8941 Instructions for Form 8941

U.S. Business Income Tax Return

i8941--2022-00-00

OMB: 1545-0123

Document [pdf]
Download: pdf | pdf
2022

Instructions for Form 8941

Department of the Treasury
Internal Revenue Service

Credit for Small Employer Health Insurance Premiums
Partnerships, S corporations, cooperatives,

Section references are to the Internal Revenue Code
unless otherwise noted.

TIP estates, trusts, and tax-exempt eligible small

Future Developments

For the latest information about developments related to
Form 8941 and its instructions, such as legislation
enacted after they were published, go to IRS.gov/
Form8941.

Reminder
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 later) use Form 8941 to
figure the credit for small employer health insurance
premiums for tax years beginning after 2009. For tax
years beginning after 2013, the credit is only available for
a 2-consecutive-tax-year credit period. The maximum
credit is generally a percentage of premiums the employer
paid during the tax year for certain health insurance
coverage the employer provided to certain employees
enrolled in a qualified health plan offered through a Small
Business Health Options Program (SHOP) Marketplace.
But the credit may be reduced by limitations based on the
employer’s full-time equivalent employees, average
annual wages, adjusted average premiums, and state
premium subsidies and tax credits.
For information about insurance plans offered

TIP through a SHOP Marketplace, visit
Healthcare.gov.

For tax-exempt eligible small employers, the
maximum credit is 35% of premiums paid, is limited to the
amount of certain payroll taxes paid, and is claimed as a
refundable credit on Form 990-T, Exempt Organization
Business Income Tax Return. A tax-exempt eligible small
employer is an eligible small employer described in
section 501(c) that is exempt from taxation under section
501(a). A tax-exempt employer not described in section
501(c) is generally not eligible to claim this credit.
However, a tax-exempt farmers’ cooperative subject to
tax under section 1381 may be able to claim the credit as
a general business credit, as discussed next.
For all other eligible small employers, the maximum
credit is 50% of premiums paid 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.
Nov 17, 2022

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 who 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.

!

3. You paid average annual wages for the tax year of
less than $58,000 per FTE. For details, see Worksheets
1 and 3.

Cat. No. 55222U

If you had more than 10 FTEs and average
annual wages of more than $28,000, 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 $58,000.

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.
Dependent coverage. Dependent coverage is generally
coverage offered separately to an individual who is or may
become eligible for coverage under the terms of a group
health plan because of a relationship to a
participant-employee, whether or not a dependent of the
participant-employee. Dependent coverage doesn’t
include coverage, such as family coverage, which
includes coverage of the participant-employee. If you pay
part or all of the cost of an employee’s dependent
coverage, use the amount you paid to figure your
employer premiums paid.

No more than one Form 8941 can be filed with a
TIP tax return, unless the exception described in
Example 2 below applies.
Example 1. You’re a sole proprietor with two separate
businesses and you file a separate Schedule C (Form
1040) 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
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

Credit Period

For tax years beginning after 2013, the credit period
during which the credit can be claimed is a
2-consecutive-tax-year period beginning with the first tax
year in which:
• An eligible small employer (or any predecessor) files an
income tax return with an attached Form 8941 with line A
checked “Yes” and a positive amount on line 12, or
• A tax-exempt eligible small employer (or any
predecessor) files Form 990-T with an attached Form
8941 with line A checked “Yes” and a positive amount on
line 12.

Employer Premiums Paid

Only premiums you paid for health insurance coverage
under a qualifying arrangement (discussed later) for
individuals considered employees are counted when
figuring your credit.
-2-

Instructions for Form 8941 (2022)

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.

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
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
Instructions for Form 8941 (2022)

Arrangements with list billing and other tiers of coverage. An arrangement that requires you to pay a
separate premium for each employee based on age or
other factors (list billing) that provides other tiers of
coverage can be a qualifying arrangement even if it
requires you to pay a uniform percentage that is less than
50% of the premium cost for some employees. It is a
qualifying arrangement (assuming employee-only
coverage is the least expensive tier of coverage) if it
-3-

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.

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).

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 2022, 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 2022.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2022.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2022.

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
employer premiums paid, and although a state premium
subsidy paid directly to an insurance provider is treated as
an employer premium you paid, the amount of your credit
can’t be more than your net premium payments.

Answer “Yes” if one of the following applies.
• You paid premiums for employee health insurance
coverage you provided through a SHOP Marketplace or
through a direct enrollment process, if available in your
state.

Line A

-4-

Instructions for Form 8941 (2022)

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

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

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.

(a)
Individuals
Considered
Employees

(b)
Employee
Hours of
Service

(c)
Employee
Wages
Paid

 1.

Waiver for Hawaii. Hawaii has received a 5-year State
Innovation Waiver under section 1332 of the Affordable
Care Act that has been extended for 5 more years.
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.

 2.
 3.
 4.
 5.
 6.

Exception for eligible small employers in certain
counties. For calendar year 2022, 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 2022 if they
properly claimed the credit under section 45R for all or
part of 2021. For details, see Notice 2018-27, 2018-20,
I.R.B. 580, available at IRS.gov/irb/
2018-20_IRB#NOT-2018-27.

 7.
 8.
 9.
10.
11.
12.
13.
14.

To see whether a particular county has coverage

15.

TIP available through a SHOP Exchange for 2022 and

16.

beyond, go to Healthcare.gov/small-business and
enter “plans and prices” in the search box.

17.
18.

Line C

19.

Answer “Yes” if a tax return you (or any predecessor) filed
for a tax year beginning after 2013 and before 2021
included a Form 8941 with line A checked “Yes” and
line 12 showing a positive amount. For more information,
see Credit Period, earlier.

20.
21.
22.
23.

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.

24.
25.
Totals:

Column (a), Individuals Considered
Employees
Enter the name or other identifying information for all
individuals considered employees for purposes of this
credit.

In general, all employees who perform services for you
during the tax year are taken into account in determining
your FTEs, average annual wages, and premiums paid.
Rules that apply to certain types of employees are
discussed below.
Instructions for Form 8941 (2022)

-5-

discussed above. A sole proprietor must include both
business and nonbusiness employees to determine FTEs,
average annual wages, and premiums paid.

Excluded employees. The following individuals aren’t
considered employees when you figure this credit. Hours
and wages of these employees and premiums paid for
them aren’t counted when you figure your credit.
• The owner of a sole proprietorship.
• A partner in a partnership.
• A shareholder who owns (after applying the section 318
constructive ownership rules) more than 2% of an S
corporation.
• A shareholder who owns (after applying the section 318
constructive ownership rules) more than 5% of the
outstanding stock or stock possessing more than 5% of
the total combined voting power of all stock of a
corporation that isn’t an S corporation.
• A person who owns more than 5% of the capital or
profits interest in any other business that isn’t a
corporation.
• Family members or a member of the household who
isn’t a family member but qualifies as a dependent on the
individual income tax return of a person listed above.
Family members include a child (or descendant of a
child), a sibling or step-sibling, a parent (or ancestor of a
parent), a step-parent, a niece or nephew, an aunt or
uncle, or a son-in-law, daughter-in-law, father-in-law,
mother-in-law, brother-in-law, or sister-in-law. A spouse of
any owner or family member listed above is also
considered a family member for this purpose.

Ministers. A minister performing services in the exercise
of the minister’s 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 the
employee does all the following.
• Provides services to you under an agreement between
you and a leasing organization.
• Has performed services for you (or for you and a
related person) substantially full time for at least 1 year.
• Performs services under your primary direction or
control.
But don’t use hours, wages, or premiums paid with
respect to the initial year of service on which leased
employee status is based.
Seasonal employees. Employees who perform labor or
services on a seasonal basis and perform labor or
services for you 120 or fewer days during the tax year
aren’t considered employees in determining FTEs and
average annual wages. But premiums paid on their behalf
are counted in determining the amount of the credit.
Seasonal workers include retail workers employed
exclusively during holiday seasons. Seasonal workers
also include workers employed exclusively during the
summer.

Column (c), Employee Wages Paid

!

CAUTION

Complete Worksheet 2 before you complete
column (c) of Worksheet 1. Do not complete
column (c) if Worksheet 2, line 3, is 25 or more.

Enter the total wages paid for the tax year for each
employee listed in column (a). But enter -0- for seasonal
employees who worked 120 or fewer days during the tax
year.

Household and other nonbusiness employees.
Household employees and other employees who aren’t
performing services in your trade or business are
considered employees if they otherwise qualify, as
-6-

Instructions for Form 8941 (2022)

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 $28,000 for the tax year. If you paid average
annual wages of $58,000 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
this number on Form 8941, line 2 . . .
3.

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 (2022)

-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 2022, 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 $28,000)

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 $28,700 from
line 3 . . . . . . . . . . . . . . . . . .

4.

5. Divide line 4 by $28,700. 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 (2022)

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 2022.
• Medicare taxes the tax-exempt employer was required
to withhold from employees’ wages in calendar year 2022.
• Medicare taxes the tax-exempt employer was required
to pay for calendar year 2022.

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 (2022)

-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 2022.
Alabama

Limestone

7,165

23,301

Petersburg

11,771

28,522

Lowndes

8,391

23,453

Prince of Wales-Hyder 11,771

28,522

Macon

7,241

20,533

Sitka

11,771

28,522

Madison

7,165

23,301

Skagway

11,771

28,522

Marengo

7,241

20,533

Southeast Fairbanks

12,011

27,855

Marion

7,241

20,533

Valdez Cordova

11,303

28,132

7,241

20,533

Wade Hampton

12,011

27,855

Wrangell City and
Borough

11,771

28,522

Yakutat

12,011

27,855

Yukon Koyukuk

12,011

27,855

County

Employee- Dependent,
Only
Family, etc.

Marshall
Mobile

7,468

22,163

Autauga

8,391

23,453

Monroe

7,241

20,533

Baldwin

7,241

20,533

Montgomery

8,391

23,453

Barbour

7,241

20,533

Morgan

7,893

19,596

Bibb

6,892

22,250

Perry

7,241

20,533

Blount

6,892

22,250

Pickens

7,241

20,533

Bullock

7,241

20,533

Pike

7,241

20,533

Butler

7,241

20,533

Randolph

7,241

20,533

Calhoun

6,836

20,924

Russell

7,210

21,092

Chambers

7,241

20,533

Shelby

6,892

22,250

Cherokee

7,241

20,533

St. Clair

6,892

22,250

Chilton

6,892

22,250

Sumter

7,241

20,533

Choctaw

7,241

20,533

Talladega

7,241

20,533

Clarke

7,241

20,533

Tallapoosa

7,241

20,533

Clay

7,241

20,533

Tuscaloosa

7,665

21,879

Cleburne

7,241

20,533

Walker

6,892

22,250

Coffee

7,241

20,533

Washington

7,241

20,533

Colbert

8,701

22,158

Wilcox

7,241

20,533

Conecuh

7,241

20,533

Winston

7,241

20,533

Coosa

7,241

20,533

Covington

7,241

20,533

Crenshaw

7,241

20,533

Cullman

7,241

20,533

County

Employee- Dependent,
Only
Family, etc.

Dale

7,241

20,533

Aleutians East

12,011

27,855

Dallas

7,241

20,533

Aleutians West

12,011

27,855

DeKalb

7,241

20,533

Anchorage

11,303

28,132

Elmore

8,391

23,453

Bethel

11,303

28,132

Escambia

7,241

20,533

Bristol Bay

12,011

27,855

Etowah

6,539

22,226

Denali

12,011

27,855

Fayette

7,241

20,533

Dillingham

11,303

28,132

Franklin

7,241

20,533

Fairbanks North Star

12,011

27,855

Geneva

7,505

22,014

Haines

11,771

28,522

Greene

7,665

21,879

Hoonah-Angoon

11,771

28,522

Hale

7,665

21,879

Juneau

11,771

28,522

Henry

7,505

22,014

Kenai Peninsula

12,011

27,855

Houston

7,505

22,014

Ketchikan Gateway

11,771

28,522

Jackson

7,241

20,533

Kodiak Island

12,011

27,855

Jefferson

6,892

22,250

Lake and Peninsula

12,011

27,855

Lamar

7,241

20,533

Matanuska Susitna

12,011

27,855

Lauderdale

8,701

22,158

Nome

12,011

27,855

Lawrence

7,893

19,596

North Slope

12,011

27,855

Lee

6,396

18,677

Northwest Arctic

12,011

27,855

Alaska

-10-

Arizona
County

Employee- Dependent,
Only
Family, etc.

Apache

8,205

23,802

Cochise

7,086

21,495

Coconino

8,205

23,802

Gila

7,189

20,592

Graham

7,086

21,495

Greenlee

7,086

21,495

La Paz

8,893

24,548

Maricopa

7,176

22,558

Mohave

8,205

23,802

Navajo

8,205

23,802

Pima

7,513

21,227

Pinal

7,189

20,592

Santa Cruz

7,513

21,227

Yavapai

7,321

21,670

Yuma

8,893

24,548

Arkansas
County

Employee- Dependent,
Only
Family, etc.

Arkansas

7,069

16,975

Ashley

7,069

16,975

Baxter

6,721

21,429

Benton

6,721

21,429

Boone

6,721

21,429

Bradley

7,069

16,975

Calhoun

7,009

23,029

Carroll

6,721

21,429

Chicot

7,069

16,975

Clark

5,177

18,872

Clay

6,792

21,560

Cleburne

6,353

17,802

Cleveland

7,069

16,975

Columbia

7,009

23,029

Conway

6,353

17,802

2022 Average Premium Tables

Craighead

6,792

21,560

Stone

6,792

21,560

Santa Clara

9,709

28,911

Crawford

6,120

21,788

Union

7,009

23,029

Santa Cruz

9,395

26,386

Crittenden

6,792

21,560

Van Buren

6,353

17,802

Shasta

9,825

23,668

Cross

6,792

21,560

Washington

6,721

21,429

Sierra

9,825

23,668

Dallas

7,069

16,975

White

6,353

17,802

Siskiyou

9,825

23,668

Desha

7,069

16,975

Woodruff

6,792

21,560

Solano

8,407

22,859

Drew

7,069

16,975

Yell

6,353

17,802

Sonoma

8,407

22,859

Faulkner

6,353

17,802

Stanislaus

9,008

24,693

Franklin

6,120

21,788

Sutter

9,825

23,668

Fulton

6,792

21,560

9,825

23,668

5,177

18,872

County

Employee- Dependent,
Only
Family, etc.

Tehama

Garland

Trinity

9,825

23,668

Grant

6,353

17,802

Alameda

9,991

26,876

Tulare

9,008

24,693

9,825

23,668

California

Greene

6,792

21,560

Alpine

Tuolumne

9,825

23,668

Hempstead

7,009

23,029

Amador

9,825

23,668

Ventura

8,551

25,169

Hot Spring

5,177

18,872

Butte

9,825

23,668

Yolo

8,099

24,093

9,825

23,668

Yuba

9,825

23,668

Howard

7,009

23,029

Calaveras

Independence

6,792

21,560

Colusa

9,825

23,668

Izard

6,792

21,560

Contra Costa

9,461

26,914

Jackson

6,792

21,560

Del Norte

9,825

23,668

Jefferson

7,069

16,975

El Dorado

8,099

24,093

County

Employee- Dependent,
Only
Family, etc.

Johnson

6,120

21,788

Fresno

8,250

25,788

Adams

7,411

21,656

9,825

23,668

Alamosa

8,633

23,653

Colorado

Lafayette

7,009

23,029

Glenn

Lawrence

6,792

21,560

Humboldt

9,825

23,668

Arapahoe

7,411

21,656

16,975

Imperial

7,920

22,422

Archuleta

8,143

24,827

7,920

22,422

Baca

8,633

23,653

Lee

7,069

Lincoln

7,069

16,975

Inyo

Little River

7,009

23,029

Kern

8,576

20,242

Bent

8,633

23,653

21,788

Kings

8,250

25,788

Boulder

7,775

22,089

9,825

23,668

Broomfield

7,411

21,656

Logan

6,120

Lonoke

6,353

17,802

Lake

Madison

6,721

21,429

Lassen

9,825

23,668

Chaffee

8,633

23,653

21,429

Los Angeles

8,516

24,150

Cheyenne

8,633

23,653

8,250

25,788

Clear Creek

7,411

21,656

Marion

6,721

Miller

7,009

23,029

Madera

Mississippi

6,792

21,560

Marin

8,407

22,859

Conejos

8,633

23,653

16,975

Mariposa

9,008

24,693

Costilla

8,633

23,653

9,825

23,668

Crowley

8,633

23,653

Monroe

7,069

Montgomery

5,177

18,872

Mendocino

Nevada

7,009

23,029

Merced

9,008

24,693

Custer

8,633

23,653

9,825

23,668

Delta

8,143

24,827

Newton

6,721

21,429

Modoc

Ouachita

7,009

23,029

Mono

7,920

22,422

Denver

7,411

21,656

Perry

6,353

17,802

Monterey

9,395

26,386

Dolores

8,143

24,827

8,407

22,859

Douglas

7,411

21,656

Phillips

7,069

16,975

Napa

Pike

5,177

18,872

Nevada

9,825

23,668

Eagle

7,932

24,678

Poinsett

6,792

21,560

Orange

9,098

26,021

El Paso

6,583

22,503

8,099

24,093

Elbert

7,411

21,656

Polk

6,120

21,788

Placer

Pope

6,353

17,802

Plumas

9,825

23,668

Fremont

8,633

23,653

17,802

Riverside

8,823

24,188

Garfield

7,932

24,678

8,099

24,093

Gilpin

7,411

21,656

Prairie

6,353

Pulaski

6,353

17,802

Sacramento

Randolph

6,792

21,560

San Benito

9,395

26,386

Grand

8,143

24,827

17,802

San Bernardino

8,823

24,188

Gunnison

8,143

24,827

7,595

19,698

Hinsdale

8,143

24,827

Saline

6,353

Scott

6,120

21,788

San Diego

Searcy

6,721

21,429

San Francisco

9,194

32,092

Huerfano

8,633

23,653

21,788

San Joaquin

9,008

24,693

Jackson

8,143

24,827

8,551

25,169

Jefferson

7,411

21,656

Sebastian

6,120

Sevier

7,009

23,029

San Luis Obispo

Sharp

6,792

21,560

San Mateo

10,893

30,804

Kiowa

8,633

23,653

21,560

Santa Barbara

8,551

25,169

Kit Carson

8,633

23,653

St. Francis

6,792

2022 Average Premium Tables

-11-

Florida

Pasco

7,525

22,543

Employee- Dependent,
Only
Family, etc.

Pinellas

7,005

22,139

Polk

7,777

22,081

Alachua

8,141

22,734

Putnam

7,723

23,177

23,653

Baker

7,672

22,501

Santa Rosa

7,366

20,819

21,955

Bay

7,455

21,468

Sarasota

6,965

21,644

7,492

23,023

La Plata

8,143

24,827

Lake

8,143

24,827

Larimer

8,694

19,692

County

Las Animas

8,633

23,653

Lincoln

8,633

Logan

6,930

Mesa

8,998

21,727

Bradford

Seminole

7,715

20,590

Mineral

8,633

23,653

Brevard

8,106

22,087

St. Johns

10,257

27,879

Moffat

8,143

24,827

Broward

7,922

23,328

St. Lucie

7,591

21,601

7,738

22,571

Montezuma

8,143

24,827

Calhoun

Sumter

7,862

24,206

Montrose

8,143

24,827

Charlotte

8,533

25,787

Suwannee

7,168

22,810

Morgan

6,930

21,955

Citrus

7,611

21,534

Taylor

8,601

24,552

7,120

22,922

Otero

8,633

23,653

Clay

Union

7,765

23,505

Ouray

8,143

24,827

Collier

7,988

29,682

Volusia

8,121

20,111

Park

7,411

21,656

Columbia

8,265

24,544

Wakulla

7,275

23,347

7,651

23,403

Walton

7,767

21,234

Washington

7,836

23,329

Phillips

6,930

21,955

DeSoto

Pitkin

7,932

24,678

Dixie

7,677

21,209

Prowers

8,633

23,653

Duval

7,299

22,097

Pueblo

6,993

18,542

Escambia

7,892

21,756

Rio Blanco

8,143

24,827

Flagler

8,191

22,670

Rio Grande

8,633

23,653

Franklin

7,622

23,949

County

Employee- Dependent,
Only
Family, etc.

Routt

8,143

24,827

Gadsden

7,421

23,387

Appling

10,583

27,444

Saguache

8,633

23,653

Gilchrist

7,198

22,553

Atkinson

7,649

20,446

24,827

Glades

8,083

25,093

Bacon

7,155

21,075

8,085

23,360

San Juan

8,143

Georgia

San Miguel

8,143

24,827

Gulf

8,395

23,946

Baker

Sedgwick

6,930

21,955

Hamilton

7,602

22,503

Baldwin

8,673

22,584

24,678

Hardee

7,526

20,987

Banks

8,299

22,594

9,031

21,237

Summit

7,932

Teller

6,583

22,503

Hendry

8,388

24,714

Barrow

Washington

6,930

21,955

Hernando

7,904

23,493

Bartow

7,850

20,580

26,016

Highlands

8,138

25,498

Ben Hill

8,599

24,744

8,599

24,744

Weld
Yuma

8,306
6,930

21,955

Connecticut

Hillsborough

7,740

25,008

Berrien

Holmes

7,599

22,612

Bibb

8,545

18,181

Indian River

7,343

21,289

Bleckley

8,545

18,181

7,155

21,075

Jackson

7,067

20,719

Brantley

Jefferson

8,243

22,557

Brooks

8,599

24,744

10,583

27,444

County

Employee- Dependent,
Only
Family, etc.

Fairfield

9,528

29,578

Lafayette

7,669

21,405

Bryan

Hartford

9,002

26,680

Lake

8,596

24,889

Bulloch

10,583

27,444

Litchfield

8,527

28,343

Lee

7,413

22,838

Burke

8,071

18,720

Middlesex

8,672

27,077

Leon

9,230

28,653

Butts

7,850

20,580

New Haven

9,794

29,443

Levy

7,368

23,288

Calhoun

8,085

23,360

New London

8,729

25,572

Liberty

7,425

22,899

Camden

7,155

21,075

Tolland

8,001

22,920

Madison

8,248

23,532

Candler

10,583

27,444

Windham

8,445

31,760

Manatee

7,718

21,046

Carroll

8,130

23,051

Marion

6,342

20,829

Catoosa

7,913

21,989

7,155

21,075

Delaware
County

Employee- Dependent,
Only
Family, etc.

All

8,846

23,764

District of Columbia
County

Employee- Dependent,
Only
Family, etc.

All

9,368

28,176

Martin

8,016

24,627

Charlton

Miami-Dade

8,031

24,816

Chatham

10,583

27,444

Monroe

8,436

25,476

Chattahoochee

7,316

18,862

8,654

22,271

Nassau

8,332

20,919

Chattooga

Okaloosa

8,059

28,477

Cherokee

7,850

20,580

Okeechobee

8,465

24,963

Clarke

9,031

21,237

8,085

23,360

Orange

7,953

20,908

Clay

Osceola

8,438

24,353

Clayton

7,850

20,580

Palm Beach

8,603

28,912

Clinch

8,599

24,744

-12-

2022 Average Premium Tables

Cobb

7,850

20,580

Lanier

8,599

24,744

Towns

8,299

22,594

Coffee

7,649

20,446

Laurens

7,649

20,446

Treutlen

7,649

20,446

Colquitt

8,599

24,744

Lee

8,085

23,360

Troup

7,316

18,862

Columbia

8,071

18,720

Liberty

10,583

27,444

Turner

8,599

24,744

Cook

8,599

24,744

Lincoln

8,071

18,720

Twiggs

8,545

18,181

Coweta

7,850

20,580

Long

10,583

27,444

Union

8,299

22,594

Crawford

8,545

18,181

Lowndes

8,599

24,744

Upson

7,316

18,862

Crisp

8,085

23,360

Lumpkin

8,299

22,594

Walker

7,913

21,989

Dade

7,913

21,989

Macon

7,316

18,862

Walton

7,850

20,580

Dawson

8,299

22,594

Madison

9,031

21,237

Ware

7,155

21,075

Decatur

8,599

24,744

Marion

7,316

18,862

Warren

8,071

18,720

DeKalb

7,850

20,580

McDuffie

8,071

18,720

Washington

8,673

22,584

Dodge

8,545

18,181

McIntosh

7,155

21,075

Wayne

7,155

21,075

Dooly

8,545

18,181

Meriwether

7,316

18,862

Webster

7,316

18,862

Dougherty

8,085

23,360

Miller

8,599

24,744

Wheeler

7,649

20,446

Douglas

7,850

20,580

Mitchell

8,085

23,360

White

8,299

22,594

Early

8,599

24,744

Monroe

8,545

18,181

Whitfield

7,946

21,682

Echols

8,599

24,744

Montgomery

7,649

20,446

Wilcox

8,545

18,181

Effingham

10,583

27,444

Morgan

9,031

21,237

Wilkes

8,071

18,720

Elbert

9,031

21,237

Murray

7,946

21,682

Wilkinson

8,673

22,584

Emanuel

8,071

18,720

Muscogee

7,316

18,862

Worth

8,085

23,360

Evans

10,583

27,444

Newton

7,850

20,580

Fannin

7,946

21,682

Oconee

9,031

21,237

Fayette

7,850

20,580

Oglethorpe

9,031

21,237

Floyd

8,654

22,271

Paulding

7,850

20,580

County

Employee- Dependent,
Only
Family, etc.

Forsyth

7,850

20,580

Peach

8,545

18,181

All

7,628

Franklin

8,299

22,594

Pickens

8,654

22,271

Fulton

7,850

20,580

Pierce

7,155

21,075

Gilmer

8,654

22,271

Pike

7,850

20,580

Glascock

8,071

18,720

Polk

8,654

22,271

Glynn

7,155

21,075

Pulaski

8,545

18,181

Gordon

8,654

22,271

Putnam

8,545

18,181

Grady

8,599

24,744

Quitman

7,316

18,862

Greene

9,031

21,237

Rabun

8,299

22,594

Gwinnett

7,850

20,580

Randolph

8,085

23,360

Habersham

8,299

22,594

Richmond

8,071

18,720

Hall

8,299

22,594

Rockdale

7,850

20,580

Hancock

8,673

22,584

Schley

8,085

23,360

Haralson

8,130

23,051

Screven

10,583

27,444

Harris

7,316

18,862

Seminole

8,599

24,744

Hart

8,299

22,594

Spalding

7,850

20,580

Heard

8,130

23,051

Stephens

8,299

22,594

Henry

7,850

20,580

Stewart

7,316

18,862

Houston

8,545

18,181

Sumter

8,085

23,360

Irwin

8,599

24,744

Talbot

7,316

18,862

Jackson

9,031

21,237

Taliaferro

8,071

18,720

Jasper

7,850

20,580

Tattnall

10,583

27,444

Jeff Davis

7,649

20,446

Taylor

7,316

18,862

Jefferson

8,071

18,720

Telfair

7,649

20,446

Jenkins

8,071

18,720

Terrell

8,085

23,360

Johnson

7,649

20,446

Thomas

8,599

24,744

Jones

8,545

18,181

Tift

8,599

24,744

Lamar

7,850

20,580

Toombs

7,649

20,446

2022 Average Premium Tables

-13-

Hawaii

21,523

Idaho
County

Employee- Dependent,
Only
Family, etc.

Ada

6,877

17,159

Adams

6,184

17,428

Bannock

8,437

18,200

Bear Lake

8,437

18,200

Benewah

7,005

16,093

Bingham

8,437

18,200

Blaine

6,228

18,948

Boise

6,184

17,428

Bonner

7,005

16,093

Bonneville

7,765

20,506

Boundary

7,005

16,093

Butte

8,437

18,200

Camas

6,228

18,948

Canyon

6,184

17,428

Caribou

8,437

18,200

Cassia

6,228

18,948

Clark

7,765

20,506

Clearwater

8,172

19,086

Custer

8,437

18,200

Elmore

6,184

17,428

Franklin

8,437

18,200

Fremont

7,765

20,506

Gem

6,184

17,428

Gooding

6,228

18,948

Fulton

8,720

21,322

Saline

9,777

25,949

Idaho

8,172

19,086

Gallatin

9,777

25,949

Sangamon

8,465

19,139

Jefferson

7,765

20,506

Greene

8,629

23,248

Schuyler

8,465

19,139

Jerome

6,228

18,948

Grundy

9,101

20,461

Scott

8,465

19,139

Kootenai

7,005

16,093

Hamilton

9,777

25,949

Shelby

8,465

19,139

Latah

7,005

16,093

Hancock

7,958

20,419

St. Clair

8,482

20,961

Lemhi

7,765

20,506

Hardin

9,777

25,949

Stark

8,720

21,322

Lewis

8,172

19,086

Henderson

7,958

20,419

Stephenson

8,972

22,362

Lincoln

6,228

18,948

Henry

7,958

20,419

Tazewell

8,720

21,322

Madison

7,765

20,506

Iroquois

9,646

23,421

Union

9,777

25,949

Minidoka

6,228

18,948

Jackson

9,777

25,949

Vermilion

9,646

23,421

Nez Perce

8,172

19,086

Jasper

9,777

25,949

Wabash

9,777

25,949

Oneida

8,437

18,200

Jefferson

9,777

25,949

Warren

7,958

20,419

Owyhee

6,184

17,428

Jersey

8,629

23,248

Washington

8,629

23,248

Payette

6,184

17,428

Jo Daviess

8,972

22,362

Wayne

9,777

25,949

Power

8,437

18,200

Johnson

9,777

25,949

White

9,777

25,949

Shoshone

7,005

16,093

Kane

8,977

24,388

Whiteside

7,958

20,419

Teton

7,765

20,506

Kankakee

9,101

20,461

Will

9,101

20,461

Twin Falls

6,228

18,948

Kendall

9,101

20,461

Williamson

9,777

25,949

Valley

6,184

17,428

Knox

8,720

21,322

Winnebago

8,972

22,362

Washington

6,184

17,428

Lake

8,029

24,199

Woodford

8,720

21,322

LaSalle

8,720

21,322

Lawrence

9,777

25,949

Illinois

Indiana

Employee- Dependent,
Only
Family, etc.

Lee

8,972

22,362

County

Livingston

9,902

24,851

County

Employee- Dependent,
Only
Family, etc.

Adams

8,465

19,139

Logan

8,465

19,139

Adams

7,478

23,214

Alexander

9,777

25,949

19,139

Allen

8,107

24,189

Bond

8,629

23,248

Macoupin

8,629

23,248

Bartholomew

7,972

22,560

Boone

8,972

22,362

Madison

8,482

20,961

Benton

8,516

25,391

Brown

8,465

19,139

25,949

Blackford

8,548

21,898

Bureau

7,958

20,419

Marshall

8,720

21,322

Boone

8,202

25,255

Calhoun

8,629

23,248

Mason

8,465

19,139

Brown

8,081

26,309

Carroll

8,972

22,362

25,949

Carroll

8,176

26,016

8,166

21,199

Macon

Marion

Massac

8,465

9,777

9,777

Cass

8,465

19,139

McDonough

8,720

21,322

Cass

Champaign

9,646

23,421

McHenry

8,029

24,199

Clark

7,522

21,081

Christian

8,465

19,139

McLean

9,902

24,851

Clay

7,068

22,156

Clark

9,646

23,421

Menard

8,465

19,139

Clinton

8,176

26,016

Clay

9,777

25,949

Mercer

7,958

20,419

Crawford

7,522

21,081

Clinton

8,629

23,248

Monroe

8,482

20,961

Daviess

8,249

25,780

Coles

9,646

23,421

Montgomery

8,629

23,248

Dearborn

8,906

24,245

Cook

8,729

23,937

Morgan

8,465

19,139

Decatur

7,972

22,560

Crawford

9,777

25,949

Moultrie

8,465

19,139

DeKalb

7,478

23,214

Cumberland

9,646

23,421

Ogle

8,972

22,362

Delaware

8,548

21,898

DeKalb

8,972

22,362

21,322

Dubois

8,249

25,780

DeWitt

9,902

24,851

Perry

9,777

25,949

Elkhart

8,340

22,494

Douglas

9,646

23,421

Piatt

9,646

23,421

Fayette

7,510

22,139

DuPage

8,977

24,388

19,139

Floyd

7,522

21,081

Edgar

9,646

23,421

Pope

9,777

25,949

Fountain

8,176

26,016

Edwards

9,777

25,949

Pulaski

9,777

25,949

Franklin

8,906

24,245

Effingham

9,777

25,949

21,322

Fulton

8,166

21,199

9,588

24,463

Peoria

Pike

Putnam

8,720

8,465

8,720

Fayette

9,777

25,949

Randolph

8,629

23,248

Gibson

Ford

9,646

23,421

Richland

9,777

25,949

Grant

8,548

21,898

Franklin

9,777

25,949

20,419

Greene

8,249

25,780

Rock Island

7,958

-14-

2022 Average Premium Tables

Hamilton

8,202

25,255

Vanderburgh

9,588

24,463

Guthrie

8,697

21,249

Hancock

7,510

22,139

Vermillion

7,068

22,156

Hamilton

6,451

20,188

Harrison

7,522

21,081

Vigo

7,068

22,156

Hancock

7,445

21,955

Hendricks

8,202

25,255

Wabash

7,478

23,214

Hardin

6,451

20,188

Henry

7,510

22,139

Warren

8,516

25,391

Harrison

8,697

21,249

Howard

8,166

21,199

Warrick

9,588

24,463

Henry

7,311

19,465

Huntington

7,478

23,214

Washington

7,522

21,081

Howard

7,445

21,955

Jackson

7,972

22,560

Wayne

7,510

22,139

Humboldt

7,445

21,955

Jasper

8,516

25,391

Wells

7,478

23,214

Ida

8,032

22,897

Jay

8,548

21,898

White

8,516

25,391

Iowa

7,127

21,569

Jefferson

7,522

21,081

Whitley

7,478

23,214

Jackson

7,127

21,569

Jennings

7,972

22,560

Jasper

7,095

22,233

Johnson

8,081

26,309

Jefferson

7,311

19,465

Knox

8,249

25,780

7,127

21,569

Kosciusko

8,340

22,494

County

Employee- Dependent,
Only
Family, etc.

Johnson
Jones

7,127

21,569

8,697

21,249

Iowa

LaGrange

7,478

23,214

Adair

Keokuk

7,311

19,465

Lake

8,474

22,352

Adams

8,697

21,249

Kossuth

7,445

21,955

LaPorte

8,474

22,352

Allamakee

7,445

21,955

Lee

7,311

19,465

7,311

19,465

Lawrence

8,081

26,309

Appanoose

Linn

7,127

21,569

Madison

7,510

22,139

Audubon

8,697

21,249

Louisa

7,311

19,465

Marion

8,202

25,255

Benton

7,127

21,569

Lucas

7,311

19,465

7,127

21,569

Marshall

8,340

22,494

Black Hawk

Lyon

8,032

22,897

Martin

8,249

25,780

Boone

6,451

20,188

Madison

7,095

22,233

7,445

21,955

Miami

8,166

21,199

Bremer

Mahaska

7,311

19,465

Monroe

8,081

26,309

Buchanan

7,127

21,569

Marion

7,095

22,233

Montgomery

8,176

26,016

Buena Vista

8,032

22,897

Marshall

6,451

20,188

7,445

21,955

Morgan

8,202

25,255

Butler

Mills

8,697

21,249

Newton

8,516

25,391

Calhoun

6,451

20,188

Mitchell

7,445

21,955

Noble

7,478

23,214

Carroll

6,451

20,188

Monona

8,032

22,897

8,697

21,249

Ohio

8,906

24,245

Cass

Monroe

7,311

19,465

Orange

8,249

25,780

Cedar

7,127

21,569

Montgomery

8,697

21,249

Owen

8,081

26,309

Cerro Gordo

7,445

21,955

Muscatine

7,311

19,465

8,032

22,897

Parke

7,068

22,156

Cherokee

O'Brien

8,032

22,897

Perry

8,249

25,780

Chickasaw

7,445

21,955

Osceola

8,032

22,897

Pike

8,249

25,780

Clarke

8,697

21,249

Page

8,697

21,249

8,032

22,897

Porter

8,474

22,352

Clay

Palo Alto

8,032

22,897

Posey

9,588

24,463

Clayton

7,127

21,569

Plymouth

8,032

22,897

Pulaski

8,166

21,199

Clinton

7,127

21,569

Pocahontas

8,032

22,897

8,032

22,897

Putnam

8,176

26,016

Crawford

Polk

7,095

22,233

Randolph

8,548

21,898

Dallas

7,095

22,233

Pottawattamie

8,697

21,249

Ripley

8,906

24,245

Davis

7,311

19,465

Poweshiek

6,451

20,188

8,697

21,249

Rush

7,972

22,560

Decatur

Ringgold

8,697

21,249

Scott

7,522

21,081

Delaware

7,127

21,569

Sac

8,032

22,897

7,311

19,465

Shelby

8,202

25,255

Des Moines

Scott

7,127

21,569

Spencer

8,249

25,780

Dickinson

8,032

22,897

Shelby

8,697

21,249

St. Joseph

8,340

22,494

Dubuque

7,127

21,569

Sioux

8,032

22,897

7,445

21,955

Starke

8,340

22,494

Emmet

Story

6,451

20,188

Steuben

7,478

23,214

Fayette

7,445

21,955

Tama

6,451

20,188

Sullivan

7,068

22,156

Floyd

7,445

21,955

Taylor

8,697

21,249

7,445

21,955

Switzerland

8,906

24,245

Franklin

Union

8,697

21,249

Tippecanoe

8,176

26,016

Fremont

8,697

21,249

Van Buren

7,311

19,465

Tipton

8,176

26,016

Greene

6,451

20,188

Wapello

7,311

19,465

22,139

Grundy

6,451

20,188

Warren

7,095

22,233

Union

7,510

2022 Average Premium Tables

-15-

Washington

7,311

19,465

Hodgeman

6,516

20,210

Stevens

6,516

20,210

Wayne

7,311

19,465

Jackson

7,004

19,947

Sumner

6,660

18,161

Webster

6,451

20,188

Jefferson

7,004

19,947

Thomas

7,246

21,412

Winnebago

7,445

21,955

Jewell

6,556

17,604

Trego

7,246

21,412

Winneshiek

7,445

21,955

Johnson

7,490

20,490

Wabaunsee

7,004

19,947

Woodbury

8,032

22,897

Kearny

6,516

20,210

Wallace

7,246

21,412

Worth

7,445

21,955

Kingman

6,660

18,161

Washington

6,556

17,604

Wright

7,445

21,955

Kiowa

6,516

20,210

Wichita

7,246

21,412

Labette

7,646

19,378

Wilson

6,660

18,161

Lane

7,246

21,412

Woodson

7,646

19,378

7,490

20,490

Wyandotte

7,490

20,490

Kansas
County

Employee- Dependent,
Only
Family, etc.

Leavenworth
Lincoln

6,556

17,604

Allen

7,646

19,378

Linn

7,004

19,947

Anderson

7,004

19,947

Logan

7,246

21,412

Atchison

7,004

19,947

Lyon

7,004

19,947

County

Employee- Dependent,
Only
Family, etc.

Barber

6,516

20,210

Marion

6,660

18,161

Adair

7,995

23,900

7,995

23,900

Kentucky

Barton

7,246

21,412

Marshall

7,004

19,947

Allen

Bourbon

7,646

19,378

McPherson

6,660

18,161

Anderson

6,923

19,939

Brown

7,004

19,947

Meade

6,516

20,210

Ballard

9,237

20,839

Butler

6,660

18,161

Miami

7,490

20,490

Barren

7,995

23,900

Chase

6,660

18,161

Mitchell

6,556

17,604

Bath

7,608

22,247

Chautauqua

6,660

18,161

Montgomery

6,660

18,161

Bell

8,511

22,079

Cherokee

7,646

19,378

Morris

6,556

17,604

Boone

6,646

20,870

Cheyenne

7,246

21,412

20,210

Bourbon

6,923

19,939

Clark

6,516

20,210

Nemaha

7,004

19,947

Boyd

7,608

22,247

Clay

6,556

17,604

Neosho

7,646

19,378

Boyle

6,923

19,939

Cloud

6,556

17,604

21,412

Bracken

7,608

22,247

Coffey

7,004

19,947

Norton

7,246

21,412

Breathitt

8,511

22,079

Comanche

6,516

20,210

Osage

7,004

19,947

Breckinridge

7,219

20,093

Cowley

6,660

18,161

21,412

Bullitt

7,219

20,093

Crawford

7,646

19,378

Ottawa

6,556

17,604

Butler

7,995

23,900

Decatur

7,246

21,412

Pawnee

6,516

20,210

Caldwell

9,237

20,839

Dickinson

6,556

17,604

21,412

Calloway

9,237

20,839

6,646

20,870

Morton

Ness

Osborne

Phillips

6,516

7,246

7,246

7,246

Doniphan

7,004

19,947

Pottawatomie

7,004

19,947

Campbell

Douglas

7,004

19,947

Pratt

6,516

20,210

Carlisle

9,237

20,839

Edwards

6,516

20,210

Rawlins

7,246

21,412

Carroll

7,219

20,093

Elk

6,660

18,161

Reno

6,660

18,161

Carter

7,608

22,247

Ellis

7,246

21,412

Republic

6,556

17,604

Casey

7,995

23,900

Ellsworth

6,556

17,604

Rice

6,660

18,161

Christian

8,681

22,562

Finney

6,516

20,210

Riley

6,556

17,604

Clark

6,923

19,939

Ford

6,516

20,210

Rooks

7,246

21,412

Clay

8,511

22,079

Franklin

7,004

19,947

Rush

7,246

21,412

Clinton

7,995

23,900

Geary

6,556

17,604

Russell

7,246

21,412

Crittenden

9,237

20,839

Gove

7,246

21,412

17,604

Cumberland

7,995

23,900

Graham

7,246

21,412

Scott

7,246

21,412

Daviess

8,681

22,562

Grant

6,516

20,210

Sedgwick

6,660

18,161

Edmonson

7,995

23,900

Gray

6,516

20,210

20,210

Elliott

7,608

22,247

Greeley

7,246

21,412

Shawnee

7,004

19,947

Estill

6,923

19,939

Greenwood

6,660

18,161

Sheridan

7,246

21,412

Fayette

6,923

19,939

Hamilton

6,516

20,210

21,412

Fleming

7,608

22,247

8,511

22,079

Saline

Seward

Sherman

6,556

6,516

7,246

Harper

6,660

18,161

Smith

7,246

21,412

Floyd

Harvey

6,660

18,161

Stafford

6,516

20,210

Franklin

6,923

19,939

Haskell

6,516

20,210

20,210

Fulton

9,237

20,839

Stanton

6,516

-16-

2022 Average Premium Tables

Gallatin

6,646

20,870

Ohio

8,681

22,562

Franklin

8,275

20,521

Garrard

6,923

19,939

Oldham

7,219

20,093

Grant

8,797

21,078

Grant

6,646

20,870

Owen

6,923

19,939

Iberia

7,541

20,453

Graves

9,237

20,839

Owsley

8,511

22,079

Iberville

8,072

21,892

Grayson

7,219

20,093

Pendleton

6,646

20,870

Jackson

8,275

20,521

Green

7,995

23,900

Perry

8,511

22,079

Jefferson

7,665

21,666

Greenup

7,608

22,247

Pike

8,511

22,079

Jefferson Davis

8,459

21,861

Hancock

8,681

22,562

Powell

6,923

19,939

Lafayette

7,541

20,453

Hardin

7,219

20,093

Pulaski

7,995

23,900

Lafourche

7,692

20,542

Harlan

8,511

22,079

Robertson

7,608

22,247

LaSalle

8,797

21,078

Harrison

6,923

19,939

Rockcastle

6,923

19,939

Lincoln

8,275

20,521

Hart

7,995

23,900

Rowan

7,608

22,247

Livingston

8,072

21,892

Henderson

8,681

22,562

Russell

7,995

23,900

Madison

8,275

20,521

Henry

7,219

20,093

Scott

6,923

19,939

Morehouse

8,275

20,521

Hickman

9,237

20,839

Shelby

7,219

20,093

Natchitoches

7,834

20,233

Hopkins

8,681

22,562

Simpson

7,995

23,900

Orleans

7,665

21,666

Jackson

6,923

19,939

Spencer

7,219

20,093

Ouachita

8,275

20,521

Jefferson

7,219

20,093

Taylor

7,995

23,900

Plaquemines

7,665

21,666

Jessamine

6,923

19,939

Todd

8,681

22,562

Pointe Coupee

8,072

21,892

Johnson

8,511

22,079

Trigg

8,681

22,562

Rapides

8,797

21,078

Kenton

6,646

20,870

Trimble

7,219

20,093

Red River

7,834

20,233

Knott

8,511

22,079

Union

8,681

22,562

Richland

8,275

20,521

Knox

8,511

22,079

Warren

7,995

23,900

Sabine

7,834

20,233

LaRue

7,219

20,093

Washington

7,219

20,093

St. Bernard

7,665

21,666

Laurel

8,511

22,079

Wayne

7,995

23,900

St. Charles

7,665

21,666

Lawrence

7,608

22,247

Webster

8,681

22,562

St. Helena

8,072

21,892

Lee

8,511

22,079

Whitley

8,511

22,079

St. James

7,665

21,666

Leslie

8,511

22,079

Wolfe

8,511

22,079

St. John Baptist

7,665

21,666

Letcher

8,511

22,079

Woodford

6,923

19,939

St. Landry

7,541

20,453

Lewis

7,608

22,247

St. Martin

7,541

20,453

Lincoln

6,923

19,939

St. Mary

7,541

20,453

Livingston

9,237

20,839

7,665

21,666

Louisiana
Employee- Dependent,
Only
Family, etc.

St. Tammany

Logan

7,995

23,900

Parish

Tangipahoa

8,072

21,892

Lyon

9,237

20,839

Acadia

7,541

20,453

Tensas

8,275

20,521

Madison

6,923

19,939

Allen

8,459

21,861

Terrebonne

7,692

20,542

8,072

21,892

Magoffin

8,511

22,079

Ascension

Union

8,275

20,521

Marion

7,219

20,093

Assumption

7,692

20,542

Vermilion

7,541

20,453

Marshall

9,237

20,839

Avoyelles

8,797

21,078

Vernon

8,797

21,078

8,459

21,861

Martin

8,511

22,079

Beauregard

Washington

8,072

21,892

Mason

7,608

22,247

Bienville

7,834

20,233

Webster

7,834

20,233

McCracken

9,237

20,839

Bossier

7,834

20,233

West Baton Rouge

8,072

21,892

7,834

20,233

McCreary

7,995

23,900

Caddo

West Carroll

8,275

20,521

McLean

8,681

22,562

Calcasieu

8,459

21,861

West Feliciana

8,072

21,892

8,275

20,521

Winn

8,797

21,078

Meade

7,219

20,093

Caldwell

Menifee

7,608

22,247

Cameron

8,459

21,861

Mercer

6,923

19,939

Catahoula

8,797

21,078

Metcalfe

7,995

23,900

Claiborne

7,834

20,233

8,797

21,078

County

Employee- Dependent,
Only
Family, etc.

Maine

Monroe

7,995

23,900

Concordia

Montgomery

6,923

19,939

DeSoto

7,834

20,233

Androscoggin

7,935

20,534

22,247

East Baton Rouge

8,072

21,892

Aroostook

9,703

24,940

8,275

20,521

Cumberland

7,655

22,574

Morgan

7,608

Muhlenberg

8,681

22,562

East Carroll

Nelson

7,219

20,093

East Feliciana

8,072

21,892

Franklin

7,935

20,534

19,939

Evangeline

7,541

20,453

Hancock

9,703

24,940

Nicholas

6,923

2022 Average Premium Tables

-17-

Kennebec

7,153

19,633

Norfolk

8,963

26,811

Lenawee

7,587

22,510

Knox

7,153

19,633

Plymouth

9,361

25,875

Livingston

7,587

22,510

Lincoln

7,153

19,633

Suffolk

8,963

26,811

Luce

9,363

22,114

Oxford

7,153

19,633

Worcester

8,989

24,581

Mackinac

8,510

22,856

Penobscot

7,935

20,534

Macomb

7,838

22,752

Piscataquis

7,935

20,534

Manistee

7,203

21,345

Sagadahoc

7,655

22,574

9,363

22,114

7,935

20,534

County

Employee- Dependent,
Only
Family, etc.

Marquette

Somerset

Mason

7,097

21,254

Waldo

7,935

20,534

Alcona

8,510

22,856

Mecosta

7,097

21,254

9,363

22,114

Michigan

Washington

9,703

24,940

Alger

Menominee

9,363

22,114

York

7,655

22,574

Allegan

7,197

21,587

Midland

7,425

21,232

Alpena

8,510

22,856

Missaukee

7,203

21,345

Antrim

7,203

21,345

Monroe

8,584

24,261

Arenac

7,898

20,833

Montcalm

7,097

21,254

Baraga

9,363

22,114

Montmorency

8,510

22,856

Maryland
County

Employee- Dependent,
Only
Family, etc.

Allegany

7,383

21,882

Barry

7,197

21,587

Muskegon

7,097

21,254

Anne Arundel

7,409

22,761

Bay

7,898

20,833

Newaygo

7,097

21,254

Baltimore

7,409

22,761

Benzie

7,203

21,345

Oakland

7,838

22,752

Baltimore City

7,409

22,761

Berrien

8,527

24,805

Oceana

7,097

21,254

Calvert

7,678

21,174

Branch

8,488

22,633

Ogemaw

8,510

22,856

Caroline

7,678

21,174

Calhoun

8,488

22,633

Ontonagon

9,363

22,114

Carroll

7,383

21,882

Cass

8,527

24,805

Osceola

7,097

21,254

Cecil

7,678

21,174

Charlevoix

7,203

21,345

Oscoda

8,510

22,856

Charles

7,678

21,174

Cheboygan

8,510

22,856

Otsego

8,510

22,856

Dorchester

7,678

21,174

Chippewa

8,510

22,856

Ottawa

7,097

21,254

Frederick

7,383

21,882

Clare

7,425

21,232

Presque Isle

8,510

22,856

Garrett

7,383

21,882

Clinton

8,521

21,466

Roscommon

8,510

22,856

Harford

7,409

22,761

Crawford

8,510

22,856

Saginaw

7,898

20,833

Howard

7,409

22,761

Delta

9,363

22,114

Sanilac

8,709

21,559

Kent

7,678

21,174

Dickinson

9,363

22,114

Schoolcraft

9,363

22,114

Montgomery

7,640

25,697

Eaton

8,521

21,466

Shiawassee

8,060

19,416

Prince George's

7,640

25,697

Emmet

7,203

21,345

St. Clair

7,875

22,787

Queen Anne’s

7,678

21,174

Genesee

8,060

19,416

St. Joseph

8,527

24,805

Somerset

7,678

21,174

Gladwin

7,425

21,232

Tuscola

8,709

21,559

St. Mary’s

7,678

21,174

Gogebic

9,363

22,114

Van Buren

8,527

24,805

Talbot

7,678

21,174

Grand Traverse

7,203

21,345

Washtenaw

7,587

22,510

Washington

7,383

21,882

Gratiot

7,898

20,833

Wayne

8,584

24,261

Wicomico

7,678

21,174

Hillsdale

8,521

21,466

Wexford

7,203

21,345

Worcester

7,678

21,174

Houghton

9,363

22,114

Huron

8,709

21,559

Ingham

8,521

21,466

7,097

21,254

County

Employee- Dependent,
Only
Family, etc.

County

Employee- Dependent,
Only
Family, etc.

Ionia
Iosco

8,510

22,856

Aitkin

8,499

19,704

Barnstable

10,057

27,157

Iron

9,363

22,114

Anoka

8,198

22,701

Berkshire

7,899

23,163

Isabella

7,425

21,232

Becker

8,286

23,575

Bristol

9,361

25,875

Jackson

8,521

21,466

Beltrami

8,499

19,704

Dukes

10,057

27,157

Kalamazoo

8,488

22,633

Benton

8,198

22,701

Essex

9,148

24,037

Kalkaska

7,203

21,345

Big Stone

9,311

21,521

Franklin

7,899

23,163

Kent

7,097

21,254

Blue Earth

10,352

21,578

Hampden

7,899

23,163

Keweenaw

9,363

22,114

Brown

8,725

22,000

Hampshire

7,899

23,163

Lake

7,097

21,254

Carlton

8,693

19,236

Middlesex

8,963

26,811

Lapeer

8,060

19,416

Carver

8,198

22,701

Nantucket

10,057

27,157

Leelanau

7,203

21,345

Cass

8,499

19,704

Massachusetts

-18-

Minnesota

2022 Average Premium Tables

Chippewa

9,311

21,521

Renville

9,311

21,521

Humphreys

6,958

18,688

Chisago

8,499

19,704

Rice

10,352

21,578

Issaquena

6,958

18,688

Clay

8,286

23,575

Rock

8,725

22,000

Itawamba

7,340

18,912

Clearwater

7,342

23,307

Roseau

8,499

19,704

Jackson

7,844

23,137

Cook

8,693

19,236

Scott

8,198

22,701

Jasper

6,958

18,688

Cottonwood

8,725

22,000

Sherburne

8,198

22,701

Jefferson

6,958

18,688

Crow Wing

8,499

19,704

Sibley

9,311

21,521

Jefferson Davis

6,958

18,688

Dakota

8,198

22,701

St. Louis

8,693

19,236

Jones

7,522

17,003

Dodge

8,999

21,065

Stearns

8,198

22,701

Kemper

6,958

18,688

Douglas

8,286

23,575

Steele

8,999

21,065

Lafayette

6,958

18,688

Faribault

10,352

21,578

Stevens

8,286

23,575

Lamar

7,522

17,003

Fillmore

8,999

21,065

Swift

9,311

21,521

Lauderdale

6,958

18,688

Freeborn

8,999

21,065

Todd

8,499

19,704

Lawrence

6,958

18,688

Goodhue

8,999

21,065

Traverse

8,286

23,575

Leake

6,958

18,688

Grant

8,286

23,575

Wabasha

8,999

21,065

Lee

7,340

18,912

Hennepin

8,198

22,701

Wadena

8,499

19,704

Leflore

6,958

18,688

Houston

8,999

21,065

Waseca

10,352

21,578

Lincoln

6,958

18,688

Hubbard

8,499

19,704

Washington

8,198

22,701

Lowndes

6,958

18,688

Isanti

8,499

19,704

Watonwan

10,352

21,578

Madison

7,262

17,274

Itasca

8,693

19,236

Wilkin

8,286

23,575

Marion

6,958

18,688

Jackson

8,725

22,000

Winona

8,999

21,065

Marshall

6,877

23,091

Kanabec

8,499

19,704

Wright

8,198

22,701

Monroe

6,958

18,688

Kandiyohi

9,311

21,521

Yellow Medicine

9,311

21,521

Montgomery

6,958

18,688

Kittson

7,342

23,307

Neshoba

6,958

18,688

Koochiching

8,693

19,236

Newton

6,958

18,688

Lac qui Parle

9,311

21,521

6,958

18,688

Mississippi
Employee- Dependent,
Only
Family, etc.

Noxubee

Lake

8,693

19,236

County

Oktibbeha

6,958

18,688

Lake of the Woods

8,693

19,236

Adams

6,958

18,688

Panola

6,958

18,688

Le Sueur

10,352

21,578

Alcorn

6,958

18,688

Pearl River

7,522

17,003

6,958

18,688

Lincoln

8,725

22,000

Amite

Perry

7,522

17,003

Lyon

9,311

21,521

Attala

6,958

18,688

Pike

6,958

18,688

Mahnomen

7,342

23,307

Benton

7,340

18,912

Pontotoc

7,340

18,912

6,958

18,688

Marshall

7,342

23,307

Bolivar

Prentiss

6,958

18,688

Martin

10,352

21,578

Calhoun

6,958

18,688

Quitman

6,958

18,688

McLeod

9,311

21,521

Carroll

6,958

18,688

Rankin

7,262

17,274

6,958

18,688

Meeker

9,311

21,521

Chickasaw

Scott

6,958

18,688

Mille Lacs

8,499

19,704

Choctaw

6,958

18,688

Sharkey

6,958

18,688

Morrison

8,499

19,704

Claiborne

6,958

18,688

Simpson

7,262

17,274

6,958

18,688

Mower

8,999

21,065

Clarke

Smith

6,958

18,688

Murray

8,725

22,000

Clay

6,958

18,688

Stone

7,844

23,137

Nicollet

10,352

21,578

Coahoma

6,958

18,688

Sunflower

6,958

18,688

7,262

17,274

Nobles

8,725

22,000

Copiah

Tallahatchie

6,958

18,688

Norman

7,342

23,307

Covington

6,958

18,688

Tate

6,877

23,091

6,877

23,091

Olmsted

8,999

21,065

DeSoto

Tippah

7,340

18,912

Otter Tail

8,286

23,575

Forrest

7,522

17,003

Tishomingo

6,958

18,688

Pennington

7,342

23,307

Franklin

6,958

18,688

Tunica

6,877

23,091

7,844

23,137

Pine

8,499

19,704

George

Union

7,340

18,912

Pipestone

8,725

22,000

Greene

7,522

17,003

Walthall

6,958

18,688

Polk

7,342

23,307

Grenada

6,958

18,688

Warren

7,262

17,274

7,844

23,137

Pope

8,286

23,575

Hancock

Washington

6,958

18,688

Ramsey

8,198

22,701

Harrison

7,844

23,137

Wayne

6,958

18,688

Red Lake

7,342

23,307

Hinds

7,262

17,274

Webster

6,958

18,688

22,000

Holmes

6,958

18,688

Wilkinson

6,958

18,688

Redwood

8,725

2022 Average Premium Tables

-19-

Winston

6,958

18,688

Iron

7,282

18,701

St. Francois

7,491

20,240

Yalobusha

6,958

18,688

Jackson

7,541

21,475

St. Louis

7,491

20,240

Yazoo

6,958

18,688

Jasper

6,032

17,957

St. Louis City

7,491

20,240

Jefferson

7,491

20,240

Ste. Genevieve

7,491

20,240

Johnson

7,494

19,730

Stoddard

8,348

21,959

8,548

20,952

Stone

7,786

21,502

Missouri
County

Employee- Dependent,
Only
Family, etc.

Knox
Laclede

7,786

21,502

Sullivan

8,548

20,952

Adair

8,548

20,952

Lafayette

7,494

19,730

Taney

7,786

21,502

Andrew

10,197

19,609

Lawrence

7,786

21,502

Texas

7,282

18,701

Atchison

10,197

19,609

Lewis

8,548

20,952

Vernon

7,494

19,730

Audrain

8,472

21,174

Lincoln

7,491

20,240

Warren

7,491

20,240

Barry

7,786

21,502

Linn

8,548

20,952

Washington

7,491

20,240

Barton

6,032

17,957

Livingston

10,197

19,609

Wayne

8,348

21,959

Bates

7,494

19,730

Macon

8,548

20,952

Webster

7,786

21,502

Benton

7,494

19,730

Madison

8,348

21,959

Worth

10,197

19,609

Bollinger

8,348

21,959

Maries

8,472

21,174

Wright

7,786

21,502

Boone

8,472

21,174

Marion

8,548

20,952

Buchanan

10,197

19,609

McDonald

6,032

17,957

Butler

8,348

21,959

Mercer

10,197

19,609

Caldwell

10,197

19,609

Miller

8,472

21,174

County

Employee- Dependent,
Only
Family, etc.

Callaway

8,472

21,174

Mississippi

8,348

21,959

Beaverhead

8,693

20,347

Camden

8,472

21,174

Moniteau

8,472

21,174

Big Horn

8,693

20,347

Cape Girardeau

8,348

21,959

Monroe

8,472

21,174

Blaine

8,693

20,347

Carroll

10,197

19,609

21,174

Broadwater

7,606

22,167

Carter

7,282

18,701

Morgan

8,472

21,174

Carbon

7,891

22,023

Cass

7,541

21,475

New Madrid

8,348

21,959

Carter

8,693

20,347

Cedar

7,786

21,502

17,957

Cascade

7,606

22,167

Chariton

8,472

21,174

Nodaway

10,197

19,609

Chouteau

7,606

22,167

Christian

7,786

21,502

Oregon

7,282

18,701

Custer

8,693

20,347

Clark

8,548

20,952

21,174

Daniels

8,693

20,347

Clay

7,541

21,475

Ozark

7,786

21,502

Dawson

8,693

20,347

Clinton

10,197

19,609

Pemiscot

8,348

21,959

Deer Lodge

7,606

22,167

Cole

8,472

21,174

21,959

Fallon

8,693

20,347

8,693

20,347

Montgomery

Newton

Osage

Perry

8,472

6,032

8,472

8,348

Montana

Cooper

8,472

21,174

Pettis

7,494

19,730

Fergus

Crawford

7,282

18,701

Phelps

7,282

18,701

Flathead

7,857

20,820

Dade

7,786

21,502

Pike

8,548

20,952

Gallatin

7,606

22,167

Dallas

7,786

21,502

Platte

7,541

21,475

Garfield

8,693

20,347

Daviess

10,197

19,609

Polk

7,786

21,502

Glacier

8,693

20,347

DeKalb

10,197

19,609

Pulaski

7,282

18,701

Golden Valley

8,693

20,347

Dent

7,282

18,701

Putnam

8,548

20,952

Granite

8,693

20,347

Douglas

7,786

21,502

Ralls

8,548

20,952

Hill

8,693

20,347

Dunklin

8,348

21,959

Randolph

8,472

21,174

Jefferson

7,606

22,167

Franklin

7,491

20,240

Ray

10,197

19,609

Judith Basin

7,606

22,167

Gasconade

8,472

21,174

18,701

Lake

7,857

20,820

Gentry

10,197

19,609

Ripley

7,282

18,701

Lewis and Clark

7,606

22,167

Greene

7,786

21,502

Saline

7,494

19,730

Liberty

8,693

20,347

Grundy

10,197

19,609

20,952

Lincoln

8,693

20,347

Harrison

10,197

19,609

Scotland

8,548

20,952

Madison

8,693

20,347

Henry

7,494

19,730

Scott

8,348

21,959

McCone

8,693

20,347

Hickory

7,786

21,502

18,701

Meagher

8,693

20,347

8,693

20,347

Reynolds

Schuyler

Shannon

7,282

8,548

7,282

Holt

10,197

19,609

Shelby

8,548

20,952

Mineral

Howard

8,472

21,174

St. Charles

7,491

20,240

Missoula

7,857

20,820

Howell

7,282

18,701

19,730

Musselshell

7,891

22,023

St. Clair

7,494

-20-

2022 Average Premium Tables

Park

8,693

20,347

Dodge

7,859

22,206

Seward

9,036

24,033

Petroleum

8,693

20,347

Douglas

7,859

22,206

Sheridan

9,129

25,388

Phillips

8,693

20,347

Dundy

9,129

25,388

Sherman

8,981

26,077

Pondera

8,693

20,347

Fillmore

9,036

24,033

Sioux

9,129

25,388

Powder River

8,693

20,347

Franklin

8,981

26,077

Stanton

8,981

26,077

Powell

8,693

20,347

Frontier

9,129

25,388

Thayer

9,036

24,033

Prairie

8,693

20,347

Furnas

8,981

26,077

Thomas

9,129

25,388

Ravalli

8,693

20,347

Gage

9,036

24,033

Thurston

7,859

22,206

Richland

8,693

20,347

Garden

9,129

25,388

Valley

8,981

26,077

Roosevelt

8,693

20,347

Garfield

8,981

26,077

Washington

7,859

22,206

Rosebud

8,693

20,347

Gosper

8,981

26,077

Wayne

8,981

26,077

Sanders

8,693

20,347

Grant

9,129

25,388

Webster

8,981

26,077

Sheridan

8,693

20,347

Greeley

8,981

26,077

Wheeler

8,981

26,077

Silver Bow

7,606

22,167

Hall

8,981

26,077

York

9,036

24,033

Stillwater

7,891

22,023

Hamilton

8,981

26,077

Sweet Grass

7,891

22,023

Harlan

8,981

26,077

Teton

7,606

22,167

Hayes

9,129

25,388

Toole

8,693

20,347

Hitchcock

9,129

25,388

County

Employee- Dependent,
Only
Family, etc.

Treasure

8,693

20,347

Holt

8,981

26,077

Carson City

7,344

19,438

Valley

8,693

20,347

Hooker

9,129

25,388

Churchill

7,741

23,111

Wheatland

8,693

20,347

Howard

8,981

26,077

Clark

7,204

20,646

7,344

19,438

Nevada

Wibaux

8,693

20,347

Jefferson

9,036

24,033

Douglas

Yellowstone

7,891

22,023

Johnson

9,036

24,033

Elko

7,741

23,111

26,077

Esmeralda

7,741

23,111

7,741

23,111

Kearney

Nebraska

8,981

Keith

9,129

25,388

Eureka

Keya Paha

8,981

26,077

Humboldt

7,741

23,111

25,388

Lander

7,741

23,111

7,741

23,111

County

Employee- Dependent,
Only
Family, etc.

Adams

8,981

26,077

Knox

8,981

26,077

Lincoln

Antelope

8,981

26,077

Lancaster

9,036

24,033

Lyon

7,344

19,438

Arthur

9,129

25,388

25,388

Mineral

7,741

23,111

Banner

9,129

25,388

Logan

9,129

25,388

Nye

7,204

20,646

Blaine

8,981

26,077

Loup

8,981

26,077

Pershing

7,741

23,111

Boone

8,981

26,077

26,077

Storey

7,344

19,438

8,331

21,180

7,741

23,111

Kimball

Lincoln

Madison

9,129

9,129

8,981

Box Butte

9,129

25,388

McPherson

9,129

25,388

Washoe

Boyd

8,981

26,077

Merrick

8,981

26,077

White Pine

Brown

9,129

25,388

Morrill

9,129

25,388

Buffalo

8,981

26,077

Nance

8,981

26,077

Burt

7,859

22,206

Nemaha

9,036

24,033

Butler

8,981

26,077

Nuckolls

8,981

26,077

Cass

7,859

22,206

Otoe

9,036

24,033

Cedar

8,981

26,077

Pawnee

9,036

24,033

Chase

9,129

25,388

Perkins

9,129

25,388

Cherry

9,129

25,388

Phelps

8,981

26,077

Cheyenne

9,129

25,388

Pierce

8,981

26,077

Clay

8,981

26,077

Platte

8,981

26,077

Colfax

8,981

26,077

Polk

8,981

26,077

Cuming

8,981

26,077

Red Willow

9,129

25,388

Custer

8,981

26,077

Richardson

9,036

24,033

Dakota

8,981

26,077

Rock

8,981

26,077

Dawes

9,129

25,388

Saline

9,036

24,033

Dawson

8,981

26,077

Sarpy

7,859

22,206

Deuel

9,129

25,388

Saunders

7,859

22,206

Dixon

8,981

26,077

Scotts Bluff

9,129

25,388

2022 Average Premium Tables

-21-

New Hampshire
County

Employee- Dependent,
Only
Family, etc.

All

7,964

26,225

New Jersey
County

Employee- Dependent,
Only
Family, etc.

All

8,090

22,786

New Mexico
County

Employee- Dependent,
Only
Family, etc.

Bernalillo

7,758

21,368

Catron

9,379

29,015

Chaves

9,379

29,015

Cibola

9,379

29,015

Colfax

9,379

29,015

Hamilton

9,118

23,428

Bertie

7,967

22,994

Curry

9,379

29,015

Herkimer

9,118

23,428

Bladen

7,233

23,420

De Baca

9,379

29,015

Jefferson

9,118

23,428

Brunswick

7,474

21,413

Doña Ana

8,107

20,387

Kings

11,243

29,771

Buncombe

7,301

21,752

Eddy

9,379

29,015

Lewis

9,118

23,428

Burke

7,023

20,967

Grant

9,379

29,015

Livingston

8,103

19,847

Cabarrus

7,131

22,733

Guadalupe

9,379

29,015

Madison

9,118

23,428

Caldwell

7,023

20,967

Harding

9,379

29,015

Monroe

8,103

19,847

Camden

7,967

22,994

Hidalgo

9,379

29,015

Montgomery

8,439

21,463

Carteret

9,047

21,390

Lea

9,379

29,015

Nassau

11,034

28,766

Caswell

7,438

25,284

Lincoln

9,379

29,015

New York

11,243

29,771

Catawba

7,023

20,967

Los Alamos

9,379

29,015

Niagara

7,921

19,730

Chatham

7,438

25,284

Luna

9,379

29,015

Oneida

9,118

23,428

Cherokee

7,301

21,752

McKinley

9,379

29,015

Onondaga

9,203

22,260

Chowan

7,967

22,994

Mora

9,379

29,015

Ontario

8,103

19,847

Clay

7,301

21,752

Otero

9,379

29,015

Orange

10,472

25,016

Cleveland

8,254

22,198

Quay

9,379

29,015

Orleans

7,921

19,730

Columbus

7,474

21,413

Rio Arriba

9,379

29,015

Oswego

9,118

23,428

Craven

9,047

21,390

Roosevelt

9,379

29,015

Otsego

9,118

23,428

Cumberland

7,233

23,420

San Juan

7,985

21,236

Putnam

10,472

25,016

Currituck

7,967

22,994

San Miguel

9,379

29,015

Queens

11,243

29,771

Dare

9,047

21,390

Sandoval

7,758

21,368

Rensselaer

8,439

21,463

Davidson

8,418

23,593

Santa Fe

8,139

24,010

Richmond

11,243

29,771

Davie

8,418

23,593

Sierra

9,379

29,015

Rockland

11,243

29,771

Duplin

7,474

21,413

Socorro

9,379

29,015

Saratoga

8,439

21,463

Durham

7,438

25,284

Taos

9,379

29,015

Schenectady

8,439

21,463

Edgecombe

8,970

27,984

Torrance

7,758

21,368

Schoharie

8,439

21,463

Forsyth

8,418

23,593

Union

9,379

29,015

Schuyler

9,203

22,260

Franklin

7,209

22,091

Valencia

7,758

21,368

Seneca

8,103

19,847

Gaston

8,254

22,198

St. Lawrence

9,118

23,428

Gates

7,967

22,994

Steuben

9,203

22,260

Graham

7,301

21,752

11,034

28,766

Granville

6,774

20,823

New York
County

Employee- Dependent,
Only
Family, etc.

Suffolk
Sullivan

10,472

25,016

Greene

8,970

27,984

Albany

8,439

21,463

Tioga

9,203

22,260

Guilford

7,341

21,582

Allegany

7,921

19,730

Tompkins

9,203

22,260

Halifax

7,967

22,994

Bronx

11,243

29,771

Ulster

10,472

25,016

Harnett

7,233

23,420

Broome

9,203

22,260

Warren

8,439

21,463

Haywood

7,301

21,752

Cattaraugus

7,921

19,730

Washington

8,439

21,463

Henderson

7,301

21,752

Cayuga

9,203

22,260

Wayne

8,103

19,847

Hertford

7,967

22,994

Chautauqua

7,921

19,730

Westchester

11,243

29,771

Hoke

7,233

23,420

Chemung

9,203

22,260

Wyoming

7,921

19,730

Hyde

9,047

21,390

Chenango

9,118

23,428

Yates

8,103

19,847

Iredell

7,023

20,967

Clinton

9,118

23,428

Jackson

7,301

21,752

Columbia

8,439

21,463

Cortland

9,203

22,260

Delaware

10,472

25,016

Dutchess

10,472

Erie

North Carolina

Johnston

7,209

22,091

Jones

9,047

21,390

County

Employee- Dependent,
Only
Family, etc.

Lee

7,438

25,284

25,016

Alamance

7,438

25,284

Lenoir

9,047

21,390

7,921

19,730

Alexander

7,023

20,967

Lincoln

8,254

22,198

Essex

9,118

23,428

Alleghany

7,736

23,965

Macon

7,301

21,752

Franklin

9,118

23,428

Anson

7,131

22,733

Madison

7,301

21,752

Fulton

8,439

21,463

Ashe

7,736

23,965

Martin

7,967

22,994

Genesee

7,921

19,730

Avery

7,301

21,752

McDowell

7,301

21,752

Greene

8,439

21,463

Beaufort

9,047

21,390

Mecklenburg

7,131

22,733

-22-

2022 Average Premium Tables

Mitchell

7,301

21,752

Cavalier

8,478

24,547

Auglaize

7,480

19,589

Montgomery

9,030

22,169

Dickey

8,478

24,547

Belmont

7,496

19,458

Moore

9,030

22,169

Divide

8,478

24,547

Brown

7,363

19,544

Nash

8,970

27,984

Dunn

8,478

24,547

Butler

7,124

22,838

New Hanover

7,474

21,413

Eddy

8,478

24,547

Carroll

7,521

21,311

Northampton

7,967

22,994

Emmons

8,478

24,547

Champaign

6,862

19,411

Onslow

7,474

21,413

Foster

8,478

24,547

Clark

6,862

19,411

Orange

7,438

25,284

Golden Valley

8,478

24,547

Clermont

7,363

19,544

Pamlico

9,047

21,390

Grand Forks

7,139

23,920

Clinton

7,363

19,544

Pasquotank

7,967

22,994

Grant

8,478

24,547

Columbiana

7,528

20,468

Pender

7,474

21,413

Griggs

8,478

24,547

Coshocton

7,496

19,458

Perquimans

7,967

22,994

Hettinger

8,478

24,547

Crawford

7,128

20,059

Person

7,438

25,284

Kidder

8,478

24,547

Cuyahoga

7,530

23,234

Pitt

8,970

27,984

La Moure

8,478

24,547

Darke

6,862

19,411

Polk

7,301

21,752

Logan

8,478

24,547

Defiance

8,137

21,370

Randolph

7,341

21,582

McHenry

8,478

24,547

Delaware

7,055

22,087

Richmond

7,233

23,420

McIntosh

8,478

24,547

Erie

8,591

20,639

Robeson

7,233

23,420

McKenzie

8,478

24,547

Fairfield

7,055

22,087

Rockingham

7,341

21,582

McLean

8,478

24,547

Fayette

7,055

22,087

Rowan

7,131

22,733

Mercer

8,478

24,547

Franklin

7,055

22,087

Rutherford

7,301

21,752

Morton

8,059

23,849

Fulton

8,137

21,370

Sampson

7,233

23,420

Mountrail

8,478

24,547

Gallia

8,906

23,548

Scotland

7,233

23,420

Nelson

8,478

24,547

Geauga

7,530

23,234

Stanly

7,131

22,733

Oliver

8,478

24,547

Greene

6,862

19,411

Stokes

8,418

23,593

Pembina

8,478

24,547

Guernsey

7,496

19,458

Surry

8,418

23,593

Pierce

8,478

24,547

Hamilton

7,124

22,838

Swain

7,301

21,752

Ramsey

8,478

24,547

Hancock

7,480

19,589

Transylvania

7,301

21,752

Ransom

8,478

24,547

Hardin

7,480

19,589

Tyrrell

9,047

21,390

Renville

8,478

24,547

Harrison

7,496

19,458

Union

7,131

22,733

Richland

8,478

24,547

Henry

8,137

21,370

Vance

6,774

20,823

Rolette

8,478

24,547

Highland

7,363

19,544

Wake

7,209

22,091

Sargent

8,478

24,547

Hocking

7,051

21,428

Warren

6,774

20,823

Sheridan

8,478

24,547

Holmes

5,810

18,897

Washington

9,047

21,390

Sioux

8,478

24,547

Huron

8,591

20,639

Watauga

7,736

23,965

Slope

8,478

24,547

Jackson

8,906

23,548

Wayne

8,970

27,984

Stark

8,478

24,547

Jefferson

7,496

19,458

Wilkes

7,736

23,965

Steele

8,478

24,547

Knox

7,055

22,087

Wilson

8,970

27,984

Stutsman

8,478

24,547

Lake

7,530

23,234

Yadkin

8,418

23,593

Towner

8,478

24,547

Lawrence

8,906

23,548

Yancey

7,301

21,752

Traill

8,478

24,547

Licking

7,055

22,087

Walsh

8,478

24,547

Logan

7,055

22,087

Ward

8,478

24,547

Lorain

7,530

23,234

Wells

8,478

24,547

Lucas

8,137

21,370

Williams

8,478

24,547

Madison

7,055

22,087

Mahoning

7,528

20,468

Marion

7,654

21,747

North Dakota
County

Employee- Dependent,
Only
Family, etc.

Adams

8,478

24,547

Barnes

8,478

24,547

Benson

8,478

24,547

7,297

22,928

8,478

24,547

County

Employee- Dependent,
Only
Family, etc.

Medina

Billings

Meigs

7,051

21,428

Bottineau

8,478

24,547

Adams

7,363

19,544

Mercer

7,480

19,589

Bowman

8,478

24,547

Allen

7,480

19,589

Miami

6,862

19,411

Burke

8,478

24,547

Ashland

7,297

22,928

Monroe

7,496

19,458

Burleigh

8,059

23,849

Ashtabula

7,530

23,234

Montgomery

6,862

19,411

Cass

7,707

24,039

Athens

7,051

21,428

Morgan

7,496

19,458

2022 Average Premium Tables

Ohio

-23-

Morrow

7,654

21,747

Custer

8,126

22,340

Wagoner

8,397

22,134

Muskingum

7,496

19,458

Delaware

8,126

22,340

Washington

8,126

22,340

Noble

7,496

19,458

Dewey

8,126

22,340

Washita

8,126

22,340

Ottawa

8,591

20,639

Ellis

8,126

22,340

Woods

8,126

22,340

Paulding

7,480

19,589

Garfield

8,126

22,340

Woodward

8,126

22,340

Perry

7,496

19,458

Garvin

8,126

22,340

Pickaway

7,055

22,087

Grady

8,463

21,112

Pike

8,906

23,548

Grant

8,126

22,340

Portage

7,297

22,928

Greer

8,126

22,340

County

Employee- Dependent,
Only
Family, etc.

Preble

6,862

19,411

Harmon

8,126

22,340

Baker

9,689

22,450

7,925

19,683

Oregon

Putnam

7,480

19,589

Harper

8,126

22,340

Benton

Richland

7,128

20,059

Haskell

8,126

22,340

Clackamas

7,421

20,588

22,340

Clatsop

9,288

23,313

9,288

23,313

Ross

8,906

23,548

Hughes

8,126

Sandusky

8,591

20,639

Jackson

8,126

22,340

Columbia

Scioto

8,906

23,548

Jefferson

8,126

22,340

Coos

9,288

23,313

22,340

Crook

9,689

22,450

9,288

23,313

Seneca

8,591

20,639

Johnston

8,126

Shelby

6,862

19,411

Kay

8,126

22,340

Curry

Stark

7,521

21,311

Kingfisher

8,126

22,340

Deschutes

7,854

23,403

7,446

20,341

Summit

7,297

22,928

Kiowa

8,126

22,340

Douglas

Trumbull

7,528

20,468

Latimer

8,126

22,340

Gilliam

9,689

22,450

Tuscarawas

7,496

19,458

Le Flore

7,472

19,440

Grant

9,689

22,450

9,689

22,450

Union

7,055

22,087

Lincoln

8,463

21,112

Harney

Van Wert

7,480

19,589

Logan

8,463

21,112

Hood River

9,689

22,450

22,340

Jackson

7,446

20,341

9,689

22,450

Vinton

8,906

23,548

Love

8,126

Warren

7,124

22,838

Major

8,126

22,340

Jefferson

Washington

7,051

21,428

Marshall

8,126

22,340

Josephine

7,446

20,341

22,340

Klamath

7,854

23,403

7,854

23,403

Wayne

5,810

18,897

Mayes

8,126

Williams

8,137

21,370

McClain

8,463

21,112

Lake

Wood

8,137

21,370

McCurtain

8,126

22,340

Lane

7,925

19,683

22,340

Lincoln

9,288

23,313

7,925

19,683

Wyandot

8,591

20,639

Oklahoma

McIntosh

8,126

Murray

8,126

22,340

Linn

Muskogee

8,126

22,340

Malheur

9,689

22,450

22,340

Marion

7,547

20,938

9,689

22,450

Noble

County

Employee- Dependent,
Only
Family, etc.

Nowata

8,126

22,340

Morrow

Adair

8,126

22,340

Okfuskee

8,126

22,340

Multnomah

7,421

20,588

Alfalfa

8,126

22,340

Oklahoma

8,463

21,112

Polk

7,547

20,938

Atoka

8,126

22,340

Okmulgee

8,397

22,134

Sherman

9,689

22,450

Beaver

8,126

22,340

Osage

8,397

22,134

Tillamook

9,288

23,313

Beckham

8,126

22,340

Ottawa

8,126

22,340

Umatilla

9,689

22,450

Blaine

8,126

22,340

Pawnee

8,397

22,134

Union

9,689

22,450

Bryan

8,126

22,340

Payne

8,126

22,340

Wallowa

9,689

22,450

Caddo

8,126

22,340

Pittsburg

8,126

22,340

Wasco

9,689

22,450

Canadian

8,463

21,112

Pontotoc

8,126

22,340

Washington

7,421

20,588

Carter

8,126

22,340

22,340

Wheeler

9,689

22,450

Cherokee

8,126

22,340

Pushmataha

8,126

22,340

Yamhill

7,421

20,588

Choctaw

8,126

22,340

Roger Mills

8,126

22,340

Cimarron

8,126

22,340

Rogers

8,397

22,134

Cleveland

8,463

21,112

Seminole

8,126

22,340

Coal

8,126

22,340

Sequoyah

7,472

19,440

Comanche

7,985

20,401

Stephens

8,126

22,340

Texas

8,126

22,340

Cotton

8,126

22,340

Pottawatomie

8,126

8,126

Craig

8,126

22,340

Tillman

8,126

22,340

Creek

8,397

22,134

Tulsa

8,397

22,134

-24-

Pennsylvania
County

Employee- Dependent,
Only
Family, etc.

Adams

8,517

24,095

Allegheny

7,505

20,973

Armstrong

7,505

20,973

Beaver

7,505

20,973

2022 Average Premium Tables

Bedford

8,469

18,764

Susquehanna

7,798

20,923

McCormick

8,590

22,487

Berks

8,517

24,095

Tioga

7,798

20,923

Newberry

8,550

21,978

Blair

8,469

18,764

Union

8,495

26,717

Oconee

9,341

25,843

Bradford

7,798

20,923

Venango

6,677

18,591

Orangeburg

8,291

23,112

Bucks

8,195

22,881

Warren

6,677

18,591

Pickens

7,983

21,437

Butler

7,505

20,973

Washington

7,505

20,973

Richland

8,074

22,898

Cambria

8,469

18,764

Wayne

7,798

20,923

Saluda

8,422

21,893

Cameron

7,314

22,737

Westmoreland

7,505

20,973

Spartanburg

7,709

22,370

Carbon

7,798

20,923

Wyoming

7,798

20,923

Sumter

7,679

18,991

Centre

8,495

26,717

York

8,517

24,095

Union

7,041

21,245

Chester

8,195

22,881

Williamsburg

7,261

21,058

Clarion

6,677

18,591

York

7,788

21,543

Clearfield

8,469

18,764

Clinton

7,798

20,923

County

Employee- Dependent,
Only
Family, etc.

Columbia

8,495

26,717

All

8,796

Crawford

6,677

18,591

Cumberland

7,824

22,892

Dauphin

7,824

22,892

Delaware

8,195

22,881

Elk

7,314

22,737

Erie

6,677

18,591

Fayette

7,505

20,973

Forest

6,677

18,591

Franklin

7,824

22,892

Fulton

7,824

22,892

Greene

7,505

20,973

Huntingdon

8,469

18,764

Indiana

7,505

20,973

Jefferson

8,469

18,764

Juniata

7,824

22,892

Lackawanna

7,798

20,923

Lancaster

8,517

24,095

Lawrence

7,505

20,973

Lebanon

7,824

22,892

Lehigh

8,495

26,717

Luzerne

7,798

20,923

Lycoming

7,798

20,923

McKean

6,677

18,591

Mercer

6,677

18,591

Mifflin

8,495

26,717

Monroe

7,798

20,923

Montgomery

8,195

22,881

Montour

8,495

26,717

Northampton

8,495

26,717

Northumberland

8,495

26,717

Perry

7,824

22,892

Philadelphia

8,195

22,881

Pike

7,798

20,923

Potter

7,314

22,737

Schuylkill

8,495

26,717

Snyder

8,495

26,717

Somerset

8,469

18,764

Sullivan

7,798

20,923

2022 Average Premium Tables

Rhode Island

South Dakota

22,443

South Carolina

County

Employee- Dependent,
Only
Family, etc.

Aurora

8,365

24,641

Employee- Dependent,
Only
Family, etc.

Beadle

7,825

23,411

County

Bennett

7,426

21,045

Abbeville

8,099

21,832

Bon Homme

8,365

24,641

Aiken

7,541

20,086

Brookings

7,825

23,411

Allendale

7,955

21,875

Brown

7,825

23,411

Anderson

7,847

21,384

Brule

8,365

24,641

Bamberg

7,113

21,596

Buffalo

8,365

24,641

Barnwell

6,912

20,869

Butte

7,426

21,045

Beaufort

8,126

20,827

Campbell

7,825

23,411

Berkeley

8,717

20,879

Charles Mix

8,365

24,641

Calhoun

7,482

21,376

Clark

7,825

23,411

Charleston

7,415

22,356

Clay

7,321

21,356

Cherokee

7,507

20,578

Codington

7,825

23,411

Chester

8,071

21,886

Corson

7,426

21,045

Chesterfield

7,763

21,539

Custer

7,426

21,045

Clarendon

6,892

21,517

Davison

8,365

24,641

Colleton

7,936

21,642

Day

7,825

23,411

Darlington

8,319

21,826

Deuel

7,825

23,411

Dillon

8,040

20,864

Dewey

7,426

21,045

Dorchester

9,023

21,735

Douglas

8,365

24,641

Edgefield

6,572

20,226

Edmunds

7,825

23,411

Fairfield

7,982

21,314

Fall River

7,426

21,045

Florence

8,165

21,727

Faulk

7,825

23,411

Georgetown

8,100

20,184

Grant

7,825

23,411

Greenville

8,011

21,912

Gregory

7,426

21,045

Greenwood

6,783

20,630

Haakon

7,426

21,045

Hampton

8,305

21,777

Hamlin

7,825

23,411

Horry

7,012

22,581

Hand

8,365

24,641

Jasper

7,799

21,474

Hanson

8,365

24,641

Kershaw

8,349

21,301

Harding

7,426

21,045

Lancaster

8,029

21,225

Hughes

8,365

24,641

Laurens

7,675

21,208

Hutchinson

8,365

24,641

Lee

7,814

21,118

Hyde

8,365

24,641

Lexington

8,215

21,027

Jackson

7,426

21,045

Marion

8,491

22,753

Jerauld

8,365

24,641

Marlboro

8,036

21,987

Jones

7,426

21,045

-25-

Kingsbury

7,825

23,411

DeKalb

6,672

16,567

Robertson

7,695

19,360

Lake

7,321

21,356

Dickson

6,733

18,618

Rutherford

7,695

19,360

Lawrence

7,426

21,045

Dyer

7,401

20,883

Scott

6,720

17,996

Lincoln

7,321

21,356

Fayette

7,200

18,799

Sequatchie

7,379

18,618

Lyman

7,426

21,045

Fentress

6,672

16,567

Sevier

6,720

17,996

Marshall

7,825

23,411

Franklin

7,379

18,618

Shelby

7,200

18,799

McCook

7,321

21,356

Gibson

7,401

20,883

Smith

6,672

16,567

McPherson

7,825

23,411

Giles

6,733

18,618

Stewart

6,733

18,618

Meade

7,426

21,045

Grainger

6,720

17,996

Sullivan

7,434

18,852

Mellette

7,426

21,045

Greene

7,434

18,852

Sumner

7,695

19,360

Miner

8,365

24,641

Grundy

7,379

18,618

Tipton

7,200

18,799

Minnehaha

7,321

21,356

Hamblen

6,720

17,996

Trousdale

7,695

19,360

Moody

7,321

21,356

Hamilton

7,379

18,618

Unicoi

7,434

18,852

Pennington

7,426

21,045

Hancock

7,434

18,852

Union

6,720

17,996

Perkins

7,426

21,045

Hardeman

7,401

20,883

Van Buren

6,672

16,567

Potter

7,825

23,411

Hardin

7,401

20,883

Warren

6,672

16,567

Roberts

7,825

23,411

Hawkins

7,434

18,852

Washington

7,434

18,852

Sanborn

8,365

24,641

Haywood

7,200

18,799

Wayne

6,733

18,618

Shannon

7,426

21,045

Henderson

7,401

20,883

Weakley

7,401

20,883

Spink

7,825

23,411

Henry

7,401

20,883

White

6,672

16,567

Stanley

7,426

21,045

Hickman

6,733

18,618

Williamson

7,695

19,360

Sully

8,365

24,641

Houston

6,733

18,618

Wilson

7,695

19,360

Todd

7,426

21,045

Humphreys

6,733

18,618

Tripp

7,426

21,045

Jackson

6,672

16,567

Turner

7,321

21,356

Jefferson

6,720

17,996

Union

7,321

21,356

Johnson

7,434

18,852

County

Employee- Dependent,
Only
Family, etc.

Walworth

7,825

23,411

Knox

6,720

17,996

Anderson

7,822

19,420

7,822

19,420

Texas

Yankton

8,365

24,641

Lake

7,401

20,883

Andrews

Ziebach

7,426

21,045

Lauderdale

7,200

18,799

Angelina

7,822

19,420

18,618

Aransas

8,102

26,628

8,440

20,716

Lawrence

Tennessee
County

Employee- Dependent,
Only
Family, etc.

6,733

Lewis

6,733

18,618

Archer

Lincoln

6,733

18,618

Armstrong

10,030

22,167

17,996

Atascosa

7,665

18,955

7,022

22,662

Loudon

6,720

Anderson

6,720

17,996

Macon

6,672

16,567

Austin

Bedford

6,733

18,618

Madison

7,401

20,883

Bailey

7,822

19,420

Benton

7,401

20,883

Marion

7,379

18,618

Bandera

7,665

18,955

Bledsoe

7,379

18,618

Marshall

6,733

18,618

Bastrop

7,061

20,191

Blount

6,720

17,996

Maury

6,733

18,618

Baylor

7,822

19,420

Bradley

7,379

18,618

McMinn

7,379

18,618

Bee

7,822

19,420

Campbell

6,720

17,996

McNairy

7,401

20,883

Bell

7,339

16,674

Cannon

6,672

16,567

Meigs

7,379

18,618

Bexar

7,665

18,955

Carroll

7,401

20,883

Monroe

6,720

17,996

Blanco

7,822

19,420

Carter

7,434

18,852

Montgomery

7,695

19,360

Borden

7,822

19,420

Cheatham

7,695

19,360

18,618

Bosque

7,822

19,420

Chester

7,401

20,883

Morgan

6,720

17,996

Bowie

6,585

18,517

Claiborne

6,720

17,996

Obion

7,401

20,883

Brazoria

7,022

22,662

Clay

6,672

16,567

16,567

Brazos

7,118

20,305

Cocke

6,720

17,996

Perry

6,733

18,618

Brewster

7,822

19,420

Coffee

6,733

18,618

Pickett

6,672

16,567

Briscoe

7,822

19,420

Crockett

7,401

20,883

18,618

Brooks

7,822

19,420

7,822

19,420

Moore

Overton

Polk

6,733

6,672

7,379

Cumberland

6,672

16,567

Putnam

6,672

16,567

Brown

Davidson

7,695

19,360

Rhea

7,379

18,618

Burleson

7,118

20,305

Decatur

7,401

20,883

17,996

Burnet

7,822

19,420

Roane

6,720

-26-

2022 Average Premium Tables

Caldwell

7,061

20,191

Freestone

7,822

19,420

Kimble

7,822

19,420

Calhoun

8,198

21,075

Frio

7,822

19,420

King

7,822

19,420

Callahan

7,456

20,335

Gaines

7,822

19,420

Kinney

7,822

19,420

Cameron

6,716

18,683

Galveston

7,022

22,662

Kleberg

7,822

19,420

Camp

7,822

19,420

Garza

7,822

19,420

Knox

7,822

19,420

Carson

10,030

22,167

Gillespie

7,822

19,420

Lamar

7,822

19,420

Cass

7,822

19,420

Glasscock

7,822

19,420

Lamb

7,822

19,420

Castro

7,822

19,420

Goliad

8,198

21,075

Lampasas

7,339

16,674

Chambers

7,022

22,662

Gonzales

7,822

19,420

LaSalle

7,822

19,420

Cherokee

7,822

19,420

Gray

7,822

19,420

Lavaca

7,822

19,420

Childress

7,822

19,420

Grayson

7,707

19,176

Lee

7,822

19,420

Clay

8,440

20,716

Gregg

6,126

22,987

Leon

7,822

19,420

Cochran

7,822

19,420

Grimes

7,822

19,420

Liberty

7,022

22,662

Coke

7,822

19,420

Guadalupe

7,665

18,955

Limestone

7,822

19,420

Coleman

7,822

19,420

Hale

7,822

19,420

Lipscomb

7,822

19,420

Collin

7,978

22,164

Hall

7,822

19,420

Live Oak

7,822

19,420

Collingsworth

7,822

19,420

Hamilton

7,822

19,420

Llano

7,822

19,420

Colorado

7,822

19,420

Hansford

7,822

19,420

Loving

7,822

19,420

Comal

7,665

18,955

Hardeman

7,822

19,420

Lubbock

6,457

21,917

Comanche

7,822

19,420

Hardin

9,052

22,480

Lynn

7,822

19,420

Concho

7,822

19,420

Harris

7,022

22,662

Madison

7,822

19,420

Cooke

7,822

19,420

Harrison

7,822

19,420

Marion

7,822

19,420

Coryell

7,339

16,674

Hartley

7,822

19,420

Martin

7,822

19,420

Cottle

7,822

19,420

Haskell

7,822

19,420

Mason

7,822

19,420

Crane

7,822

19,420

Hays

7,061

20,191

Matagorda

7,822

19,420

Crockett

7,822

19,420

Hemphill

7,822

19,420

Maverick

7,822

19,420

Crosby

6,457

21,917

Henderson

7,822

19,420

McCulloch

7,822

19,420

Culberson

7,822

19,420

Hidalgo

8,613

21,323

McLennan

5,696

16,196

Dallam

7,822

19,420

Hill

7,822

19,420

McMullen

7,822

19,420

Dallas

7,978

22,164

Hockley

7,822

19,420

Medina

7,665

18,955

Dawson

7,822

19,420

Hood

7,822

19,420

Menard

7,822

19,420

Deaf Smith

7,822

19,420

Hopkins

7,822

19,420

Midland

6,913

22,892

Delta

7,978

22,164

Houston

7,822

19,420

Milam

7,822

19,420

Denton

7,978

22,164

Howard

7,822

19,420

Mills

7,822

19,420

DeWitt

7,822

19,420

Hudspeth

7,822

19,420

Mitchell

7,822

19,420

Dickens

7,822

19,420

Hunt

7,978

22,164

Montague

7,822

19,420

Dimmit

7,822

19,420

Hutchinson

7,822

19,420

Montgomery

7,022

22,662

Donley

7,822

19,420

Irion

10,151

20,682

Moore

7,822

19,420

Duval

7,822

19,420

Jack

7,822

19,420

Morris

7,822

19,420

Eastland

7,822

19,420

Jackson

7,822

19,420

Motley

7,822

19,420

Ector

8,911

19,166

Jasper

7,822

19,420

Nacogdoches

7,822

19,420

Edwards

7,822

19,420

Jeff Davis

7,822

19,420

Navarro

7,822

19,420

El Paso

7,581

16,149

Jefferson

9,052

22,480

Newton

7,822

19,420

Ellis

7,978

22,164

Jim Hogg

7,822

19,420

Nolan

7,822

19,420

Erath

7,822

19,420

Jim Wells

7,822

19,420

Nueces

8,102

26,628

Falls

7,822

19,420

Johnson

7,978

22,164

Ochiltree

7,822

19,420

Fannin

7,822

19,420

Jones

7,456

20,335

Oldham

7,822

19,420

Fayette

7,822

19,420

Karnes

7,822

19,420

Orange

9,052

22,480

Fisher

7,822

19,420

Kaufman

7,978

22,164

Palo Pinto

7,822

19,420

Floyd

7,822

19,420

Kendall

7,665

18,955

Panola

7,822

19,420

Foard

7,822

19,420

Kenedy

7,822

19,420

Parker

7,978

22,164

Fort Bend

7,022

22,662

Kent

7,822

19,420

Parmer

7,822

19,420

Franklin

7,822

19,420

Kerr

7,822

19,420

Pecos

7,822

19,420

2022 Average Premium Tables

-27-

Virginia

Polk

7,822

19,420

Webb

7,455

20,524

Potter

10,030

22,167

Wharton

7,822

19,420

Presidio

7,822

19,420

Wheeler

7,822

19,420

County

Employee- Dependent,
Only
Family, etc.

Rains

7,822

19,420

Wichita

8,440

20,716

Accomack

7,346

19,191

Randall

10,030

22,167

Wilbarger

7,822

19,420

Albemarle

8,974

21,460

Reagan

7,822

19,420

Willacy

7,822

19,420

Alexandria City

7,542

23,327

7,346

19,191

Real

7,822

19,420

Williamson

7,061

20,191

Alleghany

Red River

7,822

19,420

Wilson

7,665

18,955

Amelia

7,131

22,408

Reeves

7,822

19,420

Winkler

7,822

19,420

Amherst

6,642

18,936

6,642

18,936

Refugio

7,822

19,420

Wise

7,978

22,164

Appomattox

Roberts

7,822

19,420

Wood

7,822

19,420

Arlington

7,542

23,327

Robertson

7,118

20,305

Yoakum

7,822

19,420

Augusta

7,346

19,191

7,346

19,191

Rockwall

7,978

22,164

Young

7,822

19,420

Bath

Runnels

7,822

19,420

Zapata

7,822

19,420

Bedford

6,642

18,936

Rusk

6,126

22,987

Zavala

7,822

19,420

Bedford City

6,642

18,936

Bland

7,346

19,191

Botetourt

7,631

22,437

7,629

18,863

Sabine

7,822

19,420

San Augustine

7,822

19,420

San Jacinto

7,022

22,662

Utah
Employee- Dependent,
Only
Family, etc.

Bristol City

San Patricio

8,102

26,628

County

Brunswick

7,346

19,191

San Saba

7,822

19,420

Beaver

7,720

21,979

Buchanan

7,346

19,191

Schleicher

7,822

19,420

Box Elder

7,158

20,264

Buckingham

7,346

19,191

8,509

23,989

Scurry

7,822

19,420

Cache

Buena Vista City

7,346

19,191

Shackelford

7,822

19,420

Carbon

7,720

21,979

Campbell

6,642

18,936

19,420

Daggett

7,720

21,979

Caroline

7,131

22,408

7,291

20,730

Shelby

7,822

Sherman

7,822

19,420

Davis

Carroll

7,346

19,191

Smith

7,669

22,893

Duchesne

7,720

21,979

Charles City

7,131

22,408

19,420

Emery

7,720

21,979

Charlotte

7,346

19,191

7,720

21,979

Somervell

7,822

Starr

7,822

19,420

Garfield

Charlottesville City

8,974

21,460

Stephens

7,822

19,420

Grand

7,720

21,979

Chesapeake City

7,659

21,119

19,420

Iron

9,091

20,622

Chesterfield

7,131

22,408

7,720

21,979

Sterling

7,822

Stonewall

7,822

19,420

Juab

Clarke

7,542

23,327

Sutton

7,822

19,420

Kane

7,720

21,979

Colonial Heights City

7,131

22,408

19,420

Millard

7,720

21,979

Covington City

7,346

19,191

7,158

20,264

Swisher

7,822

Tarrant

7,978

22,164

Morgan

Craig

7,631

22,437

Taylor

7,456

20,335

Piute

7,720

21,979

Culpeper

7,346

19,191

8,509

23,989

Terrell

7,822

19,420

Rich

Cumberland

7,131

22,408

Terry

7,822

19,420

Salt Lake

7,291

20,730

Danville City

8,956

21,176

Throckmorton

7,822

19,420

San Juan

7,720

21,979

Dickenson

7,346

19,191

7,720

21,979

Titus

7,822

19,420

Sanpete

Dinwiddie

7,131

22,408

Tom Green

10,151

20,682

Sevier

7,720

21,979

Emporia City

7,346

19,191

Travis

7,061

20,191

Summit

7,291

20,730

Essex

7,346

19,191

7,291

20,730

Trinity

7,822

19,420

Tooele

Fairfax

7,542

23,327

Tyler

7,822

19,420

Uintah

7,720

21,979

Fairfax City

7,542

23,327

22,987

Utah

6,255

21,210

Falls Church City

7,542

23,327

7,291

20,730

Upshur

6,126

Upton

7,822

19,420

Wasatch

Fauquier

7,542

23,327

Uvalde

7,822

19,420

Washington

9,091

20,622

Floyd

7,346

19,191

19,420

Wayne

7,720

21,979

Fluvanna

8,974

21,460

Weber

7,158

20,264

Franklin

7,631

22,437

Franklin City

7,346

19,191

Frederick

7,139

19,828

Fredericksburg City

7,542

23,327

Galax City

7,346

19,191

Giles

6,887

20,744

Val Verde

7,822

Van Zandt

7,822

19,420

Victoria

8,198

21,075

Walker

7,822

19,420

Waller

7,022

22,662

Ward

7,822

19,420

Washington

7,822

19,420

Vermont
County

Employee- Dependent,
Only
Family, etc.

All

8,460

-28-

23,240

2022 Average Premium Tables

Gloucester

7,659

21,119

Radford City

6,887

20,744

Kittitas

7,672

21,504

Goochland

7,131

22,408

Rappahannock

7,346

19,191

Klickitat

7,145

18,452

Grayson

7,346

19,191

Richmond

7,346

19,191

Lewis

7,967

20,803

Greene

8,974

21,460

Richmond City

7,131

22,408

Lincoln

7,333

18,084

Greensville

7,346

19,191

Roanoke

7,631

22,437

Mason

7,967

20,803

Halifax

7,346

19,191

Roanoke City

7,631

22,437

Okanogan

7,672

21,504

Hampton City

7,659

21,119

Rockbridge

7,346

19,191

Pacific

7,967

20,803

Hanover

7,131

22,408

Rockingham

7,253

21,742

Pend Oreille

7,333

18,084

Harrisonburg City

7,253

21,742

Russell

7,346

19,191

Pierce

7,967

20,803

Henrico

7,131

22,408

Salem City

7,631

22,437

San Juan

7,967

20,803

Henry

7,346

19,191

Scott

7,629

18,863

Skagit

7,967

20,803

Highland

7,346

19,191

Shenandoah

7,346

19,191

Skamania

7,145

18,452

Hopewell City

7,131

22,408

Smyth

7,346

19,191

Snohomish

7,967

20,803

Isle of Wight

7,659

21,119

Southampton

7,346

19,191

Spokane

7,333

18,084

James City

7,659

21,119

Spotsylvania

7,542

23,327

Stevens

7,333

18,084

King and Queen

7,131

22,408

Stafford

7,542

23,327

Thurston

7,967

20,803

King George

7,346

19,191

Staunton City

7,346

19,191

Wahkiakum

7,967

20,803

King William

7,131

22,408

Suffolk City

7,659

21,119

Walla Walla

7,672

21,504

Lancaster

7,346

19,191

Surry

7,659

21,119

Whatcom

7,967

20,803

Lee

7,346

19,191

Sussex

7,131

22,408

Whitman

7,672

21,504

Lexington City

7,346

19,191

Tazewell

7,346

19,191

Yakima

7,672

21,504

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

18,863

Lynchburg City

6,642

18,936

Waynesboro City

7,346

19,191

County

Employee- Dependent,
Only
Family, etc.

Madison

7,346

19,191

Westmoreland

7,346

19,191

Barbour

8,482

24,657

21,119

Berkeley

7,970

24,049

7,875

26,140

Manassas City

7,542

23,327

Williamsburg City

7,659

West Virginia

Manassas Park City

7,542

23,327

Winchester City

7,139

19,828

Boone

Martinsville City

7,346

19,191

Wise

7,346

19,191

Braxton

9,567

25,392

19,191

Brooke

7,936

24,647

21,119

Cabell

7,745

24,334

Calhoun

9,567

25,392

Clay

9,567

25,392

Doddridge

7,968

22,054

Mathews

7,659

21,119

Mecklenburg

7,346

19,191

Middlesex

7,346

19,191

Montgomery

6,887

20,744

Wythe
York

7,346
7,659

Washington

Nelson

8,974

21,460

New Kent

7,131

22,408

County

Employee- Dependent,
Only
Family, etc.

Fayette

9,567

25,392

7,672

21,504

Gilmer

7,968

22,054

Newport News City

7,659

21,119

Adams

Norfolk City

7,659

21,119

Asotin

7,672

21,504

Grant

6,607

22,895

Northampton

7,346

19,191

Benton

7,672

21,504

Greenbrier

9,567

25,392

7,672

21,504

Hampshire

6,607

22,895

Northumberland

7,346

19,191

Chelan

Norton City

7,346

19,191

Clallam

7,967

20,803

Hancock

7,936

24,647

Nottoway

7,346

19,191

Clark

7,145

18,452

Hardy

6,607

22,895

7,672

21,504

Harrison

8,482

24,657

Orange

7,346

19,191

Columbia

Page

7,346

19,191

Cowlitz

7,967

20,803

Jackson

9,390

28,051

19,191

Douglas

7,672

21,504

Jefferson

7,970

24,049

7,333

18,084

Kanawha

9,293

25,820

Patrick

7,346

Petersburg City

7,131

22,408

Ferry

Pittsylvania

8,956

21,176

Franklin

7,672

21,504

Lewis

7,968

22,054

21,119

Garfield

7,672

21,504

Lincoln

7,875

26,140

7,672

21,504

Logan

7,875

26,140

Poquoson

7,659

Portsmouth City

7,659

21,119

Grant

Powhatan

7,131

22,408

Grays Harbor

7,967

20,803

Marion

7,968

22,054

19,191

Island

7,967

20,803

Marshall

7,936

24,647

7,967

20,803

Mason

7,745

24,334

Prince Edward

7,346

Prince George

7,131

22,408

Jefferson

Prince William

7,542

23,327

King

7,851

21,289

McDowell

7,875

26,140

20,744

Kitsap

7,967

20,803

Mercer

7,754

20,390

Pulaski

6,887

2022 Average Premium Tables

-29-

Mineral

6,607

22,895

Dodge

6,944

21,470

Sawyer

7,985

25,622

Mingo

7,875

26,140

Door

7,305

22,221

Shawano

7,305

22,221

Monongalia

7,968

22,054

Douglas

7,985

25,622

Sheboygan

6,944

21,470

Monroe

7,754

20,390

Dunn

8,268

24,992

St. Croix

9,799

24,219

Morgan

6,607

22,895

Eau Claire

8,268

24,992

Taylor

7,671

22,602

Nicholas

9,567

25,392

Florence

6,647

21,458

Trempealeau

7,117

21,007

Ohio

7,936

24,647

Fond du Lac

6,944

21,470

Vernon

8,133

23,995

Pendleton

6,607

22,895

Forest

6,647

21,458

Vilas

6,647

21,458

Pleasants

9,390

28,051

Grant

8,133

23,995

Walworth

8,008

26,080

Pocahontas

8,482

24,657

Green

8,008

26,080

Washburn

7,985

25,622

Preston

8,482

24,657

Green Lake

7,489

29,125

Washington

7,826

24,696

Putnam

7,745

24,334

Iowa

8,133

23,995

Waukesha

7,826

24,696

Raleigh

7,754

20,390

Iron

6,647

21,458

Waupaca

6,944

21,470

Randolph

8,482

24,657

Jackson

7,117

21,007

Waushara

6,944

21,470

Ritchie

9,390

28,051

Jefferson

8,008

26,080

Winnebago

6,944

21,470

Roane

9,567

25,392

Juneau

7,489

29,125

Wood

8,141

24,385

Summers

7,754

20,390

Kenosha

8,772

26,795

Taylor

8,482

24,657

Kewaunee

7,305

22,221

Tucker

8,482

24,657

La Crosse

7,117

21,007

Tyler

9,390

28,051

Lafayette

8,133

23,995

County

Employee- Dependent,
Only
Family, etc.

Upshur

8,482

24,657

Langlade

6,647

21,458

Albany

8,544

24,339

8,544

24,339

Wyoming

Wayne

7,745

24,334

Lincoln

8,141

24,385

Big Horn

Webster

8,482

24,657

Manitowoc

7,305

22,221

Campbell

8,544

24,339

24,385

Carbon

8,544

24,339

8,544

24,339

Wetzel

7,968

22,054

Marathon

8,141

Wirt

9,390

28,051

Marinette

7,305

22,221

Converse

Wood

9,390

28,051

Marquette

7,489

29,125

Crook

8,544

24,339

22,221

Fremont

8,544

24,339

8,544

24,339

Wyoming

7,875

26,140

Wisconsin

Menomonee

7,305

Milwaukee

7,723

26,745

Goshen

Monroe

7,117

21,007

Hot Springs

8,544

24,339

22,221

Johnson

8,544

24,339

8,671

22,222

Employee- Dependent,
Only
Family, etc.

Oconto

County

Oneida

6,647

21,458

Laramie

Adams

7,489

29,125

Outagamie

6,944

21,470

Lincoln

8,544

24,339

Ashland

7,985

25,622

24,696

Natrona

8,899

22,349

8,544

24,339

Ozaukee

7,305

7,826

Barron

7,671

22,602

Pepin

8,268

24,992

Niobrara

Bayfield

7,985

25,622

Pierce

9,799

24,219

Park

8,544

24,339

Brown

7,305

22,221

Polk

9,799

24,219

Platte

8,544

24,339

Buffalo

7,117

21,007

Portage

8,141

24,385

Sheridan

8,544

24,339

Burnett

7,985

25,622

Price

7,671

22,602

Sublette

8,544

24,339

Calumet

6,944

21,470

Racine

8,772

26,795

Sweetwater

8,544

24,339

Chippewa

8,268

24,992

Richland

7,489

29,125

Teton

8,544

24,339

Clark

7,671

22,602

Rock

8,008

26,080

Uinta

8,544

24,339

Columbia

8,008

26,080

Rusk

7,671

22,602

Washakie

8,544

24,339

Crawford

8,133

23,995

Sauk

7,489

29,125

Weston

8,544

24,339

Dane

7,594

25,699

-30-

2022 Average Premium Tables


File Typeapplication/pdf
File Title2022 Instructions for Form 8941
SubjectInstructions for Form 8941, Credit for Small Employer Health Insurance Premiums
AuthorW:CAR:MP:FP
File Modified2022-12-12
File Created2022-11-22

© 2024 OMB.report | Privacy Policy