Program Operations Manual System (POMS)
TN 41 (03-25)
HI 01005.011 Exhibit — Standard Hospital Insurance (HI) Premiums and Surcharges
|
INCLUSIVE PERIOD
|
HI PREMIUM AMOUNT
|
SURCHARGE AMOUNT
|
|
01/25-12/25
|
518.00
|
569.80
|
|
01/24-12/24
|
505.00
|
555.50
|
|
01/23-12/23
|
506.00
|
556.60
|
|
01/22-12/22
|
499.00
|
548.90
|
|
01/21-12/21
|
471.00
|
518.00
|
|
01/20-12/20
|
458.00
|
503.80
|
|
01/19-12/19
|
437.00
|
480.70
|
|
01/18-12/18
|
422.00
|
464.20
|
|
01/17-12/17
|
413.00
|
454.30
|
|
01/16-12/16
|
411.00
|
452.10
|
|
01/15-12/15
|
407.00
|
447.70
|
|
01/14-12/14
|
426.00
|
468.60
|
|
01/13-12/13
|
441.00
|
485.10
|
|
01/12-12/12
|
451.00
|
496.10
|
|
01/11-12/11
|
450.00
|
495.00
|
|
01/10-12/10
|
461.00
|
507.10
|
|
01/09-12/09
|
443.00
|
487.30
|
|
01/08-12/08
|
423.00
|
465.30
|
|
01/07-12/07
|
410.00
|
451.00
|
|
01/06-12/06
|
393.00
|
432.30
|
|
01/05-12/05
|
375.00
|
412.50
|
|
01/04-12/04
|
343.00
|
377.30
|
|
01/03-12/03
|
316.00
|
347.60
|
|
01/02-12/02
|
319.00
|
350.90
|
|
01/01-12/01
|
300.00
|
330.00
|
|
01/00-12/00
|
301.00
|
331.10
|
|
01/98-12/99
|
309.00
|
339.90
|
|
01/97-12/97
|
311.00
|
342.10
|
|
01/96-12/96
|
289.00
|
317.90
|
|
01/95-12/95
|
261.00
|
287.10
|
|
01/94-12/94
|
245.00
|
269.50
|
|
01/93-12/93
|
221.00
|
243.10
|
|
01/92-12/92
|
192.00
|
211.20
|
|
01/91-12/91
|
177.00
|
194.70
|
|
01/90-12/90
|
175.00
|
192.50
|
|
01/89-12/89
|
156.00
|
171.60
|
|
01/88-12/88
|
234.00
|
257.40
|
|
01/87-12/87
|
226.00
|
248.60
|
|
07/86-12/86
|
214.00
|
235.40
|