TN 21 (09-01)

HI 01001.002 Premium Payable and Surcharges--2001

A. POLICY

Premium surcharges for late enrollment (see HI 01001.010) are added to the base premium amount.

The 340% premium amount given in HI 01001.001B. is effective 7/01, for enrollments during the 2001 general enrollment period (GEP).

B. LIST OF PREMIUM AND SURCHARGE AMOUNTS

Base Premium and Surcharge Amounts Payable for 2001:

Base

-

50.00

10%

-

55.00

20%

-

60.00

30%

-

65.00

40%

-

70.00

   

50%

-

75.00

60%

-

80.00

70%

-

85.00

80%

-

90.00

90%

-

95.00

   

100%

-

100.00

110%

-

105.00

120%

-

110.00

130%

-

115.00

140%

-

120.00

   

150%

-

125.00

160%

-

130.00

170%

-

135.00

180%

-

140.00

190%

-

145.00

   

200%

-

150.00

210%

-

155.00

220%

-

160.00

230%

-

165.00

240%

-

170.00

   

250%

-

175.00

260%

-

180.00

270%

-

185.00