Program Operations Manual System (POMS)
TN 40 (03-25)
HI 01005.012 Exhibit — Reduced Hospital Insurance (HI) Premiums and Surcharges
|
INCLUSIVE PERIOD
|
REDUCED PREMIUM AMOUNT
|
SURCHARGE AMOUNT
|
|
01/25-12/25
|
285.00
|
313.50
|
| 01/23-12/23 |
278.00 |
305.80 |
|
01/22-12/22
|
$274.00
|
$301.40
|
|
01/21-12/21
|
$259.00
|
$284.90
|
|
01/2020-12/2020
|
252.00
|
277.20
|
| 01/19- 12/19 |
240.00 |
264.00 |
|
01/18–12/18
|
232.00
|
255.20
|
|
01/17–12/17
|
227.00
|
249.70
|
|
01/16–12/16
|
226.00
|
248.60
|
|
01/15-12/15
|
224.00
|
246.40
|
|
01/14–12/14
|
234.00
|
257.40
|
|
01/13-12/13
|
243.00
|
267.30
|
|
01/12-12/12
|
248.00
|
272.80
|
|
01/11-12/11
|
248.00
|
272.80
|
|
01/10-12/10
|
254.00
|
279.40
|
|
01/09-12/09
|
244.00
|
268.40
|
|
01/08-12/08
|
233.00
|
256.30
|
|
01/07-12/07
|
226.00
|
248.60
|
|
01/06-12/06
|
216.00
|
237.60
|
|
01/05-12/05
|
206.00
|
226.60
|
|
01/04-12/04
|
189.00
|
207.90
|
|
01/03-12/03
|
174.00
|
191.40
|
|
01/02-12/02
|
175.00
|
192.50
|
|
01/01-12/01
|
165.00
|
181.50
|
|
01/00-12/00
|
166.00
|
182.60
|
|
01/98-12/99
|
170.00
|
187.00
|
|
01/97-12/97
|
187.00
|
205.70
|
|
01/96-12/96
|
188.00
|
206.80
|
|
01/95-12/95
|
183.00
|
201.30
|
|
01/94-12/94
|
184.00
|
202.40
|