Userid: CPM             Schema:        Leadpct: 100% Pt. size: 10     Draft         Ok to Print
                                            instrx
AH XSL/XML          Fileid: … -form-8941/2024/a/xml/cycle04/source                       (Init. & Date) _______

Page 1 of 31                                                                             15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

2024

Instructions for Form 8941

Credit for Small Employer Health Insurance Premiums

Section references are to the Internal Revenue Code                Partnerships, S corporations, cooperatives, 
unless otherwise noted.                                    TIP     estates, trusts, and tax-exempt eligible small 
                                                                   employers must file this form to claim the credit. 
Future Developments                                        All other taxpayers must not complete or file this form if 
For the latest information about developments related to   their only source for this credit is a partnership, S 
Form 8941 and its instructions, such as legislation        corporation, cooperative, estate, or trust. Instead, they 
enacted after they were published, go to IRS.gov/          must report this credit directly on line 4h in Part III of Form 
Form8941.                                                  3800, General Business Credit.

Reminder                                                   Eligible Small Employers
Waiver for Hawaii. Employers in Hawaii can’t claim this    You’re an eligible small employer for the tax year if you 
credit for insurance premiums paid for health plan years   meet the following three requirements.
beginning after 2016. For more information, see Waiver for 
                                                           1. You paid premiums for employee health insurance 
Hawaii in the instructions for line A.
                                                           coverage under a qualifying arrangement.    A 
                                                           qualifying arrangement is generally an arrangement that 
General Instructions                                       requires you to pay a uniform percentage (not less than 
                                                           50%) of the premium cost for each enrolled employee’s 
Purpose of Form                                            health insurance coverage (defined later). However, an 
Eligible small employers (defined later) use Form 8941 to  arrangement that requires you to pay a uniform premium 
figure the credit for small employer health insurance      for each enrolled employee (composite billing) and offers 
premiums for tax years beginning after 2009. For tax years different tiers of coverage (for example, employee-only, 
beginning after 2013, the credit is only available for a   dependent, and family coverage) can be a qualifying 
2-consecutive-tax-year credit period. The maximum credit   arrangement even if it requires you to pay a uniform 
is generally a percentage of premiums the employer paid    percentage that is less than 50% of the premium cost for 
during the tax year for certain health insurance coverage  employees not enrolled in employee-only coverage.
the employer provided to certain employees enrolled in a   In addition, an arrangement that requires you to pay a 
qualified health plan offered through a Small Business     separate premium for each employee based on age or 
Health Options Program (SHOP) Marketplace. But the         other factors (list billing) can be a qualifying arrangement 
credit may be reduced by limitations based on the          even if it requires you to pay a uniform percentage that is 
employer’s full-time equivalent employees, average         less than 50% of the premium cost for some employees.
annual wages, adjusted average premiums, and state 
                                                           For details, see Employer Premiums Paid Health , 
premium subsidies and tax credits.
                                                           Insurance Coverage, and Qualifying Arrangement, later.
      For information about insurance plans offered 
                                                           2. You had fewer than 25 full-time equivalent employ-
TIP   through a SHOP Marketplace, go to 
      Healthcare.gov.                                      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 
For tax-exempt eligible small employers, the               each half-time employees has 24 FTEs and can claim the 
maximum credit is 35% of premiums paid, is limited to the  credit. For details, see Worksheets 1 and 2.
amount of certain payroll taxes paid, and is claimed as a 
refundable credit on Form 990-T, Exempt Organization               Although the term “eligible small employer” is 
Business Income Tax Return. A tax-exempt eligible small    !       defined in the Internal Revenue Code to include 
employer is an eligible small employer described in        CAUTION employers with “no more than” 25 FTEs  the ,
section 501(c) that is exempt from taxation under section  phaseout of the credit amount operates in such a way that 
501(a). A tax-exempt employer not described in section     an employer with exactly 25 FTEs is not, in fact, eligible for 
501(c) is generally not eligible to claim this credit.     the credit.
However, a tax-exempt farmers’ cooperative subject to tax 
under section 1381 may be able to claim the credit as a    3. You paid average annual wages for the tax year of 
general business credit, as discussed next.                less than $65,000 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.
                              Instructions for Form 8941 (2024)  Catalog Number 55222U
Nov 20, 2024            Department of the Treasury  Internal Revenue Service  www.irs.gov

Page 2 of 31          Fileid: … -form-8941/2024/a/xml/cycle04/source                   15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

         If you had more than 10 FTEs and average annual     State premium subsidy or tax credit.   If you’re entitled 
  !      wages of more than $32,000, the FTE and             to a state tax credit or a state premium subsidy paid 
CAUTION  average annual wage limitations (discussed later) 
                                                             directly to you for premiums you paid, don’t reduce the 
will separately reduce your credit. This may reduce your     amount you paid by the credit or subsidy amount. Also, if a 
credit to zero even if you had fewer than 25 FTEs and        state pays a premium subsidy directly to your insurance 
average annual wages of less than $65,000.                   provider, treat the subsidy amount as an amount you paid 
                                                             for employee health insurance coverage.
Employers treated as a single employer.     Treat the 
following employers as a single employer to figure the       Wellness programs. A wellness program is generally an 
credit.                                                      insurance program of health promotion or disease 
• Employers who are corporations in a controlled group of    prevention. If you pay part or all of the cost of an 
corporations.                                                employee’s participation in a wellness program, treat the 
• Employers who are members of an affiliated service         amount you paid toward the employee’s participation as 
group.                                                       an amount you paid for employee health insurance 
• Employers who are partnerships, proprietorships, etc.,     coverage.
under common control. See Regulations sections               Tobacco surcharges. A tobacco surcharge is generally 
1.414(c)-2, 1.414(c)-3, and 1.414(c)-4.                      an additional amount charged for insurance for a tobacco 
• Tax-exempt employers under common control. See             user. If you pay part or all of an employee’s tobacco 
Regulations section 1.414(c)-5.                              surcharge, you can’t use the amount you paid to figure 
  For details, see section 45R(e)(5)(A) and Regulations      your employer premiums paid.
section 1.45R-2(b).
                                                             Dependent coverage. Dependent coverage is generally 
         No more than one Form 8941 can be filed with a      coverage offered separately to an individual who is or may 
TIP      tax return, unless the exception described in       become eligible for coverage under the terms of a group 
         Example 2 below applies.                            health plan because of a relationship to a 
                                                             participant-employee, whether or not a dependent of the 
  Example 1.   You’re a sole proprietor with two separate    participant-employee. Dependent coverage doesn’t 
businesses and you file a separate Schedule C (Form          include coverage, such as family coverage, which 
1040), Profit or Loss From Business, for each business.      includes coverage of the participant-employee. If you pay 
You must treat both businesses as a single employer to       part or all of the cost of an employee’s dependent 
figure the credit. You will file one Form 8941 for both      coverage, use the amount you paid to figure your 
businesses.                                                  employer premiums paid.
  Example 2.   You and your spouse are both sole             Portion of premiums paid. If you pay only a portion of 
proprietors and file a separate Schedule C (Form 1040)       the premiums and your employees pay the rest, only the 
for each of your separate businesses. Neither spouse was     portion you pay is taken into account. For this purpose, 
an employee of the other spouse or participated in the       any premium paid through a salary reduction arrangement 
management of the other spouse’s business at any time        under a section 125 cafeteria plan isn’t treated as an 
during the tax year. No more than 50% of the gross           employer paid premium. For more information on cafeteria 
income of either business was derived from royalties,        plans, see section 1 of Pub. 15-B, Employer’s Tax Guide to 
rents, dividends, interest, and annuities and you otherwise  Fringe Benefits.
meet the requirements listed in Regulations section 
1.414(c)-4(b)(5)(ii). Don’t treat both businesses as a       Example 3.      You offer health insurance coverage to 
single employer to figure the credit. If you and your spouse employees under a qualifying arrangement that requires 
are both eligible small employers, you can file two Forms    you to pay 60% of the premium cost for employee-only 
8941 with a jointly filed Form 1040 or 1040-SR.              coverage for each employee enrolled in any health 
                                                             insurance coverage you provide to employees. The total 
Credit Period                                                premium for each employee enrolled in employee-only 
For tax years beginning after 2013, the credit period        coverage is $5,200 per year or $100 ($5,200 ÷ 52) for 
during which the credit can be claimed is a                  each weekly payday. The total premium for each 
2-consecutive-tax-year period beginning with the first tax   employee enrolled in family coverage is $13,000 per year 
year in which:                                               or $250 ($13,000 ÷ 52) for each weekly payday.
• An eligible small employer (or any predecessor) files an   Each payday, you contribute $60 (60% of $100) toward 
income tax return with an attached Form 8941 with line A     the premium cost of each employee enrolled in 
checked “Yes” and a positive amount on line 12, or           employee-only coverage and withhold the remaining $40 
• A tax-exempt eligible small employer (or any               from the employee's paycheck to obtain the $100 total 
predecessor) files Form 990-T with an attached Form          weekly premium. Each payday, you contribute $60 (the 
8941 with line A checked “Yes” and a positive amount on      same amount you pay toward the premiums of employees 
line 12.                                                     enrolled in employee-only coverage) toward the premium 
                                                             cost of each employee enrolled in family coverage and 
Employer Premiums Paid                                       withhold the remaining $190 from the employee’s 
Only premiums you paid for health insurance coverage         paycheck to obtain the $250 total weekly premium.
under a qualifying arrangement (discussed later) for         To determine the premiums you paid during the tax 
individuals considered employees are counted when            year, multiply the number of pay periods during which the 
figuring your credit.

2                                                                                   Instructions for Form 8941 (2024)

Page 3 of 31         Fileid: … -form-8941/2024/a/xml/cycle04/source                       15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

employee was enrolled in the health insurance coverage         surcharge for nonparticipation). However, for purposes of 
by $60. For example, you would’ve paid $3,120 ($60 × 52)       figuring the credit, the employer contributions are taken 
for an employee who was enrolled for the entire tax year.      into account, including those contributions attributable to 
You would’ve paid $600 ($60 × 10) for an employee who          an employee’s participation in a wellness program.
was only enrolled for 10 pay periods. You will need an 
                                                               Tobacco surcharge.    Any additional amount you or your 
additional set of calculations if the premium amounts 
                                                               employee pays to cover a tobacco surcharge isn’t taken 
changed during the tax year.
                                                               into account in figuring the uniform percentage 
Health Insurance Coverage                                      requirement. Amounts you or your employee pays to cover 
                                                               a tobacco surcharge aren’t considered premiums paid for 
For tax years beginning after 2013, health insurance 
                                                               health insurance coverage when figuring this credit.
coverage generally means coverage provided to 
employees enrolled in a qualified health plan offered          Dependent coverage.   Premiums you pay for dependent 
through a Small Business Health Options Program                coverage aren’t subject to the uniform percentage 
(SHOP) Marketplace. For an exception that applies to           requirement. You aren’t required to pay a uniform 
certain employers in certain counties, see the instructions    percentage (not less than 50%) for dependent coverage.
for line A, later. If this exception applies, health insurance Arrangements with composite billing. An arrangement 
coverage means coverage, as defined under Health               that requires you to pay a uniform premium for each 
Insurance Coverage in the 2013 Instructions for Form           enrolled employee (composite billing) and offers different 
8941.                                                          tiers of coverage can be a qualifying arrangement even if it 
        A stand-alone dental plan offered through a SHOP       requires you to pay a uniform percentage that is less than 
TIP     exchange will be considered a qualified health         50% of the premium cost for employees not enrolled in 
        plan for purposes of the credit.                       employee-only coverage. It is a qualifying arrangement 
                                                               (assuming employee-only coverage is the least expensive 
        Employer premiums paid for health insurance            tier of coverage) if it requires you to pay each of the 
!       coverage can be counted in figuring the credit only    following amounts if you make the relevant tier of coverage 
CAUTION if the premiums are paid under a qualifying            available.
arrangement.                                                   • A uniform percentage (not less than 50%) of the 
                                                               premium cost for each employee (if any) enrolled in 
Qualifying Arrangement                                         employee-only coverage.
A qualifying arrangement is generally an arrangement that      • A uniform amount that is no less than the amount you 
requires you to pay a uniform percentage (not less than        would’ve paid toward employee-only coverage for each 
50%) of the premium cost for each enrolled employee's          employee (if any) enrolled in family coverage.
health insurance coverage (defined earlier). An                • A uniform amount that is no less than the amount you 
arrangement that offers different tiers of coverage (for       would’ve paid toward employee-only coverage for each 
example, employee-only and family coverage) is generally       employee (if any) enrolled in any other tier of coverage 
a qualifying arrangement if it requires you to pay a uniform   (figured separately for each tier).
percentage (not less than 50%) separately for each tier of     Arrangements with list billing and only employee-on-
coverage you offer. However, an arrangement can be a           ly coverage. An arrangement that requires you to pay a 
qualifying arrangement even if it requires you to pay a        separate premium for each employee based on age or 
uniform percentage that is less than 50% of the premium        other factors (list billing) that only provides employee-only 
cost for some employees.                                       coverage can be a qualifying arrangement even if it 
                                                               requires you to pay a uniform percentage that is less than 
For more information about the following exceptions, 
                                                               50% of the premium cost for some employees. It is a 
see Regulations section 1.45R-4.
                                                               qualifying arrangement if it requires you to pay either of 
State or local law. You will be treated as satisfying the      the following amounts.
uniform percentage requirement if your failure to otherwise    • A uniform percentage (not less than 50%) of the 
satisfy the requirement was solely attributable to             premium charged for each employee enrolled in the 
additional contributions you made to certain employees to      employee-only coverage.
comply with state or local law.                                • A uniform percentage (not less than 50%) of your 
Wellness program.   If a plan of an employer provides a        employer-computed composite rate (defined later) for your 
wellness program, for purposes of meeting the uniform          employee-only coverage for each employee enrolled in 
percentage requirement, the following applies. Any             the employee-only coverage.
additional amount of the employer contribution attributable    Arrangements with list billing and other tiers of cov-
to an employee’s participation in the wellness program         erage. An arrangement that requires you to pay a 
over the employer contribution with respect to an              separate premium for each employee based on age or 
employee that doesn’t participate in the wellness program      other factors (list billing) that provides other tiers of 
isn’t considered in calculating the uniform percentage         coverage can be a qualifying arrangement even if it 
requirement. This is true whether the difference is due to a   requires you to pay a uniform percentage that is less than 
discount for participation or a surcharge for                  50% of the premium cost for some employees. It is a 
nonparticipation. The employer contribution for employees      qualifying arrangement (assuming employee-only 
who don’t participate in the wellness program must be at       coverage is the least expensive tier of coverage) if it 
least 50% of the premium (including any premium 

Instructions for Form 8941 (2024)                                                                                         3

Page 4 of 31     Fileid: … -form-8941/2024/a/xml/cycle04/source                       15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

requires you to pay each of the following amounts if you       Net premium payments are employer premiums paid 
make the relevant tier of coverage available.                (discussed earlier) minus the amount of any state tax 
• A uniform percentage (not less than 50%) for each          credits you received or will receive and any state premium 
employee enrolled in employee-only coverage, as              subsidies paid either to you or directly to your insurance 
discussed under Arrangements with list billing and only      provider for premiums for health insurance coverage you 
employee-only coverage, earlier.                             provide under a qualifying arrangement to individuals 
• A uniform amount that is either equal to the amount you    considered employees.
would’ve paid toward employee-only coverage (as 
discussed above), a uniform percentage (not less than        Payroll Tax Limitation for Tax-Exempt 
50%) of the premium charged, or a uniform percentage         Eligible Small Employers
(not less than 50%) of your employer-computed 
                                                             The credit for tax-exempt eligible small employers can’t 
composite rate (defined below) for your family coverage, 
                                                             exceed the amount of certain payroll taxes. For tax years 
for each employee (if any) enrolled in family coverage.
                                                             beginning in 2024, payroll taxes, for this purpose, mean 
• A uniform amount that is either equal to the amount you 
                                                             only the following taxes.
would’ve paid toward employee-only coverage (as 
discussed above), a uniform percentage (not less than        • Federal income taxes the tax-exempt employer was 
                                                             required to withhold from employees’ wages in calendar 
50%) of the premium charged, or a uniform percentage 
                                                             year 2024.
(not less than 50%) of your employer-computed 
composite rate (defined below) for any other tier of         • Medicare taxes the tax-exempt employer was required 
                                                             to withhold from employees’ wages in calendar year 2024.
coverage, for each employee (if any) enrolled in any other 
tier of coverage (figured separately for each tier).         • Medicare taxes the tax-exempt employer was required 
                                                             to pay for calendar year 2024.
Employer-computed composite rate. The 
employer-computed composite rate for a tier of coverage      Premium Deduction Reduced
is the average rate determined by adding the premiums for    You must reduce your deduction for the cost of providing 
that tier of coverage for all employees eligible to          health insurance coverage to your employees by the 
participate in the health insurance plan (whether or not     amount of any credit for small employer health insurance 
they actually receive coverage under the plan or under       premiums allowed with respect to the coverage.
that tier of coverage) and dividing by the total number of 
such eligible employees.                                     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           • Section 45R.
meeting the qualifying arrangement requirement. For          • Regulations sections 1.45R-0 through 1.45R-5.
example, if you offer a major medical insurance plan and a   • IRS.gov/Affordable-Care-Act/Employers/Small-
                                                             Business-Health-Care-Tax-Credit-and-the-SHOP-
stand-alone vision plan, you generally must separately 
                                                             Marketplace.
satisfy the requirements for a qualifying arrangement with 
respect to each type of coverage. For exceptions, see 
Regulations section 1.45R-4(c).                              Specific Instructions
State subsidies and credits. For this purpose, if you’re           Partnerships, S corporations, cooperatives, 
entitled to a state tax credit or a state premium subsidy    TIP   estates, trusts, and tax-exempt eligible small 
paid directly to you for premiums you paid, don’t reduce           employers must file this form to claim the credit. 
the amount you paid by the credit or subsidy amount.         All other taxpayers must not complete or file this form if 
Also, if a state pays a premium subsidy directly to your     their only source for this credit is a partnership, S 
insurance provider, treat the subsidy amount as an           corporation, cooperative, estate, or trust. Instead, they 
amount you paid for employee health insurance coverage.      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 
Your credit may be reduced if you’re entitled to a state tax report on various lines of Form 8941.
credit or a state premium subsidy for the cost of health     • Use Worksheets 1, 2, and 3 to figure the amounts to 
insurance coverage you provide under a qualifying            report on lines 1, 2, and 3 of Form 8941.
arrangement to individuals considered employees. The         • Use Worksheet 4 to figure the amounts to report on 
state tax credit may be refundable or nonrefundable and      lines 4, 5, and 13 of Form 8941.
the state premium subsidy may be paid to you or directly     • Use Worksheets 5, 6, and 7 to figure the amounts to 
to your insurance provider.                                  report on lines 8, 9, and 14 of Form 8941.

  Although a state tax credit or premium subsidy paid        Line A
directly to you doesn’t reduce the amount of your            Answer “Yes” if one of the following applies.
employer premiums paid, and although a state premium         • You paid premiums for employee health insurance 
subsidy paid directly to an insurance provider is treated as coverage you provided through a SHOP Marketplace or 
an employer premium you paid, the amount of your credit      through a direct enrollment process, if available in your 
can’t be more than your net premium payments.                state.

4                                                                                     Instructions for Form 8941 (2024)

Page 5 of 31         Fileid: … -form-8941/2024/a/xml/cycle04/source         15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• You qualify for an exception to this requirement, as      Worksheet 1. Information Needed To 
discussed below.
                                                            Complete Line 1 and Worksheets 2 
  If you answer “Yes” because you paid premiums for 
employee health insurance coverage you provided             and 3
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,            (a)     (b)                        (c)
estate, trust, or tax-exempt eligible small employer that      Individuals  Employee                   Employee
received from another entity a credit that must be reported    Considered   Hours of                   Wages
on line 15. For more information, see the instructions for     Employees    Service                    Paid
line 15.
                                                             1.
Waiver for Hawaii.  Hawaii has received a 5-year State 
Innovation Waiver under section 1332 of the Affordable       2.
Care Act that has been extended for 5 more years.            3.
Employers in Hawaii can’t participate in the SHOP            4.
Marketplace or claim the credit for insurance premiums 
paid for health plan years beginning after 2016. For more    5.
information on the waiver, go to CMS.gov.                    6.
Exception for eligible small employers in certain            7.
counties. For calendar year 2024, SHOP Marketplaces 
in certain counties across the United States didn’t have     8.
qualified health plans available for employers to offer to   9.
employees. However, relief is available, which allows       10.
eligible small employers with a principal business address 
in those counties to claim the credit for 2024 if they      11.
properly claimed the credit under section 45R for all or    12.
part of 2023. For details, see Notice 2018-27, 2018-20, 
I.R.B. 580, available at IRS.gov/irb/                       13.
2018-20_IRB#NOT-2018-27.                                    14.
        To see whether a particular county has coverage     15.
TIP     available through a SHOP Exchange for 2024 and      16.
        beyond, go to Healthcare.gov/small-business and 
enter “plans and prices” in the search box.                 17.
                                                            18.
Line C                                                      19.
Answer “Yes” if a tax return you (or any predecessor) filed 
                                                            20.
for a tax year beginning after 2013 and before 2023 
included a Form 8941 with line A checked “Yes” and          21.
line 12 showing a positive amount. For more information,    22.
see Credit Period, earlier.
                                                            23.
  If you answer “Yes,” don’t file Form 8941 unless you’re 
                                                            24.
filing it for a partnership, S corporation, cooperative, 
estate, trust, or tax-exempt eligible small employer that   25.
received from another entity a credit that must be reported  
on line 15. An entity that qualifies for this exception     Totals:
shouldn’t report any amount on line 12. For more 
information, see the instructions for line 15.
                                                            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 (2024)                                                                                        5

Page 6 of 31  Fileid: … -form-8941/2024/a/xml/cycle04/source                      15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Excluded employees. The following individuals aren’t          discussed above. A sole proprietor must include both 
considered employees when you figure this credit. Hours       business and nonbusiness employees to determine FTEs, 
and wages of these employees and premiums paid for            average annual wages, and premiums paid.
them aren’t counted when you figure your credit.              Ministers. A minister performing services in the exercise 
• The owner of a sole proprietorship.                         of the minister’s ministry is treated as self-employed for 
• A partner in a partnership.                                 social security and Medicare purposes. However, for 
• A shareholder who owns (after applying the section 318      credit purposes, whether a minister is an employee or 
constructive ownership rules) more than 2% of an S            self-employed is determined under the common law test 
corporation.                                                  for determining worker status. Self-employed ministers 
• A shareholder who owns (after applying the section 318      aren’t considered employees.
constructive ownership rules) more than 5% of the 
outstanding stock or stock possessing more than 5% of         Column (b), Employee Hours of 
the total combined voting power of all stock of a 
                                                              Service
corporation that isn’t an S corporation.
• A person who owns more than 5% of the capital or            Enter the total hours of service for the tax year for each 
profits interest in any other business that isn’t a           employee listed in column (a). Don’t enter more than 
corporation.                                                  2,080 hours for any employee. But enter -0- for seasonal 
• Family members or a member of the household who             employees who worked 120 or fewer days during the tax 
isn’t a family member but qualifies as a dependent on the     year.
individual income tax return of a person listed above.        Employee hours of service.     An employee’s hours of 
Family members include a child (or descendant of a            service for a year include the following.
child), a sibling or step-sibling, a parent (or ancestor of a • Each hour for which the employee is paid, or entitled to 
parent), a step-parent, a niece or nephew, an aunt or         payment, for the performance of duties for the employer 
uncle, or a son-in-law, daughter-in-law, father-in-law,       during the employer’s tax year.
mother-in-law, brother-in-law, or sister-in-law. A spouse of  • Each hour for which an employee is paid, or entitled to 
any owner or family member listed above is also               payment, by the employer on account of a period of time 
considered a family member for this purpose.                  during the employer’s tax year during which no duties are 
Former employees. Premiums paid on behalf of a                performed due to vacation, holiday, illness, incapacity 
former employee with no hours of service may be treated       (including disability), layoff, jury duty, military duty, or leave 
as paid on behalf of an employee for purposes of figuring     of absence (except that no more than 160 hours of service 
the credit, provided that, if so treated, the former          are required to be counted for an employee on account of 
employee is also treated as an employee for purposes of       any single continuous period during which the employee 
the uniform percentage requirement.                           performs no duties).
                                                                To figure the total number of hours of service you must 
Leased employees. Don’t use premiums paid by the 
                                                              take into account for an employee for the year, you can 
leasing organization to figure your credit. Also, a leased 
                                                              use any of the following methods.
employee who isn’t a common law employee is 
considered an employee for credit purposes if the               Actual-hours-worked method.      Determine actual 
employee does all the following.                              hours of service from records of hours worked and hours 
• Provides services to you under an agreement between         for which payment is made or due (payment is made or 
you and a leasing organization.                               due for vacation, holiday, illness, incapacity, etc., as 
• Has performed services for you (or for you and a related    described above).
person) substantially full time for at least 1 year.            Days-worked equivalency method.        Use a 
• Performs services under your primary direction or           days-worked equivalency whereby the employee is 
control.                                                      credited with 8 hours of service for each day for which the 
                                                              employee would be required to be credited with at least 1 
  But don’t use hours, wages, or premiums paid with           hour of service under the rules described above.
respect to the initial year of service on which leased 
                                                                Weeks-worked equivalency method.       Use a 
employee status is based.
                                                              weeks-worked equivalency whereby the employee is 
Seasonal employees. Employees who perform labor or            credited with 40 hours of service for each week for which 
services on a seasonal basis and perform labor or             the employee would be required to be credited with at 
services for you 120 or fewer days during the tax year        least 1 hour of service under the rules described above.
aren’t considered employees in determining FTEs and 
average annual wages. But premiums paid on their behalf       Column (c), Employee Wages Paid
are counted in determining the amount of the credit.                  Complete Worksheet 2 before you complete 
Seasonal workers include retail workers employed                !     column (c) of Worksheet 1. Do not complete 
exclusively during holiday seasons. Seasonal workers          CAUTION column (c) if Worksheet 2, line 3, is 25 or more.
also include workers employed exclusively during the 
summer.                                                         Enter the total wages paid for the tax year for each 
Household and other nonbusiness employees.                    employee listed in column (a). But enter -0- for seasonal 
Household employees and other employees who aren’t            employees who worked 120 or fewer days during the tax 
performing services in your trade or business are             year.
considered employees if they otherwise qualify, as 

6                                                                                 Instructions for Form 8941 (2024)

Page 7 of 31                Fileid: … -form-8941/2024/a/xml/cycle04/source                  15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Wages, for this purpose, mean wages subject to social             Worksheet 4. Information Needed To 
security and Medicare tax withholding determined without 
considering any wage base limit.                                  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               (a)                                                (d)
the tax year. If you had 25 or more FTEs for the tax year,         Enrolled    (b)              (c)          Enrolled
your credit is reduced to zero.                                    Individuals Employer         Adjusted     Employee
1. Enter the total employee hours of                               Considered  Premiums         Average      Hours of
   service from Worksheet 1, column                                Employees   Paid             Premiums     Service
   (b) . . . . . . . . . . . . . . . . . . . . . . . . . 1.  
                                                                   1.
2. Hours of service per FTE . . . . . . . . .            2.  2,080
                                                                   2.
3. Full-time equivalent employees.                                 3.
   Divide line 1 by line 2. If the result isn’t a 
   whole number (0, 1, 2, etc.), generally                         4.
   round the result down to the next                               5.
   lowest whole number. For example, 
   round 2.99 down to 2. However, if the                           6.
   result is less than one, enter 1. Report                        7.
   this number on Form 8941, line 2              . . .   3.  
                                                                   8.
                                                                   9.
Worksheet 3. Information Needed To 
                                                                  10.
Complete Line 3 (Average Annual                                   11.
Wages)                                                            12.
                                                                  13.
Your credit is reduced if you paid average annual wages of 
more than $32,000 for the tax year. If you paid average           14.
annual wages of $65,000 or more for the tax year, your            15.
credit is reduced to zero.
                                                                  16.
1. Enter the total employee wages paid 
   from Worksheet 1, column (c) . . . . . .              1.       17.
2. Enter FTEs from Worksheet 2,                                   18.
   line 3 . . . . . . . . . . . . . . . . . . . . . . .  2.  
                                                                  19.
3. Average annual wages. Divide line 1 
                                                                  20.
   by line 2. If the result isn’t a multiple of 
   $1,000 ($1,000, $2,000, $3,000, etc.),                         21.
   round the result down to the next                              22.
   lowest multiple of $1,000. For example, 
   round $2,999 down to $2,000. Report                            23.
   this amount on Form 8941, line 3                . . . 3.       24.
                                                                  25.
                                                                   
                                                                  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 (2024)                                                                                           7

Page 8 of 31      Fileid: … -form-8941/2024/a/xml/cycle04/source                                  15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Column (b), Employer Premiums Paid                           enrolled for the entire tax year. You would’ve paid $570 
                                                             ($57 × 10) if the employee was only enrolled for 10 pay 
Enter the total employer premiums paid for the tax year for  periods. You’ll need an additional set of calculations if the 
each employee listed in column (a). For details, see         premium amounts changed during the tax year.
Employer Premiums Paid, earlier.
                                                             Column (d), Enrolled Employee Hours 
Column (c), Adjusted Average 
                                                             of Service
Premiums
Your credit is reduced if the employer premiums paid are            Don’t complete column (d) of Worksheet 4 if Form 
more than the employer premiums that would’ve been           !      8941, line 12, is zero.
                                                             CAUTION
paid if individuals considered employees were enrolled in 
a plan with a premium equal to the average premium for       Enter the amount from column (b) of Worksheet 1 for 
the small group market in the rating area in which the       each employee listed in column (a) of Worksheet 4.
employee enrolls for coverage.
  The rating area in which an employee enrolls for           Worksheet 5. Information Needed To 
coverage is generally the rating area where your business    Complete Line 8 (If Line 2 Is More 
is located (based on your primary business address). You 
will generally have selected a plan in your rating area that Than 10)
covers all employees located within or outside your rating 
area. However, if you have multiple businesses or            1. Enter the amount from Form 8941, 
operations in multiple states, and have set up plans in      line 7 . . . . . . . . . . . . . . . . . . . . . . . . . .   1.  
more than one SHOP Marketplace, the average premiums         2. Enter the number from Form 
may be different for employees enrolled in each SHOP         8941, line 2     . . . . . . . . . . . .     2.     
Marketplace.                                                 3. Subtract 10 from line 2 . . . . .         3.     
  Enter, for each employee listed in column (a), the         4. Divide line 3 by 15. Enter the 
premiums you would’ve paid if the employee had enrolled      result as a decimal (rounded to 
in a plan or plans with a total premium equal to the         at least 3 places)       . . . . . . . .     4.     
average premium for the small group market in the rating     5. Multiply line 1 by line 4 . . . . . . . . . . . . . .     5.  
area in which the employee enrolls for coverage.
                                                             6. Subtract line 5 from line 1. Report this 
  To find the average premium for the small group market     amount on Form 8941, line 8              . . . . . . . . .   6.  
in a rating area for tax years beginning in 2024, see the 
average premium tables at the end of these instructions. 
Family coverage includes any coverage other than             Worksheet 6. Information Needed To 
employee-only coverage.
                                                             Complete Line 9 (If Line 3 Is More 
  Example 4. Assume the same facts that were used in 
Example 3. The $60 you contribute each payday toward         Than $32,000)
employee health insurance coverage is 60% ($60 ÷ $100) 
of the weekly premium for each employee enrolled in          1. Enter the amount from Form 8941, 
employee-only coverage and 24% ($60 ÷ $250) of the             line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 
weekly premium for each employee enrolled in family          2. Enter the amount from Form 
coverage.                                                      8941, line 7   . . . . . . . . . . . . .       2. 
  In this situation, the total average premium limitation    3. Enter the amount from Form 
amounts that apply are 60% of the applicable average           8941, line 3   . . . . . . . . . . . . .       3. 
premium amounts for each employee enrolled in                4. Subtract $32,400 from line 3            .     4.  
employee-only coverage and 24% of the applicable 
average premium amounts for each employee enrolled in        5. Divide line 4 by $32,400. Enter 
family coverage.                                               the result as a decimal (rounded 
                                                               to at least 3 places) . . . . . . . .          5. 
  You have an employee enrolled in employee-only 
                                                             6. Multiply line 2 by line 5 . . . . . . . . . . . . . .
coverage who enrolled for coverage in your local rating                                                                   6. 
area. The applicable employee-only average premium           7. Subtract line 6 from line 1. Report this 
amount for the rating area is $4,940 or $95 ($4,940 ÷ 52)      amount on Form 8941, line 9            . . . . . . . . .   7. 
for each weekly payday. The amount you would’ve paid 
toward this employee’s health insurance coverage based       Line 10
on the average premiums is $57 (60% of $95) each             Enter the total amount of any state premium subsidies 
payday.                                                      paid and any state tax credits available to you for 
  To determine the premiums you would’ve paid for this       premiums included on line 4. For details, see State 
employee during the tax year if the employee had enrolled    Premium Subsidy and Tax Credit Limitation, earlier.
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 

8                                                                                           Instructions for Form 8941 (2024)

Page 9 of 31               Fileid: … -form-8941/2024/a/xml/cycle04/source                         15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Worksheet 7. Information Needed To                                  its tax liability. Therefore, to figure the unused amount of 
                                                                    the credit allocated to patrons, the cooperative must first 
Complete Line 14 (If Line 12 Is More                                figure its tax liability. While any excess is allocated to 
                                                                    patrons, any credit recapture applies as if the cooperative 
Than Zero)
                                                                    had claimed the entire credit.
1. Enter the total enrolled employee hours of                         If the cooperative is subject to the passive activity rules, 
  service from Worksheet 4, column                                  include on line 15 any credit for small employer health 
  (d) . . . . . . . . . . . . . . . . . . . . . . . . . . 1.        insurance premiums from passive activities disallowed for 
2. Hours of service per FTE . . . . . . . . . .           2.  2,080 prior years and carried forward to this year. Complete 
                                                                    Form 8810, Corporate Passive Activity Loss and Credit 
3. Divide line 1 by line 2. If the result isn’t a                   Limitations, to determine the allowed credit that must be 
  whole number (0, 1, 2, etc.), generally                           allocated to patrons. For details, see the Instructions for 
  round the result down to the next                                 Form 8810.
  lowest whole number. For example, round 
  2.99 down to 2. However, if the result is                         Estates and trusts. Allocate the credit on line 16 
  less than one, enter 1. Report this                               between the estate or trust and the beneficiaries in the 
  number on Form 8941, line 14              . . . . . .   3.        same proportion as income was allocated and enter the 
                                                                    beneficiaries’ share on line 17.
Line 15                                                               If the estate or trust is subject to the passive activity 
                                                                    rules, include on line 15 any credit for small employer 
Enter any credit for small employer health insurance 
                                                                    health insurance premiums from passive activities 
premiums from:
                                                                    disallowed for prior years and carried forward to this year. 
• Schedule K-1 (Form 1065), Partner's Share of Income, 
                                                                    Complete Form 8582-CR, Passive Activity Credit 
Deductions, Credits, etc., box 15 (code BA);
                                                                    Limitations, to determine the allowed credit that must be 
• Schedule K-1 (Form 1120-S), Shareholder's Share of 
                                                                    allocated between the estate or trust and the 
Income, Deductions, Credits, etc., box 13 (code BA);
                                                                    beneficiaries. For details, see the Instructions for Form 
• Schedule K-1 (Form 1041), Beneficiary’s Share of 
                                                                    8582-CR.
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 
      Partnerships, S corporations, cooperatives,                   taxes, for this purpose, mean only the following taxes.
TIP   estates, trusts, and tax-exempt eligible small                • Federal income taxes the tax-exempt employer was 
      employers report the above credits on line 15. All            required to withhold from employees’ wages in calendar 
other filers figuring a separate credit on earlier lines also       year 2024.
report the above credits on line 15. All others not using           • Medicare taxes the tax-exempt employer was required 
earlier lines to figure a separate credit must report the           to withhold from employees’ wages in calendar year 2024.
above credits directly on Form 3800, Part lll, line 4h.             • Medicare taxes the tax-exempt employer was required 
                                                                    to pay for calendar year 2024.
Line 17
Cooperatives.       A cooperative described in section 
1381(a) must allocate to its patrons the credit in excess of 

Instructions for Form 8941 (2024)                                                                                                9

Page 10 of 31           Fileid: … -form-8941/2024/a/xml/cycle04/source                                                                 15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 hr., 8 min.
Learning about the law or the form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      1 hr., 2 min.
Preparing and sending the form to the IRS        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   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 (2024)

Page 11 of 31       Fileid: … -form-8941/2024/a/xml/cycle04/source                         15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Average Premiums Needed To Figure Adjusted Amounts on Worksheet 4

The following tables list the average    Limestone            8,306  23,301        Petersburg          12,288            35,134
premiums for the small group market      Lowndes              8,741  23,453        Prince of Wales-Hyder 12,288          35,134
in each rating area generally listed by 
county for each state for tax years      Macon                8,328  20,937        Sitka               12,288            35,134
beginning in 2024.                       Madison              8,306  23,301        Skagway             12,288            35,134
                                         Marengo              8,328  20,937        Southeast Fairbanks 12,563            33,209
Alabama                                  Marion               8,328  20,937        Valdez Cordova      11,682            31,718
            Employee- Dependent,         Marshall             8,328  20,937        Wade Hampton        12,563            33,209
County      Only   Family, etc.          Mobile               8,215  22,163        Wrangell City and   12,288            35,134
Autauga     8,741  23,453                Monroe               8,328  20,937       Borough
 Baldwin    8,328  20,937                Montgomery           8,741  23,453        Yakutat             12,563            33,209
 Barbour    8,328  20,937                Morgan               8,446  21,495        Yukon Koyukuk       12,563            33,209

 Bibb       8,073  22,250                Perry                8,328  20,937       Arizona
 Blount     8,073  22,250                Pickens              8,328  20,937
 Bullock    8,328  20,937                Pike                 8,328  20,937                            Employee- Dependent,
                                                                                  County               Only              Family, etc.
 Butler     8,328  20,937                Randolph             8,328  20,937
                                                                                  Apache               8,205             23,802
 Calhoun    7,635  20,924                Russell              8,401  21,352
                                                                                   Cochise             7,861             21,771
 Chambers   8,328  20,937                Shelby               8,073  22,250
                                                                                   Coconino            8,205             23,802
 Cherokee   8,328  20,937                St. Clair            8,073  22,250
                                                                                   Gila                7,803             20,592
 Chilton    8,073  22,250                Sumter               8,328  20,937
                                                                                   Graham              7,861             21,771
 Choctaw    8,328  20,937                Talladega            8,328  20,937
                                                                                   Greenlee            7,861             21,771
 Clarke     8,328  20,937                Tallapoosa           8,328  20,937
                                                                                   La Paz              8,893             24,548
 Clay       8,328  20,937                Tuscaloosa           8,200  21,879
                                                                                   Maricopa            7,510             22,558
 Cleburne   8,328  20,937                Walker               8,073  22,250
                                                                                   Mohave              8,205             23,802
 Coffee     8,328  20,937                Washington           8,328  20,937
                                                                                   Navajo              8,205             23,802
 Colbert    8,710  22,810                Wilcox               8,328  20,937
                                                                                   Pima                7,513             21,227
 Conecuh    8,328  20,937                Winston              8,328  20,937
 Coosa      8,328  20,937                                                          Pinal               7,803             20,592
 Covington  8,328  20,937               Alaska                                     Santa Cruz          7,513             21,227
 Crenshaw   8,328  20,937                                                          Yavapai             8,154             21,670
                                                              Employee- Dependent,
 Cullman    8,328  20,937               County                Only   Family, etc.  Yuma                8,893             24,548

 Dale       8,328  20,937               Aleutians East        12,563 33,209       Arkansas
 Dallas     8,328  20,937                Aleutians West       12,563 33,209
 DeKalb     8,328  20,937                Anchorage            11,682 31,718                            Employee- Dependent,
                                                                                  County               Only              Family, etc.
 Elmore     8,741  23,453                Bethel               11,682 31,718
                                                                                  Arkansas             7,140             18,250
 Escambia   8,328  20,937                Bristol Bay          12,563 33,209
                                                                                   Ashley              7,140             18,250
 Etowah     7,572  22,226                Denali               12,563 33,209
                                                                                   Baxter              7,244             21,429
 Fayette    8,328  20,937                Dillingham           11,682 31,718
                                                                                   Benton              7,244             21,429
 Franklin   8,328  20,937                Fairbanks North Star 12,563 33,209
                                                                                   Boone               7,244             21,429
 Geneva     8,057  22,014                Haines               12,288 35,134
                                                                                   Bradley             7,140             18,250
 Greene     8,200  21,879                Hoonah-Angoon        12,288 35,134
                                                                                   Calhoun             7,695             23,029
 Hale       8,200  21,879                Juneau               12,288 35,134
                                                                                   Carroll             7,244             21,429
 Henry      8,057  22,014                Kenai Peninsula      12,563 33,209
                                                                                   Chicot              7,140             18,250
 Houston    8,057  22,014                Ketchikan Gateway    12,288 35,134
                                                                                   Clark               7,180             21,558
 Jackson    8,328  20,937                Kodiak Island        12,563 33,209
                                                                                   Clay                7,751             21,560
 Jefferson  8,073  22,250                Lake and Peninsula   12,563 33,209
                                                                                   Cleburne            7,231             19,797
 Lamar      8,328  20,937                Matanuska Susitna    12,563 33,209
                                                                                   Cleveland           7,140             18,250
 Lauderdale 8,710  22,810                Nome                 12,563 33,209
                                                                                   Columbia            7,695             23,029
 Lawrence   8,446  21,495                North Slope          12,563 33,209
                                                                                   Conway              7,231             19,797
 Lee        7,726  20,656                Northwest Arctic     12,563 33,209

2024 Average Premium Tables                                                                                                    11

Page 12 of 31     Fileid: … -form-8941/2024/a/xml/cycle04/source              15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Craighead       7,751 21,560  Stone           7,751  21,560         Santa Clara 9,709                                   28,911
 Crawford        6,714 21,788  Union           7,695  23,029         Santa Cruz  9,395                                   26,386
 Crittenden      7,751 21,560  Van Buren       7,231  19,797         Shasta      9,825                                   23,668
 Cross           7,751 21,560  Washington      7,244  21,429         Sierra      9,825                                   23,668
 Dallas          7,140 18,250  White           7,231  19,797         Siskiyou    9,825                                   23,668
 Desha           7,140 18,250  Woodruff        7,751  21,560         Solano      8,673                                   24,682
 Drew            7,140 18,250  Yell            7,231  19,797         Sonoma      8,673                                   24,682
 Faulkner        7,231 19,797                                        Stanislaus  9,008                                   24,693
 Franklin        6,714 21,788 California                             Sutter      9,825                                   23,668
 Fulton          7,751 21,560                  Employee- Dependent,  Tehama      9,825                                   23,668
 Garland         7,180 21,558 County           Only   Family, etc.   Trinity     9,825                                   23,668
 Grant           7,231 19,797 Alameda          9,991  26,876         Tulare      9,008                                   24,693
 Greene          7,751 21,560  Alpine          9,825  23,668         Tuolumne    9,825                                   23,668
 Hempstead       7,695 23,029  Amador          9,825  23,668         Ventura     8,551                                   25,169
 Hot Spring      7,180 21,558  Butte           9,825  23,668         Yolo        8,406                                   24,340
 Howard          7,695 23,029  Calaveras       9,825  23,668         Yuba        9,825                                   23,668
 Independence    7,751 21,560  Colusa          9,825  23,668
 Izard           7,751 21,560  Contra Costa    9,461  26,914        Colorado
 Jackson         7,751 21,560  Del Norte       9,825  23,668                     Employee- Dependent,
 Jefferson       7,140 18,250  El Dorado       8,406  24,340        County       Only                                    Family, etc.
 Johnson         6,714 21,788  Fresno          8,250  25,788         Adams       8,504                                   21,656
 Lafayette       7,695 23,029  Glenn           9,825  23,668         Alamosa     8,633                                   23,653
 Lawrence        7,751 21,560  Humboldt        9,825  23,668         Arapahoe    8,504                                   21,656
 Lee             7,140 18,250  Imperial        8,038  22,422         Archuleta   8,569                                   24,827
 Lincoln         7,140 18,250  Inyo            8,038  22,422         Baca        8,633                                   23,653
 Little River    7,695 23,029  Kern            8,576  20,941         Bent        8,633                                   23,653
 Logan           6,714 21,788  Kings           8,250  25,788         Boulder     8,665                                   22,089
 Lonoke          7,231 19,797  Lake            9,825  23,668         Broomfield  8,504                                   21,656
 Madison         7,244 21,429  Lassen          9,825  23,668         Chaffee     8,633                                   23,653
 Marion          7,244 21,429  Los Angeles     8,516  24,150         Cheyenne    8,633                                   23,653
 Miller          7,695 23,029  Madera          8,250  25,788         Clear Creek 8,504                                   21,656
 Mississippi     7,751 21,560  Marin           8,673  24,682         Conejos     8,633                                   23,653
 Monroe          7,140 18,250  Mariposa        9,008  24,693         Costilla    8,633                                   23,653
 Montgomery      7,180 21,558  Mendocino       9,825  23,668         Crowley     8,633                                   23,653
 Nevada          7,695 23,029  Merced          9,008  24,693         Custer      8,633                                   23,653
 Newton          7,244 21,429  Modoc           9,825  23,668         Delta       8,569                                   24,827
 Ouachita        7,695 23,029  Mono            8,038  22,422         Denver      8,504                                   21,656
 Perry           7,231 19,797  Monterey        9,395  26,386         Dolores     8,569                                   24,827
 Phillips        7,140 18,250  Napa            8,673  24,682         Douglas     8,504                                   21,656
 Pike            7,180 21,558  Nevada          9,825  23,668         Eagle       7,932                                   24,678
 Poinsett        7,751 21,560  Orange          9,098  26,021         El Paso     7,425                                   22,503
 Polk            6,714 21,788  Placer          8,406  24,340         Elbert      8,504                                   21,656
 Pope            7,231 19,797  Plumas          9,825  23,668         Fremont     8,633                                   23,653
 Prairie         7,231 19,797  Riverside       8,823  24,188         Garfield    7,932                                   24,678
 Pulaski         7,231 19,797  Sacramento      8,406  24,340         Gilpin      8,504                                   21,656
 Randolph        7,751 21,560  San Benito      9,395  26,386         Grand       8,569                                   24,827
 Saline          7,231 19,797  San Bernardino  8,823  24,188         Gunnison    8,569                                   24,827
 Scott           6,714 21,788  San Diego       8,224  22,479         Hinsdale    8,569                                   24,827
 Searcy          7,244 21,429  San Francisco   9,194  32,092         Huerfano    8,633                                   23,653
 Sebastian       6,714 21,788  San Joaquin     9,008  24,693         Jackson     8,569                                   24,827
 Sevier          7,695 23,029  San Luis Obispo 8,551  25,169         Jefferson   8,504                                   21,656
 Sharp           7,751 21,560  San Mateo       10,893 30,804         Kiowa       8,633                                   23,653
 St. Francis     7,751 21,560  Santa Barbara   8,551  25,169         Kit Carson  8,633                                   23,653

              12                                                    2024 Average Premium Tables

Page 13 of 31  Fileid: … -form-8941/2024/a/xml/cycle04/source                  15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 La Plata   8,569   24,827       Florida                             Pasco         7,525                                 23,362
 Lake       8,569   24,827                     Employee- Dependent,  Pinellas      8,194                                 23,018
 Larimer    8,694   20,373       County        Only  Family, etc.    Polk          9,577                                 24,469
 Las Animas 8,633   23,653       Alachua       8,574 22,734          Putnam        8,213                                 24,383
 Lincoln    8,633   23,653        Baker        7,973 24,191          Santa Rosa    7,980                                 23,369
 Logan      9,459   25,901        Bay          8,052 21,468          Sarasota      7,958                                 24,513
 Mesa       9,910   22,125        Bradford     8,111 24,389          Seminole      7,715                                 20,895
 Mineral    8,633   23,653        Brevard      9,160 26,969          St. Johns     10,257                                27,879
 Moffat     8,569   24,827        Broward      8,175 23,328          St. Lucie     7,591                                 21,601
 Montezuma  8,569   24,827        Calhoun      8,179 24,235          Sumter        8,329                                 24,392
 Montrose   8,569   24,827        Charlotte    8,533 25,787          Suwannee      8,117                                 24,652
 Morgan     9,459   25,901        Citrus       8,060 24,117          Taylor        8,601                                 24,732
 Otero      8,633   23,653        Clay         7,995 23,813          Union         8,069                                 24,395
 Ouray      8,569   24,827        Collier      7,988 29,682          Volusia       8,915                                 22,545
 Park       8,504   21,656        Columbia     8,606 25,617          Wakulla       8,092                                 24,704
 Phillips   9,459   25,901        DeSoto       8,161 25,090          Walton        8,033                                 23,143
 Pitkin     7,932   24,678        Dixie        8,049 23,261          Washington    8,243                                 24,709
 Prowers    8,633   23,653        Duval        8,681 26,581
 Pueblo     8,421   21,282        Escambia     8,119 24,945         Georgia
 Rio Blanco 8,569   24,827        Flagler      8,811 24,301                        Employee- Dependent,
 Rio Grande 8,633   23,653        Franklin     8,293 25,489         County         Only                                  Family, etc.
 Routt      8,569   24,827        Gadsden      8,215 24,406         Appling        10,583                                27,444
 Saguache   8,633   23,653        Gilchrist    8,214 24,798          Atkinson      8,296                                 26,061
 San Juan   8,569   24,827        Glades       8,262 25,093          Bacon         8,995                                 24,100
 San Miguel 8,569   24,827        Gulf         8,395 24,880          Baker         9,035                                 25,176
 Sedgwick   9,459   25,901        Hamilton     8,080 24,470          Baldwin       9,240                                 24,458
 Summit     7,932   24,678        Hardee       7,947 23,424          Banks         8,493                                 22,594
 Teller     7,425   22,503        Hendry       8,408 25,031          Barrow        9,031                                 21,237
 Washington 9,459   25,901        Hernando     8,893 23,963          Bartow        8,799                                 22,877
 Weld       8,816   26,016        Highlands    8,547 25,569          Ben Hill      8,599                                 24,744
 Yuma       9,459   25,901        Hillsborough 7,958 25,175          Berrien       8,599                                 24,744
                                  Holmes       8,083 23,872          Bibb          8,882                                 20,662
Connecticut                       Indian River 8,085 24,108          Bleckley      8,882                                 20,662
            Employee- Dependent,  Jackson      7,785 22,810          Brantley      8,995                                 24,100
County      Only    Family, etc.  Jefferson    8,349 23,916          Brooks        8,599                                 24,744
Fairfield   9,847   29,578        Lafayette    8,166 23,429          Bryan         10,583                                27,444
 Hartford   9,002   26,680        Lake         9,660 24,889          Bulloch       10,583                                27,444
 Litchfield 8,793   28,343        Lee          8,269 25,057          Burke         8,370                                 20,462
 Middlesex  9,071   27,136        Leon         9,847 28,653          Butts         8,799                                 22,877
 New Haven  9,794   29,443        Levy         7,897 24,443          Calhoun       9,035                                 25,176
 New London 10,375  25,787        Liberty      8,032 23,563          Camden        8,995                                 24,100
 Tolland    9,085   25,131        Madison      8,249 24,855          Candler       10,583                                27,444
 Windham    9,637   31,760        Manatee      7,718 21,046          Carroll       9,728                                 28,180
                                  Marion       7,167 20,829          Catoosa       9,171                                 24,214
Delaware                                                             Charlton      8,995                                 24,100
                                  Martin       8,016 24,627
            Employee- Dependent,  Miami-Dade   8,264 24,940          Chatham       10,583                                27,444
County      Only    Family, etc.  Monroe       8,436 25,476          Chattahoochee 8,306                                 21,721
All         8,846   23,764        Nassau       8,332 23,044          Chattooga     8,654                                 22,433
                                  Okaloosa     8,059 28,477          Cherokee      8,799                                 22,877
District of Columbia
                                  Okeechobee   8,534 25,640          Clarke        9,031                                 21,237
            Employee- Dependent,  Orange       7,953 22,301          Clay          9,035                                 25,176
County      Only    Family, etc.                                     Clayton       8,799                                 22,877
                                  Osceola      8,438 24,353
All         9,368   28,176                                           Clinch        8,599                                 24,744
                                  Palm Beach   8,603 28,912

2024 Average Premium Tables                                                                                                    13

Page 14 of 31   Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Cobb          8,799  22,877  Lanier     8,599  24,744          Towns      8,493                                         22,594
 Coffee        8,296  26,061  Laurens    8,296  26,061          Treutlen   8,296                                         26,061
 Colquitt      8,599  24,744  Lee        9,035  25,176          Troup      8,306                                         21,721
 Columbia      8,370  20,462  Liberty    10,583 27,444          Turner     8,599                                         24,744
 Cook          8,599  24,744  Lincoln    8,370  20,462          Twiggs     8,882                                         20,662
 Coweta        8,799  22,877  Long       10,583 27,444          Union      8,493                                         22,594
 Crawford      8,882  20,662  Lowndes    8,599  24,744          Upson      8,306                                         21,721
 Crisp         9,035  25,176  Lumpkin    8,493  22,594          Walker     9,171                                         24,214
 Dade          9,171  24,214  Macon      8,306  21,721          Walton     8,799                                         22,877
 Dawson        8,493  22,594  Madison    9,031  21,237          Ware       8,995                                         24,100
 Decatur       8,599  24,744  Marion     8,306  21,721          Warren     8,370                                         20,462
 DeKalb        8,799  22,877  McDuffie   8,370  20,462          Washington 9,240                                         24,458
 Dodge         8,882  20,662  McIntosh   8,995  24,100          Wayne      8,995                                         24,100
 Dooly         8,882  20,662 Meriwether  8,306  21,721          Webster    8,306                                         21,721
 Dougherty     9,035  25,176  Miller     8,599  24,744          Wheeler    8,296                                         26,061
 Douglas       8,799  22,877  Mitchell   9,035  25,176          White      8,493                                         22,594
 Early         8,599  24,744  Monroe     8,882  20,662          Whitfield  8,899                                         23,245
 Echols        8,599  24,744  Montgomery 8,296  26,061          Wilcox     8,882                                         20,662
 Effingham     10,583 27,444  Morgan     9,031  21,237          Wilkes     8,370                                         20,462
 Elbert        9,031  21,237  Murray     8,899  23,245          Wilkinson  9,240                                         24,458
 Emanuel       8,370  20,462  Muscogee   8,306  21,721          Worth      9,035                                         25,176
 Evans         10,583 27,444  Newton     8,799  22,877
 Fannin        8,899  23,245  Oconee     9,031  21,237         Hawaii
 Fayette       8,799  22,877  Oglethorpe 9,031  21,237                     Employee- Dependent,
 Floyd         8,654  22,433  Paulding   8,799  22,877         County      Only                                          Family, etc.
 Forsyth       8,799  22,877  Peach      8,882  20,662         All         8,011                                         22,871
 Franklin      8,493  22,594  Pickens    8,654  22,433
                                                               Idaho
 Fulton        8,799  22,877  Pierce     8,995  24,100
 Gilmer        8,654  22,433  Pike       8,799  22,877                     Employee- Dependent,
 Glascock      8,370  20,462  Polk       8,654  22,433         County      Only                                          Family, etc.
 Glynn         8,995  24,100  Pulaski    8,882  20,662         Ada         7,370                                         18,558
 Gordon        8,654  22,433  Putnam     8,882  20,662          Adams      7,815                                         19,674
 Grady         8,599  24,744  Quitman    8,306  21,721          Bannock    8,437                                         18,200
 Greene        9,031  21,237  Rabun      8,493  22,594          Bear Lake  8,437                                         18,200
 Gwinnett      8,799  22,877  Randolph   9,035  25,176          Benewah    7,039                                         16,122
 Habersham     8,493  22,594  Richmond   8,370  20,462          Bingham    8,437                                         18,200
 Hall          8,493  22,594  Rockdale   8,799  22,877          Blaine     6,966                                         18,948
 Hancock       9,240  24,458  Schley     9,035  25,176          Boise      7,815                                         19,674
 Haralson      9,728  28,180  Screven    10,583 27,444          Bonner     7,039                                         16,122
 Harris        8,306  21,721  Seminole   8,599  24,744          Bonneville 7,965                                         20,506
 Hart          8,493  22,594  Spalding   8,799  22,877          Boundary   7,039                                         16,122
 Heard         9,728  28,180  Stephens   8,493  22,594          Butte      8,437                                         18,200
 Henry         8,799  22,877  Stewart    8,306  21,721          Camas      6,966                                         18,948
 Houston       8,882  20,662  Sumter     9,035  25,176          Canyon     7,815                                         19,674
 Irwin         8,599  24,744  Talbot     8,306  21,721          Caribou    8,437                                         18,200
 Jackson       9,031  21,237  Taliaferro 8,370  20,462          Cassia     6,966                                         18,948
 Jasper        8,799  22,877  Tattnall   10,583 27,444          Clark      7,965                                         20,506
 Jeff Davis    8,296  26,061  Taylor     8,306  21,721          Clearwater 8,172                                         19,086
 Jefferson     8,370  20,462  Telfair    8,296  26,061          Custer     8,437                                         18,200
 Jenkins       8,370  20,462  Terrell    9,035  25,176          Elmore     7,815                                         19,674
 Johnson       8,296  26,061  Thomas     8,599  24,744          Franklin   8,437                                         18,200
 Jones         8,882  20,662  Tift       8,599  24,744          Fremont    7,965                                         20,506
 Lamar         8,799  22,877  Toombs     8,296  26,061          Gem        7,815                                         19,674

            14                                                     2024 Average Premium Tables

Page 15 of 31  Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Gooding    6,966 18,948          Fulton      8,744 25,140     Saline      9,777                                         25,949
 Idaho      8,172 19,086          Gallatin    9,777 25,949     Sangamon    8,465                                         23,011
 Jefferson  7,965 20,506          Greene      8,687 25,047     Schuyler    8,465                                         23,011
 Jerome     6,966 18,948          Grundy      9,101 21,765     Scott       8,465                                         23,011
 Kootenai   7,039 16,122          Hamilton    9,777 25,949     Shelby      8,465                                         23,011
 Latah      7,039 16,122          Hancock     8,243 25,623     St. Clair   8,984                                         26,654
 Lemhi      7,965 20,506          Hardin      9,777 25,949     Stark       8,744                                         25,140
 Lewis      8,172 19,086          Henderson   8,243 25,623     Stephenson  8,972                                         22,362
 Lincoln    6,966 18,948          Henry       8,243 25,623     Tazewell    8,744                                         25,140
 Madison    7,965 20,506          Iroquois    9,646 25,054     Union       9,777                                         25,949
 Minidoka   6,966 18,948          Jackson     9,777 25,949     Vermilion   9,646                                         25,054
 Nez Perce  8,172 19,086          Jasper      9,777 25,949     Wabash      9,777                                         25,949
 Oneida     8,437 18,200          Jefferson   9,777 25,949     Warren      8,243                                         25,623
 Owyhee     7,815 19,674          Jersey      8,687 25,047     Washington  8,687                                         25,047
 Payette    7,815 19,674          Jo Daviess  8,972 22,362     Wayne       9,777                                         25,949
 Power      8,437 18,200          Johnson     9,777 25,949     White       9,777                                         25,949
 Shoshone   7,039 16,122          Kane        8,977 25,172     Whiteside   8,243                                         25,623
 Teton      7,965 20,506          Kankakee    9,101 21,765     Will        9,101                                         21,765
 Twin Falls 6,966 18,948          Kendall     9,101 21,765     Williamson  9,777                                         25,949
 Valley     7,815 19,674          Knox        8,744 25,140     Winnebago   8,972                                         22,362
 Washington 7,815 19,674          Lake        8,536 25,135     Woodford    8,744                                         25,140
                                  LaSalle     8,744 25,140
Illinois                          Lawrence    9,777 25,949    Indiana
            Employee- Dependent,  Lee         8,972 22,362                 Employee- Dependent,
County      Only  Family, etc.    Livingston  9,902 24,851    County       Only                                          Family, etc.
 Adams      8,465 23,011          Logan       8,465 23,011    Adams        8,481                                         23,214
 Alexander  9,777 25,949          Macon       8,465 23,011     Allen       8,709                                         24,189
 Bond       8,687 25,047          Macoupin    8,687 25,047     Bartholomew 7,972                                         23,203
 Boone      8,972 22,362          Madison     8,984 26,654     Benton      8,516                                         25,391
 Brown      8,465 23,011          Marion      9,777 25,949     Blackford   8,548                                         25,410
 Bureau     8,243 25,623          Marshall    8,744 25,140     Boone       8,559                                         25,255
 Calhoun    8,687 25,047          Mason       8,465 23,011     Brown       8,560                                         27,709
 Carroll    8,972 22,362          Massac      9,777 25,949     Carroll     9,016                                         26,016
 Cass       8,465 23,011          McDonough   8,744 25,140     Cass        9,034                                         21,897
 Champaign  9,646 25,054          McHenry     8,536 25,135     Clark       7,522                                         22,444
 Christian  8,465 23,011          McLean      9,902 24,851     Clay        8,780                                         24,472
 Clark      9,646 25,054          Menard      8,465 23,011     Clinton     9,016                                         26,016
 Clay       9,777 25,949          Mercer      8,243 25,623     Crawford    7,522                                         22,444
 Clinton    8,687 25,047          Monroe      8,984 26,654     Daviess     8,271                                         25,780
 Coles      9,646 25,054          Montgomery  8,687 25,047     Dearborn    9,246                                         24,245
 Cook       8,729 24,808          Morgan      8,465 23,011     Decatur     7,972                                         23,203
 Crawford   9,777 25,949          Moultrie    8,465 23,011     DeKalb      8,481                                         23,214
 Cumberland 9,646 25,054          Ogle        8,972 22,362     Delaware    8,548                                         25,410
 DeKalb     8,972 22,362          Peoria      8,744 25,140     Dubois      8,271                                         25,780
 DeWitt     9,902 24,851          Perry       9,777 25,949     Elkhart     8,456                                         22,896
 Douglas    9,646 25,054          Piatt       9,646 25,054     Fayette     8,795                                         26,531
 DuPage     8,977 25,172          Pike        8,465 23,011     Floyd       7,522                                         22,444
 Edgar      9,646 25,054          Pope        9,777 25,949     Fountain    9,016                                         26,016
 Edwards    9,777 25,949          Pulaski     9,777 25,949     Franklin    9,246                                         24,245
 Effingham  9,777 25,949          Putnam      8,744 25,140     Fulton      9,034                                         21,897
 Fayette    9,777 25,949          Randolph    8,687 25,047     Gibson      9,588                                         24,463
 Ford       9,646 25,054          Richland    9,777 25,949     Grant       8,548                                         25,410
 Franklin   9,777 25,949          Rock Island 8,243 25,623     Greene      8,271                                         25,780

2024 Average Premium Tables                                                                                                    15

Page 16 of 31    Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Hamilton       8,559 25,255  Vanderburgh 9,588 24,463           Guthrie       8,697                                     21,249
 Hancock        8,795 26,531  Vermillion  8,780 24,472           Hamilton      7,966                                     23,547
 Harrison       7,522 22,444  Vigo        8,780 24,472           Hancock       8,404                                     23,443
 Hendricks      8,559 25,255  Wabash      8,481 23,214           Hardin        7,966                                     23,547
 Henry          8,795 26,531  Warren      8,516 25,391           Harrison      8,697                                     21,249
 Howard         9,034 21,897  Warrick     9,588 24,463           Henry         8,218                                     20,576
 Huntington     8,481 23,214  Washington  7,522 22,444           Howard        8,404                                     23,443
 Jackson        7,972 23,203  Wayne       8,795 26,531           Humboldt      8,404                                     23,443
 Jasper         8,516 25,391  Wells       8,481 23,214           Ida           8,772                                     22,897
 Jay            8,548 25,410  White       8,516 25,391           Iowa          8,640                                     23,258
 Jefferson      7,522 22,444  Whitley     8,481 23,214           Jackson       8,640                                     23,258
 Jennings       7,972 23,203                                     Jasper        8,281                                     23,344
 Johnson        8,560 27,709 Iowa                                Jefferson     8,218                                     20,576
 Knox           8,271 25,780              Employee- Dependent,   Johnson       8,640                                     23,258
 Kosciusko      8,456 22,896 County       Only  Family, etc.     Jones         8,640                                     23,258
 LaGrange       8,481 23,214 Adair        8,697 21,249           Keokuk        8,218                                     20,576
 Lake           8,474 23,469  Adams       8,697 21,249           Kossuth       8,404                                     23,443
 LaPorte        8,474 23,469  Allamakee   8,404 23,443           Lee           8,218                                     20,576
 Lawrence       8,560 27,709  Appanoose   8,218 20,576           Linn          8,640                                     23,258
 Madison        8,795 26,531  Audubon     8,697 21,249           Louisa        8,218                                     20,576
 Marion         8,559 25,255  Benton      8,640 23,258           Lucas         8,218                                     20,576
 Marshall       8,456 22,896  Black Hawk  8,640 23,258           Lyon          8,772                                     22,897
 Martin         8,271 25,780  Boone       7,966 23,547           Madison       8,281                                     23,344
 Miami          9,034 21,897  Bremer      8,404 23,443           Mahaska       8,218                                     20,576
 Monroe         8,560 27,709  Buchanan    8,640 23,258           Marion        8,281                                     23,344
 Montgomery     9,016 26,016  Buena Vista 8,772 22,897           Marshall      7,966                                     23,547
 Morgan         8,559 25,255  Butler      8,404 23,443           Mills         8,697                                     21,249
 Newton         8,516 25,391  Calhoun     7,966 23,547           Mitchell      8,404                                     23,443
 Noble          8,481 23,214  Carroll     7,966 23,547           Monona        8,772                                     22,897
 Ohio           9,246 24,245  Cass        8,697 21,249           Monroe        8,218                                     20,576
 Orange         8,271 25,780  Cedar       8,640 23,258           Montgomery    8,697                                     21,249
 Owen           8,560 27,709  Cerro Gordo 8,404 23,443           Muscatine     8,218                                     20,576
 Parke          8,780 24,472  Cherokee    8,772 22,897           O'Brien       8,772                                     22,897
 Perry          8,271 25,780  Chickasaw   8,404 23,443           Osceola       8,772                                     22,897
 Pike           8,271 25,780  Clarke      8,697 21,249           Page          8,697                                     21,249
 Porter         8,474 23,469  Clay        8,772 22,897           Palo Alto     8,772                                     22,897
 Posey          9,588 24,463  Clayton     8,640 23,258           Plymouth      8,772                                     22,897
 Pulaski        9,034 21,897  Clinton     8,640 23,258           Pocahontas    8,772                                     22,897
 Putnam         9,016 26,016  Crawford    8,772 22,897           Polk          8,281                                     23,344
 Randolph       8,548 25,410  Dallas      8,281 23,344           Pottawattamie 8,697                                     21,249
 Ripley         9,246 24,245  Davis       8,218 20,576           Poweshiek     7,966                                     23,547
 Rush           7,972 23,203  Decatur     8,697 21,249           Ringgold      8,697                                     21,249
 Scott          7,522 22,444  Delaware    8,640 23,258           Sac           8,772                                     22,897
 Shelby         8,559 25,255  Des Moines  8,218 20,576           Scott         8,640                                     23,258
 Spencer        8,271 25,780  Dickinson   8,772 22,897           Shelby        8,697                                     21,249
 St. Joseph     8,456 22,896  Dubuque     8,640 23,258           Sioux         8,772                                     22,897
 Starke         8,456 22,896  Emmet       8,404 23,443           Story         7,966                                     23,547
 Steuben        8,481 23,214  Fayette     8,404 23,443           Tama          7,966                                     23,547
 Sullivan       8,780 24,472  Floyd       8,404 23,443           Taylor        8,697                                     21,249
 Switzerland    9,246 24,245  Franklin    8,404 23,443           Union         8,697                                     21,249
 Tippecanoe     9,016 26,016  Fremont     8,697 21,249           Van Buren     8,218                                     20,576
 Tipton         9,016 26,016  Greene      7,966 23,547           Wapello       8,218                                     20,576
 Union          8,795 26,531  Grundy      7,966 23,547           Warren        8,281                                     23,344

             16                                                      2024 Average Premium Tables

Page 17 of 31  Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Washington 8,218 20,576          Hodgeman     6,640 20,210    Stevens      6,640                                        20,210
 Wayne      8,218 20,576          Jackson      7,618 19,947    Sumner       7,303                                        20,982
 Webster    7,966 23,547          Jefferson    7,618 19,947    Thomas       7,246                                        21,412
 Winnebago  8,404 23,443          Jewell       6,958 19,361    Trego        7,246                                        21,412
 Winneshiek 8,404 23,443          Johnson      8,105 20,832    Wabaunsee    7,618                                        19,947
 Woodbury   8,772 22,897          Kearny       6,640 20,210    Wallace      7,246                                        21,412
 Worth      8,404 23,443          Kingman      7,303 20,982    Washington   6,958                                        19,361
 Wright     8,404 23,443          Kiowa        6,640 20,210    Wichita      7,246                                        21,412
                                  Labette      7,646 19,378    Wilson       7,303                                        20,982
Kansas                            Lane         7,246 21,412    Woodson      7,646                                        19,378
            Employee- Dependent,  Leavenworth  8,105 20,832    Wyandotte    8,105                                        20,832
County      Only  Family, etc.    Lincoln      6,958 19,361
Allen       7,646 19,378          Linn         7,618 19,947   Kentucky
 Anderson   7,618 19,947          Logan        7,246 21,412                 Employee- Dependent,
 Atchison   7,618 19,947          Lyon         7,618 19,947   County        Only                                         Family, etc.
 Barber     6,640 20,210          Marion       7,303 20,982   Adair         7,995                                        23,900
 Barton     7,246 21,412          Marshall     7,618 19,947    Allen        7,995                                        23,900
 Bourbon    7,646 19,378          McPherson    7,303 20,982    Anderson     7,342                                        21,758
 Brown      7,618 19,947          Meade        6,640 20,210    Ballard      9,237                                        20,839
 Butler     7,303 20,982          Miami        8,105 20,832    Barren       7,995                                        23,900
 Chase      7,303 20,982          Mitchell     6,958 19,361    Bath         7,628                                        23,016
 Chautauqua 7,303 20,982          Montgomery   7,303 20,982    Bell         8,511                                        27,031
 Cherokee   7,646 19,378          Morris       6,958 19,361    Boone        7,287                                        22,920
 Cheyenne   7,246 21,412          Morton       6,640 20,210    Bourbon      7,342                                        21,758
 Clark      6,640 20,210          Nemaha       7,618 19,947    Boyd         7,628                                        23,016
 Clay       6,958 19,361          Neosho       7,646 19,378    Boyle        7,342                                        21,758
 Cloud      6,958 19,361          Ness         7,246 21,412    Bracken      7,628                                        23,016
 Coffey     7,618 19,947          Norton       7,246 21,412    Breathitt    8,511                                        27,031
 Comanche   6,640 20,210          Osage        7,618 19,947    Breckinridge 7,433                                        23,472
 Cowley     7,303 20,982          Osborne      7,246 21,412    Bullitt      7,433                                        23,472
 Crawford   7,646 19,378          Ottawa       6,958 19,361    Butler       7,995                                        23,900
 Decatur    7,246 21,412          Pawnee       6,640 20,210    Caldwell     9,237                                        20,839
 Dickinson  6,958 19,361          Phillips     7,246 21,412    Calloway     9,237                                        20,839
 Doniphan   7,618 19,947          Pottawatomie 7,618 19,947    Campbell     7,287                                        22,920
 Douglas    7,618 19,947          Pratt        6,640 20,210    Carlisle     9,237                                        20,839
 Edwards    6,640 20,210          Rawlins      7,246 21,412    Carroll      7,433                                        23,472
 Elk        7,303 20,982          Reno         7,303 20,982    Carter       7,628                                        23,016
 Ellis      7,246 21,412          Republic     6,958 19,361    Casey        7,995                                        23,900
 Ellsworth  6,958 19,361          Rice         7,303 20,982    Christian    8,681                                        26,611
 Finney     6,640 20,210          Riley        6,958 19,361    Clark        7,342                                        21,758
 Ford       6,640 20,210          Rooks        7,246 21,412    Clay         8,511                                        27,031
 Franklin   7,618 19,947          Rush         7,246 21,412    Clinton      7,995                                        23,900
 Geary      6,958 19,361          Russell      7,246 21,412    Crittenden   9,237                                        20,839
 Gove       7,246 21,412          Saline       6,958 19,361    Cumberland   7,995                                        23,900
 Graham     7,246 21,412          Scott        7,246 21,412    Daviess      8,681                                        26,611
 Grant      6,640 20,210          Sedgwick     7,303 20,982    Edmonson     7,995                                        23,900
 Gray       6,640 20,210          Seward       6,640 20,210    Elliott      7,628                                        23,016
 Greeley    7,246 21,412          Shawnee      7,618 19,947    Estill       7,342                                        21,758
 Greenwood  7,303 20,982          Sheridan     7,246 21,412    Fayette      7,342                                        21,758
 Hamilton   6,640 20,210          Sherman      7,246 21,412    Fleming      7,628                                        23,016
 Harper     7,303 20,982          Smith        7,246 21,412    Floyd        8,511                                        27,031
 Harvey     7,303 20,982          Stafford     6,640 20,210    Franklin     7,342                                        21,758
 Haskell    6,640 20,210          Stanton      6,640 20,210    Fulton       9,237                                        20,839

2024 Average Premium Tables                                                                                                    17

Page 18 of 31   Fileid: … -form-8941/2024/a/xml/cycle04/source                15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Gallatin      7,287 22,920  Ohio             8,681 26,611          Franklin         9,664                               20,521
 Garrard       7,342 21,758  Oldham           7,433 23,472          Grant            9,380                               24,782
 Grant         7,287 22,920  Owen             7,342 21,758          Iberia           7,992                               20,866
 Graves        9,237 20,839  Owsley           8,511 27,031          Iberville        8,791                               22,141
 Grayson       7,433 23,472  Pendleton        7,287 22,920          Jackson          9,664                               20,521
 Green         7,995 23,900  Perry            8,511 27,031          Jefferson        8,750                               22,499
 Greenup       7,628 23,016  Pike             8,511 27,031          Jefferson Davis  9,547                               21,861
 Hancock       8,681 26,611  Powell           7,342 21,758          Lafayette        7,992                               20,866
 Hardin        7,433 23,472  Pulaski          7,995 23,900          Lafourche        8,784                               20,542
 Harlan        8,511 27,031  Robertson        7,628 23,016          LaSalle          9,380                               24,782
 Harrison      7,342 21,758  Rockcastle       7,342 21,758          Lincoln          9,664                               20,521
 Hart          7,995 23,900  Rowan            7,628 23,016          Livingston       8,791                               22,141
 Henderson     8,681 26,611  Russell          7,995 23,900          Madison          9,664                               20,521
 Henry         7,433 23,472  Scott            7,342 21,758          Morehouse        9,664                               20,521
 Hickman       9,237 20,839  Shelby           7,433 23,472          Natchitoches     8,188                               21,752
 Hopkins       8,681 26,611  Simpson          7,995 23,900          Orleans          8,750                               22,499
 Jackson       7,342 21,758  Spencer          7,433 23,472          Ouachita         9,664                               20,521
 Jefferson     7,433 23,472  Taylor           7,995 23,900          Plaquemines      8,750                               22,499
 Jessamine     7,342 21,758  Todd             8,681 26,611          Pointe Coupee    8,791                               22,141
 Johnson       8,511 27,031  Trigg            8,681 26,611          Rapides          9,380                               24,782
 Kenton        7,287 22,920  Trimble          7,433 23,472          Red River        8,188                               21,752
 Knott         8,511 27,031  Union            8,681 26,611          Richland         9,664                               20,521
 Knox          8,511 27,031  Warren           7,995 23,900          Sabine           8,188                               21,752
 LaRue         7,433 23,472  Washington       7,433 23,472          St. Bernard      8,750                               22,499
 Laurel        8,511 27,031  Wayne            7,995 23,900          St. Charles      8,750                               22,499
 Lawrence      7,628 23,016  Webster          8,681 26,611          St. Helena       8,791                               22,141
 Lee           8,511 27,031  Whitley          8,511 27,031          St. James        8,750                               22,499
 Leslie        8,511 27,031  Wolfe            8,511 27,031          St. John Baptist 8,750                               22,499
 Letcher       8,511 27,031  Woodford         7,342 21,758          St. Landry       7,992                               20,866
 Lewis         7,628 23,016                                         St. Martin       7,992                               20,866
 Lincoln       7,342 21,758 Louisiana                               St. Mary         7,992                               20,866
 Livingston    9,237 20,839                   Employee- Dependent,  St. Tammany      8,750                               22,499
 Logan         7,995 23,900 Parish            Only  Family, etc.    Tangipahoa       8,791                               22,141
 Lyon          9,237 20,839 Acadia            7,992 20,866          Tensas           9,664                               20,521
 Madison       7,342 21,758  Allen            9,547 21,861          Terrebonne       8,784                               20,542
 Magoffin      8,511 27,031  Ascension        8,791 22,141          Union            9,664                               20,521
 Marion        7,433 23,472  Assumption       8,784 20,542          Vermilion        7,992                               20,866
 Marshall      9,237 20,839  Avoyelles        9,380 24,782          Vernon           9,380                               24,782
 Martin        8,511 27,031  Beauregard       9,547 21,861          Washington       8,791                               22,141
 Mason         7,628 23,016  Bienville        8,188 21,752          Webster          8,188                               21,752
 McCracken     9,237 20,839  Bossier          8,188 21,752          West Baton Rouge 8,791                               22,141
 McCreary      7,995 23,900  Caddo            8,188 21,752          West Carroll     9,664                               20,521
 McLean        8,681 26,611  Calcasieu        9,547 21,861          West Feliciana   8,791                               22,141
 Meade         7,433 23,472  Caldwell         9,664 20,521          Winn             9,380                               24,782
 Menifee       7,628 23,016  Cameron          9,547 21,861
 Mercer        7,342 21,758  Catahoula        9,380 24,782         Maine
 Metcalfe      7,995 23,900  Claiborne        8,188 21,752                           Employee- Dependent,
 Monroe        7,995 23,900  Concordia        9,380 24,782         County            Only                                Family, etc.
 Montgomery    7,342 21,758  DeSoto           8,188 21,752         Androscoggin      8,563                               23,088
 Morgan        7,628 23,016  East Baton Rouge 8,791 22,141          Aroostook        9,703                               24,940
 Muhlenberg    8,681 26,611  East Carroll     9,664 20,521          Cumberland       8,290                               23,123
 Nelson        7,433 23,472  East Feliciana   8,791 22,141          Franklin         8,563                               23,088
 Nicholas      7,342 21,758  Evangeline       7,992 20,866          Hancock          9,703                               24,940

            18                                                     2024 Average Premium Tables

Page 19 of 31     Fileid: … -form-8941/2024/a/xml/cycle04/source                      15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Kennebec        8,238  22,625         Norfolk        10,326 30,660         Lenawee      8,673                           25,644
 Knox            8,238  22,625         Plymouth       9,830  29,195         Livingston   8,673                           25,644
 Lincoln         8,238  22,625         Suffolk        10,326 30,660         Luce         10,018                          23,163
 Oxford          8,238  22,625         Worcester      9,664  28,933         Mackinac     8,510                           22,856
 Penobscot       8,563  23,088                                              Macomb       8,234                           22,845
 Piscataquis     8,563  23,088        Michigan                              Manistee     7,203                           21,345
 Sagadahoc       8,290  23,123                        Employee- Dependent,  Marquette    10,018                          23,163
 Somerset        8,563  23,088        County          Only   Family, etc.   Mason        7,127                           21,445
 Waldo           8,563  23,088        Alcona          8,510  22,856         Mecosta      7,127                           21,445
 Washington      9,703  24,940         Alger          10,018 23,163         Menominee    10,018                          23,163
 York            8,290  23,123         Allegan        8,008  23,533         Midland      8,542                           21,522
                                       Alpena         8,510  22,856         Missaukee    7,203                           21,345
Maryland                               Antrim         7,203  21,345         Monroe       9,002                           24,547
                 Employee- Dependent,  Arenac         8,524  24,111         Montcalm     7,127                           21,445
County           Only   Family, etc.   Baraga         10,018 23,163         Montmorency  8,510                           22,856
Allegany         8,282  25,727         Barry          8,008  23,533         Muskegon     7,127                           21,445
 Anne Arundel    8,273  24,972         Bay            8,524  24,111         Newaygo      7,127                           21,445
 Baltimore       8,273  24,972         Benzie         7,203  21,345         Oakland      8,234                           22,845
 Baltimore City  8,273  24,972         Berrien        8,627  24,892         Oceana       7,127                           21,445
 Calvert         8,337  21,363         Branch         9,298  25,097         Ogemaw       8,510                           22,856
 Caroline        8,337  21,363         Calhoun        9,298  25,097         Ontonagon    10,018                          23,163
 Carroll         8,282  25,727         Cass           8,627  24,892         Osceola      7,127                           21,445
 Cecil           8,337  21,363         Charlevoix     7,203  21,345         Oscoda       8,510                           22,856
 Charles         8,337  21,363         Cheboygan      8,510  22,856         Otsego       8,510                           22,856
 Dorchester      8,337  21,363         Chippewa       8,510  22,856         Ottawa       7,127                           21,445
 Frederick       8,282  25,727         Clare          8,542  21,522         Presque Isle 8,510                           22,856
 Garrett         8,282  25,727         Clinton        8,521  22,881         Roscommon    8,510                           22,856
 Harford         8,273  24,972         Crawford       8,510  22,856         Saginaw      8,524                           24,111
 Howard          8,273  24,972         Delta          10,018 23,163         Sanilac      8,709                           21,559
 Kent            8,337  21,363         Dickinson      10,018 23,163         Schoolcraft  10,018                          23,163
 Montgomery      8,718  25,697         Eaton          8,521  22,881         Shiawassee   8,060                           21,150
 Prince George’s 8,718  25,697         Emmet          7,203  21,345         St. Clair    7,875                           23,377
 Queen Anne’s    8,337  21,363         Genesee        8,060  21,150         St. Joseph   8,627                           24,892
 Somerset        8,337  21,363         Gladwin        8,542  21,522         Tuscola      8,709                           21,559
 St. Mary’s      8,337  21,363         Gogebic        10,018 23,163         Van Buren    8,627                           24,892
 Talbot          8,337  21,363         Grand Traverse 7,203  21,345         Washtenaw    8,673                           25,644
 Washington      8,282  25,727         Gratiot        8,524  24,111         Wayne        9,002                           24,547
 Wicomico        8,337  21,363         Hillsdale      8,521  22,881         Wexford      7,203                           21,345
 Worcester       8,337  21,363         Houghton       10,018 23,163
                                       Huron          8,709  21,559        Minnesota
Massachusetts                          Ingham         8,521  22,881                      Employee- Dependent,
                 Employee- Dependent,  Ionia          7,127  21,445        County        Only                            Family, etc.
County           Only   Family, etc.   Iosco          8,510  22,856        Aitkin        8,631                           22,222
Barnstable       11,896 30,964         Iron           10,018 23,163         Anoka        8,348                           23,928
 Berkshire       8,966  27,598         Isabella       8,542  21,522         Becker       8,643                           23,575
 Bristol         9,830  29,195         Jackson        8,521  22,881         Beltrami     8,631                           22,222
 Dukes           11,896 30,964         Kalamazoo      9,298  25,097         Benton       8,348                           23,928
 Essex           10,000 29,332         Kalkaska       7,203  21,345         Big Stone    9,311                           21,521
 Franklin        8,966  27,598         Kent           7,127  21,445         Blue Earth   10,352                          22,188
 Hampden         8,966  27,598         Keweenaw       10,018 23,163         Brown        9,117                           22,580
 Hampshire       8,966  27,598         Lake           7,127  21,445         Carlton      10,107                          22,968
 Middlesex       10,326 30,660         Lapeer         8,060  21,150         Carver       8,348                           23,928
 Nantucket       11,896 30,964         Leelanau       7,203  21,345         Cass         8,631                           22,222

2024 Average Premium Tables                                                                                                    19

Page 20 of 31       Fileid: … -form-8941/2024/a/xml/cycle04/source               15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Chippewa          9,311  21,521  Renville        9,311  21,521         Humphreys       7,206                            18,688
 Chisago           8,631  22,222  Rice            10,352 22,188         Issaquena       7,206                            18,688
 Clay              8,643  23,575  Rock            9,117  22,580         Itawamba        7,416                            18,912
 Clearwater        8,842  24,327  Roseau          8,631  22,222         Jackson         7,844                            23,137
 Cook              10,107 22,968  Scott           8,348  23,928         Jasper          7,206                            18,688
 Cottonwood        9,117  22,580  Sherburne       8,348  23,928         Jefferson       7,206                            18,688
 Crow Wing         8,631  22,222  Sibley          9,311  21,521         Jefferson Davis 7,206                            18,688
 Dakota            8,348  23,928  St. Louis       10,107 22,968         Jones           7,593                            18,156
 Dodge             8,999  23,347  Stearns         8,348  23,928         Kemper          7,206                            18,688
 Douglas           8,643  23,575  Steele          8,999  23,347         Lafayette       7,206                            18,688
 Faribault         10,352 22,188  Stevens         8,643  23,575         Lamar           7,593                            18,156
 Fillmore          8,999  23,347  Swift           9,311  21,521         Lauderdale      7,206                            18,688
 Freeborn          8,999  23,347  Todd            8,631  22,222         Lawrence        7,206                            18,688
 Goodhue           8,999  23,347  Traverse        8,643  23,575         Leake           7,206                            18,688
 Grant             8,643  23,575  Wabasha         8,999  23,347         Lee             7,416                            18,912
 Hennepin          8,348  23,928  Wadena          8,631  22,222         Leflore         7,206                            18,688
 Houston           8,999  23,347  Waseca          10,352 22,188         Lincoln         7,206                            18,688
 Hubbard           8,631  22,222  Washington      8,348  23,928         Lowndes         7,206                            18,688
 Isanti            8,631  22,222  Watonwan        10,352 22,188         Madison         7,604                            19,180
 Itasca            10,107 22,968  Wilkin          8,643  23,575         Marion          7,206                            18,688
 Jackson           9,117  22,580  Winona          8,999  23,347         Marshall        7,921                            23,091
 Kanabec           8,631  22,222  Wright          8,348  23,928         Monroe          7,206                            18,688
 Kandiyohi         9,311  21,521  Yellow Medicine 9,311  21,521         Montgomery      7,206                            18,688
 Kittson           8,842  24,327                                        Neshoba         7,206                            18,688
 Koochiching       10,107 22,968 Mississippi                            Newton          7,206                            18,688
 Lac qui Parle     9,311  21,521                  Employee- Dependent,  Noxubee         7,206                            18,688
 Lake              10,107 22,968 County           Only   Family, etc.   Oktibbeha       7,206                            18,688
 Lake of the Woods 10,107 22,968 Adams            7,206  18,688         Panola          7,206                            18,688
 Le Sueur          10,352 22,188  Alcorn          7,206  18,688         Pearl River     7,593                            18,156
 Lincoln           9,117  22,580  Amite           7,206  18,688         Perry           7,593                            18,156
 Lyon              9,311  21,521  Attala          7,206  18,688         Pike            7,206                            18,688
 Mahnomen          8,842  24,327  Benton          7,416  18,912         Pontotoc        7,416                            18,912
 Marshall          8,842  24,327  Bolivar         7,206  18,688         Prentiss        7,206                            18,688
 Martin            10,352 22,188  Calhoun         7,206  18,688         Quitman         7,206                            18,688
 McLeod            9,311  21,521  Carroll         7,206  18,688         Rankin          7,604                            19,180
 Meeker            9,311  21,521  Chickasaw       7,206  18,688         Scott           7,206                            18,688
 Mille Lacs        8,631  22,222  Choctaw         7,206  18,688         Sharkey         7,206                            18,688
 Morrison          8,631  22,222  Claiborne       7,206  18,688         Simpson         7,604                            19,180
 Mower             8,999  23,347  Clarke          7,206  18,688         Smith           7,206                            18,688
 Murray            9,117  22,580  Clay            7,206  18,688         Stone           7,844                            23,137
 Nicollet          10,352 22,188  Coahoma         7,206  18,688         Sunflower       7,206                            18,688
 Nobles            9,117  22,580  Copiah          7,604  19,180         Tallahatchie    7,206                            18,688
 Norman            8,842  24,327  Covington       7,206  18,688         Tate            7,921                            23,091
 Olmsted           8,999  23,347  DeSoto          7,921  23,091         Tippah          7,416                            18,912
 Otter Tail        8,643  23,575  Forrest         7,593  18,156         Tishomingo      7,206                            18,688
 Pennington        8,842  24,327  Franklin        7,206  18,688         Tunica          7,921                            23,091
 Pine              8,631  22,222  George          7,844  23,137         Union           7,416                            18,912
 Pipestone         9,117  22,580  Greene          7,593  18,156         Walthall        7,206                            18,688
 Polk              8,842  24,327  Grenada         7,206  18,688         Warren          7,604                            19,180
 Pope              8,643  23,575  Hancock         7,844  23,137         Washington      7,206                            18,688
 Ramsey            8,348  23,928  Harrison        7,844  23,137         Wayne           7,206                            18,688
 Red Lake          8,842  24,327  Hinds           7,604  19,180         Webster         7,206                            18,688
 Redwood           9,117  22,580  Holmes          7,206  18,688         Wilkinson       7,206                            18,688

             20                                                        2024 Average Premium Tables

Page 21 of 31    Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Winston        7,206  18,688         Iron        7,440  18,701  St. Francois    8,291                                   21,100
 Yalobusha      7,206  18,688         Jackson     8,884  23,815  St. Louis       8,291                                   21,100
 Yazoo          7,206  18,688         Jasper      8,606  20,620  St. Louis City  8,291                                   21,100
                                      Jefferson   8,291  21,100  Ste. Genevieve  8,291                                   21,100
Missouri                              Johnson     7,494  19,730  Stoddard        8,722                                   22,895
                Employee- Dependent,  Knox        8,548  20,952  Stone           7,880                                   21,502
County          Only   Family, etc.   Laclede     7,880  21,502  Sullivan        8,548                                   20,952
Adair           8,548  20,952         Lafayette   7,494  19,730  Taney           7,880                                   21,502
 Andrew         10,197 20,405         Lawrence    7,880  21,502  Texas           7,440                                   18,701
 Atchison       10,197 20,405         Lewis       8,548  20,952  Vernon          7,494                                   19,730
 Audrain        8,818  22,273         Lincoln     8,291  21,100  Warren          8,291                                   21,100
 Barry          7,880  21,502         Linn        8,548  20,952  Washington      8,291                                   21,100
 Barton         8,606  20,620         Livingston  10,197 20,405  Wayne           8,722                                   22,895
 Bates          7,494  19,730         Macon       8,548  20,952  Webster         7,880                                   21,502
 Benton         7,494  19,730         Madison     8,722  22,895  Worth           10,197                                  20,405
 Bollinger      8,722  22,895         Maries      8,818  22,273  Wright          7,880                                   21,502
 Boone          8,818  22,273         Marion      8,548  20,952
 Buchanan       10,197 20,405         McDonald    8,606  20,620 Montana
 Butler         8,722  22,895         Mercer      10,197 20,405                  Employee- Dependent,
 Caldwell       10,197 20,405         Miller      8,818  22,273 County           Only                                    Family, etc.
 Callaway       8,818  22,273         Mississippi 8,722  22,895 Beaverhead       8,693                                   20,506
 Camden         8,818  22,273         Moniteau    8,818  22,273  Big Horn        8,693                                   20,506
 Cape Girardeau 8,722  22,895         Monroe      8,818  22,273  Blaine          8,693                                   20,506
 Carroll        10,197 20,405         Montgomery  8,818  22,273  Broadwater      7,606                                   22,167
 Carter         7,440  18,701         Morgan      8,818  22,273  Carbon          8,123                                   22,023
 Cass           8,884  23,815         New Madrid  8,722  22,895  Carter          8,693                                   20,506
 Cedar          7,880  21,502         Newton      8,606  20,620  Cascade         7,606                                   22,167
 Chariton       8,818  22,273         Nodaway     10,197 20,405  Chouteau        7,606                                   22,167
 Christian      7,880  21,502         Oregon      7,440  18,701  Custer          8,693                                   20,506
 Clark          8,548  20,952         Osage       8,818  22,273  Daniels         8,693                                   20,506
 Clay           8,884  23,815         Ozark       7,880  21,502  Dawson          8,693                                   20,506
 Clinton        10,197 20,405         Pemiscot    8,722  22,895  Deer Lodge      7,606                                   22,167
 Cole           8,818  22,273         Perry       8,722  22,895  Fallon          8,693                                   20,506
 Cooper         8,818  22,273         Pettis      7,494  19,730  Fergus          8,693                                   20,506
 Crawford       7,440  18,701         Phelps      7,440  18,701  Flathead        7,863                                   20,820
 Dade           7,880  21,502         Pike        8,548  20,952  Gallatin        7,606                                   22,167
 Dallas         7,880  21,502         Platte      8,884  23,815  Garfield        8,693                                   20,506
 Daviess        10,197 20,405         Polk        7,880  21,502  Glacier         8,693                                   20,506
 DeKalb         10,197 20,405         Pulaski     7,440  18,701  Golden Valley   8,693                                   20,506
 Dent           7,440  18,701         Putnam      8,548  20,952  Granite         8,693                                   20,506
 Douglas        7,880  21,502         Ralls       8,548  20,952  Hill            8,693                                   20,506
 Dunklin        8,722  22,895         Randolph    8,818  22,273  Jefferson       7,606                                   22,167
 Franklin       8,291  21,100         Ray         10,197 20,405  Judith Basin    7,606                                   22,167
 Gasconade      8,818  22,273         Reynolds    7,440  18,701  Lake            7,863                                   20,820
 Gentry         10,197 20,405         Ripley      7,440  18,701  Lewis and Clark 7,606                                   22,167
 Greene         7,880  21,502         Saline      7,494  19,730  Liberty         8,693                                   20,506
 Grundy         10,197 20,405         Schuyler    8,548  20,952  Lincoln         8,693                                   20,506
 Harrison       10,197 20,405         Scotland    8,548  20,952  Madison         8,693                                   20,506
 Henry          7,494  19,730         Scott       8,722  22,895  McCone          8,693                                   20,506
 Hickory        7,880  21,502         Shannon     7,440  18,701  Meagher         8,693                                   20,506
 Holt           10,197 20,405         Shelby      8,548  20,952  Mineral         8,693                                   20,506
 Howard         8,818  22,273         St. Charles 8,291  21,100  Missoula        7,863                                   20,820
 Howell         7,440  18,701         St. Clair   7,494  19,730  Musselshell     8,123                                   22,023

2024 Average Premium Tables                                                                                                    21

Page 22 of 31    Fileid: … -form-8941/2024/a/xml/cycle04/source            15:54 - 20-Nov-2024

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

 Park           8,693 20,506          Dodge        8,710 24,343  Seward      9,037                                       25,222
 Petroleum      8,693 20,506          Douglas      8,710 24,343  Sheridan    9,959                                       25,388
 Phillips       8,693 20,506          Dundy        9,959 25,388  Sherman     9,372                                       27,787
 Pondera        8,693 20,506          Fillmore     9,037 25,222  Sioux       9,959                                       25,388
 Powder River   8,693 20,506          Franklin     9,372 27,787  Stanton     9,372                                       27,787
 Powell         8,693 20,506          Frontier     9,959 25,388  Thayer      9,037                                       25,222
 Prairie        8,693 20,506          Furnas       9,372 27,787  Thomas      9,959                                       25,388
 Ravalli        8,693 20,506          Gage         9,037 25,222  Thurston    8,710                                       24,343
 Richland       8,693 20,506          Garden       9,959 25,388  Valley      9,372                                       27,787
 Roosevelt      8,693 20,506          Garfield     9,372 27,787  Washington  8,710                                       24,343
 Rosebud        8,693 20,506          Gosper       9,372 27,787  Wayne       9,372                                       27,787
 Sanders        8,693 20,506          Grant        9,959 25,388  Webster     9,372                                       27,787
 Sheridan       8,693 20,506          Greeley      9,372 27,787  Wheeler     9,372                                       27,787
 Silver Bow     7,606 22,167          Hall         9,372 27,787  York        9,037                                       25,222
 Stillwater     8,123 22,023          Hamilton     9,372 27,787
 Sweet Grass    8,123 22,023          Harlan       9,372 27,787 Nevada
 Teton          7,606 22,167          Hayes        9,959 25,388              Employee- Dependent,
 Toole          8,693 20,506          Hitchcock    9,959 25,388 County       Only                                        Family, etc.
 Treasure       8,693 20,506          Holt         9,372 27,787 Carson City  8,478                                       22,103
 Valley         8,693 20,506          Hooker       9,959 25,388  Churchill   9,240                                       25,254
 Wheatland      8,693 20,506          Howard       9,372 27,787  Clark       8,353                                       20,646
 Wibaux         8,693 20,506          Jefferson    9,037 25,222  Douglas     8,478                                       22,103
 Yellowstone    8,123 22,023          Johnson      9,037 25,222  Elko        9,240                                       25,254
                                      Kearney      9,372 27,787  Esmeralda   9,240                                       25,254
Nebraska                              Keith        9,959 25,388  Eureka      9,240                                       25,254
                Employee- Dependent,  Keya Paha    9,372 27,787  Humboldt    9,240                                       25,254
County          Only  Family, etc.    Kimball      9,959 25,388  Lander      9,240                                       25,254
Adams           9,372 27,787          Knox         9,372 27,787  Lincoln     9,240                                       25,254
 Antelope       9,372 27,787          Lancaster    9,037 25,222  Lyon        8,478                                       22,103
 Arthur         9,959 25,388          Lincoln      9,959 25,388  Mineral     9,240                                       25,254
 Banner         9,959 25,388          Logan        9,959 25,388  Nye         8,353                                       20,646
 Blaine         9,372 27,787          Loup         9,372 27,787  Pershing    9,240                                       25,254
 Boone          9,372 27,787          Madison      9,372 27,787  Storey      8,478                                       22,103
 Box Butte      9,959 25,388          McPherson    9,959 25,388  Washoe      8,941                                       21,180
 Boyd           9,372 27,787          Merrick      9,372 27,787  White Pine  9,240                                       25,254
 Brown          9,959 25,388          Morrill      9,959 25,388
                                                                New Hampshire
 Buffalo        9,372 27,787          Nance        9,372 27,787
 Burt           8,710 24,343          Nemaha       9,037 25,222              Employee- Dependent,
 Butler         9,372 27,787          Nuckolls     9,372 27,787 County       Only                                        Family, etc.
 Cass           8,710 24,343          Otoe         9,037 25,222 All          8,591                                       26,225

 Cedar          9,372 27,787          Pawnee       9,037 25,222 New Jersey
 Chase          9,959 25,388          Perkins      9,959 25,388
 Cherry         9,959 25,388          Phelps       9,372 27,787              Employee- Dependent,
                                                                County       Only                                        Family, etc.
 Cheyenne       9,959 25,388          Pierce       9,372 27,787
                                                                All          9,236                                       27,428
 Clay           9,372 27,787          Platte       9,372 27,787
 Colfax         9,372 27,787          Polk         9,372 27,787 New Mexico
 Cuming         9,372 27,787          Red Willow   9,959 25,388
                                                                             Employee- Dependent,
 Custer         9,372 27,787          Richardson   9,037 25,222 County       Only                                        Family, etc.
 Dakota         9,372 27,787          Rock         9,372 27,787 Bernalillo   8,237                                       23,762
 Dawes          9,959 25,388          Saline       9,037 25,222  Catron      9,379                                       29,015
 Dawson         9,372 27,787          Sarpy        8,710 24,343  Chaves      9,379                                       29,015
 Deuel          9,959 25,388          Saunders     8,710 24,343  Cibola      9,379                                       29,015
 Dixon          9,372 27,787          Scotts Bluff 9,959 25,388

             22                                                     2024 Average Premium Tables