Credit for Small Employer Health Insurance Premiums

Form 8941 - Tax Credit for Employee Health Insurance Expenses of Small Employers

i8941--2019-00-00

Credit for Small Employer Health Insurance Premiums

OMB: 1545-2198

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2019

Instructions for Form 8941

Department of the Treasury
Internal Revenue Service

Credit for Small Employer Health Insurance Premiums
Section references are to the Internal Revenue Code
unless otherwise noted.

tax under section 1381 may be able to claim the credit as
a general business credit, as discussed next.

Future Developments

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.

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.

Reminders
Exception for eligible small employers in certain
counties. Certain small employers whose principal
business address is in a county with no qualified health
plan through a Small Business Health Options Program
(SHOP) Marketplace may be able to claim the credit for
small employer health insurance premiums. For more
information, see Exception for eligible small employers in
certain counties in the instructions for line A.
Waiver for Hawaii. Employers in Hawaii can’t claim this
credit for insurance premiums paid for health plan years
beginning after 2016. For more information, see Waiver
for Hawaii in the instructions for line A.

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
Dec 10, 2019

Partnerships, S corporations, cooperatives,

TIP estates, trusts, and tax-exempt eligible small

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’re 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
phaseout 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 $55,000 per FTE. For details, see Worksheets
1 and 3.

Cat. No. 55222U

If you had more than 10 FTEs and average
annual wages of more than $27,000, 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 $55,000.

State premium subsidy or tax credit. If you’re 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 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).

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.
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.
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’re a sole proprietor with two separate
businesses and you file a separate Schedule C (Form
1040 or 1040-SR) 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 or
1040-SR) 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 or
1040-SR.

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’ve paid $3,120 ($60 × 52)

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.
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Instructions for Form 8941 (2019)

including those contributions attributable to an employee’s
participation in a wellness program.

for an employee who was enrolled for the entire tax year.
You would’ve 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.

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
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.

Health Insurance Coverage

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 certain counties, see the instructions
for line A, 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.
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’ve 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’ve 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 isn’t 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,
Instructions for Form 8941 (2019)

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
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provide under a qualifying arrangement to individuals
considered employees.

discussed under Arrangements with list billing and only
employee-only coverage above.
• A uniform amount that is either equal to the amount you
would’ve 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 your family coverage,
for each employee (if any) enrolled in family coverage.
• A uniform amount that is either equal to the amount you
would’ve 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).

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
beginning in 2019, 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 2019.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2019.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2019.

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,

State subsidies and credits. For this purpose, if you’re
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.

TIP estates, trusts, and tax-exempt eligible small

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’re 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.

Line A

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.

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.

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

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.
-4-

Instructions for Form 8941 (2019)

Worksheet 1. Information Needed To
Complete Line 1 and Worksheets 2
and 3

If you answer "No," don’t file Form 8941 unless you’re
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.

If you need more rows, use a separate sheet and include
the additional amounts in the totals below.

Waiver for Hawaii. Hawaii has received a 5-year State
Innovation Waiver under section 1332 of the Affordable
Care Act. Employers in Hawaii can’t participate in the
SHOP Marketplace or claim the credit for insurance
premiums paid for health plan years beginning after 2016.
For more information on the waiver, visit CMS.gov.

(a)
Individuals
Considered
Employees

(b)
Employee
Hours of
Service

(c)
Employee
Wages
Paid

 1.

Exception for eligible small employers in certain
counties. For calendar year 2019, SHOP Marketplaces
in certain counties across the United States didn’t have
qualified health plans available for employers to offer to
employees. However, relief is available which allows
eligible small employers with a principal business address
in those counties to claim the credit for 2019 if they
properly claimed the credit under section 45R for all or
part of 2018. For details, see Notice 2018-27, 2018-20,
I.R.B. 580, available at IRS.gov/irb/
2018-20_IRB#NOT-2018-27.

 2.
 3.
 4.
 5.
 6.
 7.
 8.
 9.

To see whether a particular county has coverage
TIP available through a SHOP Exchange for 2019 and
beyond, go to Healthcare.gov/small-business and
enter “plans and prices” in the search box.

10.
11.
12.

Line C

13.

Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning in 2014, 2015, 2016, or 2017
included a Form 8941 with line A checked “Yes” and
line 12 showing a positive amount. For more information,
see Credit Period, earlier.

14.
15.
16.
17.

If you answer “Yes,” don’t file Form 8941 unless you’re
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
shouldn’t report any amount on line 12. For more
information, see the instructions for line 15.

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 (2019)

-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 isn’t 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
isn’t 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.

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 1
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 1 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
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Instructions for Form 8941 (2019)

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.

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.

(a)
Enrolled
Individuals
Considered
Employees

 3.
 4.
 5.
 6.
 7.
 8.
 9.
10.

Your credit is reduced if you paid average annual wages
of more than $27,000 for the tax year. If you paid average
annual wages of $55,000 or more for the tax year, your
credit is reduced to zero.

14.

2. Enter FTEs from Worksheet 2,
line 3 . . . . . . . . . . . . . . . . . . . . . . .

2.

3. Average annual wages. Divide line 1
by line 2. If the result isn’t 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 . . .

(d)
Enrolled
Employee
Hours of
Service

 2.

2,080

Worksheet 3. Information Needed To
Complete Line 3 (Average Annual
Wages)

1.

(c)
Adjusted
Average
Premiums

 1.

3. Full-time equivalent employees.
Divide line 1 by line 2. If the result isn’t 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
3.
this number on Form 8941, line 2 . . .

1. Enter the total employee wages paid
from Worksheet 1, column (c) . . . . . .

(b)
Employer
Premiums
Paid

11.
12.
13.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.

3.

25.
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 (2019)

-7-

Column (b), Employer Premiums Paid

enrolled for the entire tax year. You would’ve paid $570
($57 × 10) if the employee was only enrolled for 10 pay
periods. You’ll 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 (d), Enrolled Employee Hours
of Service

Column (c), Adjusted Average
Premiums

Your credit is reduced if the employer premiums paid are
more than the employer premiums that would’ve 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.

Worksheet 5. Information Needed To
Complete Line 8 (If Line 2 is More
Than 10)

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.

1. Enter the amount from Form 8941,
line 7 . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter, for each employee listed in column (a), the
premiums you would’ve 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.
To find the average premium for the small group market
in a rating area for tax years beginning in 2019, see the
average premium tables at the end of these instructions.
Family coverage includes any coverage other than
employee-only coverage.

2. Enter the number from Form
8941, line 2 . . . . . . . . . . . .

2.

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.

1.

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 $27,000)

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’ve 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’ve 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’ve paid $2,964 ($57 × 52) if the employee was

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 $27,100 from
line 3 . . . . . . . . . . . . . . . . . .

4.

5. Divide line 4 by $27,100. 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 (2019)

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.
2. Hours of service per FTE . . . . . . . . . .
3. Divide line 1 by line 2. If the result isn’t 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 . . .

2.

2,080

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.

3.

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 1120-S), box 13 (code P);
• Schedule K-1 (Form 1041), box 13 (code G); and
• Form 1099-PATR, Taxable Distributions Received
From Cooperatives, box 11, or other notice of credit
allocation.

Line 19

Partnerships, S corporations, cooperatives,
TIP estates, trusts, and tax-exempt eligible small
employers report the above credits on line 15. All
other filers figuring a separate credit on earlier lines also
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 2019.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2019.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2019.

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 hr., 8 min.
1 hr., 2 min.
2 hr., 5 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 (2019)

-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 2019.
Alabama

Limestone

6,480

18,506

Petersburg

10,239

26,762

Lowndes

7,496

19,230

Prince of Wales-Hyder 10,239

26,762

Macon

6,299

17,134

Sitka

10,239

26,762

Madison

6,480

18,506

Skagway

10,239

26,762

Marengo

6,299

17,134

Southeast Fairbanks

10,434

27,855

Marion

6,299

17,134

Valdez Cordova

9,537

28,132

Employee- Dependent,
Only
Family, etc.

Marshall

6,299

17,134

Wade Hampton

10,434

27,855

County

Mobile

7,203

17,779

10,239

26,762

Autauga

7,496

19,230

Monroe

6,299

17,134

Wrangell City and
Borough

Baldwin

6,299

17,134

Montgomery

7,496

19,230

Yakutat

10,434

27,855

Barbour

6,299

17,134

Morgan

7,893

19,596

Yukon Koyukuk

10,434

27,855

Bibb

6,653

18,549

Perry

6,299

17,134

Blount

6,653

18,549

Pickens

6,299

17,134

Bullock

6,299

17,134

Pike

6,299

17,134

Butler

6,299

17,134

Randolph

6,299

17,134

Calhoun

6,642

18,615

Russell

7,136

18,051

Chambers

6,299

17,134

Shelby

6,653

18,549

Cherokee

6,299

17,134

St. Clair

6,653

18,549

Chilton

6,653

18,549

Sumter

6,299

17,134

Choctaw

6,299

17,134

Talladega

6,299

17,134

Clarke

6,299

17,134

Tallapoosa

6,299

17,134

Clay

6,299

17,134

Tuscaloosa

7,603

16,924

Cleburne

6,299

17,134

Walker

6,653

18,549

Coffee

6,299

17,134

Washington

6,299

17,134

Colbert

8,558

19,748

Wilcox

6,299

17,134

Conecuh

6,299

17,134

Winston

6,299

17,134

Coosa

6,299

17,134

Covington

6,299

17,134

Crenshaw

6,299

17,134

Cullman

6,299

17,134

County

Employee- Dependent,
Only
Family, etc.

Dale

6,299

17,134

Aleutians East

10,434

27,855

Dallas

6,299

17,134

Aleutians West

10,434

27,855

DeKalb

6,299

17,134

Anchorage

9,537

28,132

Elmore

7,496

19,230

Bethel

9,537

28,132

Escambia

6,299

17,134

Bristol Bay

10,434

27,855

Etowah

5,846

18,202

Denali

10,434

27,855

Fayette

6,299

17,134

Dillingham

9,537

28,132

Franklin

6,299

17,134

Fairbanks North Star

10,434

27,855

Geneva

6,414

16,386

Haines

10,239

26,762

Greene

7,603

16,924

Hoonah-Angoon

10,239

26,762

Hale

7,603

16,924

Juneau

10,239

26,762

Henry

6,414

16,386

Kenai Peninsula

10,434

27,855

Houston

6,414

16,386

Ketchikan Gateway

10,239

26,762

Jackson

6,299

17,134

Kodiak Island

10,434

27,855

Jefferson

6,653

18,549

Lake and Peninsula

10,434

27,855

Lamar

6,299

17,134

Matanuska Susitna

10,434

27,855

Lauderdale

8,558

19,748

Nome

10,434

27,855

Lawrence

7,893

19,596

North Slope

10,434

27,855

Lee

6,298

15,915

Northwest Arctic

10,434

27,855

Alaska

-10-

Arizona
County

Employee- Dependent,
Only
Family, etc.

Apache

6,048

16,062

Cochise

6,445

17,906

Coconino

6,048

16,062

Gila

6,572

17,498

Graham

6,445

17,906

Greenlee

6,445

17,906

La Paz

7,570

19,901

Maricopa

5,993

17,317

Mohave

6,048

16,062

Navajo

6,048

16,062

Pima

5,732

17,791

Pinal

6,572

17,498

Santa Cruz

5,732

17,791

Yavapai

5,662

18,780

Yuma

7,570

19,901

Arkansas
County

Employee- Dependent,
Only
Family, etc.

Arkansas

5,941

14,734

Ashley

5,941

14,734

Baxter

5,349

14,692

Benton

5,349

14,692

Boone

5,349

14,692

Bradley

5,941

14,734

Calhoun

6,135

18,778

Carroll

5,349

14,692

Chicot

5,941

14,734

Clark

5,127

15,166

Clay

6,168

17,023

Cleburne

5,748

14,866

Cleveland

5,941

14,734

Columbia

6,135

18,778

Conway

5,748

14,866

2019 Average Premium Tables

Craighead

6,168

17,023

Stone

6,168

17,023

Santa Clara

7,816

20,093

Crawford

5,610

15,821

Union

6,135

18,778

Santa Cruz

6,851

16,720

Crittenden

6,168

17,023

Van Buren

5,748

14,866

Shasta

6,686

17,135

Cross

6,168

17,023

Washington

5,349

14,692

Sierra

6,686

17,135

Dallas

5,941

14,734

White

5,748

14,866

Siskiyou

6,686

17,135

Desha

5,941

14,734

Woodruff

6,168

17,023

Solano

6,899

17,066

Drew

5,941

14,734

Yell

5,748

14,866

Sonoma

6,899

17,066

Faulkner

5,748

14,866

Stanislaus

7,223

16,485

Franklin

5,610

15,821

Sutter

6,686

17,135

Fulton

6,168

17,023

6,686

17,135

5,127

15,166

County

Employee- Dependent,
Only
Family, etc.

Tehama

Garland

Trinity

6,686

17,135

Grant

5,748

14,866

Alameda

7,400

19,186

Tulare

7,223

16,485

6,686

17,135

California

Greene

6,168

17,023

Alpine

Tuolumne

6,686

17,135

Hempstead

6,135

18,778

Amador

6,686

17,135

Ventura

6,565

17,216

Hot Spring

5,127

15,166

Butte

6,686

17,135

Yolo

6,442

16,884

6,686

17,135

Yuba

6,686

17,135

Howard

6,135

18,778

Calaveras

Independence

6,168

17,023

Colusa

6,686

17,135

Izard

6,168

17,023

Contra Costa

7,587

19,440

Jackson

6,168

17,023

Del Norte

6,686

17,135

Jefferson

5,941

14,734

El Dorado

6,442

16,884

County

Employee- Dependent,
Only
Family, etc.

Johnson

5,610

15,821

Fresno

6,269

18,185

Adams

6,473

18,805

6,686

17,135

Alamosa

8,108

18,152

Colorado

Lafayette

6,135

18,778

Glenn

Lawrence

6,168

17,023

Humboldt

6,686

17,135

Arapahoe

6,473

18,805

14,734

Imperial

6,023

15,609

Archuleta

7,782

19,899

6,023

15,609

Baca

8,108

18,152

Lee

5,941

Lincoln

5,941

14,734

Inyo

Little River

6,135

18,778

Kern

7,202

17,484

Bent

8,108

18,152

15,821

Kings

6,269

18,185

Boulder

5,932

18,751

6,686

17,135

Broomfield

6,473

18,805

Logan

5,610

Lonoke

5,748

14,866

Lake

Madison

5,349

14,692

Lassen

6,686

17,135

Chaffee

8,108

18,152

14,692

Los Angeles

6,446

17,582

Cheyenne

8,108

18,152

6,269

18,185

Clear Creek

6,473

18,805

Marion

5,349

Miller

6,135

18,778

Madera

Mississippi

6,168

17,023

Marin

6,899

17,066

Conejos

8,108

18,152

14,734

Mariposa

7,223

16,485

Costilla

8,108

18,152

6,686

17,135

Crowley

8,108

18,152

Monroe

5,941

Montgomery

5,127

15,166

Mendocino

Nevada

6,135

18,778

Merced

7,223

16,485

Custer

8,108

18,152

6,686

17,135

Delta

7,782

19,899

Newton

5,349

14,692

Modoc

Ouachita

6,135

18,778

Mono

6,023

15,609

Denver

6,473

18,805

Perry

5,748

14,866

Monterey

6,851

16,720

Dolores

7,782

19,899

6,899

17,066

Douglas

6,473

18,805

Phillips

5,941

14,734

Napa

Pike

5,127

15,166

Nevada

6,686

17,135

Eagle

7,401

19,560

Poinsett

6,168

17,023

Orange

6,923

19,303

El Paso

6,109

17,296

6,442

16,884

Elbert

6,473

18,805

Polk

5,610

15,821

Placer

Pope

5,748

14,866

Plumas

6,686

17,135

Fremont

8,108

18,152

14,866

Riverside

6,189

16,406

Garfield

7,401

19,560

6,442

16,884

Gilpin

6,473

18,805

Prairie

5,748

Pulaski

5,748

14,866

Sacramento

Randolph

6,168

17,023

San Benito

6,851

16,720

Grand

7,782

19,899

14,866

San Bernardino

6,189

16,406

Gunnison

7,782

19,899

6,254

16,251

Hinsdale

7,782

19,899

Saline

5,748

Scott

5,610

15,821

San Diego

Searcy

5,349

14,692

San Francisco

6,928

22,099

Huerfano

8,108

18,152

15,821

San Joaquin

7,223

16,485

Jackson

7,782

19,899

6,565

17,216

Jefferson

6,473

18,805

Sebastian

5,610

Sevier

6,135

18,778

San Luis Obispo

Sharp

6,168

17,023

San Mateo

8,446

21,619

Kiowa

8,108

18,152

17,023

Santa Barbara

6,565

17,216

Kit Carson

8,108

18,152

St. Francis

6,168

2019 Average Premium Tables

-11-

Florida

Pasco

7,222

17,632

Employee- Dependent,
Only
Family, etc.

Pinellas

6,793

21,198

Polk

6,725

18,800

Alachua

7,824

18,767

Putnam

6,547

19,304

18,152

Baker

6,819

18,340

Santa Rosa

6,248

15,808

17,979

Bay

6,104

16,525

Sarasota

6,314

17,419

6,285

18,668

La Plata

7,782

19,899

Lake

7,782

19,899

Larimer

7,842

15,661

County

Las Animas

8,108

18,152

Lincoln

8,108

Logan

6,452

Mesa

6,247

17,485

Bradford

Seminole

6,403

16,459

Mineral

8,108

18,152

Brevard

7,268

19,268

St. Johns

6,230

20,276

Moffat

7,782

19,899

Broward

6,504

19,677

St. Lucie

6,195

16,453

6,436

18,498

Montezuma

7,782

19,899

Calhoun

Sumter

6,574

20,097

Montrose

7,782

19,899

Charlotte

7,602

21,853

Suwannee

5,954

18,191

Morgan

6,452

17,979

Citrus

6,538

16,760

Taylor

7,698

20,766

5,653

18,079

Otero

8,108

18,152

Clay

Union

6,404

18,849

Ouray

7,782

19,899

Collier

5,724

18,249

Volusia

6,515

18,059

Park

6,473

18,805

Columbia

7,619

20,834

Wakulla

6,279

18,762

6,496

19,377

Walton

6,203

15,878

Washington

6,572

19,403

Phillips

6,452

17,979

DeSoto

Pitkin

7,401

19,560

Dixie

6,175

15,955

Prowers

8,108

18,152

Duval

6,785

17,101

Pueblo

6,909

18,542

Escambia

7,011

16,923

Rio Blanco

7,782

19,899

Flagler

7,325

18,012

Rio Grande

8,108

18,152

Franklin

6,390

19,561

County

Employee- Dependent,
Only
Family, etc.

Routt

7,782

19,899

Gadsden

6,099

18,111

Appling

7,234

17,746

Saguache

8,108

18,152

Gilchrist

6,191

18,470

Atkinson

7,013

19,504

19,899

Glades

6,694

21,069

Bacon

5,509

15,512

7,132

18,814

San Juan

7,782

Georgia

San Miguel

7,782

19,899

Gulf

7,505

19,997

Baker

Sedgwick

6,452

17,979

Hamilton

6,404

18,448

Baldwin

7,411

19,119

19,560

Hardee

6,611

16,125

Banks

7,372

17,098

6,145

17,934

Summit

7,401

Teller

6,109

17,296

Hendry

7,605

21,272

Barrow

Washington

6,452

17,979

Hernando

6,880

19,628

Bartow

6,329

17,391

18,203

Highlands

7,233

22,204

Ben Hill

7,286

20,529

7,286

20,529

Weld
Yuma

6,266
6,452

17,979

Connecticut

Hillsborough

6,063

18,134

Berrien

Holmes

6,664

18,530

Bibb

6,078

17,514

Indian River

6,122

16,323

Bleckley

6,078

17,514

5,509

15,512

Jackson

5,893

15,950

Brantley

Jefferson

7,343

17,863

Brooks

7,286

20,529

7,234

17,746

County

Employee- Dependent,
Only
Family, etc.

Fairfield

7,969

22,318

Lafayette

6,707

17,496

Bryan

Hartford

7,443

20,581

Lake

7,765

20,508

Bulloch

7,234

17,746

Litchfield

7,107

21,335

Lee

6,462

18,925

Burke

6,568

18,206

Middlesex

8,289

21,538

Leon

7,004

20,060

Butts

6,329

17,391

New Haven

8,154

21,310

Levy

6,257

19,545

Calhoun

7,132

18,814

New London

6,262

16,977

Liberty

6,502

18,954

Camden

5,509

15,512

Tolland

7,371

15,494

Madison

7,585

19,890

Candler

7,234

17,746

Windham

7,732

27,150

Manatee

6,495

20,547

Carroll

6,588

19,520

Marion

5,798

16,598

Catoosa

6,368

17,840

5,509

15,512

Delaware
County

Employee- Dependent,
Only
Family, etc.

All

7,718

21,577

District of Columbia
County

Employee- Dependent,
Only
Family, etc.

All

6,547

21,926

Martin

6,960

20,401

Charlton

Miami-Dade

6,882

20,551

Chatham

7,234

17,746

Monroe

7,638

21,499

Chattahoochee

5,758

18,095

7,357

18,355

Nassau

7,343

16,112

Chattooga

Okaloosa

6,829

25,545

Cherokee

6,329

17,391

Okeechobee

7,498

20,433

Clarke

6,145

17,934

7,132

18,814

Orange

6,644

17,215

Clay

Osceola

7,510

21,366

Clayton

6,329

17,391

Palm Beach

7,054

19,831

Clinch

7,286

20,529

-12-

2019 Average Premium Tables

Cobb

6,329

17,391

Lanier

7,286

20,529

Towns

7,372

17,098

Coffee

7,013

19,504

Laurens

7,013

19,504

Treutlen

7,013

19,504

Colquitt

7,286

20,529

Lee

7,132

18,814

Troup

5,758

18,095

Columbia

6,568

18,206

Liberty

7,234

17,746

Turner

7,286

20,529

Cook

7,286

20,529

Lincoln

6,568

18,206

Twiggs

6,078

17,514

Coweta

6,329

17,391

Long

7,234

17,746

Union

7,372

17,098

Crawford

6,078

17,514

Lowndes

7,286

20,529

Upson

5,758

18,095

Crisp

7,132

18,814

Lumpkin

7,372

17,098

Walker

6,368

17,840

Dade

6,368

17,840

Macon

5,758

18,095

Walton

6,329

17,391

Dawson

7,372

17,098

Madison

6,145

17,934

Ware

5,509

15,512

Decatur

7,286

20,529

Marion

5,758

18,095

Warren

6,568

18,206

DeKalb

6,329

17,391

McDuffie

6,568

18,206

Washington

7,411

19,119

Dodge

6,078

17,514

McIntosh

5,509

15,512

Wayne

5,509

15,512

Dooly

6,078

17,514

Meriwether

5,758

18,095

Webster

5,758

18,095

Dougherty

7,132

18,814

Miller

7,286

20,529

Wheeler

7,013

19,504

Douglas

6,329

17,391

Mitchell

7,132

18,814

White

7,372

17,098

Early

7,286

20,529

Monroe

6,078

17,514

Whitfield

6,022

16,060

Echols

7,286

20,529

Montgomery

7,013

19,504

Wilcox

6,078

17,514

Effingham

7,234

17,746

Morgan

6,145

17,934

Wilkes

6,568

18,206

Elbert

6,145

17,934

Murray

6,022

16,060

Wilkinson

7,411

19,119

Emanuel

6,568

18,206

Muscogee

5,758

18,095

Worth

7,132

18,814

Evans

7,234

17,746

Newton

6,329

17,391

Fannin

6,022

16,060

Oconee

6,145

17,934

Fayette

6,329

17,391

Oglethorpe

6,145

17,934

Floyd

7,357

18,355

Paulding

6,329

17,391

County

Employee- Dependent,
Only
Family, etc.

Forsyth

6,329

17,391

Peach

6,078

17,514

All

6,207

Franklin

7,372

17,098

Pickens

7,357

18,355

Fulton

6,329

17,391

Pierce

5,509

15,512

Gilmer

7,357

18,355

Pike

6,329

17,391

Glascock

6,568

18,206

Polk

7,357

18,355

Glynn

5,509

15,512

Pulaski

6,078

17,514

Gordon

7,357

18,355

Putnam

6,078

17,514

Grady

7,286

20,529

Quitman

5,758

18,095

Greene

6,145

17,934

Rabun

7,372

17,098

Gwinnett

6,329

17,391

Randolph

7,132

18,814

Habersham

7,372

17,098

Richmond

6,568

18,206

Hall

7,372

17,098

Rockdale

6,329

17,391

Hancock

7,411

19,119

Schley

7,132

18,814

Haralson

6,588

19,520

Screven

7,234

17,746

Harris

5,758

18,095

Seminole

7,286

20,529

Hart

7,372

17,098

Spalding

6,329

17,391

Heard

6,588

19,520

Stephens

7,372

17,098

Henry

6,329

17,391

Stewart

5,758

18,095

Houston

6,078

17,514

Sumter

7,132

18,814

Irwin

7,286

20,529

Talbot

5,758

18,095

Jackson

6,145

17,934

Taliaferro

6,568

18,206

Jasper

6,329

17,391

Tattnall

7,234

17,746

Jeff Davis

7,013

19,504

Taylor

5,758

18,095

Jefferson

6,568

18,206

Telfair

7,013

19,504

Jenkins

6,568

18,206

Terrell

7,132

18,814

Johnson

7,013

19,504

Thomas

7,286

20,529

Jones

6,078

17,514

Tift

7,286

20,529

Lamar

6,329

17,391

Toombs

7,013

19,504

2019 Average Premium Tables

-13-

Hawaii

18,141

Idaho
County

Employee- Dependent,
Only
Family, etc.

Ada

5,405

15,191

Adams

5,053

14,317

Bannock

5,745

16,504

Bear Lake

5,745

16,504

Benewah

5,467

13,471

Bingham

5,745

16,504

Blaine

5,246

16,271

Boise

5,053

14,317

Bonner

5,467

13,471

Bonneville

6,016

15,461

Boundary

5,467

13,471

Butte

5,745

16,504

Camas

5,246

16,271

Canyon

5,053

14,317

Caribou

5,745

16,504

Cassia

5,246

16,271

Clark

6,016

15,461

Clearwater

5,780

16,479

Custer

5,745

16,504

Elmore

5,053

14,317

Franklin

5,745

16,504

Fremont

6,016

15,461

Gem

5,053

14,317

Gooding

5,246

16,271

Fulton

7,117

18,449

Saline

6,467

21,320

Idaho

5,780

16,479

Gallatin

6,467

21,320

Sangamon

6,399

17,438

Jefferson

6,016

15,461

Greene

6,204

17,569

Schuyler

6,399

17,438

Jerome

5,246

16,271

Grundy

7,928

20,461

Scott

6,399

17,438

Kootenai

5,467

13,471

Hamilton

6,467

21,320

Shelby

6,399

17,438

Latah

5,467

13,471

Hancock

5,393

18,874

St. Clair

6,989

18,661

Lemhi

6,016

15,461

Hardin

6,467

21,320

Stark

7,117

18,449

Lewis

5,780

16,479

Henderson

5,393

18,874

Stephenson

6,523

19,271

Lincoln

5,246

16,271

Henry

5,393

18,874

Tazewell

7,117

18,449

Madison

6,016

15,461

Iroquois

6,755

18,247

Union

6,467

21,320

Minidoka

5,246

16,271

Jackson

6,467

21,320

Vermilion

6,755

18,247

Nez Perce

5,780

16,479

Jasper

6,467

21,320

Wabash

6,467

21,320

Oneida

5,745

16,504

Jefferson

6,467

21,320

Warren

5,393

18,874

Owyhee

5,053

14,317

Jersey

6,204

17,569

Washington

6,204

17,569

Payette

5,053

14,317

Jo Daviess

6,523

19,271

Wayne

6,467

21,320

Power

5,745

16,504

Johnson

6,467

21,320

White

6,467

21,320

Shoshone

5,467

13,471

Kane

7,109

20,308

Whiteside

5,393

18,874

Teton

6,016

15,461

Kankakee

7,928

20,461

Will

7,928

20,461

Twin Falls

5,246

16,271

Kendall

7,928

20,461

Williamson

6,467

21,320

Valley

5,053

14,317

Knox

7,117

18,449

Winnebago

6,523

19,271

Washington

5,053

14,317

Lake

6,435

23,338

Woodford

7,117

18,449

LaSalle

7,117

18,449

Lawrence

6,467

21,320

Illinois

Indiana

Employee- Dependent,
Only
Family, etc.

Lee

6,523

19,271

County

Livingston

7,269

24,851

County

Employee- Dependent,
Only
Family, etc.

Adams

6,399

17,438

Logan

6,399

17,438

Adams

7,447

20,133

Alexander

6,467

21,320

17,438

Allen

6,518

18,284

Bond

6,204

17,569

Macoupin

6,204

17,569

Bartholomew

7,220

18,807

Boone

6,523

19,271

Madison

6,989

18,661

Benton

6,934

20,683

Brown

6,399

17,438

21,320

Blackford

7,432

17,837

Bureau

5,393

18,874

Marshall

7,117

18,449

Boone

6,974

20,636

Calhoun

6,204

17,569

Mason

6,399

17,438

Brown

6,293

19,033

Carroll

6,523

19,271

21,320

Carroll

6,908

21,591

6,893

18,619

Macon

Marion

Massac

6,399

6,467

6,467

Cass

6,399

17,438

McDonough

7,117

18,449

Cass

Champaign

6,755

18,247

McHenry

6,435

23,338

Clark

6,454

17,410

Christian

6,399

17,438

McLean

7,269

24,851

Clay

7,068

19,132

Clark

6,755

18,247

Menard

6,399

17,438

Clinton

6,908

21,591

Clay

6,467

21,320

Mercer

5,393

18,874

Crawford

6,454

17,410

Clinton

6,204

17,569

Monroe

6,989

18,661

Daviess

7,396

19,890

Coles

6,755

18,247

Montgomery

6,204

17,569

Dearborn

6,523

20,034

Cook

6,786

20,268

Morgan

6,399

17,438

Decatur

7,220

18,807

Crawford

6,467

21,320

Moultrie

6,399

17,438

DeKalb

7,447

20,133

Cumberland

6,755

18,247

Ogle

6,523

19,271

Delaware

7,432

17,837

DeKalb

6,523

19,271

18,449

Dubois

7,396

19,890

DeWitt

7,269

24,851

Perry

6,467

21,320

Elkhart

7,205

19,301

Douglas

6,755

18,247

Piatt

6,755

18,247

Fayette

6,074

20,055

DuPage

7,109

20,308

17,438

Floyd

6,454

17,410

Edgar

6,755

18,247

Pope

6,467

21,320

Fountain

6,908

21,591

Edwards

6,467

21,320

Pulaski

6,467

21,320

Franklin

6,523

20,034

Effingham

6,467

21,320

18,449

Fulton

6,893

18,619

8,317

20,280

Peoria

Pike

Putnam

7,117

6,399

7,117

Fayette

6,467

21,320

Randolph

6,204

17,569

Gibson

Ford

6,755

18,247

Richland

6,467

21,320

Grant

7,432

17,837

Franklin

6,467

21,320

18,874

Greene

7,396

19,890

Rock Island

5,393

-14-

2019 Average Premium Tables

Hamilton

6,974

20,636

Vanderburgh

8,317

20,280

Guthrie

7,241

16,767

Hancock

6,074

20,055

Vermillion

7,068

19,132

Hamilton

6,380

16,316

Harrison

6,454

17,410

Vigo

7,068

19,132

Hancock

6,731

18,689

Hendricks

6,974

20,636

Wabash

7,447

20,133

Hardin

6,380

16,316

Henry

6,074

20,055

Warren

6,934

20,683

Harrison

7,241

16,767

Howard

6,893

18,619

Warrick

8,317

20,280

Henry

6,650

16,174

Huntington

7,447

20,133

Washington

6,454

17,410

Howard

6,731

18,689

Jackson

7,220

18,807

Wayne

6,074

20,055

Humboldt

6,731

18,689

Jasper

6,934

20,683

Wells

7,447

20,133

Ida

6,589

16,992

Jay

7,432

17,837

White

6,934

20,683

Iowa

6,647

18,063

Jefferson

6,454

17,410

Whitley

7,447

20,133

Jackson

6,647

18,063

Jennings

7,220

18,807

Jasper

6,458

16,580

Johnson

6,293

19,033

Jefferson

6,650

16,174

Knox

7,396

19,890

6,647

18,063

Kosciusko

7,205

19,301

County

Employee- Dependent,
Only
Family, etc.

Johnson
Jones

6,647

18,063

7,241

16,767

Iowa

LaGrange

7,447

20,133

Adair

Keokuk

6,650

16,174

Lake

7,139

19,655

Adams

7,241

16,767

Kossuth

6,731

18,689

LaPorte

7,139

19,655

Allamakee

6,731

18,689

Lee

6,650

16,174

6,650

16,174

Lawrence

6,293

19,033

Appanoose

Linn

6,647

18,063

Madison

6,074

20,055

Audubon

7,241

16,767

Louisa

6,650

16,174

Marion

6,974

20,636

Benton

6,647

18,063

Lucas

6,650

16,174

6,647

18,063

Marshall

7,205

19,301

Black Hawk

Lyon

6,589

16,992

Martin

7,396

19,890

Boone

6,380

16,316

Madison

6,458

16,580

6,731

18,689

Miami

6,893

18,619

Bremer

Mahaska

6,650

16,174

Monroe

6,293

19,033

Buchanan

6,647

18,063

Marion

6,458

16,580

Montgomery

6,908

21,591

Buena Vista

6,589

16,992

Marshall

6,380

16,316

6,731

18,689

Morgan

6,974

20,636

Butler

Mills

7,241

16,767

Newton

6,934

20,683

Calhoun

6,380

16,316

Mitchell

6,731

18,689

Noble

7,447

20,133

Carroll

6,380

16,316

Monona

6,589

16,992

7,241

16,767

Ohio

6,523

20,034

Cass

Monroe

6,650

16,174

Orange

7,396

19,890

Cedar

6,647

18,063

Montgomery

7,241

16,767

Owen

6,293

19,033

Cerro Gordo

6,731

18,689

Muscatine

6,650

16,174

6,589

16,992

Parke

7,068

19,132

Cherokee

O'Brien

6,589

16,992

Perry

7,396

19,890

Chickasaw

6,731

18,689

Osceola

6,589

16,992

Pike

7,396

19,890

Clarke

7,241

16,767

Page

7,241

16,767

6,589

16,992

Porter

7,139

19,655

Clay

Palo Alto

6,589

16,992

Posey

8,317

20,280

Clayton

6,647

18,063

Plymouth

6,589

16,992

Pulaski

6,893

18,619

Clinton

6,647

18,063

Pocahontas

6,589

16,992

6,589

16,992

Putnam

6,908

21,591

Crawford

Polk

6,458

16,580

Randolph

7,432

17,837

Dallas

6,458

16,580

Pottawattamie

7,241

16,767

Ripley

6,523

20,034

Davis

6,650

16,174

Poweshiek

6,380

16,316

7,241

16,767

Rush

7,220

18,807

Decatur

Ringgold

7,241

16,767

Scott

6,454

17,410

Delaware

6,647

18,063

Sac

6,589

16,992

6,650

16,174

Shelby

6,974

20,636

Des Moines

Scott

6,647

18,063

Spencer

7,396

19,890

Dickinson

6,589

16,992

Shelby

7,241

16,767

St. Joseph

7,205

19,301

Dubuque

6,647

18,063

Sioux

6,589

16,992

6,731

18,689

Starke

7,205

19,301

Emmet

Story

6,380

16,316

Steuben

7,447

20,133

Fayette

6,731

18,689

Tama

6,380

16,316

Sullivan

7,068

19,132

Floyd

6,731

18,689

Taylor

7,241

16,767

6,731

18,689

Switzerland

6,523

20,034

Franklin

Union

7,241

16,767

Tippecanoe

6,908

21,591

Fremont

7,241

16,767

Van Buren

6,650

16,174

Tipton

6,908

21,591

Greene

6,380

16,316

Wapello

6,650

16,174

20,055

Grundy

6,380

16,316

Warren

6,458

16,580

Union

6,074

2019 Average Premium Tables

-15-

Washington

6,650

16,174

Hodgeman

6,516

19,415

Stevens

6,516

19,415

Wayne

6,650

16,174

Jackson

5,741

16,956

Sumner

5,446

16,175

Webster

6,380

16,316

Jefferson

5,741

16,956

Thomas

6,167

20,132

Winnebago

6,731

18,689

Jewell

5,210

15,803

Trego

6,167

20,132

Winneshiek

6,731

18,689

Johnson

6,519

18,536

Wabaunsee

5,741

16,956

Woodbury

6,589

16,992

Kearny

6,516

19,415

Wallace

6,167

20,132

Worth

6,731

18,689

Kingman

5,446

16,175

Washington

5,210

15,803

Wright

6,731

18,689

Kiowa

6,516

19,415

Wichita

6,167

20,132

Labette

6,232

19,378

Wilson

5,446

16,175

Lane

6,167

20,132

Woodson

6,232

19,378

6,519

18,536

Wyandotte

6,519

18,536

Kansas
County

Employee- Dependent,
Only
Family, etc.

Leavenworth
Lincoln

5,210

15,803

Allen

6,232

19,378

Linn

5,741

16,956

Anderson

5,741

16,956

Logan

6,167

20,132

Atchison

5,741

16,956

Lyon

5,741

16,956

County

Employee- Dependent,
Only
Family, etc.

Barber

6,516

19,415

Marion

5,446

16,175

Adair

5,792

16,225

5,792

16,225

Kentucky

Barton

6,167

20,132

Marshall

5,741

16,956

Allen

Bourbon

6,232

19,378

McPherson

5,446

16,175

Anderson

5,857

16,336

Brown

5,741

16,956

Meade

6,516

19,415

Ballard

7,830

18,655

Butler

5,446

16,175

Miami

6,519

18,536

Barren

5,792

16,225

Chase

5,446

16,175

Mitchell

5,210

15,803

Bath

6,144

20,621

Chautauqua

5,446

16,175

Montgomery

5,446

16,175

Bell

6,491

18,733

Cherokee

6,232

19,378

Morris

5,210

15,803

Boone

6,339

15,093

Cheyenne

6,167

20,132

19,415

Bourbon

5,857

16,336

Clark

6,516

19,415

Nemaha

5,741

16,956

Boyd

6,144

20,621

Clay

5,210

15,803

Neosho

6,232

19,378

Boyle

5,857

16,336

Cloud

5,210

15,803

20,132

Bracken

6,144

20,621

Coffey

5,741

16,956

Norton

6,167

20,132

Breathitt

6,491

18,733

Comanche

6,516

19,415

Osage

5,741

16,956

Breckinridge

5,975

16,269

Cowley

5,446

16,175

20,132

Bullitt

5,975

16,269

Crawford

6,232

19,378

Ottawa

5,210

15,803

Butler

5,792

16,225

Decatur

6,167

20,132

Pawnee

6,516

19,415

Caldwell

7,830

18,655

Dickinson

5,210

15,803

20,132

Calloway

7,830

18,655

6,339

15,093

Morton

Ness

Osborne

Phillips

6,516

6,167

6,167

6,167

Doniphan

5,741

16,956

Pottawatomie

5,741

16,956

Campbell

Douglas

5,741

16,956

Pratt

6,516

19,415

Carlisle

7,830

18,655

Edwards

6,516

19,415

Rawlins

6,167

20,132

Carroll

5,975

16,269

Elk

5,446

16,175

Reno

5,446

16,175

Carter

6,144

20,621

Ellis

6,167

20,132

Republic

5,210

15,803

Casey

5,792

16,225

Ellsworth

5,210

15,803

Rice

5,446

16,175

Christian

7,439

17,897

Finney

6,516

19,415

Riley

5,210

15,803

Clark

5,857

16,336

Ford

6,516

19,415

Rooks

6,167

20,132

Clay

6,491

18,733

Franklin

5,741

16,956

Rush

6,167

20,132

Clinton

5,792

16,225

Geary

5,210

15,803

Russell

6,167

20,132

Crittenden

7,830

18,655

Gove

6,167

20,132

15,803

Cumberland

5,792

16,225

Graham

6,167

20,132

Scott

6,167

20,132

Daviess

7,439

17,897

Grant

6,516

19,415

Sedgwick

5,446

16,175

Edmonson

5,792

16,225

Gray

6,516

19,415

19,415

Elliott

6,144

20,621

Greeley

6,167

20,132

Shawnee

5,741

16,956

Estill

5,857

16,336

Greenwood

5,446

16,175

Sheridan

6,167

20,132

Fayette

5,857

16,336

Hamilton

6,516

19,415

20,132

Fleming

6,144

20,621

6,491

18,733

Saline

Seward

Sherman

5,210

6,516

6,167

Harper

5,446

16,175

Smith

6,167

20,132

Floyd

Harvey

5,446

16,175

Stafford

6,516

19,415

Franklin

5,857

16,336

Haskell

6,516

19,415

19,415

Fulton

7,830

18,655

Stanton

6,516

-16-

2019 Average Premium Tables

Gallatin

6,339

15,093

Ohio

7,439

17,897

Franklin

7,386

17,471

Garrard

5,857

16,336

Oldham

5,975

16,269

Grant

6,784

15,197

Grant

6,339

15,093

Owen

5,857

16,336

Iberia

6,678

17,671

Graves

7,830

18,655

Owsley

6,491

18,733

Iberville

6,303

18,182

Grayson

5,975

16,269

Pendleton

6,339

15,093

Jackson

7,386

17,471

Green

5,792

16,225

Perry

6,491

18,733

Jefferson

6,367

16,795

Greenup

6,144

20,621

Pike

6,491

18,733

Jefferson Davis

6,833

20,137

Hancock

7,439

17,897

Powell

5,857

16,336

Lafayette

6,678

17,671

Hardin

5,975

16,269

Pulaski

5,792

16,225

Lafourche

6,672

16,751

Harlan

6,491

18,733

Robertson

6,144

20,621

LaSalle

6,784

15,197

Harrison

5,857

16,336

Rockcastle

5,857

16,336

Lincoln

7,386

17,471

Hart

5,792

16,225

Rowan

6,144

20,621

Livingston

6,303

18,182

Henderson

7,439

17,897

Russell

5,792

16,225

Madison

7,386

17,471

Henry

5,975

16,269

Scott

5,857

16,336

Morehouse

7,386

17,471

Hickman

7,830

18,655

Shelby

5,975

16,269

Natchitoches

7,150

18,227

Hopkins

7,439

17,897

Simpson

5,792

16,225

Orleans

6,367

16,795

Jackson

5,857

16,336

Spencer

5,975

16,269

Ouachita

7,386

17,471

Jefferson

5,975

16,269

Taylor

5,792

16,225

Plaquemines

6,367

16,795

Jessamine

5,857

16,336

Todd

7,439

17,897

Pointe Coupee

6,303

18,182

Johnson

6,491

18,733

Trigg

7,439

17,897

Rapides

6,784

15,197

Kenton

6,339

15,093

Trimble

5,975

16,269

Red River

7,150

18,227

Knott

6,491

18,733

Union

7,439

17,897

Richland

7,386

17,471

Knox

6,491

18,733

Warren

5,792

16,225

Sabine

7,150

18,227

LaRue

5,975

16,269

Washington

5,975

16,269

St. Bernard

6,367

16,795

Laurel

6,491

18,733

Wayne

5,792

16,225

St. Charles

6,367

16,795

Lawrence

6,144

20,621

Webster

7,439

17,897

St. Helena

6,303

18,182

Lee

6,491

18,733

Whitley

6,491

18,733

St. James

6,367

16,795

Leslie

6,491

18,733

Wolfe

6,491

18,733

St. John Baptist

6,367

16,795

Letcher

6,491

18,733

Woodford

5,857

16,336

St. Landry

6,678

17,671

Lewis

6,144

20,621

St. Martin

6,678

17,671

Lincoln

5,857

16,336

St. Mary

6,678

17,671

Livingston

7,830

18,655

6,367

16,795

Louisiana
Employee- Dependent,
Only
Family, etc.

St. Tammany

Logan

5,792

16,225

Parish

Tangipahoa

6,303

18,182

Lyon

7,830

18,655

Acadia

6,678

17,671

Tensas

7,386

17,471

Madison

5,857

16,336

Allen

6,833

20,137

Terrebonne

6,672

16,751

6,303

18,182

Magoffin

6,491

18,733

Ascension

Union

7,386

17,471

Marion

5,975

16,269

Assumption

6,672

16,751

Vermilion

6,678

17,671

Marshall

7,830

18,655

Avoyelles

6,784

15,197

Vernon

6,784

15,197

6,833

20,137

Martin

6,491

18,733

Beauregard

Washington

6,303

18,182

Mason

6,144

20,621

Bienville

7,150

18,227

Webster

7,150

18,227

McCracken

7,830

18,655

Bossier

7,150

18,227

West Baton Rouge

6,303

18,182

7,150

18,227

McCreary

5,792

16,225

Caddo

West Carroll

7,386

17,471

McLean

7,439

17,897

Calcasieu

6,833

20,137

West Feliciana

6,303

18,182

7,386

17,471

Winn

6,784

15,197

Meade

5,975

16,269

Caldwell

Menifee

6,144

20,621

Cameron

6,833

20,137

Mercer

5,857

16,336

Catahoula

6,784

15,197

Metcalfe

5,792

16,225

Claiborne

7,150

18,227

6,784

15,197

County

Employee- Dependent,
Only
Family, etc.

Maine

Monroe

5,792

16,225

Concordia

Montgomery

5,857

16,336

DeSoto

7,150

18,227

Androscoggin

6,100

15,419

20,621

East Baton Rouge

6,303

18,182

Aroostook

7,616

19,083

7,386

17,471

Cumberland

5,921

16,534

Morgan

6,144

Muhlenberg

7,439

17,897

East Carroll

Nelson

5,975

16,269

East Feliciana

6,303

18,182

Franklin

6,100

15,419

16,336

Evangeline

6,678

17,671

Hancock

7,616

19,083

Nicholas

5,857

2019 Average Premium Tables

-17-

Kennebec

5,989

16,501

Norfolk

8,132

23,479

Lenawee

6,203

17,028

Knox

5,989

16,501

Plymouth

7,655

21,825

Livingston

6,203

17,028

Lincoln

5,989

16,501

Suffolk

8,132

23,479

Luce

7,382

18,188

Oxford

5,989

16,501

Worcester

7,514

21,165

Mackinac

7,093

20,098

Penobscot

6,100

15,419

Macomb

6,834

21,063

Piscataquis

6,100

15,419

Manistee

5,902

18,237

Sagadahoc

5,921

16,534

7,382

18,188

6,100

15,419

County

Employee- Dependent,
Only
Family, etc.

Marquette

Somerset

Mason

5,802

17,923

Waldo

6,100

15,419

Alcona

7,093

20,098

Mecosta

5,802

17,923

7,382

18,188

Michigan

Washington

7,616

19,083

Alger

Menominee

7,382

18,188

York

5,921

16,534

Allegan

5,731

15,875

Midland

6,174

18,544

Alpena

7,093

20,098

Missaukee

5,902

18,237

Antrim

5,902

18,237

Monroe

7,085

20,883

Arenac

6,669

19,134

Montcalm

5,802

17,923

Baraga

7,382

18,188

Montmorency

7,093

20,098

Maryland
County

Employee- Dependent,
Only
Family, etc.

Allegany

6,105

16,614

Barry

5,731

15,875

Muskegon

5,802

17,923

Anne Arundel

6,283

17,851

Bay

6,669

19,134

Newaygo

5,802

17,923

Baltimore

6,283

17,851

Benzie

5,902

18,237

Oakland

6,834

21,063

Baltimore City

6,283

17,851

Berrien

6,995

21,102

Oceana

5,802

17,923

Calvert

6,409

16,242

Branch

7,153

20,696

Ogemaw

7,093

20,098

Caroline

6,409

16,242

Calhoun

7,153

20,696

Ontonagon

7,382

18,188

Carroll

6,105

16,614

Cass

6,995

21,102

Osceola

5,802

17,923

Cecil

6,409

16,242

Charlevoix

5,902

18,237

Oscoda

7,093

20,098

Charles

6,409

16,242

Cheboygan

7,093

20,098

Otsego

7,093

20,098

Dorchester

6,409

16,242

Chippewa

7,093

20,098

Ottawa

5,802

17,923

Frederick

6,105

16,614

Clare

6,174

18,544

Presque Isle

7,093

20,098

Garrett

6,105

16,614

Clinton

6,801

18,119

Roscommon

7,093

20,098

Harford

6,283

17,851

Crawford

7,093

20,098

Saginaw

6,669

19,134

Howard

6,283

17,851

Delta

7,382

18,188

Sanilac

7,188

20,214

Kent

6,409

16,242

Dickinson

7,382

18,188

Schoolcraft

7,382

18,188

Montgomery

6,615

19,793

Eaton

6,801

18,119

Shiawassee

5,843

16,944

Prince George's

6,615

19,793

Emmet

5,902

18,237

St. Clair

7,028

18,289

Queen Annes

6,409

16,242

Genesee

5,843

16,944

St. Joseph

6,995

21,102

Somerset

6,409

16,242

Gladwin

6,174

18,544

Tuscola

7,188

20,214

St. Marys

6,409

16,242

Gogebic

7,382

18,188

Van Buren

6,995

21,102

Talbot

6,409

16,242

Grand Traverse

5,902

18,237

Washtenaw

6,203

17,028

Washington

6,105

16,614

Gratiot

6,669

19,134

Wayne

7,085

20,883

Wicomico

6,409

16,242

Hillsdale

6,801

18,119

Wexford

5,902

18,237

Worcester

6,409

16,242

Houghton

7,382

18,188

Huron

7,188

20,214

Ingham

6,801

18,119

5,802

17,923

County

Employee- Dependent,
Only
Family, etc.

County

Employee- Dependent,
Only
Family, etc.

Ionia
Iosco

7,093

20,098

Aitkin

5,924

16,284

Barnstable

9,177

24,675

Iron

7,382

18,188

Anoka

6,248

18,683

Berkshire

7,264

18,934

Isabella

6,174

18,544

Becker

6,906

22,477

Bristol

7,655

21,825

Jackson

6,801

18,119

Beltrami

5,924

16,284

Dukes

9,177

24,675

Kalamazoo

7,153

20,696

Benton

6,248

18,683

Essex

7,618

21,792

Kalkaska

5,902

18,237

Big Stone

6,395

18,665

Franklin

7,264

18,934

Kent

5,802

17,923

Blue Earth

6,865

16,261

Hampden

7,264

18,934

Keweenaw

7,382

18,188

Brown

5,845

18,399

Hampshire

7,264

18,934

Lake

5,802

17,923

Carlton

6,299

15,143

Middlesex

8,132

23,479

Lapeer

5,843

16,944

Carver

6,248

18,683

Nantucket

9,177

24,675

Leelanau

5,902

18,237

Cass

5,924

16,284

Massachusetts

-18-

Minnesota

2019 Average Premium Tables

Chippewa

6,395

18,665

Renville

6,395

18,665

Humphreys

6,435

15,015

Chisago

5,924

16,284

Rice

6,865

16,261

Issaquena

6,435

15,015

Clay

6,906

22,477

Rock

5,845

18,399

Itawamba

6,546

14,065

Clearwater

6,247

20,067

Roseau

5,924

16,284

Jackson

6,674

15,493

Cook

6,299

15,143

Scott

6,248

18,683

Jasper

6,435

15,015

Cottonwood

5,845

18,399

Sherburne

6,248

18,683

Jefferson

6,435

15,015

Crow Wing

5,924

16,284

Sibley

6,395

18,665

Jefferson Davis

6,435

15,015

Dakota

6,248

18,683

St. Louis

6,299

15,143

Jones

7,123

14,222

Dodge

6,756

20,649

Stearns

6,248

18,683

Kemper

6,435

15,015

Douglas

6,906

22,477

Steele

6,756

20,649

Lafayette

6,435

15,015

Faribault

6,865

16,261

Stevens

6,906

22,477

Lamar

7,123

14,222

Fillmore

6,756

20,649

Swift

6,395

18,665

Lauderdale

6,435

15,015

Freeborn

6,756

20,649

Todd

5,924

16,284

Lawrence

6,435

15,015

Goodhue

6,756

20,649

Traverse

6,906

22,477

Leake

6,435

15,015

Grant

6,906

22,477

Wabasha

6,756

20,649

Lee

6,546

14,065

Hennepin

6,248

18,683

Wadena

5,924

16,284

Leflore

6,435

15,015

Houston

6,756

20,649

Waseca

6,865

16,261

Lincoln

6,435

15,015

Hubbard

5,924

16,284

Washington

6,248

18,683

Lowndes

6,435

15,015

Isanti

5,924

16,284

Watonwan

6,865

16,261

Madison

6,100

15,339

Itasca

6,299

15,143

Wilkin

6,906

22,477

Marion

6,435

15,015

Jackson

5,845

18,399

Winona

6,756

20,649

Marshall

5,976

16,403

Kanabec

5,924

16,284

Wright

6,248

18,683

Monroe

6,435

15,015

Kandiyohi

6,395

18,665

Yellow Medicine

6,395

18,665

Montgomery

6,435

15,015

Kittson

6,247

20,067

Neshoba

6,435

15,015

Koochiching

6,299

15,143

Newton

6,435

15,015

Lac qui Parle

6,395

18,665

6,435

15,015

Mississippi
Employee- Dependent,
Only
Family, etc.

Noxubee

Lake

6,299

15,143

County

Oktibbeha

6,435

15,015

Lake of the Woods

6,299

15,143

Adams

6,435

15,015

Panola

6,435

15,015

Le Sueur

6,865

16,261

Alcorn

6,435

15,015

Pearl River

7,123

14,222

6,435

15,015

Lincoln

5,845

18,399

Amite

Perry

7,123

14,222

Lyon

6,395

18,665

Attala

6,435

15,015

Pike

6,435

15,015

Mahnomen

6,247

20,067

Benton

6,546

14,065

Pontotoc

6,546

14,065

6,435

15,015

Marshall

6,247

20,067

Bolivar

Prentiss

6,435

15,015

Martin

6,865

16,261

Calhoun

6,435

15,015

Quitman

6,435

15,015

McLeod

6,395

18,665

Carroll

6,435

15,015

Rankin

6,100

15,339

6,435

15,015

Meeker

6,395

18,665

Chickasaw

Scott

6,435

15,015

Mille Lacs

5,924

16,284

Choctaw

6,435

15,015

Sharkey

6,435

15,015

Morrison

5,924

16,284

Claiborne

6,435

15,015

Simpson

6,100

15,339

6,435

15,015

Mower

6,756

20,649

Clarke

Smith

6,435

15,015

Murray

5,845

18,399

Clay

6,435

15,015

Stone

6,674

15,493

Nicollet

6,865

16,261

Coahoma

6,435

15,015

Sunflower

6,435

15,015

6,100

15,339

Nobles

5,845

18,399

Copiah

Tallahatchie

6,435

15,015

Norman

6,247

20,067

Covington

6,435

15,015

Tate

5,976

16,403

5,976

16,403

Olmsted

6,756

20,649

DeSoto

Tippah

6,546

14,065

Otter Tail

6,906

22,477

Forrest

7,123

14,222

Tishomingo

6,435

15,015

Pennington

6,247

20,067

Franklin

6,435

15,015

Tunica

5,976

16,403

6,674

15,493

Pine

5,924

16,284

George

Union

6,546

14,065

Pipestone

5,845

18,399

Greene

7,123

14,222

Walthall

6,435

15,015

Polk

6,247

20,067

Grenada

6,435

15,015

Warren

6,100

15,339

6,674

15,493

Pope

6,906

22,477

Hancock

Washington

6,435

15,015

Ramsey

6,248

18,683

Harrison

6,674

15,493

Wayne

6,435

15,015

Red Lake

6,247

20,067

Hinds

6,100

15,339

Webster

6,435

15,015

18,399

Holmes

6,435

15,015

Wilkinson

6,435

15,015

Redwood

5,845

2019 Average Premium Tables

-19-

Winston

6,435

15,015

Iron

6,717

16,888

St. Francois

6,530

17,116

Yalobusha

6,435

15,015

Jackson

6,170

18,006

St. Louis

6,530

17,116

Yazoo

6,435

15,015

Jasper

5,676

14,994

St. Louis City

6,530

17,116

Jefferson

6,530

17,116

Ste. Genevieve

6,530

17,116

Johnson

7,493

19,730

Stoddard

6,757

16,599

6,905

15,902

Stone

5,895

14,716

Missouri
County

Employee- Dependent,
Only
Family, etc.

Knox
Laclede

5,895

14,716

Sullivan

6,905

15,902

Adair

6,905

15,902

Lafayette

7,493

19,730

Taney

5,895

14,716

Andrew

8,139

14,166

Lawrence

5,895

14,716

Texas

6,717

16,888

Atchison

8,139

14,166

Lewis

6,905

15,902

Vernon

7,493

19,730

Audrain

6,662

18,608

Lincoln

6,530

17,116

Warren

6,530

17,116

Barry

5,895

14,716

Linn

6,905

15,902

Washington

6,530

17,116

Barton

5,676

14,994

Livingston

8,139

14,166

Wayne

6,757

16,599

Bates

7,493

19,730

Macon

6,905

15,902

Webster

5,895

14,716

Benton

7,493

19,730

Madison

6,757

16,599

Worth

8,139

14,166

Bollinger

6,757

16,599

Maries

6,662

18,608

Wright

5,895

14,716

Boone

6,662

18,608

Marion

6,905

15,902

Buchanan

8,139

14,166

McDonald

5,676

14,994

Butler

6,757

16,599

Mercer

8,139

14,166

Caldwell

8,139

14,166

Miller

6,662

18,608

County

Employee- Dependent,
Only
Family, etc.

Callaway

6,662

18,608

Mississippi

6,757

16,599

Beaverhead

7,570

16,506

Camden

6,662

18,608

Moniteau

6,662

18,608

Big Horn

7,570

16,506

Cape Girardeau

6,757

16,599

Monroe

6,662

18,608

Blaine

7,570

16,506

Carroll

8,139

14,166

18,608

Broadwater

6,661

17,335

Carter

6,717

16,888

Morgan

6,662

18,608

Carbon

6,619

17,332

Cass

6,170

18,006

New Madrid

6,757

16,599

Carter

7,570

16,506

Cedar

5,895

14,716

14,994

Cascade

6,661

17,335

Chariton

6,662

18,608

Nodaway

8,139

14,166

Chouteau

6,661

17,335

Christian

5,895

14,716

Oregon

6,717

16,888

Custer

7,570

16,506

Clark

6,905

15,902

18,608

Daniels

7,570

16,506

Clay

6,170

18,006

Ozark

5,895

14,716

Dawson

7,570

16,506

Clinton

8,139

14,166

Pemiscot

6,757

16,599

Deer Lodge

6,661

17,335

Cole

6,662

18,608

16,599

Fallon

7,570

16,506

7,570

16,506

Montgomery

Newton

Osage

Perry

6,662

5,676

6,662

6,757

Montana

Cooper

6,662

18,608

Pettis

7,493

19,730

Fergus

Crawford

6,717

16,888

Phelps

6,717

16,888

Flathead

6,270

14,877

Dade

5,895

14,716

Pike

6,905

15,902

Gallatin

6,661

17,335

Dallas

5,895

14,716

Platte

6,170

18,006

Garfield

7,570

16,506

Daviess

8,139

14,166

Polk

5,895

14,716

Glacier

7,570

16,506

DeKalb

8,139

14,166

Pulaski

6,717

16,888

Golden Valley

7,570

16,506

Dent

6,717

16,888

Putnam

6,905

15,902

Granite

7,570

16,506

Douglas

5,895

14,716

Ralls

6,905

15,902

Hill

7,570

16,506

Dunklin

6,757

16,599

Randolph

6,662

18,608

Jefferson

6,661

17,335

Franklin

6,530

17,116

Ray

8,139

14,166

Judith Basin

6,661

17,335

Gasconade

6,662

18,608

16,888

Lake

6,270

14,877

Gentry

8,139

14,166

Ripley

6,717

16,888

Lewis and Clark

6,661

17,335

Greene

5,895

14,716

Saline

7,493

19,730

Liberty

7,570

16,506

Grundy

8,139

14,166

15,902

Lincoln

7,570

16,506

Harrison

8,139

14,166

Scotland

6,905

15,902

Madison

7,570

16,506

Henry

7,493

19,730

Scott

6,757

16,599

McCone

7,570

16,506

Hickory

5,895

14,716

16,888

Meagher

7,570

16,506

7,570

16,506

Reynolds

Schuyler

Shannon

6,717

6,905

6,717

Holt

8,139

14,166

Shelby

6,905

15,902

Mineral

Howard

6,662

18,608

St. Charles

6,530

17,116

Missoula

6,270

14,877

Howell

6,717

16,888

19,730

Musselshell

6,619

17,332

St. Clair

7,493

-20-

2019 Average Premium Tables

Park

7,570

16,506

Dodge

6,135

16,793

Seward

6,164

18,040

Petroleum

7,570

16,506

Douglas

6,135

16,793

Sheridan

7,758

20,172

Phillips

7,570

16,506

Dundy

7,758

20,172

Sherman

6,394

17,384

Pondera

7,570

16,506

Fillmore

6,164

18,040

Sioux

7,758

20,172

Powder River

7,570

16,506

Franklin

6,394

17,384

Stanton

6,394

17,384

Powell

7,570

16,506

Frontier

7,758

20,172

Thayer

6,164

18,040

Prairie

7,570

16,506

Furnas

6,394

17,384

Thomas

7,758

20,172

Ravalli

7,570

16,506

Gage

6,164

18,040

Thurston

6,135

16,793

Richland

7,570

16,506

Garden

7,758

20,172

Valley

6,394

17,384

Roosevelt

7,570

16,506

Garfield

6,394

17,384

Washington

6,135

16,793

Rosebud

7,570

16,506

Gosper

6,394

17,384

Wayne

6,394

17,384

Sanders

7,570

16,506

Grant

7,758

20,172

Webster

6,394

17,384

Sheridan

7,570

16,506

Greeley

6,394

17,384

Wheeler

6,394

17,384

Silver Bow

6,661

17,335

Hall

6,394

17,384

York

6,164

18,040

Stillwater

6,619

17,332

Hamilton

6,394

17,384

Sweet Grass

6,619

17,332

Harlan

6,394

17,384

Teton

6,661

17,335

Hayes

7,758

20,172

Toole

7,570

16,506

Hitchcock

7,758

20,172

County

Employee- Dependent,
Only
Family, etc.

Treasure

7,570

16,506

Holt

6,394

17,384

Carson City

6,236

14,566

Valley

7,570

16,506

Hooker

7,758

20,172

Churchill

7,586

17,920

Wheatland

7,570

16,506

Howard

6,394

17,384

Clark

6,048

15,166

6,236

14,566

Nevada

Wibaux

7,570

16,506

Jefferson

6,164

18,040

Douglas

Yellowstone

6,619

17,332

Johnson

6,164

18,040

Elko

7,586

17,920

17,384

Esmeralda

7,586

17,920

7,586

17,920

Kearney

Nebraska

6,394

Keith

7,758

20,172

Eureka

Keya Paha

6,394

17,384

Humboldt

7,586

17,920

20,172

Lander

7,586

17,920

7,586

17,920

County

Employee- Dependent,
Only
Family, etc.

Adams

6,394

17,384

Knox

6,394

17,384

Lincoln

Antelope

6,394

17,384

Lancaster

6,164

18,040

Lyon

6,236

14,566

Arthur

7,758

20,172

20,172

Mineral

7,586

17,920

Banner

7,758

20,172

Logan

7,758

20,172

Nye

6,048

15,166

Blaine

6,394

17,384

Loup

6,394

17,384

Pershing

7,586

17,920

Boone

6,394

17,384

17,384

Storey

6,236

14,566

6,501

16,002

7,586

17,920

Kimball

Lincoln

Madison

7,758

7,758

6,394

Box Butte

7,758

20,172

McPherson

7,758

20,172

Washoe

Boyd

6,394

17,384

Merrick

6,394

17,384

White Pine

Brown

7,758

20,172

Morrill

7,758

20,172

Buffalo

6,394

17,384

Nance

6,394

17,384

Burt

6,135

16,793

Nemaha

6,164

18,040

Butler

6,394

17,384

Nuckolls

6,394

17,384

Cass

6,135

16,793

Otoe

6,164

18,040

Cedar

6,394

17,384

Pawnee

6,164

18,040

Chase

7,758

20,172

Perkins

7,758

20,172

Cherry

7,758

20,172

Phelps

6,394

17,384

Cheyenne

7,758

20,172

Pierce

6,394

17,384

Clay

6,394

17,384

Platte

6,394

17,384

Colfax

6,394

17,384

Polk

6,394

17,384

Cuming

6,394

17,384

Red Willow

7,758

20,172

Custer

6,394

17,384

Richardson

6,164

18,040

Dakota

6,394

17,384

Rock

6,394

17,384

Dawes

7,758

20,172

Saline

6,164

18,040

Dawson

6,394

17,384

Sarpy

6,135

16,793

Deuel

7,758

20,172

Saunders

6,135

16,793

Dixon

6,394

17,384

Scotts Bluff

7,758

20,172

2019 Average Premium Tables

-21-

New Hampshire
County

Employee- Dependent,
Only
Family, etc.

All

7,363

20,071

New Jersey
County

Employee- Dependent,
Only
Family, etc.

All

7,633

20,996

New Mexico
County

Employee- Dependent,
Only
Family, etc.

Bernalillo

6,433

18,699

Catron

7,212

21,288

Chaves

7,212

21,288

Cibola

7,212

21,288

Colfax

7,212

21,288

Hamilton

7,459

19,563

Bertie

7,967

20,483

Curry

7,212

21,288

Herkimer

7,459

19,563

Bladen

6,827

21,609

De Baca

7,212

21,288

Jefferson

7,459

19,563

Brunswick

7,474

19,121

Doña Ana

6,860

18,899

Kings

8,917

25,457

Buncombe

7,042

17,885

Eddy

7,212

21,288

Lewis

7,459

19,563

Burke

6,529

17,541

Grant

7,212

21,288

Livingston

6,346

17,309

Cabarrus

6,886

18,379

Guadalupe

7,212

21,288

Madison

7,459

19,563

Caldwell

6,529

17,541

Harding

7,212

21,288

Monroe

6,346

17,309

Camden

7,967

20,483

Hidalgo

7,212

21,288

Montgomery

7,176

19,007

Carteret

7,587

16,409

Lea

7,212

21,288

Nassau

8,649

24,712

Caswell

7,128

19,070

Lincoln

7,212

21,288

New York

8,917

25,457

Catawba

6,529

17,541

Los Alamos

7,212

21,288

Niagara

6,191

17,551

Chatham

7,128

19,070

Luna

7,212

21,288

Oneida

7,459

19,563

Cherokee

7,042

17,885

McKinley

7,212

21,288

Onondaga

7,217

19,022

Chowan

7,967

20,483

Mora

7,212

21,288

Ontario

6,346

17,309

Clay

7,042

17,885

Otero

7,212

21,288

Orange

7,963

18,542

Cleveland

7,364

17,247

Quay

7,212

21,288

Orleans

6,191

17,551

Columbus

7,474

19,121

Rio Arriba

7,212

21,288

Oswego

7,459

19,563

Craven

7,587

16,409

Roosevelt

7,212

21,288

Otsego

7,459

19,563

Cumberland

6,827

21,609

San Juan

6,980

18,909

Putnam

7,963

18,542

Currituck

7,967

20,483

San Miguel

7,212

21,288

Queens

8,917

25,457

Dare

7,587

16,409

Sandoval

6,433

18,699

Rensselaer

7,176

19,007

Davidson

7,499

19,330

Santa Fe

6,236

17,379

Richmond

8,917

25,457

Davie

7,499

19,330

Sierra

7,212

21,288

Rockland

8,917

25,457

Duplin

7,474

19,121

Socorro

7,212

21,288

Saratoga

7,176

19,007

Durham

7,128

19,070

Taos

7,212

21,288

Schenectady

7,176

19,007

Edgecombe

7,289

23,007

Torrance

6,433

18,699

Schoharie

7,176

19,007

Forsyth

7,499

19,330

Union

7,212

21,288

Schuyler

7,217

19,022

Franklin

6,923

18,409

Valencia

6,433

18,699

Seneca

6,346

17,309

Gaston

7,364

17,247

St. Lawrence

7,459

19,563

Gates

7,967

20,483

Steuben

7,217

19,022

Graham

7,042

17,885

8,649

24,712

Granville

6,695

16,669

New York
County

Employee- Dependent,
Only
Family, etc.

Suffolk
Sullivan

7,963

18,542

Greene

7,289

23,007

Albany

7,176

19,007

Tioga

7,217

19,022

Guilford

7,341

18,969

Allegany

6,191

17,551

Tompkins

7,217

19,022

Halifax

7,967

20,483

Bronx

8,917

25,457

Ulster

7,963

18,542

Harnett

6,827

21,609

Broome

7,217

19,022

Warren

7,176

19,007

Haywood

7,042

17,885

Cattaraugus

6,191

17,551

Washington

7,176

19,007

Henderson

7,042

17,885

Cayuga

7,217

19,022

Wayne

6,346

17,309

Hertford

7,967

20,483

Chautauqua

6,191

17,551

Westchester

8,917

25,457

Hoke

6,827

21,609

Chemung

7,217

19,022

Wyoming

6,191

17,551

Hyde

7,587

16,409

Chenango

7,459

19,563

Yates

6,346

17,309

Iredell

6,529

17,541

Clinton

7,459

19,563

Jackson

7,042

17,885

Columbia

7,176

19,007

Cortland

7,217

19,022

Delaware

7,963

18,542

Dutchess

7,963

Erie

North Carolina

Johnston

6,923

18,409

Jones

7,587

16,409

County

Employee- Dependent,
Only
Family, etc.

Lee

7,128

19,070

18,542

Alamance

7,128

19,070

Lenoir

7,587

16,409

6,191

17,551

Alexander

6,529

17,541

Lincoln

7,364

17,247

Essex

7,459

19,563

Alleghany

7,736

20,799

Macon

7,042

17,885

Franklin

7,459

19,563

Anson

6,886

18,379

Madison

7,042

17,885

Fulton

7,176

19,007

Ashe

7,736

20,799

Martin

7,967

20,483

Genesee

6,191

17,551

Avery

7,042

17,885

McDowell

7,042

17,885

Greene

7,176

19,007

Beaufort

7,587

16,409

Mecklenburg

6,886

18,379

-22-

2019 Average Premium Tables

Mitchell

7,042

17,885

Cavalier

7,030

18,339

Auglaize

7,480

17,852

Montgomery

8,244

17,272

Dickey

7,030

18,339

Belmont

7,496

19,458

Moore

8,244

17,272

Divide

7,030

18,339

Brown

7,363

17,732

Nash

7,289

23,007

Dunn

7,030

18,339

Butler

6,812

17,724

New Hanover

7,474

19,121

Eddy

7,030

18,339

Carroll

7,521

18,388

Northampton

7,967

20,483

Emmons

7,030

18,339

Champaign

6,576

18,414

Onslow

7,474

19,121

Foster

7,030

18,339

Clark

6,576

18,414

Orange

7,128

19,070

Golden Valley

7,030

18,339

Clermont

7,363

17,732

Pamlico

7,587

16,409

Grand Forks

6,538

17,815

Clinton

7,363

17,732

Pasquotank

7,967

20,483

Grant

7,030

18,339

Columbiana

7,489

19,976

Pender

7,474

19,121

Griggs

7,030

18,339

Coshocton

7,496

19,458

Perquimans

7,967

20,483

Hettinger

7,030

18,339

Crawford

7,128

18,124

Person

7,128

19,070

Kidder

7,030

18,339

Cuyahoga

7,530

19,965

Pitt

7,289

23,007

La Moure

7,030

18,339

Darke

6,576

18,414

Polk

7,042

17,885

Logan

7,030

18,339

Defiance

7,834

17,908

Randolph

7,341

18,969

McHenry

7,030

18,339

Delaware

6,996

20,049

Richmond

6,827

21,609

McIntosh

7,030

18,339

Erie

7,709

18,253

Robeson

6,827

21,609

McKenzie

7,030

18,339

Fairfield

6,996

20,049

Rockingham

7,341

18,969

McLean

7,030

18,339

Fayette

6,996

20,049

Rowan

6,886

18,379

Mercer

7,030

18,339

Franklin

6,996

20,049

Rutherford

7,042

17,885

Morton

6,060

17,251

Fulton

7,834

17,908

Sampson

6,827

21,609

Mountrail

7,030

18,339

Gallia

8,906

21,506

Scotland

6,827

21,609

Nelson

7,030

18,339

Geauga

7,530

19,965

Stanly

6,886

18,379

Oliver

7,030

18,339

Greene

6,576

18,414

Stokes

7,499

19,330

Pembina

7,030

18,339

Guernsey

7,496

19,458

Surry

7,499

19,330

Pierce

7,030

18,339

Hamilton

6,812

17,724

Swain

7,042

17,885

Ramsey

7,030

18,339

Hancock

7,480

17,852

Transylvania

7,042

17,885

Ransom

7,030

18,339

Hardin

7,480

17,852

Tyrrell

7,587

16,409

Renville

7,030

18,339

Harrison

7,496

19,458

Union

6,886

18,379

Richland

7,030

18,339

Henry

7,834

17,908

Vance

6,695

16,669

Rolette

7,030

18,339

Highland

7,363

17,732

Wake

6,923

18,409

Sargent

7,030

18,339

Hocking

6,280

17,410

Warren

6,695

16,669

Sheridan

7,030

18,339

Holmes

5,810

15,865

Washington

7,587

16,409

Sioux

7,030

18,339

Huron

7,709

18,253

Watauga

7,736

20,799

Slope

7,030

18,339

Jackson

8,906

21,506

Wayne

7,289

23,007

Stark

7,030

18,339

Jefferson

7,496

19,458

Wilkes

7,736

20,799

Steele

7,030

18,339

Knox

6,996

20,049

Wilson

7,289

23,007

Stutsman

7,030

18,339

Lake

7,530

19,965

Yadkin

7,499

19,330

Towner

7,030

18,339

Lawrence

8,906

21,506

Yancey

7,042

17,885

Traill

7,030

18,339

Licking

6,996

20,049

Walsh

7,030

18,339

Logan

6,996

20,049

Ward

7,030

18,339

Lorain

7,530

19,965

Wells

7,030

18,339

Lucas

7,834

17,908

Williams

7,030

18,339

Madison

6,996

20,049

Mahoning

7,489

19,976

Marion

7,654

19,546

North Dakota
County

Employee- Dependent,
Only
Family, etc.

Adams

7,030

18,339

Barnes

7,030

18,339

Benson

7,030

18,339

6,887

18,942

7,030

18,339

County

Employee- Dependent,
Only
Family, etc.

Medina

Billings

Meigs

6,280

17,410

Bottineau

7,030

18,339

Adams

7,363

17,732

Mercer

7,480

17,852

Bowman

7,030

18,339

Allen

7,480

17,852

Miami

6,576

18,414

Burke

7,030

18,339

Ashland

6,887

18,942

Monroe

7,496

19,458

Burleigh

6,060

17,251

Ashtabula

7,530

19,965

Montgomery

6,576

18,414

Cass

6,347

17,424

Athens

6,280

17,410

Morgan

7,496

19,458

2019 Average Premium Tables

Ohio

-23-

Morrow

7,654

19,546

Custer

6,658

17,292

Wagoner

6,619

17,136

Muskingum

7,496

19,458

Delaware

6,658

17,292

Washington

6,658

17,292

Noble

7,496

19,458

Dewey

6,658

17,292

Washita

6,658

17,292

Ottawa

7,709

18,253

Ellis

6,658

17,292

Woods

6,658

17,292

Paulding

7,480

17,852

Garfield

6,658

17,292

Woodward

6,658

17,292

Perry

7,496

19,458

Garvin

6,658

17,292

Pickaway

6,996

20,049

Grady

6,804

18,124

Pike

8,906

21,506

Grant

6,658

17,292

Portage

6,887

18,942

Greer

6,658

17,292

County

Employee- Dependent,
Only
Family, etc.

Preble

6,576

18,414

Harmon

6,658

17,292

Baker

7,410

16,123

6,176

19,683

Oregon

Putnam

7,480

17,852

Harper

6,658

17,292

Benton

Richland

7,128

18,124

Haskell

6,658

17,292

Clackamas

6,401

17,765

17,292

Clatsop

7,722

17,625

7,722

17,625

Ross

8,906

21,506

Hughes

6,658

Sandusky

7,709

18,253

Jackson

6,658

17,292

Columbia

Scioto

8,906

21,506

Jefferson

6,658

17,292

Coos

7,722

17,625

17,292

Crook

7,410

16,123

7,722

17,625

Seneca

7,709

18,253

Johnston

6,658

Shelby

6,576

18,414

Kay

6,658

17,292

Curry

Stark

7,521

18,388

Kingfisher

6,658

17,292

Deschutes

6,083

15,753

6,534

16,310

Summit

6,887

18,942

Kiowa

6,658

17,292

Douglas

Trumbull

7,489

19,976

Latimer

6,658

17,292

Gilliam

7,410

16,123

Tuscarawas

7,496

19,458

Le Flore

6,192

15,725

Grant

7,410

16,123

7,410

16,123

Union

6,996

20,049

Lincoln

6,804

18,124

Harney

Van Wert

7,480

17,852

Logan

6,804

18,124

Hood River

7,410

16,123

17,292

Jackson

6,534

16,310

7,410

16,123

Vinton

8,906

21,506

Love

6,658

Warren

6,812

17,724

Major

6,658

17,292

Jefferson

Washington

6,280

17,410

Marshall

6,658

17,292

Josephine

6,534

16,310

17,292

Klamath

6,083

15,753

6,083

15,753

Wayne

5,810

15,865

Mayes

6,658

Williams

7,834

17,908

McClain

6,804

18,124

Lake

Wood

7,834

17,908

McCurtain

6,658

17,292

Lane

6,176

19,683

17,292

Lincoln

7,722

17,625

6,176

19,683

Wyandot

7,709

18,253

Oklahoma

McIntosh

6,658

Murray

6,658

17,292

Linn

Muskogee

6,658

17,292

Malheur

7,410

16,123

17,292

Marion

6,316

16,282

7,410

16,123

Noble

County

Employee- Dependent,
Only
Family, etc.

Nowata

6,658

17,292

Morrow

Adair

6,658

17,292

Okfuskee

6,658

17,292

Multnomah

6,401

17,765

Alfalfa

6,658

17,292

Oklahoma

6,804

18,124

Polk

6,316

16,282

Atoka

6,658

17,292

Okmulgee

6,619

17,136

Sherman

7,410

16,123

Beaver

6,658

17,292

Osage

6,619

17,136

Tillamook

7,722

17,625

Beckham

6,658

17,292

Ottawa

6,658

17,292

Umatilla

7,410

16,123

Blaine

6,658

17,292

Pawnee

6,619

17,136

Union

7,410

16,123

Bryan

6,658

17,292

Payne

6,658

17,292

Wallowa

7,410

16,123

Caddo

6,658

17,292

Pittsburg

6,658

17,292

Wasco

7,410

16,123

Canadian

6,804

18,124

Pontotoc

6,658

17,292

Washington

6,401

17,765

Carter

6,658

17,292

17,292

Wheeler

7,410

16,123

Cherokee

6,658

17,292

Pushmataha

6,658

17,292

Yamhill

6,401

17,765

Choctaw

6,658

17,292

Roger Mills

6,658

17,292

Cimarron

6,658

17,292

Rogers

6,619

17,136

Cleveland

6,804

18,124

Seminole

6,658

17,292

Coal

6,658

17,292

Sequoyah

6,192

15,725

Comanche

6,685

16,097

Stephens

6,658

17,292

Texas

6,658

17,292

Cotton

6,658

17,292

Pottawatomie

6,658

6,658

Craig

6,658

17,292

Tillman

6,658

17,292

Creek

6,619

17,136

Tulsa

6,619

17,136

-24-

Pennsylvania
County

Employee- Dependent,
Only
Family, etc.

Adams

6,718

19,207

Allegheny

6,766

18,256

Armstrong

6,766

18,256

Beaver

6,766

18,256

2019 Average Premium Tables

Bedford

6,932

16,622

Susquehanna

7,282

18,425

McCormick

7,551

19,332

Berks

6,718

19,207

Tioga

7,282

18,425

Newberry

7,334

18,941

Blair

6,932

16,622

Union

7,272

20,506

Oconee

7,338

19,082

Bradford

7,282

18,425

Venango

5,642

15,573

Orangeburg

6,893

20,724

Bucks

7,839

20,694

Warren

5,642

15,573

Pickens

6,171

17,325

Butler

6,766

18,256

Washington

6,766

18,256

Richland

6,053

20,866

Cambria

6,932

16,622

Wayne

7,282

18,425

Saluda

7,316

18,880

Cameron

6,783

19,635

Westmoreland

6,766

18,256

Spartanburg

5,824

18,070

Carbon

7,282

18,425

Wyoming

7,282

18,425

Sumter

6,687

17,932

Centre

7,272

20,506

York

6,718

19,207

Union

5,364

17,073

Chester

7,839

20,694

Williamsburg

6,083

18,433

Clarion

5,642

15,573

York

6,594

18,408

Clearfield

6,932

16,622

Clinton

7,282

18,425

County

Employee- Dependent,
Only
Family, etc.

Columbia

7,272

20,506

All

7,217

Crawford

5,642

15,573

Cumberland

6,997

18,746

Dauphin

6,997

18,746

Delaware

7,839

20,694

Elk

6,783

19,635

Erie

5,642

15,573

Fayette

6,766

18,256

Forest

5,642

15,573

Franklin

6,997

18,746

Fulton

6,997

18,746

Greene

6,766

18,256

Huntingdon

6,932

16,622

Indiana

6,766

18,256

Jefferson

6,932

16,622

Juniata

6,997

18,746

Lackawanna

7,282

18,425

Lancaster

6,718

19,207

Lawrence

6,766

18,256

Lebanon

6,997

18,746

Lehigh

7,272

20,506

Luzerne

7,282

18,425

Lycoming

7,282

18,425

McKean

5,642

15,573

Mercer

5,642

15,573

Mifflin

7,272

20,506

Monroe

7,282

18,425

Montgomery

7,839

20,694

Montour

7,272

20,506

Northampton

7,272

20,506

Northumberland

7,272

20,506

Perry

6,997

18,746

Philadelphia

7,839

20,694

Pike

7,282

18,425

Potter

6,783

19,635

Schuylkill

7,272

20,506

Snyder

7,272

20,506

Somerset

6,932

16,622

Sullivan

7,282

18,425

2019 Average Premium Tables

Rhode Island

South Dakota

20,932

South Carolina

County

Employee- Dependent,
Only
Family, etc.

Aurora

7,907

19,079

Employee- Dependent,
Only
Family, etc.

Beadle

7,158

17,863

County

Bennett

7,063

17,039

Abbeville

6,937

19,410

Bon Homme

7,907

19,079

Aiken

6,117

15,486

Brookings

7,158

17,863

Allendale

6,207

18,048

Brown

7,158

17,863

Anderson

7,072

20,897

Brule

7,907

19,079

Bamberg

5,453

17,258

Buffalo

7,907

19,079

Barnwell

5,417

16,644

Butte

7,063

17,039

Beaufort

6,876

18,316

Campbell

7,158

17,863

Berkeley

6,494

19,824

Charles Mix

7,907

19,079

Calhoun

5,641

17,217

Clark

7,158

17,863

Charleston

6,104

18,664

Clay

6,868

18,090

Cherokee

5,861

17,324

Codington

7,158

17,863

Chester

6,690

18,238

Corson

7,063

17,039

Chesterfield

6,121

18,019

Custer

7,063

17,039

Clarendon

5,288

18,028

Davison

7,907

19,079

Colleton

6,048

17,391

Day

7,158

17,863

Darlington

7,418

18,649

Deuel

7,158

17,863

Dillon

6,435

17,750

Dewey

7,063

17,039

Dorchester

7,056

17,141

Douglas

7,907

19,079

Edgefield

5,360

16,845

Edmunds

7,158

17,863

Fairfield

6,380

18,051

Fall River

7,063

17,039

Florence

6,547

19,833

Faulk

7,158

17,863

Georgetown

6,771

17,131

Grant

7,158

17,863

Greenville

6,183

17,603

Gregory

7,063

17,039

Greenwood

5,526

17,333

Haakon

7,063

17,039

Hampton

6,829

18,188

Hamlin

7,158

17,863

Horry

6,623

17,579

Hand

7,907

19,079

Jasper

6,165

17,459

Hanson

7,907

19,079

Kershaw

7,411

19,413

Harding

7,063

17,039

Lancaster

6,894

18,137

Hughes

7,907

19,079

Laurens

6,269

17,346

Hutchinson

7,907

19,079

Lee

6,062

17,542

Hyde

7,907

19,079

Lexington

6,284

19,137

Jackson

7,063

17,039

Marion

7,353

19,620

Jerauld

7,907

19,079

Marlboro

6,555

18,442

Jones

7,063

17,039

-25-

Kingsbury

7,158

17,863

DeKalb

6,067

14,772

Robertson

6,193

16,390

Lake

6,868

18,090

Dickson

6,673

14,604

Rutherford

6,193

16,390

Lawrence

7,063

17,039

Dyer

5,873

18,231

Scott

6,173

15,636

Lincoln

6,868

18,090

Fayette

6,361

16,072

Sequatchie

6,707

16,039

Lyman

7,063

17,039

Fentress

6,067

14,772

Sevier

6,173

15,636

Marshall

7,158

17,863

Franklin

6,707

16,039

Shelby

6,361

16,072

McCook

6,868

18,090

Gibson

5,873

18,231

Smith

6,067

14,772

McPherson

7,158

17,863

Giles

6,673

14,604

Stewart

6,673

14,604

Meade

7,063

17,039

Grainger

6,173

15,636

Sullivan

5,856

17,206

Mellette

7,063

17,039

Greene

5,856

17,206

Sumner

6,193

16,390

Miner

7,907

19,079

Grundy

6,707

16,039

Tipton

6,361

16,072

Minnehaha

6,868

18,090

Hamblen

6,173

15,636

Trousdale

6,193

16,390

Moody

6,868

18,090

Hamilton

6,707

16,039

Unicoi

5,856

17,206

Pennington

7,063

17,039

Hancock

5,856

17,206

Union

6,173

15,636

Perkins

7,063

17,039

Hardeman

5,873

18,231

Van Buren

6,067

14,772

Potter

7,158

17,863

Hardin

5,873

18,231

Warren

6,067

14,772

Roberts

7,158

17,863

Hawkins

5,856

17,206

Washington

5,856

17,206

Sanborn

7,907

19,079

Haywood

6,361

16,072

Wayne

6,673

14,604

Shannon

7,063

17,039

Henderson

5,873

18,231

Weakley

5,873

18,231

Spink

7,158

17,863

Henry

5,873

18,231

White

6,067

14,772

Stanley

7,063

17,039

Hickman

6,673

14,604

Williamson

6,193

16,390

Sully

7,907

19,079

Houston

6,673

14,604

Wilson

6,193

16,390

Todd

7,063

17,039

Humphreys

6,673

14,604

Tripp

7,063

17,039

Jackson

6,067

14,772

Turner

6,868

18,090

Jefferson

6,173

15,636

Union

6,868

18,090

Johnson

5,856

17,206

County

Employee- Dependent,
Only
Family, etc.

Walworth

7,158

17,863

Knox

6,173

15,636

Anderson

7,421

17,326

7,421

17,326

Texas

Yankton

7,907

19,079

Lake

5,873

18,231

Andrews

Ziebach

7,063

17,039

Lauderdale

6,361

16,072

Angelina

7,421

17,326

14,604

Aransas

6,054

18,124

8,349

17,553

Lawrence

Tennessee
County

Employee- Dependent,
Only
Family, etc.

6,673

Lewis

6,673

14,604

Archer

Lincoln

6,673

14,604

Armstrong

8,887

18,344

15,636

Atascosa

6,176

16,027

6,665

19,326

Loudon

6,173

Anderson

6,173

15,636

Macon

6,067

14,772

Austin

Bedford

6,673

14,604

Madison

5,873

18,231

Bailey

7,421

17,326

Benton

5,873

18,231

Marion

6,707

16,039

Bandera

6,176

16,027

Bledsoe

6,707

16,039

Marshall

6,673

14,604

Bastrop

6,060

17,738

Blount

6,173

15,636

Maury

6,673

14,604

Baylor

7,421

17,326

Bradley

6,707

16,039

McMinn

6,707

16,039

Bee

7,421

17,326

Campbell

6,173

15,636

McNairy

5,873

18,231

Bell

7,339

16,416

Cannon

6,067

14,772

Meigs

6,707

16,039

Bexar

6,176

16,027

Carroll

5,873

18,231

Monroe

6,173

15,636

Blanco

7,421

17,326

Carter

5,856

17,206

Montgomery

6,193

16,390

Borden

7,421

17,326

Cheatham

6,193

16,390

14,604

Bosque

7,421

17,326

Chester

5,873

18,231

Morgan

6,173

15,636

Bowie

5,777

15,218

Claiborne

6,173

15,636

Obion

5,873

18,231

Brazoria

6,665

19,326

Clay

6,067

14,772

14,772

Brazos

5,625

17,003

Cocke

6,173

15,636

Perry

6,673

14,604

Brewster

7,421

17,326

Coffee

6,673

14,604

Pickett

6,067

14,772

Briscoe

7,421

17,326

Crockett

5,873

18,231

16,039

Brooks

7,421

17,326

7,421

17,326

Moore

Overton

Polk

6,673

6,067

6,707

Cumberland

6,067

14,772

Putnam

6,067

14,772

Brown

Davidson

6,193

16,390

Rhea

6,707

16,039

Burleson

5,625

17,003

Decatur

5,873

18,231

15,636

Burnet

7,421

17,326

Roane

6,173

-26-

2019 Average Premium Tables

Caldwell

6,060

17,738

Freestone

7,421

17,326

Kimble

7,421

17,326

Calhoun

6,130

16,603

Frio

7,421

17,326

King

7,421

17,326

Callahan

7,233

17,164

Gaines

7,421

17,326

Kinney

7,421

17,326

Cameron

6,716

13,007

Galveston

6,665

19,326

Kleberg

7,421

17,326

Camp

7,421

17,326

Garza

7,421

17,326

Knox

7,421

17,326

Carson

8,887

18,344

Gillespie

7,421

17,326

Lamar

7,421

17,326

Cass

7,421

17,326

Glasscock

7,421

17,326

Lamb

7,421

17,326

Castro

7,421

17,326

Goliad

6,130

16,603

Lampasas

7,339

16,416

Chambers

6,665

19,326

Gonzales

7,421

17,326

LaSalle

7,421

17,326

Cherokee

7,421

17,326

Gray

7,421

17,326

Lavaca

7,421

17,326

Childress

7,421

17,326

Grayson

7,707

16,960

Lee

7,421

17,326

Clay

8,349

17,553

Gregg

6,073

21,028

Leon

7,421

17,326

Cochran

7,421

17,326

Grimes

7,421

17,326

Liberty

6,665

19,326

Coke

7,421

17,326

Guadalupe

6,176

16,027

Limestone

7,421

17,326

Coleman

7,421

17,326

Hale

7,421

17,326

Lipscomb

7,421

17,326

Collin

6,756

18,502

Hall

7,421

17,326

Live Oak

7,421

17,326

Collingsworth

7,421

17,326

Hamilton

7,421

17,326

Llano

7,421

17,326

Colorado

7,421

17,326

Hansford

7,421

17,326

Loving

7,421

17,326

Comal

6,176

16,027

Hardeman

7,421

17,326

Lubbock

5,362

16,772

Comanche

7,421

17,326

Hardin

7,483

20,152

Lynn

7,421

17,326

Concho

7,421

17,326

Harris

6,665

19,326

Madison

7,421

17,326

Cooke

7,421

17,326

Harrison

7,421

17,326

Marion

7,421

17,326

Coryell

7,339

16,416

Hartley

7,421

17,326

Martin

7,421

17,326

Cottle

7,421

17,326

Haskell

7,421

17,326

Mason

7,421

17,326

Crane

7,421

17,326

Hays

6,060

17,738

Matagorda

7,421

17,326

Crockett

7,421

17,326

Hemphill

7,421

17,326

Maverick

7,421

17,326

Crosby

5,362

16,772

Henderson

7,421

17,326

McCulloch

7,421

17,326

Culberson

7,421

17,326

Hidalgo

6,218

16,790

McLennan

5,103

14,214

Dallam

7,421

17,326

Hill

7,421

17,326

McMullen

7,421

17,326

Dallas

6,756

18,502

Hockley

7,421

17,326

Medina

6,176

16,027

Dawson

7,421

17,326

Hood

7,421

17,326

Menard

7,421

17,326

Deaf Smith

7,421

17,326

Hopkins

7,421

17,326

Midland

6,019

16,287

Delta

6,756

18,502

Houston

7,421

17,326

Milam

7,421

17,326

Denton

6,756

18,502

Howard

7,421

17,326

Mills

7,421

17,326

DeWitt

7,421

17,326

Hudspeth

7,421

17,326

Mitchell

7,421

17,326

Dickens

7,421

17,326

Hunt

6,756

18,502

Montague

7,421

17,326

Dimmit

7,421

17,326

Hutchinson

7,421

17,326

Montgomery

6,665

19,326

Donley

7,421

17,326

Irion

7,565

15,887

Moore

7,421

17,326

Duval

7,421

17,326

Jack

7,421

17,326

Morris

7,421

17,326

Eastland

7,421

17,326

Jackson

7,421

17,326

Motley

7,421

17,326

Ector

8,281

18,635

Jasper

7,421

17,326

Nacogdoches

7,421

17,326

Edwards

7,421

17,326

Jeff Davis

7,421

17,326

Navarro

7,421

17,326

El Paso

6,912

16,149

Jefferson

7,483

20,152

Newton

7,421

17,326

Ellis

6,756

18,502

Jim Hogg

7,421

17,326

Nolan

7,421

17,326

Erath

7,421

17,326

Jim Wells

7,421

17,326

Nueces

6,054

18,124

Falls

7,421

17,326

Johnson

6,756

18,502

Ochiltree

7,421

17,326

Fannin

7,421

17,326

Jones

7,233

17,164

Oldham

7,421

17,326

Fayette

7,421

17,326

Karnes

7,421

17,326

Orange

7,483

20,152

Fisher

7,421

17,326

Kaufman

6,756

18,502

Palo Pinto

7,421

17,326

Floyd

7,421

17,326

Kendall

6,176

16,027

Panola

7,421

17,326

Foard

7,421

17,326

Kenedy

7,421

17,326

Parker

6,756

18,502

Fort Bend

6,665

19,326

Kent

7,421

17,326

Parmer

7,421

17,326

Franklin

7,421

17,326

Kerr

7,421

17,326

Pecos

7,421

17,326

2019 Average Premium Tables

-27-

Virginia

Polk

7,421

17,326

Webb

7,084

18,329

Potter

8,887

18,344

Wharton

7,421

17,326

Presidio

7,421

17,326

Wheeler

7,421

17,326

County

Employee- Dependent,
Only
Family, etc.

Rains

7,421

17,326

Wichita

8,349

17,553

Accomack

6,046

16,178

Randall

8,887

18,344

Wilbarger

7,421

17,326

Albemarle

5,735

17,551

Reagan

7,421

17,326

Willacy

7,421

17,326

Alexandria City

6,924

20,141

6,046

16,178

Real

7,421

17,326

Williamson

6,060

17,738

Alleghany

Red River

7,421

17,326

Wilson

6,176

16,027

Amelia

6,243

18,322

Reeves

7,421

17,326

Winkler

7,421

17,326

Amherst

6,132

16,715

6,132

16,715

Refugio

7,421

17,326

Wise

6,756

18,502

Appomattox

Roberts

7,421

17,326

Wood

7,421

17,326

Arlington

6,924

20,141

Robertson

5,625

17,003

Yoakum

7,421

17,326

Augusta

6,046

16,178

6,046

16,178

Rockwall

6,756

18,502

Young

7,421

17,326

Bath

Runnels

7,421

17,326

Zapata

7,421

17,326

Bedford

6,132

16,715

Rusk

6,073

21,028

Zavala

7,421

17,326

Bedford City

6,132

16,715

Bland

6,046

16,178

Botetourt

6,413

18,068

7,233

14,350

Sabine

7,421

17,326

San Augustine

7,421

17,326

San Jacinto

6,665

19,326

Utah
Employee- Dependent,
Only
Family, etc.

Bristol City

San Patricio

6,054

18,124

County

Brunswick

6,046

16,178

San Saba

7,421

17,326

Beaver

6,852

19,272

Buchanan

6,046

16,178

Schleicher

7,421

17,326

Box Elder

6,057

16,370

Buckingham

6,046

16,178

6,974

18,509

Scurry

7,421

17,326

Cache

Buena Vista City

6,046

16,178

Shackelford

7,421

17,326

Carbon

6,852

19,272

Campbell

6,132

16,715

17,326

Daggett

6,852

19,272

Caroline

6,243

18,322

5,884

17,953

Shelby

7,421

Sherman

7,421

17,326

Davis

Carroll

6,046

16,178

Smith

6,387

19,926

Duchesne

6,852

19,272

Charles City

6,243

18,322

17,326

Emery

6,852

19,272

Charlotte

6,046

16,178

6,852

19,272

Somervell

7,421

Starr

7,421

17,326

Garfield

Charlottesville City

5,735

17,551

Stephens

7,421

17,326

Grand

6,852

19,272

Chesapeake City

6,959

18,060

17,326

Iron

7,759

16,705

Chesterfield

6,243

18,322

6,852

19,272

Sterling

7,421

Stonewall

7,421

17,326

Juab

Clarke

6,924

20,141

Sutton

7,421

17,326

Kane

6,852

19,272

Colonial Heights City

6,243

18,322

17,326

Millard

6,852

19,272

Covington City

6,046

16,178

6,057

16,370

Swisher

7,421

Tarrant

6,756

18,502

Morgan

Craig

6,413

18,068

Taylor

7,233

17,164

Piute

6,852

19,272

Culpeper

6,046

16,178

6,974

18,509

Terrell

7,421

17,326

Rich

Cumberland

6,243

18,322

Terry

7,421

17,326

Salt Lake

5,884

17,953

Danville City

8,443

17,778

Throckmorton

7,421

17,326

San Juan

6,852

19,272

Dickenson

6,046

16,178

6,852

19,272

Titus

7,421

17,326

Sanpete

Dinwiddie

6,243

18,322

Tom Green

7,565

15,887

Sevier

6,852

19,272

Emporia City

6,046

16,178

Travis

6,060

17,738

Summit

5,884

17,953

Essex

6,046

16,178

5,884

17,953

Trinity

7,421

17,326

Tooele

Fairfax

6,924

20,141

Tyler

7,421

17,326

Uintah

6,852

19,272

Fairfax City

6,924

20,141

21,028

Utah

5,501

17,140

Falls Church City

6,924

20,141

5,884

17,953

Upshur

6,073

Upton

7,421

17,326

Wasatch

Fauquier

6,924

20,141

Uvalde

7,421

17,326

Washington

7,759

16,705

Floyd

6,046

16,178

17,326

Wayne

6,852

19,272

Fluvanna

5,735

17,551

Weber

6,057

16,370

Franklin

6,413

18,068

Franklin City

6,046

16,178

Frederick

6,155

16,364

Fredericksburg City

6,924

20,141

Galax City

6,046

16,178

Giles

6,248

17,327

Val Verde

7,421

Van Zandt

7,421

17,326

Victoria

6,130

16,603

Walker

7,421

17,326

Waller

6,665

19,326

Ward

7,421

17,326

Washington

7,421

17,326

Vermont
County

Employee- Dependent,
Only
Family, etc.

All

6,408

-28-

18,237

2019 Average Premium Tables

Gloucester

6,959

18,060

Radford City

6,248

17,327

Kittitas

6,107

18,564

Goochland

6,243

18,322

Rappahannock

6,046

16,178

Klickitat

6,381

18,452

Grayson

6,046

16,178

Richmond

6,046

16,178

Lewis

6,527

19,100

Greene

5,735

17,551

Richmond City

6,243

18,322

Lincoln

5,603

15,040

Greensville

6,046

16,178

Roanoke

6,413

18,068

Mason

6,527

19,100

Halifax

6,046

16,178

Roanoke City

6,413

18,068

Okanogan

6,107

18,564

Hampton City

6,959

18,060

Rockbridge

6,046

16,178

Pacific

6,527

19,100

Hanover

6,243

18,322

Rockingham

6,132

19,072

Pend Oreille

5,603

15,040

Harrisonburg City

6,132

19,072

Russell

6,046

16,178

Pierce

6,527

19,100

Henrico

6,243

18,322

Salem City

6,413

18,068

San Juan

6,527

19,100

Henry

6,046

16,178

Scott

7,233

14,350

Skagit

6,527

19,100

Highland

6,046

16,178

Shenandoah

6,046

16,178

Skamania

6,381

18,452

Hopewell City

6,243

18,322

Smyth

6,046

16,178

Snohomish

6,527

19,100

Isle of Wight

6,959

18,060

Southampton

6,046

16,178

Spokane

5,603

15,040

James City

6,959

18,060

Spotsylvania

6,924

20,141

Stevens

5,603

15,040

King and Queen

6,243

18,322

Stafford

6,924

20,141

Thurston

6,527

19,100

King George

6,046

16,178

Staunton City

6,046

16,178

Wahkiakum

6,527

19,100

King William

6,243

18,322

Suffolk City

6,959

18,060

Walla Walla

6,107

18,564

Lancaster

6,046

16,178

Surry

6,959

18,060

Whatcom

6,527

19,100

Lee

6,046

16,178

Sussex

6,243

18,322

Whitman

6,107

18,564

Lexington City

6,046

16,178

Tazewell

6,046

16,178

Yakima

6,107

18,564

Loudoun

6,924

20,141

Virginia Beach City

6,959

18,060

Louisa

6,243

18,322

Warren

6,924

20,141

Lunenburg

6,046

16,178

Washington

7,233

14,350

Lynchburg City

6,132

16,715

Waynesboro City

6,046

16,178

County

Employee- Dependent,
Only
Family, etc.

Madison

6,046

16,178

Westmoreland

6,046

16,178

Barbour

7,346

17,065

18,060

Berkeley

6,272

18,365

6,925

22,008

Manassas City

6,924

20,141

Williamsburg City

6,959

West Virginia

Manassas Park City

6,924

20,141

Winchester City

6,155

16,364

Boone

Martinsville City

6,046

16,178

Wise

6,046

16,178

Braxton

7,267

20,797

16,178

Brooke

6,313

19,396

18,060

Cabell

6,855

18,411

Calhoun

7,267

20,797

Clay

7,267

20,797

Doddridge

6,706

17,518

Mathews

6,959

18,060

Mecklenburg

6,046

16,178

Middlesex

6,046

16,178

Montgomery

6,248

17,327

Wythe
York

6,046
6,959

Washington

Nelson

5,735

17,551

New Kent

6,243

18,322

County

Employee- Dependent,
Only
Family, etc.

Fayette

7,267

20,797

6,107

18,564

Gilmer

6,706

17,518

Newport News City

6,959

18,060

Adams

Norfolk City

6,959

18,060

Asotin

6,107

18,564

Grant

6,607

17,760

Northampton

6,046

16,178

Benton

6,107

18,564

Greenbrier

7,267

20,797

6,107

18,564

Hampshire

6,607

17,760

Northumberland

6,046

16,178

Chelan

Norton City

6,046

16,178

Clallam

6,527

19,100

Hancock

6,313

19,396

Nottoway

6,046

16,178

Clark

6,381

18,452

Hardy

6,607

17,760

6,107

18,564

Harrison

7,346

17,065

Orange

6,046

16,178

Columbia

Page

6,046

16,178

Cowlitz

6,527

19,100

Jackson

8,485

19,409

16,178

Douglas

6,107

18,564

Jefferson

6,272

18,365

5,603

15,040

Kanawha

7,292

19,499

Patrick

6,046

Petersburg City

6,243

18,322

Ferry

Pittsylvania

8,443

17,778

Franklin

6,107

18,564

Lewis

6,706

17,518

18,060

Garfield

6,107

18,564

Lincoln

6,925

22,008

6,107

18,564

Logan

6,925

22,008

Poquoson

6,959

Portsmouth City

6,959

18,060

Grant

Powhatan

6,243

18,322

Grays Harbor

6,527

19,100

Marion

6,706

17,518

16,178

Island

6,527

19,100

Marshall

6,313

19,396

6,527

19,100

Mason

6,855

18,411

Prince Edward

6,046

Prince George

6,243

18,322

Jefferson

Prince William

6,924

20,141

King

6,470

20,561

McDowell

6,925

22,008

17,327

Kitsap

6,527

19,100

Mercer

7,158

20,390

Pulaski

6,248

2019 Average Premium Tables

-29-

Mineral

6,607

17,760

Dodge

6,352

18,113

Sawyer

6,793

21,126

Mingo

6,925

22,008

Door

6,160

19,098

Shawano

6,160

19,098

Monongalia

6,706

17,518

Douglas

6,793

21,126

Sheboygan

6,352

18,113

Monroe

7,158

20,390

Dunn

8,268

20,922

St. Croix

7,883

16,612

Morgan

6,607

17,760

Eau Claire

8,268

20,922

Taylor

7,523

18,069

Nicholas

7,267

20,797

Florence

6,621

17,777

Trempealeau

6,922

19,611

Ohio

6,313

19,396

Fond du Lac

6,352

18,113

Vernon

8,132

20,925

Pendleton

6,607

17,760

Forest

6,621

17,777

Vilas

6,621

17,777

Pleasants

8,485

19,409

Grant

8,132

20,925

Walworth

6,843

22,185

Pocahontas

7,346

17,065

Green

6,843

22,185

Washburn

6,793

21,126

Preston

7,346

17,065

Green Lake

5,897

19,105

Washington

6,775

18,407

Putnam

6,855

18,411

Iowa

8,132

20,925

Waukesha

6,775

18,407

Raleigh

7,158

20,390

Iron

6,621

17,777

Waupaca

6,352

18,113

Randolph

7,346

17,065

Jackson

6,922

19,611

Waushara

6,352

18,113

Ritchie

8,485

19,409

Jefferson

6,843

22,185

Winnebago

6,352

18,113

Roane

7,267

20,797

Juneau

5,897

19,105

Wood

7,426

18,200

Summers

7,158

20,390

Kenosha

6,697

19,952

Taylor

7,346

17,065

Kewaunee

6,160

19,098

Tucker

7,346

17,065

La Crosse

6,922

19,611

Tyler

8,485

19,409

Lafayette

8,132

20,925

County

Employee- Dependent,
Only
Family, etc.

Upshur

7,346

17,065

Langlade

6,621

17,777

Albany

8,074

20,787

8,074

20,787

Wyoming

Wayne

6,855

18,411

Lincoln

7,426

18,200

Big Horn

Webster

7,346

17,065

Manitowoc

6,160

19,098

Campbell

8,074

20,787

18,200

Carbon

8,074

20,787

8,074

20,787

Wetzel

6,706

17,518

Marathon

7,426

Wirt

8,485

19,409

Marinette

6,160

19,098

Converse

Wood

8,485

19,409

Marquette

5,897

19,105

Crook

8,074

20,787

19,098

Fremont

8,074

20,787

8,074

20,787

Wyoming

6,925

22,008

Wisconsin

Menomonee

6,160

Milwaukee

6,875

20,659

Goshen

Monroe

6,922

19,611

Hot Springs

8,074

20,787

19,098

Johnson

8,074

20,787

7,803

20,476

Employee- Dependent,
Only
Family, etc.

Oconto

County

Oneida

6,621

17,777

Laramie

Adams

5,897

19,105

Outagamie

6,352

18,113

Lincoln

8,074

20,787

Ashland

6,793

21,126

18,407

Natrona

7,514

20,850

8,074

20,787

Ozaukee

6,160

6,775

Barron

7,523

18,069

Pepin

8,268

20,922

Niobrara

Bayfield

6,793

21,126

Pierce

7,883

16,612

Park

8,074

20,787

Brown

6,160

19,098

Polk

7,883

16,612

Platte

8,074

20,787

Buffalo

6,922

19,611

Portage

7,426

18,200

Sheridan

8,074

20,787

Burnett

6,793

21,126

Price

7,523

18,069

Sublette

8,074

20,787

Calumet

6,352

18,113

Racine

6,697

19,952

Sweetwater

8,074

20,787

Chippewa

8,268

20,922

Richland

5,897

19,105

Teton

8,074

20,787

Clark

7,523

18,069

Rock

6,843

22,185

Uinta

8,074

20,787

Columbia

6,843

22,185

Rusk

7,523

18,069

Washakie

8,074

20,787

Crawford

8,132

20,925

Sauk

5,897

19,105

Weston

8,074

20,787

Dane

6,570

19,001

-30-

2019 Average Premium Tables


File Typeapplication/pdf
File Title2019 Instructions for Form 8941
SubjectInstructions for Form 8941, Credit for Small Employer Health Insurance Premiums
AuthorW:CAR:MP:FP
File Modified2019-12-31
File Created2019-12-10

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