8941 Instructions for Form 8941

Caution: DRAFT—NOT FOR FILING
This is an early release draft of an IRS tax form, instructions, or
publication, which the IRS is providing for your information as a courtesy.
Do not file draft forms. Also, do not rely on draft forms, instructions, and
publications for filing. We generally do not release drafts of forms until we
believe we have incorporated all changes. However, unexpected issues
sometimes arise, or legislation is passed, necessitating a change to a draft
form. In addition, forms generally are subject to OMB approval before they
can be officially released. Drafts of instructions and publications usually
have at least some changes before being officially released.
Early release drafts are at IRS.gov/DraftForms, and may remain there
even after the final release is posted at IRS.gov/DownloadForms. All
information about all forms, instructions, and pubs is at IRS.gov/Forms.
Almost every form and publication also has its own page on IRS.gov. For
example, the Form 1040 page is at IRS.gov/Form1040; the Publication 17
page is at IRS.gov/Pub17; the Form W-4 page is at IRS.gov/W4; and the
Schedule A (Form 1040) page is at IRS.gov/ScheduleA. If typing in a link
above instead of clicking on it, be sure to type the link into the address bar
of your browser, not in a Search box. Note that these are friendly shortcut
links that will automatically go to the actual link for the page.
If you wish, you can submit comments about draft or final forms,
instructions, or publications at IRS.gov/FormsComments. We cannot
respond to all comments due to the high volume we receive. Please note that
we may not be able to consider many suggestions until the subsequent
revision of the product.

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