Form 8941 การ สอน

Department of the Treasury

Internal Revenue Service

2023

Instructions for Form 8941

Credit for Small Employer Health Insurance Premiums

Section references are to the Internal Revenue Code

unless otherwise noted.

Partnerships, S corporations, cooperatives,

estates, trusts, and tax-exempt eligible small

employers must file this form to claim the credit.

TIP

Future Developments

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.

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.

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.

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 details, see Employer Premiums Paid, Health

Insurance Coverage, and Qualifying Arrangement, later.

For information about insurance plans offered

2. You had fewer than 25 full-time equivalent employ-

ees (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.

through a SHOP Marketplace, go to

Healthcare.gov.

TIP

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.

Although the term “eligible small employer” is

defined in the Internal Revenue Code to include

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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 $62,000 per FTE. For details, see Worksheets

1 and 3.

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, General Business Credit.

Nov 8, 2023

Cat. No. 55222U

If you had more than 10 FTEs and average annual

wages of more than $30,000, the FTE and

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.

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

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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 $62,000.

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

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corporations.

Employers who are members of an affiliated service

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group.

Employers who are partnerships, proprietorships, etc.,

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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).

No more than one Form 8941 can be filed with a

tax return, unless the exception described in

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Example 2 below applies.

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.

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 1. You’re a sole proprietor with two separate

businesses and you file a separate Schedule C (Form

1040), Profit or Loss From Business, 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.

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

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:

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

An eligible small employer (or any predecessor) files an

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the premium cost of each employee enrolled in

income tax return with an attached Form 8941 with line A

checked “Yes” and a positive amount on line 12, or

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.

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.

To determine the premiums you paid during the tax

year, multiply the number of pay periods during which the

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Instructions for Form 8941 (2023)

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.

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.

Tobacco surcharge. Any additional amount you or your

employee pays to cover a tobacco surcharge isn’t taken

into account in figuring the uniform percentage

requirement. Amounts you or your employee pays 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 stand-alone dental plan offered through a SHOP

exchange will be considered a qualified health

plan for purposes of the credit.

TIP

Employer premiums paid for health insurance

coverage can be counted in figuring the credit only

if the premiums are paid under a qualifying

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CAUTION

arrangement.

A uniform percentage (not less than 50%) of the

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premium cost for each employee (if any) enrolled in

employee-only coverage.

Qualifying Arrangement

A uniform amount that is no less than the amount you

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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

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

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would’ve paid toward employee-only coverage for each

employee (if any) enrolled in any other tier of coverage

(figured separately for each tier).

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-on-

ly 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.

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.

A uniform percentage (not less than 50%) of the

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premium charged for each employee enrolled in the

employee-only coverage.

A uniform percentage (not less than 50%) of your

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employer-computed composite rate (defined later) for your

employee-only coverage for each employee enrolled in

the employee-only coverage.

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

Arrangements with list billing and other tiers of cov-

erage. 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

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 premium

Instructions for Form 8941 (2023)

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requires you to pay each of the following amounts if you

make the relevant tier of coverage available.

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.

A uniform percentage (not less than 50%) for each

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employee enrolled in employee-only coverage, as

discussed under Arrangements with list billing and only

employee-only coverage, earlier.

A uniform amount that is either equal to the amount you

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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

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 2023, payroll taxes, for this purpose, mean

only the following taxes.

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

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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).

Federal income taxes the tax-exempt employer was

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required to withhold from employees’ wages in calendar

year 2023.

Medicare taxes the tax-exempt employer was required

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to withhold from employees’ wages in calendar year 2023.

Medicare taxes the tax-exempt employer was required

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to pay for calendar year 2023.

Employer-computed composite rate. The

Premium Deduction Reduced

employer-computed composite rate for a tier of coverage

is the average rate determined by adding the premiums for

that tier of coverage for all employees eligible to

participate in the health insurance plan (whether or not

they actually receive coverage under the plan or under

that tier of coverage) and dividing by the total number of

such eligible employees.

You must reduce your deduction for the cost of providing

health insurance coverage to your employees by the

amount of any credit for small employer health insurance

premiums allowed with respect to the coverage.

More Information

For more information about this credit, see the following.

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).

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.

Section 45R.

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Regulations sections 1.45R-0 through 1.45R-5.

IRS.gov/Affordable-Care-Act/Employers/Small-

Business-Health-Care -T a x-Credit-and-the-SHOP-

Marketplace.

Specific Instructions

Partnerships, S corporations, cooperatives,

estates, trusts, and tax-exempt eligible small

employers must file this form to claim the credit.

TIP

All other taxpayers must not complete or file this form if

their only source for this credit is a partnership, S

corporation, cooperative, estate, or trust. Instead, they

must report this credit directly on line 4h in Part III of Form

3800.

State Premium Subsidy and Tax

Credit Limitation

Use Worksheets 1 through 7 to figure the amounts to

report on various lines of Form 8941.

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, 2, and 3 to figure the amounts to

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report on lines 1, 2, and 3 of Form 8941.

Use Worksheet 4 to figure the amounts to report on

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lines 4, 5, and 13 of Form 8941.

Use Worksheets 5, 6, and 7 to figure the amounts to

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report on lines 8, 9, and 14 of Form 8941.

Line A

Although a state tax credit or premium subsidy paid

directly to you doesn’t reduce the amount of your

employer premiums paid, and although a state premium

subsidy paid directly to an insurance provider is treated as

an employer premium you paid, the amount of your credit

can’t be more than your net premium payments.

Answer “Yes” if one of the following applies.

You paid premiums for employee health insurance

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coverage you provided through a SHOP Marketplace or

through a direct enrollment process, if available in your

state.

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Instructions for Form 8941 (2023)

You qualify for an exception to this requirement, as

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Worksheet 1. Information Needed To

Complete Line 1 and Worksheets 2

and 3

discussed below.

If you answer “Yes” because you paid premiums for

employee health insurance coverage you provided

through a SHOP Marketplace, enter the Marketplace

identifier, if any.

If you 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)

(b)

(c)

Employee

Wages

Paid

Individuals

Considered

Employees

Employee

Hours of

Service

ꢀ1.

ꢀ2.

ꢀ3.

ꢀ4.

ꢀ5.

ꢀ6.

ꢀ7.

ꢀ8.

ꢀ9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

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, go to CMS.gov.

Exception for eligible small employers in certain

counties. For calendar year 2023, 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 2023 if they

properly claimed the credit under section 45R for all or

part of 2022. For details, see Notice 2018-27, 2018-20,

I.R.B. 580, available at IRS.gov/irb/

2018-20_IRB#NO T -2018-27.

To see whether a particular county has coverage

available through a SHOP Exchange for 2023 and

beyond, go to Healthcare.gov/small-business and

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enter “plans and prices” in the search box.

Line C

Answer “Yes” if a tax return you (or any predecessor) filed

for a tax year beginning after 2013 and before 2022

included a Form 8941 with line A checked “Yes” and

line 12 showing a positive amount. For more information,

see Credit Period, earlier.

If you answer “Yes,” don’t file Form 8941 unless you’re

filing it for a partnership, S corporation, cooperative,

estate, trust, or tax-exempt eligible small employer that

received from another entity a credit that must be reported

on line 15. An entity that qualifies for this exception

shouldn’t report any amount on line 12. For more

information, see the instructions for line 15.

Totals:

Column (a), Individuals Considered

Employees

Enter the name or other identifying information for all

individuals considered employees for purposes of this

credit.

In general, all employees who perform services for you

during the tax year are taken into account in determining

your FTEs, average annual wages, and premiums paid.

Rules that apply to certain types of employees are

discussed below.

Instructions for Form 8941 (2023)

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discussed above. A sole proprietor must include both

business and nonbusiness employees to determine FTEs,

average annual wages, and premiums paid.

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.

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.

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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

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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.

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.

A person who owns more than 5% of the capital or

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profits interest in any other business that isn’t a

corporation.

Family members or a member of the household who

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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.

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

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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).

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.

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).

Provides services to you under an agreement between

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you and a leasing organization.

Has performed services for you (or for you and a related

•

Days-worked equivalency method. Use a

person) substantially full time for at least 1 year.

Performs services under your primary direction or

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.

•

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.

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

Column (c), Employee Wages Paid

Complete Worksheet 2 before you complete

column (c) of Worksheet 1. Do not complete

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CAUTION

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.

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Instructions for Form 8941 (2023)

Wages, for this purpose, mean wages subject to social

security and Medicare tax withholding determined without

considering any wage base limit.

Worksheet 4. Information Needed To

Complete Lines 4, 5, and 13 and

Worksheet 7

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 FTEs for

the tax year. If you had 25 or more FTEs for the tax year,

your credit is reduced to zero.

(a)

(d)

Enrolled

(b)

(c)

Enrolled

Employee

Hours of

Service

Individuals

Considered

Employees

Employer

Premiums

Paid

Adjusted

Average

Premiums

1. Enter the total employee hours of

service from Worksheet 1, column

(b) . . . . . . . . . . . . . . . . . . . . . . . . .

Hours of service per FTE . . . . . . . . .

1.

2.

ꢀ1.

2,080

2.

ꢀ2.

ꢀ3.

ꢀ4.

ꢀ5.

ꢀ6.

ꢀ7.

ꢀ8.

ꢀ9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

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.

Worksheet 3. Information Needed To

Complete Line 3 (Average Annual

Wages)

Your credit is reduced if you paid average annual wages of

more than $30,000 for the tax year. If you paid average

annual wages of $62,000 or more for the tax year, your

credit is reduced to zero.

1. Enter the total employee wages paid

from Worksheet 1, column (c) . . . . . .

1.

2.

2. Enter FTEs from Worksheet 2,

line 3 . . . . . . . . . . . . . . . . . . . . . . .

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 . . .

3.

Totals:

Column (a), Enrolled Individuals

Considered Employees

Enter the name or other identifying information for each

individual listed in column (a) of Worksheet 1 who was

enrolled in health insurance coverage you provided to

employees during the tax year under a qualifying

arrangement. For details, see Health Insurance Coverage

and Qualifying Arrangement, earlier.

Instructions for Form 8941 (2023)

-7-

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.

Column (b), Employer Premiums Paid

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

Don’t complete column (d) of Worksheet 4 if Form

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.

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

1.

2. Enter the number from Form

8941, line 2 . . . . . . . . . . . .

2.

3.

3. Subtract 10 from line 2 . . . . .

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.

4. Divide line 3 by 15. Enter the

result as a decimal (rounded to

at least 3 places) . . . . . . . .

4.

5. Multiply line 1 by line 4 . . . . . . . . . . . . . .

5.

6.

6. Subtract line 5 from line 1. Report this

amount on Form 8941, line 8 . . . . . . . . .

To find the average premium for the small group market

in a rating area for tax years beginning in 2023, see the

average premium tables at the end of these instructions.

Family coverage includes any coverage other than

employee-only coverage.

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.

Worksheet 6. Information Needed To

Complete Line 9 (If Line 3 Is More

Than $30,000)

1. Enter the amount from Form 8941,

line 8 . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2. Enter the amount from Form

8941, line 7 . . . . . . . . . . . . .

2.

3. Enter the amount from Form

8941, line 3 . . . . . . . . . . . . .

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

3.

4.

4. Subtract $30,700 from line 3

.

5. Divide line 4 by $30,700. Enter

the result as a decimal (rounded

to at least 3 places) . . . . . . . .

5.

6. Multiply line 2 by line 5 . . . . . . . . . . . . . .

6.

7.

7. Subtract line 6 from line 1. Report this

amount on Form 8941, line 9 . . . . . . . . .

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 T a x Credit Limitation, earlier.

-8-

Instructions for Form 8941 (2023)

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.

Worksheet 7. Information Needed To

Complete Line 14 (If Line 12 Is More

Than Zero)

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.

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.

1. Enter the total enrolled employee hours of

service from Worksheet 4, column

(d) . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Hours of service per FTE . . . . . . . . . .

1.

2.

2,080

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 . . . . . .

3.

If the estate or trust is subject to the passive activity

rules, include on line 15 any credit for small employer

health insurance premiums from passive activities

disallowed for prior years and carried forward to this year.

Complete Form 8582-CR, Passive Activity Credit

Limitations, to determine the allowed credit that must be

allocated between the estate or trust and the

beneficiaries. For details, see the Instructions for Form

8582-CR.

Line 15

Enter any credit for small employer health insurance

premiums from:

Schedule K-1 (Form 1065), Partner's Share of Income,

•

Deductions, Credits, etc., box 15 (code BA);

Schedule K-1 (Form 1120-S), Shareholder's Share of

•

Income, Deductions, Credits, etc., box 13 (code BA);

Schedule K-1 (Form 1041), Beneficiary’s Share of

•

Income, Deductions, Credits, etc., box 13 (code G); and

Form 1099-PATR, Taxable Distributions Received From

•

Line 19

Cooperatives, box 12, or other notice of credit allocation.

Enter the total amount of certain payroll taxes. Payroll

taxes, for this purpose, mean only the following taxes.

Partnerships, S corporations, cooperatives,

estates, trusts, and tax-exempt eligible small

Federal income taxes the tax-exempt employer was

TIP

•

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.

required to withhold from employees’ wages in calendar

year 2023.

Medicare taxes the tax-exempt employer was required

•

to withhold from employees’ wages in calendar year 2023.

Medicare taxes the tax-exempt employer was required

•

to pay for calendar year 2023.

Line 17

Cooperatives. A cooperative described in section

1381(a) must allocate to its patrons the credit in excess of

Instructions for Form 8941 (2023)

-9-

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.

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.

-10-

Instructions for Form 8941 (2023)

Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4

The following tables list the average

Limestone

Lowndes

Macon

7,262

8,391

7,241

7,262

7,241

7,468

7,241

8,391

7,893

7,241

7,210

7,061

7,241

7,665

7,061

7,241

23,301

23,453

20,533

23,301

20,533

22,163

20,533

23,453

19,596

20,533

21,092

22,250

20,533

21,879

22,250

20,533

Petersburg

11,771

31,062

30,930

29,868

30,930

31,062

premiums for the small group market

in each rating area generally listed by

county for each state for tax years

beginning in 2023.

Prince of Wales-Hyder 11,771

Sitka

11,771

12,011

11,303

12,011

11,771

Madison

Marengo

Marion

Skagway

Southeast Fairbanks

Valdez Cordova

Wade Hampton

Alabama

Marshall

Mobile

Employee- Dependent,

County

Autauga

Baldwin

Barbour

Bibb

Only

Family, etc.

23,453

20,533

22,250

20,533

20,924

20,533

22,250

20,533

22,810

20,533

23,453

20,533

22,226

20,533

22,014

21,879

22,014

20,533

22,250

20,533

22,810

19,596

19,185

Wrangell City and

Borough

8,391

7,241

7,061

7,241

6,836

7,241

7,061

7,241

8,701

7,241

8,391

7,241

6,539

7,241

7,505

7,665

7,505

7,241

7,061

7,241

8,701

7,893

6,462

Monroe

Montgomery

Morgan

Perry

Yakutat

12,011

30,930

Yukon Koyukuk

Arizona

Blount

Pickens

Pike

Bullock

Butler

Employee- Dependent,

Only

County

Apache

Cochise

Coconino

Gila

Family, etc.

23,802

21,771

23,802

20,592

21,771

24,548

22,558

23,802

21,227

20,592

21,227

21,670

24,548

Randolph

Russell

8,205

7,758

8,205

7,732

7,758

8,893

7,176

8,205

7,513

7,732

7,513

7,412

8,893

Calhoun

Chambers

Cherokee

Chilton

Choctaw

Clarke

Shelby

St. Clair

Sumter

Graham

Greenlee

La Paz

Talladega

Tallapoosa

Tuscaloosa

Walker

Clay

Maricopa

Mohave

Navajo

Pima

Cleburne

Coffee

Washington

Wilcox

Colbert

Conecuh

Coosa

Winston

Pinal

Santa Cruz

Yavapai

Yuma

Alaska

Covington

Crenshaw

Cullman

Dale

Employee- Dependent,

Only

County

Family, etc.

30,930

29,868

30,930

29,868

30,930

31,062

30,930

31,062

30,930

Aleutians East

Aleutians West

Anchorage

12,011

11,303

12,011

11,303

12,011

11,771

12,011

11,771

12,011

Arkansas

Dallas

Employee- Dependent,

Only

DeKalb

Elmore

Escambia

Etowah

Fayette

Franklin

Geneva

Greene

Hale

County

Arkansas

Ashley

Family, etc.

17,389

21,429

17,389

23,029

21,429

17,389

18,872

21,560

19,164

17,389

23,029

19,164

Bethel

7,140

7,244

7,140

7,695

7,244

7,140

6,191

7,751

7,028

7,140

7,695

7,028

Bristol Bay

Denali

Baxter

Dillingham

Benton

Boone

Fairbanks North Star

Haines

Bradley

Calhoun

Carroll

Hoonah-Angoon

Juneau

Henry

Kenai Peninsula

Ketchikan Gateway

Kodiak Island

Lake and Peninsula

Matanuska Susitna

Nome

Chicot

Houston

Jackson

Jefferson

Lamar

Clark

Clay

Cleburne

Cleveland

Columbia

Conway

Lauderdale

Lawrence

Lee

North Slope

Northwest Arctic

2023 Average Premium Tables

-11-

Craighead

Crawford

Crittenden

Cross

7,751

6,714

7,751

7,140

7,028

6,714

7,751

6,191

7,028

7,751

7,695

6,191

7,695

7,751

7,140

6,714

7,695

7,751

7,140

7,695

6,714

7,028

7,244

7,695

7,751

7,140

6,191

7,695

7,244

7,695

7,028

7,140

6,191

7,751

6,714

7,028

7,751

7,028

6,714

7,244

6,714

7,695

7,751

21,560

21,788

21,560

17,389

19,164

21,788

21,560

18,872

19,164

21,560

23,029

18,872

23,029

21,560

17,389

21,788

23,029

21,560

17,389

23,029

21,788

19,164

21,429

23,029

21,560

17,389

18,872

23,029

21,429

23,029

19,164

17,389

18,872

21,560

21,788

19,164

21,560

19,164

21,788

21,429

21,788

23,029

21,560

Stone

7,751

7,695

7,028

7,244

7,028

7,751

7,028

21,560

23,029

19,164

21,429

19,164

21,560

19,164

Santa Clara

Santa Cruz

Shasta

Sierra

9,709

9,395

9,825

8,407

9,008

9,825

9,008

9,825

8,551

8,099

9,825

28,911

26,386

23,668

22,859

24,693

23,668

24,693

23,668

25,169

24,093

23,668

Union

Van Buren

Washington

White

Dallas

Siskiyou

Solano

Sonoma

Stanislaus

Sutter

Desha

Woodruff

Yell

Drew

Faulkner

Franklin

Fulton

California

Tehama

Trinity

Employee- Dependent,

Only

County

Family, etc.

26,876

23,668

26,914

23,668

24,093

25,788

23,668

22,422

20,242

25,788

23,668

24,150

25,788

22,859

24,693

23,668

24,693

23,668

22,422

26,386

22,859

23,668

26,021

24,093

23,668

24,188

24,093

26,386

24,188

19,698

32,092

24,693

25,169

30,804

25,169

Garland

Grant

Alameda

Alpine

9,991

9,825

9,461

9,825

8,099

8,250

9,825

8,038

8,576

8,250

9,825

8,516

8,250

8,407

9,008

9,825

9,008

9,825

8,038

9,395

8,407

9,825

9,098

8,099

9,825

8,823

8,099

9,395

8,823

7,936

9,194

9,008

8,551

10,893

8,551

Tulare

Greene

Hempstead

Hot Spring

Howard

Independence

Izard

Tuolumne

Ventura

Yolo

Amador

Butte

Calaveras

Colusa

Yuba

Colorado

Contra Costa

Del Norte

El Dorado

Fresno

Jackson

Jefferson

Johnson

Lafayette

Lawrence

Lee

Employee- Dependent,

Only

County

Adams

Family, etc.

21,656

23,653

21,656

24,827

23,653

22,089

21,656

23,653

21,656

23,653

24,827

21,656

24,827

21,656

24,678

22,503

21,656

23,653

24,678

21,656

24,827

23,653

24,827

21,656

23,653

7,411

8,633

7,411

8,143

8,633

7,775

7,411

8,633

7,411

8,633

8,143

7,411

8,143

7,411

7,932

6,583

7,411

8,633

7,932

7,411

8,143

8,633

8,143

7,411

8,633

Glenn

Alamosa

Arapahoe

Archuleta

Baca

Humboldt

Imperial

Inyo

Lincoln

Little River

Logan

Kern

Bent

Kings

Boulder

Broomfield

Chaffee

Cheyenne

Clear Creek

Conejos

Costilla

Crowley

Custer

Lake

Lonoke

Madison

Marion

Lassen

Los Angeles

Madera

Miller

Marin

Mississippi

Monroe

Montgomery

Nevada

Newton

Ouachita

Perry

Mariposa

Mendocino

Merced

Modoc

Delta

Mono

Denver

Monterey

Napa

Dolores

Douglas

Eagle

Phillips

Pike

Nevada

Orange

El Paso

Elbert

Poinsett

Polk

Placer

Plumas

Fremont

Garfield

Gilpin

Pope

Riverside

Sacramento

San Benito

San Bernardino

San Diego

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Santa Barbara

Prairie

Pulaski

Randolph

Saline

Grand

Gunnison

Hinsdale

Huerfano

Jackson

Jefferson

Kiowa

Scott

Searcy

Sebastian

Sevier

Sharp

Kit Carson

St. Francis

-12-

2023 Average Premium Tables

Florida

La Plata

Lake

8,143

8,694

8,633

8,054

8,998

8,633

8,143

8,054

8,633

8,143

7,411

8,054

7,932

8,633

7,319

8,143

8,633

8,143

8,633

8,143

8,054

7,932

6,583

8,054

8,306

8,054

24,827

19,824

23,653

23,081

21,727

23,653

24,827

23,081

23,653

24,827

21,656

23,081

24,678

23,653

20,347

24,827

23,653

24,827

23,653

24,827

23,081

24,678

22,503

23,081

26,016

23,081

Pasco

7,525

7,371

8,801

7,836

7,489

7,521

7,715

10,257

7,591

7,862

7,668

8,601

7,932

8,323

7,548

7,767

7,947

22,543

22,139

22,081

23,177

20,819

21,644

20,590

27,879

21,601

24,206

22,810

24,552

23,505

20,111

23,347

21,234

23,329

Pinellas

Polk

Employee- Dependent,

County

Alachua

Baker

Only

Family, etc.

22,734

22,501

21,468

23,023

23,208

23,328

22,571

25,787

21,534

22,922

29,682

24,544

23,403

21,209

22,097

21,756

22,670

23,949

23,387

22,553

25,093

23,946

22,503

20,987

24,714

23,493

25,498

25,008

22,612

21,289

20,719

22,557

21,405

24,889

22,838

28,653

23,288

22,899

23,532

21,046

20,829

24,627

24,816

25,476

20,919

28,477

24,963

20,908

24,353

28,912

Larimer

Las Animas

Lincoln

Logan

8,574

7,715

7,461

7,686

8,879

7,925

7,789

8,533

7,757

7,626

7,988

8,265

7,735

7,911

7,679

7,892

8,808

8,034

7,735

7,658

8,083

8,395

7,602

7,526

8,388

8,890

8,138

7,740

7,742

7,568

7,381

8,243

7,903

9,585

7,667

9,230

7,541

7,894

8,248

7,718

6,342

8,016

8,031

8,436

8,332

8,059

8,465

7,953

8,438

8,603

Putnam

Santa Rosa

Sarasota

Seminole

St. Johns

St. Lucie

Sumter

Bay

Bradford

Brevard

Broward

Calhoun

Charlotte

Citrus

Mesa

Mineral

Moffat

Montezuma

Montrose

Morgan

Otero

Suwannee

Taylor

Clay

Union

Collier

Ouray

Volusia

Columbia

DeSoto

Dixie

Park

Wakulla

Walton

Phillips

Pitkin

Washington

Duval

Prowers

Pueblo

Georgia

Escambia

Flagler

Rio Blanco

Rio Grande

Routt

Employee- Dependent,

Only

County

Appling

Atkinson

Bacon

Family, etc.

27,444

22,962

23,290

25,176

24,458

22,594

21,237

22,689

24,744

20,662

23,290

24,744

27,444

20,462

22,689

25,176

23,290

27,444

24,070

23,868

23,290

27,444

20,658

22,433

22,689

21,237

25,176

22,689

24,744

Franklin

Gadsden

Gilchrist

Glades

Gulf

10,583

7,649

7,887

8,463

8,673

8,299

9,031

7,850

8,599

8,545

7,887

8,599

10,583

8,071

7,850

8,463

7,887

10,583

8,130

7,913

7,887

10,583

7,316

8,654

7,850

9,031

8,463

7,850

8,599

Saguache

San Juan

San Miguel

Sedgwick

Summit

Teller

Baker

Baldwin

Banks

Hamilton

Hardee

Hendry

Hernando

Highlands

Hillsborough

Holmes

Indian River

Jackson

Jefferson

Lafayette

Lake

Barrow

Bartow

Ben Hill

Berrien

Bibb

Washington

Weld

Yuma

Connecticut

Bleckley

Brantley

Brooks

Bryan

Employee- Dependent,

Only

County

Family, etc.

29,578

26,680

28,343

27,077

29,443

25,787

22,920

31,760

Fairfield

9,528

9,002

8,527

8,672

9,794

8,729

8,001

8,489

Bulloch

Burke

Hartford

Litchfield

Middlesex

New Haven

New London

Tolland

Lee

Butts

Leon

Calhoun

Camden

Candler

Carroll

Levy

Liberty

Madison

Manatee

Marion

Windham

Catoosa

Charlton

Chatham

Chattahoochee

Chattooga

Cherokee

Clarke

Delaware

Martin

Miami-Dade

Monroe

Nassau

Okaloosa

Okeechobee

Orange

Osceola

Palm Beach

Employee- Dependent,

Only

County

Family, etc.

All

8,846

23,764

District of Columbia

Employee- Dependent,

Only

Clay

County

Family, etc.

Clayton

Clinch

All

9,368

28,176

2023 Average Premium Tables

-13-

Cobb

7,850

7,649

8,599

8,071

8,599

7,850

8,545

8,463

7,913

8,299

8,599

7,850

8,545

8,463

7,850

8,599

10,583

9,031

8,071

10,583

8,050

7,850

8,654

7,850

8,299

7,850

8,654

8,071

7,887

8,654

8,599

9,031

7,850

8,299

8,673

8,130

7,316

8,299

8,130

7,850

8,545

8,599

9,031

7,850

7,649

8,071

7,649

8,545

7,850

22,689

22,962

24,744

20,462

24,744

22,689

20,662

25,176

23,868

22,594

24,744

22,689

20,662

25,176

22,689

24,744

27,444

21,237

20,462

27,444

23,245

22,689

22,433

22,689

22,594

22,689

22,433

20,462

23,290

22,433

24,744

21,237

22,689

22,594

24,458

24,070

20,658

22,594

24,070

22,689

20,662

24,744

21,237

22,689

22,962

20,462

22,962

20,662

22,689

Lanier

8,599

7,649

8,463

10,583

8,071

10,583

8,599

8,299

7,316

9,031

7,316

8,071

7,887

7,316

8,599

8,463

8,545

7,649

9,031

8,050

7,316

7,850

9,031

7,850

8,545

8,654

7,887

7,850

8,654

8,545

7,316

8,299

8,463

8,071

7,850

8,463

10,583

8,599

7,850

8,299

7,316

8,463

7,316

8,071

10,583

7,316

7,649

8,463

8,599

7,649

24,744

22,962

25,176

27,444

20,462

27,444

24,744

22,594

20,658

21,237

20,658

20,462

23,290

20,658

24,744

25,176

20,662

22,962

21,237

23,245

20,658

22,689

21,237

22,689

20,662

22,433

23,290

22,689

22,433

20,662

20,658

22,594

25,176

20,462

22,689

25,176

27,444

24,744

22,689

22,594

20,658

25,176

20,658

20,462

27,444

20,658

22,962

25,176

24,744

22,962

Towns

8,299

7,649

7,316

8,599

8,545

8,299

7,316

7,913

7,850

7,887

8,071

8,673

7,887

7,316

7,649

8,299

8,050

8,545

8,071

8,673

8,463

22,594

22,962

20,658

24,744

20,662

22,594

20,658

23,868

22,689

23,290

20,462

24,458

23,290

20,658

22,962

22,594

23,245

20,662

20,462

24,458

25,176

Coffee

Colquitt

Columbia

Cook

Laurens

Lee

Treutlen

Troup

Liberty

Turner

Lincoln

Long

Twiggs

Union

Coweta

Crawford

Crisp

Lowndes

Lumpkin

Macon

Upson

Walker

Walton

Ware

Dade

Dawson

Decatur

DeKalb

Dodge

Dooly

Madison

Marion

Warren

Washington

Wayne

Webster

Wheeler

White

McDuffie

McIntosh

Meriwether

Miller

Dougherty

Douglas

Early

Mitchell

Monroe

Montgomery

Morgan

Murray

Whitfield

Wilcox

Wilkes

Wilkinson

Worth

Echols

Effingham

Elbert

Emanuel

Evans

Muscogee

Newton

Oconee

Oglethorpe

Paulding

Peach

Hawaii

Fannin

Fayette

Floyd

Employee- Dependent,

Only

County

Family, etc.

All

8,011

21,523

Forsyth

Franklin

Fulton

Pickens

Pierce

Idaho

Employee- Dependent,

Only

Gilmer

Glascock

Glynn

Pike

County

Ada

Family, etc.

18,558

18,579

18,200

16,122

18,200

18,948

18,579

16,122

20,506

16,122

18,200

18,948

18,579

18,200

18,948

20,506

19,086

18,200

18,579

18,200

20,506

18,579

Polk

7,011

6,888

8,437

7,005

8,437

6,476

6,888

7,005

7,918

7,005

8,437

6,476

6,888

8,437

6,476

7,918

8,172

8,437

6,888

8,437

7,918

6,888

Pulaski

Putnam

Quitman

Rabun

Adams

Bannock

Bear Lake

Benewah

Bingham

Blaine

Gordon

Grady

Greene

Gwinnett

Habersham

Hall

Randolph

Richmond

Rockdale

Schley

Boise

Hancock

Haralson

Harris

Bonner

Bonneville

Boundary

Butte

Screven

Seminole

Spalding

Stephens

Stewart

Sumter

Talbot

Hart

Heard

Camas

Canyon

Caribou

Cassia

Clark

Henry

Houston

Irwin

Jackson

Jasper

Jeff Davis

Jefferson

Jenkins

Johnson

Jones

Taliaferro

Tattnall

Taylor

Clearwater

Custer

Telfair

Elmore

Franklin

Fremont

Gem

Terrell

Thomas

Tift

Lamar

Toombs

-14-

2023 Average Premium Tables

Gooding

Idaho

6,476

8,172

7,918

6,476

7,005

7,918

8,172

6,476

7,918

6,476

8,172

8,437

6,888

8,437

7,005

7,918

6,476

6,888

18,948

19,086

20,506

18,948

16,122

20,506

19,086

18,948

20,506

18,948

19,086

18,200

18,579

18,200

16,122

20,506

18,948

18,579

Fulton

8,720

9,777

8,687

9,101

9,777

8,243

9,777

8,243

9,646

9,777

8,687

8,972

9,777

8,977

9,101

8,720

8,491

8,720

9,777

8,972

9,902

8,465

8,687

8,482

9,777

8,720

8,465

9,777

8,720

8,491

9,902

8,465

8,243

8,482

8,687

8,465

8,972

8,720

9,777

9,646

8,465

9,777

8,720

8,687

9,777

8,243

23,057

25,949

25,047

20,715

25,949

22,350

25,949

22,350

23,421

25,949

25,047

22,362

25,949

24,388

20,715

23,057

24,199

23,057

25,949

22,362

24,851

20,916

25,047

22,961

25,949

23,057

20,916

25,949

23,057

24,199

24,851

20,916

22,350

22,961

25,047

20,916

22,362

23,057

25,949

23,421

20,916

25,949

23,057

25,047

25,949

22,350

Saline

9,777

8,465

8,482

8,720

8,972

8,720

9,777

9,646

9,777

8,243

8,687

9,777

8,243

9,101

9,777

8,972

8,720

25,949

20,916

22,961

23,057

22,362

23,057

25,949

23,421

25,949

22,350

25,047

25,949

22,350

20,715

25,949

22,362

23,057

Gallatin

Greene

Grundy

Hamilton

Hancock

Hardin

Sangamon

Schuyler

Scott

Jefferson

Jerome

Kootenai

Latah

Shelby

St. Clair

Stark

Lemhi

Lewis

Henderson

Henry

Stephenson

Tazewell

Union

Lincoln

Madison

Minidoka

Nez Perce

Oneida

Owyhee

Payette

Power

Iroquois

Jackson

Jasper

Vermilion

Wabash

Warren

Jefferson

Jersey

Washington

Wayne

Jo Daviess

Johnson

Kane

White

Shoshone

Teton

Whiteside

Will

Kankakee

Kendall

Knox

Twin Falls

Valley

Williamson

Winnebago

Woodford

Washington

Lake

LaSalle

Lawrence

Lee

Indiana

Illinois

Employee- Dependent,

Only

Employee- Dependent,

Only

County

Adams

Allen

Family, etc.

23,214

24,189

22,956

25,391

23,755

25,255

26,469

26,016

21,331

21,619

23,405

26,016

21,619

25,780

24,245

22,956

23,214

23,755

25,780

22,494

24,148

21,619

26,016

24,245

21,331

24,463

23,755

25,780

County

Adams

Alexander

Bond

Family, etc.

20,916

25,949

25,047

22,362

20,916

22,350

25,047

22,362

20,916

23,421

20,916

23,421

25,949

25,047

23,421

23,937

25,949

23,421

22,362

24,851

23,421

24,388

23,421

25,949

23,421

25,949

Livingston

Logan

7,571

8,107

7,972

8,516

8,548

8,202

8,081

8,352

8,166

7,522

7,770

8,352

7,522

8,249

8,906

7,972

7,571

8,548

8,249

8,340

8,158

7,522

8,352

8,906

8,166

9,588

8,548

8,249

8,465

9,777

8,687

8,972

8,465

8,243

8,687

8,972

8,465

9,646

8,465

9,646

9,777

8,687

9,646

8,729

9,777

9,646

8,972

9,902

9,646

8,977

9,646

9,777

9,646

9,777

Macon

Bartholomew

Benton

Blackford

Boone

Macoupin

Madison

Marion

Boone

Brown

Bureau

Calhoun

Carroll

Marshall

Mason

Brown

Carroll

Massac

McDonough

McHenry

McLean

Menard

Mercer

Monroe

Montgomery

Morgan

Moultrie

Ogle

Cass

Clark

Champaign

Christian

Clark

Clay

Clinton

Crawford

Daviess

Dearborn

Decatur

DeKalb

Delaware

Dubois

Elkhart

Fayette

Floyd

Clay

Clinton

Coles

Cook

Crawford

Cumberland

DeKalb

DeWitt

Douglas

DuPage

Edgar

Peoria

Perry

Piatt

Pike

Fountain

Franklin

Fulton

Pope

Edwards

Effingham

Fayette

Ford

Pulaski

Putnam

Randolph

Richland

Rock Island

Gibson

Grant

Greene

Franklin

2023 Average Premium Tables

-15-

Hamilton

Hancock

Harrison

Hendricks

Henry

8,202

8,158

7,522

8,202

8,158

8,166

7,571

7,972

8,516

8,548

7,522

7,972

8,081

8,249

8,340

7,571

8,474

8,081

8,158

8,202

8,340

8,249

8,166

8,081

8,352

8,202

8,516

7,571

8,906

8,249

8,081

7,770

8,249

8,474

9,588

8,166

8,352

8,548

8,906

7,972

7,522

8,202

8,249

8,340

7,571

7,770

8,906

8,352

8,158

25,255

24,148

21,619

25,255

24,148

21,331

23,214

22,956

25,391

23,755

21,619

22,956

26,469

25,780

22,494

23,214

22,352

26,469

24,148

25,255

22,494

25,780

21,331

26,469

26,016

25,255

25,391

23,214

24,245

25,780

26,469

23,405

25,780

22,352

24,463

21,331

26,016

23,755

24,245

22,956

21,619

25,255

25,780

22,494

23,214

23,405

24,245

26,016

24,148

Vanderburgh

Vermillion

Vigo

9,588

7,770

7,571

8,516

9,588

7,522

8,158

7,571

8,516

7,571

24,463

23,405

23,214

25,391

24,463

21,619

24,148

23,214

25,391

23,214

Guthrie

Hamilton

Hancock

Hardin

8,697

6,970

7,445

6,970

8,697

7,311

7,445

8,032

7,270

7,095

7,311

7,270

7,311

7,445

7,311

7,270

7,311

8,032

7,095

7,311

7,095

6,970

8,697

7,445

8,032

7,311

8,697

7,311

8,032

8,697

8,032

7,095

8,697

6,970

8,697

8,032

7,270

8,697

8,032

6,970

8,697

7,311

7,095

21,249

20,188

21,955

20,188

21,249

19,465

21,955

22,897

21,569

22,233

19,465

21,569

19,465

21,955

19,465

21,569

19,465

22,897

22,233

19,465

22,233

20,188

21,249

21,955

22,897

19,465

21,249

19,465

22,897

21,249

22,897

22,233

21,249

20,188

21,249

22,897

21,569

21,249

22,897

20,188

21,249

19,465

22,233

Wabash

Warren

Warrick

Washington

Wayne

Harrison

Henry

Howard

Huntington

Jackson

Jasper

Howard

Humboldt

Ida

Wells

Jay

White

Iowa

Jefferson

Jennings

Johnson

Knox

Whitley

Jackson

Jasper

Jefferson

Johnson

Jones

Iowa

Employee- Dependent,

Only

County

Adair

Family, etc.

21,249

21,955

19,465

21,249

21,569

20,188

21,955

21,569

22,897

21,955

20,188

21,249

21,569

21,955

22,897

21,955

21,249

22,897

21,569

22,897

22,233

19,465

21,249

21,569

19,465

22,897

21,569

21,955

21,249

20,188

Kosciusko

LaGrange

Lake

8,697

7,445

7,311

8,697

7,270

6,970

7,445

7,270

8,032

7,445

6,970

8,697

7,270

7,445

8,032

7,445

8,697

8,032

7,270

8,032

7,095

7,311

8,697

7,270

7,311

8,032

7,270

7,445

8,697

6,970

Keokuk

Kossuth

Lee

Adams

Allamakee

Appanoose

Audubon

Benton

LaPorte

Lawrence

Madison

Marion

Marshall

Martin

Linn

Louisa

Lucas

Black Hawk

Boone

Lyon

Madison

Mahaska

Marion

Marshall

Mills

Bremer

Miami

Buchanan

Buena Vista

Butler

Monroe

Montgomery

Morgan

Newton

Noble

Calhoun

Carroll

Mitchell

Monona

Monroe

Montgomery

Muscatine

O'Brien

Osceola

Page

Cass

Ohio

Cedar

Orange

Owen

Cerro Gordo

Cherokee

Chickasaw

Clarke

Parke

Perry

Pike

Clay

Porter

Palo Alto

Plymouth

Pocahontas

Polk

Clayton

Clinton

Posey

Pulaski

Putnam

Randolph

Ripley

Crawford

Dallas

Pottawattamie

Poweshiek

Ringgold

Sac

Davis

Decatur

Delaware

Des Moines

Dickinson

Dubuque

Emmet

Rush

Scott

Shelby

Scott

Spencer

St. Joseph

Starke

Shelby

Sioux

Story

Fayette

Steuben

Sullivan

Switzerland

Tippecanoe

Tipton

Tama

Floyd

Taylor

Franklin

Fremont

Greene

Grundy

Union

Van Buren

Wapello

Warren

Union

-16-

2023 Average Premium Tables

Washington

Wayne

7,311

6,970

7,445

8,032

7,445

19,465

20,188

21,955

22,897

21,955

Hodgeman

Jackson

Jefferson

Jewell

6,640

7,004

6,556

7,490

6,640

6,660

6,640

7,646

7,246

7,490

6,556

7,004

7,246

7,004

6,660

7,004

6,660

6,640

7,490

6,556

6,660

6,556

6,640

7,004

7,646

7,246

7,004

7,246

6,556

6,640

7,246

7,004

6,640

7,246

6,660

6,556

6,660

6,556

7,246

6,556

7,246

6,660

6,640

7,004

7,246

6,640

20,210

19,947

17,604

20,490

20,210

18,161

20,210

19,378

21,412

20,490

17,604

19,947

21,412

19,947

18,161

19,947

18,161

20,210

20,490

17,604

18,161

17,604

20,210

19,947

19,378

21,412

19,947

21,412

17,604

20,210

21,412

19,947

20,210

21,412

18,161

17,604

18,161

17,604

21,412

17,604

21,412

18,161

20,210

19,947

21,412

20,210

Stevens

Sumner

6,640

6,660

7,246

7,004

7,246

6,556

7,246

6,660

7,646

7,490

20,210

18,161

21,412

19,947

21,412

17,604

21,412

18,161

19,378

20,490

Webster

Winnebago

Winneshiek

Woodbury

Worth

Thomas

Trego

Johnson

Kearny

Kingman

Kiowa

Wabaunsee

Wallace

Washington

Wichita

Wright

Labette

Lane

Wilson

Kansas

Woodson

Wyandotte

Leavenworth

Lincoln

Linn

Employee- Dependent,

Only

County

Allen

Family, etc.

19,378

19,947

20,210

21,412

19,378

19,947

18,161

19,378

21,412

20,210

17,604

19,947

20,210

18,161

19,378

21,412

17,604

19,947

20,210

18,161

21,412

17,604

20,210

19,947

17,604

21,412

20,210

21,412

18,161

20,210

18,161

20,210

Kentucky

7,646

7,004

6,640

7,246

7,646

7,004

6,660

7,646

7,246

6,640

6,556

7,004

6,640

6,660

7,646

7,246

6,556

7,004

6,640

6,660

7,246

6,556

6,640

7,004

6,556

7,246

6,640

7,246

6,660

6,640

6,660

6,640

Anderson

Atchison

Barber

Barton

Logan

Employee- Dependent,

Only

County

Adair

Family, etc.

23,900

19,939

20,839

23,900

22,247

23,588

20,870

19,939

22,247

19,939

22,247

23,588

20,556

23,900

20,839

20,870

20,839

20,556

22,247

23,900

23,593

19,939

23,588

23,900

20,839

23,900

23,593

23,900

22,247

19,939

22,247

23,588

19,939

20,839

Lyon

7,995

6,923

9,237

7,995

7,608

8,511

6,901

6,923

7,608

6,923

7,608

8,511

7,219

7,995

9,237

6,901

9,237

7,219

7,608

7,995

8,681

6,923

8,511

7,995

9,237

7,995

8,681

7,995

7,608

6,923

7,608

8,511

6,923

9,237

Marion

Marshall

McPherson

Meade

Miami

Allen

Anderson

Ballard

Barren

Bath

Bourbon

Brown

Butler

Chase

Mitchell

Montgomery

Morris

Bell

Chautauqua

Cherokee

Cheyenne

Clark

Boone

Bourbon

Boyd

Morton

Nemaha

Neosho

Ness

Boyle

Clay

Bracken

Breathitt

Breckinridge

Bullitt

Cloud

Coffey

Norton

Comanche

Cowley

Crawford

Decatur

Dickinson

Doniphan

Douglas

Edwards

Elk

Osage

Osborne

Ottawa

Pawnee

Phillips

Pottawatomie

Pratt

Butler

Caldwell

Calloway

Campbell

Carlisle

Carroll

Rawlins

Reno

Carter

Casey

Ellis

Republic

Rice

Christian

Clark

Ellsworth

Finney

Riley

Clay

Ford

Rooks

Clinton

Crittenden

Cumberland

Daviess

Edmonson

Elliott

Franklin

Geary

Rush

Russell

Saline

Gove

Graham

Grant

Scott

Sedgwick

Seward

Shawnee

Sheridan

Sherman

Smith

Gray

Estill

Greeley

Greenwood

Hamilton

Harper

Harvey

Haskell

Fayette

Fleming

Floyd

Franklin

Fulton

Stafford

Stanton

2023 Average Premium Tables

-17-

Gallatin

Garrard

Grant

6,901

6,923

6,901

9,237

7,219

7,995

7,608

8,681

7,219

8,511

6,923

7,995

8,681

7,219

9,237

8,681

6,923

7,219

6,923

8,511

6,901

8,511

7,219

8,511

7,608

8,511

7,608

6,923

9,237

7,995

9,237

6,923

8,511

7,219

9,237

8,511

7,608

9,237

7,995

8,681

7,219

7,608

6,923

7,995

6,923

7,608

8,681

7,219

6,923

20,870

19,939

20,870

20,839

20,556

23,900

22,247

23,593

20,556

23,588

19,939

23,900

23,593

20,556

20,839

23,593

19,939

20,556

19,939

23,588

20,870

23,588

20,556

23,588

22,247

23,588

22,247

19,939

20,839

23,900

20,839

19,939

23,588

20,556

20,839

23,588

22,247

20,839

23,900

23,593

20,556

22,247

19,939

23,900

19,939

22,247

23,593

20,556

19,939

Ohio

8,681

7,219

6,923

8,511

6,901

8,511

6,923

7,995

7,608

6,923

7,608

7,995

6,923

7,219

7,995

7,219

7,995

8,681

7,219

8,681

7,995

7,219

7,995

8,681

8,511

6,923

23,593

20,556

19,939

23,588

20,870

23,588

19,939

23,900

22,247

19,939

22,247

23,900

19,939

20,556

23,900

20,556

23,900

23,593

20,556

23,593

23,900

20,556

23,900

23,593

23,588

19,939

Franklin

8,275

8,797

7,541

8,072

8,275

7,665

8,459

7,541

7,692

8,797

8,275

8,072

8,275

7,834

7,665

8,275

7,665

8,072

8,797

7,834

8,275

7,834

7,665

8,072

7,665

7,541

7,665

8,072

8,275

7,692

8,275

7,541

8,797

8,072

7,834

8,072

8,275

8,072

8,797

20,521

22,437

20,453

21,892

20,521

21,666

21,861

20,453

20,542

22,437

20,521

21,892

20,521

21,179

21,666

20,521

21,666

21,892

22,437

21,179

20,521

21,179

21,666

21,892

21,666

20,453

21,666

21,892

20,521

20,542

20,521

20,453

22,437

21,892

21,179

21,892

20,521

21,892

22,437

Oldham

Owen

Grant

Iberia

Graves

Grayson

Green

Owsley

Pendleton

Perry

Iberville

Jackson

Jefferson

Jefferson Davis

Lafayette

Lafourche

LaSalle

Greenup

Hancock

Hardin

Pike

Powell

Pulaski

Robertson

Rockcastle

Rowan

Russell

Scott

Harlan

Harrison

Hart

Lincoln

Livingston

Madison

Henderson

Henry

Morehouse

Natchitoches

Orleans

Hickman

Hopkins

Jackson

Jefferson

Jessamine

Johnson

Kenton

Knott

Shelby

Simpson

Spencer

Taylor

Ouachita

Plaquemines

Pointe Coupee

Rapides

Todd

Trigg

Trimble

Union

Red River

Richland

Knox

Warren

Washington

Wayne

Webster

Whitley

Wolfe

Sabine

LaRue

St. Bernard

St. Charles

St. Helena

St. James

St. John Baptist

St. Landry

St. Martin

St. Mary

Laurel

Lawrence

Lee

Leslie

Letcher

Lewis

Woodford

Louisiana

Lincoln

Livingston

Logan

St. Tammany

Tangipahoa

Tensas

Employee- Dependent,

Only

Parish

Family, etc.

20,453

21,861

21,892

20,542

22,437

21,861

21,179

21,861

20,521

21,861

22,437

21,179

22,437

21,179

21,892

20,521

21,892

20,453

Acadia

7,541

8,459

8,072

7,692

8,797

8,459

7,834

8,459

8,275

8,459

8,797

7,834

8,797

7,834

8,072

8,275

8,072

7,541

Lyon

Allen

Madison

Magoffin

Marion

Terrebonne

Union

Ascension

Assumption

Avoyelles

Beauregard

Bienville

Vermilion

Vernon

Marshall

Martin

Washington

Webster

Mason

Bossier

McCracken

McCreary

McLean

Meade

West Baton Rouge

West Carroll

West Feliciana

Winn

Caddo

Calcasieu

Caldwell

Cameron

Catahoula

Claiborne

Concordia

DeSoto

Menifee

Mercer

Metcalfe

Monroe

Montgomery

Morgan

Muhlenberg

Nelson

Nicholas

Maine

Employee- Dependent,

Only

County

Family, etc.

Androscoggin

Aroostook

Cumberland

Franklin

8,045

9,703

7,735

8,045

9,703

22,601

East Baton Rouge

East Carroll

East Feliciana

Evangeline

24,940

22,574

22,601

Hancock

24,940

-18-

2023 Average Premium Tables

Kennebec

Knox

7,517

8,045

7,735

8,045

9,703

7,735

20,158

22,601

22,574

22,601

24,940

22,574

Norfolk

9,358

9,361

9,358

8,989

26,811

25,875

26,811

25,350

Lenawee

Livingston

Luce

7,587

9,363

8,510

7,838

7,203

9,363

7,097

9,363

7,425

7,203

8,584

7,097

8,510

7,097

7,838

7,097

8,510

9,363

7,097

8,510

7,097

8,510

7,898

8,709

9,363

8,060

7,875

8,527

8,709

8,527

7,587

8,584

7,203

22,510

22,114

22,856

22,752

21,345

22,114

21,254

22,114

21,232

21,345

24,261

21,254

22,856

21,254

22,752

21,254

22,856

22,114

21,254

22,856

21,254

22,856

20,833

21,559

22,114

19,416

22,787

24,805

21,559

24,805

22,510

24,261

21,345

Plymouth

Suffolk

Lincoln

Oxford

Worcester

Mackinac

Macomb

Manistee

Marquette

Mason

Penobscot

Piscataquis

Sagadahoc

Somerset

Waldo

Michigan

Employee- Dependent,

Only

County

Alcona

Alger

Family, etc.

22,856

22,114

21,587

22,856

21,345

20,833

22,114

21,587

20,833

21,345

24,805

22,633

24,805

21,345

22,856

21,232

21,466

22,856

22,114

21,466

21,345

19,416

21,232

22,114

21,345

20,833

21,466

22,114

21,559

21,466

21,254

22,856

22,114

21,232

21,466

22,633

21,345

21,254

22,114

21,254

19,416

21,345

8,510

9,363

7,197

8,510

7,203

7,898

9,363

7,197

7,898

7,203

8,527

8,488

8,527

7,203

8,510

7,425

8,521

8,510

9,363

8,521

7,203

8,060

7,425

9,363

7,203

7,898

8,521

9,363

8,709

8,521

7,097

8,510

9,363

7,425

8,521

8,488

7,203

7,097

9,363

7,097

8,060

7,203

Mecosta

Menominee

Midland

Washington

York

Allegan

Alpena

Antrim

Missaukee

Monroe

Maryland

Arenac

Baraga

Barry

Montcalm

Montmorency

Muskegon

Newaygo

Oakland

Employee- Dependent,

Only

County

Family, etc.

24,040

22,894

21,174

24,040

21,174

24,040

22,894

21,174

25,697

21,174

24,040

21,174

Allegany

Anne Arundel

Baltimore

Baltimore City

Calvert

8,282

8,273

8,337

8,282

8,337

8,282

8,273

8,337

8,718

8,337

8,282

8,337

Bay

Benzie

Berrien

Branch

Calhoun

Cass

Oceana

Ogemaw

Ontonagon

Osceola

Caroline

Carroll

Charlevoix

Cheboygan

Chippewa

Clare

Cecil

Oscoda

Charles

Otsego

Dorchester

Frederick

Garrett

Ottawa

Presque Isle

Roscommon

Saginaw

Sanilac

Clinton

Crawford

Delta

Harford

Howard

Dickinson

Eaton

Kent

Schoolcraft

Shiawassee

St. Clair

Montgomery

Prince George’s

Queen Anne’s

Somerset

St. Mary’s

Talbot

Emmet

Genesee

Gladwin

Gogebic

Grand Traverse

Gratiot

St. Joseph

Tuscola

Van Buren

Washtenaw

Wayne

Washington

Wicomico

Worcester

Hillsdale

Houghton

Huron

Wexford

Minnesota

Massachusetts

Ingham

Ionia

Employee- Dependent,

Only

County

Aitkin

Family, etc.

22,222

23,928

23,575

22,222

23,928

21,521

21,766

22,580

21,889

23,928

22,222

Employee- Dependent,

Only

County

Family, etc.

27,157

24,733

25,875

27,157

25,727

24,733

26,811

27,157

Iosco

8,499

8,198

8,286

8,499

8,198

9,311

10,352

8,725

8,693

8,198

8,499

Barnstable

Berkshire

Bristol

11,191

8,363

9,361

11,191

9,148

8,363

9,358

11,191

Iron

Anoka

Isabella

Jackson

Kalamazoo

Kalkaska

Kent

Becker

Beltrami

Benton

Big Stone

Blue Earth

Brown

Dukes

Essex

Franklin

Hampden

Hampshire

Middlesex

Nantucket

Keweenaw

Lake

Carlton

Carver

Cass

Lapeer

Leelanau

2023 Average Premium Tables

-19-

Chippewa

Chisago

Clay

9,311

8,499

8,286

7,342

8,693

8,725

8,499

8,198

8,999

8,286

10,352

8,999

8,286

8,198

8,999

8,499

8,693

8,725

8,499

9,311

7,342

8,693

9,311

8,693

10,352

8,725

9,311

7,342

10,352

9,311

8,499

8,999

8,725

10,352

8,725

7,342

8,999

8,286

7,342

8,499

8,725

7,342

8,286

8,198

7,342

8,725

21,521

22,222

23,575

23,307

21,889

22,580

22,222

23,928

23,347

23,575

21,766

23,347

23,575

23,928

23,347

22,222

21,889

22,580

22,222

21,521

23,307

21,889

21,521

21,889

21,766

22,580

21,521

23,307

21,766

21,521

22,222

23,347

22,580

21,766

22,580

23,307

23,347

23,575

23,307

22,222

22,580

23,307

23,575

23,928

23,307

22,580

Renville

Rice

9,311

10,352

8,725

8,499

8,198

9,311

8,693

8,198

8,999

8,286

9,311

8,499

8,286

8,999

8,499

10,352

8,198

10,352

8,286

8,999

8,198

9,311

21,521

21,766

22,580

22,222

23,928

21,521

21,889

23,928

23,347

23,575

21,521

22,222

23,575

23,347

22,222

21,766

23,928

21,766

23,575

23,347

23,928

21,521

Humphreys

Issaquena

Itawamba

Jackson

Jasper

6,958

7,340

7,844

6,958

7,522

6,958

7,522

6,958

7,340

6,958

7,262

6,958

6,877

6,958

7,522

6,958

7,340

6,958

7,262

6,958

7,262

6,958

7,844

6,958

6,877

7,340

6,958

6,877

7,340

6,958

7,262

6,958

18,688

18,912

23,137

18,688

17,322

18,688

17,322

18,688

18,912

18,688

17,857

18,688

23,091

18,688

17,322

18,688

18,912

18,688

17,857

18,688

17,857

18,688

23,137

18,688

23,091

18,912

18,688

23,091

18,912

18,688

17,857

18,688

Rock

Clearwater

Cook

Roseau

Scott

Cottonwood

Crow Wing

Dakota

Sherburne

Sibley

Jefferson

Jefferson Davis

Jones

St. Louis

Stearns

Steele

Dodge

Kemper

Lafayette

Lamar

Douglas

Faribault

Fillmore

Freeborn

Goodhue

Grant

Stevens

Swift

Lauderdale

Lawrence

Leake

Todd

Traverse

Wabasha

Wadena

Waseca

Washington

Watonwan

Wilkin

Lee

Hennepin

Houston

Hubbard

Isanti

Leflore

Lincoln

Lowndes

Madison

Marion

Itasca

Jackson

Kanabec

Kandiyohi

Kittson

Winona

Wright

Marshall

Monroe

Montgomery

Neshoba

Newton

Noxubee

Oktibbeha

Panola

Yellow Medicine

Mississippi

Koochiching

Lac qui Parle

Lake

Employee- Dependent,

Only

County

Adams

Alcorn

Family, etc.

18,688

18,912

18,688

17,857

18,688

23,091

17,322

18,688

23,137

17,322

18,688

23,137

17,857

18,688

6,958

7,340

6,958

7,262

6,958

6,877

7,522

6,958

7,844

7,522

6,958

7,844

7,262

6,958

Lake of the Woods

Le Sueur

Lincoln

Pearl River

Perry

Amite

Attala

Lyon

Pike

Benton

Bolivar

Mahnomen

Marshall

Martin

Pontotoc

Prentiss

Quitman

Rankin

Calhoun

Carroll

McLeod

Meeker

Chickasaw

Choctaw

Claiborne

Clarke

Scott

Mille Lacs

Morrison

Mower

Sharkey

Simpson

Smith

Clay

Murray

Stone

Coahoma

Copiah

Covington

DeSoto

Forrest

Franklin

George

Greene

Grenada

Hancock

Harrison

Hinds

Nicollet

Sunflower

Tallahatchie

Tate

Nobles

Norman

Olmsted

Otter Tail

Pennington

Pine

Tippah

Tishomingo

Tunica

Union

Pipestone

Polk

Walthall

Warren

Pope

Washington

Wayne

Ramsey

Red Lake

Redwood

Webster

Wilkinson

Holmes

-20-

2023 Average Premium Tables

Winston

Yalobusha

Yazoo

6,958

18,688

Iron

7,282

8,567

7,152

7,712

7,494

8,548

7,843

7,494

7,843

8,548

7,712

8,548

10,197

8,548

8,348

8,472

8,548

7,152

10,197

8,472

8,348

8,472

8,348

7,152

10,197

7,282

8,472

7,843

8,348

7,494

7,282

8,548

8,567

7,843

7,282

8,548

8,472

10,197

7,282

7,494

8,548

8,348

7,282

8,548

7,712

7,494

18,701

22,493

19,025

20,240

19,730

20,952

21,502

19,730

21,502

20,952

20,240

20,952

19,609

20,952

22,895

21,174

20,952

19,025

19,609

21,174

22,895

21,174

22,895

19,025

19,609

18,701

21,174

21,502

22,895

19,730

18,701

20,952

22,493

21,502

18,701

20,952

21,174

19,609

18,701

19,730

20,952

22,895

18,701

20,952

20,240

19,730

St. Francois

St. Louis

St. Louis City

Ste. Genevieve

Stoddard

Stone

7,712

8,348

7,843

8,548

7,843

7,282

7,494

7,712

8,348

7,843

10,197

7,843

20,240

22,895

21,502

20,952

21,502

18,701

19,730

20,240

22,895

21,502

19,609

21,502

Jackson

Jasper

Jefferson

Johnson

Knox

Missouri

Employee- Dependent,

Only

County

Adair

Family, etc.

20,952

19,609

21,174

21,502

19,025

19,730

22,895

21,174

19,609

22,895

19,609

21,174

22,895

19,609

18,701

22,493

21,502

21,174

21,502

20,952

22,493

19,609

21,174

18,701

21,502

19,609

18,701

21,502

22,895

20,240

21,174

19,609

21,502

19,609

19,730

21,502

19,609

21,174

18,701

Laclede

Lafayette

Lawrence

Lewis

Sullivan

Taney

8,548

10,197

8,472

7,843

7,152

7,494

8,348

8,472

10,197

8,348

10,197

8,472

8,348

10,197

7,282

8,567

7,843

8,472

7,843

8,548

8,567

10,197

8,472

7,282

7,843

10,197

7,282

7,843

8,348

7,712

8,472

10,197

7,843

10,197

7,494

7,843

10,197

8,472

7,282

Andrew

Atchison

Audrain

Barry

Texas

Vernon

Lincoln

Linn

Warren

Washington

Wayne

Barton

Bates

Livingston

Macon

Webster

Worth

Benton

Bollinger

Boone

Madison

Maries

Wright

Marion

McDonald

Mercer

Miller

Montana

Buchanan

Butler

Employee- Dependent,

Only

County

Beaverhead

Big Horn

Blaine

Family, etc.

20,347

22,167

22,023

20,347

22,167

20,347

22,167

20,347

20,820

22,167

20,347

22,167

20,820

22,167

20,347

20,820

22,023

Caldwell

Callaway

Camden

Cape Girardeau

Carroll

8,693

7,606

8,123

8,693

7,606

8,693

7,606

8,693

7,863

7,606

8,693

7,606

7,863

7,606

8,693

7,863

8,123

Mississippi

Moniteau

Monroe

Montgomery

Morgan

New Madrid

Newton

Nodaway

Oregon

Osage

Broadwater

Carbon

Carter

Cass

Cascade

Chouteau

Custer

Cedar

Chariton

Christian

Clark

Daniels

Dawson

Deer Lodge

Fallon

Clay

Ozark

Clinton

Cole

Pemiscot

Perry

Fergus

Cooper

Crawford

Dade

Pettis

Flathead

Gallatin

Phelps

Pike

Garfield

Glacier

Dallas

Platte

Daviess

DeKalb

Dent

Polk

Golden Valley

Granite

Pulaski

Putnam

Ralls

Hill

Douglas

Dunklin

Franklin

Gasconade

Gentry

Greene

Grundy

Harrison

Henry

Jefferson

Judith Basin

Lake

Randolph

Ray

Reynolds

Ripley

Lewis and Clark

Liberty

Saline

Lincoln

Schuyler

Scotland

Scott

Madison

McCone

Meagher

Mineral

Hickory

Holt

Shannon

Shelby

St. Charles

St. Clair

Missoula

Musselshell

Howard

Howell

2023 Average Premium Tables

-21-

Park

8,693

7,606

8,123

7,606

8,693

8,123

20,347

22,167

22,023

22,167

20,347

22,023

Dodge

7,859

9,129

9,036

8,981

9,129

8,981

9,036

9,129

8,981

9,129

8,981

9,129

8,981

9,129

8,981

9,036

8,981

9,129

8,981

9,129

8,981

9,036

9,129

8,981

9,129

8,981

9,129

8,981

9,036

8,981

9,036

9,129

8,981

9,129

9,036

8,981

9,036

7,859

9,129

22,206

25,388

24,033

26,077

25,388

26,077

24,033

25,388

26,077

25,388

26,077

25,388

26,077

25,388

26,077

24,033

26,077

25,388

26,077

25,388

26,077

24,033

25,388

26,077

25,388

26,077

25,388

26,077

24,033

26,077

24,033

25,388

26,077

25,388

24,033

26,077

24,033

22,206

25,388

Seward

Sheridan

Sherman

Sioux

9,036

9,129

8,981

9,129

8,981

9,036

9,129

7,859

8,981

7,859

8,981

9,036

24,033

25,388

26,077

25,388

26,077

24,033

25,388

22,206

26,077

22,206

26,077

24,033

Petroleum

Phillips

Douglas

Dundy

Pondera

Powder River

Powell

Fillmore

Franklin

Frontier

Furnas

Gage

Stanton

Thayer

Prairie

Thomas

Thurston

Valley

Ravalli

Richland

Roosevelt

Rosebud

Sanders

Sheridan

Silver Bow

Stillwater

Sweet Grass

Teton

Garden

Garfield

Gosper

Grant

Washington

Wayne

Webster

Wheeler

York

Greeley

Hall

Hamilton

Harlan

Nevada

Hayes

Employee- Dependent,

Only

County

Carson City

Churchill

Clark

Family, etc.

19,438

23,111

20,646

19,438

23,111

19,438

23,111

20,646

23,111

19,438

21,180

23,111

Toole

Hitchcock

Holt

7,344

7,741

7,204

7,344

7,741

7,344

7,741

7,204

7,741

7,344

8,331

7,741

Treasure

Valley

Hooker

Howard

Jefferson

Johnson

Kearney

Keith

Wheatland

Wibaux

Douglas

Elko

Yellowstone

Esmeralda

Eureka

Humboldt

Lander

Lincoln

Lyon

Nebraska

Keya Paha

Kimball

Knox

Employee- Dependent,

Only

County

Adams

Antelope

Arthur

Banner

Blaine

Boone

Box Butte

Boyd

Family, etc.

26,077

25,388

26,077

25,388

26,077

25,388

26,077

22,206

26,077

22,206

26,077

25,388

26,077

25,388

26,077

25,388

26,077

8,981

9,129

8,981

9,129

8,981

9,129

8,981

7,859

8,981

7,859

8,981

9,129

8,981

9,129

8,981

9,129

8,981

Lancaster

Lincoln

Logan

Mineral

Nye

Pershing

Storey

Loup

Madison

McPherson

Merrick

Morrill

Washoe

White Pine

Brown

Buffalo

Burt

New Hampshire

Nance

Employee- Dependent,

Only

Nemaha

Nuckolls

Otoe

County

Family, etc.

Butler

All

8,498

26,225

Cass

Cedar

Chase

Cherry

Cheyenne

Clay

Pawnee

Perkins

Phelps

Pierce

New Jersey

Employee- Dependent,

Only

County

Family, etc.

All

8,090

24,143

Platte

Colfax

Cuming

Custer

Dakota

Dawes

Dawson

Deuel

Polk

New Mexico

Red Willow

Richardson

Rock

Employee- Dependent,

Only

County

Bernalillo

Catron

Family, etc.

7,758

9,379

21,368

Saline

29,015

Sarpy

Chaves

Cibola

29,015

Saunders

Scotts Bluff

29,015

Dixon

-22-

2023 Average Premium Tables

Colfax

9,379

8,107

9,379

7,985

9,379

7,758

8,139

9,379

7,758

9,379

7,758

29,015

20,387

29,015

21,236

29,015

21,368

24,010

29,015

21,368

29,015

21,368

Hamilton

Herkimer

Jefferson

Kings

9,203

11,243

9,203

8,103

9,203

8,103

8,439

11,034

11,243

8,449

9,203

8,103

10,472

8,449

9,203

10,472

11,243

8,439

11,243

8,439

9,203

8,103

9,203

11,034

10,472

9,203

10,472

8,439

8,103

11,243

8,449

8,103

25,195

29,771

25,195

20,885

25,195

20,885

21,463

28,766

29,771

20,437

25,195

22,260

20,885

25,016

20,437

25,195

25,016

29,771

21,463

29,771

21,463

22,260

20,885

25,195

22,260

28,766

25,016

22,260

25,016

21,463

20,885

29,771

20,437

20,885

Bertie

7,967

7,391

7,906

8,305

7,960

7,893

7,960

7,967

9,047

7,851

7,960

7,851

8,305

7,967

8,305

8,254

7,906

9,047

7,391

7,967

9,047

8,418

7,906

7,851

8,970

8,418

7,278

8,254

7,967

8,305

7,403

8,970

7,650

7,967

7,391

8,305

7,967

7,391

9,047

7,960

8,305

7,278

9,047

7,851

9,047

8,254

8,305

7,967

8,305

7,893

22,994

23,420

21,413

21,752

21,585

22,733

21,585

22,994

21,390

25,284

21,585

25,284

21,752

22,994

21,752

22,198

21,413

21,390

23,420

22,994

21,390

23,593

21,413

25,284

27,984

23,593

22,091

22,198

22,994

21,752

20,823

27,984

21,582

22,994

23,420

21,752

22,994

23,420

21,390

21,585

21,752

22,091

21,390

25,284

21,390

22,198

21,752

22,994

21,752

22,733

Curry

Bladen

De Baca

Doña Ana

Eddy

Brunswick

Buncombe

Burke

Lewis

Grant

Livingston

Madison

Monroe

Cabarrus

Caldwell

Camden

Carteret

Caswell

Catawba

Chatham

Cherokee

Chowan

Clay

Guadalupe

Harding

Hidalgo

Lea

Montgomery

Nassau

Lincoln

Los Alamos

Luna

New York

Niagara

Oneida

McKinley

Mora

Onondaga

Ontario

Otero

Orange

Cleveland

Columbus

Craven

Quay

Orleans

Rio Arriba

Roosevelt

San Juan

San Miguel

Sandoval

Santa Fe

Sierra

Oswego

Otsego

Cumberland

Currituck

Dare

Putnam

Queens

Rensselaer

Richmond

Rockland

Saratoga

Schenectady

Schoharie

Schuyler

Seneca

Davidson

Davie

Duplin

Socorro

Taos

Durham

Edgecombe

Forsyth

Franklin

Gaston

Gates

Torrance

Union

Valencia

St. Lawrence

Steuben

Suffolk

New York

Graham

Granville

Greene

Guilford

Halifax

Employee- Dependent,

Only

County

Albany

Family, etc.

21,463

20,437

29,771

22,260

20,437

22,260

20,437

22,260

25,195

21,463

22,260

25,016

20,437

25,195

21,463

20,437

21,463

Sullivan

8,439

8,449

11,243

9,203

8,449

9,203

8,449

9,203

8,439

9,203

10,472

8,449

9,203

8,439

8,449

8,439

Tioga

Allegany

Bronx

Tompkins

Ulster

Harnett

Haywood

Henderson

Hertford

Hoke

Broome

Cattaraugus

Cayuga

Chautauqua

Chemung

Chenango

Clinton

Warren

Washington

Wayne

Westchester

Wyoming

Yates

Hyde

Iredell

Jackson

Johnston

Jones

North Carolina

Columbia

Cortland

Delaware

Dutchess

Erie

Employee- Dependent,

Only

County

Alamance

Alexander

Alleghany

Anson

Family, etc.

25,284

21,585

23,965

22,733

23,965

21,752

21,390

Lee

7,851

7,960

8,494

7,893

8,494

8,305

9,047

Lenoir

Lincoln

Essex

Macon

Franklin

Fulton

Madison

Martin

Ashe

Avery

Genesee

Greene

McDowell

Mecklenburg

Beaufort

2023 Average Premium Tables

-23-

Mitchell

Montgomery

Moore

8,305

9,310

8,970

7,906

7,967

7,906

7,851

9,047

7,967

7,906

7,967

7,851

8,970

8,305

7,650

7,391

7,650

7,893

8,305

7,391

7,893

8,418

8,305

9,047

7,893

7,403

7,278

7,403

9,047

8,494

8,970

8,494

8,970

8,418

8,305

21,752

22,169

27,984

21,413

22,994

21,413

25,284

21,390

22,994

21,413

22,994

25,284

27,984

21,752

21,582

23,420

21,582

22,733

21,752

23,420

22,733

23,593

21,752

21,390

22,733

20,823

22,091

20,823

21,390

23,965

27,984

23,965

27,984

23,593

21,752

Cavalier

Dickey

8,478

7,369

8,478

8,214

8,478

24,547

23,920

24,547

23,849

24,547

Auglaize

Belmont

Brown

8,334

7,905

7,700

7,872

7,693

7,552

7,700

7,575

7,905

7,799

8,331

7,552

8,137

7,351

8,591

7,351

8,137

9,816

8,331

7,552

7,905

7,872

8,334

7,905

8,137

7,700

8,183

6,481

8,591

9,816

7,905

7,351

8,331

9,816

7,351

8,331

8,137

7,351

7,575

7,861

8,141

8,183

8,334

7,552

7,905

7,552

7,905

21,287

19,458

19,544

23,435

22,733

21,207

19,544

21,064

19,458

20,711

23,234

21,207

21,370

22,087

22,268

22,087

21,370

25,764

23,234

21,207

19,458

23,435

21,287

19,458

21,370

19,544

21,428

20,621

22,268

25,764

19,458

22,087

23,234

25,764

22,087

23,234

21,370

22,087

21,064

21,747

22,928

21,428

21,287

21,207

19,458

21,207

19,458

Divide

Nash

Dunn

Butler

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Eddy

Carroll

Emmons

Foster

Champaign

Clark

Golden Valley

Grand Forks

Grant

Clermont

Clinton

Columbiana

Coshocton

Crawford

Cuyahoga

Darke

Griggs

Perquimans

Person

Hettinger

Kidder

Pitt

La Moure

Logan

Polk

Defiance

Delaware

Erie

Randolph

Richmond

Robeson

Rockingham

Rowan

McHenry

McIntosh

McKenzie

McLean

Mercer

Morton

Mountrail

Nelson

Oliver

Fairfield

Fayette

Franklin

Fulton

Rutherford

Sampson

Scotland

Stanly

Gallia

Geauga

Greene

Guernsey

Hamilton

Hancock

Hardin

Stokes

Pembina

Pierce

Surry

Swain

Ramsey

Ransom

Renville

Richland

Rolette

Sargent

Sheridan

Sioux

Transylvania

Tyrrell

Harrison

Henry

Union

Vance

Highland

Hocking

Holmes

Huron

Wake

Warren

Washington

Watauga

Wayne

Slope

Jackson

Jefferson

Knox

Stark

Wilkes

Steele

Wilson

Stutsman

Towner

Traill

Lake

Yadkin

Lawrence

Licking

Yancey

Walsh

Logan

North Dakota

Ward

Lorain

Wells

Lucas

Employee- Dependent,

Only

County

Adams

Barnes

Benson

Billings

Bottineau

Bowman

Burke

Family, etc.

24,547

23,849

24,039

Williams

Madison

Mahoning

Marion

8,478

8,214

7,707

Ohio

Medina

Meigs

Employee- Dependent,

Only

County

Adams

Allen

Family, etc.

7,700

8,334

8,141

8,331

8,183

19,544

Mercer

21,287

Miami

Ashland

Ashtabula

Athens

22,928

Monroe

Montgomery

Morgan

23,234

Burleigh

Cass

21,428

-24-

2023 Average Premium Tables

Morrow

Muskingum

Noble

7,861

7,905

8,591

8,334

7,905

7,351

9,816

8,141

7,552

8,334

7,799

9,816

8,591

9,816

8,591

7,552

7,693

8,141

7,575

7,905

7,351

8,334

9,816

7,872

8,183

6,481

8,137

8,591

21,747

19,458

22,268

21,287

19,458

22,087

25,764

22,928

21,207

21,287

20,711

25,764

22,268

25,764

22,268

21,207

22,733

22,928

21,064

19,458

22,087

21,287

25,764

23,435

21,428

20,621

21,370

22,268

Custer

8,126

8,463

8,126

7,472

8,463

8,126

8,463

8,126

8,463

8,397

8,126

8,397

8,126

8,397

8,126

7,472

8,126

8,397

22,340

21,112

22,340

19,440

21,112

22,340

21,112

22,340

21,112

22,134

22,340

22,134

22,340

22,134

22,340

19,440

22,340

22,134

Wagoner

Washington

Washita

8,397

8,126

22,134

22,340

Delaware

Dewey

Ottawa

Paulding

Perry

Ellis

Woods

Garfield

Garvin

Woodward

Oregon

Pickaway

Pike

Grady

Grant

Employee- Dependent,

Only

County

Baker

Family, etc.

24,154

21,095

22,379

23,313

24,154

23,313

23,403

22,230

24,154

22,230

24,154

22,230

23,403

21,095

23,313

21,095

24,154

21,686

24,154

22,379

21,686

24,154

23,313

24,154

22,379

24,154

22,379

Portage

Preble

Greer

9,689

7,925

7,421

9,288

9,689

9,288

8,511

8,028

9,689

8,028

9,689

8,028

8,511

7,925

9,288

7,925

9,689

7,547

9,689

7,421

7,547

9,689

9,288

9,689

7,421

9,689

7,421

Harmon

Harper

Benton

Clackamas

Clatsop

Columbia

Coos

Putnam

Richland

Ross

Haskell

Hughes

Jackson

Jefferson

Johnston

Kay

Sandusky

Scioto

Crook

Seneca

Shelby

Curry

Deschutes

Douglas

Gilliam

Stark

Kingfisher

Kiowa

Summit

Trumbull

Tuscarawas

Union

Latimer

Le Flore

Lincoln

Logan

Grant

Harney

Hood River

Jackson

Jefferson

Josephine

Klamath

Lake

Van Wert

Vinton

Love

Warren

Washington

Wayne

Major

Marshall

Mayes

Williams

Wood

McClain

McCurtain

McIntosh

Murray

Lane

Lincoln

Linn

Wyandot

Oklahoma

Malheur

Marion

Muskogee

Noble

Employee- Dependent,

Only

Morrow

Multnomah

Polk

County

Adair

Family, etc.

22,340

21,112

22,340

21,112

22,340

20,401

22,340

22,134

Nowata

Okfuskee

Oklahoma

Okmulgee

Osage

8,126

8,463

8,126

8,463

8,126

7,985

8,126

8,397

Alfalfa

Sherman

Tillamook

Umatilla

Union

Atoka

Beaver

Beckham

Blaine

Ottawa

Pawnee

Payne

Wallowa

Wasco

Bryan

Caddo

Canadian

Carter

Pittsburg

Pontotoc

Pottawatomie

Pushmataha

Roger Mills

Rogers

Seminole

Sequoyah

Stephens

Texas

Washington

Wheeler

Yamhill

Cherokee

Choctaw

Cimarron

Cleveland

Coal

Pennsylvania

Employee- Dependent,

Only

County

Adams

Family, etc.

8,983

8,022

24,095

Comanche

Cotton

Allegheny

Armstrong

Beaver

22,027

Craig

Tillman

Tulsa

22,027

Creek

2023 Average Premium Tables

-25-

Bedford

Berks

8,469

8,983

8,469

8,137

8,596

8,022

8,469

7,314

8,137

8,694

8,596

7,425

8,469

8,137

8,694

7,425

8,863

8,596

7,314

7,425

8,022

7,425

8,863

8,022

8,469

8,022

8,469

8,863

8,137

8,983

8,022

8,863

8,694

8,137

7,425

8,694

8,137

8,596

8,694

8,863

8,596

8,137

7,314

8,694

8,469

8,137

20,575

24,095

20,575

23,020

23,467

22,027

20,575

22,737

23,020

26,717

23,467

20,206

20,575

23,020

26,717

20,206

24,699

23,467

22,737

20,206

22,027

20,206

24,699

22,027

20,575

22,027

20,575

24,699

23,020

24,095

22,027

24,699

26,717

23,020

20,206

26,717

23,020

23,467

26,717

24,699

23,467

23,020

22,737

26,717

20,575

23,020

Susquehanna

Tioga

8,137

8,694

7,425

8,022

8,137

8,022

8,137

8,983

23,020

26,717

20,206

22,027

23,020

22,027

23,020

24,095

McCormick

Newberry

Oconee

8,590

8,550

9,341

8,291

7,983

8,074

8,422

7,709

7,846

7,512

7,776

7,868

22,973

22,352

25,843

23,112

22,026

23,003

22,368

22,457

20,767

21,717

22,421

22,286

Blair

Union

Bradford

Bucks

Venango

Warren

Orangeburg

Pickens

Butler

Washington

Wayne

Richland

Saluda

Cambria

Cameron

Carbon

Westmoreland

Wyoming

York

Spartanburg

Sumter

Centre

Union

Chester

Clarion

Williamsburg

York

Rhode Island

Clearfield

Clinton

Employee- Dependent,

Only

South Dakota

County

Family, etc.

All

8,796

24,780

Columbia

Crawford

Cumberland

Dauphin

Delaware

Elk

Employee- Dependent,

Only

County

Aurora

Family, etc.

24,641

23,411

21,478

24,641

23,411

24,641

21,478

23,411

24,641

23,411

21,356

23,411

21,478

24,641

23,411

21,478

24,641

23,411

21,478

23,411

21,478

23,411

24,641

21,478

24,641

21,478

24,641

21,478

South Carolina

8,365

7,952

7,735

8,365

7,952

8,365

7,735

7,952

8,365

7,952

7,477

7,952

7,735

8,365

7,952

7,735

8,365

7,952

7,735

7,952

7,735

7,952

8,365

7,735

8,365

7,735

8,365

7,735

Beadle

Bennett

Bon Homme

Brookings

Brown

Employee- Dependent,

Only

County

Family, etc.

22,442

21,404

22,061

22,069

22,564

21,743

21,663

21,748

22,009

22,902

22,225

21,886

22,551

21,976

23,075

22,772

21,490

22,684

22,065

22,308

22,796

21,834

22,390

22,222

22,455

22,581

22,874

22,207

21,741

21,804

22,307

22,393

23,343

22,442

Abbeville

Aiken

8,099

7,627

7,955

8,023

7,536

7,463

8,126

8,717

7,775

7,808

7,663

8,071

7,988

7,369

8,068

8,319

8,040

9,023

7,449

7,982

8,165

8,100

8,011

7,464

8,305

7,496

7,826

8,349

8,029

7,684

7,814

8,215

8,491

8,036

Erie

Allendale

Anderson

Bamberg

Barnwell

Beaufort

Berkeley

Calhoun

Charleston

Cherokee

Chester

Fayette

Brule

Forest

Buffalo

Butte

Franklin

Fulton

Campbell

Charles Mix

Clark

Greene

Huntingdon

Indiana

Clay

Jefferson

Juniata

Codington

Corson

Custer

Lackawanna

Lancaster

Lawrence

Lebanon

Lehigh

Chesterfield

Clarendon

Colleton

Darlington

Dillon

Davison

Day

Deuel

Dewey

Luzerne

Lycoming

McKean

Mercer

Dorchester

Edgefield

Fairfield

Douglas

Edmunds

Fall River

Faulk

Florence

Georgetown

Greenville

Greenwood

Hampton

Horry

Mifflin

Grant

Monroe

Montgomery

Montour

Northampton

Northumberland

Perry

Gregory

Haakon

Hamlin

Hand

Jasper

Hanson

Harding

Hughes

Hutchinson

Hyde

Kershaw

Lancaster

Laurens

Lee

Philadelphia

Pike

Potter

Schuylkill

Snyder

Lexington

Marion

Jackson

Jerauld

Jones

Somerset

Sullivan

Marlboro

-26-

2023 Average Premium Tables

Kingsbury

Lake

7,952

7,477

7,735

7,477

7,735

7,952

7,477

7,952

7,735

8,365

7,477

7,735

7,952

8,365

7,735

7,952

7,735

8,365

7,735

7,477

7,952

8,365

7,735

23,411

21,356

21,478

21,356

21,478

23,411

21,356

23,411

21,478

24,641

21,356

21,478

23,411

24,641

21,478

23,411

21,478

24,641

21,478

21,356

23,411

24,641

21,478

DeKalb

Dickson

Dyer

6,672

7,001

7,401

7,276

6,672

7,379

7,401

7,001

6,720

7,434

7,379

6,720

7,379

7,434

7,401

7,434

7,276

7,401

7,001

6,672

6,720

7,434

6,720

7,401

7,276

7,001

6,720

6,672

7,401

7,379

7,001

7,379

7,401

7,379

6,720

7,695

7,001

6,720

7,401

6,672

7,001

6,672

7,379

6,672

7,379

6,720

16,567

18,618

20,883

18,799

16,567

18,618

20,883

18,618

17,996

18,852

18,618

17,996

18,618

18,852

20,883

18,852

18,799

20,883

18,618

16,567

17,996

18,852

17,996

20,883

18,799

18,618

17,996

16,567

20,883

18,618

20,883

18,618

17,996

19,360

18,618

17,996

20,883

16,567

18,618

16,567

18,618

16,567

18,618

17,996

Robertson

Rutherford

Scott

7,695

6,720

7,379

6,720

7,276

6,672

7,001

7,434

7,695

7,276

7,695

7,434

6,720

6,672

7,434

7,001

7,401

6,672

7,695

19,360

17,996

18,618

17,996

18,799

16,567

18,618

18,852

19,360

18,799

19,360

18,852

17,996

16,567

18,852

18,618

20,883

16,567

19,360

Lawrence

Lincoln

Lyman

Fayette

Fentress

Franklin

Gibson

Giles

Sequatchie

Sevier

Marshall

McCook

McPherson

Meade

Mellette

Miner

Shelby

Smith

Stewart

Sullivan

Sumner

Tipton

Grainger

Greene

Grundy

Hamblen

Hamilton

Hancock

Hardeman

Hardin

Minnehaha

Moody

Trousdale

Unicoi

Pennington

Perkins

Potter

Union

Van Buren

Warren

Roberts

Sanborn

Shannon

Spink

Hawkins

Haywood

Henderson

Henry

Washington

Wayne

Weakley

White

Stanley

Sully

Hickman

Houston

Humphreys

Jackson

Jefferson

Johnson

Knox

Williamson

Wilson

Todd

Texas

Tripp

Turner

Employee- Dependent,

Only

County

Anderson

Andrews

Angelina

Aransas

Archer

Family, etc.

20,066

26,628

20,716

23,705

18,955

22,662

20,066

18,955

20,191

20,066

18,547

18,955

20,066

20,522

22,662

20,305

20,066

20,305

20,066

Union

7,822

8,102

8,440

10,030

7,665

7,250

7,822

7,665

7,061

7,822

8,124

7,665

7,822

7,368

7,250

7,118

7,822

7,118

7,822

Walworth

Yankton

Ziebach

Lake

Lauderdale

Lawrence

Lewis

Tennessee

Armstrong

Atascosa

Austin

Lincoln

Loudon

Macon

Employee- Dependent,

Only

County

Anderson

Bedford

Benton

Family, etc.

17,996

18,618

20,883

18,618

17,996

18,618

17,996

16,567

20,883

18,852

19,360

20,883

17,996

16,567

17,996

18,618

20,883

16,567

19,360

20,883

6,720

7,001

7,401

7,379

6,720

7,379

6,720

6,672

7,401

7,434

7,695

7,401

6,720

6,672

6,720

7,001

7,401

6,672

7,695

7,401

Bailey

Madison

Marion

Bandera

Bastrop

Baylor

Bledsoe

Blount

Marshall

Maury

Bee

Bradley

Campbell

Cannon

Carroll

McMinn

McNairy

Meigs

Bell

Bexar

Blanco

Borden

Bosque

Bowie

Monroe

Montgomery

Moore

Carter

Cheatham

Chester

Claiborne

Clay

Morgan

Obion

Brazoria

Brazos

Brewster

Briscoe

Brooks

Brown

Overton

Perry

Cocke

Coffee

Pickett

Crockett

Cumberland

Davidson

Decatur

Polk

Putnam

Rhea

Burleson

Burnet

Roane

2023 Average Premium Tables

-27-

Caldwell

Calhoun

Callahan

Cameron

Camp

7,061

8,198

7,456

6,716

7,822

10,030

7,822

7,250

7,822

8,440

7,822

7,978

7,822

7,665

7,822

8,124

7,822

7,143

7,822

7,978

7,822

7,978

7,822

8,911

7,822

7,581

7,978

7,822

7,250

7,822

20,191

21,897

20,335

18,893

20,066

23,705

20,066

22,662

20,066

20,716

20,066

22,164

20,066

18,955

20,066

18,547

20,066

21,917

20,066

22,164

20,066

22,164

20,066

19,166

20,066

16,149

22,164

20,066

22,662

20,066

Freestone

Frio

7,822

7,250

7,822

8,198

7,822

7,707

6,632

7,822

7,665

7,822

9,052

7,250

7,822

7,061

7,822

8,613

7,822

7,978

7,822

10,151

7,822

9,052

7,822

7,978

7,456

7,822

7,978

7,665

7,822

20,066

22,662

20,066

21,897

20,066

19,921

22,987

20,066

18,955

20,066

22,480

22,662

20,066

20,191

20,066

21,323

20,066

22,164

20,066

23,008

20,066

22,480

20,066

22,164

20,335

20,066

22,164

18,955

20,066

Kimble

7,822

8,124

7,822

7,250

7,822

7,143

7,822

5,891

7,822

7,665

7,822

6,913

7,822

7,250

7,822

8,102

7,822

9,052

7,822

7,978

7,822

20,066

18,547

20,066

22,662

20,066

21,917

20,066

17,785

20,066

18,955

20,066

22,892

20,066

22,662

20,066

26,628

20,066

22,480

20,066

22,164

20,066

King

Gaines

Galveston

Garza

Kinney

Kleberg

Knox

Carson

Cass

Gillespie

Glasscock

Goliad

Lamar

Lamb

Castro

Lampasas

LaSalle

Lavaca

Lee

Chambers

Cherokee

Childress

Clay

Gonzales

Gray

Grayson

Gregg

Leon

Cochran

Coke

Grimes

Guadalupe

Hale

Liberty

Limestone

Lipscomb

Live Oak

Llano

Coleman

Collin

Hall

Collingsworth

Colorado

Comal

Hamilton

Hansford

Hardeman

Hardin

Loving

Lubbock

Lynn

Comanche

Concho

Cooke

Harris

Madison

Marion

Harrison

Hartley

Haskell

Hays

Coryell

Cottle

Martin

Mason

Crane

Matagorda

Maverick

McCulloch

McLennan

McMullen

Medina

Menard

Midland

Milam

Crockett

Crosby

Culberson

Dallam

Dallas

Hemphill

Henderson

Hidalgo

Hill

Hockley

Hood

Dawson

Deaf Smith

Delta

Hopkins

Houston

Howard

Hudspeth

Hunt

Denton

DeWitt

Dickens

Dimmit

Donley

Duval

Mills

Mitchell

Montague

Montgomery

Moore

Hutchinson

Irion

Jack

Morris

Eastland

Ector

Jackson

Jasper

Motley

Nacogdoches

Navarro

Newton

Nolan

Edwards

El Paso

Ellis

Jeff Davis

Jefferson

Jim Hogg

Jim Wells

Johnson

Jones

Erath

Nueces

Ochiltree

Oldham

Orange

Palo Pinto

Panola

Falls

Fannin

Fayette

Fisher

Karnes

Kaufman

Kendall

Kenedy

Kent

Floyd

Foard

Parker

Fort Bend

Franklin

Parmer

Pecos

Kerr

-28-

2023 Average Premium Tables

Virginia

Polk

7,822

10,030

7,822

10,030

7,822

7,118

7,978

7,822

6,632

7,822

7,250

8,102

7,822

7,669

7,822

7,978

7,456

7,822

10,151

7,061

7,822

6,632

7,822

8,198

7,822

7,250

7,822

20,066

23,705

20,066

23,705

20,066

20,305

22,164

20,066

22,987

20,066

22,662

26,628

20,066

22,893

20,066

22,164

20,335

20,066

23,008

20,191

20,066

22,987

20,066

21,897

20,066

22,662

20,066

Webb

8,091

7,822

8,440

7,822

7,061

7,665

7,822

7,978

7,822

21,227

20,066

20,716

20,066

20,191

18,955

20,066

22,164

20,066

Potter

Wharton

Wheeler

Wichita

Wilbarger

Willacy

Williamson

Wilson

Winkler

Wise

Employee- Dependent,

County

Only

Family, etc.

20,308

21,460

23,327

20,308

22,408

20,171

23,327

20,308

20,171

20,308

22,437

19,493

20,308

20,171

22,408

20,308

22,408

20,308

21,460

21,119

22,408

23,327

22,408

20,308

22,437

20,308

22,408

21,176

20,308

22,408

20,308

23,327

20,308

21,460

22,437

20,308

21,890

23,327

20,308

20,744

Presidio

Rains

Accomack

Albemarle

Alexandria City

Alleghany

Amelia

7,539

8,974

8,021

7,539

7,693

6,642

8,021

7,539

6,642

7,539

8,194

7,843

7,539

6,642

7,693

7,539

7,693

7,539

8,974

7,782

7,693

8,021

7,693

7,539

8,194

7,539

7,693

8,956

7,539

7,693

7,539

8,021

7,539

8,974

8,194

7,539

8,090

8,021

7,539

6,887

Randall

Reagan

Real

Red River

Reeves

Refugio

Roberts

Robertson

Rockwall

Runnels

Rusk

Amherst

Appomattox

Arlington

Wood

Augusta

Yoakum

Young

Bath

Bedford

Zapata

Zavala

Bedford City

Bland

Sabine

Utah

Botetourt

San Augustine

San Jacinto

San Patricio

San Saba

Schleicher

Scurry

Bristol City

Brunswick

Buchanan

Buckingham

Buena Vista City

Campbell

Caroline

Employee- Dependent,

Only

County

Beaver

Box Elder

Cache

Carbon

Daggett

Davis

Family, etc.

23,521

22,242

23,989

23,521

22,868

23,521

22,531

23,521

22,242

23,521

23,989

22,868

23,521

22,868

23,521

22,542

22,868

22,531

23,521

22,242

7,720

7,158

8,509

7,720

7,291

7,720

9,091

7,720

7,158

7,720

8,509

7,291

7,720

7,291

7,720

6,933

7,291

9,091

7,720

7,158

Shackelford

Shelby

Carroll

Sherman

Smith

Duchesne

Emery

Garfield

Grand

Charles City

Charlotte

Somervell

Starr

Charlottesville City

Chesapeake City

Chesterfield

Clarke

Stephens

Sterling

Stonewall

Sutton

Iron

Juab

Kane

Colonial Heights City

Covington City

Craig

Millard

Morgan

Piute

Swisher

Tarrant

Culpeper

Taylor

Rich

Cumberland

Danville City

Dickenson

Dinwiddie

Emporia City

Essex

Terrell

Salt Lake

San Juan

Sanpete

Sevier

Terry

Throckmorton

Titus

Tom Green

Travis

Summit

Tooele

Uintah

Utah

Fairfax

Trinity

Fairfax City

Falls Church City

Fauquier

Tyler

Upshur

Upton

Wasatch

Washington

Wayne

Weber

Floyd

Uvalde

Fluvanna

Val Verde

Van Zandt

Victoria

Walker

Franklin

Franklin City

Frederick

Vermont

Fredericksburg City

Galax City

Giles

Employee- Dependent,

Only

Waller

County

Family, etc.

Ward

All

8,460

23,240

Washington

2023 Average Premium Tables

-29-

Gloucester

Goochland

Grayson

7,782

7,693

7,539

8,974

7,539

7,782

7,693

7,253

7,693

7,539

7,693

7,782

7,693

7,539

7,693

7,539

8,021

7,693

7,539

6,642

7,539

8,021

7,539

7,782

7,539

6,887

8,974

7,693

7,782

7,539

7,693

8,956

7,782

7,693

7,539

7,693

8,021

6,887

21,119

22,408

20,308

21,460

20,308

21,119

22,408

21,742

22,408

20,308

22,408

21,119

22,408

20,308

22,408

20,308

23,327

22,408

20,308

20,171

20,308

23,327

20,308

21,119

20,308

20,744

21,460

22,408

21,119

20,308

22,408

21,176

21,119

22,408

20,308

22,408

23,327

20,744

Radford City

Rappahannock

Richmond

Richmond City

Roanoke

6,887

7,539

7,693

8,194

7,539

7,253

7,539

8,194

7,843

7,539

8,021

7,539

7,782

7,693

7,539

7,782

8,021

7,843

7,539

7,782

8,090

7,539

7,782

20,744

20,308

22,408

22,437

20,308

21,742

20,308

22,437

19,493

20,308

23,327

20,308

21,119

22,408

20,308

21,119

23,327

19,493

20,308

21,119

21,890

20,308

21,119

Kittitas

7,672

7,145

7,967

7,417

7,967

7,672

7,967

7,417

7,967

7,145

7,967

7,417

7,967

7,672

7,967

7,672

22,822

20,391

20,803

19,788

20,803

22,822

20,803

19,788

20,803

20,391

20,803

19,788

20,803

22,822

20,803

22,822

Klickitat

Lewis

Greene

Lincoln

Greensville

Halifax

Mason

Roanoke City

Rockbridge

Rockingham

Russell

Okanogan

Pacific

Hampton City

Hanover

Pend Oreille

Pierce

Harrisonburg City

Henrico

Salem City

Scott

San Juan

Skagit

Henry

Highland

Shenandoah

Smyth

Skamania

Snohomish

Spokane

Stevens

Thurston

Wahkiakum

Walla Walla

Whatcom

Whitman

Yakima

Hopewell City

Isle of Wight

James City

King and Queen

King George

King William

Lancaster

Southampton

Spotsylvania

Stafford

Staunton City

Suffolk City

Surry

Lee

Sussex

Lexington City

Loudoun

Tazewell

Virginia Beach City

Warren

West Virginia

Louisa

Lunenburg

Lynchburg City

Madison

Washington

Waynesboro City

Westmoreland

Williamsburg City

Winchester City

Wise

Employee- Dependent,

Only

County

Barbour

Berkeley

Boone

Family, etc.

27,010

24,140

26,140

25,392

27,737

25,542

25,392

24,704

25,392

24,704

24,907

25,392

24,907

27,737

24,907

27,010

28,051

24,140

28,870

24,704

26,140

24,704

27,737

25,542

26,140

21,360

9,242

8,573

8,389

9,567

8,840

8,675

9,567

9,107

9,567

9,107

7,539

9,567

7,539

8,840

7,539

9,242

9,704

8,573

10,466

9,107

8,389

9,107

8,840

8,675

8,389

8,780

Manassas City

Manassas Park City

Martinsville City

Mathews

Braxton

Brooke

Cabell

Wythe

Mecklenburg

Middlesex

York

Calhoun

Clay

Washington

Montgomery

Nelson

Doddridge

Fayette

Gilmer

Employee- Dependent,

Only

County

Adams

Asotin

Family, etc.

22,822

20,803

20,391

22,822

20,803

22,822

19,788

22,822

20,803

21,509

20,803

New Kent

7,672

7,967

7,145

7,672

7,967

7,672

7,417

7,672

7,967

7,851

7,967

Newport News City

Norfolk City

Northampton

Northumberland

Norton City

Nottoway

Grant

Benton

Chelan

Clallam

Clark

Greenbrier

Hampshire

Hancock

Hardy

Columbia

Cowlitz

Douglas

Ferry

Harrison

Jackson

Jefferson

Kanawha

Lewis

Orange

Page

Patrick

Petersburg City

Pittsylvania

Poquoson

Franklin

Garfield

Grant

Lincoln

Logan

Portsmouth City

Powhatan

Grays Harbor

Island

Marion

Marshall

Mason

Prince Edward

Prince George

Prince William

Pulaski

Jefferson

King

McDowell

Mercer

Kitsap

-30-

2023 Average Premium Tables

Mineral

Mingo

7,539

8,389

9,107

8,780

7,539

9,567

8,840

7,539

9,704

9,242

8,675

8,780

9,242

9,704

9,567

8,780

9,242

9,704

9,242

8,675

9,242

9,107

9,704

8,389

24,907

26,140

24,704

21,360

24,907

25,392

27,737

24,907

28,051

27,010

25,542

21,360

27,010

28,051

25,392

21,360

27,010

28,051

27,010

25,542

27,010

24,704

28,051

26,140

Dodge

7,712

7,748

9,003

8,268

6,695

7,712

6,695

8,133

8,344

8,246

8,133

6,695

7,925

8,344

8,246

9,382

7,748

7,925

8,133

6,695

9,019

7,748

9,019

7,748

8,246

7,748

7,939

7,925

7,748

6,695

7,712

8,177

8,268

9,799

9,019

8,104

9,382

8,246

8,344

8,104

8,246

22,786

22,230

25,622

24,992

21,458

22,786

21,458

23,995

26,080

29,125

23,995

21,458

22,747

26,080

29,125

26,795

22,230

22,747

23,995

21,458

25,476

22,230

25,476

22,230

29,125

22,230

26,745

22,747

22,230

21,458

22,786

24,978

24,992

25,801

25,476

22,602

26,795

29,125

26,080

22,602

29,125

Sawyer

9,003

7,748

7,712

9,799

8,104

7,925

8,133

6,695

8,344

9,003

8,177

7,712

9,019

25,622

22,230

22,786

25,801

22,602

22,747

23,995

21,458

26,080

25,622

24,978

22,786

25,476

Door

Shawano

Sheboygan

St. Croix

Taylor

Monongalia

Monroe

Morgan

Nicholas

Ohio

Douglas

Dunn

Eau Claire

Florence

Fond du Lac

Forest

Trempealeau

Vernon

Pendleton

Pleasants

Pocahontas

Preston

Putnam

Raleigh

Randolph

Ritchie

Vilas

Grant

Walworth

Washburn

Washington

Waukesha

Waupaca

Waushara

Winnebago

Wood

Green

Green Lake

Iowa

Iron

Jackson

Jefferson

Juneau

Kenosha

Kewaunee

La Crosse

Lafayette

Langlade

Lincoln

Roane

Summers

Taylor

Wyoming

Tucker

Employee- Dependent,

Only

County

Albany

Family, etc.

24,339

22,222

24,339

24,281

24,339

Tyler

8,863

8,671

8,863

9,630

8,863

Upshur

Wayne

Big Horn

Campbell

Carbon

Converse

Crook

Webster

Wetzel

Manitowoc

Marathon

Marinette

Marquette

Menomonee

Milwaukee

Monroe

Oconto

Oneida

Outagamie

Ozaukee

Pepin

Wirt

Wood

Fremont

Goshen

Hot Springs

Johnson

Laramie

Lincoln

Wyoming

Wisconsin

Employee- Dependent,

Only

County

Adams

Ashland

Barron

Family, etc.

29,125

25,622

22,602

25,622

22,230

22,747

25,622

22,786

24,992

22,602

26,080

23,995

25,699

8,246

9,003

8,104

9,003

7,748

7,925

9,003

7,712

8,268

8,104

8,344

8,133

7,594

Natrona

Niobrara

Park

Bayfield

Brown

Pierce

Platte

Polk

Sheridan

Sublette

Sweetwater

Teton

Buffalo

Burnett

Calumet

Chippewa

Clark

Portage

Price

Racine

Richland

Rock

Uinta

Washakie

Weston

Columbia

Crawford

Dane

Rusk

Sauk

2023 Average Premium Tables

-31-

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