|
Number of months coverage |
Member Only |
Addition of one dependent |
Member plus one dependent |
Addition of two or more dependents |
Member plus two or more dependents |
|
|
Base |
Tax |
Base |
Tax |
Base |
Tax |
Base |
Tax |
Base |
Tax |
|
1 |
$52.78 |
$4.22 |
$52.78 |
$4.22 |
$105.56 |
$8.44 |
$105.56 |
$8.44 |
$158.33 |
$12.67 |
|
2 |
$105.56 |
$8.44 |
$105.56 |
$8.44 |
$211.11 |
$16.89 |
$211.11 |
$16.89 |
$316.67 |
$25.33 |
|
3 |
$158.33 |
$12.67 |
$158.33 |
$12.67 |
$316.67 |
$25.33 |
$316.67 |
$25.33 |
$475.00 |
$38.00 |
|
4 |
$211.11 |
$16.89 |
$211.11 |
$16.89 |
$422.22 |
$33.78 |
$422.22 |
$33.78 |
$633.33 |
$50.67 |
|
5 |
$263.89 |
$21.11 |
$263.89 |
$21.11 |
$527.78 |
$42.22 |
$527.78 |
$42.22 |
$791.67 |
$63.33 |
|
6 |
$316.67 |
$25.33 |
$316.67 |
$25.33 |
$633.33 |
$50.67 |
$633.33 |
$50.67 |
$950.00 |
$76.00 |
|
7 |
$369.44 |
$29.56 |
$369.44 |
$29.56 |
$738.89 |
$59.11 |
$738.89 |
$59.11 |
$1,108.33 |
$88.67 |
|
8 |
$422.22 |
$33.78 |
$422.22 |
$33.78 |
$844.44 |
$67.56 |
$844.44 |
$67.56 |
$1,266.67 |
$101.33 |
|
9 |
$475.00 |
$38.00 |
$475.00 |
$38.00 |
$950.00 |
$76.00 |
$950.00 |
$76.00 |
$1,425.00 |
$114.00 |
|
10 |
$527.78 |
$42.22 |
$527.78 |
$42.22 |
$1,055.56 |
$84.44 |
$1,055.56 |
$84.44 |
$1,583.33 |
$126.67 |
|
11 |
$580.56 |
$46.44 |
$580.56 |
$46.44 |
$1,161.11 |
$92.89 |
$1,161.11 |
$92.89 |
$1,741.67 |
$139.33 |
|
12 |
$633.33 |
$50.67 |
$633.33 |
$50.67 |
$1,266.67 |
$101.33 |
$1,266.67 |
$101.33 |
$1,900.00 |
$152.00 |
|
|
A |
a |
B |
b |
C |
c |
D |
d |
E |
e |
|
|
|
|
|
|
A + B = C |
a + b = c |
|
|
A + D = E |
a + d = e |
|
|
|
