SFY 2020 Hourly Co-pay

Family Cost Participation Tables

Effective: July 1, 2019

NJEIS Family Cost Participation Table 2 of 12 Effective Date: July 1, 2019

Family Cost Participation Tables Instructions

1. If a family’s income is below 300% Federal Poverty Level (FPL), they will have no costparticipation. The 300% FPL table below identifies the starting income for assessing familycost participation.

300% FPL Table

2. A family’s co-pay will never exceed the actual hourly cost of service.

3. If the family size is greater than 8, call DOH-NJEIS for the family’s monthly costparticipation.

4. A family may estimate their co-payment by calculating wages/fees/commissions, interest,dividends, pensions, annuities, IRA withdrawals, and other personal and business income andthen using the total, locate that amount on the Family Cost Participation Table and then lookunder the appropriate family size for the family’s estimated hourly co-payment. This onlyserves as an estimate of the family co-pay pending an NJEIS determined income and co-payprovided through the Family Cost Participation Notice which then serves as the basis forbilling.

5. If a family’s income exceeds the highest income level on the table, the hourly co-pay will bethe actual cost of the service based on the NJEIS Provider Rates. The family’s monthlymaximum Family Cost Participation will be the maximum monthly family cost participationat $440,000 plus 0.375% of the family's incremental annual income above $440,000.

Family Size 2 3 4 5 6 7 8 300% FPL $50,730 $63,990 $77,250 $90,510 $103,770 $117,030 $130,290

Monthly Billing Worksheet

1. Enter the hourly co-pay from the table.

2. Enter the estimated number of hours of service a family will receive in a month.

3. Calculate the estimated monthly cost of service by multiplying line 1 times 2.

4. Enter the monthly maximum cost participation from the table.

5. Take the lesser of line 3, or 4. This is the family’s estimated monthly family costparticipation.

New Jersey Early Intervention SystemFamily Co Pay Tables

The Hourly Co-Pay is pro-rated in 15 minute increments for billing purposes.

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max$0 $45,000 - - - - - - - - - - - - - -

$45,000 $45,500 - - - - - - - - - - - - - - $45,500 $46,000 - - - - - - - - - - - - - - $46,000 $46,500 - - - - - - - - - - - - - - $46,500 $47,000 - - - - - - - - - - - - - - $47,000 $47,500 - - - - - - - - - - - - - - $47,500 $48,000 - - - - - - - - - - - - - - $48,000 $48,500 - - - - - - - - - - - - - - $48,500 $49,000 - - - - - - - - - - - - - - $49,000 $49,500 - - - - - - - - - - - - - - $49,500 $50,000 - - - - - - - - - - - - - - $50,000 $50,500 - - - - - - - - - - - - - - $50,500 $51,000 - - - - - - - - - - - - - - $51,000 $51,500 2.00 170.00 - - - - - - - - - - - - $51,500 $52,000 2.00 171.67 - - - - - - - - - - - - $52,000 $52,500 2.00 173.33 - - - - - - - - - - - - $52,500 $53,000 2.00 175.00 - - - - - - - - - - - - $53,000 $53,500 3.00 176.67 - - - - - - - - - - - - $53,500 $54,000 3.00 178.33 - - - - - - - - - - - - $54,000 $54,500 3.00 180.00 - - - - - - - - - - - - $54,500 $55,000 3.00 181.67 - - - - - - - - - - - - $55,000 $55,500 4.00 183.33 - - - - - - - - - - - - $55,500 $56,000 4.00 185.00 - - - - - - - - - - - - $56,000 $56,500 4.00 186.67 - - - - - - - - - - - - $56,500 $57,000 4.00 188.33 - - - - - - - - - - - - $57,000 $57,500 4.00 190.00 - - - - - - - - - - - - $57,500 $58,000 5.00 191.67 - - - - - - - - - - - - $58,000 $58,500 5.00 193.33 - - - - - - - - - - - - $58,500 $59,000 5.00 195.00 - - - - - - - - - - - - $59,000 $59,500 5.00 196.67 - - - - - - - - - - - - $59,500 $60,000 6.00 198.46 - - - - - - - - - - - - $60,000 $60,500 6.00 200.34 - - - - - - - - - - - - $60,500 $61,000 6.00 202.21 - - - - - - - - - - - - $61,000 $61,500 7.00 204.09 - - - - - - - - - - - - $61,500 $62,000 7.00 205.96 - - - - - - - - - - - - $62,000 $62,500 7.00 207.84 - - - - - - - - - - - - $62,500 $63,000 7.00 209.71 - - - - - - - - - - - - $63,000 $63,500 7.00 211.59 - - - - - - - - - - - - $63,500 $64,000 7.00 213.46 - - - - - - - - - - - - $64,000 $64,500 8.00 215.34 2.00 213.33 - - - - - - - - - - $64,500 $65,000 8.00 217.21 2.00 215.00 - - - - - - - - - - $65,000 $65,500 8.00 219.09 2.00 216.67 - - - - - - - - - - $65,500 $66,000 8.00 220.96 2.00 218.33 - - - - - - - - - - $66,000 $66,500 8.00 222.84 2.00 220.00 - - - - - - - - - - $66,500 $67,000 8.00 224.71 2.00 221.67 - - - - - - - - - - $67,000 $67,500 8.00 226.59 3.00 223.33 - - - - - - - - - - $67,500 $68,000 9.00 228.46 3.00 225.00 - - - - - - - - - - $68,000 $68,500 9.00 230.34 3.00 226.67 - - - - - - - - - - $68,500 $69,000 9.00 232.21 3.00 228.33 - - - - - - - - - - $69,000 $69,500 9.00 234.09 3.00 230.00 - - - - - - - - - - $69,500 $70,000 9.00 235.96 4.00 231.67 - - - - - - - - - - $70,000 $70,500 9.00 237.84 4.00 233.33 - - - - - - - - - - $70,500 $71,000 10.00 239.71 4.00 235.00 - - - - - - - - - - $71,000 $71,500 10.00 241.59 4.00 236.67 - - - - - - - - - - $71,500 $72,000 10.00 243.46 4.00 238.33 - - - - - - - - - - $72,000 $72,500 10.00 245.34 4.00 240.00 - - - - - - - - - - $72,500 $73,000 10.00 247.21 5.00 241.67 - - - - - - - - - - $73,000 $73,500 10.00 249.09 5.00 243.33 - - - - - - - - - - $73,500 $74,000 10.00 250.96 5.00 245.00 - - - - - - - - - - $74,000 $74,500 11.00 252.84 5.00 246.67 - - - - - - - - - - $74,500 $75,000 11.00 254.71 5.00 248.33 - - - - - - - - - - $75,000 $75,500 11.00 256.59 6.00 250.14 - - - - - - - - - - $75,500 $76,000 11.00 258.46 6.00 252.02 - - - - - - - - - - $76,000 $76,500 11.00 260.34 6.00 253.89 - - - - - - - - - - $76,500 $77,000 11.00 262.21 7.00 255.77 - - - - - - - - - - $77,000 $77,500 12.00 264.09 7.00 257.64 - - - - - - - - - - $77,500 $78,000 12.00 265.96 7.00 259.52 2.00 258.33 - - - - - - - - $78,000 $78,500 12.00 267.84 7.00 261.39 2.00 260.00 - - - - - - - - $78,500 $79,000 12.00 269.71 7.00 263.27 2.00 261.67 - - - - - - - - $79,000 $79,500 12.00 271.59 7.00 265.14 2.00 263.33 - - - - - - - - $79,500 $80,000 13.00 273.46 8.00 267.02 2.00 265.00 - - - - - - - -

7 8Determined Income is

2 3 4 5 6

NJEIS Family Cost Participation Table Page 3 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$80,000 $80,500 13.00 275.34 8.00 268.89 2.00 266.67 - - - - - - - - $80,500 $81,000 13.00 277.21 8.00 270.77 2.00 268.33 - - - - - - - - $81,000 $81,500 13.00 279.09 8.00 272.64 3.00 270.00 - - - - - - - - $81,500 $82,000 13.00 280.96 8.00 274.52 3.00 271.67 - - - - - - - - $82,000 $82,500 13.00 282.84 8.00 276.39 3.00 273.33 - - - - - - - - $82,500 $83,000 14.00 284.71 8.00 278.27 3.00 275.00 - - - - - - - - $83,000 $83,500 14.00 286.59 9.00 280.14 3.00 276.67 - - - - - - - - $83,500 $84,000 14.00 288.46 9.00 282.02 3.00 278.33 - - - - - - - - $84,000 $84,500 14.00 290.34 9.00 283.89 4.00 280.00 - - - - - - - - $84,500 $85,000 14.00 292.21 9.00 285.77 4.00 281.67 - - - - - - - - $85,000 $85,500 15.00 294.09 9.00 287.64 4.00 283.33 - - - - - - - - $85,500 $86,000 15.00 295.96 9.00 289.52 4.00 285.00 - - - - - - - - $86,000 $86,500 15.00 297.84 10.00 291.39 4.00 286.67 - - - - - - - - $86,500 $87,000 15.00 299.71 10.00 293.27 4.00 288.33 - - - - - - - - $87,000 $87,500 15.00 301.59 10.00 295.14 4.00 290.00 - - - - - - - - $87,500 $88,000 15.00 303.46 10.00 297.02 5.00 291.67 - - - - - - - - $88,000 $88,500 16.00 305.34 10.00 298.89 5.00 293.33 - - - - - - - - $88,500 $89,000 16.00 307.21 10.00 300.77 5.00 295.00 - - - - - - - - $89,000 $89,500 16.00 309.09 10.00 302.64 5.00 296.67 - - - - - - - - $89,500 $90,000 16.00 310.96 11.00 304.52 5.00 298.33 - - - - - - - - $90,000 $90,500 16.00 312.84 11.00 306.39 5.00 300.00 - - - - - - - - $90,500 $91,000 17.00 314.71 11.00 308.27 6.00 301.82 - - - - - - - - $91,000 $91,500 17.00 316.59 11.00 310.14 6.00 303.70 2.00 303.33 - - - - - - $91,500 $92,000 17.00 318.46 11.00 312.02 6.00 305.57 2.00 305.00 - - - - - - $92,000 $92,500 17.00 320.34 11.00 313.89 7.00 307.45 2.00 306.67 - - - - - - $92,500 $93,000 17.00 322.21 12.00 315.77 7.00 309.32 2.00 308.33 - - - - - - $93,000 $93,500 17.00 324.09 12.00 317.64 7.00 311.20 2.00 310.00 - - - - - - $93,500 $94,000 18.00 325.96 12.00 319.52 7.00 313.07 2.00 311.67 - - - - - - $94,000 $94,500 18.00 327.84 12.00 321.39 7.00 314.95 2.00 313.33 - - - - - - $94,500 $95,000 18.00 329.71 12.00 323.27 7.00 316.82 3.00 315.00 - - - - - - $95,000 $95,500 18.00 331.59 12.00 325.14 8.00 318.70 3.00 316.67 - - - - - - $95,500 $96,000 19.00 333.46 13.00 327.02 8.00 320.57 3.00 318.33 - - - - - - $96,000 $96,500 19.00 335.34 13.00 328.89 8.00 322.45 3.00 320.00 - - - - - - $96,500 $97,000 19.00 337.21 13.00 330.77 8.00 324.32 3.00 321.67 - - - - - - $97,000 $97,500 19.00 339.09 13.00 332.64 8.00 326.20 3.00 323.33 - - - - - - $97,500 $98,000 20.00 340.96 13.00 334.52 8.00 328.07 3.00 325.00 - - - - - - $98,000 $98,500 20.00 342.84 13.00 336.39 8.00 329.95 3.00 326.67 - - - - - - $98,500 $99,000 20.00 344.71 14.00 338.27 9.00 331.82 4.00 328.33 - - - - - - $99,000 $99,500 20.00 346.59 14.00 340.14 9.00 333.70 4.00 330.00 - - - - - - $99,500 $100,000 21.00 348.46 14.00 342.02 9.00 335.57 4.00 331.67 - - - - - -

$100,000 $100,500 21.00 350.34 14.00 343.89 9.00 337.45 4.00 333.33 - - - - - - $100,500 $101,000 21.00 352.21 14.00 345.77 9.00 339.32 4.00 335.00 - - - - - - $101,000 $101,500 21.00 354.09 14.00 347.64 9.00 341.20 4.00 336.67 - - - - - - $101,500 $102,000 22.00 355.96 15.00 349.52 10.00 343.07 4.00 338.33 - - - - - - $102,000 $102,500 22.00 357.84 15.00 351.39 10.00 344.95 5.00 340.00 - - - - - - $102,500 $103,000 22.00 359.71 15.00 353.27 10.00 346.82 5.00 341.67 - - - - - - $103,000 $103,500 22.00 361.59 15.00 355.14 10.00 348.70 5.00 343.33 - - - - - - $103,500 $104,000 22.00 363.46 15.00 357.02 10.00 350.57 5.00 345.00 - - - - - - $104,000 $104,500 23.00 365.34 16.00 358.89 10.00 352.45 5.00 346.67 2.00 346.67 - - - - $104,500 $105,000 23.00 367.21 16.00 360.77 10.00 354.32 5.00 348.33 2.00 348.33 - - - - $105,000 $105,500 23.00 369.09 16.00 362.64 11.00 356.20 5.00 350.00 2.00 350.00 - - - - $105,500 $106,000 23.00 370.96 16.00 364.52 11.00 358.07 5.00 351.67 2.00 351.67 - - - - $106,000 $106,500 24.00 372.84 16.00 366.39 11.00 359.95 6.00 353.50 2.00 353.33 - - - - $106,500 $107,000 24.00 374.71 16.00 368.27 11.00 361.82 6.00 355.38 2.00 355.00 - - - - $107,000 $107,500 24.00 376.59 17.00 370.14 11.00 363.70 6.00 357.25 2.00 356.67 - - - - $107,500 $108,000 24.00 378.46 17.00 372.02 11.00 365.57 7.00 359.13 2.00 358.33 - - - - $108,000 $108,500 25.00 380.34 17.00 373.89 12.00 367.45 7.00 361.00 2.00 360.00 - - - - $108,500 $109,000 25.00 382.21 17.00 375.77 12.00 369.32 7.00 362.88 3.00 361.67 - - - - $109,000 $109,500 25.00 384.09 17.00 377.64 12.00 371.20 7.00 364.75 3.00 363.33 - - - - $109,500 $110,000 25.00 385.96 18.00 379.52 12.00 373.07 7.00 366.63 3.00 365.00 - - - - $110,000 $110,500 26.00 387.84 18.00 381.39 12.00 374.95 7.00 368.50 3.00 366.67 - - - - $110,500 $111,000 26.00 389.71 18.00 383.27 12.00 376.82 8.00 370.38 3.00 368.33 - - - - $111,000 $111,500 26.00 391.59 18.00 385.14 13.00 378.70 8.00 372.25 3.00 370.00 - - - - $111,500 $112,000 27.00 393.46 18.00 387.02 13.00 380.57 8.00 374.13 3.00 371.67 - - - - $112,000 $112,500 27.00 395.34 19.00 388.89 13.00 382.45 8.00 376.00 3.00 373.33 - - - - $112,500 $113,000 27.00 397.21 19.00 390.77 13.00 384.32 8.00 377.88 4.00 375.00 - - - - $113,000 $113,500 28.00 399.09 19.00 392.64 13.00 386.20 8.00 379.75 4.00 376.67 - - - - $113,500 $114,000 28.00 400.96 19.00 394.52 13.00 388.07 8.00 381.63 4.00 378.33 - - - - $114,000 $114,500 28.00 402.84 19.00 396.39 13.00 389.95 9.00 383.50 4.00 380.00 - - - - $114,500 $115,000 29.00 404.71 19.00 398.27 14.00 391.82 9.00 385.38 4.00 381.67 - - - - $115,000 $115,500 29.00 406.59 20.00 400.14 14.00 393.70 9.00 387.25 4.00 383.33 - - - - $115,500 $116,000 29.00 408.46 20.00 402.02 14.00 395.57 9.00 389.13 4.00 385.00 - - - - $116,000 $116,500 30.00 410.34 20.00 403.89 14.00 397.45 9.00 391.00 4.00 386.67 - - - - $116,500 $117,000 30.00 412.21 20.00 405.77 14.00 399.32 9.00 392.88 4.00 388.33 - - - - $117,000 $117,500 30.00 414.09 20.00 407.64 14.00 401.20 10.00 394.75 5.00 390.00 - - - - $117,500 $118,000 31.00 415.96 21.00 409.52 15.00 403.07 10.00 396.63 5.00 391.67 2.00 391.67 - - $118,000 $118,500 31.00 417.84 21.00 411.39 15.00 404.95 10.00 398.50 5.00 393.33 2.00 393.33 - - $118,500 $119,000 31.00 419.71 21.00 413.27 15.00 406.82 10.00 400.38 5.00 395.00 2.00 395.00 - - $119,000 $119,500 32.00 421.59 21.00 415.14 15.00 408.70 10.00 402.25 5.00 396.67 2.00 396.67 - - $119,500 $120,000 32.00 423.46 21.00 417.02 15.00 410.57 10.00 404.13 5.00 398.33 2.00 398.33 - -

NJEIS Family Cost Participation Table Page 4 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$120,000 $120,500 32.00 425.34 22.00 418.89 16.00 412.45 11.00 406.00 5.00 400.00 2.00 400.00 - - $120,500 $121,000 33.00 427.21 22.00 420.77 16.00 414.32 11.00 407.88 5.00 401.67 2.00 401.67 - - $121,000 $121,500 33.00 429.09 22.00 422.64 16.00 416.20 11.00 409.75 5.00 403.33 2.00 403.33 - - $121,500 $122,000 33.00 430.96 22.00 424.52 16.00 418.07 11.00 411.63 6.00 405.18 2.00 405.00 - - $122,000 $122,500 34.00 432.84 23.00 426.39 16.00 419.95 11.00 413.50 6.00 407.06 2.00 406.67 - - $122,500 $123,000 34.00 434.71 23.00 428.27 16.00 421.82 11.00 415.38 6.00 408.93 3.00 408.33 - - $123,000 $123,500 34.00 436.59 23.00 430.14 17.00 423.70 11.00 417.25 7.00 410.81 3.00 410.00 - - $123,500 $124,000 35.00 438.46 23.00 432.02 17.00 425.57 12.00 419.13 7.00 412.68 3.00 411.67 - - $124,000 $124,500 35.00 440.34 24.00 433.89 17.00 427.45 12.00 421.00 7.00 414.56 3.00 413.33 - - $124,500 $125,000 35.00 442.21 24.00 435.77 17.00 429.32 12.00 422.88 7.00 416.43 3.00 415.00 - - $125,000 $125,500 36.00 444.09 24.00 437.64 17.00 431.20 12.00 424.75 7.00 418.31 3.00 416.67 - - $125,500 $126,000 36.00 445.96 24.00 439.52 18.00 433.07 12.00 426.63 7.00 420.18 3.00 418.33 - - $126,000 $126,500 36.00 447.84 25.00 441.39 18.00 434.95 12.00 428.50 8.00 422.06 3.00 420.00 - - $126,500 $127,000 37.00 449.71 25.00 443.27 18.00 436.82 13.00 430.38 8.00 423.93 3.00 421.67 - - $127,000 $127,500 37.00 451.59 25.00 445.14 18.00 438.70 13.00 432.25 8.00 425.81 4.00 423.33 - - $127,500 $128,000 37.00 453.46 25.00 447.02 18.00 440.57 13.00 434.13 8.00 427.68 4.00 425.00 - - $128,000 $128,500 38.00 455.34 26.00 448.89 18.00 442.45 13.00 436.00 8.00 429.56 4.00 426.67 - - $128,500 $129,000 38.00 457.21 26.00 450.77 19.00 444.32 13.00 437.88 8.00 431.43 4.00 428.33 - - $129,000 $129,500 38.00 459.09 26.00 452.64 19.00 446.20 13.00 439.75 8.00 433.31 4.00 430.00 - - $129,500 $130,000 39.00 460.96 26.00 454.52 19.00 448.07 13.00 441.63 9.00 435.18 4.00 431.67 - - $130,000 $130,500 39.00 462.84 27.00 456.39 19.00 449.95 14.00 443.50 9.00 437.06 4.00 433.33 - - $130,500 $131,000 39.00 464.71 27.00 458.27 19.00 451.82 14.00 445.38 9.00 438.93 4.00 435.00 2.00 435.00 $131,000 $131,500 40.00 466.59 27.00 460.14 20.00 453.70 14.00 447.25 9.00 440.81 4.00 436.67 2.00 436.67 $131,500 $132,000 40.00 468.46 27.00 462.02 20.00 455.57 14.00 449.13 9.00 442.68 4.00 438.33 2.00 438.33 $132,000 $132,500 40.00 470.34 27.00 463.89 20.00 457.45 14.00 451.00 9.00 444.56 5.00 440.00 2.00 440.00 $132,500 $133,000 41.00 472.21 28.00 465.77 20.00 459.32 14.00 452.88 10.00 446.43 5.00 441.67 2.00 441.67 $133,000 $133,500 41.00 474.09 28.00 467.64 20.00 461.20 15.00 454.75 10.00 448.31 5.00 443.33 2.00 443.33 $133,500 $134,000 41.00 475.96 28.00 469.52 20.00 463.07 15.00 456.63 10.00 450.18 5.00 445.00 2.00 445.00 $134,000 $134,500 42.00 477.84 28.00 471.39 21.00 464.95 15.00 458.50 10.00 452.06 5.00 446.67 2.00 446.67 $134,500 $135,000 42.00 479.71 29.00 473.27 21.00 466.82 15.00 460.38 10.00 453.93 5.00 448.33 2.00 448.33 $135,000 $135,500 43.00 481.59 29.00 475.14 21.00 468.70 15.00 462.25 10.00 455.81 5.00 450.00 2.00 450.00 $135,500 $136,000 43.00 483.46 29.00 477.02 21.00 470.57 15.00 464.13 11.00 457.68 5.00 451.67 2.00 451.67 $136,000 $136,500 43.00 485.34 29.00 478.89 21.00 472.45 16.00 466.00 11.00 459.56 5.00 453.33 3.00 453.33 $136,500 $137,000 44.00 487.21 30.00 480.77 22.00 474.32 16.00 467.88 11.00 461.43 5.00 455.00 3.00 455.00 $137,000 $137,500 44.00 489.09 30.00 482.64 22.00 476.20 16.00 469.75 11.00 463.31 6.00 456.86 3.00 456.67 $137,500 $138,000 44.00 490.96 30.00 484.52 22.00 478.07 16.00 471.63 11.00 465.18 6.00 458.74 3.00 458.33 $138,000 $138,500 45.00 492.84 30.00 486.39 22.00 479.95 16.00 473.50 11.00 467.06 6.00 460.61 3.00 460.00 $138,500 $139,000 45.00 494.71 31.00 488.27 22.00 481.82 16.00 475.38 11.00 468.93 7.00 462.49 3.00 461.67 $139,000 $139,500 45.00 496.59 31.00 490.14 22.00 483.70 17.00 477.25 12.00 470.81 7.00 464.36 3.00 463.33 $139,500 $140,000 46.00 498.46 31.00 492.02 23.00 485.57 17.00 479.13 12.00 472.68 7.00 466.24 3.00 465.00 $140,000 $140,500 46.00 500.34 32.00 493.89 23.00 487.45 17.00 481.00 12.00 474.56 7.00 468.11 3.00 466.67 $140,500 $141,000 46.00 502.21 32.00 495.77 23.00 489.32 17.00 482.88 12.00 476.43 7.00 469.99 3.00 468.33 $141,000 $141,500 47.00 504.09 32.00 497.64 23.00 491.20 17.00 484.75 12.00 478.31 7.00 471.86 3.00 470.00 $141,500 $142,000 47.00 505.96 33.00 499.52 23.00 493.07 18.00 486.63 12.00 480.18 8.00 473.74 4.00 471.67 $142,000 $142,500 47.00 507.84 33.00 501.39 24.00 494.95 18.00 488.50 13.00 482.06 8.00 475.61 4.00 473.33 $142,500 $143,000 48.00 509.71 33.00 503.27 24.00 496.82 18.00 490.38 13.00 483.93 8.00 477.49 4.00 475.00 $143,000 $143,500 48.00 511.59 34.00 505.14 24.00 498.70 18.00 492.25 13.00 485.81 8.00 479.36 4.00 476.67 $143,500 $144,000 48.00 513.46 34.00 507.02 24.00 500.57 18.00 494.13 13.00 487.68 8.00 481.24 4.00 478.33 $144,000 $144,500 49.00 515.34 34.00 508.89 25.00 502.45 18.00 496.00 13.00 489.56 8.00 483.11 4.00 480.00 $144,500 $145,000 49.00 517.21 35.00 510.77 25.00 504.32 19.00 497.88 13.00 491.43 8.00 484.99 4.00 481.67 $145,000 $145,500 50.00 519.09 35.00 512.64 25.00 506.20 19.00 499.75 13.00 493.31 9.00 486.86 4.00 483.33 $145,500 $146,000 50.00 520.96 35.00 514.52 25.00 508.07 19.00 501.63 14.00 495.18 9.00 488.74 4.00 485.00 $146,000 $146,500 50.00 522.84 36.00 516.39 26.00 509.95 19.00 503.50 14.00 497.06 9.00 490.61 4.00 486.67 $146,500 $147,000 51.00 524.71 36.00 518.27 26.00 511.82 19.00 505.38 14.00 498.93 9.00 492.49 4.00 488.33 $147,000 $147,500 51.00 526.59 36.00 520.14 26.00 513.70 20.00 507.25 14.00 500.81 9.00 494.36 5.00 490.00 $147,500 $148,000 51.00 528.46 37.00 522.02 26.00 515.57 20.00 509.13 14.00 502.68 9.00 496.24 5.00 491.67 $148,000 $148,500 52.00 530.34 37.00 523.89 26.00 517.45 20.00 511.00 14.00 504.56 10.00 498.11 5.00 493.33 $148,500 $149,000 52.00 532.21 37.00 525.77 27.00 519.32 20.00 512.88 15.00 506.43 10.00 499.99 5.00 495.00 $149,000 $149,500 52.00 534.09 38.00 527.64 27.00 521.20 20.00 514.75 15.00 508.31 10.00 501.86 5.00 496.67 $149,500 $150,000 53.00 535.96 38.00 529.52 27.00 523.07 20.00 516.63 15.00 510.18 10.00 503.74 5.00 498.33 $150,000 $150,500 53.00 537.84 38.00 531.39 27.00 524.95 21.00 518.50 15.00 512.06 10.00 505.61 5.00 500.00 $150,500 $151,000 54.00 539.71 39.00 533.27 28.00 526.82 21.00 520.38 15.00 513.93 10.00 507.49 5.00 501.67 $151,000 $151,500 54.00 541.59 39.00 535.14 28.00 528.70 21.00 522.25 15.00 515.81 11.00 509.36 5.00 503.33 $151,500 $152,000 54.00 543.46 39.00 537.02 28.00 530.57 21.00 524.13 16.00 517.68 11.00 511.24 5.00 505.00 $152,000 $152,500 55.00 545.34 40.00 538.89 28.00 532.45 21.00 526.00 16.00 519.56 11.00 513.11 5.00 506.67 $152,500 $153,000 55.00 547.21 40.00 540.77 29.00 534.32 22.00 527.88 16.00 521.43 11.00 514.99 6.00 508.54 $153,000 $153,500 55.00 549.09 40.00 542.64 29.00 536.20 22.00 529.75 16.00 523.31 11.00 516.86 6.00 510.41 $153,500 $154,000 56.00 550.96 41.00 544.52 29.00 538.07 22.00 531.63 16.00 525.18 11.00 518.74 6.00 512.29 $154,000 $154,500 56.00 552.84 41.00 546.39 29.00 539.95 22.00 533.50 16.00 527.06 11.00 520.61 7.00 514.16 $154,500 $155,000 56.00 554.71 41.00 548.27 30.00 541.82 22.00 535.38 16.00 528.93 12.00 522.49 7.00 516.04 $155,000 $155,500 57.00 556.59 42.00 550.14 30.00 543.70 22.00 537.25 17.00 530.81 12.00 524.36 7.00 517.91 $155,500 $156,000 57.00 558.46 42.00 552.02 30.00 545.57 23.00 539.13 17.00 532.68 12.00 526.24 7.00 519.79 $156,000 $156,500 58.00 560.34 42.00 553.89 30.00 547.45 23.00 541.00 17.00 534.56 12.00 528.11 7.00 521.66 $156,500 $157,000 58.00 562.21 43.00 555.77 31.00 549.32 23.00 542.88 17.00 536.43 12.00 529.99 7.00 523.54 $157,000 $157,500 58.00 564.09 43.00 557.64 31.00 551.20 23.00 544.75 17.00 538.31 12.00 531.86 8.00 525.41 $157,500 $158,000 59.00 565.96 43.00 559.52 31.00 553.07 23.00 546.63 17.00 540.18 13.00 533.74 8.00 527.29 $158,000 $158,500 59.00 567.84 44.00 561.39 31.00 554.95 24.00 548.50 18.00 542.06 13.00 535.61 8.00 529.16 $158,500 $159,000 59.00 569.71 44.00 563.27 32.00 556.82 24.00 550.38 18.00 543.93 13.00 537.49 8.00 531.04 $159,000 $159,500 60.00 571.59 44.00 565.14 32.00 558.70 24.00 552.25 18.00 545.81 13.00 539.36 8.00 532.91 $159,500 $160,000 60.00 573.46 45.00 567.02 32.00 560.57 24.00 554.13 18.00 547.68 13.00 541.24 8.00 534.79

NJEIS Family Cost Participation Table Page 5 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$160,000 $160,500 60.00 575.34 45.00 568.89 32.00 562.45 24.00 556.00 18.00 549.56 13.00 543.11 8.00 536.66 $160,500 $161,000 61.00 577.21 45.00 570.77 32.00 564.32 24.00 557.88 19.00 551.43 13.00 544.99 9.00 538.54 $161,000 $161,500 61.00 579.09 46.00 572.64 33.00 566.20 25.00 559.75 19.00 553.31 14.00 546.86 9.00 540.41 $161,500 $162,000 62.00 580.96 46.00 574.52 33.00 568.07 25.00 561.63 19.00 555.18 14.00 548.74 9.00 542.29 $162,000 $162,500 62.00 582.84 46.00 576.39 33.00 569.95 25.00 563.50 19.00 557.06 14.00 550.61 9.00 544.16 $162,500 $163,000 62.00 584.71 47.00 578.27 33.00 571.82 25.00 565.38 19.00 558.93 14.00 552.49 9.00 546.04 $163,000 $163,500 63.00 586.59 47.00 580.14 34.00 573.70 25.00 567.25 19.00 560.81 14.00 554.36 9.00 547.91 $163,500 $164,000 63.00 588.46 47.00 582.02 34.00 575.57 26.00 569.13 20.00 562.68 14.00 556.24 10.00 549.79 $164,000 $164,500 64.00 590.34 48.00 583.89 34.00 577.45 26.00 571.00 20.00 564.56 15.00 558.11 10.00 551.66 $164,500 $165,000 64.00 592.21 48.00 585.77 34.00 579.32 26.00 572.88 20.00 566.43 15.00 559.99 10.00 553.54 $165,000 $165,500 64.00 594.09 48.00 587.64 35.00 581.20 26.00 574.75 20.00 568.31 15.00 561.86 10.00 555.41 $165,500 $166,000 65.00 595.96 49.00 589.52 35.00 583.07 26.00 576.63 20.00 570.18 15.00 563.74 10.00 557.29 $166,000 $166,500 65.00 597.84 49.00 591.39 35.00 584.95 26.00 578.50 21.00 572.06 15.00 565.61 10.00 559.16 $166,500 $167,000 66.00 599.71 49.00 593.27 35.00 586.82 27.00 580.38 21.00 573.93 15.00 567.49 11.00 561.04 $167,000 $167,500 66.00 601.59 50.00 595.14 36.00 588.70 27.00 582.25 21.00 575.81 16.00 569.36 11.00 562.91 $167,500 $168,000 66.00 603.46 50.00 597.02 36.00 590.57 27.00 584.13 21.00 577.68 16.00 571.24 11.00 564.79 $168,000 $168,500 67.00 605.34 50.00 598.89 36.00 592.45 27.00 586.00 21.00 579.56 16.00 573.11 11.00 566.66 $168,500 $169,000 67.00 607.21 51.00 600.77 37.00 594.32 28.00 587.88 21.00 581.43 16.00 574.99 11.00 568.54 $169,000 $169,500 67.00 609.09 51.00 602.64 37.00 596.20 28.00 589.75 22.00 583.31 16.00 576.86 11.00 570.41 $169,500 $170,000 68.00 610.96 52.00 604.52 37.00 598.07 28.00 591.63 22.00 585.18 16.00 578.74 11.00 572.29 $170,000 $170,500 68.00 612.84 52.00 606.39 38.00 599.95 28.00 593.50 22.00 587.06 16.00 580.61 12.00 574.16 $170,500 $171,000 69.00 614.71 52.00 608.27 38.00 601.82 29.00 595.38 22.00 588.93 17.00 582.49 12.00 576.04 $171,000 $171,500 69.00 616.59 53.00 610.14 38.00 603.70 29.00 597.25 22.00 590.81 17.00 584.36 12.00 577.91 $171,500 $172,000 69.00 618.46 53.00 612.02 39.00 605.57 29.00 599.13 23.00 592.68 17.00 586.24 12.00 579.79 $172,000 $172,500 70.00 620.34 53.00 613.89 39.00 607.45 29.00 601.00 23.00 594.56 17.00 588.11 12.00 581.66 $172,500 $173,000 70.00 622.21 54.00 615.77 39.00 609.32 30.00 602.88 23.00 596.43 17.00 589.99 12.00 583.54 $173,000 $173,500 71.00 624.09 54.00 617.64 40.00 611.20 30.00 604.75 23.00 598.31 17.00 591.86 13.00 585.41 $173,500 $174,000 71.00 625.96 54.00 619.52 40.00 613.07 30.00 606.63 23.00 600.18 18.00 593.74 13.00 587.29 $174,000 $174,500 71.00 627.84 55.00 621.39 40.00 614.95 30.00 608.50 23.00 602.06 18.00 595.61 13.00 589.16 $174,500 $175,000 72.00 629.71 55.00 623.27 41.00 616.82 31.00 610.38 24.00 603.93 18.00 597.49 13.00 591.04 $175,000 $175,500 72.00 631.59 55.00 625.14 41.00 618.70 31.00 612.25 24.00 605.81 18.00 599.36 13.00 592.91 $175,500 $176,000 73.00 633.46 56.00 627.02 41.00 620.57 31.00 614.13 24.00 607.68 18.00 601.24 13.00 594.79 $176,000 $176,500 73.00 635.34 56.00 628.89 42.00 622.45 31.00 616.00 24.00 609.56 18.00 603.11 13.00 596.66 $176,500 $177,000 73.00 637.21 56.00 630.77 42.00 624.32 31.00 617.88 24.00 611.43 19.00 604.99 14.00 598.54 $177,000 $177,500 74.00 639.09 57.00 632.64 42.00 626.20 32.00 619.75 25.00 613.31 19.00 606.86 14.00 600.41 $177,500 $178,000 74.00 640.96 57.00 634.52 43.00 628.07 32.00 621.63 25.00 615.18 19.00 608.74 14.00 602.29 $178,000 $178,500 75.00 642.84 57.00 636.39 43.00 629.95 32.00 623.50 25.00 617.06 19.00 610.61 14.00 604.16 $178,500 $179,000 75.00 644.71 58.00 638.27 43.00 631.82 32.00 625.38 25.00 618.93 19.00 612.49 14.00 606.04 $179,000 $179,500 75.00 646.59 58.00 640.14 44.00 633.70 33.00 627.25 25.00 620.81 19.00 614.36 14.00 607.91 $179,500 $180,000 76.00 648.46 59.00 642.02 44.00 635.57 33.00 629.13 26.00 622.68 20.00 616.24 15.00 609.79 $180,000 $180,500 76.00 650.34 59.00 643.89 44.00 637.45 33.00 631.00 26.00 624.56 20.00 618.11 15.00 611.66 $180,500 $181,000 76.00 652.21 59.00 645.77 45.00 639.32 33.00 632.88 26.00 626.43 20.00 619.99 15.00 613.54 $181,000 $181,500 77.00 654.09 60.00 647.64 45.00 641.20 34.00 634.75 26.00 628.31 20.00 621.86 15.00 615.41 $181,500 $182,000 77.00 655.96 60.00 649.52 45.00 643.07 34.00 636.63 26.00 630.18 20.00 623.74 15.00 617.29 $182,000 $182,500 78.00 657.84 60.00 651.39 46.00 644.95 34.00 638.50 26.00 632.06 21.00 625.61 15.00 619.16 $182,500 $183,000 78.00 659.71 61.00 653.27 46.00 646.82 34.00 640.38 27.00 633.93 21.00 627.49 16.00 621.04 $183,000 $183,500 78.00 661.59 61.00 655.14 46.00 648.70 35.00 642.25 27.00 635.81 21.00 629.36 16.00 622.91 $183,500 $184,000 79.00 663.46 61.00 657.02 47.00 650.57 35.00 644.13 27.00 637.68 21.00 631.24 16.00 624.79 $184,000 $184,500 79.00 665.34 62.00 658.89 47.00 652.45 35.00 646.00 27.00 639.56 21.00 633.11 16.00 626.66 $184,500 $185,000 80.00 667.21 62.00 660.77 47.00 654.32 35.00 647.88 27.00 641.43 21.00 634.99 16.00 628.54 $185,000 $185,500 80.00 669.09 62.00 662.64 48.00 656.20 36.00 649.75 28.00 643.31 22.00 636.86 16.00 630.41 $185,500 $186,000 80.00 670.96 63.00 664.52 48.00 658.07 36.00 651.63 28.00 645.18 22.00 638.74 16.00 632.29 $186,000 $186,500 81.00 672.84 63.00 666.39 48.00 659.95 36.00 653.50 28.00 647.06 22.00 640.61 17.00 634.16 $186,500 $187,000 81.00 674.71 64.00 668.27 49.00 661.82 36.00 655.38 28.00 648.93 22.00 642.49 17.00 636.04 $187,000 $187,500 82.00 676.59 64.00 670.14 49.00 663.70 37.00 657.25 28.00 650.81 22.00 644.36 17.00 637.91 $187,500 $188,000 82.00 678.46 64.00 672.02 49.00 665.57 37.00 659.13 28.00 652.68 23.00 646.24 17.00 639.79 $188,000 $188,500 82.00 680.34 65.00 673.89 50.00 667.45 37.00 661.00 29.00 654.56 23.00 648.11 17.00 641.66 $188,500 $189,000 83.00 682.21 65.00 675.77 50.00 669.32 37.00 662.88 29.00 656.43 23.00 649.99 17.00 643.54 $189,000 $189,500 83.00 684.09 65.00 677.64 50.00 671.20 37.00 664.75 29.00 658.31 23.00 651.86 18.00 645.41 $189,500 $190,000 84.00 685.96 66.00 679.52 51.00 673.07 38.00 666.63 29.00 660.18 23.00 653.74 18.00 647.29 $190,000 $190,500 84.00 687.84 66.00 681.39 51.00 674.95 38.00 668.50 29.00 662.06 23.00 655.61 18.00 649.16 $190,500 $191,000 84.00 689.71 66.00 683.27 51.00 676.82 38.00 670.38 30.00 663.93 24.00 657.49 18.00 651.04 $191,000 $191,500 85.00 691.59 67.00 685.14 52.00 678.70 38.00 672.25 30.00 665.81 24.00 659.36 18.00 652.91 $191,500 $192,000 85.00 693.46 67.00 687.02 52.00 680.57 39.00 674.13 30.00 667.68 24.00 661.24 18.00 654.79 $192,000 $192,500 85.00 695.34 68.00 688.89 52.00 682.45 39.00 676.00 30.00 669.56 24.00 663.11 18.00 656.66 $192,500 $193,000 86.00 697.21 68.00 690.77 53.00 684.32 39.00 677.88 31.00 671.43 24.00 664.99 19.00 658.54 $193,000 $193,500 86.00 699.09 68.00 692.64 53.00 686.20 39.00 679.75 31.00 673.31 25.00 666.86 19.00 660.41 $193,500 $194,000 87.00 700.96 69.00 694.52 53.00 688.07 40.00 681.63 31.00 675.18 25.00 668.74 19.00 662.29 $194,000 $194,500 87.00 702.84 69.00 696.39 54.00 689.95 40.00 683.50 31.00 677.06 25.00 670.61 19.00 664.16 $194,500 $195,000 87.00 704.71 69.00 698.27 54.00 691.82 40.00 685.38 31.00 678.93 25.00 672.49 19.00 666.04 $195,000 $195,500 88.00 706.59 70.00 700.14 54.00 693.70 40.00 687.25 32.00 680.81 25.00 674.36 19.00 667.91 $195,500 $196,000 88.00 708.46 70.00 702.02 55.00 695.57 41.00 689.13 32.00 682.68 25.00 676.24 20.00 669.79 $196,000 $196,500 89.00 710.34 70.00 703.89 55.00 697.45 41.00 691.00 32.00 684.56 26.00 678.11 20.00 671.66 $196,500 $197,000 89.00 712.21 71.00 705.77 55.00 699.32 41.00 692.88 32.00 686.43 26.00 679.99 20.00 673.54 $197,000 $197,500 89.00 714.09 71.00 707.64 56.00 701.20 41.00 694.75 33.00 688.31 26.00 681.86 20.00 675.41 $197,500 $198,000 90.00 715.96 72.00 709.52 56.00 703.07 42.00 696.63 33.00 690.18 26.00 683.74 20.00 677.29 $198,000 $198,500 90.00 717.84 72.00 711.39 56.00 704.95 42.00 698.50 33.00 692.06 26.00 685.61 21.00 679.16 $198,500 $199,000 91.00 719.71 72.00 713.27 57.00 706.82 42.00 700.38 33.00 693.93 27.00 687.49 21.00 681.04 $199,000 $199,500 91.00 721.59 73.00 715.14 57.00 708.70 43.00 702.25 34.00 695.81 27.00 689.36 21.00 682.91 $199,500 $200,000 91.00 723.46 73.00 717.02 57.00 710.57 43.00 704.13 34.00 697.68 27.00 691.24 21.00 684.79

NJEIS Family Cost Participation Table Page 6 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$200,000 $200,500 92.00 725.34 73.00 718.89 58.00 712.45 43.00 706.00 34.00 699.56 27.00 693.11 21.00 686.66 $200,500 $201,000 92.00 727.21 74.00 720.77 58.00 714.32 44.00 707.88 34.00 701.43 27.00 694.99 21.00 688.54 $201,000 $201,500 92.00 729.09 74.00 722.64 58.00 716.20 44.00 709.75 35.00 703.31 27.00 696.86 22.00 690.41 $201,500 $202,000 93.00 730.96 74.00 724.52 59.00 718.07 44.00 711.63 35.00 705.18 28.00 698.74 22.00 692.29 $202,000 $202,500 93.00 732.84 75.00 726.39 59.00 719.95 45.00 713.50 35.00 707.06 28.00 700.61 22.00 694.16 $202,500 $203,000 94.00 734.71 75.00 728.27 59.00 721.82 45.00 715.38 35.00 708.93 28.00 702.49 22.00 696.04 $203,000 $203,500 94.00 736.59 76.00 730.14 60.00 723.70 45.00 717.25 36.00 710.81 28.00 704.36 22.00 697.91 $203,500 $204,000 94.00 738.46 76.00 732.02 60.00 725.57 46.00 719.13 36.00 712.68 28.00 706.24 23.00 699.79 $204,000 $204,500 95.00 740.34 76.00 733.89 61.00 727.45 46.00 721.00 36.00 714.56 29.00 708.11 23.00 701.66 $204,500 $205,000 95.00 742.21 77.00 735.77 61.00 729.32 46.00 722.88 36.00 716.43 29.00 709.99 23.00 703.54 $205,000 $205,500 96.00 744.09 77.00 737.64 61.00 731.20 47.00 724.75 36.00 718.31 29.00 711.86 23.00 705.41 $205,500 $206,000 96.00 745.96 78.00 739.52 62.00 733.07 47.00 726.63 37.00 720.18 29.00 713.74 23.00 707.29 $206,000 $206,500 96.00 747.84 78.00 741.39 62.00 734.95 47.00 728.50 37.00 722.06 29.00 715.61 23.00 709.16 $206,500 $207,000 97.00 749.71 78.00 743.27 62.00 736.82 48.00 730.38 37.00 723.93 29.00 717.49 24.00 711.04 $207,000 $207,500 97.00 751.59 79.00 745.14 63.00 738.70 48.00 732.25 37.00 725.81 30.00 719.36 24.00 712.91 $207,500 $208,000 98.00 753.46 79.00 747.02 63.00 740.57 48.00 734.13 38.00 727.68 30.00 721.24 24.00 714.79 $208,000 $208,500 98.00 755.34 80.00 748.89 63.00 742.45 49.00 736.00 38.00 729.56 30.00 723.11 24.00 716.66 $208,500 $209,000 98.00 757.21 80.00 750.77 64.00 744.32 49.00 737.88 38.00 731.43 30.00 724.99 24.00 718.54 $209,000 $209,500 99.00 759.09 80.00 752.64 64.00 746.20 49.00 739.75 38.00 733.31 30.00 726.86 25.00 720.41 $209,500 $210,000 99.00 760.96 81.00 754.52 64.00 748.07 50.00 741.63 39.00 735.18 31.00 728.74 25.00 722.29 $210,000 $210,500 100.00 762.84 81.00 756.39 65.00 749.95 50.00 743.50 39.00 737.06 31.00 730.61 25.00 724.16 $210,500 $211,000 100.00 764.71 81.00 758.27 65.00 751.82 50.00 745.38 39.00 738.93 31.00 732.49 25.00 726.04 $211,000 $211,500 100.00 766.59 82.00 760.14 65.00 753.70 51.00 747.25 39.00 740.81 31.00 734.36 25.00 727.91 $211,500 $212,000 101.00 768.46 82.00 762.02 66.00 755.57 51.00 749.13 40.00 742.68 31.00 736.24 25.00 729.79 $212,000 $212,500 101.00 770.34 83.00 763.89 66.00 757.45 51.00 751.00 40.00 744.56 31.00 738.11 26.00 731.66 $212,500 $213,000 101.00 772.21 83.00 765.77 66.00 759.32 52.00 752.88 40.00 746.43 32.00 739.99 26.00 733.54 $213,000 $213,500 102.00 774.09 83.00 767.64 67.00 761.20 52.00 754.75 40.00 748.31 32.00 741.86 26.00 735.41 $213,500 $214,000 102.00 775.96 84.00 769.52 67.00 763.07 52.00 756.63 41.00 750.18 32.00 743.74 26.00 737.29 $214,000 $214,500 103.00 777.84 84.00 771.39 68.00 764.95 53.00 758.50 41.00 752.06 32.00 745.61 26.00 739.16 $214,500 $215,000 103.00 779.71 85.00 773.27 68.00 766.82 53.00 760.38 41.00 753.93 32.00 747.49 27.00 741.04 $215,000 $215,500 103.00 781.59 85.00 775.14 68.00 768.70 53.00 762.25 41.00 755.81 33.00 749.36 27.00 742.91 $215,500 $216,000 104.00 783.46 85.00 777.02 69.00 770.57 54.00 764.13 42.00 757.68 33.00 751.24 27.00 744.79 $216,000 $216,500 104.00 785.34 86.00 778.89 69.00 772.45 54.00 766.00 42.00 759.56 33.00 753.11 27.00 746.66 $216,500 $217,000 105.00 787.21 86.00 780.77 69.00 774.32 54.00 767.88 42.00 761.43 33.00 754.99 27.00 748.54 $217,000 $217,500 105.00 789.09 87.00 782.64 70.00 776.20 55.00 769.75 42.00 763.31 34.00 756.86 27.00 750.41 $217,500 $218,000 105.00 790.96 87.00 784.52 70.00 778.07 55.00 771.63 42.00 765.18 34.00 758.74 28.00 752.29 $218,000 $218,500 106.00 792.84 87.00 786.39 70.00 779.95 55.00 773.50 43.00 767.06 34.00 760.61 28.00 754.16 $218,500 $219,000 106.00 794.71 88.00 788.27 71.00 781.82 56.00 775.38 43.00 768.93 34.00 762.49 28.00 756.04 $219,000 $219,500 107.00 796.59 88.00 790.14 71.00 783.70 56.00 777.25 43.00 770.81 35.00 764.36 28.00 757.91 $219,500 $220,000 107.00 798.46 88.00 792.02 71.00 785.57 56.00 779.13 43.00 772.68 35.00 766.24 28.00 759.79 $220,000 $220,500 107.00 800.34 89.00 793.89 72.00 787.45 57.00 781.00 44.00 774.56 35.00 768.11 29.00 761.66 $220,500 $221,000 108.00 802.21 89.00 795.77 72.00 789.32 57.00 782.88 44.00 776.43 35.00 769.99 29.00 763.54 $221,000 $221,500 108.00 804.09 90.00 797.64 72.00 791.20 57.00 784.75 44.00 778.31 36.00 771.86 29.00 765.41 $221,500 $222,000 109.00 805.96 90.00 799.52 73.00 793.07 58.00 786.63 44.00 780.18 36.00 773.74 29.00 767.29 $222,000 $222,500 109.00 807.84 90.00 801.39 73.00 794.95 58.00 788.50 45.00 782.06 36.00 775.61 29.00 769.16 $222,500 $223,000 109.00 809.71 91.00 803.27 74.00 796.82 58.00 790.38 45.00 783.93 36.00 777.49 29.00 771.04 $223,000 $223,500 110.00 811.59 91.00 805.14 74.00 798.70 59.00 792.25 45.00 785.81 36.00 779.36 30.00 772.91 $223,500 $224,000 110.00 813.46 92.00 807.02 74.00 800.57 59.00 794.13 45.00 787.68 37.00 781.24 30.00 774.79 $224,000 $224,500 110.00 815.34 92.00 808.89 75.00 802.45 59.00 796.00 46.00 789.56 37.00 783.11 30.00 776.66 $224,500 $225,000 110.00 817.21 92.00 810.77 75.00 804.32 60.00 797.88 46.00 791.43 37.00 784.99 30.00 778.54 $225,000 $225,500 110.00 819.09 93.00 812.64 75.00 806.20 60.00 799.75 46.00 793.31 37.00 786.86 30.00 780.41 $225,500 $226,000 110.00 820.96 93.00 814.52 76.00 808.07 60.00 801.63 46.00 795.18 38.00 788.74 31.00 782.29 $226,000 $226,500 110.00 822.84 94.00 816.39 76.00 809.95 61.00 803.50 47.00 797.06 38.00 790.61 31.00 784.16 $226,500 $227,000 110.00 824.71 94.00 818.27 76.00 811.82 61.00 805.38 47.00 798.93 38.00 792.49 31.00 786.04 $227,000 $227,500 110.00 826.59 94.00 820.14 77.00 813.70 62.00 807.25 47.00 800.81 38.00 794.36 31.00 787.91 $227,500 $228,000 110.00 828.46 95.00 822.02 77.00 815.57 62.00 809.13 48.00 802.68 39.00 796.24 31.00 789.79 $228,000 $228,500 110.00 830.34 95.00 823.89 78.00 817.45 62.00 811.00 48.00 804.56 39.00 798.11 31.00 791.66 $228,500 $229,000 110.00 832.21 96.00 825.77 78.00 819.32 63.00 812.88 48.00 806.43 39.00 799.99 32.00 793.54 $229,000 $229,500 110.00 834.09 96.00 827.64 78.00 821.20 63.00 814.75 49.00 808.31 39.00 801.86 32.00 795.41 $229,500 $230,000 110.00 835.96 96.00 829.52 79.00 823.07 63.00 816.63 49.00 810.18 40.00 803.74 32.00 797.29 $230,000 $230,500 110.00 837.84 97.00 831.39 79.00 824.95 64.00 818.50 49.00 812.06 40.00 805.61 32.00 799.16 $230,500 $231,000 110.00 839.71 97.00 833.27 79.00 826.82 64.00 820.38 50.00 813.93 40.00 807.49 32.00 801.04 $231,000 $231,500 110.00 841.59 97.00 835.14 80.00 828.70 64.00 822.25 50.00 815.81 40.00 809.36 33.00 802.91 $231,500 $232,000 110.00 843.46 98.00 837.02 80.00 830.57 65.00 824.13 50.00 817.68 41.00 811.24 33.00 804.79 $232,000 $232,500 110.00 845.34 98.00 838.89 80.00 832.45 65.00 826.00 51.00 819.56 41.00 813.11 33.00 806.66 $232,500 $233,000 110.00 847.21 99.00 840.77 81.00 834.32 65.00 827.88 51.00 821.43 41.00 814.99 33.00 808.54 $233,000 $233,500 110.00 849.09 99.00 842.64 81.00 836.20 66.00 829.75 51.00 823.31 41.00 816.86 33.00 810.41 $233,500 $234,000 110.00 850.96 99.00 844.52 82.00 838.07 66.00 831.63 52.00 825.18 41.00 818.74 33.00 812.29 $234,000 $234,500 110.00 852.84 100.00 846.39 82.00 839.95 66.00 833.50 52.00 827.06 42.00 820.61 34.00 814.16 $234,500 $235,000 110.00 854.71 100.00 848.27 82.00 841.82 67.00 835.38 52.00 828.93 42.00 822.49 34.00 816.04 $235,000 $235,500 110.00 856.59 101.00 850.14 83.00 843.70 67.00 837.25 53.00 830.81 42.00 824.36 34.00 817.91 $235,500 $236,000 110.00 858.46 101.00 852.02 83.00 845.57 67.00 839.13 53.00 832.68 42.00 826.24 34.00 819.79 $236,000 $236,500 110.00 860.34 101.00 853.89 83.00 847.45 68.00 841.00 53.00 834.56 43.00 828.11 34.00 821.66 $236,500 $237,000 110.00 862.21 102.00 855.77 84.00 849.32 68.00 842.88 54.00 836.43 43.00 829.99 35.00 823.54 $237,000 $237,500 110.00 864.09 102.00 857.64 84.00 851.20 68.00 844.75 54.00 838.31 43.00 831.86 35.00 825.41 $237,500 $238,000 110.00 865.96 103.00 859.52 84.00 853.07 69.00 846.63 54.00 840.18 43.00 833.74 35.00 827.29 $238,000 $238,500 110.00 867.84 103.00 861.39 85.00 854.95 69.00 848.50 55.00 842.06 44.00 835.61 35.00 829.16 $238,500 $239,000 110.00 869.71 103.00 863.27 85.00 856.82 70.00 850.38 55.00 843.93 44.00 837.49 35.00 831.04 $239,000 $239,500 110.00 871.59 104.00 865.14 86.00 858.70 70.00 852.25 55.00 845.81 44.00 839.36 35.00 832.91 $239,500 $240,000 110.00 873.46 104.00 867.02 86.00 860.57 70.00 854.13 56.00 847.68 44.00 841.24 36.00 834.79

NJEIS Family Cost Participation Table Page 7 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$240,000 $240,500 110.00 875.34 105.00 868.89 86.00 862.45 71.00 856.00 56.00 849.56 45.00 843.11 36.00 836.66 $240,500 $241,000 110.00 877.21 105.00 870.77 87.00 864.32 71.00 857.88 56.00 851.43 45.00 844.99 36.00 838.54 $241,000 $241,500 110.00 879.09 105.00 872.64 87.00 866.20 71.00 859.75 57.00 853.31 45.00 846.86 36.00 840.41 $241,500 $242,000 110.00 880.96 106.00 874.52 87.00 868.07 72.00 861.63 57.00 855.18 45.00 848.74 37.00 842.29 $242,000 $242,500 110.00 882.84 106.00 876.39 88.00 869.95 72.00 863.50 57.00 857.06 46.00 850.61 37.00 844.16 $242,500 $243,000 110.00 884.71 106.00 878.27 88.00 871.82 72.00 865.38 58.00 858.93 46.00 852.49 37.00 846.04 $243,000 $243,500 110.00 886.59 107.00 880.14 89.00 873.70 73.00 867.25 58.00 860.81 46.00 854.36 37.00 847.91 $243,500 $244,000 110.00 888.46 107.00 882.02 89.00 875.57 73.00 869.13 58.00 862.68 46.00 856.24 38.00 849.79 $244,000 $244,500 110.00 890.34 108.00 883.89 89.00 877.45 73.00 871.00 59.00 864.56 47.00 858.11 38.00 851.66 $244,500 $245,000 110.00 892.21 108.00 885.77 90.00 879.32 74.00 872.88 59.00 866.43 47.00 859.99 38.00 853.54 $245,000 $245,500 110.00 894.09 108.00 887.64 90.00 881.20 74.00 874.75 59.00 868.31 47.00 861.86 38.00 855.41 $245,500 $246,000 110.00 895.96 109.00 889.52 90.00 883.07 74.00 876.63 60.00 870.18 47.00 863.74 39.00 857.29 $246,000 $246,500 110.00 897.84 109.00 891.39 91.00 884.95 75.00 878.50 60.00 872.06 47.00 865.61 39.00 859.16 $246,500 $247,000 110.00 899.71 110.00 893.27 91.00 886.82 75.00 880.38 60.00 873.93 48.00 867.49 39.00 861.04 $247,000 $247,500 110.00 901.59 110.00 895.14 92.00 888.70 75.00 882.25 61.00 875.81 48.00 869.36 39.00 862.91 $247,500 $248,000 110.00 903.46 110.00 897.02 92.00 890.57 76.00 884.13 61.00 877.68 48.00 871.24 40.00 864.79 $248,000 $248,500 110.00 905.34 110.00 898.89 92.00 892.45 76.00 886.00 61.00 879.56 48.00 873.11 40.00 866.66 $248,500 $249,000 110.00 907.21 110.00 900.77 93.00 894.32 77.00 887.88 62.00 881.43 49.00 874.99 40.00 868.54 $249,000 $249,500 110.00 909.09 110.00 902.64 93.00 896.20 77.00 889.75 62.00 883.31 49.00 876.86 40.00 870.41 $249,500 $250,000 110.00 910.96 110.00 904.52 93.00 898.07 77.00 891.63 62.00 885.18 49.00 878.74 41.00 872.29 $250,000 $250,500 110.00 912.84 110.00 906.39 94.00 899.95 78.00 893.50 63.00 887.06 49.00 880.61 41.00 874.16 $250,500 $251,000 110.00 914.71 110.00 908.27 94.00 901.82 78.00 895.38 63.00 888.93 50.00 882.49 41.00 876.04 $251,000 $251,500 110.00 916.59 110.00 910.14 95.00 903.70 78.00 897.25 63.00 890.81 50.00 884.36 41.00 877.91 $251,500 $252,000 110.00 918.46 110.00 912.02 95.00 905.57 79.00 899.13 64.00 892.68 50.00 886.24 41.00 879.79 $252,000 $252,500 110.00 920.34 110.00 913.89 95.00 907.45 79.00 901.00 64.00 894.56 50.00 888.11 42.00 881.66 $252,500 $253,000 110.00 922.21 110.00 915.77 96.00 909.32 79.00 902.88 64.00 896.43 51.00 889.99 42.00 883.54 $253,000 $253,500 110.00 924.09 110.00 917.64 96.00 911.20 80.00 904.75 65.00 898.31 51.00 891.86 42.00 885.41 $253,500 $254,000 110.00 925.96 110.00 919.52 97.00 913.07 80.00 906.63 65.00 900.18 51.00 893.74 42.00 887.29 $254,000 $254,500 110.00 927.84 110.00 921.39 97.00 914.95 80.00 908.50 65.00 902.06 51.00 895.61 43.00 889.16 $254,500 $255,000 110.00 929.71 110.00 923.27 97.00 916.82 81.00 910.38 66.00 903.93 52.00 897.49 43.00 891.04 $255,000 $255,500 110.00 931.59 110.00 925.14 98.00 918.70 81.00 912.25 66.00 905.81 52.00 899.36 43.00 892.91 $255,500 $256,000 110.00 933.46 110.00 927.02 98.00 920.57 81.00 914.13 66.00 907.68 52.00 901.24 43.00 894.79 $256,000 $256,500 110.00 935.34 110.00 928.89 99.00 922.45 82.00 916.00 67.00 909.56 53.00 903.11 44.00 896.66 $256,500 $257,000 110.00 937.21 110.00 930.77 99.00 924.32 82.00 917.88 67.00 911.43 53.00 904.99 44.00 898.54 $257,000 $257,500 110.00 939.09 110.00 932.64 99.00 926.20 82.00 919.75 67.00 913.31 53.00 906.86 44.00 900.41 $257,500 $258,000 110.00 940.96 110.00 934.52 100.00 928.07 83.00 921.63 68.00 915.18 54.00 908.74 44.00 902.29 $258,000 $258,500 110.00 942.84 110.00 936.39 100.00 929.95 83.00 923.50 68.00 917.06 54.00 910.61 45.00 904.16 $258,500 $259,000 110.00 944.71 110.00 938.27 101.00 931.82 84.00 925.38 68.00 918.93 54.00 912.49 45.00 906.04 $259,000 $259,500 110.00 946.59 110.00 940.14 101.00 933.70 84.00 927.25 69.00 920.81 55.00 914.36 45.00 907.91 $259,500 $260,000 110.00 948.46 110.00 942.02 101.00 935.57 84.00 929.13 69.00 922.68 55.00 916.24 45.00 909.79 $260,000 $260,500 110.00 950.34 110.00 943.89 102.00 937.45 85.00 931.00 69.00 924.56 55.00 918.11 46.00 911.66 $260,500 $261,000 110.00 952.21 110.00 945.77 102.00 939.32 85.00 932.88 70.00 926.43 56.00 919.99 46.00 913.54 $261,000 $261,500 110.00 954.09 110.00 947.64 102.00 941.20 85.00 934.75 70.00 928.31 56.00 921.86 46.00 915.41 $261,500 $262,000 110.00 955.96 110.00 949.52 103.00 943.07 86.00 936.63 71.00 930.18 56.00 923.74 46.00 917.29 $262,000 $262,500 110.00 957.84 110.00 951.39 103.00 944.95 86.00 938.50 71.00 932.06 57.00 925.61 46.00 919.16 $262,500 $263,000 110.00 959.71 110.00 953.27 104.00 946.82 86.00 940.38 71.00 933.93 57.00 927.49 47.00 921.04 $263,000 $263,500 110.00 961.59 110.00 955.14 104.00 948.70 87.00 942.25 72.00 935.81 57.00 929.36 47.00 922.91 $263,500 $264,000 110.00 963.46 110.00 957.02 104.00 950.57 87.00 944.13 72.00 937.68 58.00 931.24 47.00 924.79 $264,000 $264,500 110.00 965.34 110.00 958.89 105.00 952.45 88.00 946.00 72.00 939.56 58.00 933.11 47.00 926.66 $264,500 $265,000 110.00 967.21 110.00 960.77 105.00 954.32 88.00 947.88 73.00 941.43 58.00 934.99 48.00 928.54 $265,000 $265,500 110.00 969.09 110.00 962.64 106.00 956.20 88.00 949.75 73.00 943.31 59.00 936.86 48.00 930.41 $265,500 $266,000 110.00 970.96 110.00 964.52 106.00 958.07 89.00 951.63 73.00 945.18 59.00 938.74 48.00 932.29 $266,000 $266,500 110.00 972.84 110.00 966.39 106.00 959.95 89.00 953.50 74.00 947.06 59.00 940.61 48.00 934.16 $266,500 $267,000 110.00 974.71 110.00 968.27 107.00 961.82 89.00 955.38 74.00 948.93 60.00 942.49 49.00 936.04 $267,000 $267,500 110.00 976.59 110.00 970.14 107.00 963.70 90.00 957.25 74.00 950.81 60.00 944.36 49.00 937.91 $267,500 $268,000 110.00 978.46 110.00 972.02 108.00 965.57 90.00 959.13 75.00 952.68 60.00 946.24 49.00 939.79 $268,000 $268,500 110.00 980.34 110.00 973.89 108.00 967.45 90.00 961.00 75.00 954.56 61.00 948.11 49.00 941.66 $268,500 $269,000 110.00 982.21 110.00 975.77 108.00 969.32 91.00 962.88 75.00 956.43 61.00 949.99 50.00 943.54 $269,000 $269,500 110.00 984.09 110.00 977.64 109.00 971.20 91.00 964.75 76.00 958.31 61.00 951.86 50.00 945.41 $269,500 $270,000 110.00 985.96 110.00 979.52 109.00 973.07 92.00 966.63 76.00 960.18 62.00 953.74 50.00 947.29 $270,000 $270,500 110.00 987.84 110.00 981.39 110.00 974.95 92.00 968.50 76.00 962.06 62.00 955.61 50.00 949.16 $270,500 $271,000 110.00 989.71 110.00 983.27 110.00 976.82 92.00 970.38 77.00 963.93 62.00 957.49 51.00 951.04 $271,000 $271,500 110.00 991.59 110.00 985.14 110.00 978.70 93.00 972.25 77.00 965.81 63.00 959.36 51.00 952.91 $271,500 $272,000 110.00 993.46 110.00 987.02 110.00 980.57 93.00 974.13 77.00 967.68 63.00 961.24 51.00 954.79 $272,000 $272,500 110.00 995.34 110.00 988.89 110.00 982.45 93.00 976.00 78.00 969.56 63.00 963.11 51.00 956.66 $272,500 $273,000 110.00 997.21 110.00 990.77 110.00 984.32 94.00 977.88 78.00 971.43 64.00 964.99 52.00 958.54 $273,000 $273,500 110.00 999.09 110.00 992.64 110.00 986.20 94.00 979.75 79.00 973.31 64.00 966.86 52.00 960.41 $273,500 $274,000 110.00 1,000.96 110.00 994.52 110.00 988.07 94.00 981.63 79.00 975.18 64.00 968.74 52.00 962.29 $274,000 $274,500 110.00 1,002.84 110.00 996.39 110.00 989.95 95.00 983.50 79.00 977.06 65.00 970.61 52.00 964.16 $274,500 $275,000 110.00 1,004.71 110.00 998.27 110.00 991.82 95.00 985.38 80.00 978.93 65.00 972.49 52.00 966.04 $275,000 $275,500 110.00 1,006.59 110.00 1,000.14 110.00 993.70 96.00 987.25 80.00 980.81 65.00 974.36 53.00 967.91 $275,500 $276,000 110.00 1,008.46 110.00 1,002.02 110.00 995.57 96.00 989.13 80.00 982.68 66.00 976.24 53.00 969.79 $276,000 $276,500 110.00 1,010.34 110.00 1,003.89 110.00 997.45 96.00 991.00 81.00 984.56 66.00 978.11 53.00 971.66 $276,500 $277,000 110.00 1,012.21 110.00 1,005.77 110.00 999.32 97.00 992.88 81.00 986.43 66.00 979.99 53.00 973.54 $277,000 $277,500 110.00 1,014.09 110.00 1,007.64 110.00 1,001.20 97.00 994.75 81.00 988.31 67.00 981.86 54.00 975.41 $277,500 $278,000 110.00 1,015.96 110.00 1,009.52 110.00 1,003.07 97.00 996.63 82.00 990.18 67.00 983.74 54.00 977.29 $278,000 $278,500 110.00 1,017.84 110.00 1,011.39 110.00 1,004.95 98.00 998.50 82.00 992.06 67.00 985.61 54.00 979.16 $278,500 $279,000 110.00 1,019.71 110.00 1,013.27 110.00 1,006.82 98.00 1,000.38 82.00 993.93 68.00 987.49 54.00 981.04 $279,000 $279,500 110.00 1,021.59 110.00 1,015.14 110.00 1,008.70 98.00 1,002.25 83.00 995.81 68.00 989.36 55.00 982.91 $279,500 $280,000 110.00 1,023.46 110.00 1,017.02 110.00 1,010.57 99.00 1,004.13 83.00 997.68 68.00 991.24 55.00 984.79

NJEIS Family Cost Participation Table Page 8 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$280,000 $280,500 110.00 1,025.34 110.00 1,018.89 110.00 1,012.45 99.00 1,006.00 83.00 999.56 69.00 993.11 55.00 986.66 $280,500 $281,000 110.00 1,027.21 110.00 1,020.77 110.00 1,014.32 100.00 1,007.88 84.00 1,001.43 69.00 994.99 55.00 988.54 $281,000 $281,500 110.00 1,029.09 110.00 1,022.64 110.00 1,016.20 100.00 1,009.75 84.00 1,003.31 69.00 996.86 56.00 990.41 $281,500 $282,000 110.00 1,030.96 110.00 1,024.52 110.00 1,018.07 100.00 1,011.63 84.00 1,005.18 70.00 998.74 56.00 992.29 $282,000 $282,500 110.00 1,032.84 110.00 1,026.39 110.00 1,019.95 101.00 1,013.50 85.00 1,007.06 70.00 1,000.61 56.00 994.16 $282,500 $283,000 110.00 1,034.71 110.00 1,028.27 110.00 1,021.82 101.00 1,015.38 85.00 1,008.93 70.00 1,002.49 56.00 996.04 $283,000 $283,500 110.00 1,036.59 110.00 1,030.14 110.00 1,023.70 101.00 1,017.25 86.00 1,010.81 71.00 1,004.36 57.00 997.91 $283,500 $284,000 110.00 1,038.46 110.00 1,032.02 110.00 1,025.57 102.00 1,019.13 86.00 1,012.68 71.00 1,006.24 57.00 999.79 $284,000 $284,500 110.00 1,040.34 110.00 1,033.89 110.00 1,027.45 102.00 1,021.00 86.00 1,014.56 71.00 1,008.11 57.00 1,001.66 $284,500 $285,000 110.00 1,042.21 110.00 1,035.77 110.00 1,029.32 103.00 1,022.88 87.00 1,016.43 72.00 1,009.99 58.00 1,003.54 $285,000 $285,500 110.00 1,044.09 110.00 1,037.64 110.00 1,031.20 103.00 1,024.75 87.00 1,018.31 72.00 1,011.86 58.00 1,005.41 $285,500 $286,000 110.00 1,045.96 110.00 1,039.52 110.00 1,033.07 103.00 1,026.63 87.00 1,020.18 72.00 1,013.74 58.00 1,007.29 $286,000 $286,500 110.00 1,047.84 110.00 1,041.39 110.00 1,034.95 104.00 1,028.50 88.00 1,022.06 73.00 1,015.61 59.00 1,009.16 $286,500 $287,000 110.00 1,049.71 110.00 1,043.27 110.00 1,036.82 104.00 1,030.38 88.00 1,023.93 73.00 1,017.49 59.00 1,011.04 $287,000 $287,500 110.00 1,051.59 110.00 1,045.14 110.00 1,038.70 104.00 1,032.25 88.00 1,025.81 73.00 1,019.36 59.00 1,012.91 $287,500 $288,000 110.00 1,053.46 110.00 1,047.02 110.00 1,040.57 105.00 1,034.13 89.00 1,027.68 74.00 1,021.24 60.00 1,014.79 $288,000 $288,500 110.00 1,055.34 110.00 1,048.89 110.00 1,042.45 105.00 1,036.00 89.00 1,029.56 74.00 1,023.11 60.00 1,016.66 $288,500 $289,000 110.00 1,057.21 110.00 1,050.77 110.00 1,044.32 106.00 1,037.88 89.00 1,031.43 74.00 1,024.99 60.00 1,018.54 $289,000 $289,500 110.00 1,059.09 110.00 1,052.64 110.00 1,046.20 106.00 1,039.75 90.00 1,033.31 75.00 1,026.86 61.00 1,020.41 $289,500 $290,000 110.00 1,060.96 110.00 1,054.52 110.00 1,048.07 106.00 1,041.63 90.00 1,035.18 75.00 1,028.74 61.00 1,022.29 $290,000 $290,500 110.00 1,062.84 110.00 1,056.39 110.00 1,049.95 107.00 1,043.50 90.00 1,037.06 75.00 1,030.61 61.00 1,024.16 $290,500 $291,000 110.00 1,064.71 110.00 1,058.27 110.00 1,051.82 107.00 1,045.38 91.00 1,038.93 76.00 1,032.49 62.00 1,026.04 $291,000 $291,500 110.00 1,066.59 110.00 1,060.14 110.00 1,053.70 107.00 1,047.25 91.00 1,040.81 76.00 1,034.36 62.00 1,027.91 $291,500 $292,000 110.00 1,068.46 110.00 1,062.02 110.00 1,055.57 108.00 1,049.13 91.00 1,042.68 76.00 1,036.24 62.00 1,029.79 $292,000 $292,500 110.00 1,070.34 110.00 1,063.89 110.00 1,057.45 108.00 1,051.00 92.00 1,044.56 77.00 1,038.11 63.00 1,031.66 $292,500 $293,000 110.00 1,072.21 110.00 1,065.77 110.00 1,059.32 109.00 1,052.88 92.00 1,046.43 77.00 1,039.99 63.00 1,033.54 $293,000 $293,500 110.00 1,074.09 110.00 1,067.64 110.00 1,061.20 109.00 1,054.75 92.00 1,048.31 77.00 1,041.86 63.00 1,035.41 $293,500 $294,000 110.00 1,075.96 110.00 1,069.52 110.00 1,063.07 109.00 1,056.63 93.00 1,050.18 78.00 1,043.74 64.00 1,037.29 $294,000 $294,500 110.00 1,077.84 110.00 1,071.39 110.00 1,064.95 110.00 1,058.50 93.00 1,052.06 78.00 1,045.61 64.00 1,039.16 $294,500 $295,000 110.00 1,079.71 110.00 1,073.27 110.00 1,066.82 110.00 1,060.38 94.00 1,053.93 78.00 1,047.49 64.00 1,041.04 $295,000 $295,500 110.00 1,081.59 110.00 1,075.14 110.00 1,068.70 110.00 1,062.25 94.00 1,055.81 79.00 1,049.36 65.00 1,042.91 $295,500 $296,000 110.00 1,083.46 110.00 1,077.02 110.00 1,070.57 110.00 1,064.13 94.00 1,057.68 79.00 1,051.24 65.00 1,044.79 $296,000 $296,500 110.00 1,085.34 110.00 1,078.89 110.00 1,072.45 110.00 1,066.00 95.00 1,059.56 80.00 1,053.11 65.00 1,046.66 $296,500 $297,000 110.00 1,087.21 110.00 1,080.77 110.00 1,074.32 110.00 1,067.88 95.00 1,061.43 80.00 1,054.99 66.00 1,048.54 $297,000 $297,500 110.00 1,089.09 110.00 1,082.64 110.00 1,076.20 110.00 1,069.75 95.00 1,063.31 80.00 1,056.86 66.00 1,050.41 $297,500 $298,000 110.00 1,090.96 110.00 1,084.52 110.00 1,078.07 110.00 1,071.63 96.00 1,065.18 81.00 1,058.74 66.00 1,052.29 $298,000 $298,500 110.00 1,092.84 110.00 1,086.39 110.00 1,079.95 110.00 1,073.50 96.00 1,067.06 81.00 1,060.61 67.00 1,054.16 $298,500 $299,000 110.00 1,094.71 110.00 1,088.27 110.00 1,081.82 110.00 1,075.38 96.00 1,068.93 81.00 1,062.49 67.00 1,056.04 $299,000 $299,500 110.00 1,096.59 110.00 1,090.14 110.00 1,083.70 110.00 1,077.25 97.00 1,070.81 82.00 1,064.36 67.00 1,057.91 $299,500 $300,000 110.00 1,098.46 110.00 1,092.02 110.00 1,085.57 110.00 1,079.13 97.00 1,072.68 82.00 1,066.24 68.00 1,059.79 $300,000 $300,500 110.00 1,100.34 110.00 1,093.89 110.00 1,087.45 110.00 1,081.00 98.00 1,074.56 82.00 1,068.11 68.00 1,061.66 $300,500 $301,000 110.00 1,102.21 110.00 1,095.77 110.00 1,089.32 110.00 1,082.88 98.00 1,076.43 83.00 1,069.99 68.00 1,063.54 $301,000 $301,500 110.00 1,104.09 110.00 1,097.64 110.00 1,091.20 110.00 1,084.75 98.00 1,078.31 83.00 1,071.86 69.00 1,065.41 $301,500 $302,000 110.00 1,105.96 110.00 1,099.52 110.00 1,093.07 110.00 1,086.63 99.00 1,080.18 83.00 1,073.74 69.00 1,067.29 $302,000 $302,500 110.00 1,107.84 110.00 1,101.39 110.00 1,094.95 110.00 1,088.50 99.00 1,082.06 84.00 1,075.61 69.00 1,069.16 $302,500 $303,000 110.00 1,109.71 110.00 1,103.27 110.00 1,096.82 110.00 1,090.38 99.00 1,083.93 84.00 1,077.49 70.00 1,071.04 $303,000 $303,500 110.00 1,111.59 110.00 1,105.14 110.00 1,098.70 110.00 1,092.25 100.00 1,085.81 84.00 1,079.36 70.00 1,072.91 $303,500 $304,000 110.00 1,113.46 110.00 1,107.02 110.00 1,100.57 110.00 1,094.13 100.00 1,087.68 85.00 1,081.24 70.00 1,074.79 $304,000 $304,500 110.00 1,115.34 110.00 1,108.89 110.00 1,102.45 110.00 1,096.00 100.00 1,089.56 85.00 1,083.11 71.00 1,076.66 $304,500 $305,000 110.00 1,117.21 110.00 1,110.77 110.00 1,104.32 110.00 1,097.88 101.00 1,091.43 85.00 1,084.99 71.00 1,078.54 $305,000 $305,500 110.00 1,119.09 110.00 1,112.64 110.00 1,106.20 110.00 1,099.75 101.00 1,093.31 86.00 1,086.86 71.00 1,080.41 $305,500 $306,000 110.00 1,120.96 110.00 1,114.52 110.00 1,108.07 110.00 1,101.63 102.00 1,095.18 86.00 1,088.74 72.00 1,082.29 $306,000 $306,500 110.00 1,122.84 110.00 1,116.39 110.00 1,109.95 110.00 1,103.50 102.00 1,097.06 86.00 1,090.61 72.00 1,084.16 $306,500 $307,000 110.00 1,124.71 110.00 1,118.27 110.00 1,111.82 110.00 1,105.38 102.00 1,098.93 87.00 1,092.49 72.00 1,086.04 $307,000 $307,500 110.00 1,126.59 110.00 1,120.14 110.00 1,113.70 110.00 1,107.25 103.00 1,100.81 87.00 1,094.36 73.00 1,087.91 $307,500 $308,000 110.00 1,128.46 110.00 1,122.02 110.00 1,115.57 110.00 1,109.13 103.00 1,102.68 88.00 1,096.24 73.00 1,089.79 $308,000 $308,500 110.00 1,130.34 110.00 1,123.89 110.00 1,117.45 110.00 1,111.00 103.00 1,104.56 88.00 1,098.11 73.00 1,091.66 $308,500 $309,000 110.00 1,132.21 110.00 1,125.77 110.00 1,119.32 110.00 1,112.88 104.00 1,106.43 88.00 1,099.99 74.00 1,093.54 $309,000 $309,500 110.00 1,134.09 110.00 1,127.64 110.00 1,121.20 110.00 1,114.75 104.00 1,108.31 89.00 1,101.86 74.00 1,095.41 $309,500 $310,000 110.00 1,135.96 110.00 1,129.52 110.00 1,123.07 110.00 1,116.63 104.00 1,110.18 89.00 1,103.74 74.00 1,097.29 $310,000 $310,500 110.00 1,137.84 110.00 1,131.39 110.00 1,124.95 110.00 1,118.50 105.00 1,112.06 89.00 1,105.61 75.00 1,099.16 $310,500 $311,000 110.00 1,139.71 110.00 1,133.27 110.00 1,126.82 110.00 1,120.38 105.00 1,113.93 90.00 1,107.49 75.00 1,101.04 $311,000 $311,500 110.00 1,141.59 110.00 1,135.14 110.00 1,128.70 110.00 1,122.25 106.00 1,115.81 90.00 1,109.36 75.00 1,102.91 $311,500 $312,000 110.00 1,143.46 110.00 1,137.02 110.00 1,130.57 110.00 1,124.13 106.00 1,117.68 90.00 1,111.24 76.00 1,104.79 $312,000 $312,500 110.00 1,145.34 110.00 1,138.89 110.00 1,132.45 110.00 1,126.00 106.00 1,119.56 91.00 1,113.11 76.00 1,106.66 $312,500 $313,000 110.00 1,147.21 110.00 1,140.77 110.00 1,134.32 110.00 1,127.88 107.00 1,121.43 91.00 1,114.99 76.00 1,108.54 $313,000 $313,500 110.00 1,149.09 110.00 1,142.64 110.00 1,136.20 110.00 1,129.75 107.00 1,123.31 91.00 1,116.86 77.00 1,110.41 $313,500 $314,000 110.00 1,150.96 110.00 1,144.52 110.00 1,138.07 110.00 1,131.63 107.00 1,125.18 92.00 1,118.74 77.00 1,112.29 $314,000 $314,500 110.00 1,152.84 110.00 1,146.39 110.00 1,139.95 110.00 1,133.50 108.00 1,127.06 92.00 1,120.61 77.00 1,114.16 $314,500 $315,000 110.00 1,154.71 110.00 1,148.27 110.00 1,141.82 110.00 1,135.38 108.00 1,128.93 92.00 1,122.49 78.00 1,116.04 $315,000 $315,500 110.00 1,156.59 110.00 1,150.14 110.00 1,143.70 110.00 1,137.25 108.00 1,130.81 93.00 1,124.36 78.00 1,117.91 $315,500 $316,000 110.00 1,158.46 110.00 1,152.02 110.00 1,145.57 110.00 1,139.13 109.00 1,132.68 93.00 1,126.24 78.00 1,119.79 $316,000 $316,500 110.00 1,160.34 110.00 1,153.89 110.00 1,147.45 110.00 1,141.00 109.00 1,134.56 93.00 1,128.11 79.00 1,121.66 $316,500 $317,000 110.00 1,162.21 110.00 1,155.77 110.00 1,149.32 110.00 1,142.88 110.00 1,136.43 94.00 1,129.99 79.00 1,123.54 $317,000 $317,500 110.00 1,164.09 110.00 1,157.64 110.00 1,151.20 110.00 1,144.75 110.00 1,138.31 94.00 1,131.86 79.00 1,125.41 $317,500 $318,000 110.00 1,165.96 110.00 1,159.52 110.00 1,153.07 110.00 1,146.63 110.00 1,140.18 95.00 1,133.74 80.00 1,127.29 $318,000 $318,500 110.00 1,167.84 110.00 1,161.39 110.00 1,154.95 110.00 1,148.50 110.00 1,142.06 95.00 1,135.61 80.00 1,129.16 $318,500 $319,000 110.00 1,169.71 110.00 1,163.27 110.00 1,156.82 110.00 1,150.38 110.00 1,143.93 95.00 1,137.49 80.00 1,131.04 $319,000 $319,500 110.00 1,171.59 110.00 1,165.14 110.00 1,158.70 110.00 1,152.25 110.00 1,145.81 96.00 1,139.36 81.00 1,132.91 $319,500 $320,000 110.00 1,173.46 110.00 1,167.02 110.00 1,160.57 110.00 1,154.13 110.00 1,147.68 96.00 1,141.24 81.00 1,134.79

NJEIS Family Cost Participation Table Page 9 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$320,000 $320,500 110.00 1,175.34 110.00 1,168.89 110.00 1,162.45 110.00 1,156.00 110.00 1,149.56 96.00 1,143.11 81.00 1,136.66 $320,500 $321,000 110.00 1,177.21 110.00 1,170.77 110.00 1,164.32 110.00 1,157.88 110.00 1,151.43 97.00 1,144.99 82.00 1,138.54 $321,000 $321,500 110.00 1,179.09 110.00 1,172.64 110.00 1,166.20 110.00 1,159.75 110.00 1,153.31 97.00 1,146.86 82.00 1,140.41 $321,500 $322,000 110.00 1,180.96 110.00 1,174.52 110.00 1,168.07 110.00 1,161.63 110.00 1,155.18 97.00 1,148.74 82.00 1,142.29 $322,000 $322,500 110.00 1,182.84 110.00 1,176.39 110.00 1,169.95 110.00 1,163.50 110.00 1,157.06 98.00 1,150.61 83.00 1,144.16 $322,500 $323,000 110.00 1,184.71 110.00 1,178.27 110.00 1,171.82 110.00 1,165.38 110.00 1,158.93 98.00 1,152.49 83.00 1,146.04 $323,000 $323,500 110.00 1,186.59 110.00 1,180.14 110.00 1,173.70 110.00 1,167.25 110.00 1,160.81 98.00 1,154.36 83.00 1,147.91 $323,500 $324,000 110.00 1,188.46 110.00 1,182.02 110.00 1,175.57 110.00 1,169.13 110.00 1,162.68 99.00 1,156.24 84.00 1,149.79 $324,000 $324,500 110.00 1,190.34 110.00 1,183.89 110.00 1,177.45 110.00 1,171.00 110.00 1,164.56 99.00 1,158.11 84.00 1,151.66 $324,500 $325,000 110.00 1,192.21 110.00 1,185.77 110.00 1,179.32 110.00 1,172.88 110.00 1,166.43 99.00 1,159.99 84.00 1,153.54 $325,000 $325,500 110.00 1,194.09 110.00 1,187.64 110.00 1,181.20 110.00 1,174.75 110.00 1,168.31 100.00 1,161.86 85.00 1,155.41 $325,500 $326,000 110.00 1,195.96 110.00 1,189.52 110.00 1,183.07 110.00 1,176.63 110.00 1,170.18 100.00 1,163.74 85.00 1,157.29 $326,000 $326,500 110.00 1,197.84 110.00 1,191.39 110.00 1,184.95 110.00 1,178.50 110.00 1,172.06 100.00 1,165.61 85.00 1,159.16 $326,500 $327,000 110.00 1,199.71 110.00 1,193.27 110.00 1,186.82 110.00 1,180.38 110.00 1,173.93 101.00 1,167.49 86.00 1,161.04 $327,000 $327,500 110.00 1,201.59 110.00 1,195.14 110.00 1,188.70 110.00 1,182.25 110.00 1,175.81 101.00 1,169.36 86.00 1,162.91 $327,500 $328,000 110.00 1,203.46 110.00 1,197.02 110.00 1,190.57 110.00 1,184.13 110.00 1,177.68 101.00 1,171.24 86.00 1,164.79 $328,000 $328,500 110.00 1,205.34 110.00 1,198.89 110.00 1,192.45 110.00 1,186.00 110.00 1,179.56 102.00 1,173.11 87.00 1,166.66 $328,500 $329,000 110.00 1,207.21 110.00 1,200.77 110.00 1,194.32 110.00 1,187.88 110.00 1,181.43 102.00 1,174.99 87.00 1,168.54 $329,000 $329,500 110.00 1,209.09 110.00 1,202.64 110.00 1,196.20 110.00 1,189.75 110.00 1,183.31 103.00 1,176.86 87.00 1,170.41 $329,500 $330,000 110.00 1,210.96 110.00 1,204.52 110.00 1,198.07 110.00 1,191.63 110.00 1,185.18 103.00 1,178.74 88.00 1,172.29 $330,000 $330,500 110.00 1,212.84 110.00 1,206.39 110.00 1,199.95 110.00 1,193.50 110.00 1,187.06 103.00 1,180.61 88.00 1,174.16 $330,500 $331,000 110.00 1,214.71 110.00 1,208.27 110.00 1,201.82 110.00 1,195.38 110.00 1,188.93 104.00 1,182.49 89.00 1,176.04 $331,000 $331,500 110.00 1,216.59 110.00 1,210.14 110.00 1,203.70 110.00 1,197.25 110.00 1,190.81 104.00 1,184.36 89.00 1,177.91 $331,500 $332,000 110.00 1,218.46 110.00 1,212.02 110.00 1,205.57 110.00 1,199.13 110.00 1,192.68 104.00 1,186.24 89.00 1,179.79 $332,000 $332,500 110.00 1,220.34 110.00 1,213.89 110.00 1,207.45 110.00 1,201.00 110.00 1,194.56 105.00 1,188.11 90.00 1,181.66 $332,500 $333,000 110.00 1,222.21 110.00 1,215.77 110.00 1,209.32 110.00 1,202.88 110.00 1,196.43 105.00 1,189.99 90.00 1,183.54 $333,000 $333,500 110.00 1,224.09 110.00 1,217.64 110.00 1,211.20 110.00 1,204.75 110.00 1,198.31 105.00 1,191.86 90.00 1,185.41 $333,500 $334,000 110.00 1,225.96 110.00 1,219.52 110.00 1,213.07 110.00 1,206.63 110.00 1,200.18 106.00 1,193.74 91.00 1,187.29 $334,000 $334,500 110.00 1,227.84 110.00 1,221.39 110.00 1,214.95 110.00 1,208.50 110.00 1,202.06 106.00 1,195.61 91.00 1,189.16 $334,500 $335,000 110.00 1,229.71 110.00 1,223.27 110.00 1,216.82 110.00 1,210.38 110.00 1,203.93 106.00 1,197.49 91.00 1,191.04 $335,000 $335,500 110.00 1,231.59 110.00 1,225.14 110.00 1,218.70 110.00 1,212.25 110.00 1,205.81 107.00 1,199.36 92.00 1,192.91 $335,500 $336,000 110.00 1,233.46 110.00 1,227.02 110.00 1,220.57 110.00 1,214.13 110.00 1,207.68 107.00 1,201.24 92.00 1,194.79 $336,000 $336,500 110.00 1,235.34 110.00 1,228.89 110.00 1,222.45 110.00 1,216.00 110.00 1,209.56 108.00 1,203.11 92.00 1,196.66 $336,500 $337,000 110.00 1,237.21 110.00 1,230.77 110.00 1,224.32 110.00 1,217.88 110.00 1,211.43 108.00 1,204.99 93.00 1,198.54 $337,000 $337,500 110.00 1,239.09 110.00 1,232.64 110.00 1,226.20 110.00 1,219.75 110.00 1,213.31 108.00 1,206.86 93.00 1,200.41 $337,500 $338,000 110.00 1,240.96 110.00 1,234.52 110.00 1,228.07 110.00 1,221.63 110.00 1,215.18 109.00 1,208.74 93.00 1,202.29 $338,000 $338,500 110.00 1,242.84 110.00 1,236.39 110.00 1,229.95 110.00 1,223.50 110.00 1,217.06 109.00 1,210.61 94.00 1,204.16 $338,500 $339,000 110.00 1,244.71 110.00 1,238.27 110.00 1,231.82 110.00 1,225.38 110.00 1,218.93 109.00 1,212.49 94.00 1,206.04 $339,000 $339,500 110.00 1,246.59 110.00 1,240.14 110.00 1,233.70 110.00 1,227.25 110.00 1,220.81 110.00 1,214.36 94.00 1,207.91 $339,500 $340,000 110.00 1,248.46 110.00 1,242.02 110.00 1,235.57 110.00 1,229.13 110.00 1,222.68 110.00 1,216.24 95.00 1,209.79 $340,000 $340,500 110.00 1,250.34 110.00 1,243.89 110.00 1,237.45 110.00 1,231.00 110.00 1,224.56 110.00 1,218.11 95.00 1,211.66 $340,500 $341,000 110.00 1,252.21 110.00 1,245.77 110.00 1,239.32 110.00 1,232.88 110.00 1,226.43 110.00 1,219.99 95.00 1,213.54 $341,000 $341,500 110.00 1,254.09 110.00 1,247.64 110.00 1,241.20 110.00 1,234.75 110.00 1,228.31 110.00 1,221.86 96.00 1,215.41 $341,500 $342,000 110.00 1,255.96 110.00 1,249.52 110.00 1,243.07 110.00 1,236.63 110.00 1,230.18 110.00 1,223.74 96.00 1,217.29 $342,000 $342,500 110.00 1,257.84 110.00 1,251.39 110.00 1,244.95 110.00 1,238.50 110.00 1,232.06 110.00 1,225.61 97.00 1,219.16 $342,500 $343,000 110.00 1,259.71 110.00 1,253.27 110.00 1,246.82 110.00 1,240.38 110.00 1,233.93 110.00 1,227.49 97.00 1,221.04 $343,000 $343,500 110.00 1,261.59 110.00 1,255.14 110.00 1,248.70 110.00 1,242.25 110.00 1,235.81 110.00 1,229.36 97.00 1,222.91 $343,500 $344,000 110.00 1,263.46 110.00 1,257.02 110.00 1,250.57 110.00 1,244.13 110.00 1,237.68 110.00 1,231.24 98.00 1,224.79 $344,000 $344,500 110.00 1,265.34 110.00 1,258.89 110.00 1,252.45 110.00 1,246.00 110.00 1,239.56 110.00 1,233.11 98.00 1,226.66 $344,500 $345,000 110.00 1,267.21 110.00 1,260.77 110.00 1,254.32 110.00 1,247.88 110.00 1,241.43 110.00 1,234.99 98.00 1,228.54 $345,000 $345,500 110.00 1,269.09 110.00 1,262.64 110.00 1,256.20 110.00 1,249.75 110.00 1,243.31 110.00 1,236.86 99.00 1,230.41 $345,500 $346,000 110.00 1,270.96 110.00 1,264.52 110.00 1,258.07 110.00 1,251.63 110.00 1,245.18 110.00 1,238.74 99.00 1,232.29 $346,000 $346,500 110.00 1,272.84 110.00 1,266.39 110.00 1,259.95 110.00 1,253.50 110.00 1,247.06 110.00 1,240.61 99.00 1,234.16 $346,500 $347,000 110.00 1,274.71 110.00 1,268.27 110.00 1,261.82 110.00 1,255.38 110.00 1,248.93 110.00 1,242.49 100.00 1,236.04 $347,000 $347,500 110.00 1,276.59 110.00 1,270.14 110.00 1,263.70 110.00 1,257.25 110.00 1,250.81 110.00 1,244.36 100.00 1,237.91 $347,500 $348,000 110.00 1,278.46 110.00 1,272.02 110.00 1,265.57 110.00 1,259.13 110.00 1,252.68 110.00 1,246.24 100.00 1,239.79 $348,000 $348,500 110.00 1,280.34 110.00 1,273.89 110.00 1,267.45 110.00 1,261.00 110.00 1,254.56 110.00 1,248.11 101.00 1,241.66 $348,500 $349,000 110.00 1,282.21 110.00 1,275.77 110.00 1,269.32 110.00 1,262.88 110.00 1,256.43 110.00 1,249.99 101.00 1,243.54 $349,000 $349,500 110.00 1,284.09 110.00 1,277.64 110.00 1,271.20 110.00 1,264.75 110.00 1,258.31 110.00 1,251.86 101.00 1,245.41 $349,500 $350,000 110.00 1,285.96 110.00 1,279.52 110.00 1,273.07 110.00 1,266.63 110.00 1,260.18 110.00 1,253.74 102.00 1,247.29 $350,000 $350,500 110.00 1,287.84 110.00 1,281.39 110.00 1,274.95 110.00 1,268.50 110.00 1,262.06 110.00 1,255.61 102.00 1,249.16 $350,500 $351,000 110.00 1,289.71 110.00 1,283.27 110.00 1,276.82 110.00 1,270.38 110.00 1,263.93 110.00 1,257.49 102.00 1,251.04 $351,000 $351,500 110.00 1,291.59 110.00 1,285.14 110.00 1,278.70 110.00 1,272.25 110.00 1,265.81 110.00 1,259.36 103.00 1,252.91 $351,500 $352,000 110.00 1,293.46 110.00 1,287.02 110.00 1,280.57 110.00 1,274.13 110.00 1,267.68 110.00 1,261.24 103.00 1,254.79 $352,000 $352,500 110.00 1,295.34 110.00 1,288.89 110.00 1,282.45 110.00 1,276.00 110.00 1,269.56 110.00 1,263.11 104.00 1,256.66 $352,500 $353,000 110.00 1,297.21 110.00 1,290.77 110.00 1,284.32 110.00 1,277.88 110.00 1,271.43 110.00 1,264.99 104.00 1,258.54 $353,000 $353,500 110.00 1,299.09 110.00 1,292.64 110.00 1,286.20 110.00 1,279.75 110.00 1,273.31 110.00 1,266.86 104.00 1,260.41 $353,500 $354,000 110.00 1,300.96 110.00 1,294.52 110.00 1,288.07 110.00 1,281.63 110.00 1,275.18 110.00 1,268.74 105.00 1,262.29 $354,000 $354,500 110.00 1,302.84 110.00 1,296.39 110.00 1,289.95 110.00 1,283.50 110.00 1,277.06 110.00 1,270.61 105.00 1,264.16 $354,500 $355,000 110.00 1,304.71 110.00 1,298.27 110.00 1,291.82 110.00 1,285.38 110.00 1,278.93 110.00 1,272.49 105.00 1,266.04 $355,000 $355,500 110.00 1,306.59 110.00 1,300.14 110.00 1,293.70 110.00 1,287.25 110.00 1,280.81 110.00 1,274.36 106.00 1,267.91 $355,500 $356,000 110.00 1,308.46 110.00 1,302.02 110.00 1,295.57 110.00 1,289.13 110.00 1,282.68 110.00 1,276.24 106.00 1,269.79 $356,000 $356,500 110.00 1,310.34 110.00 1,303.89 110.00 1,297.45 110.00 1,291.00 110.00 1,284.56 110.00 1,278.11 106.00 1,271.66 $356,500 $357,000 110.00 1,312.21 110.00 1,305.77 110.00 1,299.32 110.00 1,292.88 110.00 1,286.43 110.00 1,279.99 107.00 1,273.54 $357,000 $357,500 110.00 1,314.09 110.00 1,307.64 110.00 1,301.20 110.00 1,294.75 110.00 1,288.31 110.00 1,281.86 107.00 1,275.41 $357,500 $358,000 110.00 1,315.96 110.00 1,309.52 110.00 1,303.07 110.00 1,296.63 110.00 1,290.18 110.00 1,283.74 107.00 1,277.29 $358,000 $358,500 110.00 1,317.84 110.00 1,311.39 110.00 1,304.95 110.00 1,298.50 110.00 1,292.06 110.00 1,285.61 108.00 1,279.16 $358,500 $359,000 110.00 1,319.71 110.00 1,313.27 110.00 1,306.82 110.00 1,300.38 110.00 1,293.93 110.00 1,287.49 108.00 1,281.04 $359,000 $359,500 110.00 1,321.59 110.00 1,315.14 110.00 1,308.70 110.00 1,302.25 110.00 1,295.81 110.00 1,289.36 108.00 1,282.91 $359,500 $360,000 110.00 1,323.46 110.00 1,317.02 110.00 1,310.57 110.00 1,304.13 110.00 1,297.68 110.00 1,291.24 109.00 1,284.79

NJEIS Family Cost Participation Table Page 10 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$360,000 $360,500 110.00 1,325.34 110.00 1,318.89 110.00 1,312.45 110.00 1,306.00 110.00 1,299.56 110.00 1,293.11 109.00 1,286.66 $360,500 $361,000 110.00 1,327.21 110.00 1,320.77 110.00 1,314.32 110.00 1,307.88 110.00 1,301.43 110.00 1,294.99 109.00 1,288.54 $361,000 $361,500 110.00 1,329.09 110.00 1,322.64 110.00 1,316.20 110.00 1,309.75 110.00 1,303.31 110.00 1,296.86 110.00 1,290.41 $361,500 $362,000 110.00 1,330.96 110.00 1,324.52 110.00 1,318.07 110.00 1,311.63 110.00 1,305.18 110.00 1,298.74 110.00 1,292.29 $362,000 $362,500 110.00 1,332.84 110.00 1,326.39 110.00 1,319.95 110.00 1,313.50 110.00 1,307.06 110.00 1,300.61 110.00 1,294.16 $362,500 $363,000 110.00 1,334.71 110.00 1,328.27 110.00 1,321.82 110.00 1,315.38 110.00 1,308.93 110.00 1,302.49 110.00 1,296.04 $363,000 $363,500 110.00 1,336.59 110.00 1,330.14 110.00 1,323.70 110.00 1,317.25 110.00 1,310.81 110.00 1,304.36 110.00 1,297.91 $363,500 $364,000 110.00 1,338.46 110.00 1,332.02 110.00 1,325.57 110.00 1,319.13 110.00 1,312.68 110.00 1,306.24 110.00 1,299.79 $364,000 $364,500 110.00 1,340.34 110.00 1,333.89 110.00 1,327.45 110.00 1,321.00 110.00 1,314.56 110.00 1,308.11 110.00 1,301.66 $364,500 $365,000 110.00 1,342.21 110.00 1,335.77 110.00 1,329.32 110.00 1,322.88 110.00 1,316.43 110.00 1,309.99 110.00 1,303.54 $365,000 $365,500 110.00 1,344.09 110.00 1,337.64 110.00 1,331.20 110.00 1,324.75 110.00 1,318.31 110.00 1,311.86 110.00 1,305.41 $365,500 $366,000 110.00 1,345.96 110.00 1,339.52 110.00 1,333.07 110.00 1,326.63 110.00 1,320.18 110.00 1,313.74 110.00 1,307.29 $366,000 $366,500 110.00 1,347.84 110.00 1,341.39 110.00 1,334.95 110.00 1,328.50 110.00 1,322.06 110.00 1,315.61 110.00 1,309.16 $366,500 $367,000 110.00 1,349.71 110.00 1,343.27 110.00 1,336.82 110.00 1,330.38 110.00 1,323.93 110.00 1,317.49 110.00 1,311.04 $367,000 $367,500 110.00 1,351.59 110.00 1,345.14 110.00 1,338.70 110.00 1,332.25 110.00 1,325.81 110.00 1,319.36 110.00 1,312.91 $367,500 $368,000 110.00 1,353.46 110.00 1,347.02 110.00 1,340.57 110.00 1,334.13 110.00 1,327.68 110.00 1,321.24 110.00 1,314.79 $368,000 $368,500 110.00 1,355.34 110.00 1,348.89 110.00 1,342.45 110.00 1,336.00 110.00 1,329.56 110.00 1,323.11 110.00 1,316.66 $368,500 $369,000 110.00 1,357.21 110.00 1,350.77 110.00 1,344.32 110.00 1,337.88 110.00 1,331.43 110.00 1,324.99 110.00 1,318.54 $369,000 $369,500 110.00 1,359.09 110.00 1,352.64 110.00 1,346.20 110.00 1,339.75 110.00 1,333.31 110.00 1,326.86 110.00 1,320.41 $369,500 $370,000 110.00 1,360.96 110.00 1,354.52 110.00 1,348.07 110.00 1,341.63 110.00 1,335.18 110.00 1,328.74 110.00 1,322.29 $370,000 $370,500 110.00 1,362.84 110.00 1,356.39 110.00 1,349.95 110.00 1,343.50 110.00 1,337.06 110.00 1,330.61 110.00 1,324.16 $370,500 $371,000 110.00 1,364.71 110.00 1,358.27 110.00 1,351.82 110.00 1,345.38 110.00 1,338.93 110.00 1,332.49 110.00 1,326.04 $371,000 $371,500 110.00 1,366.59 110.00 1,360.14 110.00 1,353.70 110.00 1,347.25 110.00 1,340.81 110.00 1,334.36 110.00 1,327.91 $371,500 $372,000 110.00 1,368.46 110.00 1,362.02 110.00 1,355.57 110.00 1,349.13 110.00 1,342.68 110.00 1,336.24 110.00 1,329.79 $372,000 $372,500 110.00 1,370.34 110.00 1,363.89 110.00 1,357.45 110.00 1,351.00 110.00 1,344.56 110.00 1,338.11 110.00 1,331.66 $372,500 $373,000 110.00 1,372.21 110.00 1,365.77 110.00 1,359.32 110.00 1,352.88 110.00 1,346.43 110.00 1,339.99 110.00 1,333.54 $373,000 $373,500 110.00 1,374.09 110.00 1,367.64 110.00 1,361.20 110.00 1,354.75 110.00 1,348.31 110.00 1,341.86 110.00 1,335.41 $373,500 $374,000 110.00 1,375.96 110.00 1,369.52 110.00 1,363.07 110.00 1,356.63 110.00 1,350.18 110.00 1,343.74 110.00 1,337.29 $374,000 $374,500 110.00 1,377.84 110.00 1,371.39 110.00 1,364.95 110.00 1,358.50 110.00 1,352.06 110.00 1,345.61 110.00 1,339.16 $374,500 $375,000 110.00 1,379.71 110.00 1,373.27 110.00 1,366.82 110.00 1,360.38 110.00 1,353.93 110.00 1,347.49 110.00 1,341.04 $375,000 $375,500 110.00 1,381.59 110.00 1,375.14 110.00 1,368.70 110.00 1,362.25 110.00 1,355.81 110.00 1,349.36 110.00 1,342.91 $375,500 $376,000 110.00 1,383.46 110.00 1,377.02 110.00 1,370.57 110.00 1,364.13 110.00 1,357.68 110.00 1,351.24 110.00 1,344.79 $376,000 $376,500 110.00 1,385.34 110.00 1,378.89 110.00 1,372.45 110.00 1,366.00 110.00 1,359.56 110.00 1,353.11 110.00 1,346.66 $376,500 $377,000 110.00 1,387.21 110.00 1,380.77 110.00 1,374.32 110.00 1,367.88 110.00 1,361.43 110.00 1,354.99 110.00 1,348.54 $377,000 $377,500 110.00 1,389.09 110.00 1,382.64 110.00 1,376.20 110.00 1,369.75 110.00 1,363.31 110.00 1,356.86 110.00 1,350.41 $377,500 $378,000 110.00 1,390.96 110.00 1,384.52 110.00 1,378.07 110.00 1,371.63 110.00 1,365.18 110.00 1,358.74 110.00 1,352.29 $378,000 $378,500 110.00 1,392.84 110.00 1,386.39 110.00 1,379.95 110.00 1,373.50 110.00 1,367.06 110.00 1,360.61 110.00 1,354.16 $378,500 $379,000 110.00 1,394.71 110.00 1,388.27 110.00 1,381.82 110.00 1,375.38 110.00 1,368.93 110.00 1,362.49 110.00 1,356.04 $379,000 $379,500 110.00 1,396.59 110.00 1,390.14 110.00 1,383.70 110.00 1,377.25 110.00 1,370.81 110.00 1,364.36 110.00 1,357.91 $379,500 $380,000 110.00 1,398.46 110.00 1,392.02 110.00 1,385.57 110.00 1,379.13 110.00 1,372.68 110.00 1,366.24 110.00 1,359.79 $380,000 $380,500 110.00 1,400.34 110.00 1,393.89 110.00 1,387.45 110.00 1,381.00 110.00 1,374.56 110.00 1,368.11 110.00 1,361.66 $380,500 $381,000 110.00 1,402.21 110.00 1,395.77 110.00 1,389.32 110.00 1,382.88 110.00 1,376.43 110.00 1,369.99 110.00 1,363.54 $381,000 $381,500 110.00 1,404.09 110.00 1,397.64 110.00 1,391.20 110.00 1,384.75 110.00 1,378.31 110.00 1,371.86 110.00 1,365.41 $381,500 $382,000 110.00 1,405.96 110.00 1,399.52 110.00 1,393.07 110.00 1,386.63 110.00 1,380.18 110.00 1,373.74 110.00 1,367.29 $382,000 $382,500 110.00 1,407.84 110.00 1,401.39 110.00 1,394.95 110.00 1,388.50 110.00 1,382.06 110.00 1,375.61 110.00 1,369.16 $382,500 $383,000 110.00 1,409.71 110.00 1,403.27 110.00 1,396.82 110.00 1,390.38 110.00 1,383.93 110.00 1,377.49 110.00 1,371.04 $383,000 $383,500 110.00 1,411.59 110.00 1,405.14 110.00 1,398.70 110.00 1,392.25 110.00 1,385.81 110.00 1,379.36 110.00 1,372.91 $383,500 $384,000 110.00 1,413.46 110.00 1,407.02 110.00 1,400.57 110.00 1,394.13 110.00 1,387.68 110.00 1,381.24 110.00 1,374.79 $384,000 $384,500 110.00 1,415.34 110.00 1,408.89 110.00 1,402.45 110.00 1,396.00 110.00 1,389.56 110.00 1,383.11 110.00 1,376.66 $384,500 $385,000 110.00 1,417.21 110.00 1,410.77 110.00 1,404.32 110.00 1,397.88 110.00 1,391.43 110.00 1,384.99 110.00 1,378.54 $385,000 $385,500 110.00 1,419.09 110.00 1,412.64 110.00 1,406.20 110.00 1,399.75 110.00 1,393.31 110.00 1,386.86 110.00 1,380.41 $385,500 $386,000 110.00 1,420.96 110.00 1,414.52 110.00 1,408.07 110.00 1,401.63 110.00 1,395.18 110.00 1,388.74 110.00 1,382.29 $386,000 $386,500 110.00 1,422.84 110.00 1,416.39 110.00 1,409.95 110.00 1,403.50 110.00 1,397.06 110.00 1,390.61 110.00 1,384.16 $386,500 $387,000 110.00 1,424.71 110.00 1,418.27 110.00 1,411.82 110.00 1,405.38 110.00 1,398.93 110.00 1,392.49 110.00 1,386.04 $387,000 $387,500 110.00 1,426.59 110.00 1,420.14 110.00 1,413.70 110.00 1,407.25 110.00 1,400.81 110.00 1,394.36 110.00 1,387.91 $387,500 $388,000 110.00 1,428.46 110.00 1,422.02 110.00 1,415.57 110.00 1,409.13 110.00 1,402.68 110.00 1,396.24 110.00 1,389.79 $388,000 $388,500 110.00 1,430.34 110.00 1,423.89 110.00 1,417.45 110.00 1,411.00 110.00 1,404.56 110.00 1,398.11 110.00 1,391.66 $388,500 $389,000 110.00 1,432.21 110.00 1,425.77 110.00 1,419.32 110.00 1,412.88 110.00 1,406.43 110.00 1,399.99 110.00 1,393.54 $389,000 $389,500 110.00 1,434.09 110.00 1,427.64 110.00 1,421.20 110.00 1,414.75 110.00 1,408.31 110.00 1,401.86 110.00 1,395.41 $389,500 $390,000 110.00 1,435.96 110.00 1,429.52 110.00 1,423.07 110.00 1,416.63 110.00 1,410.18 110.00 1,403.74 110.00 1,397.29 $390,000 $390,500 110.00 1,437.84 110.00 1,431.39 110.00 1,424.95 110.00 1,418.50 110.00 1,412.06 110.00 1,405.61 110.00 1,399.16 $390,500 $391,000 110.00 1,439.71 110.00 1,433.27 110.00 1,426.82 110.00 1,420.38 110.00 1,413.93 110.00 1,407.49 110.00 1,401.04 $391,000 $391,500 110.00 1,441.59 110.00 1,435.14 110.00 1,428.70 110.00 1,422.25 110.00 1,415.81 110.00 1,409.36 110.00 1,402.91 $391,500 $392,000 110.00 1,443.46 110.00 1,437.02 110.00 1,430.57 110.00 1,424.13 110.00 1,417.68 110.00 1,411.24 110.00 1,404.79 $392,000 $392,500 110.00 1,445.34 110.00 1,438.89 110.00 1,432.45 110.00 1,426.00 110.00 1,419.56 110.00 1,413.11 110.00 1,406.66 $392,500 $393,000 110.00 1,447.21 110.00 1,440.77 110.00 1,434.32 110.00 1,427.88 110.00 1,421.43 110.00 1,414.99 110.00 1,408.54 $393,000 $393,500 110.00 1,449.09 110.00 1,442.64 110.00 1,436.20 110.00 1,429.75 110.00 1,423.31 110.00 1,416.86 110.00 1,410.41 $393,500 $394,000 110.00 1,450.96 110.00 1,444.52 110.00 1,438.07 110.00 1,431.63 110.00 1,425.18 110.00 1,418.74 110.00 1,412.29 $394,000 $394,500 110.00 1,452.84 110.00 1,446.39 110.00 1,439.95 110.00 1,433.50 110.00 1,427.06 110.00 1,420.61 110.00 1,414.16 $394,500 $395,000 110.00 1,454.71 110.00 1,448.27 110.00 1,441.82 110.00 1,435.38 110.00 1,428.93 110.00 1,422.49 110.00 1,416.04 $395,000 $395,500 110.00 1,456.59 110.00 1,450.14 110.00 1,443.70 110.00 1,437.25 110.00 1,430.81 110.00 1,424.36 110.00 1,417.91 $395,500 $396,000 110.00 1,458.46 110.00 1,452.02 110.00 1,445.57 110.00 1,439.13 110.00 1,432.68 110.00 1,426.24 110.00 1,419.79 $396,000 $396,500 110.00 1,460.34 110.00 1,453.89 110.00 1,447.45 110.00 1,441.00 110.00 1,434.56 110.00 1,428.11 110.00 1,421.66 $396,500 $397,000 110.00 1,462.21 110.00 1,455.77 110.00 1,449.32 110.00 1,442.88 110.00 1,436.43 110.00 1,429.99 110.00 1,423.54 $397,000 $397,500 110.00 1,464.09 110.00 1,457.64 110.00 1,451.20 110.00 1,444.75 110.00 1,438.31 110.00 1,431.86 110.00 1,425.41 $397,500 $398,000 110.00 1,465.96 110.00 1,459.52 110.00 1,453.07 110.00 1,446.63 110.00 1,440.18 110.00 1,433.74 110.00 1,427.29 $398,000 $398,500 110.00 1,467.84 110.00 1,461.39 110.00 1,454.95 110.00 1,448.50 110.00 1,442.06 110.00 1,435.61 110.00 1,429.16 $398,500 $399,000 110.00 1,469.71 110.00 1,463.27 110.00 1,456.82 110.00 1,450.38 110.00 1,443.93 110.00 1,437.49 110.00 1,431.04 $399,000 $399,500 110.00 1,471.59 110.00 1,465.14 110.00 1,458.70 110.00 1,452.25 110.00 1,445.81 110.00 1,439.36 110.00 1,432.91 $399,500 $400,000 110.00 1,473.46 110.00 1,467.02 110.00 1,460.57 110.00 1,454.13 110.00 1,447.68 110.00 1,441.24 110.00 1,434.79

NJEIS Family Cost Participation Table Page 11 of 12 Effective July 1, 2019

If your NJEIS And Your Family Size Is

At But lessleast- than- Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly Hourly Monthly

Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max Co-pay Max

7 8Determined Income is

2 3 4 5 6

$400,000 $400,500 110.00 1,475.34 110.00 1,468.89 110.00 1,462.45 110.00 1,456.00 110.00 1,449.56 110.00 1,443.11 110.00 1,436.66 $400,500 $401,000 110.00 1,477.21 110.00 1,470.77 110.00 1,464.32 110.00 1,457.88 110.00 1,451.43 110.00 1,444.99 110.00 1,438.54 $401,000 $401,500 110.00 1,479.09 110.00 1,472.64 110.00 1,466.20 110.00 1,459.75 110.00 1,453.31 110.00 1,446.86 110.00 1,440.41 $401,500 $402,000 110.00 1,480.96 110.00 1,474.52 110.00 1,468.07 110.00 1,461.63 110.00 1,455.18 110.00 1,448.74 110.00 1,442.29 $402,000 $402,500 110.00 1,482.84 110.00 1,476.39 110.00 1,469.95 110.00 1,463.50 110.00 1,457.06 110.00 1,450.61 110.00 1,444.16 $402,500 $403,000 110.00 1,484.71 110.00 1,478.27 110.00 1,471.82 110.00 1,465.38 110.00 1,458.93 110.00 1,452.49 110.00 1,446.04 $403,000 $403,500 110.00 1,486.59 110.00 1,480.14 110.00 1,473.70 110.00 1,467.25 110.00 1,460.81 110.00 1,454.36 110.00 1,447.91 $403,500 $404,000 110.00 1,488.46 110.00 1,482.02 110.00 1,475.57 110.00 1,469.13 110.00 1,462.68 110.00 1,456.24 110.00 1,449.79 $404,000 $404,500 110.00 1,490.34 110.00 1,483.89 110.00 1,477.45 110.00 1,471.00 110.00 1,464.56 110.00 1,458.11 110.00 1,451.66 $404,500 $405,000 110.00 1,492.21 110.00 1,485.77 110.00 1,479.32 110.00 1,472.88 110.00 1,466.43 110.00 1,459.99 110.00 1,453.54 $405,000 $405,500 110.00 1,494.09 110.00 1,487.64 110.00 1,481.20 110.00 1,474.75 110.00 1,468.31 110.00 1,461.86 110.00 1,455.41 $405,500 $406,000 110.00 1,495.96 110.00 1,489.52 110.00 1,483.07 110.00 1,476.63 110.00 1,470.18 110.00 1,463.74 110.00 1,457.29 $406,000 $406,500 110.00 1,497.84 110.00 1,491.39 110.00 1,484.95 110.00 1,478.50 110.00 1,472.06 110.00 1,465.61 110.00 1,459.16 $406,500 $407,000 110.00 1,499.71 110.00 1,493.27 110.00 1,486.82 110.00 1,480.38 110.00 1,473.93 110.00 1,467.49 110.00 1,461.04 $407,000 $407,500 110.00 1,501.59 110.00 1,495.14 110.00 1,488.70 110.00 1,482.25 110.00 1,475.81 110.00 1,469.36 110.00 1,462.91 $407,500 $408,000 110.00 1,503.46 110.00 1,497.02 110.00 1,490.57 110.00 1,484.13 110.00 1,477.68 110.00 1,471.24 110.00 1,464.79 $408,000 $408,500 110.00 1,505.34 110.00 1,498.89 110.00 1,492.45 110.00 1,486.00 110.00 1,479.56 110.00 1,473.11 110.00 1,466.66 $408,500 $409,000 110.00 1,507.21 110.00 1,500.77 110.00 1,494.32 110.00 1,487.88 110.00 1,481.43 110.00 1,474.99 110.00 1,468.54 $409,000 $409,500 110.00 1,509.09 110.00 1,502.64 110.00 1,496.20 110.00 1,489.75 110.00 1,483.31 110.00 1,476.86 110.00 1,470.41 $409,500 $410,000 110.00 1,510.96 110.00 1,504.52 110.00 1,498.07 110.00 1,491.63 110.00 1,485.18 110.00 1,478.74 110.00 1,472.29 $410,000 $410,500 110.00 1,512.84 110.00 1,506.39 110.00 1,499.95 110.00 1,493.50 110.00 1,487.06 110.00 1,480.61 110.00 1,474.16 $410,500 $411,000 110.00 1,514.71 110.00 1,508.27 110.00 1,501.82 110.00 1,495.38 110.00 1,488.93 110.00 1,482.49 110.00 1,476.04 $411,000 $411,500 110.00 1,516.59 110.00 1,510.14 110.00 1,503.70 110.00 1,497.25 110.00 1,490.81 110.00 1,484.36 110.00 1,477.91 $411,500 $412,000 110.00 1,518.46 110.00 1,512.02 110.00 1,505.57 110.00 1,499.13 110.00 1,492.68 110.00 1,486.24 110.00 1,479.79 $412,000 $412,500 110.00 1,520.34 110.00 1,513.89 110.00 1,507.45 110.00 1,501.00 110.00 1,494.56 110.00 1,488.11 110.00 1,481.66 $412,500 $413,000 110.00 1,522.21 110.00 1,515.77 110.00 1,509.32 110.00 1,502.88 110.00 1,496.43 110.00 1,489.99 110.00 1,483.54 $413,000 $413,500 110.00 1,524.09 110.00 1,517.64 110.00 1,511.20 110.00 1,504.75 110.00 1,498.31 110.00 1,491.86 110.00 1,485.41 $413,500 $414,000 110.00 1,525.96 110.00 1,519.52 110.00 1,513.07 110.00 1,506.63 110.00 1,500.18 110.00 1,493.74 110.00 1,487.29 $414,000 $414,500 110.00 1,527.84 110.00 1,521.39 110.00 1,514.95 110.00 1,508.50 110.00 1,502.06 110.00 1,495.61 110.00 1,489.16 $414,500 $415,000 110.00 1,529.71 110.00 1,523.27 110.00 1,516.82 110.00 1,510.38 110.00 1,503.93 110.00 1,497.49 110.00 1,491.04 $415,000 $415,500 110.00 1,531.59 110.00 1,525.14 110.00 1,518.70 110.00 1,512.25 110.00 1,505.81 110.00 1,499.36 110.00 1,492.91 $415,500 $416,000 110.00 1,533.46 110.00 1,527.02 110.00 1,520.57 110.00 1,514.13 110.00 1,507.68 110.00 1,501.24 110.00 1,494.79 $416,000 $416,500 110.00 1,535.34 110.00 1,528.89 110.00 1,522.45 110.00 1,516.00 110.00 1,509.56 110.00 1,503.11 110.00 1,496.66 $416,500 $417,000 110.00 1,537.21 110.00 1,530.77 110.00 1,524.32 110.00 1,517.88 110.00 1,511.43 110.00 1,504.99 110.00 1,498.54 $417,000 $417,500 110.00 1,539.09 110.00 1,532.64 110.00 1,526.20 110.00 1,519.75 110.00 1,513.31 110.00 1,506.86 110.00 1,500.41 $417,500 $418,000 110.00 1,540.96 110.00 1,534.52 110.00 1,528.07 110.00 1,521.63 110.00 1,515.18 110.00 1,508.74 110.00 1,502.29 $418,000 $418,500 110.00 1,542.84 110.00 1,536.39 110.00 1,529.95 110.00 1,523.50 110.00 1,517.06 110.00 1,510.61 110.00 1,504.16 $418,500 $419,000 110.00 1,544.71 110.00 1,538.27 110.00 1,531.82 110.00 1,525.38 110.00 1,518.93 110.00 1,512.49 110.00 1,506.04 $419,000 $419,500 110.00 1,546.59 110.00 1,540.14 110.00 1,533.70 110.00 1,527.25 110.00 1,520.81 110.00 1,514.36 110.00 1,507.91 $419,500 $420,000 110.00 1,548.46 110.00 1,542.02 110.00 1,535.57 110.00 1,529.13 110.00 1,522.68 110.00 1,516.24 110.00 1,509.79 $420,000 $420,500 110.00 1,550.34 110.00 1,543.89 110.00 1,537.45 110.00 1,531.00 110.00 1,524.56 110.00 1,518.11 110.00 1,511.66 $420,500 $421,000 110.00 1,552.21 110.00 1,545.77 110.00 1,539.32 110.00 1,532.88 110.00 1,526.43 110.00 1,519.99 110.00 1,513.54 $421,000 $421,500 110.00 1,554.09 110.00 1,547.64 110.00 1,541.20 110.00 1,534.75 110.00 1,528.31 110.00 1,521.86 110.00 1,515.41 $421,500 $422,000 110.00 1,555.96 110.00 1,549.52 110.00 1,543.07 110.00 1,536.63 110.00 1,530.18 110.00 1,523.74 110.00 1,517.29 $422,000 $422,500 110.00 1,557.84 110.00 1,551.39 110.00 1,544.95 110.00 1,538.50 110.00 1,532.06 110.00 1,525.61 110.00 1,519.16 $422,500 $423,000 110.00 1,559.71 110.00 1,553.27 110.00 1,546.82 110.00 1,540.38 110.00 1,533.93 110.00 1,527.49 110.00 1,521.04 $423,000 $423,500 110.00 1,561.59 110.00 1,555.14 110.00 1,548.70 110.00 1,542.25 110.00 1,535.81 110.00 1,529.36 110.00 1,522.91 $423,500 $424,000 110.00 1,563.46 110.00 1,557.02 110.00 1,550.57 110.00 1,544.13 110.00 1,537.68 110.00 1,531.24 110.00 1,524.79 $424,000 $424,500 110.00 1,565.34 110.00 1,558.89 110.00 1,552.45 110.00 1,546.00 110.00 1,539.56 110.00 1,533.11 110.00 1,526.66 $424,500 $425,000 110.00 1,567.21 110.00 1,560.77 110.00 1,554.32 110.00 1,547.88 110.00 1,541.43 110.00 1,534.99 110.00 1,528.54 $425,000 $425,500 110.00 1,569.09 110.00 1,562.64 110.00 1,556.20 110.00 1,549.75 110.00 1,543.31 110.00 1,536.86 110.00 1,530.41 $425,500 $426,000 110.00 1,570.96 110.00 1,564.52 110.00 1,558.07 110.00 1,551.63 110.00 1,545.18 110.00 1,538.74 110.00 1,532.29 $426,000 $426,500 110.00 1,572.84 110.00 1,566.39 110.00 1,559.95 110.00 1,553.50 110.00 1,547.06 110.00 1,540.61 110.00 1,534.16 $426,500 $427,000 110.00 1,574.71 110.00 1,568.27 110.00 1,561.82 110.00 1,555.38 110.00 1,548.93 110.00 1,542.49 110.00 1,536.04 $427,000 $427,500 110.00 1,576.59 110.00 1,570.14 110.00 1,563.70 110.00 1,557.25 110.00 1,550.81 110.00 1,544.36 110.00 1,537.91 $427,500 $428,000 110.00 1,578.46 110.00 1,572.02 110.00 1,565.57 110.00 1,559.13 110.00 1,552.68 110.00 1,546.24 110.00 1,539.79 $428,000 $428,500 110.00 1,580.34 110.00 1,573.89 110.00 1,567.45 110.00 1,561.00 110.00 1,554.56 110.00 1,548.11 110.00 1,541.66 $428,500 $429,000 110.00 1,582.21 110.00 1,575.77 110.00 1,569.32 110.00 1,562.88 110.00 1,556.43 110.00 1,549.99 110.00 1,543.54 $429,000 $429,500 110.00 1,584.09 110.00 1,577.64 110.00 1,571.20 110.00 1,564.75 110.00 1,558.31 110.00 1,551.86 110.00 1,545.41 $429,500 $430,000 110.00 1,585.96 110.00 1,579.52 110.00 1,573.07 110.00 1,566.63 110.00 1,560.18 110.00 1,553.74 110.00 1,547.29 $430,000 $430,500 110.00 1,587.84 110.00 1,581.39 110.00 1,574.95 110.00 1,568.50 110.00 1,562.06 110.00 1,555.61 110.00 1,549.16 $430,500 $431,000 110.00 1,589.71 110.00 1,583.27 110.00 1,576.82 110.00 1,570.38 110.00 1,563.93 110.00 1,557.49 110.00 1,551.04 $431,000 $431,500 110.00 1,591.59 110.00 1,585.14 110.00 1,578.70 110.00 1,572.25 110.00 1,565.81 110.00 1,559.36 110.00 1,552.91 $431,500 $432,000 110.00 1,593.46 110.00 1,587.02 110.00 1,580.57 110.00 1,574.13 110.00 1,567.68 110.00 1,561.24 110.00 1,554.79 $432,000 $432,500 110.00 1,595.34 110.00 1,588.89 110.00 1,582.45 110.00 1,576.00 110.00 1,569.56 110.00 1,563.11 110.00 1,556.66 $432,500 $433,000 110.00 1,597.21 110.00 1,590.77 110.00 1,584.32 110.00 1,577.88 110.00 1,571.43 110.00 1,564.99 110.00 1,558.54 $433,000 $433,500 110.00 1,599.09 110.00 1,592.64 110.00 1,586.20 110.00 1,579.75 110.00 1,573.31 110.00 1,566.86 110.00 1,560.41 $433,500 $434,000 110.00 1,600.96 110.00 1,594.52 110.00 1,588.07 110.00 1,581.63 110.00 1,575.18 110.00 1,568.74 110.00 1,562.29 $434,000 $434,500 110.00 1,602.84 110.00 1,596.39 110.00 1,589.95 110.00 1,583.50 110.00 1,577.06 110.00 1,570.61 110.00 1,564.16 $434,500 $435,000 110.00 1,604.71 110.00 1,598.27 110.00 1,591.82 110.00 1,585.38 110.00 1,578.93 110.00 1,572.49 110.00 1,566.04 $435,000 $435,500 110.00 1,606.59 110.00 1,600.14 110.00 1,593.70 110.00 1,587.25 110.00 1,580.81 110.00 1,574.36 110.00 1,567.91 $435,500 $436,000 110.00 1,608.46 110.00 1,602.02 110.00 1,595.57 110.00 1,589.13 110.00 1,582.68 110.00 1,576.24 110.00 1,569.79 $436,000 $436,500 110.00 1,610.34 110.00 1,603.89 110.00 1,597.45 110.00 1,591.00 110.00 1,584.56 110.00 1,578.11 110.00 1,571.66 $436,500 $437,000 110.00 1,612.21 110.00 1,605.77 110.00 1,599.32 110.00 1,592.88 110.00 1,586.43 110.00 1,579.99 110.00 1,573.54 $437,000 $437,500 110.00 1,614.09 110.00 1,607.64 110.00 1,601.20 110.00 1,594.75 110.00 1,588.31 110.00 1,581.86 110.00 1,575.41 $437,500 $438,000 110.00 1,615.96 110.00 1,609.52 110.00 1,603.07 110.00 1,596.63 110.00 1,590.18 110.00 1,583.74 110.00 1,577.29 $438,000 $438,500 110.00 1,617.84 110.00 1,611.39 110.00 1,604.95 110.00 1,598.50 110.00 1,592.06 110.00 1,585.61 110.00 1,579.16 $438,500 $439,000 110.00 1,619.71 110.00 1,613.27 110.00 1,606.82 110.00 1,600.38 110.00 1,593.93 110.00 1,587.49 110.00 1,581.04 $439,000 $439,500 110.00 1,621.59 110.00 1,615.14 110.00 1,608.70 110.00 1,602.25 110.00 1,595.81 110.00 1,589.36 110.00 1,582.91 $439,500 $440,000 110.00 1,623.46 110.00 1,617.02 110.00 1,610.57 110.00 1,604.13 110.00 1,597.68 110.00 1,591.24 110.00 1,584.79 $440,000 $440,500 110.00 1,625.34 110.00 1,618.89 110.00 1,612.45 110.00 1,606.00 110.00 1,599.56 110.00 1,593.11 110.00 1,586.66

NJEIS Family Cost Participation Table Page 12 of 12 Effective July 1, 2019