HI 01005.011: Exhibit — Standard Hospital Insurance (HI) Premiums and Surcharges
Effective Dates: 11/21/2016 - Present- Effective Dates: 01/02/2018 - Present
- TN 21 (10-04)
- HI 01005.011 Exhibit — Standard Hospital Insurance (HI) Premiums and Surcharges
- INCLUSIVE PERIOD
- HI PREMIUM AMOUNT
- SURCHARGE AMOUNT
- 01/18–12/18
- 422.00
- 464.20
- 01/17–12/17
- 413.00
- 454.30
- 01/16–12/16
- 411.00
- 452.10
- 01/15-12/15
- 407.00
- 447.70
- 01/14–12/14
- 426.00
- 468.60
- 01/13-12/13
- 441.00
- 485.10
- 01/12-12/12
- 451.00
- 496.10
- 01/11-12/11
- 450.00
- 495.00
- 01/10-12/10
- 461.00
- 507.10
- 01/09-12/09
- 443.00
- 487.30
- 01/08-12/08
- 423.00
- 465.30
- 01/07-12/07
- 410.00
- 451.00
- 01/06-12/06
- 393.00
- 432.30
- 01/05-12/05
- 375.00
- 412.50
- 01/04-12/04
- 343.00
- 377.30
- 01/03-12/03
- 316.00
- 347.60
- 01/02-12/02
- 319.00
- 350.90
- 01/01-12/01
- 300.00
- 330.00
- 01/00-12/00
- 301.00
- 331.10
- 01/98-12/99
- 309.00
- 339.90
- 01/97-12/97
- 311.00
- 342.10
- 01/96-12/96
- 289.00
- 317.90
- 01/95-12/95
- 261.00
- 287.10
- 01/94-12/94
- 245.00
- 269.50
- 01/93-12/93
- 221.00
- 243.10
- 01/92-12/92
- 192.00
- 211.20
- 01/91-12/91
- 177.00
- 194.70
- 01/90-12/90
- 175.00
- 192.50
- 01/89-12/89
- 156.00
- 171.60
- 01/88-12/88
- 234.00
- 257.40
- 01/87-12/87
- 226.00
- 248.60
- 07/86-12/86
- 214.00
- 235.40
x
← This means that the line
Effective Dates: 11/21/2016 - Present
was removed and
Effective Dates: 01/02/2018 - Present
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.