5,603
14,976
King and Queen
6,243
16,308
Stafford
6,924
18,884
Thurston
6,527
16,846
King George
5,731
15,557
Staunton City
5,731
15,557
Wahkiakum
6,527
16,846
King William
6,243
16,308
Suffolk City
6,718
16,597
Walla Walla
6,107
16,053
Lancaster
5,731
15,557
Surry
6,718
16,597
Whatcom
6,527
16,846
Lee
5,731
15,557
Sussex
6,243
16,308
Whitman
6,107
16,053
Lexington City
5,731
15,557
Tazewell
5,731
15,557
Yakima
6,107
16,053
Loudoun
6,924
18,884
Virginia Beach City
6,718
16,597
Louisa
6,243
16,308
Warren
6,924
18,884
Lunenburg
5,731
15,557
Washington
6,831
14,350
Lynchburg City
5,519
15,132
Waynesboro City
5,731
15,557
County
Employee- Dependent,
Only
Family, etc.
Madison
5,731
15,557
Westmoreland
5,731
15,557
Barbour
7,346
16,359
16,597
Berkeley
6,272
17,901
6,925
18,623
Manassas City
6,924
18,884
Williamsburg City
6,718
West Virginia
Manassas Park City
6,924
18,884
Winchester City
5,532
14,279
Boone
Martinsville City
5,731
15,557
Wise
5,731
15,557
Braxton
7,267
20,572
15,557
Brooke
6,313
17,672
16,597
Cabell
6,855
18,411
Calhoun
7,267
20,572
Clay
7,267
20,572
Doddridge
6,706
17,518
Mathews
6,718
16,597
Mecklenburg
5,731
15,557
Middlesex
5,731
15,557
Montgomery
5,548
15,322
Wythe
York
5,731
6,718
Washington
Nelson
5,503
15,071
New Kent
6,243
16,308
County
Employee- Dependent,
Only
Family, etc.
Fayette
7,267
20,572
6,107
16,053
Gilmer
6,706
17,518
Newport News City
6,718
16,597
Adams
Norfolk City
6,718
16,597
Asotin
6,107
16,053
Grant
6,607
16,639
Northampton
5,731
15,557
Benton
6,107
16,053
Greenbrier
7,267
20,572
6,107
16,053
Hampshire
6,607
16,639
Northumberland
5,731
15,557
Chelan
Norton City
5,731
15,557
Clallam
6,527
16,846
Hancock
6,313
17,672
Nottoway
5,731
15,557
Clark
6,381
17,857
Hardy
6,607
16,639
6,107
16,053
Harrison
7,346
16,359
Orange
5,731
15,557
Columbia
Page
5,731
15,557
Cowlitz
6,527
16,846
Jackson
8,485
17,032
15,557
Douglas
6,107
16,053
Jefferson
6,272
17,901
5,603
14,976
Kanawha
7,292
17,554
Patrick
5,731
Petersburg City
6,243
16,308
Ferry
Pittsylvania
6,835
15,325
Franklin
6,107
16,053
Lewis
6,706
17,518
16,597
Garfield
6,107
16,053
Lincoln
6,925
18,623
6,107
16,053
Logan
6,925
18,623
Poquoson
6,718
Portsmouth City
6,718
16,597
Grant
Powhatan
6,243
16,308
Grays Harbor
6,527
16,846
Marion
6,706
17,518
15,557
Island
6,527
16,846
Marshall
6,313
17,672
6,527
16,846
Mason
6,855
18,411
Prince Edward
5,731
Prince George
6,243
16,308
Jefferson
Prince William
6,924
18,884
King
6,470
17,962
McDowell
6,925
18,623
15,322
Kitsap
6,527
16,846
Mercer
7,158
19,408
Pulaski
5,548
2017 Average Premium Tables
-29-
Mineral
6,607
16,639
Dodge
6,352
18,101
Sawyer
6,084
18,724
Mingo
6,925
18,623
Door
5,990
17,556
Shawano
5,990
17,556
Monongalia
6,706
17,518
Douglas
6,084
18,724
Sheboygan
6,352
18,101
Monroe
7,158
19,408
Dunn
8,268
19,809
St. Croix
6,221
16,612
Morgan
6,607
16,639
Eau Claire
8,268
19,809
Taylor
7,523
17,880
Nicholas
7,267
20,572
Florence
6,621
17,777
Trempealeau
6,922
19,611
DRAFT AS OF
November 22, 2017
Ohio
6,313
17,672
Fond du Lac
6,352
18,101
Vernon
6,934
19,707
Pendleton
6,607
16,639
Forest
6,621
17,777
Vilas
6,621
17,777
Pleasants
8,485
17,032
Grant
6,934
19,707
Walworth
6,433
20,968
Pocahontas
7,346
16,359
Green
6,433
20,968
Washburn
6,084
18,724
Preston
7,346
16,359
Green Lake
5,793
17,632
Washington
6,675
17,268
Putnam
6,855
18,411
Iowa
6,934
19,707
Waukesha
6,675
17,268
Raleigh
7,158
19,408
Iron
6,621
17,777
Waupaca
6,352
18,101
Randolph
7,346
16,359
Jackson
6,922
19,611
Waushara
6,352
18,101
Ritchie
8,485
17,032
Jefferson
6,433
20,968
Winnebago
6,352
18,101
Roane
7,267
20,572
Juneau
5,793
17,632
Wood
7,069
17,511
Summers
7,158
19,408
Kenosha
6,526
19,952
Taylor
7,346
16,359
Kewaunee
5,990
17,556
Tucker
7,346
16,359
La Crosse
6,922
19,611
Tyler
8,485
17,032
Lafayette
6,934
19,707
County
Employee- Dependent,
Only
Family, etc.
Upshur
7,346
16,359
Langlade
6,621
17,777
Albany
7,563
19,502
7,563
19,502
Wyoming
Wayne
6,855
18,411
Lincoln
7,069
17,511
Big Horn
Webster
7,346
16,359
Manitowoc
5,990
17,556
Campbell
7,563
19,502
17,511
Carbon
7,563
19,502
7,563
19,502
Wetzel
6,706
17,518
Marathon
7,069
Wirt
8,485
17,032
Marinette
5,990
17,556
Converse
Wood
8,485
17,032
Marquette
5,793
17,632
Crook
7,563
19,502
17,556
Fremont
7,563
19,502
7,563
19,502
Wyoming
6,925
18,623
Wisconsin
Menomonee
5,990
Milwaukee
6,594
19,579
Goshen
Monroe
6,922
19,611
Hot Springs
7,563
19,502
17,556
Johnson
7,563
19,502
7,419
18,667
Employee- Dependent,
Only
Family, etc.
Oconto
County
Oneida
6,621
17,777
Laramie
Adams
5,793
17,632
Outagamie
6,352
18,101
Lincoln
7,563
19,502
Ashland
6,084
18,724
17,268
Natrona
7,028
19,188
7,563
19,502
Ozaukee
5,990
6,675
Barron
7,523
17,880
Pepin
8,268
19,809
Niobrara
Bayfield
6,084
18,724
Pierce
6,221
16,612
Park
7,563
19,502
Brown
5,990
17,556
Polk
6,221
16,612
Platte
7,563
19,502
Buffalo
6,922
19,611
Portage
7,069
17,511
Sheridan
7,563
19,502
Burnett
6,084
18,724
Price
7,523
17,880
Sublette
7,563
19,502
Calumet
6,352
18,101
Racine
6,526
19,952
Sweetwater
7,563
19,502
Chippewa
8,268
19,809
Richland
5,793
17,632
Teton
7,563
19,502
Clark
7,523
17,880
Rock
6,433
20,968
Uinta
7,563
19,502
Columbia
6,433
20,968
Rusk
7,523
17,880
Washakie
7,563
19,502
Crawford
6,934
19,707
Sauk
5,793
17,632
Weston
7,563
19,502
Dane
6,193
17,738
-30-
2017 Average Premium Tables
| File Type | application/pdf |
| File Title | 2017 Instructions for Form 8941 |
| Subject | Instructions for Form 8941, Credit for Small Employer Health Insurance Premiums |
| Author | W:CAR:MP:FP |
| File Modified | 2017-11-22 |
| File Created | 2017-11-22 |