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equal to 250% FPL. Please refer to the attached income charts demonstrating this. Above 100-150% FPL One child $7 Two or more children $14 Above 150-200% FPL One child $16 Two children $32 Three or more children $48 Above 200-250% FPL One child $24 Two children $48 Three or more children $72 Families who prepay three months of premiums will not have to pay a premium for the fourth month. Families who use recurring electronic fund or credit card transfers receive a 25% discount on monthly family contributions. Community Provider Plan. MRMIB will also designate a “Community Provider Plan” by geographic area. This is the plan in the area with the highest percentage of traditional and safety net providers. These packages will have the following monthly base premiums: Community Provider Plan Above 100-150% FPL One child $4 Two or more children $8 Above 150-200% FPL One child $13 Two children $26 Three or more children $39 Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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