Family Size

Gross Income

Monthly/Annual

1-  Person

Covered

2-people Covered

3+ people covered

1

$584.00-604.00/$7,248

$11/$132

XXXXXXXXXXX

XXXXXXXX

$1,014-1034 /$12,408

$32/$384

XXXXXXXXXXX

XXXXXXXX

$1,111-1,131/$13,572

$43/$516

XXXXXXXXXXX

XXXXXXXX

$1,310/$15,715

$63/$756

XXXXXXXXXXX

XXXXXXXX

2

$744.00-771.00/$9,090

$7/$84

$14/$168

XXXXXXXX

$986-1,013/$12,156

$12/$144

$24/$288

XXXXXXXX

$1579 –1606/$19,272

$30/$360

$61/$732

XXXXXXXX

$2709 -2737/$32,844

$120/$1,440

$240/$2,880

XXXXXXXX

3

$1,255-1,289/$15,468

$10/$1,200

$20/$240

$29/$348

$1973 – 2007/ $24,084

$25/$300

$50/$600

$76/$912

$2,143-2,178/$26,136

$35/$420

$69/$828

$104/$1,248

$2,519-2,553/$30,636

$50/$600

$100/$1,200

$150/$1,800

$3408 – 3443/$41,316

$100/$1,200

$201/$2,412

$301/$3,612

4

$1,533-1,575/$18,900

$12/$144

$24/$288

$36/$432

$2,156 – 2,198/$26,376

$28/336

$55/$660

$83/$996

$2,654-2,695/$32,340

$43/$516

$86/$1,032

$128/$1,536

$3,027-3,069/$36,828

$60/$720

$120/$1,440

$180/$2,160

$4107-4148/$49,776

$121/$1,452

$242/$2,904

$363/$4,356

5

$1,763-1,812/$21,744

$14/$168

$27/$324

$41/$492

$2,646-2,695/$32,340

$34/$408

$68/$816

$101/$1,212

$3,136-3,185/$38,220

$51/$612

$101/$1,212

$152/$1,824

$3529 – 3578/ $42,936

$70/$840

$140/$1,680

$210/$2,520

$4805 – 4854/$58,248

$142/$1,704

$283/$3,396

$425/$5,100