| Premium Unit Size 1 | Monthly Premium | Premium Unit Size 2 | Monthly Premium | Premium Unit Size 3 | Monthly Premium |
|---|---|---|---|---|---|
| 1671 - 1850 | $17 | 2248 - 2489 | $22 | 2823 - 3127 | $28 |
| 1850 - 2030 | $23 | 2489 - 2730 | $31 | 3127- 3433 | $39 |
| 2030 - 2211 | $30 | 2730 - 2973 | $41 | 3433 - 3738 | $51 |
| 2211 - 2391 | $39 | 2973 - 3216 | $52 | 3738 - 4043 | $65 |
| 2391 - 2572 | $48 | 3216 - 3459 | $64 | 4043 - 4348 | $81 |
| 2572 - 2752 | $58 | 3459 - 3702 | $78 | 4348 - 4653 | $98 |
| 2752 - 2933 | $69 | 3702 - 3945 | $93 | 4653 - 4958 | $116 |
| 2933 - 3113 | $81 | 3945 - 4187 | $109 | 4958 - 5264 | $136 |
| 3113 - 3294 | $93 | 4187 - 4430 | $126 | 5264 - 5569 | $158 |
| 3294 - 3474 | $107 | 4430 - 4673 | $144 | 5569 - 5874 | $181 |
| 3474 - 3655 | $122 | 4673 - 4916 | $164 | 5874 - 6179 | $206 |
| 3655 - 3835 | $137 | 4916 - 5159 | $184 | 6179 - 6484 | $232 |
| 3835 - 4016 | $153 | 5159 - 5402 | $206 | 6484 - 6789 | $259 |
| 4016 - 4196 | $171 | 5402 - 5644 | $230 | 6789 - 7095 | $289 |
| 4196 - 4377 | $189 | 5644 - 5887 | $254 | 7095 - 7400 | $319 |
| 4377 - 4557 | $208 | 5887 - 6130 | $280 | 7400 - 7705 | $352 |
If the gross income is higher than the amounts on this chart then the premium amount is 5% of the gross.