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Add a Spouse
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Add Spouse
Only up to 3 dependents age 20 and under are calculated in the SLCSP monthly premium, even if you have more than 3 depends age 20 and under in your tax household.
Dependents Age 20 and Under
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Add 1
Add 2
Add 3
Add Dependents Over Age 21 and Over
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Add 1
Add 2
Add 3
Add 4
Add 5
Add 6
Tax Household Member
For example, if your coverge began May 1, 2022, enter the age of each person as of May 1, 2022. Round up if any household member had a birthday in that month.
Member's Age on Coverage Start Date
Primary Subscriber
Spouse
Dependent Age 20 and Under
Dependent Age 20 and Under
Dependent Age 20 and Under
Dependent Age 20 and Under
Dependent Age 20 and Under
Dependent Age 20 and Under
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Dependent Age 21 and Over
Monthly Premium for the Second Lowest Cost Silver Plan (SLCSP)
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