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