HI 01001: Supplementary Medical Insurance
TN 31 (11-09)
A. Exhibit - Premiums and Surcharges - 1990 through 1994
|
1990 |
1991 |
1992 |
1993 |
1994 |
|
|---|---|---|---|---|---|
|
Base |
28.60 |
29.90 |
31.80 |
36.60 |
41.10 |
|
10% |
31.50 |
32.90 |
35.00 |
40.30 |
45.20 |
|
20% |
34.30 |
35.90 |
38.20 |
43.90 |
49.30 |
|
30% |
37.20 |
38.90 |
41.30 |
47.60 |
53.40 |
|
40% |
40.00 |
41.90 |
44.50 |
51.20 |
57.50 |
|
50% |
42.90 |
44.90 |
47.70 |
54.90 |
61.70 |
|
60% |
45.80 |
47.80 |
50.90 |
58.60 |
65.80 |
|
70% |
48.60 |
50.80 |
54.10 |
62.20 |
69.90 |
|
80% |
51.50 |
53.80 |
57.20 |
65.90 |
74.00 |
|
90% |
54.30 |
56.80 |
60.40 |
69.50 |
78.10 |
|
100% |
57.20 |
59.80 |
63.60 |
73.20 |
82.20 |
|
110% |
60.10 |
62.80 |
66.80 |
76.90 |
86.30 |
|
120% |
62.90 |
65.80 |
70.00 |
80.50 |
90.40 |
|
130% |
65.80 |
68.80 |
73.10 |
84.20 |
94.50 |
|
140% |
68.60 |
71.80 |
76.30 |
87.80 |
98.60 |
|
150% |
71.50 |
74.80 |
79.50 |
91.50 |
102.80 |
|
160% |
74.40 |
77.70 |
82.70 |
95.20 |
106.90 |
|
170% |
77.20 |
80.70 |
85.90 |
98.80 |
111.00 |
|
180% |
80.10 |
83.70 |
89.00 |
102.50 |
115.10 |
|
190% |
82.90 |
86.70 |
92.20 |
106.10 |
119.20 |
|
200% |
85.80 |
89.70 |
95.40 |
109.80 |
123.30 |
|
210% |
88.70 |
92.70 |
98.60 |
113.50 |
127.40 |
|
220% |
91.50 |
95.70 |
101.80 |
117.10 |
131.50 |
|
230% |
94.40 |
98.70 |
104.90 |
120.80 |
135.60 |
|
240% |
101.70 |
108.10 |
124.40 |
139.70 |
|
|
250% |
111.30 |
128.10 |
143.90 |
||
|
260% |
148.00 |
||||
|
270% |
152.00 |
||||
B. Exhibit - Premiums and Surcharges - 1995 through 2001
|
|
1995 |
1996 |
1997 and 1998 |
1999 and 2000 |
2001 |
|---|---|---|---|---|---|
|
Base |
46.10 |
42.50 |
43.80 |
45.50 |
50.00 |
|
10% |
50.70 |
46.80 |
48.20 |
50.10 |
55.00 |
|
20% |
55.30 |
51.00 |
52.60 |
54.60 |
60.00 |
|
30% |
59.90 |
55.30 |
56.90 |
59.20 |
65.00 |
|
40% |
64.50 |
59.50 |
61.30 |
63.70 |
70.00 |
|
50% |
69.20 |
63.80 |
65.70 |
68.30 |
75.00 |
|
60% |
73.80 |
68.00 |
70.10 |
72.80 |
80.00 |
|
70% |
78.40 |
72.30 |
74.50 |
77.40 |
85.00 |
|
80% |
83.00 |
76.50 |
78.80 |
81.90 |
90.00 |
|
90% |
87.60 |
80.80 |
83.20 |
86.50 |
95.00 |
|
100% |
92.20 |
85.00 |
87.60 |
91.00 |
100.00 |
|
110% |
96.80 |
89.30 |
92.00 |
95.60 |
105.00 |
|
120% |
101.40 |
93.50 |
96.40 |
100.10 |
110.00 |
|
130% |
106.00 |
97.80 |
100.70 |
104.70 |
115.00 |
|
140% |
110.60 |
102.00 |
105.10 |
109.20 |
120.00 |
|
150% |
115.30 |
106.30 |
109.50 |
113.80 |
125.00 |
|
160% |
119.90 |
110.50 |
113.90 |
118.30 |
130.00 |
|
170% |
124.50 |
114.80 |
118.30 |
122.90 |
135.00 |
|
180% |
129.10 |
119.00 |
122.60 |
127.40 |
140.00 |
|
190% |
133.70 |
123.30 |
127.00 |
132.00 |
145.00 |
|
200% |
138.30 |
127.50 |
131.40 |
136.50 |
150.00 |
|
210% |
142.90 |
131.80 |
135.80 |
141.10 |
155.00 |
|
220% |
147.50 |
136.00 |
140.20 |
145.60 |
160.00 |
|
230% |
152.10 |
140.30 |
144.50 |
150.20 |
165.00 |
|
240% |
156.70 |
144.50 |
148.90 |
154.70 |
170.00 |
|
250% |
161.40 |
148.80 |
153.30 |
159.30 |
175.00 |
|
260% |
166.00 |
153.00 |
157.70 |
163.80 |
180.00 |
|
270% |
170.60 |
157.30 |
162.10 |
168.40 |
185.00 |
|
280% |
175.20 |
161.50 |
166.40 |
172.90 |
190.00 |
|
290% |
165.80 |
170.80 |
177.50 |
195.00 |
|
|
300% |
175.20 |
182.00 |
200.00 |
||
|
310% |
179.60* |
186.60 |
205.00 |
||
|
320% |
191.10 |
210.00 |
|||
|
330% |
195.70** |
215.00 |
|||
|
340% |
220.00 |
* Applies for 1998 only.
** Applies for 2000 only.
C. Exhibit - Premiums and Surcharges - 2002 through 2009
|
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
2008 |
2009 |
|
|---|---|---|---|---|---|---|---|---|
|
Base |
54.00 |
58.70 |
66.60 |
78.20 |
88.50 |
93.50 |
96.40 |
96.40 |
|
10% |
59.40 |
64.60 |
73.30 |
86.00 |
97.40 |
102.90 |
106.00 |
106.00 |
|
20% |
64.80 |
70.40 |
79.90 |
93.80 |
106.20 |
112.20 |
115.70 |
115.70 |
|
30% |
70.20 |
76.30 |
86.60 |
101.70 |
115.10 |
121.60 |
125.30 |
125.30 |
|
40% |
75.60 |
82.20 |
93.20 |
109.50 |
123.90 |
130.90 |
135.00 |
135.00 |
|
50% |
81.00 |
88.10 |
99.90 |
117.30 |
132.80 |
140.30 |
144.60 |
144.60 |
|
60% |
86.40 |
93.90 |
106.60 |
125.10 |
141.60 |
149.60 |
154.20 |
154.20 |
|
70% |
91.80 |
99.80 |
113.20 |
132.90 |
150.50 |
159.00 |
163.90 |
163.90 |
|
80% |
97.20 |
105.70 |
119.90 |
140.80 |
159.30 |
168.30 |
173.50 |
173.50 |
|
90% |
102.60 |
111.50 |
126.50 |
148.60 |
168.20 |
177.70 |
183.20 |
183.20 |
|
100% |
108.00 |
117.40 |
133.20 |
156.40 |
177.00 |
187.00 |
192.80 |
192.80 |
|
110% |
113.40 |
123.30 |
139.90 |
164.20 |
185.90 |
196.40 |
202.40 |
202.40 |
|
120% |
118.80 |
129.10 |
146.50 |
172.00 |
194.70 |
205.70 |
212.10 |
212.10 |
|
130% |
124.20 |
135.00 |
153.20 |
179.90 |
203.60 |
215.10 |
221.70 |
221.70 |
|
140% |
129.60 |
140.90 |
159.80 |
187.70 |
212.40 |
224.40 |
231.40 |
231.40 |
|
150% |
135.00 |
146.80 |
166.50 |
195.50 |
221.30 |
233.80 |
241.00 |
241.00 |
|
160% |
140.40 |
152.60 |
173.20 |
203.30 |
230.10 |
243.10 |
250.60 |
250.60 |
|
170% |
145.80 |
158.50 |
179.80 |
211.10 |
239.00 |
252.50 |
260.30 |
260.30 |
|
180% |
151.20 |
164.40 |
186.50 |
219.00 |
247.80 |
261.80 |
269.90 |
269.90 |
|
190% |
156.60 |
170.20 |
193.10 |
226.80 |
256.70 |
271.20 |
279.60 |
279.60 |
|
200% |
162.00 |
176.10 |
199.80 |
234.60 |
265.50 |
280.50 |
289.20 |
289.20 |
|
210% |
167.40 |
182.00 |
206.50 |
242.40 |
274.40 |
289.90 |
298.80 |
298.80 |
|
220% |
172.80 |
187.80 |
213.10 |
250.20 |
283.20 |
299.20 |
308.50 |
308.50 |
|
230% |
178.20 |
193.70 |
219.80 |
258.10 |
292.10 |
308.60 |
318.10 |
318.10 |
|
240% |
183.60 |
199.60 |
226.40 |
265.90 |
300.90 |
317.90 |
327.80 |
327.80 |
|
250% |
189.00 |
205.50 |
233.10 |
273.70 |
309.80 |
327.30 |
337.40 |
337.40 |
|
260% |
194.40 |
211.30 |
239.80 |
281.50 |
318.60 |
336.60 |
347.00 |
347.00 |
|
270% |
199.80 |
217.20 |
246.40 |
289.30 |
327.50 |
346.00 |
356.70 |
356.70 |
|
280% |
205.20 |
223.10 |
253.10 |
297.20 |
336.30 |
355.30 |
366.30 |
366.30 |
|
290% |
210.60 |
228.90 |
259.70 |
305.00 |
345.20 |
364.70 |
376.00 |
376.00 |
|
300% |
216.00 |
234.80 |
266.40 |
312.80 |
354.00 |
374.00 |
385.60 |
385.60 |
|
310% |
221.40 |
240.70 |
273.10 |
320.60 |
362.90 |
383.40 |
395.20 |
395.20 |
|
320% |
226.80 |
246.50 |
279.70 |
328.40 |
371.70 |
392.70 |
404.90 |
404.90 |
|
330% |
232.20 |
252.40 |
286.40 |
336.30 |
380.60 |
402.10 |
414.50 |
414.50 |
|
340% |
237.60 |
258.30 |
293.00 |
344.10 |
389.40 |
411.40 |
424.20 |
424.20 |
|
350% |
243.00 |
264.20 |
299.70 |
351.90 |
398.30 |
420.80 |
433.80 |
433.80 |
|
360% |
270.00 |
306.40 |
359.70 |
407.10 |
430.10 |
443.40 |
443.40 |
|
|
370% |
313.00 |
367.50 |
416.00 |
439.50 |
453.10 |
453.10 |
||
|
380% |
375.40 |
424.80 |
448.80 |
462.70 |
462.70 |
|||
|
390% |
433.70 |
458.20 |
472.40 |
472.40 |
||||
|
400% |
467.50 |
482.00 |
482.00 |
|||||
|
410% |
491.60 |
501.30 |
||||||
|
420% |
D. Premiums and Surcharges – 2010 Through 2018
Surcharge Amounts (on Part B standard premium amount) for 2010 through 2018.
|
2010 |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
2017 and 2018 |
|
|---|---|---|---|---|---|---|---|---|
|
Base |
110.50 |
115.40 |
99.90 |
104.90 |
104.90 |
104.90 |
121.80 |
134.00 |
|
10% |
121.60 |
126.90 |
109.90 |
$115.40 |
115.40 |
115.40 |
134.00 |
147.40 |
|
20% |
132.60 |
138.50 |
119.90 |
$125.90 |
125.90 |
125.90 |
146.20 |
160.80 |
|
30% |
143.70 |
150.00 |
129.90 |
$136.40 |
136.40 |
136.40 |
158.30 |
174.20 |
|
40% |
154.70 |
161.60 |
139.90 |
$146.90 |
146.90 |
146.90 |
170.50 |
187.60 |
|
50% |
165.80 |
173.10 |
149.90 |
$157.40 |
157.40 |
157.40 |
182.70 |
201.00 |
|
60% |
176.80 |
184.60 |
159.80 |
$167.80 |
167.80 |
167.80 |
194.90 |
214.40 |
|
70% |
187.90 |
196.20 |
169.80 |
$178.30 |
178.30 |
178.30 |
207.10 |
227.80 |
|
80% |
198.90 |
207.70 |
179.80 |
$188.80 |
188.80 |
188.80 |
219.20 |
241.20 |
|
90% |
210.00 |
219.30 |
189.80 |
$199.30 |
199.30 |
199.30 |
231.40 |
254.60 |
|
100% |
221.00 |
230.80 |
199.80 |
$209.80 |
209.80 |
209.80 |
243.60 |
268.00 |
|
110% |
232.10 |
242.30 |
209.80 |
$220.30 |
220.30 |
220.30 |
255.80 |
281.40 |
|
120% |
243.10 |
253.90 |
219.80 |
$230.80 |
230.80 |
230.80 |
268.00 |
294.80 |
|
130% |
254.20 |
265.40 |
229.80 |
$241.30 |
241.30 |
241.30 |
280.10 |
308.20 |
|
140% |
265.20 |
277.00 |
239.80 |
$251.80 |
251.80 |
251.80 |
292.30 |
321.60 |
|
150% |
276.30 |
288.50 |
249.80 |
$262.30 |
262.30 |
262.30 |
304.50 |
335.00 |
|
160% |
287.30 |
300.00 |
259.70 |
$272.70 |
272.70 |
272.70 |
316.70 |
348.40 |
|
170% |
298.40 |
311.60 |
269.70 |
$283.20 |
283.20 |
283.20 |
328.90 |
361.80 |
|
180% |
309.40 |
323.10 |
279.70 |
$293.70 |
293.70 |
293.70 |
341.00 |
375.20 |
|
190% |
320.50 |
334.70 |
289.70 |
$304.20 |
304.20 |
304.20 |
353.20 |
388.60 |
|
200% |
331.50 |
346.20 |
299.70 |
$314.70 |
314.70 |
314.70 |
365.40 |
402.00 |
|
210% |
342.60 |
357.70 |
309.70 |
$325.20 |
325.20 |
325.20 |
377.60 |
415.40 |
|
220% |
353.60 |
369.30 |
319.70 |
$335.70 |
335.70 |
335.70 |
389.80 |
428.80 |
|
230% |
364.70 |
380.80 |
329.70 |
$346.20 |
346.20 |
346.20 |
401.90 |
442.20 |
|
240% |
375.70 |
392.40 |
339.70 |
$356.70 |
356.70 |
356.70 |
414.10 |
455.60 |
|
250% |
386.80 |
403.90 |
349.70 |
$367.20 |
367.20 |
367.20 |
426.30 |
469.00 |
|
260% |
397.80 |
415.40 |
359.60 |
$377.60 |
377.60 |
377.60 |
438.50 |
482.40 |
|
270% |
408.90 |
427.00 |
369.60 |
$388.10 |
388.10 |
388.10 |
450.70 |
495.80 |
|
280% |
419.90 |
438.50 |
379.60 |
$398.60 |
398.60 |
398.60 |
462.80 |
509.20 |
|
290% |
431.00 |
450.10 |
389.60 |
$409.10 |
409.10 |
409.10 |
475.00 |
522.60 |
|
300% |
442.00 |
461.60 |
399.60 |
$419.60 |
419.60 |
419.60 |
487.20 |
536.00 |
|
310% |
353.10 |
473.10 |
409.60 |
$430.10 |
430.10 |
430.10 |
499.40 |
549.40 |
|
320% |
464.10 |
484.70 |
419.60 |
$440.60 |
440.60 |
440.60 |
511.60 |
562.80 |
|
330% |
475.20 |
496.20 |
429.60 |
$451.10 |
451.10 |
451.10 |
523.70 |
576.20 |
|
340% |
486.20 |
507.80 |
439.60 |
$461.60 |
461.30 |
461.60 |
535.90 |
589.60 |
|
350% |
497.30 |
519.30 |
449.60 |
$472.10 |
472.10 |
472.10 |
548.10 |
603.00 |
|
360% |
508.30 |
530.80 |
459.50 |
$482.50 |
482.50 |
482.50 |
560.20 |
616.40 |
|
370% |
519.40 |
542.40 |
469.50 |
$493.00 |
493.00 |
493.00 |
572.40 |
629.80 |
|
380% |
530.40 |
553.90 |
479.50 |
$503.50 |
503.50 |
503.50 |
584.70 |
643.20 |
|
390% |
541.50 |
565.50 |
489.50 |
$514.00 |
514.00 |
514.00 |
596.80 |
656.60 |
|
400% |
552.50 |
577.00 |
499.50 |
$524.50 |
524.50 |
524.50 |
609.00 |
670.00 |
|
410% |
563.60 |
588.50 |
509.50 |
$535.00 |
535.00 |
535.00 |
621.10 |
683.40 |
|
420% |
574.60 |
600.10 |
519.50 |
$545.50 |
545.50 |
545.50 |
633.40 |
696.80 |
|
430% |
585.70 |
611.60 |
529.50 |
$556.00 |
556.00 |
556.00 |
645.50 |
710.20 |
|
440% |
623.20 |
539.50 |
$566.50 |
556.50 |
566.50 |
657.70 |
723.60 |
|
|
450% |
549.50 |
$577.00 |
577.00 |
577.00 |
669.90 |
737.00 |
||
|
460% |
$587.40 |
587.40 |
587.40 |
682.00 |
750.40 |
|||
|
470% |
597.90 |
597.90 |
694.20 |
763.80 |
||||
|
480% |
608.40 |
706.40 |
777.20 |