U.S. Individual Income Tax Return Forms

U.S. Individual Income Tax Return

i8941--2020-00-00

U.S. Individual Income Tax Return Forms

OMB: 1545-0074

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2020

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 and can be taken against
both regular and alternative minimum tax. The credit 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
Nov 16, 2020

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 example, an employer with 48 employees that are
each half-time employees has 24 FTEs and can claim the
credit. For details, see Worksheets 1 and 2.
Although the term “eligible small employer” is
defined in the Internal Revenue Code to include
CAUTION 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.

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Cat. No. 55222U

Employer Premiums Paid

3. You paid average annual wages for the tax year of
less than $56,000 per FTE. For details, see Worksheets
1 and 3.

Only premiums you paid for health insurance coverage
under a qualifying arrangement (discussed later) for
individuals considered employees are counted when
figuring your credit.

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 $56,000.

!

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, treat the
amount you paid toward the employee’s participation as
an amount you paid for employee health insurance
coverage.
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.

No more than one Form 8941 can be filed with a

TIP tax return, unless the exception described in

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.

Example 2 below applies.

Example 1. You’re a sole proprietor with two separate
businesses and you file a separate Schedule C (Form
1040) for each business. You must treat both businesses
as a single employer to figure the credit. You will file one
Form 8941 for both businesses.
Example 2. You and your spouse are both sole
proprietors and file a separate Schedule C (Form 1040)
for each of your separate businesses. Neither spouse was
an employee of the other spouse or participated in the
management of the other spouse’s business at any time
during the tax year. No more than 50% of the gross
income of either business was derived from royalties,
rents, dividends, interest, and annuities and you otherwise
meet the requirements listed in Regulations section
1.414(c)-4(b)(5)(ii). Don’t treat both businesses as a
single employer to figure the credit. If you and your
spouse are both eligible small employers, you can file two
Forms 8941 with a jointly filed Form 1040 or 1040-SR.

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 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

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.

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Instructions for Form 8941 (2020)

requirement. This is true whether the difference is due to a
discount for participation or a surcharge for
nonparticipation. The employer contribution for
employees who don’t participate in the wellness program
must be at least 50% of the premium (including any
premium surcharge for nonparticipation). However, for
purposes of figuring the credit, the employer contributions
are taken into account, including those contributions
attributable to an employee’s participation in a wellness
program.

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)
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
each of the following amounts if you make the relevant tier
of coverage available.
• 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, the following applies. 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 considered in calculating the uniform percentage
Instructions for Form 8941 (2020)

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
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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.

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 each of the following amounts if you
make the relevant tier of coverage available.
• A uniform percentage (not less than 50%) for each
employee enrolled in employee-only coverage, as
discussed under Arrangements with list billing and only
employee-only coverage above.
• A uniform amount that is either equal to the amount you
would’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).

Net premium payments are employer premiums paid
(discussed earlier) minus the amount of any state tax
credits you received or will receive and any state premium
subsidies paid either to you or directly to your insurance
provider for premiums for health insurance coverage you
provide under a qualifying arrangement to individuals
considered employees.

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 2020, 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 2020.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2020.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2020.

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.

Premium Deduction Reduced

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

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.

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.

State Premium Subsidy and Tax
Credit Limitation

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.

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.

Although a state tax credit or premium subsidy paid
directly to you doesn’t reduce the amount of your

Answer “Yes” if one of the following applies.

Line A

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Instructions for Form 8941 (2020)

• 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.

Worksheet 1. Information Needed To
Complete Line 1 and Worksheets 2
and 3
If you need more rows, use a separate sheet and include
the additional amounts in the totals below.

If you answer “Yes” because you paid premiums for
employee health insurance coverage you provided
through a SHOP Marketplace, enter the Marketplace
identifier, if any.

(a)
Individuals
Considered
Employees

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.

(b)
Employee
Hours of
Service

(c)
Employee
Wages
Paid

 1.
 2.
 3.
 4.

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.

 5.
 6.
 7.
 8.

Exception for eligible small employers in certain
counties. For calendar year 2020, 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 2020 if they
properly claimed the credit under section 45R for all or
part of 2019. For details, see Notice 2018-27, 2018-20,
I.R.B. 580, available at IRS.gov/irb/
2018-20_IRB#NOT-2018-27.

 9.

To see whether a particular county has coverage
TIP available through a SHOP Exchange for 2020 and
beyond, go to Healthcare.gov/small-business and
enter “plans and prices” in the search box.

17.

10.
11.
12.
13.
14.
15.
16.
18.
19.
20.

Line C

21.

Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning in 2014, 2015, 2016, 2017, or
2018 included a Form 8941 with line A checked “Yes” and
line 12 showing a positive amount. For more information,
see Credit Period, earlier.

22.
23.
24.
25.

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.

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 (2020)

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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 (2020)

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 $56,000 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 (2020)

-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 2020, 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 $27,600 from
line 3 . . . . . . . . . . . . . . . . . .

4.

5. Divide line 4 by $27,600. 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 (2020)

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 12, 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 2020.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2020.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2020.

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 (2020)

-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 2020.
Alabama

Limestone

6,480

19,585

Petersburg

11,771

28,003

Lowndes

7,502

19,230

Prince of Wales-Hyder 11,771

28,003

Macon

6,364

17,134

Sitka

11,771

28,003

Madison

6,480

19,585

Skagway

11,771

28,003

Marengo

6,364

17,134

Southeast Fairbanks

12,011

27,855

Marion

6,364

17,134

Valdez Cordova

11,303

28,132

Employee- Dependent,
Only
Family, etc.

Marshall

6,364

17,134

Wade Hampton

12,011

27,855

County

Mobile

7,238

18,375

11,771

28,003

Autauga

7,502

19,230

Monroe

6,364

17,134

Wrangell City and
Borough

Baldwin

6,364

17,134

Montgomery

7,502

19,230

Yakutat

12,011

27,855

Barbour

6,364

17,134

Morgan

7,893

19,596

Yukon Koyukuk

12,011

27,855

Bibb

6,653

18,914

Perry

6,364

17,134

Blount

6,653

18,914

Pickens

6,364

17,134

Bullock

6,364

17,134

Pike

6,364

17,134

Butler

6,364

17,134

Randolph

6,364

17,134

Calhoun

6,836

18,615

Russell

7,136

18,051

Chambers

6,364

17,134

Shelby

6,653

18,914

Cherokee

6,364

17,134

St. Clair

6,653

18,914

Chilton

6,653

18,914

Sumter

6,364

17,134

Choctaw

6,364

17,134

Talladega

6,364

17,134

Clarke

6,364

17,134

Tallapoosa

6,364

17,134

Clay

6,364

17,134

Tuscaloosa

7,603

18,629

Cleburne

6,364

17,134

Walker

6,653

18,914

Coffee

6,364

17,134

Washington

6,364

17,134

Colbert

8,654

19,748

Wilcox

6,364

17,134

Conecuh

6,364

17,134

Winston

6,364

17,134

Coosa

6,364

17,134

Covington

6,364

17,134

Crenshaw

6,364

17,134

Cullman

6,364

17,134

County

Employee- Dependent,
Only
Family, etc.

Dale

6,364

17,134

Aleutians East

12,011

27,855

Dallas

6,364

17,134

Aleutians West

12,011

27,855

DeKalb

6,364

17,134

Anchorage

11,303

28,132

Elmore

7,502

19,230

Bethel

11,303

28,132

Escambia

6,364

17,134

Bristol Bay

12,011

27,855

Etowah

6,447

18,794

Denali

12,011

27,855

Fayette

6,364

17,134

Dillingham

11,303

28,132

Franklin

6,364

17,134

Fairbanks North Star

12,011

27,855

Geneva

6,455

17,196

Haines

11,771

28,003

Greene

7,603

18,629

Hoonah-Angoon

11,771

28,003

Hale

7,603

18,629

Juneau

11,771

28,003

Henry

6,455

17,196

Kenai Peninsula

12,011

27,855

Houston

6,455

17,196

Ketchikan Gateway

11,771

28,003

Jackson

6,364

17,134

Kodiak Island

12,011

27,855

Jefferson

6,653

18,914

Lake and Peninsula

12,011

27,855

Lamar

6,364

17,134

Matanuska Susitna

12,011

27,855

Lauderdale

8,654

19,748

Nome

12,011

27,855

Lawrence

7,893

19,596

North Slope

12,011

27,855

Lee

6,298

15,915

Northwest Arctic

12,011

27,855

Alaska

-10-

Arizona
County

Employee- Dependent,
Only
Family, etc.

Apache

6,048

17,726

Cochise

6,445

17,906

Coconino

6,048

17,726

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

17,726

Navajo

6,048

17,726

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

6,450

16,114

Ashley

6,450

16,114

Baxter

6,120

17,714

Benton

6,120

17,714

Boone

6,120

17,714

Bradley

6,450

16,114

Calhoun

6,538

22,348

Carroll

6,120

17,714

Chicot

6,450

16,114

Clark

5,127

17,075

Clay

6,209

19,137

Cleburne

5,886

16,588

Cleveland

6,450

16,114

Columbia

6,538

22,348

Conway

5,886

16,588

2020 Average Premium Tables

Craighead

6,209

19,137

Stone

6,209

19,137

Santa Clara

8,304

24,507

Crawford

6,021

18,584

Union

6,538

22,348

Santa Cruz

7,301

19,546

Crittenden

6,209

19,137

Van Buren

5,886

16,588

Shasta

7,436

18,868

Cross

6,209

19,137

Washington

6,120

17,714

Sierra

7,436

18,868

Dallas

6,450

16,114

White

5,886

16,588

Siskiyou

7,436

18,868

Desha

6,450

16,114

Woodruff

6,209

19,137

Solano

7,057

19,020

Drew

6,450

16,114

Yell

5,886

16,588

Sonoma

7,057

19,020

Faulkner

5,886

16,588

Stanislaus

7,778

20,227

Franklin

6,021

18,584

Sutter

7,436

18,868

Fulton

6,209

19,137

7,436

18,868

5,127

17,075

County

Employee- Dependent,
Only
Family, etc.

Tehama

Garland

Trinity

7,436

18,868

Grant

5,886

16,588

Alameda

7,649

22,491

Tulare

7,778

20,227

7,436

18,868

California

Greene

6,209

19,137

Alpine

Tuolumne

7,436

18,868

Hempstead

6,538

22,348

Amador

7,436

18,868

Ventura

7,193

20,308

Hot Spring

5,127

17,075

Butte

7,436

18,868

Yolo

6,881

20,484

7,436

18,868

Yuba

7,436

18,868

Howard

6,538

22,348

Calaveras

Independence

6,209

19,137

Colusa

7,436

18,868

Izard

6,209

19,137

Contra Costa

8,093

22,307

Jackson

6,209

19,137

Del Norte

7,436

18,868

Jefferson

6,450

16,114

El Dorado

6,881

20,484

County

Employee- Dependent,
Only
Family, etc.

Johnson

6,021

18,584

Fresno

6,633

22,121

Adams

6,490

19,791

7,436

18,868

Alamosa

8,108

20,892

Colorado

Lafayette

6,538

22,348

Glenn

Lawrence

6,209

19,137

Humboldt

7,436

18,868

Arapahoe

6,490

19,791

16,114

Imperial

6,376

18,072

Archuleta

7,782

22,728

6,376

18,072

Baca

8,108

20,892

Lee

6,450

Lincoln

6,450

16,114

Inyo

Little River

6,538

22,348

Kern

7,202

18,566

Bent

8,108

20,892

18,584

Kings

6,633

22,121

Boulder

5,932

20,656

7,436

18,868

Broomfield

6,490

19,791

Logan

6,021

Lonoke

5,886

16,588

Lake

Madison

6,120

17,714

Lassen

7,436

18,868

Chaffee

8,108

20,892

17,714

Los Angeles

7,135

21,647

Cheyenne

8,108

20,892

6,633

22,121

Clear Creek

6,490

19,791

Marion

6,120

Miller

6,538

22,348

Madera

Mississippi

6,209

19,137

Marin

7,057

19,020

Conejos

8,108

20,892

16,114

Mariposa

7,778

20,227

Costilla

8,108

20,892

7,436

18,868

Crowley

8,108

20,892

Monroe

6,450

Montgomery

5,127

17,075

Mendocino

Nevada

6,538

22,348

Merced

7,778

20,227

Custer

8,108

20,892

7,436

18,868

Delta

7,782

22,728

Newton

6,120

17,714

Modoc

Ouachita

6,538

22,348

Mono

6,376

18,072

Denver

6,490

19,791

Perry

5,886

16,588

Monterey

7,301

19,546

Dolores

7,782

22,728

7,057

19,020

Douglas

6,490

19,791

Phillips

6,450

16,114

Napa

Pike

5,127

17,075

Nevada

7,436

18,868

Eagle

7,401

22,402

Poinsett

6,209

19,137

Orange

7,256

23,118

El Paso

6,109

19,408

6,881

20,484

Elbert

6,490

19,791

Polk

6,021

18,584

Placer

Pope

5,886

16,588

Plumas

7,436

18,868

Fremont

8,108

20,892

16,588

Riverside

7,232

19,737

Garfield

7,401

22,402

6,881

20,484

Gilpin

6,490

19,791

Prairie

5,886

Pulaski

5,886

16,588

Sacramento

Randolph

6,209

19,137

San Benito

7,301

19,546

Grand

7,782

22,728

16,588

San Bernardino

7,232

19,737

Gunnison

7,782

22,728

6,411

18,778

Hinsdale

7,782

22,728

Saline

5,886

Scott

6,021

18,584

San Diego

Searcy

6,120

17,714

San Francisco

7,867

25,686

Huerfano

8,108

20,892

18,584

San Joaquin

7,778

20,227

Jackson

7,782

22,728

7,193

20,308

Jefferson

6,490

19,791

Sebastian

6,021

Sevier

6,538

22,348

San Luis Obispo

Sharp

6,209

19,137

San Mateo

9,354

25,434

Kiowa

8,108

20,892

19,137

Santa Barbara

7,193

20,308

Kit Carson

8,108

20,892

St. Francis

6,209

2020 Average Premium Tables

-11-

Florida

Pasco

7,366

19,962

Employee- Dependent,
Only
Family, etc.

Pinellas

7,005

22,139

Polk

6,725

20,680

Alachua

8,141

20,991

Putnam

7,340

21,416

20,892

Baker

7,456

20,822

Santa Rosa

6,952

18,849

19,153

Bay

7,014

19,289

Sarasota

6,807

18,517

7,019

20,950

La Plata

7,782

22,728

Lake

7,782

22,728

Larimer

7,842

17,707

County

Las Animas

8,108

20,892

Lincoln

8,108

Logan

6,452

Mesa

6,247

18,275

Bradford

Seminole

7,594

18,876

Mineral

8,108

20,892

Brevard

7,746

21,890

St. Johns

8,328

24,303

Moffat

7,782

22,728

Broward

7,291

20,593

St. Lucie

7,232

19,964

7,197

20,787

Montezuma

7,782

22,728

Calhoun

Sumter

7,459

22,769

Montrose

7,782

22,728

Charlotte

8,184

23,859

Suwannee

6,687

20,690

Morgan

6,452

19,153

Citrus

7,199

19,641

Taylor

8,290

22,921

6,623

20,828

Otero

8,108

20,892

Clay

Union

7,237

21,396

Ouray

7,782

22,728

Collier

6,543

20,510

Volusia

7,427

20,111

Park

6,490

19,791

Columbia

7,858

22,655

Wakulla

6,944

21,188

7,292

21,687

Walton

7,307

19,391

Washington

7,346

21,567

Phillips

6,452

19,153

DeSoto

Pitkin

7,401

22,402

Dixie

7,073

19,151

Prowers

8,108

20,892

Duval

7,059

20,947

Pueblo

6,909

18,542

Escambia

7,575

19,577

Rio Blanco

7,782

22,728

Flagler

7,911

21,062

Rio Grande

8,108

20,892

Franklin

7,209

22,002

County

Employee- Dependent,
Only
Family, etc.

Routt

7,782

22,728

Gadsden

6,968

20,814

Appling

8,036

19,774

Saguache

8,108

20,892

Gilchrist

6,775

20,814

Atkinson

7,013

19,504

22,728

Glades

7,542

23,373

Bacon

5,784

17,208

7,132

20,481

San Juan

7,782

Georgia

San Miguel

7,782

22,728

Gulf

8,044

22,150

Baker

Sedgwick

6,452

19,153

Hamilton

7,132

20,720

Baldwin

7,411

19,588

22,402

Hardee

7,067

18,671

Banks

7,658

19,049

7,359

18,509

Summit

7,401

Teller

6,109

19,408

Hendry

8,068

23,309

Barrow

Washington

6,452

19,153

Hernando

7,636

21,653

Bartow

6,646

19,111

20,915

Highlands

7,693

23,786

Ben Hill

7,286

20,627

7,286

20,627

Weld
Yuma

6,519
6,452

19,153

Connecticut

Hillsborough

6,699

20,406

Berrien

Holmes

7,262

20,832

Bibb

6,078

17,514

Indian River

6,943

19,312

Bleckley

6,078

17,514

5,784

17,208

Jackson

6,718

18,756

Brantley

Jefferson

7,826

20,388

Brooks

7,286

20,627

8,036

19,774

County

Employee- Dependent,
Only
Family, etc.

Fairfield

8,215

22,318

Lafayette

7,206

19,409

Bryan

Hartford

7,690

20,581

Lake

8,231

22,177

Bulloch

8,036

19,774

Litchfield

7,478

22,054

Lee

7,413

22,034

Burke

6,803

18,522

Middlesex

8,289

21,538

Leon

8,289

23,046

Butts

6,646

19,111

New Haven

8,748

21,530

Levy

7,075

21,653

Calhoun

7,132

20,481

New London

6,262

16,977

Liberty

7,211

21,544

Camden

5,784

17,208

Tolland

7,379

15,494

Madison

7,995

21,842

Candler

8,036

19,774

Windham

8,445

27,550

Manatee

7,419

20,547

Carroll

6,646

19,857

Marion

6,342

18,693

Catoosa

6,536

18,934

5,784

17,208

Delaware
County

Employee- Dependent,
Only
Family, etc.

All

8,444

23,587

District of Columbia
County

Employee- Dependent,
Only
Family, etc.

All

7,071

22,894

Martin

7,619

22,929

Charlton

Miami-Dade

7,671

23,473

Chatham

8,036

19,774

Monroe

8,165

23,652

Chattahoochee

5,900

18,654

7,357

18,983

Nassau

7,901

18,734

Chattooga

Okaloosa

7,623

27,260

Cherokee

6,646

19,111

Okeechobee

8,056

22,815

Clarke

7,359

18,509

7,132

20,481

Orange

6,830

19,653

Clay

Osceola

8,112

22,721

Clayton

6,646

19,111

Palm Beach

8,029

23,416

Clinch

7,286

20,627

-12-

2020 Average Premium Tables

Cobb

6,646

19,111

Lanier

7,286

20,627

Towns

7,658

19,049

Coffee

7,013

19,504

Laurens

7,013

19,504

Treutlen

7,013

19,504

Colquitt

7,286

20,627

Lee

7,132

20,481

Troup

5,900

18,654

Columbia

6,803

18,522

Liberty

8,036

19,774

Turner

7,286

20,627

Cook

7,286

20,627

Lincoln

6,803

18,522

Twiggs

6,078

17,514

Coweta

6,646

19,111

Long

8,036

19,774

Union

7,658

19,049

Crawford

6,078

17,514

Lowndes

7,286

20,627

Upson

5,900

18,654

Crisp

7,132

20,481

Lumpkin

7,658

19,049

Walker

6,536

18,934

Dade

6,536

18,934

Macon

5,900

18,654

Walton

6,646

19,111

Dawson

7,658

19,049

Madison

7,359

18,509

Ware

5,784

17,208

Decatur

7,286

20,627

Marion

5,900

18,654

Warren

6,803

18,522

DeKalb

6,646

19,111

McDuffie

6,803

18,522

Washington

7,411

19,588

Dodge

6,078

17,514

McIntosh

5,784

17,208

Wayne

5,784

17,208

Dooly

6,078

17,514

Meriwether

5,900

18,654

Webster

5,900

18,654

Dougherty

7,132

20,481

Miller

7,286

20,627

Wheeler

7,013

19,504

Douglas

6,646

19,111

Mitchell

7,132

20,481

White

7,658

19,049

Early

7,286

20,627

Monroe

6,078

17,514

Whitfield

6,991

18,208

Echols

7,286

20,627

Montgomery

7,013

19,504

Wilcox

6,078

17,514

Effingham

8,036

19,774

Morgan

7,359

18,509

Wilkes

6,803

18,522

Elbert

7,359

18,509

Murray

6,991

18,208

Wilkinson

7,411

19,588

Emanuel

6,803

18,522

Muscogee

5,900

18,654

Worth

7,132

20,481

Evans

8,036

19,774

Newton

6,646

19,111

Fannin

6,991

18,208

Oconee

7,359

18,509

Fayette

6,646

19,111

Oglethorpe

7,359

18,509

Floyd

7,357

18,983

Paulding

6,646

19,111

County

Employee- Dependent,
Only
Family, etc.

Forsyth

6,646

19,111

Peach

6,078

17,514

All

6,993

Franklin

7,658

19,049

Pickens

7,357

18,983

Fulton

6,646

19,111

Pierce

5,784

17,208

Gilmer

7,357

18,983

Pike

6,646

19,111

Glascock

6,803

18,522

Polk

7,357

18,983

Glynn

5,784

17,208

Pulaski

6,078

17,514

Gordon

7,357

18,983

Putnam

6,078

17,514

Grady

7,286

20,627

Quitman

5,900

18,654

Greene

7,359

18,509

Rabun

7,658

19,049

Gwinnett

6,646

19,111

Randolph

7,132

20,481

Habersham

7,658

19,049

Richmond

6,803

18,522

Hall

7,658

19,049

Rockdale

6,646

19,111

Hancock

7,411

19,588

Schley

7,132

20,481

Haralson

6,646

19,857

Screven

8,036

19,774

Harris

5,900

18,654

Seminole

7,286

20,627

Hart

7,658

19,049

Spalding

6,646

19,111

Heard

6,646

19,857

Stephens

7,658

19,049

Henry

6,646

19,111

Stewart

5,900

18,654

Houston

6,078

17,514

Sumter

7,132

20,481

Irwin

7,286

20,627

Talbot

5,900

18,654

Jackson

7,359

18,509

Taliaferro

6,803

18,522

Jasper

6,646

19,111

Tattnall

8,036

19,774

Jeff Davis

7,013

19,504

Taylor

5,900

18,654

Jefferson

6,803

18,522

Telfair

7,013

19,504

Jenkins

6,803

18,522

Terrell

7,132

20,481

Johnson

7,013

19,504

Thomas

7,286

20,627

Jones

6,078

17,514

Tift

7,286

20,627

Lamar

6,646

19,111

Toombs

7,013

19,504

2020 Average Premium Tables

-13-

Hawaii

20,813

Idaho
County

Employee- Dependent,
Only
Family, etc.

Ada

6,050

15,291

Adams

5,587

14,317

Bannock

6,358

16,504

Bear Lake

6,358

16,504

Benewah

6,197

14,300

Bingham

6,358

16,504

Blaine

6,095

16,987

Boise

5,587

14,317

Bonner

6,197

14,300

Bonneville

6,574

16,177

Boundary

6,197

14,300

Butte

6,358

16,504

Camas

6,095

16,987

Canyon

5,587

14,317

Caribou

6,358

16,504

Cassia

6,095

16,987

Clark

6,574

16,177

Clearwater

6,698

16,479

Custer

6,358

16,504

Elmore

5,587

14,317

Franklin

6,358

16,504

Fremont

6,574

16,177

Gem

5,587

14,317

Gooding

6,095

16,987

Fulton

7,800

19,904

Saline

7,805

23,378

Idaho

6,698

16,479

Gallatin

7,805

23,378

Sangamon

7,294

17,919

Jefferson

6,574

16,177

Greene

6,987

19,098

Schuyler

7,294

17,919

Jerome

6,095

16,987

Grundy

8,001

20,461

Scott

7,294

17,919

Kootenai

6,197

14,300

Hamilton

7,805

23,378

Shelby

7,294

17,919

Latah

6,197

14,300

Hancock

6,317

18,874

St. Clair

7,726

19,935

Lemhi

6,574

16,177

Hardin

7,805

23,378

Stark

7,800

19,904

Lewis

6,698

16,479

Henderson

6,317

18,874

Stephenson

7,565

19,271

Lincoln

6,095

16,987

Henry

6,317

18,874

Tazewell

7,800

19,904

Madison

6,574

16,177

Iroquois

7,518

19,061

Union

7,805

23,378

Minidoka

6,095

16,987

Jackson

7,805

23,378

Vermilion

7,518

19,061

Nez Perce

6,698

16,479

Jasper

7,805

23,378

Wabash

7,805

23,378

Oneida

6,358

16,504

Jefferson

7,805

23,378

Warren

6,317

18,874

Owyhee

5,587

14,317

Jersey

6,987

19,098

Washington

6,987

19,098

Payette

5,587

14,317

Jo Daviess

7,565

19,271

Wayne

7,805

23,378

Power

6,358

16,504

Johnson

7,805

23,378

White

7,805

23,378

Shoshone

6,197

14,300

Kane

7,901

21,382

Whiteside

6,317

18,874

Teton

6,574

16,177

Kankakee

8,001

20,461

Will

8,001

20,461

Twin Falls

6,095

16,987

Kendall

8,001

20,461

Williamson

7,805

23,378

Valley

5,587

14,317

Knox

7,800

19,904

Winnebago

7,565

19,271

Washington

5,587

14,317

Lake

6,690

23,338

Woodford

7,800

19,904

LaSalle

7,800

19,904

Lawrence

7,805

23,378

Illinois

Indiana

Employee- Dependent,
Only
Family, etc.

Lee

7,565

19,271

County

Livingston

8,401

24,851

County

Employee- Dependent,
Only
Family, etc.

Adams

7,294

17,919

Logan

7,294

17,919

Adams

7,447

23,214

Alexander

7,805

23,378

17,919

Allen

7,176

23,045

Bond

6,987

19,098

Macoupin

6,987

19,098

Bartholomew

7,632

22,560

Boone

7,565

19,271

Madison

7,726

19,935

Benton

7,559

25,391

Brown

7,294

17,919

23,378

Blackford

7,432

21,898

Bureau

6,317

18,874

Marshall

7,800

19,904

Boone

7,104

25,255

Calhoun

6,987

19,098

Mason

7,294

17,919

Brown

7,225

22,415

Carroll

7,565

19,271

23,378

Carroll

6,908

25,729

6,893

21,199

Macon

Marion

Massac

7,294

7,805

7,805

Cass

7,294

17,919

McDonough

7,800

19,904

Cass

Champaign

7,518

19,061

McHenry

6,690

23,338

Clark

6,454

21,081

Christian

7,294

17,919

McLean

8,401

24,851

Clay

7,068

22,156

Clark

7,518

19,061

Menard

7,294

17,919

Clinton

6,908

25,729

Clay

7,805

23,378

Mercer

6,317

18,874

Crawford

6,454

21,081

Clinton

6,987

19,098

Monroe

7,726

19,935

Daviess

7,396

22,769

Coles

7,518

19,061

Montgomery

6,987

19,098

Dearborn

7,583

24,245

Cook

7,432

21,993

Morgan

7,294

17,919

Decatur

7,632

22,560

Crawford

7,805

23,378

Moultrie

7,294

17,919

DeKalb

7,447

23,214

Cumberland

7,518

19,061

Ogle

7,565

19,271

Delaware

7,432

21,898

DeKalb

7,565

19,271

19,904

Dubois

7,396

22,769

DeWitt

8,401

24,851

Perry

7,805

23,378

Elkhart

7,585

22,494

Douglas

7,518

19,061

Piatt

7,518

19,061

Fayette

7,173

22,139

DuPage

7,901

21,382

17,919

Floyd

6,454

21,081

Edgar

7,518

19,061

Pope

7,805

23,378

Fountain

6,908

25,729

Edwards

7,805

23,378

Pulaski

7,805

23,378

Franklin

7,583

24,245

Effingham

7,805

23,378

19,904

Fulton

6,893

21,199

8,317

24,463

Peoria

Pike

Putnam

7,800

7,294

7,800

Fayette

7,805

23,378

Randolph

6,987

19,098

Gibson

Ford

7,518

19,061

Richland

7,805

23,378

Grant

7,432

21,898

Franklin

7,805

23,378

18,874

Greene

7,396

22,769

Rock Island

6,317

-14-

2020 Average Premium Tables

Hamilton

7,104

25,255

Vanderburgh

8,317

24,463

Guthrie

7,284

16,767

Hancock

7,173

22,139

Vermillion

7,068

22,156

Hamilton

6,380

19,023

Harrison

6,454

21,081

Vigo

7,068

22,156

Hancock

6,731

19,889

Hendricks

7,104

25,255

Wabash

7,447

23,214

Hardin

6,380

19,023

Henry

7,173

22,139

Warren

7,559

25,391

Harrison

7,284

16,767

Howard

6,893

21,199

Warrick

8,317

24,463

Henry

6,650

17,923

Huntington

7,447

23,214

Washington

6,454

21,081

Howard

6,731

19,889

Jackson

7,632

22,560

Wayne

7,173

22,139

Humboldt

6,731

19,889

Jasper

7,559

25,391

Wells

7,447

23,214

Ida

6,589

18,908

Jay

7,432

21,898

White

7,559

25,391

Iowa

6,647

18,721

Jefferson

6,454

21,081

Whitley

7,447

23,214

Jackson

6,647

18,721

Jennings

7,632

22,560

Jasper

6,458

18,089

Johnson

7,225

22,415

Jefferson

6,650

17,923

Knox

7,396

22,769

6,647

18,721

Kosciusko

7,585

22,494

County

Employee- Dependent,
Only
Family, etc.

Johnson
Jones

6,647

18,721

7,284

16,767

Iowa

LaGrange

7,447

23,214

Adair

Keokuk

6,650

17,923

Lake

7,666

22,333

Adams

7,284

16,767

Kossuth

6,731

19,889

LaPorte

7,666

22,333

Allamakee

6,731

19,889

Lee

6,650

17,923

6,650

17,923

Lawrence

7,225

22,415

Appanoose

Linn

6,647

18,721

Madison

7,173

22,139

Audubon

7,284

16,767

Louisa

6,650

17,923

Marion

7,104

25,255

Benton

6,647

18,721

Lucas

6,650

17,923

6,647

18,721

Marshall

7,585

22,494

Black Hawk

Lyon

6,589

18,908

Martin

7,396

22,769

Boone

6,380

19,023

Madison

6,458

18,089

6,731

19,889

Miami

6,893

21,199

Bremer

Mahaska

6,650

17,923

Monroe

7,225

22,415

Buchanan

6,647

18,721

Marion

6,458

18,089

Montgomery

6,908

25,729

Buena Vista

6,589

18,908

Marshall

6,380

19,023

6,731

19,889

Morgan

7,104

25,255

Butler

Mills

7,284

16,767

Newton

7,559

25,391

Calhoun

6,380

19,023

Mitchell

6,731

19,889

Noble

7,447

23,214

Carroll

6,380

19,023

Monona

6,589

18,908

7,284

16,767

Ohio

7,583

24,245

Cass

Monroe

6,650

17,923

Orange

7,396

22,769

Cedar

6,647

18,721

Montgomery

7,284

16,767

Owen

7,225

22,415

Cerro Gordo

6,731

19,889

Muscatine

6,650

17,923

6,589

18,908

Parke

7,068

22,156

Cherokee

O'Brien

6,589

18,908

Perry

7,396

22,769

Chickasaw

6,731

19,889

Osceola

6,589

18,908

Pike

7,396

22,769

Clarke

7,284

16,767

Page

7,284

16,767

6,589

18,908

Porter

7,666

22,333

Clay

Palo Alto

6,589

18,908

Posey

8,317

24,463

Clayton

6,647

18,721

Plymouth

6,589

18,908

Pulaski

6,893

21,199

Clinton

6,647

18,721

Pocahontas

6,589

18,908

6,589

18,908

Putnam

6,908

25,729

Crawford

Polk

6,458

18,089

Randolph

7,432

21,898

Dallas

6,458

18,089

Pottawattamie

7,284

16,767

Ripley

7,583

24,245

Davis

6,650

17,923

Poweshiek

6,380

19,023

7,284

16,767

Rush

7,632

22,560

Decatur

Ringgold

7,284

16,767

Scott

6,454

21,081

Delaware

6,647

18,721

Sac

6,589

18,908

6,650

17,923

Shelby

7,104

25,255

Des Moines

Scott

6,647

18,721

Spencer

7,396

22,769

Dickinson

6,589

18,908

Shelby

7,284

16,767

St. Joseph

7,585

22,494

Dubuque

6,647

18,721

Sioux

6,589

18,908

6,731

19,889

Starke

7,585

22,494

Emmet

Story

6,380

19,023

Steuben

7,447

23,214

Fayette

6,731

19,889

Tama

6,380

19,023

Sullivan

7,068

22,156

Floyd

6,731

19,889

Taylor

7,284

16,767

6,731

19,889

Switzerland

7,583

24,245

Franklin

Union

7,284

16,767

Tippecanoe

6,908

25,729

Fremont

7,284

16,767

Van Buren

6,650

17,923

Tipton

6,908

25,729

Greene

6,380

19,023

Wapello

6,650

17,923

22,139

Grundy

6,380

19,023

Warren

6,458

18,089

Union

7,173

2020 Average Premium Tables

-15-

Washington

6,650

17,923

Hodgeman

6,516

19,415

Stevens

6,516

19,415

Wayne

6,650

17,923

Jackson

5,741

16,956

Sumner

5,511

16,298

Webster

6,380

19,023

Jefferson

5,741

16,956

Thomas

6,172

20,132

Winnebago

6,731

19,889

Jewell

5,509

15,803

Trego

6,172

20,132

Winneshiek

6,731

19,889

Johnson

6,630

18,536

Wabaunsee

5,741

16,956

Woodbury

6,589

18,908

Kearny

6,516

19,415

Wallace

6,172

20,132

Worth

6,731

19,889

Kingman

5,511

16,298

Washington

5,509

15,803

Wright

6,731

19,889

Kiowa

6,516

19,415

Wichita

6,172

20,132

Labette

6,886

19,378

Wilson

5,511

16,298

Lane

6,172

20,132

Woodson

6,886

19,378

6,630

18,536

Wyandotte

6,630

18,536

Kansas
County

Employee- Dependent,
Only
Family, etc.

Leavenworth
Lincoln

5,509

15,803

Allen

6,886

19,378

Linn

5,741

16,956

Anderson

5,741

16,956

Logan

6,172

20,132

Atchison

5,741

16,956

Lyon

5,741

16,956

County

Employee- Dependent,
Only
Family, etc.

Barber

6,516

19,415

Marion

5,511

16,298

Adair

6,272

19,247

6,272

19,247

Kentucky

Barton

6,172

20,132

Marshall

5,741

16,956

Allen

Bourbon

6,886

19,378

McPherson

5,511

16,298

Anderson

6,226

19,187

Brown

5,741

16,956

Meade

6,516

19,415

Ballard

8,670

19,250

Butler

5,511

16,298

Miami

6,630

18,536

Barren

6,272

19,247

Chase

5,511

16,298

Mitchell

5,509

15,803

Bath

7,159

20,621

Chautauqua

5,511

16,298

Montgomery

5,511

16,298

Bell

6,994

21,247

Cherokee

6,886

19,378

Morris

5,509

15,803

Boone

6,339

16,734

Cheyenne

6,172

20,132

19,415

Bourbon

6,226

19,187

Clark

6,516

19,415

Nemaha

5,741

16,956

Boyd

7,159

20,621

Clay

5,509

15,803

Neosho

6,886

19,378

Boyle

6,226

19,187

Cloud

5,509

15,803

20,132

Bracken

7,159

20,621

Coffey

5,741

16,956

Norton

6,172

20,132

Breathitt

6,994

21,247

Comanche

6,516

19,415

Osage

5,741

16,956

Breckinridge

6,775

18,840

Cowley

5,511

16,298

20,132

Bullitt

6,775

18,840

Crawford

6,886

19,378

Ottawa

5,509

15,803

Butler

6,272

19,247

Decatur

6,172

20,132

Pawnee

6,516

19,415

Caldwell

8,670

19,250

Dickinson

5,509

15,803

20,132

Calloway

8,670

19,250

6,339

16,734

Morton

Ness

Osborne

Phillips

6,516

6,172

6,172

6,172

Doniphan

5,741

16,956

Pottawatomie

5,741

16,956

Campbell

Douglas

5,741

16,956

Pratt

6,516

19,415

Carlisle

8,670

19,250

Edwards

6,516

19,415

Rawlins

6,172

20,132

Carroll

6,775

18,840

Elk

5,511

16,298

Reno

5,511

16,298

Carter

7,159

20,621

Ellis

6,172

20,132

Republic

5,509

15,803

Casey

6,272

19,247

Ellsworth

5,509

15,803

Rice

5,511

16,298

Christian

8,172

20,031

Finney

6,516

19,415

Riley

5,509

15,803

Clark

6,226

19,187

Ford

6,516

19,415

Rooks

6,172

20,132

Clay

6,994

21,247

Franklin

5,741

16,956

Rush

6,172

20,132

Clinton

6,272

19,247

Geary

5,509

15,803

Russell

6,172

20,132

Crittenden

8,670

19,250

Gove

6,172

20,132

15,803

Cumberland

6,272

19,247

Graham

6,172

20,132

Scott

6,172

20,132

Daviess

8,172

20,031

Grant

6,516

19,415

Sedgwick

5,511

16,298

Edmonson

6,272

19,247

Gray

6,516

19,415

19,415

Elliott

7,159

20,621

Greeley

6,172

20,132

Shawnee

5,741

16,956

Estill

6,226

19,187

Greenwood

5,511

16,298

Sheridan

6,172

20,132

Fayette

6,226

19,187

Hamilton

6,516

19,415

20,132

Fleming

7,159

20,621

6,994

21,247

Saline

Seward

Sherman

5,509

6,516

6,172

Harper

5,511

16,298

Smith

6,172

20,132

Floyd

Harvey

5,511

16,298

Stafford

6,516

19,415

Franklin

6,226

19,187

Haskell

6,516

19,415

19,415

Fulton

8,670

19,250

Stanton

6,516

-16-

2020 Average Premium Tables

Gallatin

6,339

16,734

Ohio

8,172

20,031

Franklin

7,876

17,471

Garrard

6,226

19,187

Oldham

6,775

18,840

Grant

7,930

16,248

Grant

6,339

16,734

Owen

6,226

19,187

Iberia

7,541

17,671

Graves

8,670

19,250

Owsley

6,994

21,247

Iberville

7,533

18,621

Grayson

6,775

18,840

Pendleton

6,339

16,734

Jackson

7,876

17,471

Green

6,272

19,247

Perry

6,994

21,247

Jefferson

7,139

16,795

Greenup

7,159

20,621

Pike

6,994

21,247

Jefferson Davis

7,717

20,137

Hancock

8,172

20,031

Powell

6,226

19,187

Lafayette

7,541

17,671

Hardin

6,775

18,840

Pulaski

6,272

19,247

Lafourche

7,514

16,842

Harlan

6,994

21,247

Robertson

7,159

20,621

LaSalle

7,930

16,248

Harrison

6,226

19,187

Rockcastle

6,226

19,187

Lincoln

7,876

17,471

Hart

6,272

19,247

Rowan

7,159

20,621

Livingston

7,533

18,621

Henderson

8,172

20,031

Russell

6,272

19,247

Madison

7,876

17,471

Henry

6,775

18,840

Scott

6,226

19,187

Morehouse

7,876

17,471

Hickman

8,670

19,250

Shelby

6,775

18,840

Natchitoches

7,794

18,227

Hopkins

8,172

20,031

Simpson

6,272

19,247

Orleans

7,139

16,795

Jackson

6,226

19,187

Spencer

6,775

18,840

Ouachita

7,876

17,471

Jefferson

6,775

18,840

Taylor

6,272

19,247

Plaquemines

7,139

16,795

Jessamine

6,226

19,187

Todd

8,172

20,031

Pointe Coupee

7,533

18,621

Johnson

6,994

21,247

Trigg

8,172

20,031

Rapides

7,930

16,248

Kenton

6,339

16,734

Trimble

6,775

18,840

Red River

7,794

18,227

Knott

6,994

21,247

Union

8,172

20,031

Richland

7,876

17,471

Knox

6,994

21,247

Warren

6,272

19,247

Sabine

7,794

18,227

LaRue

6,775

18,840

Washington

6,775

18,840

St. Bernard

7,139

16,795

Laurel

6,994

21,247

Wayne

6,272

19,247

St. Charles

7,139

16,795

Lawrence

7,159

20,621

Webster

8,172

20,031

St. Helena

7,533

18,621

Lee

6,994

21,247

Whitley

6,994

21,247

St. James

7,139

16,795

Leslie

6,994

21,247

Wolfe

6,994

21,247

St. John Baptist

7,139

16,795

Letcher

6,994

21,247

Woodford

6,226

19,187

St. Landry

7,541

17,671

Lewis

7,159

20,621

St. Martin

7,541

17,671

Lincoln

6,226

19,187

St. Mary

7,541

17,671

Livingston

8,670

19,250

7,139

16,795

Louisiana
Employee- Dependent,
Only
Family, etc.

St. Tammany

Logan

6,272

19,247

Parish

Tangipahoa

7,533

18,621

Lyon

8,670

19,250

Acadia

7,541

17,671

Tensas

7,876

17,471

Madison

6,226

19,187

Allen

7,717

20,137

Terrebonne

7,514

16,842

7,533

18,621

Magoffin

6,994

21,247

Ascension

Union

7,876

17,471

Marion

6,775

18,840

Assumption

7,514

16,842

Vermilion

7,541

17,671

Marshall

8,670

19,250

Avoyelles

7,930

16,248

Vernon

7,930

16,248

7,717

20,137

Martin

6,994

21,247

Beauregard

Washington

7,533

18,621

Mason

7,159

20,621

Bienville

7,794

18,227

Webster

7,794

18,227

McCracken

8,670

19,250

Bossier

7,794

18,227

West Baton Rouge

7,533

18,621

7,794

18,227

McCreary

6,272

19,247

Caddo

West Carroll

7,876

17,471

McLean

8,172

20,031

Calcasieu

7,717

20,137

West Feliciana

7,533

18,621

7,876

17,471

Winn

7,930

16,248

Meade

6,775

18,840

Caldwell

Menifee

7,159

20,621

Cameron

7,717

20,137

Mercer

6,226

19,187

Catahoula

7,930

16,248

Metcalfe

6,272

19,247

Claiborne

7,794

18,227

7,930

16,248

County

Employee- Dependent,
Only
Family, etc.

Maine

Monroe

6,272

19,247

Concordia

Montgomery

6,226

19,187

DeSoto

7,794

18,227

Androscoggin

7,192

18,426

20,621

East Baton Rouge

7,533

18,621

Aroostook

8,765

22,414

7,876

17,471

Cumberland

6,617

20,113

Morgan

7,159

Muhlenberg

8,172

20,031

East Carroll

Nelson

6,775

18,840

East Feliciana

7,533

18,621

Franklin

7,192

18,426

19,187

Evangeline

7,541

17,671

Hancock

8,765

22,414

Nicholas

6,226

2020 Average Premium Tables

-17-

Kennebec

6,448

17,487

Norfolk

8,383

24,824

Lenawee

6,203

17,552

Knox

6,448

17,487

Plymouth

8,742

23,617

Livingston

6,203

17,552

Lincoln

6,448

17,487

Suffolk

8,383

24,824

Luce

7,933

22,114

Oxford

6,448

17,487

Worcester

8,078

22,773

Mackinac

7,145

20,938

Penobscot

7,192

18,426

Macomb

6,883

21,063

Piscataquis

7,192

18,426

Manistee

5,945

18,848

Sagadahoc

6,617

20,113

7,933

22,114

7,192

18,426

County

Employee- Dependent,
Only
Family, etc.

Marquette

Somerset

Mason

5,904

17,923

Waldo

7,192

18,426

Alcona

7,145

20,938

Mecosta

5,904

17,923

7,933

22,114

Michigan

Washington

8,765

22,414

Alger

Menominee

7,933

22,114

York

6,617

20,113

Allegan

5,731

16,385

Midland

6,448

19,013

Alpena

7,145

20,938

Missaukee

5,945

18,848

Antrim

5,945

18,848

Monroe

7,321

20,883

Arenac

6,682

19,134

Montcalm

5,904

17,923

Baraga

7,933

22,114

Montmorency

7,145

20,938

Maryland
County

Employee- Dependent,
Only
Family, etc.

Allegany

6,579

17,064

Barry

5,731

16,385

Muskegon

5,904

17,923

Anne Arundel

6,699

18,952

Bay

6,682

19,134

Newaygo

5,904

17,923

Baltimore

6,699

18,952

Benzie

5,945

18,848

Oakland

6,883

21,063

Baltimore City

6,699

18,952

Berrien

6,995

22,809

Oceana

5,904

17,923

Calvert

7,186

17,282

Branch

7,590

20,696

Ogemaw

7,145

20,938

Caroline

7,186

17,282

Calhoun

7,590

20,696

Ontonagon

7,933

22,114

Carroll

6,579

17,064

Cass

6,995

22,809

Osceola

5,904

17,923

Cecil

7,186

17,282

Charlevoix

5,945

18,848

Oscoda

7,145

20,938

Charles

7,186

17,282

Cheboygan

7,145

20,938

Otsego

7,145

20,938

Dorchester

7,186

17,282

Chippewa

7,145

20,938

Ottawa

5,904

17,923

Frederick

6,579

17,064

Clare

6,448

19,013

Presque Isle

7,145

20,938

Garrett

6,579

17,064

Clinton

6,916

18,119

Roscommon

7,145

20,938

Harford

6,699

18,952

Crawford

7,145

20,938

Saginaw

6,682

19,134

Howard

6,699

18,952

Delta

7,933

22,114

Sanilac

7,278

20,214

Kent

7,186

17,282

Dickinson

7,933

22,114

Schoolcraft

7,933

22,114

Montgomery

7,440

20,776

Eaton

6,916

18,119

Shiawassee

6,652

17,204

Prince George's

7,440

20,776

Emmet

5,945

18,848

St. Clair

7,028

20,467

Queen Annes

7,186

17,282

Genesee

6,652

17,204

St. Joseph

6,995

22,809

Somerset

7,186

17,282

Gladwin

6,448

19,013

Tuscola

7,278

20,214

St. Marys

7,186

17,282

Gogebic

7,933

22,114

Van Buren

6,995

22,809

Talbot

7,186

17,282

Grand Traverse

5,945

18,848

Washtenaw

6,203

17,552

Washington

6,579

17,064

Gratiot

6,682

19,134

Wayne

7,321

20,883

Wicomico

7,186

17,282

Hillsdale

6,916

18,119

Wexford

5,945

18,848

Worcester

7,186

17,282

Houghton

7,933

22,114

Huron

7,278

20,214

Ingham

6,916

18,119

5,904

17,923

County

Employee- Dependent,
Only
Family, etc.

County

Employee- Dependent,
Only
Family, etc.

Ionia
Iosco

7,145

20,938

Aitkin

6,199

17,504

Barnstable

9,659

26,571

Iron

7,933

22,114

Anoka

6,997

19,865

Berkshire

7,276

20,079

Isabella

6,448

19,013

Becker

7,038

23,197

Bristol

8,742

23,617

Jackson

6,916

18,119

Beltrami

6,199

17,504

Dukes

9,659

26,571

Kalamazoo

7,590

20,696

Benton

6,997

19,865

Essex

7,796

22,455

Kalkaska

5,945

18,848

Big Stone

7,397

19,436

Franklin

7,276

20,079

Kent

5,904

17,923

Blue Earth

7,937

19,988

Hampden

7,276

20,079

Keweenaw

7,933

22,114

Brown

6,588

19,311

Hampshire

7,276

20,079

Lake

5,904

17,923

Carlton

6,700

17,572

Middlesex

8,383

24,824

Lapeer

6,652

17,204

Carver

6,997

19,865

Nantucket

9,659

26,571

Leelanau

5,945

18,848

Cass

6,199

17,504

Massachusetts

-18-

Minnesota

2020 Average Premium Tables

Chippewa

7,397

19,436

Renville

7,397

19,436

Humphreys

6,646

18,050

Chisago

6,199

17,504

Rice

7,937

19,988

Issaquena

6,646

18,050

Clay

7,038

23,197

Rock

6,588

19,311

Itawamba

7,057

16,769

Clearwater

6,378

20,920

Roseau

6,199

17,504

Jackson

7,057

18,474

Cook

6,700

17,572

Scott

6,997

19,865

Jasper

6,646

18,050

Cottonwood

6,588

19,311

Sherburne

6,997

19,865

Jefferson

6,646

18,050

Crow Wing

6,199

17,504

Sibley

7,397

19,436

Jefferson Davis

6,646

18,050

Dakota

6,997

19,865

St. Louis

6,700

17,572

Jones

7,319

15,139

Dodge

6,756

20,649

Stearns

6,997

19,865

Kemper

6,646

18,050

Douglas

7,038

23,197

Steele

6,756

20,649

Lafayette

6,646

18,050

Faribault

7,937

19,988

Stevens

7,038

23,197

Lamar

7,319

15,139

Fillmore

6,756

20,649

Swift

7,397

19,436

Lauderdale

6,646

18,050

Freeborn

6,756

20,649

Todd

6,199

17,504

Lawrence

6,646

18,050

Goodhue

6,756

20,649

Traverse

7,038

23,197

Leake

6,646

18,050

Grant

7,038

23,197

Wabasha

6,756

20,649

Lee

7,057

16,769

Hennepin

6,997

19,865

Wadena

6,199

17,504

Leflore

6,646

18,050

Houston

6,756

20,649

Waseca

7,937

19,988

Lincoln

6,646

18,050

Hubbard

6,199

17,504

Washington

6,997

19,865

Lowndes

6,646

18,050

Isanti

6,199

17,504

Watonwan

7,937

19,988

Madison

6,422

17,239

Itasca

6,700

17,572

Wilkin

7,038

23,197

Marion

6,646

18,050

Jackson

6,588

19,311

Winona

6,756

20,649

Marshall

6,271

19,331

Kanabec

6,199

17,504

Wright

6,997

19,865

Monroe

6,646

18,050

Kandiyohi

7,397

19,436

Yellow Medicine

7,397

19,436

Montgomery

6,646

18,050

Kittson

6,378

20,920

Neshoba

6,646

18,050

Koochiching

6,700

17,572

Newton

6,646

18,050

Lac qui Parle

7,397

19,436

6,646

18,050

Mississippi
Employee- Dependent,
Only
Family, etc.

Noxubee

Lake

6,700

17,572

County

Oktibbeha

6,646

18,050

Lake of the Woods

6,700

17,572

Adams

6,646

18,050

Panola

6,646

18,050

Le Sueur

7,937

19,988

Alcorn

6,646

18,050

Pearl River

7,319

15,139

6,646

18,050

Lincoln

6,588

19,311

Amite

Perry

7,319

15,139

Lyon

7,397

19,436

Attala

6,646

18,050

Pike

6,646

18,050

Mahnomen

6,378

20,920

Benton

7,057

16,769

Pontotoc

7,057

16,769

6,646

18,050

Marshall

6,378

20,920

Bolivar

Prentiss

6,646

18,050

Martin

7,937

19,988

Calhoun

6,646

18,050

Quitman

6,646

18,050

McLeod

7,397

19,436

Carroll

6,646

18,050

Rankin

6,422

17,239

6,646

18,050

Meeker

7,397

19,436

Chickasaw

Scott

6,646

18,050

Mille Lacs

6,199

17,504

Choctaw

6,646

18,050

Sharkey

6,646

18,050

Morrison

6,199

17,504

Claiborne

6,646

18,050

Simpson

6,422

17,239

6,646

18,050

Mower

6,756

20,649

Clarke

Smith

6,646

18,050

Murray

6,588

19,311

Clay

6,646

18,050

Stone

7,057

18,474

Nicollet

7,937

19,988

Coahoma

6,646

18,050

Sunflower

6,646

18,050

6,422

17,239

Nobles

6,588

19,311

Copiah

Tallahatchie

6,646

18,050

Norman

6,378

20,920

Covington

6,646

18,050

Tate

6,271

19,331

6,271

19,331

Olmsted

6,756

20,649

DeSoto

Tippah

7,057

16,769

Otter Tail

7,038

23,197

Forrest

7,319

15,139

Tishomingo

6,646

18,050

Pennington

6,378

20,920

Franklin

6,646

18,050

Tunica

6,271

19,331

7,057

18,474

Pine

6,199

17,504

George

Union

7,057

16,769

Pipestone

6,588

19,311

Greene

7,319

15,139

Walthall

6,646

18,050

Polk

6,378

20,920

Grenada

6,646

18,050

Warren

6,422

17,239

7,057

18,474

Pope

7,038

23,197

Hancock

Washington

6,646

18,050

Ramsey

6,997

19,865

Harrison

7,057

18,474

Wayne

6,646

18,050

Red Lake

6,378

20,920

Hinds

6,422

17,239

Webster

6,646

18,050

19,311

Holmes

6,646

18,050

Wilkinson

6,646

18,050

Redwood

6,588

2020 Average Premium Tables

-19-

Winston

6,646

18,050

Iron

6,717

16,888

St. Francois

6,530

17,116

Yalobusha

6,646

18,050

Jackson

6,390

18,090

St. Louis

6,530

17,116

Yazoo

6,646

18,050

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

6,290

16,082

Missouri
County

Employee- Dependent,
Only
Family, etc.

Knox
Laclede

6,290

16,082

Sullivan

6,905

15,902

Adair

6,905

15,902

Lafayette

7,493

19,730

Taney

6,290

16,082

Andrew

8,473

14,166

Lawrence

6,290

16,082

Texas

6,717

16,888

Atchison

8,473

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

6,290

16,082

Linn

6,905

15,902

Washington

6,530

17,116

Barton

5,676

14,994

Livingston

8,473

14,166

Wayne

6,757

16,599

Bates

7,493

19,730

Macon

6,905

15,902

Webster

6,290

16,082

Benton

7,493

19,730

Madison

6,757

16,599

Worth

8,473

14,166

Bollinger

6,757

16,599

Maries

6,662

18,608

Wright

6,290

16,082

Boone

6,662

18,608

Marion

6,905

15,902

Buchanan

8,473

14,166

McDonald

5,676

14,994

Butler

6,757

16,599

Mercer

8,473

14,166

Caldwell

8,473

14,166

Miller

6,662

18,608

County

Employee- Dependent,
Only
Family, etc.

Callaway

6,662

18,608

Mississippi

6,757

16,599

Beaverhead

7,671

17,348

Camden

6,662

18,608

Moniteau

6,662

18,608

Big Horn

7,671

17,348

Cape Girardeau

6,757

16,599

Monroe

6,662

18,608

Blaine

7,671

17,348

Carroll

8,473

14,166

18,608

Broadwater

6,661

18,324

Carter

6,717

16,888

Morgan

6,662

18,608

Carbon

6,619

18,736

Cass

6,390

18,090

New Madrid

6,757

16,599

Carter

7,671

17,348

Cedar

6,290

16,082

14,994

Cascade

6,661

18,324

Chariton

6,662

18,608

Nodaway

8,473

14,166

Chouteau

6,661

18,324

Christian

6,290

16,082

Oregon

6,717

16,888

Custer

7,671

17,348

Clark

6,905

15,902

18,608

Daniels

7,671

17,348

Clay

6,390

18,090

Ozark

6,290

16,082

Dawson

7,671

17,348

Clinton

8,473

14,166

Pemiscot

6,757

16,599

Deer Lodge

6,661

18,324

Cole

6,662

18,608

16,599

Fallon

7,671

17,348

7,671

17,348

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

6,364

17,742

Dade

6,290

16,082

Pike

6,905

15,902

Gallatin

6,661

18,324

Dallas

6,290

16,082

Platte

6,390

18,090

Garfield

7,671

17,348

Daviess

8,473

14,166

Polk

6,290

16,082

Glacier

7,671

17,348

DeKalb

8,473

14,166

Pulaski

6,717

16,888

Golden Valley

7,671

17,348

Dent

6,717

16,888

Putnam

6,905

15,902

Granite

7,671

17,348

Douglas

6,290

16,082

Ralls

6,905

15,902

Hill

7,671

17,348

Dunklin

6,757

16,599

Randolph

6,662

18,608

Jefferson

6,661

18,324

Franklin

6,530

17,116

Ray

8,473

14,166

Judith Basin

6,661

18,324

Gasconade

6,662

18,608

16,888

Lake

6,364

17,742

Gentry

8,473

14,166

Ripley

6,717

16,888

Lewis and Clark

6,661

18,324

Greene

6,290

16,082

Saline

7,493

19,730

Liberty

7,671

17,348

Grundy

8,473

14,166

15,902

Lincoln

7,671

17,348

Harrison

8,473

14,166

Scotland

6,905

15,902

Madison

7,671

17,348

Henry

7,493

19,730

Scott

6,757

16,599

McCone

7,671

17,348

Hickory

6,290

16,082

16,888

Meagher

7,671

17,348

7,671

17,348

Reynolds

Schuyler

Shannon

6,717

6,905

6,717

Holt

8,473

14,166

Shelby

6,905

15,902

Mineral

Howard

6,662

18,608

St. Charles

6,530

17,116

Missoula

6,364

17,742

Howell

6,717

16,888

19,730

Musselshell

6,619

18,736

St. Clair

7,493

-20-

2020 Average Premium Tables

Park

7,671

17,348

Dodge

6,503

18,868

Seward

6,547

19,849

Petroleum

7,671

17,348

Douglas

6,503

18,868

Sheridan

7,892

21,943

Phillips

7,671

17,348

Dundy

7,892

21,943

Sherman

6,969

20,323

Pondera

7,671

17,348

Fillmore

6,547

19,849

Sioux

7,892

21,943

Powder River

7,671

17,348

Franklin

6,969

20,323

Stanton

6,969

20,323

Powell

7,671

17,348

Frontier

7,892

21,943

Thayer

6,547

19,849

Prairie

7,671

17,348

Furnas

6,969

20,323

Thomas

7,892

21,943

Ravalli

7,671

17,348

Gage

6,547

19,849

Thurston

6,503

18,868

Richland

7,671

17,348

Garden

7,892

21,943

Valley

6,969

20,323

Roosevelt

7,671

17,348

Garfield

6,969

20,323

Washington

6,503

18,868

Rosebud

7,671

17,348

Gosper

6,969

20,323

Wayne

6,969

20,323

Sanders

7,671

17,348

Grant

7,892

21,943

Webster

6,969

20,323

Sheridan

7,671

17,348

Greeley

6,969

20,323

Wheeler

6,969

20,323

Silver Bow

6,661

18,324

Hall

6,969

20,323

York

6,547

19,849

Stillwater

6,619

18,736

Hamilton

6,969

20,323

Sweet Grass

6,619

18,736

Harlan

6,969

20,323

Teton

6,661

18,324

Hayes

7,892

21,943

Toole

7,671

17,348

Hitchcock

7,892

21,943

County

Employee- Dependent,
Only
Family, etc.

Treasure

7,671

17,348

Holt

6,969

20,323

Carson City

6,296

15,350

Valley

7,671

17,348

Hooker

7,892

21,943

Churchill

7,586

19,806

Wheatland

7,671

17,348

Howard

6,969

20,323

Clark

6,048

18,187

6,296

15,350

Nevada

Wibaux

7,671

17,348

Jefferson

6,547

19,849

Douglas

Yellowstone

6,619

18,736

Johnson

6,547

19,849

Elko

7,586

19,806

20,323

Esmeralda

7,586

19,806

7,586

19,806

Kearney

Nebraska

6,969

Keith

7,892

21,943

Eureka

Keya Paha

6,969

20,323

Humboldt

7,586

19,806

21,943

Lander

7,586

19,806

7,586

19,806

County

Employee- Dependent,
Only
Family, etc.

Adams

6,969

20,323

Knox

6,969

20,323

Lincoln

Antelope

6,969

20,323

Lancaster

6,547

19,849

Lyon

6,296

15,350

Arthur

7,892

21,943

21,943

Mineral

7,586

19,806

Banner

7,892

21,943

Logan

7,892

21,943

Nye

6,048

18,187

Blaine

6,969

20,323

Loup

6,969

20,323

Pershing

7,586

19,806

Boone

6,969

20,323

20,323

Storey

6,296

15,350

6,981

18,962

7,586

19,806

Kimball

Lincoln

Madison

7,892

7,892

6,969

Box Butte

7,892

21,943

McPherson

7,892

21,943

Washoe

Boyd

6,969

20,323

Merrick

6,969

20,323

White Pine

Brown

7,892

21,943

Morrill

7,892

21,943

Buffalo

6,969

20,323

Nance

6,969

20,323

Burt

6,503

18,868

Nemaha

6,547

19,849

Butler

6,969

20,323

Nuckolls

6,969

20,323

Cass

6,503

18,868

Otoe

6,547

19,849

Cedar

6,969

20,323

Pawnee

6,547

19,849

Chase

7,892

21,943

Perkins

7,892

21,943

Cherry

7,892

21,943

Phelps

6,969

20,323

Cheyenne

7,892

21,943

Pierce

6,969

20,323

Clay

6,969

20,323

Platte

6,969

20,323

Colfax

6,969

20,323

Polk

6,969

20,323

Cuming

6,969

20,323

Red Willow

7,892

21,943

Custer

6,969

20,323

Richardson

6,547

19,849

Dakota

6,969

20,323

Rock

6,969

20,323

Dawes

7,892

21,943

Saline

6,547

19,849

Dawson

6,969

20,323

Sarpy

6,503

18,868

Deuel

7,892

21,943

Saunders

6,503

18,868

Dixon

6,969

20,323

Scotts Bluff

7,892

21,943

2020 Average Premium Tables

-21-

New Hampshire
County

Employee- Dependent,
Only
Family, etc.

All

7,363

20,889

New Jersey
County

Employee- Dependent,
Only
Family, etc.

All

8,090

21,601

New Mexico
County

Employee- Dependent,
Only
Family, etc.

Bernalillo

6,798

18,699

Catron

8,553

23,423

Chaves

8,553

23,423

Cibola

8,553

23,423

Colfax

8,553

23,423

Hamilton

7,885

22,540

Bertie

7,967

20,483

Curry

8,553

23,423

Herkimer

7,885

22,540

Bladen

7,233

21,609

De Baca

8,553

23,423

Jefferson

7,885

22,540

Brunswick

7,474

19,121

Doña Ana

6,860

18,980

Kings

9,659

29,771

Buncombe

7,042

18,350

Eddy

8,553

23,423

Lewis

7,885

22,540

Burke

6,529

19,000

Grant

8,553

23,423

Livingston

6,941

19,847

Cabarrus

6,886

19,226

Guadalupe

8,553

23,423

Madison

7,885

22,540

Caldwell

6,529

19,000

Harding

8,553

23,423

Monroe

6,941

19,847

Camden

7,967

20,483

Hidalgo

8,553

23,423

Montgomery

7,383

21,433

Carteret

7,871

18,197

Lea

8,553

23,423

Nassau

9,224

28,140

Caswell

7,128

20,739

Lincoln

8,553

23,423

New York

9,659

29,771

Catawba

6,529

19,000

Los Alamos

8,553

23,423

Niagara

6,806

19,730

Chatham

7,128

20,739

Luna

8,553

23,423

Oneida

7,885

22,540

Cherokee

7,042

18,350

McKinley

8,553

23,423

Onondaga

7,940

22,260

Chowan

7,967

20,483

Mora

8,553

23,423

Ontario

6,941

19,847

Clay

7,042

18,350

Otero

8,553

23,423

Orange

8,882

21,464

Cleveland

7,492

20,082

Quay

8,553

23,423

Orleans

6,806

19,730

Columbus

7,474

19,121

Rio Arriba

8,553

23,423

Oswego

7,885

22,540

Craven

7,871

18,197

Roosevelt

8,553

23,423

Otsego

7,885

22,540

Cumberland

7,233

21,609

San Juan

7,018

18,909

Putnam

8,882

21,464

Currituck

7,967

20,483

San Miguel

8,553

23,423

Queens

9,659

29,771

Dare

7,871

18,197

Sandoval

6,798

18,699

Rensselaer

7,383

21,433

Davidson

7,499

20,349

Santa Fe

7,123

17,684

Richmond

9,659

29,771

Davie

7,499

20,349

Sierra

8,553

23,423

Rockland

9,659

29,771

Duplin

7,474

19,121

Socorro

8,553

23,423

Saratoga

7,383

21,433

Durham

7,128

20,739

Taos

8,553

23,423

Schenectady

7,383

21,433

Edgecombe

7,289

23,007

Torrance

6,798

18,699

Schoharie

7,383

21,433

Forsyth

7,499

20,349

Union

8,553

23,423

Schuyler

7,940

22,260

Franklin

6,923

19,540

Valencia

6,798

18,699

Seneca

6,941

19,847

Gaston

7,492

20,082

St. Lawrence

7,885

22,540

Gates

7,967

20,483

Steuben

7,940

22,260

Graham

7,042

18,350

9,224

28,140

Granville

6,736

18,464

New York
County

Employee- Dependent,
Only
Family, etc.

Suffolk
Sullivan

8,882

21,464

Greene

7,289

23,007

Albany

7,383

21,433

Tioga

7,940

22,260

Guilford

7,341

19,809

Allegany

6,806

19,730

Tompkins

7,940

22,260

Halifax

7,967

20,483

Bronx

9,659

29,771

Ulster

8,882

21,464

Harnett

7,233

21,609

Broome

7,940

22,260

Warren

7,383

21,433

Haywood

7,042

18,350

Cattaraugus

6,806

19,730

Washington

7,383

21,433

Henderson

7,042

18,350

Cayuga

7,940

22,260

Wayne

6,941

19,847

Hertford

7,967

20,483

Chautauqua

6,806

19,730

Westchester

9,659

29,771

Hoke

7,233

21,609

Chemung

7,940

22,260

Wyoming

6,806

19,730

Hyde

7,871

18,197

Chenango

7,885

22,540

Yates

6,941

19,847

Iredell

6,529

19,000

Clinton

7,885

22,540

Jackson

7,042

18,350

Columbia

7,383

21,433

Cortland

7,940

22,260

Delaware

8,882

21,464

Dutchess

8,882

Erie

North Carolina

Johnston

6,923

19,540

Jones

7,871

18,197

County

Employee- Dependent,
Only
Family, etc.

Lee

7,128

20,739

21,464

Alamance

7,128

20,739

Lenoir

7,871

18,197

6,806

19,730

Alexander

6,529

19,000

Lincoln

7,492

20,082

Essex

7,885

22,540

Alleghany

7,736

21,519

Macon

7,042

18,350

Franklin

7,885

22,540

Anson

6,886

19,226

Madison

7,042

18,350

Fulton

7,383

21,433

Ashe

7,736

21,519

Martin

7,967

20,483

Genesee

6,806

19,730

Avery

7,042

18,350

McDowell

7,042

18,350

Greene

7,383

21,433

Beaufort

7,871

18,197

Mecklenburg

6,886

19,226

-22-

2020 Average Premium Tables

Mitchell

7,042

18,350

Cavalier

7,501

19,786

Auglaize

7,480

19,589

Montgomery

9,030

19,601

Dickey

7,501

19,786

Belmont

7,496

19,458

Moore

9,030

19,601

Divide

7,501

19,786

Brown

7,363

19,533

Nash

7,289

23,007

Dunn

7,501

19,786

Butler

6,820

20,816

New Hanover

7,474

19,121

Eddy

7,501

19,786

Carroll

7,521

21,193

Northampton

7,967

20,483

Emmons

7,501

19,786

Champaign

6,829

19,411

Onslow

7,474

19,121

Foster

7,501

19,786

Clark

6,829

19,411

Orange

7,128

20,739

Golden Valley

7,501

19,786

Clermont

7,363

19,533

Pamlico

7,871

18,197

Grand Forks

7,097

18,758

Clinton

7,363

19,533

Pasquotank

7,967

20,483

Grant

7,501

19,786

Columbiana

7,489

20,468

Pender

7,474

19,121

Griggs

7,501

19,786

Coshocton

7,496

19,458

Perquimans

7,967

20,483

Hettinger

7,501

19,786

Crawford

7,128

19,831

Person

7,128

20,739

Kidder

7,501

19,786

Cuyahoga

7,530

21,580

Pitt

7,289

23,007

La Moure

7,501

19,786

Darke

6,829

19,411

Polk

7,042

18,350

Logan

7,501

19,786

Defiance

8,137

21,370

Randolph

7,341

19,809

McHenry

7,501

19,786

Delaware

6,996

22,087

Richmond

7,233

21,609

McIntosh

7,501

19,786

Erie

8,591

20,639

Robeson

7,233

21,609

McKenzie

7,501

19,786

Fairfield

6,996

22,087

Rockingham

7,341

19,809

McLean

7,501

19,786

Fayette

6,996

22,087

Rowan

6,886

19,226

Mercer

7,501

19,786

Franklin

6,996

22,087

Rutherford

7,042

18,350

Morton

6,883

18,125

Fulton

8,137

21,370

Sampson

7,233

21,609

Mountrail

7,501

19,786

Gallia

8,906

23,548

Scotland

7,233

21,609

Nelson

7,501

19,786

Geauga

7,530

21,580

Stanly

6,886

19,226

Oliver

7,501

19,786

Greene

6,829

19,411

Stokes

7,499

20,349

Pembina

7,501

19,786

Guernsey

7,496

19,458

Surry

7,499

20,349

Pierce

7,501

19,786

Hamilton

6,820

20,816

Swain

7,042

18,350

Ramsey

7,501

19,786

Hancock

7,480

19,589

Transylvania

7,042

18,350

Ransom

7,501

19,786

Hardin

7,480

19,589

Tyrrell

7,871

18,197

Renville

7,501

19,786

Harrison

7,496

19,458

Union

6,886

19,226

Richland

7,501

19,786

Henry

8,137

21,370

Vance

6,736

18,464

Rolette

7,501

19,786

Highland

7,363

19,533

Wake

6,923

19,540

Sargent

7,501

19,786

Hocking

7,051

21,428

Warren

6,736

18,464

Sheridan

7,501

19,786

Holmes

5,810

16,634

Washington

7,871

18,197

Sioux

7,501

19,786

Huron

8,591

20,639

Watauga

7,736

21,519

Slope

7,501

19,786

Jackson

8,906

23,548

Wayne

7,289

23,007

Stark

7,501

19,786

Jefferson

7,496

19,458

Wilkes

7,736

21,519

Steele

7,501

19,786

Knox

6,996

22,087

Wilson

7,289

23,007

Stutsman

7,501

19,786

Lake

7,530

21,580

Yadkin

7,499

20,349

Towner

7,501

19,786

Lawrence

8,906

23,548

Yancey

7,042

18,350

Traill

7,501

19,786

Licking

6,996

22,087

Walsh

7,501

19,786

Logan

6,996

22,087

Ward

7,501

19,786

Lorain

7,530

21,580

Wells

7,501

19,786

Lucas

8,137

21,370

Williams

7,501

19,786

Madison

6,996

22,087

Mahoning

7,489

20,468

Marion

7,654

21,747

North Dakota
County

Employee- Dependent,
Only
Family, etc.

Adams

7,501

19,786

Barnes

7,501

19,786

Benson

7,501

19,786

7,297

22,924

7,501

19,786

County

Employee- Dependent,
Only
Family, etc.

Medina

Billings

Meigs

7,051

21,428

Bottineau

7,501

19,786

Adams

7,363

19,533

Mercer

7,480

19,589

Bowman

7,501

19,786

Allen

7,480

19,589

Miami

6,829

19,411

Burke

7,501

19,786

Ashland

7,297

22,924

Monroe

7,496

19,458

Burleigh

6,883

18,125

Ashtabula

7,530

21,580

Montgomery

6,829

19,411

Cass

6,845

18,722

Athens

7,051

21,428

Morgan

7,496

19,458

2020 Average Premium Tables

Ohio

-23-

Morrow

7,654

21,747

Custer

6,658

18,162

Wagoner

6,864

18,835

Muskingum

7,496

19,458

Delaware

6,658

18,162

Washington

6,658

18,162

Noble

7,496

19,458

Dewey

6,658

18,162

Washita

6,658

18,162

Ottawa

8,591

20,639

Ellis

6,658

18,162

Woods

6,658

18,162

Paulding

7,480

19,589

Garfield

6,658

18,162

Woodward

6,658

18,162

Perry

7,496

19,458

Garvin

6,658

18,162

Pickaway

6,996

22,087

Grady

6,804

18,124

Pike

8,906

23,548

Grant

6,658

18,162

Portage

7,297

22,924

Greer

6,658

18,162

County

Employee- Dependent,
Only
Family, etc.

Preble

6,829

19,411

Harmon

6,658

18,162

Baker

8,032

18,221

6,556

19,683

Oregon

Putnam

7,480

19,589

Harper

6,658

18,162

Benton

Richland

7,128

19,831

Haskell

6,658

18,162

Clackamas

6,401

17,971

18,162

Clatsop

7,917

20,515

7,917

20,515

Ross

8,906

23,548

Hughes

6,658

Sandusky

8,591

20,639

Jackson

6,658

18,162

Columbia

Scioto

8,906

23,548

Jefferson

6,658

18,162

Coos

7,917

20,515

18,162

Crook

8,032

18,221

7,917

20,515

Seneca

8,591

20,639

Johnston

6,658

Shelby

6,829

19,411

Kay

6,658

18,162

Curry

Stark

7,521

21,193

Kingfisher

6,658

18,162

Deschutes

6,083

19,263

6,534

17,708

Summit

7,297

22,924

Kiowa

6,658

18,162

Douglas

Trumbull

7,489

20,468

Latimer

6,658

18,162

Gilliam

8,032

18,221

Tuscarawas

7,496

19,458

Le Flore

6,283

16,749

Grant

8,032

18,221

8,032

18,221

Union

6,996

22,087

Lincoln

6,804

18,124

Harney

Van Wert

7,480

19,589

Logan

6,804

18,124

Hood River

8,032

18,221

18,162

Jackson

6,534

17,708

8,032

18,221

Vinton

8,906

23,548

Love

6,658

Warren

6,820

20,816

Major

6,658

18,162

Jefferson

Washington

7,051

21,428

Marshall

6,658

18,162

Josephine

6,534

17,708

18,162

Klamath

6,083

19,263

6,083

19,263

Wayne

5,810

16,634

Mayes

6,658

Williams

8,137

21,370

McClain

6,804

18,124

Lake

Wood

8,137

21,370

McCurtain

6,658

18,162

Lane

6,556

19,683

18,162

Lincoln

7,917

20,515

6,556

19,683

Wyandot

8,591

20,639

Oklahoma

McIntosh

6,658

Murray

6,658

18,162

Linn

Muskogee

6,658

18,162

Malheur

8,032

18,221

18,162

Marion

6,316

17,110

8,032

18,221

Noble

County

Employee- Dependent,
Only
Family, etc.

Nowata

6,658

18,162

Morrow

Adair

6,658

18,162

Okfuskee

6,658

18,162

Multnomah

6,401

17,971

Alfalfa

6,658

18,162

Oklahoma

6,804

18,124

Polk

6,316

17,110

Atoka

6,658

18,162

Okmulgee

6,864

18,835

Sherman

8,032

18,221

Beaver

6,658

18,162

Osage

6,864

18,835

Tillamook

7,917

20,515

Beckham

6,658

18,162

Ottawa

6,658

18,162

Umatilla

8,032

18,221

Blaine

6,658

18,162

Pawnee

6,864

18,835

Union

8,032

18,221

Bryan

6,658

18,162

Payne

6,658

18,162

Wallowa

8,032

18,221

Caddo

6,658

18,162

Pittsburg

6,658

18,162

Wasco

8,032

18,221

Canadian

6,804

18,124

Pontotoc

6,658

18,162

Washington

6,401

17,971

Carter

6,658

18,162

18,162

Wheeler

8,032

18,221

Cherokee

6,658

18,162

Pushmataha

6,658

18,162

Yamhill

6,401

17,971

Choctaw

6,658

18,162

Roger Mills

6,658

18,162

Cimarron

6,658

18,162

Rogers

6,864

18,835

Cleveland

6,804

18,124

Seminole

6,658

18,162

Coal

6,658

18,162

Sequoyah

6,283

16,749

Comanche

6,813

16,976

Stephens

6,658

18,162

Texas

6,658

18,162

Cotton

6,658

18,162

Pottawatomie

6,658

6,658

Craig

6,658

18,162

Tillman

6,658

18,162

Creek

6,864

18,835

Tulsa

6,864

18,835

-24-

Pennsylvania
County

Employee- Dependent,
Only
Family, etc.

Adams

7,546

21,105

Allegheny

6,933

19,582

Armstrong

6,933

19,582

Beaver

6,933

19,582

2020 Average Premium Tables

Bedford

7,397

17,192

Susquehanna

7,282

19,690

McCormick

8,307

19,838

Berks

7,546

21,105

Tioga

7,282

19,690

Newberry

8,267

19,629

Blair

7,397

17,192

Union

7,272

23,760

Oconee

8,295

22,348

Bradford

7,282

19,690

Venango

6,088

17,396

Orangeburg

8,046

21,360

Bucks

7,839

22,060

Warren

6,088

17,396

Pickens

7,456

18,583

Butler

6,933

19,582

Washington

6,933

19,582

Richland

7,043

22,133

Cambria

7,397

17,192

Wayne

7,282

19,690

Saluda

8,235

19,296

Cameron

7,151

21,373

Westmoreland

6,933

19,582

Spartanburg

6,896

20,056

Carbon

7,282

19,690

Wyoming

7,282

19,690

Sumter

7,591

17,932

Centre

7,272

23,760

York

7,546

21,105

Union

6,154

17,880

Chester

7,839

22,060

Williamsburg

6,904

19,333

Clarion

6,088

17,396

York

7,775

19,145

Clearfield

7,397

17,192

Clinton

7,282

19,690

County

Employee- Dependent,
Only
Family, etc.

Columbia

7,272

23,760

All

7,859

Crawford

6,088

17,396

Cumberland

6,997

20,639

Dauphin

6,997

20,639

Delaware

7,839

22,060

Elk

7,151

21,373

Erie

6,088

17,396

Fayette

6,933

19,582

Forest

6,088

17,396

Franklin

6,997

20,639

Fulton

6,997

20,639

Greene

6,933

19,582

Huntingdon

7,397

17,192

Indiana

6,933

19,582

Jefferson

7,397

17,192

Juniata

6,997

20,639

Lackawanna

7,282

19,690

Lancaster

7,546

21,105

Lawrence

6,933

19,582

Lebanon

6,997

20,639

Lehigh

7,272

23,760

Luzerne

7,282

19,690

Lycoming

7,282

19,690

McKean

6,088

17,396

Mercer

6,088

17,396

Mifflin

7,272

23,760

Monroe

7,282

19,690

Montgomery

7,839

22,060

Montour

7,272

23,760

Northampton

7,272

23,760

Northumberland

7,272

23,760

Perry

6,997

20,639

Philadelphia

7,839

22,060

Pike

7,282

19,690

Potter

7,151

21,373

Schuylkill

7,272

23,760

Snyder

7,272

23,760

Somerset

7,397

17,192

Sullivan

7,282

19,690

2020 Average Premium Tables

Rhode Island

South Dakota

21,309

South Carolina

County

Employee- Dependent,
Only
Family, etc.

Aurora

8,300

21,803

Employee- Dependent,
Only
Family, etc.

Beadle

7,393

20,421

County

Bennett

7,311

20,126

Abbeville

7,869

20,197

Bon Homme

8,300

21,803

Aiken

7,165

18,595

Brookings

7,393

20,421

Allendale

7,395

19,173

Brown

7,393

20,421

Anderson

7,847

20,897

Brule

8,300

21,803

Bamberg

6,248

18,519

Buffalo

8,300

21,803

Barnwell

6,186

17,955

Butte

7,311

20,126

Beaufort

7,903

18,421

Campbell

7,393

20,421

Berkeley

6,651

19,824

Charles Mix

8,300

21,803

Calhoun

6,827

18,396

Clark

7,393

20,421

Charleston

7,415

19,948

Clay

7,181

20,479

Cherokee

7,033

18,443

Codington

7,393

20,421

Chester

7,762

19,226

Corson

7,311

20,126

Chesterfield

7,357

19,072

Custer

7,311

20,126

Clarendon

6,046

18,785

Davison

8,300

21,803

Colleton

7,315

18,545

Day

7,393

20,421

Darlington

8,162

19,364

Deuel

7,393

20,421

Dillon

7,495

18,148

Dewey

7,311

20,126

Dorchester

8,240

18,702

Douglas

8,300

21,803

Edgefield

6,164

17,948

Edmunds

7,393

20,421

Fairfield

7,521

19,007

Fall River

7,311

20,126

Florence

7,810

19,997

Faulk

7,393

20,421

Georgetown

7,870

18,007

Grant

7,393

20,421

Greenville

7,205

19,147

Gregory

7,311

20,126

Greenwood

6,297

17,903

Haakon

7,311

20,126

Hampton

7,877

19,097

Hamlin

7,393

20,421

Horry

7,012

21,383

Hand

8,300

21,803

Jasper

7,402

18,527

Hanson

8,300

21,803

Kershaw

8,284

20,144

Harding

7,311

20,126

Lancaster

7,718

18,674

Hughes

8,300

21,803

Laurens

7,297

18,430

Hutchinson

8,300

21,803

Lee

7,271

18,574

Hyde

8,300

21,803

Lexington

7,550

19,369

Jackson

7,311

20,126

Marion

8,331

20,373

Jerauld

8,300

21,803

Marlboro

7,669

19,206

Jones

7,311

20,126

-25-

Kingsbury

7,393

20,421

DeKalb

6,067

16,567

Robertson

6,583

18,999

Lake

7,181

20,479

Dickson

6,673

15,728

Rutherford

6,583

18,999

Lawrence

7,311

20,126

Dyer

6,825

20,883

Scott

6,173

17,996

Lincoln

7,181

20,479

Fayette

6,415

18,799

Sequatchie

6,780

18,618

Lyman

7,311

20,126

Fentress

6,067

16,567

Sevier

6,173

17,996

Marshall

7,393

20,421

Franklin

6,780

18,618

Shelby

6,415

18,799

McCook

7,181

20,479

Gibson

6,825

20,883

Smith

6,067

16,567

McPherson

7,393

20,421

Giles

6,673

15,728

Stewart

6,673

15,728

Meade

7,311

20,126

Grainger

6,173

17,996

Sullivan

5,881

18,355

Mellette

7,311

20,126

Greene

5,881

18,355

Sumner

6,583

18,999

Miner

8,300

21,803

Grundy

6,780

18,618

Tipton

6,415

18,799

Minnehaha

7,181

20,479

Hamblen

6,173

17,996

Trousdale

6,583

18,999

Moody

7,181

20,479

Hamilton

6,780

18,618

Unicoi

5,881

18,355

Pennington

7,311

20,126

Hancock

5,881

18,355

Union

6,173

17,996

Perkins

7,311

20,126

Hardeman

6,825

20,883

Van Buren

6,067

16,567

Potter

7,393

20,421

Hardin

6,825

20,883

Warren

6,067

16,567

Roberts

7,393

20,421

Hawkins

5,881

18,355

Washington

5,881

18,355

Sanborn

8,300

21,803

Haywood

6,415

18,799

Wayne

6,673

15,728

Shannon

7,311

20,126

Henderson

6,825

20,883

Weakley

6,825

20,883

Spink

7,393

20,421

Henry

6,825

20,883

White

6,067

16,567

Stanley

7,311

20,126

Hickman

6,673

15,728

Williamson

6,583

18,999

Sully

8,300

21,803

Houston

6,673

15,728

Wilson

6,583

18,999

Todd

7,311

20,126

Humphreys

6,673

15,728

Tripp

7,311

20,126

Jackson

6,067

16,567

Turner

7,181

20,479

Jefferson

6,173

17,996

Union

7,181

20,479

Johnson

5,881

18,355

County

Employee- Dependent,
Only
Family, etc.

Walworth

7,393

20,421

Knox

6,173

17,996

Anderson

7,421

18,696

7,421

18,696

Texas

Yankton

8,300

21,803

Lake

6,825

20,883

Andrews

Ziebach

7,311

20,126

Lauderdale

6,415

18,799

Angelina

7,421

18,696

15,728

Aransas

6,906

22,570

8,440

19,625

Lawrence

Tennessee
County

Employee- Dependent,
Only
Family, etc.

6,673

Lewis

6,673

15,728

Archer

Lincoln

6,673

15,728

Armstrong

9,936

22,167

17,996

Atascosa

6,835

17,544

6,840

22,358

Loudon

6,173

Anderson

6,173

17,996

Macon

6,067

16,567

Austin

Bedford

6,673

15,728

Madison

6,825

20,883

Bailey

7,421

18,696

Benton

6,825

20,883

Marion

6,780

18,618

Bandera

6,835

17,544

Bledsoe

6,780

18,618

Marshall

6,673

15,728

Bastrop

6,830

20,191

Blount

6,173

17,996

Maury

6,673

15,728

Baylor

7,421

18,696

Bradley

6,780

18,618

McMinn

6,780

18,618

Bee

7,421

18,696

Campbell

6,173

17,996

McNairy

6,825

20,883

Bell

7,339

16,416

Cannon

6,067

16,567

Meigs

6,780

18,618

Bexar

6,835

17,544

Carroll

6,825

20,883

Monroe

6,173

17,996

Blanco

7,421

18,696

Carter

5,881

18,355

Montgomery

6,583

18,999

Borden

7,421

18,696

Cheatham

6,583

18,999

15,728

Bosque

7,421

18,696

Chester

6,825

20,883

Morgan

6,173

17,996

Bowie

6,253

17,651

Claiborne

6,173

17,996

Obion

6,825

20,883

Brazoria

6,840

22,358

Clay

6,067

16,567

16,567

Brazos

6,137

19,688

Cocke

6,173

17,996

Perry

6,673

15,728

Brewster

7,421

18,696

Coffee

6,673

15,728

Pickett

6,067

16,567

Briscoe

7,421

18,696

Crockett

6,825

20,883

18,618

Brooks

7,421

18,696

7,421

18,696

Moore

Overton

Polk

6,673

6,067

6,780

Cumberland

6,067

16,567

Putnam

6,067

16,567

Brown

Davidson

6,583

18,999

Rhea

6,780

18,618

Burleson

6,137

19,688

Decatur

6,825

20,883

17,996

Burnet

7,421

18,696

Roane

6,173

-26-

2020 Average Premium Tables

Caldwell

6,830

20,191

Freestone

7,421

18,696

Kimble

7,421

18,696

Calhoun

7,019

19,083

Frio

7,421

18,696

King

7,421

18,696

Callahan

7,399

19,412

Gaines

7,421

18,696

Kinney

7,421

18,696

Cameron

6,716

15,988

Galveston

6,840

22,358

Kleberg

7,421

18,696

Camp

7,421

18,696

Garza

7,421

18,696

Knox

7,421

18,696

Carson

9,936

22,167

Gillespie

7,421

18,696

Lamar

7,421

18,696

Cass

7,421

18,696

Glasscock

7,421

18,696

Lamb

7,421

18,696

Castro

7,421

18,696

Goliad

7,019

19,083

Lampasas

7,339

16,416

Chambers

6,840

22,358

Gonzales

7,421

18,696

LaSalle

7,421

18,696

Cherokee

7,421

18,696

Gray

7,421

18,696

Lavaca

7,421

18,696

Childress

7,421

18,696

Grayson

7,707

18,670

Lee

7,421

18,696

Clay

8,440

19,625

Gregg

6,073

22,987

Leon

7,421

18,696

Cochran

7,421

18,696

Grimes

7,421

18,696

Liberty

6,840

22,358

Coke

7,421

18,696

Guadalupe

6,835

17,544

Limestone

7,421

18,696

Coleman

7,421

18,696

Hale

7,421

18,696

Lipscomb

7,421

18,696

Collin

7,839

22,047

Hall

7,421

18,696

Live Oak

7,421

18,696

Collingsworth

7,421

18,696

Hamilton

7,421

18,696

Llano

7,421

18,696

Colorado

7,421

18,696

Hansford

7,421

18,696

Loving

7,421

18,696

Comal

6,835

17,544

Hardeman

7,421

18,696

Lubbock

6,117

20,071

Comanche

7,421

18,696

Hardin

7,682

22,480

Lynn

7,421

18,696

Concho

7,421

18,696

Harris

6,840

22,358

Madison

7,421

18,696

Cooke

7,421

18,696

Harrison

7,421

18,696

Marion

7,421

18,696

Coryell

7,339

16,416

Hartley

7,421

18,696

Martin

7,421

18,696

Cottle

7,421

18,696

Haskell

7,421

18,696

Mason

7,421

18,696

Crane

7,421

18,696

Hays

6,830

20,191

Matagorda

7,421

18,696

Crockett

7,421

18,696

Hemphill

7,421

18,696

Maverick

7,421

18,696

Crosby

6,117

20,071

Henderson

7,421

18,696

McCulloch

7,421

18,696

Culberson

7,421

18,696

Hidalgo

7,301

19,219

McLennan

5,624

15,474

Dallam

7,421

18,696

Hill

7,421

18,696

McMullen

7,421

18,696

Dallas

7,839

22,047

Hockley

7,421

18,696

Medina

6,835

17,544

Dawson

7,421

18,696

Hood

7,421

18,696

Menard

7,421

18,696

Deaf Smith

7,421

18,696

Hopkins

7,421

18,696

Midland

6,019

18,708

Delta

7,839

22,047

Houston

7,421

18,696

Milam

7,421

18,696

Denton

7,839

22,047

Howard

7,421

18,696

Mills

7,421

18,696

DeWitt

7,421

18,696

Hudspeth

7,421

18,696

Mitchell

7,421

18,696

Dickens

7,421

18,696

Hunt

7,839

22,047

Montague

7,421

18,696

Dimmit

7,421

18,696

Hutchinson

7,421

18,696

Montgomery

6,840

22,358

Donley

7,421

18,696

Irion

8,955

18,365

Moore

7,421

18,696

Duval

7,421

18,696

Jack

7,421

18,696

Morris

7,421

18,696

Eastland

7,421

18,696

Jackson

7,421

18,696

Motley

7,421

18,696

Ector

8,911

19,166

Jasper

7,421

18,696

Nacogdoches

7,421

18,696

Edwards

7,421

18,696

Jeff Davis

7,421

18,696

Navarro

7,421

18,696

El Paso

7,550

16,149

Jefferson

7,682

22,480

Newton

7,421

18,696

Ellis

7,839

22,047

Jim Hogg

7,421

18,696

Nolan

7,421

18,696

Erath

7,421

18,696

Jim Wells

7,421

18,696

Nueces

6,906

22,570

Falls

7,421

18,696

Johnson

7,839

22,047

Ochiltree

7,421

18,696

Fannin

7,421

18,696

Jones

7,399

19,412

Oldham

7,421

18,696

Fayette

7,421

18,696

Karnes

7,421

18,696

Orange

7,682

22,480

Fisher

7,421

18,696

Kaufman

7,839

22,047

Palo Pinto

7,421

18,696

Floyd

7,421

18,696

Kendall

6,835

17,544

Panola

7,421

18,696

Foard

7,421

18,696

Kenedy

7,421

18,696

Parker

7,839

22,047

Fort Bend

6,840

22,358

Kent

7,421

18,696

Parmer

7,421

18,696

Franklin

7,421

18,696

Kerr

7,421

18,696

Pecos

7,421

18,696

2020 Average Premium Tables

-27-

Virginia

Polk

7,421

18,696

Webb

7,455

20,274

Potter

9,936

22,167

Wharton

7,421

18,696

Presidio

7,421

18,696

Wheeler

7,421

18,696

County

Employee- Dependent,
Only
Family, etc.

Rains

7,421

18,696

Wichita

8,440

19,625

Accomack

7,346

19,191

Randall

9,936

22,167

Wilbarger

7,421

18,696

Albemarle

7,584

20,604

Reagan

7,421

18,696

Willacy

7,421

18,696

Alexandria City

7,542

23,327

7,346

19,191

Real

7,421

18,696

Williamson

6,830

20,191

Alleghany

Red River

7,421

18,696

Wilson

6,835

17,544

Amelia

7,131

22,408

Reeves

7,421

18,696

Winkler

7,421

18,696

Amherst

6,596

18,601

6,596

18,601

Refugio

7,421

18,696

Wise

7,839

22,047

Appomattox

Roberts

7,421

18,696

Wood

7,421

18,696

Arlington

7,542

23,327

Robertson

6,137

19,688

Yoakum

7,421

18,696

Augusta

7,346

19,191

7,346

19,191

Rockwall

7,839

22,047

Young

7,421

18,696

Bath

Runnels

7,421

18,696

Zapata

7,421

18,696

Bedford

6,596

18,601

Rusk

6,073

22,987

Zavala

7,421

18,696

Bedford City

6,596

18,601

Bland

7,346

19,191

Botetourt

7,502

22,016

7,629

17,414

Sabine

7,421

18,696

San Augustine

7,421

18,696

San Jacinto

6,840

22,358

Utah
Employee- Dependent,
Only
Family, etc.

Bristol City

San Patricio

6,906

22,570

County

Brunswick

7,346

19,191

San Saba

7,421

18,696

Beaver

6,852

19,272

Buchanan

7,346

19,191

Schleicher

7,421

18,696

Box Elder

6,057

16,370

Buckingham

7,346

19,191

6,974

18,788

Scurry

7,421

18,696

Cache

Buena Vista City

7,346

19,191

Shackelford

7,421

18,696

Carbon

6,852

19,272

Campbell

6,596

18,601

18,696

Daggett

6,852

19,272

Caroline

7,131

22,408

5,884

17,953

Shelby

7,421

Sherman

7,421

18,696

Davis

Carroll

7,346

19,191

Smith

6,904

22,893

Duchesne

6,852

19,272

Charles City

7,131

22,408

18,696

Emery

6,852

19,272

Charlotte

7,346

19,191

6,852

19,272

Somervell

7,421

Starr

7,421

18,696

Garfield

Charlottesville City

7,584

20,604

Stephens

7,421

18,696

Grand

6,852

19,272

Chesapeake City

7,659

21,119

18,696

Iron

7,759

16,800

Chesterfield

7,131

22,408

6,852

19,272

Sterling

7,421

Stonewall

7,421

18,696

Juab

Clarke

7,542

23,327

Sutton

7,421

18,696

Kane

6,852

19,272

Colonial Heights City

7,131

22,408

18,696

Millard

6,852

19,272

Covington City

7,346

19,191

6,057

16,370

Swisher

7,421

Tarrant

7,839

22,047

Morgan

Craig

7,502

22,016

Taylor

7,399

19,412

Piute

6,852

19,272

Culpeper

7,346

19,191

6,974

18,788

Terrell

7,421

18,696

Rich

Cumberland

7,131

22,408

Terry

7,421

18,696

Salt Lake

5,884

17,953

Danville City

8,956

21,176

Throckmorton

7,421

18,696

San Juan

6,852

19,272

Dickenson

7,346

19,191

6,852

19,272

Titus

7,421

18,696

Sanpete

Dinwiddie

7,131

22,408

Tom Green

8,955

18,365

Sevier

6,852

19,272

Emporia City

7,346

19,191

Travis

6,830

20,191

Summit

5,884

17,953

Essex

7,346

19,191

5,884

17,953

Trinity

7,421

18,696

Tooele

Fairfax

7,542

23,327

Tyler

7,421

18,696

Uintah

6,852

19,272

Fairfax City

7,542

23,327

22,987

Utah

5,501

17,342

Falls Church City

7,542

23,327

5,884

17,953

Upshur

6,073

Upton

7,421

18,696

Wasatch

Fauquier

7,542

23,327

Uvalde

7,421

18,696

Washington

7,759

16,800

Floyd

7,346

19,191

18,696

Wayne

6,852

19,272

Fluvanna

7,584

20,604

Weber

6,057

16,370

Franklin

7,502

22,016

Franklin City

7,346

19,191

Frederick

7,139

19,737

Fredericksburg City

7,542

23,327

Galax City

7,346

19,191

Giles

6,887

20,730

Val Verde

7,421

Van Zandt

7,421

18,696

Victoria

7,019

19,083

Walker

7,421

18,696

Waller

6,840

22,358

Ward

7,421

18,696

Washington

7,421

18,696

Vermont
County

Employee- Dependent,
Only
Family, etc.

All

7,516

-28-

20,543

2020 Average Premium Tables

Gloucester

7,659

21,119

Radford City

6,887

20,730

Kittitas

6,501

18,564

Goochland

7,131

22,408

Rappahannock

7,346

19,191

Klickitat

6,469

18,452

Grayson

7,346

19,191

Richmond

7,346

19,191

Lewis

6,985

19,530

Greene

7,584

20,604

Richmond City

7,131

22,408

Lincoln

5,842

16,070

Greensville

7,346

19,191

Roanoke

7,502

22,016

Mason

6,985

19,530

Halifax

7,346

19,191

Roanoke City

7,502

22,016

Okanogan

6,501

18,564

Hampton City

7,659

21,119

Rockbridge

7,346

19,191

Pacific

6,985

19,530

Hanover

7,131

22,408

Rockingham

6,958

21,742

Pend Oreille

5,842

16,070

Harrisonburg City

6,958

21,742

Russell

7,346

19,191

Pierce

6,985

19,530

Henrico

7,131

22,408

Salem City

7,502

22,016

San Juan

6,985

19,530

Henry

7,346

19,191

Scott

7,629

17,414

Skagit

6,985

19,530

Highland

7,346

19,191

Shenandoah

7,346

19,191

Skamania

6,469

18,452

Hopewell City

7,131

22,408

Smyth

7,346

19,191

Snohomish

6,985

19,530

Isle of Wight

7,659

21,119

Southampton

7,346

19,191

Spokane

5,842

16,070

James City

7,659

21,119

Spotsylvania

7,542

23,327

Stevens

5,842

16,070

King and Queen

7,131

22,408

Stafford

7,542

23,327

Thurston

6,985

19,530

King George

7,346

19,191

Staunton City

7,346

19,191

Wahkiakum

6,985

19,530

King William

7,131

22,408

Suffolk City

7,659

21,119

Walla Walla

6,501

18,564

Lancaster

7,346

19,191

Surry

7,659

21,119

Whatcom

6,985

19,530

Lee

7,346

19,191

Sussex

7,131

22,408

Whitman

6,501

18,564

Lexington City

7,346

19,191

Tazewell

7,346

19,191

Yakima

6,501

18,564

Loudoun

7,542

23,327

Virginia Beach City

7,659

21,119

Louisa

7,131

22,408

Warren

7,542

23,327

Lunenburg

7,346

19,191

Washington

7,629

17,414

Lynchburg City

6,596

18,601

Waynesboro City

7,346

19,191

County

Employee- Dependent,
Only
Family, etc.

Madison

7,346

19,191

Westmoreland

7,346

19,191

Barbour

8,041

17,908

21,119

Berkeley

7,226

18,930

7,779

22,008

Manassas City

7,542

23,327

Williamsburg City

7,659

West Virginia

Manassas Park City

7,542

23,327

Winchester City

7,139

19,737

Boone

Martinsville City

7,346

19,191

Wise

7,346

19,191

Braxton

7,916

20,797

19,191

Brooke

7,541

19,840

21,119

Cabell

6,855

18,411

Calhoun

7,916

20,797

Clay

7,916

20,797

Doddridge

6,995

17,518

Mathews

7,659

21,119

Mecklenburg

7,346

19,191

Middlesex

7,346

19,191

Montgomery

6,887

20,730

Wythe
York

7,346
7,659

Washington

Nelson

7,584

20,604

New Kent

7,131

22,408

County

Employee- Dependent,
Only
Family, etc.

Fayette

7,916

20,797

6,501

18,564

Gilmer

6,995

17,518

Newport News City

7,659

21,119

Adams

Norfolk City

7,659

21,119

Asotin

6,501

18,564

Grant

6,607

17,760

Northampton

7,346

19,191

Benton

6,501

18,564

Greenbrier

7,916

20,797

6,501

18,564

Hampshire

6,607

17,760

Northumberland

7,346

19,191

Chelan

Norton City

7,346

19,191

Clallam

6,985

19,530

Hancock

7,541

19,840

Nottoway

7,346

19,191

Clark

6,469

18,452

Hardy

6,607

17,760

6,501

18,564

Harrison

8,041

17,908

Orange

7,346

19,191

Columbia

Page

7,346

19,191

Cowlitz

6,985

19,530

Jackson

8,689

20,180

19,191

Douglas

6,501

18,564

Jefferson

7,226

18,930

5,842

16,070

Kanawha

8,584

19,499

Patrick

7,346

Petersburg City

7,131

22,408

Ferry

Pittsylvania

8,956

21,176

Franklin

6,501

18,564

Lewis

6,995

17,518

21,119

Garfield

6,501

18,564

Lincoln

7,779

22,008

6,501

18,564

Logan

7,779

22,008

Poquoson

7,659

Portsmouth City

7,659

21,119

Grant

Powhatan

7,131

22,408

Grays Harbor

6,985

19,530

Marion

6,995

17,518

19,191

Island

6,985

19,530

Marshall

7,541

19,840

6,985

19,530

Mason

6,855

18,411

Prince Edward

7,346

Prince George

7,131

22,408

Jefferson

Prince William

7,542

23,327

King

6,728

20,561

McDowell

7,779

22,008

20,730

Kitsap

6,985

19,530

Mercer

7,406

20,390

Pulaski

6,887

2020 Average Premium Tables

-29-

Mineral

6,607

17,760

Dodge

6,376

18,113

Sawyer

7,468

21,934

Mingo

7,779

22,008

Door

6,295

19,098

Shawano

6,295

19,098

Monongalia

6,995

17,518

Douglas

7,468

21,934

Sheboygan

6,376

18,113

Monroe

7,406

20,390

Dunn

8,268

21,526

St. Croix

8,316

19,516

Morgan

6,607

17,760

Eau Claire

8,268

21,526

Taylor

7,523

19,196

Nicholas

7,916

20,797

Florence

6,621

18,403

Trempealeau

6,922

19,611

Ohio

7,541

19,840

Fond du Lac

6,376

18,113

Vernon

8,132

20,925

Pendleton

6,607

17,760

Forest

6,621

18,403

Vilas

6,621

18,403

Pleasants

8,689

20,180

Grant

8,132

20,925

Walworth

6,843

23,239

Pocahontas

8,041

17,908

Green

6,843

23,239

Washburn

7,468

21,934

Preston

8,041

17,908

Green Lake

5,971

22,364

Washington

6,775

19,038

Putnam

6,855

18,411

Iowa

8,132

20,925

Waukesha

6,775

19,038

Raleigh

7,406

20,390

Iron

6,621

18,403

Waupaca

6,376

18,113

Randolph

8,041

17,908

Jackson

6,922

19,611

Waushara

6,376

18,113

Ritchie

8,689

20,180

Jefferson

6,843

23,239

Winnebago

6,376

18,113

Roane

7,916

20,797

Juneau

5,971

22,364

Wood

7,426

21,396

Summers

7,406

20,390

Kenosha

7,113

21,248

Taylor

8,041

17,908

Kewaunee

6,295

19,098

Tucker

8,041

17,908

La Crosse

6,922

19,611

Tyler

8,689

20,180

Lafayette

8,132

20,925

County

Employee- Dependent,
Only
Family, etc.

Upshur

8,041

17,908

Langlade

6,621

18,403

Albany

8,074

21,196

8,074

21,196

Wyoming

Wayne

6,855

18,411

Lincoln

7,426

21,396

Big Horn

Webster

8,041

17,908

Manitowoc

6,295

19,098

Campbell

8,074

21,196

21,396

Carbon

8,074

21,196

8,074

21,196

Wetzel

6,995

17,518

Marathon

7,426

Wirt

8,689

20,180

Marinette

6,295

19,098

Converse

Wood

8,689

20,180

Marquette

5,971

22,364

Crook

8,074

21,196

19,098

Fremont

8,074

21,196

8,074

21,196

Wyoming

7,779

22,008

Wisconsin

Menomonee

6,295

Milwaukee

6,972

22,831

Goshen

Monroe

6,922

19,611

Hot Springs

8,074

21,196

19,098

Johnson

8,074

21,196

7,803

20,476

Employee- Dependent,
Only
Family, etc.

Oconto

County

Oneida

6,621

18,403

Laramie

Adams

5,971

22,364

Outagamie

6,376

18,113

Lincoln

8,074

21,196

Ashland

7,468

21,934

19,038

Natrona

7,514

20,850

8,074

21,196

Ozaukee

6,295

6,775

Barron

7,523

19,196

Pepin

8,268

21,526

Niobrara

Bayfield

7,468

21,934

Pierce

8,316

19,516

Park

8,074

21,196

Brown

6,295

19,098

Polk

8,316

19,516

Platte

8,074

21,196

Buffalo

6,922

19,611

Portage

7,426

21,396

Sheridan

8,074

21,196

Burnett

7,468

21,934

Price

7,523

19,196

Sublette

8,074

21,196

Calumet

6,376

18,113

Racine

7,113

21,248

Sweetwater

8,074

21,196

Chippewa

8,268

21,526

Richland

5,971

22,364

Teton

8,074

21,196

Clark

7,523

19,196

Rock

6,843

23,239

Uinta

8,074

21,196

Columbia

6,843

23,239

Rusk

7,523

19,196

Washakie

8,074

21,196

Crawford

8,132

20,925

Sauk

5,971

22,364

Weston

8,074

21,196

Dane

6,763

20,936

-30-

2020 Average Premium Tables


File Typeapplication/pdf
File Title2020 Instructions for Form 8941
SubjectInstructions for Form 8941, Credit for Small Employer Health Insurance Premiums
AuthorW:CAR:MP:FP
File Modified2020-12-15
File Created2020-11-16

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