Add a 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 more information
Add Dependents Over Age 21 and Over
   
Tax Household Member
For example, if your coverge began May 1, 2023, enter the age of each person as of May 1, 2023. Round up if any household member had a birthday in the month your coverage started. Member's Age on Coverage Start Date more information
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)