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. Add Dependents Age 20 and Under

For example, if your coverge began May 1, 2024, enter the age of each person as of May 1, 2024. Round up if any household member had a birthday in the month your coverage started. Member's Age on Coverage Start Date