SFY 2021 Hourly Co-pay Family Cost Participation Tables

SSFY 20 Hourly Co-pay

Family CostParticipation Tables

Effective: July 1, 20

NJEIS Family Cost Participation Table 2 of 12 Effective Date: July 1, 20

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 8300% FPL $ , 0 $6 , 0 $7 , 0 $ , 0 $ , 0 $11 , 0 $1 , 0

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 - - - - - - - - - - - - - - $51,500 $52,000 - - - - - - - - - - - - - - $52,000 $52,500 2.00 173.33 - - - - - - - - - - - - $52,500 $53,000 2.00 175.00 - - - - - - - - - - - - $53,000 $53,500 2.00 176.67 - - - - - - - - - - - - $53,500 $54,000 2.00 178.33 - - - - - - - - - - - - $54,000 $54,500 3.00 180.00 - - - - - - - - - - - - $54,500 $55,000 3.00 181.67 - - - - - - - - - - - - $55,000 $55,500 3.00 183.33 - - - - - - - - - - - - $55,500 $56,000 3.00 185.00 - - - - - - - - - - - - $56,000 $56,500 3.00 186.67 - - - - - - - - - - - - $56,500 $57,000 4.00 188.33 - - - - - - - - - - - - $57,000 $57,500 4.00 190.00 - - - - - - - - - - - - $57,500 $58,000 4.00 191.67 - - - - - - - - - - - - $58,000 $58,500 4.00 193.33 - - - - - - - - - - - - $58,500 $59,000 5.00 195.00 - - - - - - - - - - - - $59,000 $59,500 5.00 196.67 - - - - - - - - - - - - $59,500 $60,000 5.00 198.33 - - - - - - - - - - - - $60,000 $60,500 5.00 200.00 - - - - - - - - - - - - $60,500 $61,000 6.00 201.73 - - - - - - - - - - - - $61,000 $61,500 6.00 203.61 - - - - - - - - - - - - $61,500 $62,000 6.00 205.48 - - - - - - - - - - - - $62,000 $62,500 7.00 207.36 - - - - - - - - - - - - $62,500 $63,000 7.00 209.23 - - - - - - - - - - - - $63,000 $63,500 7.00 211.11 - - - - - - - - - - - - $63,500 $64,000 7.00 212.98 - - - - - - - - - - - - $64,000 $64,500 7.00 214.86 - - - - - - - - - - - - $64,500 $65,000 7.00 216.73 - - - - - - - - - - - - $65,000 $65,500 7.00 218.61 - - - - - - - - - - - - $65,500 $66,000 8.00 220.48 2.00 218.33 - - - - - - - - - - $66,000 $66,500 8.00 222.36 2.00 220.00 - - - - - - - - - - $66,500 $67,000 8.00 224.23 2.00 221.67 - - - - - - - - - - $67,000 $67,500 8.00 226.11 2.00 223.33 - - - - - - - - - - $67,500 $68,000 8.00 227.98 2.00 225.00 - - - - - - - - - - $68,000 $68,500 8.00 229.86 3.00 226.67 - - - - - - - - - - $68,500 $69,000 9.00 231.73 3.00 228.33 - - - - - - - - - - $69,000 $69,500 9.00 233.61 3.00 230.00 - - - - - - - - - - $69,500 $70,000 9.00 235.48 3.00 231.67 - - - - - - - - - - $70,000 $70,500 9.00 237.36 3.00 233.33 - - - - - - - - - - $70,500 $71,000 9.00 239.23 3.00 235.00 - - - - - - - - - - $71,000 $71,500 9.00 241.11 4.00 236.67 - - - - - - - - - - $71,500 $72,000 9.00 242.98 4.00 238.33 - - - - - - - - - - $72,000 $72,500 10.00 244.86 4.00 240.00 - - - - - - - - - - $72,500 $73,000 10.00 246.73 4.00 241.67 - - - - - - - - - - $73,000 $73,500 10.00 248.61 4.00 243.33 - - - - - - - - - - $73,500 $74,000 10.00 250.48 5.00 245.00 - - - - - - - - - - $74,000 $74,500 10.00 252.36 5.00 246.67 - - - - - - - - - - $74,500 $75,000 10.00 254.23 5.00 248.33 - - - - - - - - - - $75,000 $75,500 11.00 256.11 5.00 250.00 - - - - - - - - - - $75,500 $76,000 11.00 257.98 5.00 251.67 - - - - - - - - - - $76,000 $76,500 11.00 259.86 5.00 253.33 - - - - - - - - - - $76,500 $77,000 11.00 261.73 6.00 255.20 - - - - - - - - - - $77,000 $77,500 11.00 263.61 6.00 257.08 - - - - - - - - - - $77,500 $78,000 11.00 265.48 6.00 258.95 - - - - - - - - - - $78,000 $78,500 12.00 267.36 7.00 260.83 - - - - - - - - - - $78,500 $79,000 12.00 269.23 7.00 262.70 - - - - - - - - - - $79,000 $79,500 12.00 271.11 7.00 264.58 2.00 263.33 - - - - - - - - $79,500 $80,000 12.00 272.98 7.00 266.45 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, 2015

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 12.00 274.86 7.00 268.33 2.00 266.67 - - - - - - - - $80,500 $81,000 12.00 276.73 7.00 270.20 2.00 268.33 - - - - - - - - $81,000 $81,500 13.00 278.61 8.00 272.08 2.00 270.00 - - - - - - - - $81,500 $82,000 13.00 280.48 8.00 273.95 2.00 271.67 - - - - - - - - $82,000 $82,500 13.00 282.36 8.00 275.83 2.00 273.33 - - - - - - - - $82,500 $83,000 13.00 284.23 8.00 277.70 3.00 275.00 - - - - - - - - $83,000 $83,500 13.00 286.11 8.00 279.58 3.00 276.67 - - - - - - - - $83,500 $84,000 14.00 287.98 8.00 281.45 3.00 278.33 - - - - - - - - $84,000 $84,500 14.00 289.86 8.00 283.33 3.00 280.00 - - - - - - - - $84,500 $85,000 14.00 291.73 9.00 285.20 3.00 281.67 - - - - - - - - $85,000 $85,500 14.00 293.61 9.00 287.08 3.00 283.33 - - - - - - - - $85,500 $86,000 14.00 295.48 9.00 288.95 4.00 285.00 - - - - - - - - $86,000 $86,500 14.00 297.36 9.00 290.83 4.00 286.67 - - - - - - - - $86,500 $87,000 15.00 299.23 9.00 292.70 4.00 288.33 - - - - - - - - $87,000 $87,500 15.00 301.11 9.00 294.58 4.00 290.00 - - - - - - - - $87,500 $88,000 15.00 302.98 10.00 296.45 4.00 291.67 - - - - - - - - $88,000 $88,500 15.00 304.86 10.00 298.33 4.00 293.33 - - - - - - - - $88,500 $89,000 15.00 306.73 10.00 300.20 4.00 295.00 - - - - - - - - $89,000 $89,500 16.00 308.61 10.00 302.08 5.00 296.67 - - - - - - - - $89,500 $90,000 16.00 310.48 10.00 303.95 5.00 298.33 - - - - - - - - $90,000 $90,500 16.00 312.36 10.00 305.83 5.00 300.00 - - - - - - - - $90,500 $91,000 16.00 314.23 11.00 307.70 5.00 301.67 - - - - - - - - $91,000 $91,500 16.00 316.11 11.00 309.58 5.00 303.33 - - - - - - - - $91,500 $92,000 16.00 317.98 11.00 311.45 5.00 305.00 - - - - - - - - $92,000 $92,500 17.00 319.86 11.00 313.33 6.00 306.79 - - - - - - - - $92,500 $93,000 17.00 321.73 11.00 315.20 6.00 308.67 2.00 308.33 - - - - - - $93,000 $93,500 17.00 323.61 11.00 317.08 6.00 310.54 2.00 310.00 - - - - - - $93,500 $94,000 17.00 325.48 11.00 318.95 7.00 312.42 2.00 311.67 - - - - - - $94,000 $94,500 17.00 327.36 12.00 320.83 7.00 314.29 2.00 313.33 - - - - - - $94,500 $95,000 18.00 329.23 12.00 322.70 7.00 316.17 2.00 315.00 - - - - - - $95,000 $95,500 18.00 331.11 12.00 324.58 7.00 318.04 2.00 316.67 - - - - - - $95,500 $96,000 18.00 332.98 12.00 326.45 7.00 319.92 2.00 318.33 - - - - - - $96,000 $96,500 18.00 334.86 12.00 328.33 7.00 321.79 2.00 320.00 - - - - - - $96,500 $97,000 18.00 336.73 12.00 330.20 8.00 323.67 3.00 321.67 - - - - - - $97,000 $97,500 19.00 338.61 13.00 332.08 8.00 325.54 3.00 323.33 - - - - - - $97,500 $98,000 19.00 340.48 13.00 333.95 8.00 327.42 3.00 325.00 - - - - - - $98,000 $98,500 19.00 342.36 13.00 335.83 8.00 329.29 3.00 326.67 - - - - - - $98,500 $99,000 19.00 344.23 13.00 337.70 8.00 331.17 3.00 328.33 - - - - - - $99,000 $99,500 20.00 346.11 13.00 339.58 8.00 333.04 3.00 330.00 - - - - - - $99,500 $100,000 20.00 347.98 13.00 341.45 8.00 334.92 3.00 331.67 - - - - - -

$100,000 $100,500 20.00 349.86 14.00 343.33 9.00 336.79 4.00 333.33 - - - - - - $100,500 $101,000 20.00 351.73 14.00 345.20 9.00 338.67 4.00 335.00 - - - - - - $101,000 $101,500 21.00 353.61 14.00 347.08 9.00 340.54 4.00 336.67 - - - - - - $101,500 $102,000 21.00 355.48 14.00 348.95 9.00 342.42 4.00 338.33 - - - - - - $102,000 $102,500 21.00 357.36 14.00 350.83 9.00 344.29 4.00 340.00 - - - - - - $102,500 $103,000 21.00 359.23 15.00 352.70 9.00 346.17 4.00 341.67 - - - - - - $103,000 $103,500 22.00 361.11 15.00 354.58 10.00 348.04 4.00 343.33 - - - - - - $103,500 $104,000 22.00 362.98 15.00 356.45 10.00 349.92 4.00 345.00 - - - - - - $104,000 $104,500 22.00 364.86 15.00 358.33 10.00 351.79 5.00 346.67 - - - - - - $104,500 $105,000 22.00 366.73 15.00 360.20 10.00 353.67 5.00 348.33 - - - - - - $105,000 $105,500 23.00 368.61 15.00 362.08 10.00 355.54 5.00 350.00 - - - - - - $105,500 $106,000 23.00 370.48 16.00 363.95 10.00 357.42 5.00 351.67 2.00 351.67 - - - - $106,000 $106,500 23.00 372.36 16.00 365.83 10.00 359.29 5.00 353.33 2.00 353.33 - - - - $106,500 $107,000 23.00 374.23 16.00 367.70 11.00 361.17 5.00 355.00 2.00 355.00 - - - - $107,000 $107,500 24.00 376.11 16.00 369.58 11.00 363.04 5.00 356.67 2.00 356.67 - - - - $107,500 $108,000 24.00 377.98 16.00 371.45 11.00 364.92 6.00 358.38 2.00 358.33 - - - - $108,000 $108,500 24.00 379.86 17.00 373.33 11.00 366.79 6.00 360.26 2.00 360.00 - - - - $108,500 $109,000 24.00 381.73 17.00 375.20 11.00 368.67 6.00 362.13 2.00 361.67 - - - - $109,000 $109,500 24.00 383.61 17.00 377.08 11.00 370.54 7.00 364.01 2.00 363.33 - - - - $109,500 $110,000 25.00 385.48 17.00 378.95 12.00 372.42 7.00 365.88 2.00 365.00 - - - - $110,000 $110,500 25.00 387.36 17.00 380.83 12.00 374.29 7.00 367.76 2.00 366.67 - - - - $110,500 $111,000 25.00 389.23 17.00 382.70 12.00 376.17 7.00 369.63 3.00 368.33 - - - - $111,000 $111,500 25.00 391.11 18.00 384.58 12.00 378.04 7.00 371.51 3.00 370.00 - - - - $111,500 $112,000 26.00 392.98 18.00 386.45 12.00 379.92 7.00 373.38 3.00 371.67 - - - - $112,000 $112,500 26.00 394.86 18.00 388.33 12.00 381.79 7.00 375.26 3.00 373.33 - - - - $112,500 $113,000 26.00 396.73 18.00 390.20 13.00 383.67 8.00 377.13 3.00 375.00 - - - - $113,000 $113,500 27.00 398.61 18.00 392.08 13.00 385.54 8.00 379.01 3.00 376.67 - - - - $113,500 $114,000 27.00 400.48 19.00 393.95 13.00 387.42 8.00 380.88 3.00 378.33 - - - - $114,000 $114,500 27.00 402.36 19.00 395.83 13.00 389.29 8.00 382.76 3.00 380.00 - - - - $114,500 $115,000 28.00 404.23 19.00 397.70 13.00 391.17 8.00 384.63 4.00 381.67 - - - - $115,000 $115,500 28.00 406.11 19.00 399.58 13.00 393.04 8.00 386.51 4.00 383.33 - - - - $115,500 $116,000 28.00 407.98 19.00 401.45 13.00 394.92 9.00 388.38 4.00 385.00 - - - - $116,000 $116,500 29.00 409.86 19.00 403.33 14.00 396.79 9.00 390.26 4.00 386.67 - - - - $116,500 $117,000 29.00 411.73 20.00 405.20 14.00 398.67 9.00 392.13 4.00 388.33 - - - - $117,000 $117,500 29.00 413.61 20.00 407.08 14.00 400.54 9.00 394.01 4.00 390.00 - - - - $117,500 $118,000 30.00 415.48 20.00 408.95 14.00 402.42 9.00 395.88 4.00 391.67 - - - - $118,000 $118,500 30.00 417.36 20.00 410.83 14.00 404.29 9.00 397.76 4.00 393.33 - - - - $118,500 $119,000 30.00 419.23 20.00 412.70 14.00 406.17 9.00 399.63 4.00 395.00 - - - - $119,000 $119,500 31.00 421.11 21.00 414.58 15.00 408.04 10.00 401.51 5.00 396.67 2.00 396.67 - - $119,500 $120,000 31.00 422.98 21.00 416.45 15.00 409.92 10.00 403.38 5.00 398.33 2.00 398.33 - -

NJEIS Family Cost Participation Table Page 4 of 12 Effective July 1, 2015

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 31.00 424.86 21.00 418.33 15.00 411.79 10.00 405.26 5.00 400.00 2.00 400.00 - - $120,500 $121,000 32.00 426.73 21.00 420.20 15.00 413.67 10.00 407.13 5.00 401.67 2.00 401.67 - - $121,000 $121,500 32.00 428.61 21.00 422.08 15.00 415.54 10.00 409.01 5.00 403.33 2.00 403.33 - - $121,500 $122,000 32.00 430.48 22.00 423.95 16.00 417.42 10.00 410.88 5.00 405.00 2.00 405.00 - - $122,000 $122,500 33.00 432.36 22.00 425.83 16.00 419.29 11.00 412.76 5.00 406.67 2.00 406.67 - - $122,500 $123,000 33.00 434.23 22.00 427.70 16.00 421.17 11.00 414.63 5.00 408.33 2.00 408.33 - - $123,000 $123,500 33.00 436.11 22.00 429.58 16.00 423.04 11.00 416.51 5.00 410.00 2.00 410.00 - - $123,500 $124,000 34.00 437.98 23.00 431.45 16.00 424.92 11.00 418.38 6.00 411.85 2.00 411.67 - - $124,000 $124,500 34.00 439.86 23.00 433.33 16.00 426.79 11.00 420.26 6.00 413.73 2.00 413.33 - - $124,500 $125,000 34.00 441.73 23.00 435.20 17.00 428.67 11.00 422.13 6.00 415.60 3.00 415.00 - - $125,000 $125,500 35.00 443.61 23.00 437.08 17.00 430.54 12.00 424.01 7.00 417.48 3.00 416.67 - - $125,500 $126,000 35.00 445.48 24.00 438.95 17.00 432.42 12.00 425.88 7.00 419.35 3.00 418.33 - - $126,000 $126,500 35.00 447.36 24.00 440.83 17.00 434.29 12.00 427.76 7.00 421.23 3.00 420.00 - - $126,500 $127,000 36.00 449.23 24.00 442.70 17.00 436.17 12.00 429.63 7.00 423.10 3.00 421.67 - - $127,000 $127,500 36.00 451.11 24.00 444.58 18.00 438.04 12.00 431.51 7.00 424.98 3.00 423.33 - - $127,500 $128,000 36.00 452.98 25.00 446.45 18.00 439.92 12.00 433.38 7.00 426.85 3.00 425.00 - - $128,000 $128,500 37.00 454.86 25.00 448.33 18.00 441.79 12.00 435.26 8.00 428.73 3.00 426.67 - - $128,500 $129,000 37.00 456.73 25.00 450.20 18.00 443.67 13.00 437.13 8.00 430.60 3.00 428.33 - - $129,000 $129,500 37.00 458.61 25.00 452.08 18.00 445.54 13.00 439.01 8.00 432.48 4.00 430.00 - - $129,500 $130,000 38.00 460.48 26.00 453.95 18.00 447.42 13.00 440.88 8.00 434.35 4.00 431.67 - - $130,000 $130,500 38.00 462.36 26.00 455.83 19.00 449.29 13.00 442.76 8.00 436.23 4.00 433.33 - - $130,500 $131,000 38.00 464.23 26.00 457.70 19.00 451.17 13.00 444.63 8.00 438.10 4.00 435.00 - - $131,000 $131,500 39.00 466.11 26.00 459.58 19.00 453.04 13.00 446.51 8.00 439.98 4.00 436.67 - - $131,500 $132,000 39.00 467.98 26.00 461.45 19.00 454.92 14.00 448.38 9.00 441.85 4.00 438.33 - - $132,000 $132,500 39.00 469.86 27.00 463.33 19.00 456.79 14.00 450.26 9.00 443.73 4.00 440.00 - - $132,500 $133,000 40.00 471.73 27.00 465.20 20.00 458.67 14.00 452.13 9.00 445.60 4.00 441.67 2.00 441.67 $133,000 $133,500 40.00 473.61 27.00 467.08 20.00 460.54 14.00 454.01 9.00 447.48 4.00 443.33 2.00 443.33 $133,500 $134,000 40.00 475.48 27.00 468.95 20.00 462.42 14.00 455.88 9.00 449.35 4.00 445.00 2.00 445.00 $134,000 $134,500 41.00 477.36 28.00 470.83 20.00 464.29 14.00 457.76 9.00 451.23 5.00 446.67 2.00 446.67 $134,500 $135,000 41.00 479.23 28.00 472.70 20.00 466.17 14.00 459.63 10.00 453.10 5.00 448.33 2.00 448.33 $135,000 $135,500 41.00 481.11 28.00 474.58 20.00 468.04 15.00 461.51 10.00 454.98 5.00 450.00 2.00 450.00 $135,500 $136,000 42.00 482.98 28.00 476.45 21.00 469.92 15.00 463.38 10.00 456.85 5.00 451.67 2.00 451.67 $136,000 $136,500 42.00 484.86 29.00 478.33 21.00 471.79 15.00 465.26 10.00 458.73 5.00 453.33 2.00 453.33 $136,500 $137,000 42.00 486.73 29.00 480.20 21.00 473.67 15.00 467.13 10.00 460.60 5.00 455.00 2.00 455.00 $137,000 $137,500 43.00 488.61 29.00 482.08 21.00 475.54 15.00 469.01 10.00 462.48 5.00 456.67 2.00 456.67 $137,500 $138,000 43.00 490.48 29.00 483.95 21.00 477.42 15.00 470.88 11.00 464.35 5.00 458.33 2.00 458.33 $138,000 $138,500 43.00 492.36 30.00 485.83 22.00 479.29 16.00 472.76 11.00 466.23 5.00 460.00 2.00 460.00 $138,500 $139,000 44.00 494.23 30.00 487.70 22.00 481.17 16.00 474.63 11.00 468.10 5.00 461.67 3.00 461.67 $139,000 $139,500 44.00 496.11 30.00 489.58 22.00 483.04 16.00 476.51 11.00 469.98 6.00 463.44 3.00 463.33 $139,500 $140,000 45.00 497.98 30.00 491.45 22.00 484.92 16.00 478.38 11.00 471.85 6.00 465.32 3.00 465.00 $140,000 $140,500 45.00 499.86 31.00 493.33 22.00 486.79 16.00 480.26 11.00 473.73 6.00 467.19 3.00 466.67 $140,500 $141,000 45.00 501.73 31.00 495.20 22.00 488.67 16.00 482.13 11.00 475.60 7.00 469.07 3.00 468.33 $141,000 $141,500 46.00 503.61 31.00 497.08 23.00 490.54 17.00 484.01 12.00 477.48 7.00 470.94 3.00 470.00 $141,500 $142,000 46.00 505.48 31.00 498.95 23.00 492.42 17.00 485.88 12.00 479.35 7.00 472.82 3.00 471.67 $142,000 $142,500 46.00 507.36 32.00 500.83 23.00 494.29 17.00 487.76 12.00 481.23 7.00 474.69 3.00 473.33 $142,500 $143,000 47.00 509.23 32.00 502.70 23.00 496.17 17.00 489.63 12.00 483.10 7.00 476.57 3.00 475.00 $143,000 $143,500 47.00 511.11 32.00 504.58 23.00 498.04 17.00 491.51 12.00 484.98 7.00 478.44 3.00 476.67 $143,500 $144,000 47.00 512.98 33.00 506.45 24.00 499.92 18.00 493.38 12.00 486.85 7.00 480.32 4.00 478.33 $144,000 $144,500 48.00 514.86 33.00 508.33 24.00 501.79 18.00 495.26 13.00 488.73 8.00 482.19 4.00 480.00 $144,500 $145,000 48.00 516.73 33.00 510.20 24.00 503.67 18.00 497.13 13.00 490.60 8.00 484.07 4.00 481.67 $145,000 $145,500 48.00 518.61 34.00 512.08 24.00 505.54 18.00 499.01 13.00 492.48 8.00 485.94 4.00 483.33 $145,500 $146,000 49.00 520.48 34.00 513.95 24.00 507.42 18.00 500.88 13.00 494.35 8.00 487.82 4.00 485.00 $146,000 $146,500 49.00 522.36 34.00 515.83 25.00 509.29 18.00 502.76 13.00 496.23 8.00 489.69 4.00 486.67 $146,500 $147,000 49.00 524.23 35.00 517.70 25.00 511.17 19.00 504.63 13.00 498.10 8.00 491.57 4.00 488.33 $147,000 $147,500 50.00 526.11 35.00 519.58 25.00 513.04 19.00 506.51 13.00 499.98 9.00 493.44 4.00 490.00 $147,500 $148,000 50.00 527.98 35.00 521.45 25.00 514.92 19.00 508.38 14.00 501.85 9.00 495.32 4.00 491.67 $148,000 $148,500 51.00 529.86 36.00 523.33 26.00 516.79 19.00 510.26 14.00 503.73 9.00 497.19 4.00 493.33 $148,500 $149,000 51.00 531.73 36.00 525.20 26.00 518.67 19.00 512.13 14.00 505.60 9.00 499.07 4.00 495.00 $149,000 $149,500 51.00 533.61 36.00 527.08 26.00 520.54 20.00 514.01 14.00 507.48 9.00 500.94 4.00 496.67 $149,500 $150,000 52.00 535.48 37.00 528.95 26.00 522.42 20.00 515.88 14.00 509.35 9.00 502.82 5.00 498.33 $150,000 $150,500 52.00 537.36 37.00 530.83 27.00 524.29 20.00 517.76 14.00 511.23 10.00 504.69 5.00 500.00 $150,500 $151,000 52.00 539.23 37.00 532.70 27.00 526.17 20.00 519.63 15.00 513.10 10.00 506.57 5.00 501.67 $151,000 $151,500 53.00 541.11 38.00 534.58 27.00 528.04 20.00 521.51 15.00 514.98 10.00 508.44 5.00 503.33 $151,500 $152,000 53.00 542.98 38.00 536.45 27.00 529.92 20.00 523.38 15.00 516.85 10.00 510.32 5.00 505.00 $152,000 $152,500 53.00 544.86 38.00 538.33 28.00 531.79 21.00 525.26 15.00 518.73 10.00 512.19 5.00 506.67 $152,500 $153,000 54.00 546.73 39.00 540.20 28.00 533.67 21.00 527.13 15.00 520.60 10.00 514.07 5.00 508.33 $153,000 $153,500 54.00 548.61 39.00 542.08 28.00 535.54 21.00 529.01 15.00 522.48 10.00 515.94 5.00 510.00 $153,500 $154,000 55.00 550.48 39.00 543.95 28.00 537.42 21.00 530.88 16.00 524.35 11.00 517.82 5.00 511.67 $154,000 $154,500 55.00 552.36 40.00 545.83 28.00 539.29 21.00 532.76 16.00 526.23 11.00 519.69 5.00 513.33 $154,500 $155,000 55.00 554.23 40.00 547.70 29.00 541.17 22.00 534.63 16.00 528.10 11.00 521.57 6.00 515.03 $155,000 $155,500 56.00 556.11 40.00 549.58 29.00 543.04 22.00 536.51 16.00 529.98 11.00 523.44 6.00 516.91 $155,500 $156,000 56.00 557.98 41.00 551.45 29.00 544.92 22.00 538.38 16.00 531.85 11.00 525.32 6.00 518.78 $156,000 $156,500 56.00 559.86 41.00 553.33 29.00 546.79 22.00 540.26 16.00 533.73 11.00 527.19 6.00 520.66 $156,500 $157,000 57.00 561.73 41.00 555.20 30.00 548.67 22.00 542.13 16.00 535.60 12.00 529.07 7.00 522.53 $157,000 $157,500 57.00 563.61 42.00 557.08 30.00 550.54 22.00 544.01 17.00 537.48 12.00 530.94 7.00 524.41 $157,500 $158,000 57.00 565.48 42.00 558.95 30.00 552.42 23.00 545.88 17.00 539.35 12.00 532.82 7.00 526.28 $158,000 $158,500 58.00 567.36 42.00 560.83 30.00 554.29 23.00 547.76 17.00 541.23 12.00 534.69 7.00 528.16 $158,500 $159,000 58.00 569.23 43.00 562.70 31.00 556.17 23.00 549.63 17.00 543.10 12.00 536.57 7.00 530.03 $159,000 $159,500 59.00 571.11 43.00 564.58 31.00 558.04 23.00 551.51 17.00 544.98 12.00 538.44 7.00 531.91 $159,500 $160,000 59.00 572.98 43.00 566.45 31.00 559.92 23.00 553.38 17.00 546.85 12.00 540.32 8.00 533.78

NJEIS Family Cost Participation Table Page 5 of 12 Effective July 1, 2015

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 59.00 574.86 44.00 568.33 31.00 561.79 24.00 555.26 18.00 548.73 13.00 542.19 8.00 535.66 $160,500 $161,000 60.00 576.73 44.00 570.20 32.00 563.67 24.00 557.13 18.00 550.60 13.00 544.07 8.00 537.53 $161,000 $161,500 60.00 578.61 44.00 572.08 32.00 565.54 24.00 559.01 18.00 552.48 13.00 545.94 8.00 539.41 $161,500 $162,000 60.00 580.48 45.00 573.95 32.00 567.42 24.00 560.88 18.00 554.35 13.00 547.82 8.00 541.28 $162,000 $162,500 61.00 582.36 45.00 575.83 32.00 569.29 24.00 562.76 18.00 556.23 13.00 549.69 8.00 543.16 $162,500 $163,000 61.00 584.23 45.00 577.70 33.00 571.17 24.00 564.63 19.00 558.10 13.00 551.57 9.00 545.03 $163,000 $163,500 61.00 586.11 46.00 579.58 33.00 573.04 25.00 566.51 19.00 559.98 14.00 553.44 9.00 546.91 $163,500 $164,000 62.00 587.98 46.00 581.45 33.00 574.92 25.00 568.38 19.00 561.85 14.00 555.32 9.00 548.78 $164,000 $164,500 62.00 589.86 46.00 583.33 33.00 576.79 25.00 570.26 19.00 563.73 14.00 557.19 9.00 550.66 $164,500 $165,000 63.00 591.73 47.00 585.20 34.00 578.67 25.00 572.13 19.00 565.60 14.00 559.07 9.00 552.53 $165,000 $165,500 63.00 593.61 47.00 587.08 34.00 580.54 25.00 574.01 19.00 567.48 14.00 560.94 9.00 554.41 $165,500 $166,000 63.00 595.48 47.00 588.95 34.00 582.42 26.00 575.88 20.00 569.35 14.00 562.82 9.00 556.28 $166,000 $166,500 64.00 597.36 48.00 590.83 34.00 584.29 26.00 577.76 20.00 571.23 15.00 564.69 10.00 558.16 $166,500 $167,000 64.00 599.23 48.00 592.70 34.00 586.17 26.00 579.63 20.00 573.10 15.00 566.57 10.00 560.03 $167,000 $167,500 65.00 601.11 48.00 594.58 35.00 588.04 26.00 581.51 20.00 574.98 15.00 568.44 10.00 561.91 $167,500 $168,000 65.00 602.98 49.00 596.45 35.00 589.92 26.00 583.38 20.00 576.85 15.00 570.32 10.00 563.78 $168,000 $168,500 65.00 604.86 49.00 598.33 35.00 591.79 27.00 585.26 21.00 578.73 15.00 572.19 10.00 565.66 $168,500 $169,000 66.00 606.73 50.00 600.20 35.00 593.67 27.00 587.13 21.00 580.60 15.00 574.07 10.00 567.53 $169,000 $169,500 66.00 608.61 50.00 602.08 36.00 595.54 27.00 589.01 21.00 582.48 15.00 575.94 11.00 569.41 $169,500 $170,000 66.00 610.48 50.00 603.95 36.00 597.42 27.00 590.88 21.00 584.35 16.00 577.82 11.00 571.28 $170,000 $170,500 67.00 612.36 51.00 605.83 36.00 599.29 27.00 592.76 21.00 586.23 16.00 579.69 11.00 573.16 $170,500 $171,000 67.00 614.23 51.00 607.70 36.00 601.17 28.00 594.63 21.00 588.10 16.00 581.57 11.00 575.03 $171,000 $171,500 68.00 616.11 51.00 609.58 37.00 603.04 28.00 596.51 22.00 589.98 16.00 583.44 11.00 576.91 $171,500 $172,000 68.00 617.98 52.00 611.45 37.00 604.92 28.00 598.38 22.00 591.85 16.00 585.32 11.00 578.78 $172,000 $172,500 68.00 619.86 52.00 613.33 37.00 606.79 28.00 600.26 22.00 593.73 16.00 587.19 11.00 580.66 $172,500 $173,000 69.00 621.73 52.00 615.20 38.00 608.67 29.00 602.13 22.00 595.60 17.00 589.07 12.00 582.53 $173,000 $173,500 69.00 623.61 53.00 617.08 38.00 610.54 29.00 604.01 22.00 597.48 17.00 590.94 12.00 584.41 $173,500 $174,000 70.00 625.48 53.00 618.95 38.00 612.42 29.00 605.88 23.00 599.35 17.00 592.82 12.00 586.28 $174,000 $174,500 70.00 627.36 53.00 620.83 39.00 614.29 29.00 607.76 23.00 601.23 17.00 594.69 12.00 588.16 $174,500 $175,000 70.00 629.23 54.00 622.70 39.00 616.17 30.00 609.63 23.00 603.10 17.00 596.57 12.00 590.03 $175,000 $175,500 71.00 631.11 54.00 624.58 39.00 618.04 30.00 611.51 23.00 604.98 17.00 598.44 12.00 591.91 $175,500 $176,000 71.00 632.98 54.00 626.45 40.00 619.92 30.00 613.38 23.00 606.85 17.00 600.32 13.00 593.78 $176,000 $176,500 72.00 634.86 55.00 628.33 40.00 621.79 30.00 615.26 23.00 608.73 18.00 602.19 13.00 595.66 $176,500 $177,000 72.00 636.73 55.00 630.20 40.00 623.67 30.00 617.13 24.00 610.60 18.00 604.07 13.00 597.53 $177,000 $177,500 72.00 638.61 55.00 632.08 41.00 625.54 31.00 619.01 24.00 612.48 18.00 605.94 13.00 599.41 $177,500 $178,000 73.00 640.48 56.00 633.95 41.00 627.42 31.00 620.88 24.00 614.35 18.00 607.82 13.00 601.28 $178,000 $178,500 73.00 642.36 56.00 635.83 41.00 629.29 31.00 622.76 24.00 616.23 18.00 609.69 13.00 603.16 $178,500 $179,000 74.00 644.23 56.00 637.70 42.00 631.17 31.00 624.63 24.00 618.10 18.00 611.57 14.00 605.03 $179,000 $179,500 74.00 646.11 57.00 639.58 42.00 633.04 32.00 626.51 25.00 619.98 19.00 613.44 14.00 606.91 $179,500 $180,000 74.00 647.98 57.00 641.45 42.00 634.92 32.00 628.38 25.00 621.85 19.00 615.32 14.00 608.78 $180,000 $180,500 75.00 649.86 58.00 643.33 43.00 636.79 32.00 630.26 25.00 623.73 19.00 617.19 14.00 610.66 $180,500 $181,000 75.00 651.73 58.00 645.20 43.00 638.67 32.00 632.13 25.00 625.60 19.00 619.07 14.00 612.53 $181,000 $181,500 75.00 653.61 58.00 647.08 43.00 640.54 33.00 634.01 25.00 627.48 19.00 620.94 14.00 614.41 $181,500 $182,000 76.00 655.48 59.00 648.95 44.00 642.42 33.00 635.88 25.00 629.35 20.00 622.82 14.00 616.28 $182,000 $182,500 76.00 657.36 59.00 650.83 44.00 644.29 33.00 637.76 26.00 631.23 20.00 624.69 15.00 618.16 $182,500 $183,000 77.00 659.23 59.00 652.70 44.00 646.17 33.00 639.63 26.00 633.10 20.00 626.57 15.00 620.03 $183,000 $183,500 77.00 661.11 60.00 654.58 45.00 648.04 34.00 641.51 26.00 634.98 20.00 628.44 15.00 621.91 $183,500 $184,000 77.00 662.98 60.00 656.45 45.00 649.92 34.00 643.38 26.00 636.85 20.00 630.32 15.00 623.78 $184,000 $184,500 78.00 664.86 60.00 658.33 45.00 651.79 34.00 645.26 26.00 638.73 20.00 632.19 15.00 625.66 $184,500 $185,000 78.00 666.73 61.00 660.20 46.00 653.67 34.00 647.13 27.00 640.60 21.00 634.07 15.00 627.53 $185,000 $185,500 79.00 668.61 61.00 662.08 46.00 655.54 35.00 649.01 27.00 642.48 21.00 635.94 16.00 629.41 $185,500 $186,000 79.00 670.48 61.00 663.95 46.00 657.42 35.00 650.88 27.00 644.35 21.00 637.82 16.00 631.28 $186,000 $186,500 79.00 672.36 62.00 665.83 47.00 659.29 35.00 652.76 27.00 646.23 21.00 639.69 16.00 633.16 $186,500 $187,000 80.00 674.23 62.00 667.70 47.00 661.17 35.00 654.63 27.00 648.10 21.00 641.57 16.00 635.03 $187,000 $187,500 80.00 676.11 62.00 669.58 47.00 663.04 36.00 656.51 27.00 649.98 22.00 643.44 16.00 636.91 $187,500 $188,000 81.00 677.98 63.00 671.45 48.00 664.92 36.00 658.38 28.00 651.85 22.00 645.32 16.00 638.78 $188,000 $188,500 81.00 679.86 63.00 673.33 48.00 666.79 36.00 660.26 28.00 653.73 22.00 647.19 16.00 640.66 $188,500 $189,000 81.00 681.73 64.00 675.20 48.00 668.67 36.00 662.13 28.00 655.60 22.00 649.07 17.00 642.53 $189,000 $189,500 82.00 683.61 64.00 677.08 49.00 670.54 36.00 664.01 28.00 657.48 22.00 650.94 17.00 644.41 $189,500 $190,000 82.00 685.48 64.00 678.95 49.00 672.42 37.00 665.88 28.00 659.35 22.00 652.82 17.00 646.28 $190,000 $190,500 83.00 687.36 65.00 680.83 49.00 674.29 37.00 667.76 29.00 661.23 23.00 654.69 17.00 648.16 $190,500 $191,000 83.00 689.23 65.00 682.70 50.00 676.17 37.00 669.63 29.00 663.10 23.00 656.57 17.00 650.03 $191,000 $191,500 83.00 691.11 65.00 684.58 50.00 678.04 37.00 671.51 29.00 664.98 23.00 658.44 17.00 651.91 $191,500 $192,000 84.00 692.98 66.00 686.45 50.00 679.92 38.00 673.38 29.00 666.85 23.00 660.32 18.00 653.78 $192,000 $192,500 84.00 694.86 66.00 688.33 51.00 681.79 38.00 675.26 29.00 668.73 23.00 662.19 18.00 655.66 $192,500 $193,000 84.00 696.73 66.00 690.20 51.00 683.67 38.00 677.13 29.00 670.60 24.00 664.07 18.00 657.53 $193,000 $193,500 85.00 698.61 67.00 692.08 51.00 685.54 38.00 679.01 30.00 672.48 24.00 665.94 18.00 659.41 $193,500 $194,000 85.00 700.48 67.00 693.95 52.00 687.42 39.00 680.88 30.00 674.35 24.00 667.82 18.00 661.28 $194,000 $194,500 86.00 702.36 68.00 695.83 52.00 689.29 39.00 682.76 30.00 676.23 24.00 669.69 18.00 663.16 $194,500 $195,000 86.00 704.23 68.00 697.70 52.00 691.17 39.00 684.63 30.00 678.10 24.00 671.57 19.00 665.03 $195,000 $195,500 86.00 706.11 68.00 699.58 53.00 693.04 39.00 686.51 31.00 679.98 24.00 673.44 19.00 666.91 $195,500 $196,000 87.00 707.98 69.00 701.45 53.00 694.92 40.00 688.38 31.00 681.85 25.00 675.32 19.00 668.78 $196,000 $196,500 87.00 709.86 69.00 703.33 53.00 696.79 40.00 690.26 31.00 683.73 25.00 677.19 19.00 670.66 $196,500 $197,000 88.00 711.73 69.00 705.20 54.00 698.67 40.00 692.13 31.00 685.60 25.00 679.07 19.00 672.53 $197,000 $197,500 88.00 713.61 70.00 707.08 54.00 700.54 40.00 694.01 32.00 687.48 25.00 680.94 19.00 674.41 $197,500 $198,000 88.00 715.48 70.00 708.95 54.00 702.42 41.00 695.88 32.00 689.35 25.00 682.82 19.00 676.28 $198,000 $198,500 89.00 717.36 71.00 710.83 55.00 704.29 41.00 697.76 32.00 691.23 26.00 684.69 20.00 678.16 $198,500 $199,000 89.00 719.23 71.00 712.70 55.00 706.17 41.00 699.63 32.00 693.10 26.00 686.57 20.00 680.03 $199,000 $199,500 90.00 721.11 71.00 714.58 56.00 708.04 41.00 701.51 32.00 694.98 26.00 688.44 20.00 681.91 $199,500 $200,000 90.00 722.98 72.00 716.45 56.00 709.92 42.00 703.38 33.00 696.85 26.00 690.32 20.00 683.78

NJEIS Family Cost Participation Table Page 6 of 12 Effective July 1, 2015

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 90.00 724.86 72.00 718.33 56.00 711.79 42.00 705.26 33.00 698.73 26.00 692.19 20.00 685.66 $200,500 $201,000 91.00 726.73 72.00 720.20 57.00 713.67 42.00 707.13 33.00 700.60 26.00 694.07 21.00 687.53 $201,000 $201,500 91.00 728.61 73.00 722.08 57.00 715.54 43.00 709.01 33.00 702.48 27.00 695.94 21.00 689.41 $201,500 $202,000 91.00 730.48 73.00 723.95 57.00 717.42 43.00 710.88 34.00 704.35 27.00 697.82 21.00 691.28 $202,000 $202,500 92.00 732.36 73.00 725.83 58.00 719.29 43.00 712.76 34.00 706.23 27.00 699.69 21.00 693.16 $202,500 $203,000 92.00 734.23 74.00 727.70 58.00 721.17 44.00 714.63 34.00 708.10 27.00 701.57 21.00 695.03 $203,000 $203,500 93.00 736.11 74.00 729.58 58.00 723.04 44.00 716.51 34.00 709.98 27.00 703.44 21.00 696.91 $203,500 $204,000 93.00 737.98 75.00 731.45 59.00 724.92 44.00 718.38 35.00 711.85 28.00 705.32 22.00 698.78 $204,000 $204,500 93.00 739.86 75.00 733.33 59.00 726.79 45.00 720.26 35.00 713.73 28.00 707.19 22.00 700.66 $204,500 $205,000 94.00 741.73 75.00 735.20 59.00 728.67 45.00 722.13 35.00 715.60 28.00 709.07 22.00 702.53 $205,000 $205,500 94.00 743.61 76.00 737.08 60.00 730.54 45.00 724.01 35.00 717.48 28.00 710.94 22.00 704.41 $205,500 $206,000 95.00 745.48 76.00 738.95 60.00 732.42 46.00 725.88 36.00 719.35 28.00 712.82 22.00 706.28 $206,000 $206,500 95.00 747.36 76.00 740.83 60.00 734.29 46.00 727.76 36.00 721.23 28.00 714.69 23.00 708.16 $206,500 $207,000 95.00 749.23 77.00 742.70 61.00 736.17 46.00 729.63 36.00 723.10 29.00 716.57 23.00 710.03 $207,000 $207,500 96.00 751.11 77.00 744.58 61.00 738.04 47.00 731.51 36.00 724.98 29.00 718.44 23.00 711.91 $207,500 $208,000 96.00 752.98 77.00 746.45 61.00 739.92 47.00 733.38 37.00 726.85 29.00 720.32 23.00 713.78 $208,000 $208,500 97.00 754.86 78.00 748.33 62.00 741.79 47.00 735.26 37.00 728.73 29.00 722.19 23.00 715.66 $208,500 $209,000 97.00 756.73 78.00 750.20 62.00 743.67 48.00 737.13 37.00 730.60 29.00 724.07 23.00 717.53 $209,000 $209,500 97.00 758.61 79.00 752.08 62.00 745.54 48.00 739.01 37.00 732.48 30.00 725.94 24.00 719.41 $209,500 $210,000 98.00 760.48 79.00 753.95 63.00 747.42 48.00 740.88 38.00 734.35 30.00 727.82 24.00 721.28 $210,000 $210,500 98.00 762.36 79.00 755.83 63.00 749.29 49.00 742.76 38.00 736.23 30.00 729.69 24.00 723.16 $210,500 $211,000 99.00 764.23 80.00 757.70 64.00 751.17 49.00 744.63 38.00 738.10 30.00 731.57 24.00 725.03 $211,000 $211,500 99.00 766.11 80.00 759.58 64.00 753.04 49.00 746.51 38.00 739.98 30.00 733.44 24.00 726.91 $211,500 $212,000 99.00 767.98 81.00 761.45 64.00 754.92 50.00 748.38 38.00 741.85 30.00 735.32 25.00 728.78 $212,000 $212,500 100.00 769.86 81.00 763.33 65.00 756.79 50.00 750.26 39.00 743.73 31.00 737.19 25.00 730.66 $212,500 $213,000 100.00 771.73 81.00 765.20 65.00 758.67 50.00 752.13 39.00 745.60 31.00 739.07 25.00 732.53 $213,000 $213,500 100.00 773.61 82.00 767.08 65.00 760.54 51.00 754.01 39.00 747.48 31.00 740.94 25.00 734.41 $213,500 $214,000 101.00 775.48 82.00 768.95 66.00 762.42 51.00 755.88 39.00 749.35 31.00 742.82 25.00 736.28 $214,000 $214,500 101.00 777.36 83.00 770.83 66.00 764.29 51.00 757.76 40.00 751.23 31.00 744.69 25.00 738.16 $214,500 $215,000 102.00 779.23 83.00 772.70 66.00 766.17 52.00 759.63 40.00 753.10 32.00 746.57 26.00 740.03 $215,000 $215,500 102.00 781.11 83.00 774.58 67.00 768.04 52.00 761.51 40.00 754.98 32.00 748.44 26.00 741.91 $215,500 $216,000 102.00 782.98 84.00 776.45 67.00 769.92 52.00 763.38 40.00 756.85 32.00 750.32 26.00 743.78 $216,000 $216,500 103.00 784.86 84.00 778.33 67.00 771.79 53.00 765.26 41.00 758.73 32.00 752.19 26.00 745.66 $216,500 $217,000 103.00 786.73 85.00 780.20 68.00 773.67 53.00 767.13 41.00 760.60 32.00 754.07 26.00 747.53 $217,000 $217,500 104.00 788.61 85.00 782.08 68.00 775.54 53.00 769.01 41.00 762.48 32.00 755.94 27.00 749.41 $217,500 $218,000 104.00 790.48 85.00 783.95 68.00 777.42 54.00 770.88 41.00 764.35 33.00 757.82 27.00 751.28 $218,000 $218,500 104.00 792.36 86.00 785.83 69.00 779.29 54.00 772.76 42.00 766.23 33.00 759.69 27.00 753.16 $218,500 $219,000 105.00 794.23 86.00 787.70 69.00 781.17 54.00 774.63 42.00 768.10 33.00 761.57 27.00 755.03 $219,000 $219,500 105.00 796.11 86.00 789.58 69.00 783.04 55.00 776.51 42.00 769.98 33.00 763.44 27.00 756.91 $219,500 $220,000 106.00 797.98 87.00 791.45 70.00 784.92 55.00 778.38 42.00 771.85 34.00 765.32 27.00 758.78 $220,000 $220,500 106.00 799.86 87.00 793.33 70.00 786.79 55.00 780.26 43.00 773.73 34.00 767.19 28.00 760.66 $220,500 $221,000 106.00 801.73 88.00 795.20 71.00 788.67 56.00 782.13 43.00 775.60 34.00 769.07 28.00 762.53 $221,000 $221,500 107.00 803.61 88.00 797.08 71.00 790.54 56.00 784.01 43.00 777.48 34.00 770.94 28.00 764.41 $221,500 $222,000 107.00 805.48 88.00 798.95 71.00 792.42 56.00 785.88 43.00 779.35 35.00 772.82 28.00 766.28 $222,000 $222,500 108.00 807.36 89.00 800.83 72.00 794.29 57.00 787.76 44.00 781.23 35.00 774.69 28.00 768.16 $222,500 $223,000 108.00 809.23 89.00 802.70 72.00 796.17 57.00 789.63 44.00 783.10 35.00 776.57 29.00 770.03 $223,000 $223,500 108.00 811.11 90.00 804.58 72.00 798.04 57.00 791.51 44.00 784.98 35.00 778.44 29.00 771.91 $223,500 $224,000 109.00 812.98 90.00 806.45 73.00 799.92 58.00 793.38 44.00 786.85 35.00 780.32 29.00 773.78 $224,000 $224,500 109.00 814.86 90.00 808.33 73.00 801.79 58.00 795.26 44.00 788.73 36.00 782.19 29.00 775.66 $224,500 $225,000 109.00 816.73 91.00 810.20 73.00 803.67 58.00 797.13 45.00 790.60 36.00 784.07 29.00 777.53 $225,000 $225,500 110.00 818.61 91.00 812.08 74.00 805.54 59.00 799.01 45.00 792.48 36.00 785.94 29.00 779.41 $225,500 $226,000 110.00 820.48 92.00 813.95 74.00 807.42 59.00 800.88 45.00 794.35 36.00 787.82 30.00 781.28 $226,000 $226,500 110.00 822.36 92.00 815.83 74.00 809.29 59.00 802.76 45.00 796.23 37.00 789.69 30.00 783.16 $226,500 $227,000 110.00 824.23 92.00 817.70 75.00 811.17 60.00 804.63 46.00 798.10 37.00 791.57 30.00 785.03 $227,000 $227,500 110.00 826.11 93.00 819.58 75.00 813.04 60.00 806.51 46.00 799.98 37.00 793.44 30.00 786.91 $227,500 $228,000 110.00 827.98 93.00 821.45 76.00 814.92 60.00 808.38 46.00 801.85 37.00 795.32 30.00 788.78 $228,000 $228,500 110.00 829.86 94.00 823.33 76.00 816.79 61.00 810.26 46.00 803.73 38.00 797.19 31.00 790.66 $228,500 $229,000 110.00 831.73 94.00 825.20 76.00 818.67 61.00 812.13 47.00 805.60 38.00 799.07 31.00 792.53 $229,000 $229,500 110.00 833.61 94.00 827.08 77.00 820.54 61.00 814.01 47.00 807.48 38.00 800.94 31.00 794.41 $229,500 $230,000 110.00 835.48 95.00 828.95 77.00 822.42 62.00 815.88 47.00 809.35 38.00 802.82 31.00 796.28 $230,000 $230,500 110.00 837.36 95.00 830.83 77.00 824.29 62.00 817.76 48.00 811.23 39.00 804.69 31.00 798.16 $230,500 $231,000 110.00 839.23 95.00 832.70 78.00 826.17 62.00 819.63 48.00 813.10 39.00 806.57 31.00 800.03 $231,000 $231,500 110.00 841.11 96.00 834.58 78.00 828.04 63.00 821.51 48.00 814.98 39.00 808.44 32.00 801.91 $231,500 $232,000 110.00 842.98 96.00 836.45 78.00 829.92 63.00 823.38 49.00 816.85 39.00 810.32 32.00 803.78 $232,000 $232,500 110.00 844.86 97.00 838.33 79.00 831.79 63.00 825.26 49.00 818.73 40.00 812.19 32.00 805.66 $232,500 $233,000 110.00 846.73 97.00 840.20 79.00 833.67 64.00 827.13 49.00 820.60 40.00 814.07 32.00 807.53 $233,000 $233,500 110.00 848.61 97.00 842.08 80.00 835.54 64.00 829.01 50.00 822.48 40.00 815.94 32.00 809.41 $233,500 $234,000 110.00 850.48 98.00 843.95 80.00 837.42 64.00 830.88 50.00 824.35 40.00 817.82 33.00 811.28 $234,000 $234,500 110.00 852.36 98.00 845.83 80.00 839.29 65.00 832.76 50.00 826.23 40.00 819.69 33.00 813.16 $234,500 $235,000 110.00 854.23 99.00 847.70 81.00 841.17 65.00 834.63 51.00 828.10 41.00 821.57 33.00 815.03 $235,000 $235,500 110.00 856.11 99.00 849.58 81.00 843.04 65.00 836.51 51.00 829.98 41.00 823.44 33.00 816.91 $235,500 $236,000 110.00 857.98 99.00 851.45 81.00 844.92 66.00 838.38 51.00 831.85 41.00 825.32 33.00 818.78 $236,000 $236,500 110.00 859.86 100.00 853.33 82.00 846.79 66.00 840.26 52.00 833.73 41.00 827.19 33.00 820.66 $236,500 $237,000 110.00 861.73 100.00 855.20 82.00 848.67 66.00 842.13 52.00 835.60 42.00 829.07 34.00 822.53 $237,000 $237,500 110.00 863.61 101.00 857.08 82.00 850.54 67.00 844.01 52.00 837.48 42.00 830.94 34.00 824.41 $237,500 $238,000 110.00 865.48 101.00 858.95 83.00 852.42 67.00 845.88 53.00 839.35 42.00 832.82 34.00 826.28 $238,000 $238,500 110.00 867.36 101.00 860.83 83.00 854.29 67.00 847.76 53.00 841.23 42.00 834.69 34.00 828.16 $238,500 $239,000 110.00 869.23 102.00 862.70 84.00 856.17 68.00 849.63 53.00 843.10 43.00 836.57 34.00 830.03 $239,000 $239,500 110.00 871.11 102.00 864.58 84.00 858.04 68.00 851.51 54.00 844.98 43.00 838.44 35.00 831.91 $239,500 $240,000 110.00 872.98 102.00 866.45 84.00 859.92 68.00 853.38 54.00 846.85 43.00 840.32 35.00 833.78

NJEIS Family Cost Participation Table Page 7 of 12 Effective July 1, 2015

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 $240,500 110.00 874.86 103.00 868.33 85.00 861.79 69.00 855.26 54.00 848.73 43.00 842.19 35.00 835.66 $240,500 $241,000 110.00 876.73 103.00 870.20 85.00 863.67 69.00 857.13 55.00 850.60 44.00 844.07 35.00 837.53 $241,000 $241,500 110.00 878.61 104.00 872.08 85.00 865.54 70.00 859.01 55.00 852.48 44.00 845.94 35.00 839.41 $241,500 $242,000 110.00 880.48 104.00 873.95 86.00 867.42 70.00 860.88 55.00 854.35 44.00 847.82 35.00 841.28 $242,000 $242,500 110.00 882.36 104.00 875.83 86.00 869.29 70.00 862.76 56.00 856.23 44.00 849.69 36.00 843.16 $242,500 $243,000 110.00 884.23 105.00 877.70 86.00 871.17 71.00 864.63 56.00 858.10 45.00 851.57 36.00 845.03 $243,000 $243,500 110.00 886.11 105.00 879.58 87.00 873.04 71.00 866.51 56.00 859.98 45.00 853.44 36.00 846.91 $243,500 $244,000 110.00 887.98 106.00 881.45 87.00 874.92 71.00 868.38 57.00 861.85 45.00 855.32 36.00 848.78 $244,000 $244,500 110.00 889.86 106.00 883.33 88.00 876.79 72.00 870.26 57.00 863.73 45.00 857.19 37.00 850.66 $244,500 $245,000 110.00 891.73 106.00 885.20 88.00 878.67 72.00 872.13 57.00 865.60 46.00 859.07 37.00 852.53 $245,000 $245,500 110.00 893.61 107.00 887.08 88.00 880.54 72.00 874.01 58.00 867.48 46.00 860.94 37.00 854.41 $245,500 $246,000 110.00 895.48 107.00 888.95 89.00 882.42 73.00 875.88 58.00 869.35 46.00 862.82 37.00 856.28 $246,000 $246,500 110.00 897.36 108.00 890.83 89.00 884.29 73.00 877.76 58.00 871.23 46.00 864.69 37.00 858.16 $246,500 $247,000 110.00 899.23 108.00 892.70 89.00 886.17 73.00 879.63 59.00 873.10 46.00 866.57 38.00 860.03 $247,000 $247,500 110.00 901.11 108.00 894.58 90.00 888.04 74.00 881.51 59.00 874.98 47.00 868.44 38.00 861.91 $247,500 $248,000 110.00 902.98 109.00 896.45 90.00 889.92 74.00 883.38 59.00 876.85 47.00 870.32 38.00 863.78 $248,000 $248,500 110.00 904.86 109.00 898.33 90.00 891.79 74.00 885.26 60.00 878.73 47.00 872.19 38.00 865.66 $248,500 $249,000 110.00 906.73 110.00 900.20 91.00 893.67 75.00 887.13 60.00 880.60 47.00 874.07 39.00 867.53 $249,000 $249,500 110.00 908.61 110.00 902.08 91.00 895.54 75.00 889.01 60.00 882.48 48.00 875.94 39.00 869.41 $249,500 $250,000 110.00 910.48 110.00 903.95 92.00 897.42 75.00 890.88 61.00 884.35 48.00 877.82 39.00 871.28 $250,000 $250,500 110.00 912.36 110.00 905.83 92.00 899.29 76.00 892.76 61.00 886.23 48.00 879.69 39.00 873.16 $250,500 $251,000 110.00 914.23 110.00 907.70 92.00 901.17 76.00 894.63 61.00 888.10 48.00 881.57 40.00 875.03 $251,000 $251,500 110.00 916.11 110.00 909.58 93.00 903.04 77.00 896.51 62.00 889.98 49.00 883.44 40.00 876.91 $251,500 $252,000 110.00 917.98 110.00 911.45 93.00 904.92 77.00 898.38 62.00 891.85 49.00 885.32 40.00 878.78 $252,000 $252,500 110.00 919.86 110.00 913.33 94.00 906.79 77.00 900.26 62.00 893.73 49.00 887.19 40.00 880.66 $252,500 $253,000 110.00 921.73 110.00 915.20 94.00 908.67 78.00 902.13 63.00 895.60 49.00 889.07 41.00 882.53 $253,000 $253,500 110.00 923.61 110.00 917.08 94.00 910.54 78.00 904.01 63.00 897.48 50.00 890.94 41.00 884.41 $253,500 $254,000 110.00 925.48 110.00 918.95 95.00 912.42 78.00 905.88 63.00 899.35 50.00 892.82 41.00 886.28 $254,000 $254,500 110.00 927.36 110.00 920.83 95.00 914.29 79.00 907.76 64.00 901.23 50.00 894.69 41.00 888.16 $254,500 $255,000 110.00 929.23 110.00 922.70 96.00 916.17 79.00 909.63 64.00 903.10 50.00 896.57 42.00 890.03 $255,000 $255,500 110.00 931.11 110.00 924.58 96.00 918.04 79.00 911.51 64.00 904.98 51.00 898.44 42.00 891.91 $255,500 $256,000 110.00 932.98 110.00 926.45 96.00 919.92 80.00 913.38 65.00 906.85 51.00 900.32 42.00 893.78 $256,000 $256,500 110.00 934.86 110.00 928.33 97.00 921.79 80.00 915.26 65.00 908.73 51.00 902.19 42.00 895.66 $256,500 $257,000 110.00 936.73 110.00 930.20 97.00 923.67 80.00 917.13 65.00 910.60 51.00 904.07 43.00 897.53 $257,000 $257,500 110.00 938.61 110.00 932.08 97.00 925.54 81.00 919.01 66.00 912.48 52.00 905.94 43.00 899.41 $257,500 $258,000 110.00 940.48 110.00 933.95 98.00 927.42 81.00 920.88 66.00 914.35 52.00 907.82 43.00 901.28 $258,000 $258,500 110.00 942.36 110.00 935.83 98.00 929.29 81.00 922.76 66.00 916.23 52.00 909.69 43.00 903.16 $258,500 $259,000 110.00 944.23 110.00 937.70 99.00 931.17 82.00 924.63 67.00 918.10 52.00 911.57 43.00 905.03 $259,000 $259,500 110.00 946.11 110.00 939.58 99.00 933.04 82.00 926.51 67.00 919.98 53.00 913.44 44.00 906.91 $259,500 $260,000 110.00 947.98 110.00 941.45 99.00 934.92 82.00 928.38 67.00 921.85 53.00 915.32 44.00 908.78 $260,000 $260,500 110.00 949.86 110.00 943.33 100.00 936.79 83.00 930.26 68.00 923.73 53.00 917.19 44.00 910.66 $260,500 $261,000 110.00 951.73 110.00 945.20 100.00 938.67 83.00 932.13 68.00 925.60 54.00 919.07 44.00 912.53 $261,000 $261,500 110.00 953.61 110.00 947.08 101.00 940.54 83.00 934.01 68.00 927.48 54.00 920.94 45.00 914.41 $261,500 $262,000 110.00 955.48 110.00 948.95 101.00 942.42 84.00 935.88 69.00 929.35 54.00 922.82 45.00 916.28 $262,000 $262,500 110.00 957.36 110.00 950.83 101.00 944.29 84.00 937.76 69.00 931.23 55.00 924.69 45.00 918.16 $262,500 $263,000 110.00 959.23 110.00 952.70 102.00 946.17 85.00 939.63 69.00 933.10 55.00 926.57 45.00 920.03 $263,000 $263,500 110.00 961.11 110.00 954.58 102.00 948.04 85.00 941.51 70.00 934.98 55.00 928.44 46.00 921.91 $263,500 $264,000 110.00 962.98 110.00 956.45 103.00 949.92 85.00 943.38 70.00 936.85 56.00 930.32 46.00 923.78 $264,000 $264,500 110.00 964.86 110.00 958.33 103.00 951.79 86.00 945.26 70.00 938.73 56.00 932.19 46.00 925.66 $264,500 $265,000 110.00 966.73 110.00 960.20 103.00 953.67 86.00 947.13 71.00 940.60 56.00 934.07 46.00 927.53 $265,000 $265,500 110.00 968.61 110.00 962.08 104.00 955.54 86.00 949.01 71.00 942.48 57.00 935.94 47.00 929.41 $265,500 $266,000 110.00 970.48 110.00 963.95 104.00 957.42 87.00 950.88 71.00 944.35 57.00 937.82 47.00 931.28 $266,000 $266,500 110.00 972.36 110.00 965.83 105.00 959.29 87.00 952.76 72.00 946.23 57.00 939.69 47.00 933.16 $266,500 $267,000 110.00 974.23 110.00 967.70 105.00 961.17 88.00 954.63 72.00 948.10 58.00 941.57 47.00 935.03 $267,000 $267,500 110.00 976.11 110.00 969.58 105.00 963.04 88.00 956.51 72.00 949.98 58.00 943.44 48.00 936.91 $267,500 $268,000 110.00 977.98 110.00 971.45 106.00 964.92 88.00 958.38 73.00 951.85 58.00 945.32 48.00 938.78 $268,000 $268,500 110.00 979.86 110.00 973.33 106.00 966.79 89.00 960.26 73.00 953.73 59.00 947.19 48.00 940.66 $268,500 $269,000 110.00 981.73 110.00 975.20 106.00 968.67 89.00 962.13 73.00 955.60 59.00 949.07 48.00 942.53 $269,000 $269,500 110.00 983.61 110.00 977.08 107.00 970.54 89.00 964.01 74.00 957.48 59.00 950.94 48.00 944.41 $269,500 $270,000 110.00 985.48 110.00 978.95 107.00 972.42 90.00 965.88 74.00 959.35 60.00 952.82 49.00 946.28 $270,000 $270,500 110.00 987.36 110.00 980.83 108.00 974.29 90.00 967.76 74.00 961.23 60.00 954.69 49.00 948.16 $270,500 $271,000 110.00 989.23 110.00 982.70 108.00 976.17 90.00 969.63 75.00 963.10 60.00 956.57 49.00 950.03 $271,000 $271,500 110.00 991.11 110.00 984.58 108.00 978.04 91.00 971.51 75.00 964.98 61.00 958.44 49.00 951.91 $271,500 $272,000 110.00 992.98 110.00 986.45 109.00 979.92 91.00 973.38 76.00 966.85 61.00 960.32 50.00 953.78 $272,000 $272,500 110.00 994.86 110.00 988.33 109.00 981.79 92.00 975.26 76.00 968.73 61.00 962.19 50.00 955.66 $272,500 $273,000 110.00 996.73 110.00 990.20 110.00 983.67 92.00 977.13 76.00 970.60 62.00 964.07 50.00 957.53 $273,000 $273,500 110.00 998.61 110.00 992.08 110.00 985.54 92.00 979.01 77.00 972.48 62.00 965.94 50.00 959.41 $273,500 $274,000 110.00 1,000.48 110.00 993.95 110.00 987.42 93.00 980.88 77.00 974.35 62.00 967.82 51.00 961.28 $274,000 $274,500 110.00 1,002.36 110.00 995.83 110.00 989.29 93.00 982.76 77.00 976.23 63.00 969.69 51.00 963.16 $274,500 $275,000 110.00 1,004.23 110.00 997.70 110.00 991.17 93.00 984.63 78.00 978.10 63.00 971.57 51.00 965.03 $275,000 $275,500 110.00 1,006.11 110.00 999.58 110.00 993.04 94.00 986.51 78.00 979.98 63.00 973.44 51.00 966.91 $275,500 $276,000 110.00 1,007.98 110.00 1,001.45 110.00 994.92 94.00 988.38 78.00 981.85 64.00 975.32 52.00 968.78 $276,000 $276,500 110.00 1,009.86 110.00 1,003.33 110.00 996.79 94.00 990.26 79.00 983.73 64.00 977.19 52.00 970.66 $276,500 $277,000 110.00 1,011.73 110.00 1,005.20 110.00 998.67 95.00 992.13 79.00 985.60 64.00 979.07 52.00 972.53 $277,000 $277,500 110.00 1,013.61 110.00 1,007.08 110.00 1,000.54 95.00 994.01 79.00 987.48 65.00 980.94 52.00 974.41 $277,500 $278,000 110.00 1,015.48 110.00 1,008.95 110.00 1,002.42 96.00 995.88 80.00 989.35 65.00 982.82 53.00 976.28 $278,000 $278,500 110.00 1,017.36 110.00 1,010.83 110.00 1,004.29 96.00 997.76 80.00 991.23 65.00 984.69 53.00 978.16 $278,500 $279,000 110.00 1,019.23 110.00 1,012.70 110.00 1,006.17 96.00 999.63 80.00 993.10 66.00 986.57 53.00 980.03 $279,000 $279,500 110.00 1,021.11 110.00 1,014.58 110.00 1,008.04 97.00 1,001.51 81.00 994.98 66.00 988.44 53.00 981.91 $279,500 $280,000 110.00 1,022.98 110.00 1,016.45 110.00 1,009.92 97.00 1,003.38 81.00 996.85 66.00 990.32 54.00 983.78

NJEIS Family Cost Participation Table Page 8 of 12 Effective July 1, 2015

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 1,024.86 110.00 1,018.33 110.00 1,011.79 97.00 1,005.26 81.00 998.73 67.00 992.19 54.00 985.66 $280,500 $281,000 110.00 1,026.73 110.00 1,020.20 110.00 1,013.67 98.00 1,007.13 82.00 1,000.60 67.00 994.07 54.00 987.53 $281,000 $281,500 110.00 1,028.61 110.00 1,022.08 110.00 1,015.54 98.00 1,009.01 82.00 1,002.48 67.00 995.94 54.00 989.41 $281,500 $282,000 110.00 1,030.48 110.00 1,023.95 110.00 1,017.42 98.00 1,010.88 83.00 1,004.35 68.00 997.82 54.00 991.28 $282,000 $282,500 110.00 1,032.36 110.00 1,025.83 110.00 1,019.29 99.00 1,012.76 83.00 1,006.23 68.00 999.69 55.00 993.16 $282,500 $283,000 110.00 1,034.23 110.00 1,027.70 110.00 1,021.17 99.00 1,014.63 83.00 1,008.10 68.00 1,001.57 55.00 995.03 $283,000 $283,500 110.00 1,036.11 110.00 1,029.58 110.00 1,023.04 100.00 1,016.51 84.00 1,009.98 69.00 1,003.44 55.00 996.91 $283,500 $284,000 110.00 1,037.98 110.00 1,031.45 110.00 1,024.92 100.00 1,018.38 84.00 1,011.85 69.00 1,005.32 55.00 998.78 $284,000 $284,500 110.00 1,039.86 110.00 1,033.33 110.00 1,026.79 100.00 1,020.26 84.00 1,013.73 69.00 1,007.19 56.00 1,000.66 $284,500 $285,000 110.00 1,041.73 110.00 1,035.20 110.00 1,028.67 101.00 1,022.13 85.00 1,015.60 70.00 1,009.07 56.00 1,002.53 $285,000 $285,500 110.00 1,043.61 110.00 1,037.08 110.00 1,030.54 101.00 1,024.01 85.00 1,017.48 70.00 1,010.94 56.00 1,004.41 $285,500 $286,000 110.00 1,045.48 110.00 1,038.95 110.00 1,032.42 101.00 1,025.88 85.00 1,019.35 70.00 1,012.82 56.00 1,006.28 $286,000 $286,500 110.00 1,047.36 110.00 1,040.83 110.00 1,034.29 102.00 1,027.76 86.00 1,021.23 71.00 1,014.69 57.00 1,008.16 $286,500 $287,000 110.00 1,049.23 110.00 1,042.70 110.00 1,036.17 102.00 1,029.63 86.00 1,023.10 71.00 1,016.57 57.00 1,010.03 $287,000 $287,500 110.00 1,051.11 110.00 1,044.58 110.00 1,038.04 102.00 1,031.51 86.00 1,024.98 71.00 1,018.44 57.00 1,011.91 $287,500 $288,000 110.00 1,052.98 110.00 1,046.45 110.00 1,039.92 103.00 1,033.38 87.00 1,026.85 72.00 1,020.32 57.00 1,013.78 $288,000 $288,500 110.00 1,054.86 110.00 1,048.33 110.00 1,041.79 103.00 1,035.26 87.00 1,028.73 72.00 1,022.19 58.00 1,015.66 $288,500 $289,000 110.00 1,056.73 110.00 1,050.20 110.00 1,043.67 104.00 1,037.13 87.00 1,030.60 72.00 1,024.07 58.00 1,017.53 $289,000 $289,500 110.00 1,058.61 110.00 1,052.08 110.00 1,045.54 104.00 1,039.01 88.00 1,032.48 73.00 1,025.94 58.00 1,019.41 $289,500 $290,000 110.00 1,060.48 110.00 1,053.95 110.00 1,047.42 104.00 1,040.88 88.00 1,034.35 73.00 1,027.82 59.00 1,021.28 $290,000 $290,500 110.00 1,062.36 110.00 1,055.83 110.00 1,049.29 105.00 1,042.76 88.00 1,036.23 73.00 1,029.69 59.00 1,023.16 $290,500 $291,000 110.00 1,064.23 110.00 1,057.70 110.00 1,051.17 105.00 1,044.63 89.00 1,038.10 74.00 1,031.57 59.00 1,025.03 $291,000 $291,500 110.00 1,066.11 110.00 1,059.58 110.00 1,053.04 105.00 1,046.51 89.00 1,039.98 74.00 1,033.44 60.00 1,026.91 $291,500 $292,000 110.00 1,067.98 110.00 1,061.45 110.00 1,054.92 106.00 1,048.38 89.00 1,041.85 74.00 1,035.32 60.00 1,028.78 $292,000 $292,500 110.00 1,069.86 110.00 1,063.33 110.00 1,056.79 106.00 1,050.26 90.00 1,043.73 75.00 1,037.19 60.00 1,030.66 $292,500 $293,000 110.00 1,071.73 110.00 1,065.20 110.00 1,058.67 107.00 1,052.13 90.00 1,045.60 75.00 1,039.07 61.00 1,032.53 $293,000 $293,500 110.00 1,073.61 110.00 1,067.08 110.00 1,060.54 107.00 1,054.01 91.00 1,047.48 75.00 1,040.94 61.00 1,034.41 $293,500 $294,000 110.00 1,075.48 110.00 1,068.95 110.00 1,062.42 107.00 1,055.88 91.00 1,049.35 76.00 1,042.82 61.00 1,036.28 $294,000 $294,500 110.00 1,077.36 110.00 1,070.83 110.00 1,064.29 108.00 1,057.76 91.00 1,051.23 76.00 1,044.69 62.00 1,038.16 $294,500 $295,000 110.00 1,079.23 110.00 1,072.70 110.00 1,066.17 108.00 1,059.63 92.00 1,053.10 76.00 1,046.57 62.00 1,040.03 $295,000 $295,500 110.00 1,081.11 110.00 1,074.58 110.00 1,068.04 108.00 1,061.51 92.00 1,054.98 77.00 1,048.44 62.00 1,041.91 $295,500 $296,000 110.00 1,082.98 110.00 1,076.45 110.00 1,069.92 109.00 1,063.38 92.00 1,056.85 77.00 1,050.32 63.00 1,043.78 $296,000 $296,500 110.00 1,084.86 110.00 1,078.33 110.00 1,071.79 109.00 1,065.26 93.00 1,058.73 77.00 1,052.19 63.00 1,045.66 $296,500 $297,000 110.00 1,086.73 110.00 1,080.20 110.00 1,073.67 110.00 1,067.13 93.00 1,060.60 78.00 1,054.07 63.00 1,047.53 $297,000 $297,500 110.00 1,088.61 110.00 1,082.08 110.00 1,075.54 110.00 1,069.01 93.00 1,062.48 78.00 1,055.94 64.00 1,049.41 $297,500 $298,000 110.00 1,090.48 110.00 1,083.95 110.00 1,077.42 110.00 1,070.88 94.00 1,064.35 78.00 1,057.82 64.00 1,051.28 $298,000 $298,500 110.00 1,092.36 110.00 1,085.83 110.00 1,079.29 110.00 1,072.76 94.00 1,066.23 79.00 1,059.69 64.00 1,053.16 $298,500 $299,000 110.00 1,094.23 110.00 1,087.70 110.00 1,081.17 110.00 1,074.63 94.00 1,068.10 79.00 1,061.57 65.00 1,055.03 $299,000 $299,500 110.00 1,096.11 110.00 1,089.58 110.00 1,083.04 110.00 1,076.51 95.00 1,069.98 79.00 1,063.44 65.00 1,056.91 $299,500 $300,000 110.00 1,097.98 110.00 1,091.45 110.00 1,084.92 110.00 1,078.38 95.00 1,071.85 80.00 1,065.32 65.00 1,058.78 $300,000 $300,500 110.00 1,099.86 110.00 1,093.33 110.00 1,086.79 110.00 1,080.26 95.00 1,073.73 80.00 1,067.19 66.00 1,060.66 $300,500 $301,000 110.00 1,101.73 110.00 1,095.20 110.00 1,088.67 110.00 1,082.13 96.00 1,075.60 80.00 1,069.07 66.00 1,062.53 $301,000 $301,500 110.00 1,103.61 110.00 1,097.08 110.00 1,090.54 110.00 1,084.01 96.00 1,077.48 81.00 1,070.94 66.00 1,064.41 $301,500 $302,000 110.00 1,105.48 110.00 1,098.95 110.00 1,092.42 110.00 1,085.88 97.00 1,079.35 81.00 1,072.82 67.00 1,066.28 $302,000 $302,500 110.00 1,107.36 110.00 1,100.83 110.00 1,094.29 110.00 1,087.76 97.00 1,081.23 82.00 1,074.69 67.00 1,068.16 $302,500 $303,000 110.00 1,109.23 110.00 1,102.70 110.00 1,096.17 110.00 1,089.63 97.00 1,083.10 82.00 1,076.57 67.00 1,070.03 $303,000 $303,500 110.00 1,111.11 110.00 1,104.58 110.00 1,098.04 110.00 1,091.51 98.00 1,084.98 82.00 1,078.44 68.00 1,071.91 $303,500 $304,000 110.00 1,112.98 110.00 1,106.45 110.00 1,099.92 110.00 1,093.38 98.00 1,086.85 83.00 1,080.32 68.00 1,073.78 $304,000 $304,500 110.00 1,114.86 110.00 1,108.33 110.00 1,101.79 110.00 1,095.26 98.00 1,088.73 83.00 1,082.19 68.00 1,075.66 $304,500 $305,000 110.00 1,116.73 110.00 1,110.20 110.00 1,103.67 110.00 1,097.13 99.00 1,090.60 83.00 1,084.07 69.00 1,077.53 $305,000 $305,500 110.00 1,118.61 110.00 1,112.08 110.00 1,105.54 110.00 1,099.01 99.00 1,092.48 84.00 1,085.94 69.00 1,079.41 $305,500 $306,000 110.00 1,120.48 110.00 1,113.95 110.00 1,107.42 110.00 1,100.88 99.00 1,094.35 84.00 1,087.82 69.00 1,081.28 $306,000 $306,500 110.00 1,122.36 110.00 1,115.83 110.00 1,109.29 110.00 1,102.76 100.00 1,096.23 84.00 1,089.69 70.00 1,083.16 $306,500 $307,000 110.00 1,124.23 110.00 1,117.70 110.00 1,111.17 110.00 1,104.63 100.00 1,098.10 85.00 1,091.57 70.00 1,085.03 $307,000 $307,500 110.00 1,126.11 110.00 1,119.58 110.00 1,113.04 110.00 1,106.51 101.00 1,099.98 85.00 1,093.44 70.00 1,086.91 $307,500 $308,000 110.00 1,127.98 110.00 1,121.45 110.00 1,114.92 110.00 1,108.38 101.00 1,101.85 85.00 1,095.32 71.00 1,088.78 $308,000 $308,500 110.00 1,129.86 110.00 1,123.33 110.00 1,116.79 110.00 1,110.26 101.00 1,103.73 86.00 1,097.19 71.00 1,090.66 $308,500 $309,000 110.00 1,131.73 110.00 1,125.20 110.00 1,118.67 110.00 1,112.13 102.00 1,105.60 86.00 1,099.07 71.00 1,092.53 $309,000 $309,500 110.00 1,133.61 110.00 1,127.08 110.00 1,120.54 110.00 1,114.01 102.00 1,107.48 86.00 1,100.94 72.00 1,094.41 $309,500 $310,000 110.00 1,135.48 110.00 1,128.95 110.00 1,122.42 110.00 1,115.88 102.00 1,109.35 87.00 1,102.82 72.00 1,096.28 $310,000 $310,500 110.00 1,137.36 110.00 1,130.83 110.00 1,124.29 110.00 1,117.76 103.00 1,111.23 87.00 1,104.69 72.00 1,098.16 $310,500 $311,000 110.00 1,139.23 110.00 1,132.70 110.00 1,126.17 110.00 1,119.63 103.00 1,113.10 87.00 1,106.57 73.00 1,100.03 $311,000 $311,500 110.00 1,141.11 110.00 1,134.58 110.00 1,128.04 110.00 1,121.51 103.00 1,114.98 88.00 1,108.44 73.00 1,101.91 $311,500 $312,000 110.00 1,142.98 110.00 1,136.45 110.00 1,129.92 110.00 1,123.38 104.00 1,116.85 88.00 1,110.32 73.00 1,103.78 $312,000 $312,500 110.00 1,144.86 110.00 1,138.33 110.00 1,131.79 110.00 1,125.26 104.00 1,118.73 89.00 1,112.19 74.00 1,105.66 $312,500 $313,000 110.00 1,146.73 110.00 1,140.20 110.00 1,133.67 110.00 1,127.13 105.00 1,120.60 89.00 1,114.07 74.00 1,107.53 $313,000 $313,500 110.00 1,148.61 110.00 1,142.08 110.00 1,135.54 110.00 1,129.01 105.00 1,122.48 89.00 1,115.94 74.00 1,109.41 $313,500 $314,000 110.00 1,150.48 110.00 1,143.95 110.00 1,137.42 110.00 1,130.88 105.00 1,124.35 90.00 1,117.82 75.00 1,111.28 $314,000 $314,500 110.00 1,152.36 110.00 1,145.83 110.00 1,139.29 110.00 1,132.76 106.00 1,126.23 90.00 1,119.69 75.00 1,113.16 $314,500 $315,000 110.00 1,154.23 110.00 1,147.70 110.00 1,141.17 110.00 1,134.63 106.00 1,128.10 90.00 1,121.57 75.00 1,115.03 $315,000 $315,500 110.00 1,156.11 110.00 1,149.58 110.00 1,143.04 110.00 1,136.51 106.00 1,129.98 91.00 1,123.44 76.00 1,116.91 $315,500 $316,000 110.00 1,157.98 110.00 1,151.45 110.00 1,144.92 110.00 1,138.38 107.00 1,131.85 91.00 1,125.32 76.00 1,118.78 $316,000 $316,500 110.00 1,159.86 110.00 1,153.33 110.00 1,146.79 110.00 1,140.26 107.00 1,133.73 91.00 1,127.19 76.00 1,120.66 $316,500 $317,000 110.00 1,161.73 110.00 1,155.20 110.00 1,148.67 110.00 1,142.13 107.00 1,135.60 92.00 1,129.07 77.00 1,122.53 $317,000 $317,500 110.00 1,163.61 110.00 1,157.08 110.00 1,150.54 110.00 1,144.01 108.00 1,137.48 92.00 1,130.94 77.00 1,124.41 $317,500 $318,000 110.00 1,165.48 110.00 1,158.95 110.00 1,152.42 110.00 1,145.88 108.00 1,139.35 92.00 1,132.82 77.00 1,126.28 $318,000 $318,500 110.00 1,167.36 110.00 1,160.83 110.00 1,154.29 110.00 1,147.76 109.00 1,141.23 93.00 1,134.69 78.00 1,128.16 $318,500 $319,000 110.00 1,169.23 110.00 1,162.70 110.00 1,156.17 110.00 1,149.63 109.00 1,143.10 93.00 1,136.57 78.00 1,130.03 $319,000 $319,500 110.00 1,171.11 110.00 1,164.58 110.00 1,158.04 110.00 1,151.51 109.00 1,144.98 93.00 1,138.44 78.00 1,131.91 $319,500 $320,000 110.00 1,172.98 110.00 1,166.45 110.00 1,159.92 110.00 1,153.38 110.00 1,146.85 94.00 1,140.32 79.00 1,133.78

NJEIS Family Cost Participation Table Page 9 of 12 Effective July 1, 2015

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 1,174.86 110.00 1,168.33 110.00 1,161.79 110.00 1,155.26 110.00 1,148.73 94.00 1,142.19 79.00 1,135.66 $320,500 $321,000 110.00 1,176.73 110.00 1,170.20 110.00 1,163.67 110.00 1,157.13 110.00 1,150.60 94.00 1,144.07 79.00 1,137.53 $321,000 $321,500 110.00 1,178.61 110.00 1,172.08 110.00 1,165.54 110.00 1,159.01 110.00 1,152.48 95.00 1,145.94 80.00 1,139.41 $321,500 $322,000 110.00 1,180.48 110.00 1,173.95 110.00 1,167.42 110.00 1,160.88 110.00 1,154.35 95.00 1,147.82 80.00 1,141.28 $322,000 $322,500 110.00 1,182.36 110.00 1,175.83 110.00 1,169.29 110.00 1,162.76 110.00 1,156.23 95.00 1,149.69 80.00 1,143.16 $322,500 $323,000 110.00 1,184.23 110.00 1,177.70 110.00 1,171.17 110.00 1,164.63 110.00 1,158.10 96.00 1,151.57 81.00 1,145.03 $323,000 $323,500 110.00 1,186.11 110.00 1,179.58 110.00 1,173.04 110.00 1,166.51 110.00 1,159.98 96.00 1,153.44 81.00 1,146.91 $323,500 $324,000 110.00 1,187.98 110.00 1,181.45 110.00 1,174.92 110.00 1,168.38 110.00 1,161.85 97.00 1,155.32 81.00 1,148.78 $324,000 $324,500 110.00 1,189.86 110.00 1,183.33 110.00 1,176.79 110.00 1,170.26 110.00 1,163.73 97.00 1,157.19 82.00 1,150.66 $324,500 $325,000 110.00 1,191.73 110.00 1,185.20 110.00 1,178.67 110.00 1,172.13 110.00 1,165.60 97.00 1,159.07 82.00 1,152.53 $325,000 $325,500 110.00 1,193.61 110.00 1,187.08 110.00 1,180.54 110.00 1,174.01 110.00 1,167.48 98.00 1,160.94 82.00 1,154.41 $325,500 $326,000 110.00 1,195.48 110.00 1,188.95 110.00 1,182.42 110.00 1,175.88 110.00 1,169.35 98.00 1,162.82 83.00 1,156.28 $326,000 $326,500 110.00 1,197.36 110.00 1,190.83 110.00 1,184.29 110.00 1,177.76 110.00 1,171.23 98.00 1,164.69 83.00 1,158.16 $326,500 $327,000 110.00 1,199.23 110.00 1,192.70 110.00 1,186.17 110.00 1,179.63 110.00 1,173.10 99.00 1,166.57 83.00 1,160.03 $327,000 $327,500 110.00 1,201.11 110.00 1,194.58 110.00 1,188.04 110.00 1,181.51 110.00 1,174.98 99.00 1,168.44 84.00 1,161.91 $327,500 $328,000 110.00 1,202.98 110.00 1,196.45 110.00 1,189.92 110.00 1,183.38 110.00 1,176.85 99.00 1,170.32 84.00 1,163.78 $328,000 $328,500 110.00 1,204.86 110.00 1,198.33 110.00 1,191.79 110.00 1,185.26 110.00 1,178.73 100.00 1,172.19 84.00 1,165.66 $328,500 $329,000 110.00 1,206.73 110.00 1,200.20 110.00 1,193.67 110.00 1,187.13 110.00 1,180.60 100.00 1,174.07 85.00 1,167.53 $329,000 $329,500 110.00 1,208.61 110.00 1,202.08 110.00 1,195.54 110.00 1,189.01 110.00 1,182.48 100.00 1,175.94 85.00 1,169.41 $329,500 $330,000 110.00 1,210.48 110.00 1,203.95 110.00 1,197.42 110.00 1,190.88 110.00 1,184.35 101.00 1,177.82 85.00 1,171.28 $330,000 $330,500 110.00 1,212.36 110.00 1,205.83 110.00 1,199.29 110.00 1,192.76 110.00 1,186.23 101.00 1,179.69 86.00 1,173.16 $330,500 $331,000 110.00 1,214.23 110.00 1,207.70 110.00 1,201.17 110.00 1,194.63 110.00 1,188.10 101.00 1,181.57 86.00 1,175.03 $331,000 $331,500 110.00 1,216.11 110.00 1,209.58 110.00 1,203.04 110.00 1,196.51 110.00 1,189.98 102.00 1,183.44 86.00 1,176.91 $331,500 $332,000 110.00 1,217.98 110.00 1,211.45 110.00 1,204.92 110.00 1,198.38 110.00 1,191.85 102.00 1,185.32 87.00 1,178.78 $332,000 $332,500 110.00 1,219.86 110.00 1,213.33 110.00 1,206.79 110.00 1,200.26 110.00 1,193.73 102.00 1,187.19 87.00 1,180.66 $332,500 $333,000 110.00 1,221.73 110.00 1,215.20 110.00 1,208.67 110.00 1,202.13 110.00 1,195.60 103.00 1,189.07 88.00 1,182.53 $333,000 $333,500 110.00 1,223.61 110.00 1,217.08 110.00 1,210.54 110.00 1,204.01 110.00 1,197.48 103.00 1,190.94 88.00 1,184.41 $333,500 $334,000 110.00 1,225.48 110.00 1,218.95 110.00 1,212.42 110.00 1,205.88 110.00 1,199.35 104.00 1,192.82 88.00 1,186.28 $334,000 $334,500 110.00 1,227.36 110.00 1,220.83 110.00 1,214.29 110.00 1,207.76 110.00 1,201.23 104.00 1,194.69 89.00 1,188.16 $334,500 $335,000 110.00 1,229.23 110.00 1,222.70 110.00 1,216.17 110.00 1,209.63 110.00 1,203.10 104.00 1,196.57 89.00 1,190.03 $335,000 $335,500 110.00 1,231.11 110.00 1,224.58 110.00 1,218.04 110.00 1,211.51 110.00 1,204.98 105.00 1,198.44 89.00 1,191.91 $335,500 $336,000 110.00 1,232.98 110.00 1,226.45 110.00 1,219.92 110.00 1,213.38 110.00 1,206.85 105.00 1,200.32 90.00 1,193.78 $336,000 $336,500 110.00 1,234.86 110.00 1,228.33 110.00 1,221.79 110.00 1,215.26 110.00 1,208.73 105.00 1,202.19 90.00 1,195.66 $336,500 $337,000 110.00 1,236.73 110.00 1,230.20 110.00 1,223.67 110.00 1,217.13 110.00 1,210.60 106.00 1,204.07 90.00 1,197.53 $337,000 $337,500 110.00 1,238.61 110.00 1,232.08 110.00 1,225.54 110.00 1,219.01 110.00 1,212.48 106.00 1,205.94 91.00 1,199.41 $337,500 $338,000 110.00 1,240.48 110.00 1,233.95 110.00 1,227.42 110.00 1,220.88 110.00 1,214.35 106.00 1,207.82 91.00 1,201.28 $338,000 $338,500 110.00 1,242.36 110.00 1,235.83 110.00 1,229.29 110.00 1,222.76 110.00 1,216.23 107.00 1,209.69 91.00 1,203.16 $338,500 $339,000 110.00 1,244.23 110.00 1,237.70 110.00 1,231.17 110.00 1,224.63 110.00 1,218.10 107.00 1,211.57 92.00 1,205.03 $339,000 $339,500 110.00 1,246.11 110.00 1,239.58 110.00 1,233.04 110.00 1,226.51 110.00 1,219.98 107.00 1,213.44 92.00 1,206.91 $339,500 $340,000 110.00 1,247.98 110.00 1,241.45 110.00 1,234.92 110.00 1,228.38 110.00 1,221.85 108.00 1,215.32 92.00 1,208.78 $340,000 $340,500 110.00 1,249.86 110.00 1,243.33 110.00 1,236.79 110.00 1,230.26 110.00 1,223.73 108.00 1,217.19 93.00 1,210.66 $340,500 $341,000 110.00 1,251.73 110.00 1,245.20 110.00 1,238.67 110.00 1,232.13 110.00 1,225.60 109.00 1,219.07 93.00 1,212.53 $341,000 $341,500 110.00 1,253.61 110.00 1,247.08 110.00 1,240.54 110.00 1,234.01 110.00 1,227.48 109.00 1,220.94 93.00 1,214.41 $341,500 $342,000 110.00 1,255.48 110.00 1,248.95 110.00 1,242.42 110.00 1,235.88 110.00 1,229.35 109.00 1,222.82 94.00 1,216.28 $342,000 $342,500 110.00 1,257.36 110.00 1,250.83 110.00 1,244.29 110.00 1,237.76 110.00 1,231.23 110.00 1,224.69 94.00 1,218.16 $342,500 $343,000 110.00 1,259.23 110.00 1,252.70 110.00 1,246.17 110.00 1,239.63 110.00 1,233.10 110.00 1,226.57 95.00 1,220.03 $343,000 $343,500 110.00 1,261.11 110.00 1,254.58 110.00 1,248.04 110.00 1,241.51 110.00 1,234.98 110.00 1,228.44 95.00 1,221.91 $343,500 $344,000 110.00 1,262.98 110.00 1,256.45 110.00 1,249.92 110.00 1,243.38 110.00 1,236.85 110.00 1,230.32 95.00 1,223.78 $344,000 $344,500 110.00 1,264.86 110.00 1,258.33 110.00 1,251.79 110.00 1,245.26 110.00 1,238.73 110.00 1,232.19 96.00 1,225.66 $344,500 $345,000 110.00 1,266.73 110.00 1,260.20 110.00 1,253.67 110.00 1,247.13 110.00 1,240.60 110.00 1,234.07 96.00 1,227.53 $345,000 $345,500 110.00 1,268.61 110.00 1,262.08 110.00 1,255.54 110.00 1,249.01 110.00 1,242.48 110.00 1,235.94 96.00 1,229.41 $345,500 $346,000 110.00 1,270.48 110.00 1,263.95 110.00 1,257.42 110.00 1,250.88 110.00 1,244.35 110.00 1,237.82 97.00 1,231.28 $346,000 $346,500 110.00 1,272.36 110.00 1,265.83 110.00 1,259.29 110.00 1,252.76 110.00 1,246.23 110.00 1,239.69 97.00 1,233.16 $346,500 $347,000 110.00 1,274.23 110.00 1,267.70 110.00 1,261.17 110.00 1,254.63 110.00 1,248.10 110.00 1,241.57 97.00 1,235.03 $347,000 $347,500 110.00 1,276.11 110.00 1,269.58 110.00 1,263.04 110.00 1,256.51 110.00 1,249.98 110.00 1,243.44 98.00 1,236.91 $347,500 $348,000 110.00 1,277.98 110.00 1,271.45 110.00 1,264.92 110.00 1,258.38 110.00 1,251.85 110.00 1,245.32 98.00 1,238.78 $348,000 $348,500 110.00 1,279.86 110.00 1,273.33 110.00 1,266.79 110.00 1,260.26 110.00 1,253.73 110.00 1,247.19 98.00 1,240.66 $348,500 $349,000 110.00 1,281.73 110.00 1,275.20 110.00 1,268.67 110.00 1,262.13 110.00 1,255.60 110.00 1,249.07 99.00 1,242.53 $349,000 $349,500 110.00 1,283.61 110.00 1,277.08 110.00 1,270.54 110.00 1,264.01 110.00 1,257.48 110.00 1,250.94 99.00 1,244.41 $349,500 $350,000 110.00 1,285.48 110.00 1,278.95 110.00 1,272.42 110.00 1,265.88 110.00 1,259.35 110.00 1,252.82 99.00 1,246.28 $350,000 $350,500 110.00 1,287.36 110.00 1,280.83 110.00 1,274.29 110.00 1,267.76 110.00 1,261.23 110.00 1,254.69 100.00 1,248.16 $350,500 $351,000 110.00 1,289.23 110.00 1,282.70 110.00 1,276.17 110.00 1,269.63 110.00 1,263.10 110.00 1,256.57 100.00 1,250.03 $351,000 $351,500 110.00 1,291.11 110.00 1,284.58 110.00 1,278.04 110.00 1,271.51 110.00 1,264.98 110.00 1,258.44 100.00 1,251.91 $351,500 $352,000 110.00 1,292.98 110.00 1,286.45 110.00 1,279.92 110.00 1,273.38 110.00 1,266.85 110.00 1,260.32 101.00 1,253.78 $352,000 $352,500 110.00 1,294.86 110.00 1,288.33 110.00 1,281.79 110.00 1,275.26 110.00 1,268.73 110.00 1,262.19 101.00 1,255.66 $352,500 $353,000 110.00 1,296.73 110.00 1,290.20 110.00 1,283.67 110.00 1,277.13 110.00 1,270.60 110.00 1,264.07 102.00 1,257.53 $353,000 $353,500 110.00 1,298.61 110.00 1,292.08 110.00 1,285.54 110.00 1,279.01 110.00 1,272.48 110.00 1,265.94 102.00 1,259.41 $353,500 $354,000 110.00 1,300.48 110.00 1,293.95 110.00 1,287.42 110.00 1,280.88 110.00 1,274.35 110.00 1,267.82 102.00 1,261.28 $354,000 $354,500 110.00 1,302.36 110.00 1,295.83 110.00 1,289.29 110.00 1,282.76 110.00 1,276.23 110.00 1,269.69 103.00 1,263.16 $354,500 $355,000 110.00 1,304.23 110.00 1,297.70 110.00 1,291.17 110.00 1,284.63 110.00 1,278.10 110.00 1,271.57 103.00 1,265.03 $355,000 $355,500 110.00 1,306.11 110.00 1,299.58 110.00 1,293.04 110.00 1,286.51 110.00 1,279.98 110.00 1,273.44 103.00 1,266.91 $355,500 $356,000 110.00 1,307.98 110.00 1,301.45 110.00 1,294.92 110.00 1,288.38 110.00 1,281.85 110.00 1,275.32 104.00 1,268.78 $356,000 $356,500 110.00 1,309.86 110.00 1,303.33 110.00 1,296.79 110.00 1,290.26 110.00 1,283.73 110.00 1,277.19 104.00 1,270.66 $356,500 $357,000 110.00 1,311.73 110.00 1,305.20 110.00 1,298.67 110.00 1,292.13 110.00 1,285.60 110.00 1,279.07 104.00 1,272.53 $357,000 $357,500 110.00 1,313.61 110.00 1,307.08 110.00 1,300.54 110.00 1,294.01 110.00 1,287.48 110.00 1,280.94 105.00 1,274.41 $357,500 $358,000 110.00 1,315.48 110.00 1,308.95 110.00 1,302.42 110.00 1,295.88 110.00 1,289.35 110.00 1,282.82 105.00 1,276.28 $358,000 $358,500 110.00 1,317.36 110.00 1,310.83 110.00 1,304.29 110.00 1,297.76 110.00 1,291.23 110.00 1,284.69 105.00 1,278.16 $358,500 $359,000 110.00 1,319.23 110.00 1,312.70 110.00 1,306.17 110.00 1,299.63 110.00 1,293.10 110.00 1,286.57 106.00 1,280.03 $359,000 $359,500 110.00 1,321.11 110.00 1,314.58 110.00 1,308.04 110.00 1,301.51 110.00 1,294.98 110.00 1,288.44 106.00 1,281.91 $359,500 $360,000 110.00 1,322.98 110.00 1,316.45 110.00 1,309.92 110.00 1,303.38 110.00 1,296.85 110.00 1,290.32 106.00 1,283.78

NJEIS Family Cost Participation Table Page 10 of 12 Effective July 1, 2015

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 1,324.86 110.00 1,318.33 110.00 1,311.79 110.00 1,305.26 110.00 1,298.73 110.00 1,292.19 107.00 1,285.66 $360,500 $361,000 110.00 1,326.73 110.00 1,320.20 110.00 1,313.67 110.00 1,307.13 110.00 1,300.60 110.00 1,294.07 107.00 1,287.53 $361,000 $361,500 110.00 1,328.61 110.00 1,322.08 110.00 1,315.54 110.00 1,309.01 110.00 1,302.48 110.00 1,295.94 107.00 1,289.41 $361,500 $362,000 110.00 1,330.48 110.00 1,323.95 110.00 1,317.42 110.00 1,310.88 110.00 1,304.35 110.00 1,297.82 108.00 1,291.28 $362,000 $362,500 110.00 1,332.36 110.00 1,325.83 110.00 1,319.29 110.00 1,312.76 110.00 1,306.23 110.00 1,299.69 108.00 1,293.16 $362,500 $363,000 110.00 1,334.23 110.00 1,327.70 110.00 1,321.17 110.00 1,314.63 110.00 1,308.10 110.00 1,301.57 108.00 1,295.03 $363,000 $363,500 110.00 1,336.11 110.00 1,329.58 110.00 1,323.04 110.00 1,316.51 110.00 1,309.98 110.00 1,303.44 109.00 1,296.91 $363,500 $364,000 110.00 1,337.98 110.00 1,331.45 110.00 1,324.92 110.00 1,318.38 110.00 1,311.85 110.00 1,305.32 109.00 1,298.78 $364,000 $364,500 110.00 1,339.86 110.00 1,333.33 110.00 1,326.79 110.00 1,320.26 110.00 1,313.73 110.00 1,307.19 110.00 1,300.66 $364,500 $365,000 110.00 1,341.73 110.00 1,335.20 110.00 1,328.67 110.00 1,322.13 110.00 1,315.60 110.00 1,309.07 110.00 1,302.53 $365,000 $365,500 110.00 1,343.61 110.00 1,337.08 110.00 1,330.54 110.00 1,324.01 110.00 1,317.48 110.00 1,310.94 110.00 1,304.41 $365,500 $366,000 110.00 1,345.48 110.00 1,338.95 110.00 1,332.42 110.00 1,325.88 110.00 1,319.35 110.00 1,312.82 110.00 1,306.28 $366,000 $366,500 110.00 1,347.36 110.00 1,340.83 110.00 1,334.29 110.00 1,327.76 110.00 1,321.23 110.00 1,314.69 110.00 1,308.16 $366,500 $367,000 110.00 1,349.23 110.00 1,342.70 110.00 1,336.17 110.00 1,329.63 110.00 1,323.10 110.00 1,316.57 110.00 1,310.03 $367,000 $367,500 110.00 1,351.11 110.00 1,344.58 110.00 1,338.04 110.00 1,331.51 110.00 1,324.98 110.00 1,318.44 110.00 1,311.91 $367,500 $368,000 110.00 1,352.98 110.00 1,346.45 110.00 1,339.92 110.00 1,333.38 110.00 1,326.85 110.00 1,320.32 110.00 1,313.78 $368,000 $368,500 110.00 1,354.86 110.00 1,348.33 110.00 1,341.79 110.00 1,335.26 110.00 1,328.73 110.00 1,322.19 110.00 1,315.66 $368,500 $369,000 110.00 1,356.73 110.00 1,350.20 110.00 1,343.67 110.00 1,337.13 110.00 1,330.60 110.00 1,324.07 110.00 1,317.53 $369,000 $369,500 110.00 1,358.61 110.00 1,352.08 110.00 1,345.54 110.00 1,339.01 110.00 1,332.48 110.00 1,325.94 110.00 1,319.41 $369,500 $370,000 110.00 1,360.48 110.00 1,353.95 110.00 1,347.42 110.00 1,340.88 110.00 1,334.35 110.00 1,327.82 110.00 1,321.28 $370,000 $370,500 110.00 1,362.36 110.00 1,355.83 110.00 1,349.29 110.00 1,342.76 110.00 1,336.23 110.00 1,329.69 110.00 1,323.16 $370,500 $371,000 110.00 1,364.23 110.00 1,357.70 110.00 1,351.17 110.00 1,344.63 110.00 1,338.10 110.00 1,331.57 110.00 1,325.03 $371,000 $371,500 110.00 1,366.11 110.00 1,359.58 110.00 1,353.04 110.00 1,346.51 110.00 1,339.98 110.00 1,333.44 110.00 1,326.91 $371,500 $372,000 110.00 1,367.98 110.00 1,361.45 110.00 1,354.92 110.00 1,348.38 110.00 1,341.85 110.00 1,335.32 110.00 1,328.78 $372,000 $372,500 110.00 1,369.86 110.00 1,363.33 110.00 1,356.79 110.00 1,350.26 110.00 1,343.73 110.00 1,337.19 110.00 1,330.66 $372,500 $373,000 110.00 1,371.73 110.00 1,365.20 110.00 1,358.67 110.00 1,352.13 110.00 1,345.60 110.00 1,339.07 110.00 1,332.53 $373,000 $373,500 110.00 1,373.61 110.00 1,367.08 110.00 1,360.54 110.00 1,354.01 110.00 1,347.48 110.00 1,340.94 110.00 1,334.41 $373,500 $374,000 110.00 1,375.48 110.00 1,368.95 110.00 1,362.42 110.00 1,355.88 110.00 1,349.35 110.00 1,342.82 110.00 1,336.28 $374,000 $374,500 110.00 1,377.36 110.00 1,370.83 110.00 1,364.29 110.00 1,357.76 110.00 1,351.23 110.00 1,344.69 110.00 1,338.16 $374,500 $375,000 110.00 1,379.23 110.00 1,372.70 110.00 1,366.17 110.00 1,359.63 110.00 1,353.10 110.00 1,346.57 110.00 1,340.03 $375,000 $375,500 110.00 1,381.11 110.00 1,374.58 110.00 1,368.04 110.00 1,361.51 110.00 1,354.98 110.00 1,348.44 110.00 1,341.91 $375,500 $376,000 110.00 1,382.98 110.00 1,376.45 110.00 1,369.92 110.00 1,363.38 110.00 1,356.85 110.00 1,350.32 110.00 1,343.78 $376,000 $376,500 110.00 1,384.86 110.00 1,378.33 110.00 1,371.79 110.00 1,365.26 110.00 1,358.73 110.00 1,352.19 110.00 1,345.66 $376,500 $377,000 110.00 1,386.73 110.00 1,380.20 110.00 1,373.67 110.00 1,367.13 110.00 1,360.60 110.00 1,354.07 110.00 1,347.53 $377,000 $377,500 110.00 1,388.61 110.00 1,382.08 110.00 1,375.54 110.00 1,369.01 110.00 1,362.48 110.00 1,355.94 110.00 1,349.41 $377,500 $378,000 110.00 1,390.48 110.00 1,383.95 110.00 1,377.42 110.00 1,370.88 110.00 1,364.35 110.00 1,357.82 110.00 1,351.28 $378,000 $378,500 110.00 1,392.36 110.00 1,385.83 110.00 1,379.29 110.00 1,372.76 110.00 1,366.23 110.00 1,359.69 110.00 1,353.16 $378,500 $379,000 110.00 1,394.23 110.00 1,387.70 110.00 1,381.17 110.00 1,374.63 110.00 1,368.10 110.00 1,361.57 110.00 1,355.03 $379,000 $379,500 110.00 1,396.11 110.00 1,389.58 110.00 1,383.04 110.00 1,376.51 110.00 1,369.98 110.00 1,363.44 110.00 1,356.91 $379,500 $380,000 110.00 1,397.98 110.00 1,391.45 110.00 1,384.92 110.00 1,378.38 110.00 1,371.85 110.00 1,365.32 110.00 1,358.78 $380,000 $380,500 110.00 1,399.86 110.00 1,393.33 110.00 1,386.79 110.00 1,380.26 110.00 1,373.73 110.00 1,367.19 110.00 1,360.66 $380,500 $381,000 110.00 1,401.73 110.00 1,395.20 110.00 1,388.67 110.00 1,382.13 110.00 1,375.60 110.00 1,369.07 110.00 1,362.53 $381,000 $381,500 110.00 1,403.61 110.00 1,397.08 110.00 1,390.54 110.00 1,384.01 110.00 1,377.48 110.00 1,370.94 110.00 1,364.41 $381,500 $382,000 110.00 1,405.48 110.00 1,398.95 110.00 1,392.42 110.00 1,385.88 110.00 1,379.35 110.00 1,372.82 110.00 1,366.28 $382,000 $382,500 110.00 1,407.36 110.00 1,400.83 110.00 1,394.29 110.00 1,387.76 110.00 1,381.23 110.00 1,374.69 110.00 1,368.16 $382,500 $383,000 110.00 1,409.23 110.00 1,402.70 110.00 1,396.17 110.00 1,389.63 110.00 1,383.10 110.00 1,376.57 110.00 1,370.03 $383,000 $383,500 110.00 1,411.11 110.00 1,404.58 110.00 1,398.04 110.00 1,391.51 110.00 1,384.98 110.00 1,378.44 110.00 1,371.91 $383,500 $384,000 110.00 1,412.98 110.00 1,406.45 110.00 1,399.92 110.00 1,393.38 110.00 1,386.85 110.00 1,380.32 110.00 1,373.78 $384,000 $384,500 110.00 1,414.86 110.00 1,408.33 110.00 1,401.79 110.00 1,395.26 110.00 1,388.73 110.00 1,382.19 110.00 1,375.66 $384,500 $385,000 110.00 1,416.73 110.00 1,410.20 110.00 1,403.67 110.00 1,397.13 110.00 1,390.60 110.00 1,384.07 110.00 1,377.53 $385,000 $385,500 110.00 1,418.61 110.00 1,412.08 110.00 1,405.54 110.00 1,399.01 110.00 1,392.48 110.00 1,385.94 110.00 1,379.41 $385,500 $386,000 110.00 1,420.48 110.00 1,413.95 110.00 1,407.42 110.00 1,400.88 110.00 1,394.35 110.00 1,387.82 110.00 1,381.28 $386,000 $386,500 110.00 1,422.36 110.00 1,415.83 110.00 1,409.29 110.00 1,402.76 110.00 1,396.23 110.00 1,389.69 110.00 1,383.16 $386,500 $387,000 110.00 1,424.23 110.00 1,417.70 110.00 1,411.17 110.00 1,404.63 110.00 1,398.10 110.00 1,391.57 110.00 1,385.03 $387,000 $387,500 110.00 1,426.11 110.00 1,419.58 110.00 1,413.04 110.00 1,406.51 110.00 1,399.98 110.00 1,393.44 110.00 1,386.91 $387,500 $388,000 110.00 1,427.98 110.00 1,421.45 110.00 1,414.92 110.00 1,408.38 110.00 1,401.85 110.00 1,395.32 110.00 1,388.78 $388,000 $388,500 110.00 1,429.86 110.00 1,423.33 110.00 1,416.79 110.00 1,410.26 110.00 1,403.73 110.00 1,397.19 110.00 1,390.66 $388,500 $389,000 110.00 1,431.73 110.00 1,425.20 110.00 1,418.67 110.00 1,412.13 110.00 1,405.60 110.00 1,399.07 110.00 1,392.53 $389,000 $389,500 110.00 1,433.61 110.00 1,427.08 110.00 1,420.54 110.00 1,414.01 110.00 1,407.48 110.00 1,400.94 110.00 1,394.41 $389,500 $390,000 110.00 1,435.48 110.00 1,428.95 110.00 1,422.42 110.00 1,415.88 110.00 1,409.35 110.00 1,402.82 110.00 1,396.28 $390,000 $390,500 110.00 1,437.36 110.00 1,430.83 110.00 1,424.29 110.00 1,417.76 110.00 1,411.23 110.00 1,404.69 110.00 1,398.16 $390,500 $391,000 110.00 1,439.23 110.00 1,432.70 110.00 1,426.17 110.00 1,419.63 110.00 1,413.10 110.00 1,406.57 110.00 1,400.03 $391,000 $391,500 110.00 1,441.11 110.00 1,434.58 110.00 1,428.04 110.00 1,421.51 110.00 1,414.98 110.00 1,408.44 110.00 1,401.91 $391,500 $392,000 110.00 1,442.98 110.00 1,436.45 110.00 1,429.92 110.00 1,423.38 110.00 1,416.85 110.00 1,410.32 110.00 1,403.78 $392,000 $392,500 110.00 1,444.86 110.00 1,438.33 110.00 1,431.79 110.00 1,425.26 110.00 1,418.73 110.00 1,412.19 110.00 1,405.66 $392,500 $393,000 110.00 1,446.73 110.00 1,440.20 110.00 1,433.67 110.00 1,427.13 110.00 1,420.60 110.00 1,414.07 110.00 1,407.53 $393,000 $393,500 110.00 1,448.61 110.00 1,442.08 110.00 1,435.54 110.00 1,429.01 110.00 1,422.48 110.00 1,415.94 110.00 1,409.41 $393,500 $394,000 110.00 1,450.48 110.00 1,443.95 110.00 1,437.42 110.00 1,430.88 110.00 1,424.35 110.00 1,417.82 110.00 1,411.28 $394,000 $394,500 110.00 1,452.36 110.00 1,445.83 110.00 1,439.29 110.00 1,432.76 110.00 1,426.23 110.00 1,419.69 110.00 1,413.16 $394,500 $395,000 110.00 1,454.23 110.00 1,447.70 110.00 1,441.17 110.00 1,434.63 110.00 1,428.10 110.00 1,421.57 110.00 1,415.03 $395,000 $395,500 110.00 1,456.11 110.00 1,449.58 110.00 1,443.04 110.00 1,436.51 110.00 1,429.98 110.00 1,423.44 110.00 1,416.91 $395,500 $396,000 110.00 1,457.98 110.00 1,451.45 110.00 1,444.92 110.00 1,438.38 110.00 1,431.85 110.00 1,425.32 110.00 1,418.78 $396,000 $396,500 110.00 1,459.86 110.00 1,453.33 110.00 1,446.79 110.00 1,440.26 110.00 1,433.73 110.00 1,427.19 110.00 1,420.66 $396,500 $397,000 110.00 1,461.73 110.00 1,455.20 110.00 1,448.67 110.00 1,442.13 110.00 1,435.60 110.00 1,429.07 110.00 1,422.53 $397,000 $397,500 110.00 1,463.61 110.00 1,457.08 110.00 1,450.54 110.00 1,444.01 110.00 1,437.48 110.00 1,430.94 110.00 1,424.41 $397,500 $398,000 110.00 1,465.48 110.00 1,458.95 110.00 1,452.42 110.00 1,445.88 110.00 1,439.35 110.00 1,432.82 110.00 1,426.28 $398,000 $398,500 110.00 1,467.36 110.00 1,460.83 110.00 1,454.29 110.00 1,447.76 110.00 1,441.23 110.00 1,434.69 110.00 1,428.16 $398,500 $399,000 110.00 1,469.23 110.00 1,462.70 110.00 1,456.17 110.00 1,449.63 110.00 1,443.10 110.00 1,436.57 110.00 1,430.03 $399,000 $399,500 110.00 1,471.11 110.00 1,464.58 110.00 1,458.04 110.00 1,451.51 110.00 1,444.98 110.00 1,438.44 110.00 1,431.91 $399,500 $400,000 110.00 1,472.98 110.00 1,466.45 110.00 1,459.92 110.00 1,453.38 110.00 1,446.85 110.00 1,440.32 110.00 1,433.78

NJEIS Family Cost Participation Table Page 11 of 12 Effective July 1, 2015

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 1,474.86 110.00 1,468.33 110.00 1,461.79 110.00 1,455.26 110.00 1,448.73 110.00 1,442.19 110.00 1,435.66 $400,500 $401,000 110.00 1,476.73 110.00 1,470.20 110.00 1,463.67 110.00 1,457.13 110.00 1,450.60 110.00 1,444.07 110.00 1,437.53 $401,000 $401,500 110.00 1,478.61 110.00 1,472.08 110.00 1,465.54 110.00 1,459.01 110.00 1,452.48 110.00 1,445.94 110.00 1,439.41 $401,500 $402,000 110.00 1,480.48 110.00 1,473.95 110.00 1,467.42 110.00 1,460.88 110.00 1,454.35 110.00 1,447.82 110.00 1,441.28 $402,000 $402,500 110.00 1,482.36 110.00 1,475.83 110.00 1,469.29 110.00 1,462.76 110.00 1,456.23 110.00 1,449.69 110.00 1,443.16 $402,500 $403,000 110.00 1,484.23 110.00 1,477.70 110.00 1,471.17 110.00 1,464.63 110.00 1,458.10 110.00 1,451.57 110.00 1,445.03 $403,000 $403,500 110.00 1,486.11 110.00 1,479.58 110.00 1,473.04 110.00 1,466.51 110.00 1,459.98 110.00 1,453.44 110.00 1,446.91 $403,500 $404,000 110.00 1,487.98 110.00 1,481.45 110.00 1,474.92 110.00 1,468.38 110.00 1,461.85 110.00 1,455.32 110.00 1,448.78 $404,000 $404,500 110.00 1,489.86 110.00 1,483.33 110.00 1,476.79 110.00 1,470.26 110.00 1,463.73 110.00 1,457.19 110.00 1,450.66 $404,500 $405,000 110.00 1,491.73 110.00 1,485.20 110.00 1,478.67 110.00 1,472.13 110.00 1,465.60 110.00 1,459.07 110.00 1,452.53 $405,000 $405,500 110.00 1,493.61 110.00 1,487.08 110.00 1,480.54 110.00 1,474.01 110.00 1,467.48 110.00 1,460.94 110.00 1,454.41 $405,500 $406,000 110.00 1,495.48 110.00 1,488.95 110.00 1,482.42 110.00 1,475.88 110.00 1,469.35 110.00 1,462.82 110.00 1,456.28 $406,000 $406,500 110.00 1,497.36 110.00 1,490.83 110.00 1,484.29 110.00 1,477.76 110.00 1,471.23 110.00 1,464.69 110.00 1,458.16 $406,500 $407,000 110.00 1,499.23 110.00 1,492.70 110.00 1,486.17 110.00 1,479.63 110.00 1,473.10 110.00 1,466.57 110.00 1,460.03 $407,000 $407,500 110.00 1,501.11 110.00 1,494.58 110.00 1,488.04 110.00 1,481.51 110.00 1,474.98 110.00 1,468.44 110.00 1,461.91 $407,500 $408,000 110.00 1,502.98 110.00 1,496.45 110.00 1,489.92 110.00 1,483.38 110.00 1,476.85 110.00 1,470.32 110.00 1,463.78 $408,000 $408,500 110.00 1,504.86 110.00 1,498.33 110.00 1,491.79 110.00 1,485.26 110.00 1,478.73 110.00 1,472.19 110.00 1,465.66 $408,500 $409,000 110.00 1,506.73 110.00 1,500.20 110.00 1,493.67 110.00 1,487.13 110.00 1,480.60 110.00 1,474.07 110.00 1,467.53 $409,000 $409,500 110.00 1,508.61 110.00 1,502.08 110.00 1,495.54 110.00 1,489.01 110.00 1,482.48 110.00 1,475.94 110.00 1,469.41 $409,500 $410,000 110.00 1,510.48 110.00 1,503.95 110.00 1,497.42 110.00 1,490.88 110.00 1,484.35 110.00 1,477.82 110.00 1,471.28 $410,000 $410,500 110.00 1,512.36 110.00 1,505.83 110.00 1,499.29 110.00 1,492.76 110.00 1,486.23 110.00 1,479.69 110.00 1,473.16 $410,500 $411,000 110.00 1,514.23 110.00 1,507.70 110.00 1,501.17 110.00 1,494.63 110.00 1,488.10 110.00 1,481.57 110.00 1,475.03 $411,000 $411,500 110.00 1,516.11 110.00 1,509.58 110.00 1,503.04 110.00 1,496.51 110.00 1,489.98 110.00 1,483.44 110.00 1,476.91 $411,500 $412,000 110.00 1,517.98 110.00 1,511.45 110.00 1,504.92 110.00 1,498.38 110.00 1,491.85 110.00 1,485.32 110.00 1,478.78 $412,000 $412,500 110.00 1,519.86 110.00 1,513.33 110.00 1,506.79 110.00 1,500.26 110.00 1,493.73 110.00 1,487.19 110.00 1,480.66 $412,500 $413,000 110.00 1,521.73 110.00 1,515.20 110.00 1,508.67 110.00 1,502.13 110.00 1,495.60 110.00 1,489.07 110.00 1,482.53 $413,000 $413,500 110.00 1,523.61 110.00 1,517.08 110.00 1,510.54 110.00 1,504.01 110.00 1,497.48 110.00 1,490.94 110.00 1,484.41 $413,500 $414,000 110.00 1,525.48 110.00 1,518.95 110.00 1,512.42 110.00 1,505.88 110.00 1,499.35 110.00 1,492.82 110.00 1,486.28 $414,000 $414,500 110.00 1,527.36 110.00 1,520.83 110.00 1,514.29 110.00 1,507.76 110.00 1,501.23 110.00 1,494.69 110.00 1,488.16 $414,500 $415,000 110.00 1,529.23 110.00 1,522.70 110.00 1,516.17 110.00 1,509.63 110.00 1,503.10 110.00 1,496.57 110.00 1,490.03 $415,000 $415,500 110.00 1,531.11 110.00 1,524.58 110.00 1,518.04 110.00 1,511.51 110.00 1,504.98 110.00 1,498.44 110.00 1,491.91 $415,500 $416,000 110.00 1,532.98 110.00 1,526.45 110.00 1,519.92 110.00 1,513.38 110.00 1,506.85 110.00 1,500.32 110.00 1,493.78 $416,000 $416,500 110.00 1,534.86 110.00 1,528.33 110.00 1,521.79 110.00 1,515.26 110.00 1,508.73 110.00 1,502.19 110.00 1,495.66 $416,500 $417,000 110.00 1,536.73 110.00 1,530.20 110.00 1,523.67 110.00 1,517.13 110.00 1,510.60 110.00 1,504.07 110.00 1,497.53 $417,000 $417,500 110.00 1,538.61 110.00 1,532.08 110.00 1,525.54 110.00 1,519.01 110.00 1,512.48 110.00 1,505.94 110.00 1,499.41 $417,500 $418,000 110.00 1,540.48 110.00 1,533.95 110.00 1,527.42 110.00 1,520.88 110.00 1,514.35 110.00 1,507.82 110.00 1,501.28 $418,000 $418,500 110.00 1,542.36 110.00 1,535.83 110.00 1,529.29 110.00 1,522.76 110.00 1,516.23 110.00 1,509.69 110.00 1,503.16 $418,500 $419,000 110.00 1,544.23 110.00 1,537.70 110.00 1,531.17 110.00 1,524.63 110.00 1,518.10 110.00 1,511.57 110.00 1,505.03 $419,000 $419,500 110.00 1,546.11 110.00 1,539.58 110.00 1,533.04 110.00 1,526.51 110.00 1,519.98 110.00 1,513.44 110.00 1,506.91 $419,500 $420,000 110.00 1,547.98 110.00 1,541.45 110.00 1,534.92 110.00 1,528.38 110.00 1,521.85 110.00 1,515.32 110.00 1,508.78 $420,000 $420,500 110.00 1,549.86 110.00 1,543.33 110.00 1,536.79 110.00 1,530.26 110.00 1,523.73 110.00 1,517.19 110.00 1,510.66 $420,500 $421,000 110.00 1,551.73 110.00 1,545.20 110.00 1,538.67 110.00 1,532.13 110.00 1,525.60 110.00 1,519.07 110.00 1,512.53 $421,000 $421,500 110.00 1,553.61 110.00 1,547.08 110.00 1,540.54 110.00 1,534.01 110.00 1,527.48 110.00 1,520.94 110.00 1,514.41 $421,500 $422,000 110.00 1,555.48 110.00 1,548.95 110.00 1,542.42 110.00 1,535.88 110.00 1,529.35 110.00 1,522.82 110.00 1,516.28 $422,000 $422,500 110.00 1,557.36 110.00 1,550.83 110.00 1,544.29 110.00 1,537.76 110.00 1,531.23 110.00 1,524.69 110.00 1,518.16 $422,500 $423,000 110.00 1,559.23 110.00 1,552.70 110.00 1,546.17 110.00 1,539.63 110.00 1,533.10 110.00 1,526.57 110.00 1,520.03 $423,000 $423,500 110.00 1,561.11 110.00 1,554.58 110.00 1,548.04 110.00 1,541.51 110.00 1,534.98 110.00 1,528.44 110.00 1,521.91 $423,500 $424,000 110.00 1,562.98 110.00 1,556.45 110.00 1,549.92 110.00 1,543.38 110.00 1,536.85 110.00 1,530.32 110.00 1,523.78 $424,000 $424,500 110.00 1,564.86 110.00 1,558.33 110.00 1,551.79 110.00 1,545.26 110.00 1,538.73 110.00 1,532.19 110.00 1,525.66 $424,500 $425,000 110.00 1,566.73 110.00 1,560.20 110.00 1,553.67 110.00 1,547.13 110.00 1,540.60 110.00 1,534.07 110.00 1,527.53 $425,000 $425,500 110.00 1,568.61 110.00 1,562.08 110.00 1,555.54 110.00 1,549.01 110.00 1,542.48 110.00 1,535.94 110.00 1,529.41 $425,500 $426,000 110.00 1,570.48 110.00 1,563.95 110.00 1,557.42 110.00 1,550.88 110.00 1,544.35 110.00 1,537.82 110.00 1,531.28 $426,000 $426,500 110.00 1,572.36 110.00 1,565.83 110.00 1,559.29 110.00 1,552.76 110.00 1,546.23 110.00 1,539.69 110.00 1,533.16 $426,500 $427,000 110.00 1,574.23 110.00 1,567.70 110.00 1,561.17 110.00 1,554.63 110.00 1,548.10 110.00 1,541.57 110.00 1,535.03 $427,000 $427,500 110.00 1,576.11 110.00 1,569.58 110.00 1,563.04 110.00 1,556.51 110.00 1,549.98 110.00 1,543.44 110.00 1,536.91 $427,500 $428,000 110.00 1,577.98 110.00 1,571.45 110.00 1,564.92 110.00 1,558.38 110.00 1,551.85 110.00 1,545.32 110.00 1,538.78 $428,000 $428,500 110.00 1,579.86 110.00 1,573.33 110.00 1,566.79 110.00 1,560.26 110.00 1,553.73 110.00 1,547.19 110.00 1,540.66 $428,500 $429,000 110.00 1,581.73 110.00 1,575.20 110.00 1,568.67 110.00 1,562.13 110.00 1,555.60 110.00 1,549.07 110.00 1,542.53 $429,000 $429,500 110.00 1,583.61 110.00 1,577.08 110.00 1,570.54 110.00 1,564.01 110.00 1,557.48 110.00 1,550.94 110.00 1,544.41 $429,500 $430,000 110.00 1,585.48 110.00 1,578.95 110.00 1,572.42 110.00 1,565.88 110.00 1,559.35 110.00 1,552.82 110.00 1,546.28 $430,000 $430,500 110.00 1,587.36 110.00 1,580.83 110.00 1,574.29 110.00 1,567.76 110.00 1,561.23 110.00 1,554.69 110.00 1,548.16 $430,500 $431,000 110.00 1,589.23 110.00 1,582.70 110.00 1,576.17 110.00 1,569.63 110.00 1,563.10 110.00 1,556.57 110.00 1,550.03 $431,000 $431,500 110.00 1,591.11 110.00 1,584.58 110.00 1,578.04 110.00 1,571.51 110.00 1,564.98 110.00 1,558.44 110.00 1,551.91 $431,500 $432,000 110.00 1,592.98 110.00 1,586.45 110.00 1,579.92 110.00 1,573.38 110.00 1,566.85 110.00 1,560.32 110.00 1,553.78 $432,000 $432,500 110.00 1,594.86 110.00 1,588.33 110.00 1,581.79 110.00 1,575.26 110.00 1,568.73 110.00 1,562.19 110.00 1,555.66 $432,500 $433,000 110.00 1,596.73 110.00 1,590.20 110.00 1,583.67 110.00 1,577.13 110.00 1,570.60 110.00 1,564.07 110.00 1,557.53 $433,000 $433,500 110.00 1,598.61 110.00 1,592.08 110.00 1,585.54 110.00 1,579.01 110.00 1,572.48 110.00 1,565.94 110.00 1,559.41 $433,500 $434,000 110.00 1,600.48 110.00 1,593.95 110.00 1,587.42 110.00 1,580.88 110.00 1,574.35 110.00 1,567.82 110.00 1,561.28 $434,000 $434,500 110.00 1,602.36 110.00 1,595.83 110.00 1,589.29 110.00 1,582.76 110.00 1,576.23 110.00 1,569.69 110.00 1,563.16 $434,500 $435,000 110.00 1,604.23 110.00 1,597.70 110.00 1,591.17 110.00 1,584.63 110.00 1,578.10 110.00 1,571.57 110.00 1,565.03 $435,000 $435,500 110.00 1,606.11 110.00 1,599.58 110.00 1,593.04 110.00 1,586.51 110.00 1,579.98 110.00 1,573.44 110.00 1,566.91 $435,500 $436,000 110.00 1,607.98 110.00 1,601.45 110.00 1,594.92 110.00 1,588.38 110.00 1,581.85 110.00 1,575.32 110.00 1,568.78 $436,000 $436,500 110.00 1,609.86 110.00 1,603.33 110.00 1,596.79 110.00 1,590.26 110.00 1,583.73 110.00 1,577.19 110.00 1,570.66 $436,500 $437,000 110.00 1,611.73 110.00 1,605.20 110.00 1,598.67 110.00 1,592.13 110.00 1,585.60 110.00 1,579.07 110.00 1,572.53 $437,000 $437,500 110.00 1,613.61 110.00 1,607.08 110.00 1,600.54 110.00 1,594.01 110.00 1,587.48 110.00 1,580.94 110.00 1,574.41 $437,500 $438,000 110.00 1,615.48 110.00 1,608.95 110.00 1,602.42 110.00 1,595.88 110.00 1,589.35 110.00 1,582.82 110.00 1,576.28 $438,000 $438,500 110.00 1,617.36 110.00 1,610.83 110.00 1,604.29 110.00 1,597.76 110.00 1,591.23 110.00 1,584.69 110.00 1,578.16 $438,500 $439,000 110.00 1,619.23 110.00 1,612.70 110.00 1,606.17 110.00 1,599.63 110.00 1,593.10 110.00 1,586.57 110.00 1,580.03 $439,000 $439,500 110.00 1,621.11 110.00 1,614.58 110.00 1,608.04 110.00 1,601.51 110.00 1,594.98 110.00 1,588.44 110.00 1,581.91 $439,500 $440,000 110.00 1,622.98 110.00 1,616.45 110.00 1,609.92 110.00 1,603.38 110.00 1,596.85 110.00 1,590.32 110.00 1,583.78 $440,000 $440,500 110.00 1,624.86 110.00 1,618.33 110.00 1,611.79 110.00 1,605.26 110.00 1,598.73 110.00 1,592.19 110.00 1,585.66 $440,500 $441,000 110.00 1,626.73 110.00 1,620.20 110.00 1,613.67 110.00 1,607.13 110.00 1,600.60 110.00 1,594.07 110.00 1,587.53 $441,000 $441,500 110.00 1,628.61 110.00 1,622.08 110.00 1,615.54 110.00 1,609.01 110.00 1,602.48 110.00 1,595.94 110.00 1,589.41 $441,500 $442,000 110.00 1,630.48 110.00 1,623.95 110.00 1,617.42 110.00 1,610.88 110.00 1,604.35 110.00 1,597.82 110.00 1,591.28 $442,000 $442,500 110.00 1,632.36 110.00 1,625.83 110.00 1,619.29 110.00 1,612.76 110.00 1,606.23 110.00 1,599.69 110.00 1,593.16 $442,500 $443,000 110.00 1,634.23 110.00 1,627.70 110.00 1,621.17 110.00 1,614.63 110.00 1,608.10 110.00 1,601.57 110.00 1,595.03 $443,000 $443,500 110.00 1,636.11 110.00 1,629.58 110.00 1,623.04 110.00 1,616.51 110.00 1,609.98 110.00 1,603.44 110.00 1,596.91 $443,500 $444,000 110.00 1,637.98 110.00 1,631.45 110.00 1,624.92 110.00 1,618.38 110.00 1,611.85 110.00 1,605.32 110.00 1,598.78 $444,000 $444,500 110.00 1,639.86 110.00 1,633.33 110.00 1,626.79 110.00 1,620.26 110.00 1,613.73 110.00 1,607.19 110.00 1,600.66 $444,500 $445,000 110.00 1,641.73 110.00 1,635.20 110.00 1,628.67 110.00 1,622.13 110.00 1,615.60 110.00 1,609.07 110.00 1,602.53 $445,000 $445,500 110.00 1,643.61 110.00 1,637.08 110.00 1,630.54 110.00 1,624.01 110.00 1,617.48 110.00 1,610.94 110.00 1,604.41 $445,500 $446,000 110.00 1,645.48 110.00 1,638.95 110.00 1,632.42 110.00 1,625.88 110.00 1,619.35 110.00 1,612.82 110.00 1,606.28 $446,000 $446,500 110.00 1,647.36 110.00 1,640.83 110.00 1,634.29 110.00 1,627.76 110.00 1,621.23 110.00 1,614.69 110.00 1,608.16 $446,500 $447,000 110.00 1,649.23 110.00 1,642.70 110.00 1,636.17 110.00 1,629.63 110.00 1,623.10 110.00 1,616.57 110.00 1,610.03 $447,000 $447,500 110.00 1,651.11 110.00 1,644.58 110.00 1,638.04 110.00 1,631.51 110.00 1,624.98 110.00 1,618.44 110.00 1,611.91 $447,500 $448,000 110.00 1,652.98 110.00 1,646.45 110.00 1,639.92 110.00 1,633.38 110.00 1,626.85 110.00 1,620.32 110.00 1,613.78 $448,000 $448,500 110.00 1,654.86 110.00 1,648.33 110.00 1,641.79 110.00 1,635.26 110.00 1,628.73 110.00 1,622.19 110.00 1,615.66 $448,500 $449,000 110.00 1,656.73 110.00 1,650.20 110.00 1,643.67 110.00 1,637.13 110.00 1,630.60 110.00 1,624.07 110.00 1,617.53 $449,000 $449,500 110.00 1,658.61 110.00 1,652.08 110.00 1,645.54 110.00 1,639.01 110.00 1,632.48 110.00 1,625.94 110.00 1,619.41 $449,500 $450,000 110.00 1,660.48 110.00 1,653.95 110.00 1,647.42 110.00 1,640.88 110.00 1,634.35 110.00 1,627.82 110.00 1,621.28 $450,000 $450,500 110.00 1,662.36 110.00 1,655.83 110.00 1,649.29 110.00 1,642.76 110.00 1,636.23 110.00 1,629.69 110.00 1,623.16 $450,500 $451,000 110.00 1,664.23 110.00 1,657.70 110.00 1,651.17 110.00 1,644.63 110.00 1,638.10 110.00 1,631.57 110.00 1,625.03 $451,000 $451,500 110.00 1,666.11 110.00 1,659.58 110.00 1,653.04 110.00 1,646.51 110.00 1,639.98 110.00 1,633.44 110.00 1,626.91 $451,500 $452,000 110.00 1,667.98 110.00 1,661.45 110.00 1,654.92 110.00 1,648.38 110.00 1,641.85 110.00 1,635.32 110.00 1,628.78 $452,000 $452,500 110.00 1,669.86 110.00 1,663.33 110.00 1,656.79 110.00 1,650.26 110.00 1,643.73 110.00 1,637.19 110.00 1,630.66 $452,500 $453,000 110.00 1,671.73 110.00 1,665.20 110.00 1,658.67 110.00 1,652.13 110.00 1,645.60 110.00 1,639.07 110.00 1,632.53 $453,000 $453,500 110.00 1,673.61 110.00 1,667.08 110.00 1,660.54 110.00 1,654.01 110.00 1,647.48 110.00 1,640.94 110.00 1,634.41 $453,500 $454,000 110.00 1,675.48 110.00 1,668.95 110.00 1,662.42 110.00 1,655.88 110.00 1,649.35 110.00 1,642.82 110.00 1,636.28 $454,000 $454,500 110.00 1,677.36 110.00 1,670.83 110.00 1,664.29 110.00 1,657.76 110.00 1,651.23 110.00 1,644.69 110.00 1,638.16 $454,500 $455,000 110.00 1,679.23 110.00 1,672.70 110.00 1,666.17 110.00 1,659.63 110.00 1,653.10 110.00 1,646.57 110.00 1,640.03 $455,000 $455,500 110.00 1,681.11 110.00 1,674.58 110.00 1,668.04 110.00 1,661.51 110.00 1,654.98 110.00 1,648.44 110.00 1,641.91 $455,500 $456,000 110.00 1,682.98 110.00 1,676.45 110.00 1,669.92 110.00 1,663.38 110.00 1,656.85 110.00 1,650.32 110.00 1,643.78 $456,000 $456,500 110.00 1,684.86 110.00 1,678.33 110.00 1,671.79 110.00 1,665.26 110.00 1,658.73 110.00 1,652.19 110.00 1,645.66 $456,500 $457,000 110.00 1,686.73 110.00 1,680.20 110.00 1,673.67 110.00 1,667.13 110.00 1,660.60 110.00 1,654.07 110.00 1,647.53 $457,000 $457,500 110.00 1,688.61 110.00 1,682.08 110.00 1,675.54 110.00 1,669.01 110.00 1,662.48 110.00 1,655.94 110.00 1,649.41 $457,500 $458,000 110.00 1,690.48 110.00 1,683.95 110.00 1,677.42 110.00 1,670.88 110.00 1,664.35 110.00 1,657.82 110.00 1,651.28 $458,000 $458,500 110.00 1,692.36 110.00 1,685.83 110.00 1,679.29 110.00 1,672.76 110.00 1,666.23 110.00 1,659.69 110.00 1,653.16 $458,500 $459,000 110.00 1,694.23 110.00 1,687.70 110.00 1,681.17 110.00 1,674.63 110.00 1,668.10 110.00 1,661.57 110.00 1,655.03

NJEIS Family Cost Participation Table Page 12 of 12 Effective July 1, 2015

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

$459,000 $459,500 110.00 1,696.11 110.00 1,689.58 110.00 1,683.04 110.00 1,676.51 110.00 1,669.98 110.00 1,663.44 110.00 1,656.91 $459,500 $460,000 110.00 1,697.98 110.00 1,691.45 110.00 1,684.92 110.00 1,678.38 110.00 1,671.85 110.00 1,665.32 110.00 1,658.78 $460,000 $460,500 110.00 1,699.86 110.00 1,693.33 110.00 1,686.79 110.00 1,680.26 110.00 1,673.73 110.00 1,667.19 110.00 1,660.66 $460,500 $461,000 110.00 1,701.73 110.00 1,695.20 110.00 1,688.67 110.00 1,682.13 110.00 1,675.60 110.00 1,669.07 110.00 1,662.53 $461,000 $461,500 110.00 1,703.61 110.00 1,697.08 110.00 1,690.54 110.00 1,684.01 110.00 1,677.48 110.00 1,670.94 110.00 1,664.41 $461,500 $462,000 110.00 1,705.48 110.00 1,698.95 110.00 1,692.42 110.00 1,685.88 110.00 1,679.35 110.00 1,672.82 110.00 1,666.28 $462,000 $462,500 110.00 1,707.36 110.00 1,700.83 110.00 1,694.29 110.00 1,687.76 110.00 1,681.23 110.00 1,674.69 110.00 1,668.16 $462,500 $463,000 110.00 1,709.23 110.00 1,702.70 110.00 1,696.17 110.00 1,689.63 110.00 1,683.10 110.00 1,676.57 110.00 1,670.03 $463,000 $463,500 110.00 1,711.11 110.00 1,704.58 110.00 1,698.04 110.00 1,691.51 110.00 1,684.98 110.00 1,678.44 110.00 1,671.91 $463,500 $464,000 110.00 1,712.98 110.00 1,706.45 110.00 1,699.92 110.00 1,693.38 110.00 1,686.85 110.00 1,680.32 110.00 1,673.78 $464,000 $464,500 110.00 1,714.86 110.00 1,708.33 110.00 1,701.79 110.00 1,695.26 110.00 1,688.73 110.00 1,682.19 110.00 1,675.66 $464,500 $465,000 110.00 1,716.73 110.00 1,710.20 110.00 1,703.67 110.00 1,697.13 110.00 1,690.60 110.00 1,684.07 110.00 1,677.53 $465,000 $465,500 110.00 1,718.61 110.00 1,712.08 110.00 1,705.54 110.00 1,699.01 110.00 1,692.48 110.00 1,685.94 110.00 1,679.41 $465,500 $466,000 110.00 1,720.48 110.00 1,713.95 110.00 1,707.42 110.00 1,700.88 110.00 1,694.35 110.00 1,687.82 110.00 1,681.28 $466,000 $466,500 110.00 1,722.36 110.00 1,715.83 110.00 1,709.29 110.00 1,702.76 110.00 1,696.23 110.00 1,689.69 110.00 1,683.16 $466,500 $467,000 110.00 1,724.23 110.00 1,717.70 110.00 1,711.17 110.00 1,704.63 110.00 1,698.10 110.00 1,691.57 110.00 1,685.03 $467,000 $467,500 110.00 1,726.11 110.00 1,719.58 110.00 1,713.04 110.00 1,706.51 110.00 1,699.98 110.00 1,693.44 110.00 1,686.91 $467,500 $468,000 110.00 1,727.98 110.00 1,721.45 110.00 1,714.92 110.00 1,708.38 110.00 1,701.85 110.00 1,695.32 110.00 1,688.78 $468,000 $468,500 110.00 1,729.86 110.00 1,723.33 110.00 1,716.79 110.00 1,710.26 110.00 1,703.73 110.00 1,697.19 110.00 1,690.66 $468,500 $469,000 110.00 1,731.73 110.00 1,725.20 110.00 1,718.67 110.00 1,712.13 110.00 1,705.60 110.00 1,699.07 110.00 1,692.53 $469,000 $469,500 110.00 1,733.61 110.00 1,727.08 110.00 1,720.54 110.00 1,714.01 110.00 1,707.48 110.00 1,700.94 110.00 1,694.41 $469,500 $470,000 110.00 1,735.48 110.00 1,728.95 110.00 1,722.42 110.00 1,715.88 110.00 1,709.35 110.00 1,702.82 110.00 1,696.28 $470,000 $470,500 110.00 1,737.36 110.00 1,730.83 110.00 1,724.29 110.00 1,717.76 110.00 1,711.23 110.00 1,704.69 110.00 1,698.16 $470,500 $471,000 110.00 1,739.23 110.00 1,732.70 110.00 1,726.17 110.00 1,719.63 110.00 1,713.10 110.00 1,706.57 110.00 1,700.03 $471,000 $471,500 110.00 1,741.11 110.00 1,734.58 110.00 1,728.04 110.00 1,721.51 110.00 1,714.98 110.00 1,708.44 110.00 1,701.91 $471,500 $472,000 110.00 1,742.98 110.00 1,736.45 110.00 1,729.92 110.00 1,723.38 110.00 1,716.85 110.00 1,710.32 110.00 1,703.78 $472,000 $472,500 110.00 1,744.86 110.00 1,738.33 110.00 1,731.79 110.00 1,725.26 110.00 1,718.73 110.00 1,712.19 110.00 1,705.66 $472,500 $473,000 110.00 1,746.73 110.00 1,740.20 110.00 1,733.67 110.00 1,727.13 110.00 1,720.60 110.00 1,714.07 110.00 1,707.53 $473,000 $473,500 110.00 1,748.61 110.00 1,742.08 110.00 1,735.54 110.00 1,729.01 110.00 1,722.48 110.00 1,715.94 110.00 1,709.41 $473,500 $474,000 110.00 1,750.48 110.00 1,743.95 110.00 1,737.42 110.00 1,730.88 110.00 1,724.35 110.00 1,717.82 110.00 1,711.28 $474,000 $474,500 110.00 1,752.36 110.00 1,745.83 110.00 1,739.29 110.00 1,732.76 110.00 1,726.23 110.00 1,719.69 110.00 1,713.16 $474,500 $475,000 110.00 1,754.23 110.00 1,747.70 110.00 1,741.17 110.00 1,734.63 110.00 1,728.10 110.00 1,721.57 110.00 1,715.03 $475,000 $475,500 110.00 1,756.11 110.00 1,749.58 110.00 1,743.04 110.00 1,736.51 110.00 1,729.98 110.00 1,723.44 110.00 1,716.91 $475,500 $476,000 110.00 1,757.98 110.00 1,751.45 110.00 1,744.92 110.00 1,738.38 110.00 1,731.85 110.00 1,725.32 110.00 1,718.78 $476,000 $476,500 110.00 1,759.86 110.00 1,753.33 110.00 1,746.79 110.00 1,740.26 110.00 1,733.73 110.00 1,727.19 110.00 1,720.66 $476,500 $477,000 110.00 1,761.73 110.00 1,755.20 110.00 1,748.67 110.00 1,742.13 110.00 1,735.60 110.00 1,729.07 110.00 1,722.53 $477,000 $477,500 110.00 1,763.61 110.00 1,757.08 110.00 1,750.54 110.00 1,744.01 110.00 1,737.48 110.00 1,730.94 110.00 1,724.41 $477,500 $478,000 110.00 1,765.48 110.00 1,758.95 110.00 1,752.42 110.00 1,745.88 110.00 1,739.35 110.00 1,732.82 110.00 1,726.28 $478,000 $478,500 110.00 1,767.36 110.00 1,760.83 110.00 1,754.29 110.00 1,747.76 110.00 1,741.23 110.00 1,734.69 110.00 1,728.16 $478,500 $479,000 110.00 1,769.23 110.00 1,762.70 110.00 1,756.17 110.00 1,749.63 110.00 1,743.10 110.00 1,736.57 110.00 1,730.03 $479,000 $479,500 110.00 1,771.11 110.00 1,764.58 110.00 1,758.04 110.00 1,751.51 110.00 1,744.98 110.00 1,738.44 110.00 1,731.91 $479,500 $480,000 110.00 1,772.98 110.00 1,766.45 110.00 1,759.92 110.00 1,753.38 110.00 1,746.85 110.00 1,740.32 110.00 1,733.78 $480,000 $480,500 110.00 1,774.86 110.00 1,768.33 110.00 1,761.79 110.00 1,755.26 110.00 1,748.73 110.00 1,742.19 110.00 1,735.66 $480,500 $481,000 110.00 1,776.73 110.00 1,770.20 110.00 1,763.67 110.00 1,757.13 110.00 1,750.60 110.00 1,744.07 110.00 1,737.53 $481,000 $481,500 110.00 1,778.61 110.00 1,772.08 110.00 1,765.54 110.00 1,759.01 110.00 1,752.48 110.00 1,745.94 110.00 1,739.41 $481,500 $482,000 110.00 1,780.48 110.00 1,773.95 110.00 1,767.42 110.00 1,760.88 110.00 1,754.35 110.00 1,747.82 110.00 1,741.28 $482,000 $482,500 110.00 1,782.36 110.00 1,775.83 110.00 1,769.29 110.00 1,762.76 110.00 1,756.23 110.00 1,749.69 110.00 1,743.16 $482,500 $483,000 110.00 1,784.23 110.00 1,777.70 110.00 1,771.17 110.00 1,764.63 110.00 1,758.10 110.00 1,751.57 110.00 1,745.03 $483,000 $483,500 110.00 1,786.11 110.00 1,779.58 110.00 1,773.04 110.00 1,766.51 110.00 1,759.98 110.00 1,753.44 110.00 1,746.91 $483,500 $484,000 110.00 1,787.98 110.00 1,781.45 110.00 1,774.92 110.00 1,768.38 110.00 1,761.85 110.00 1,755.32 110.00 1,748.78 $484,000 $484,500 110.00 1,789.86 110.00 1,783.33 110.00 1,776.79 110.00 1,770.26 110.00 1,763.73 110.00 1,757.19 110.00 1,750.66 $484,500 $485,000 110.00 1,791.73 110.00 1,785.20 110.00 1,778.67 110.00 1,772.13 110.00 1,765.60 110.00 1,759.07 110.00 1,752.53 $485,000 $485,500 110.00 1,793.61 110.00 1,787.08 110.00 1,780.54 110.00 1,774.01 110.00 1,767.48 110.00 1,760.94 110.00 1,754.41 $485,500 $486,000 110.00 1,795.48 110.00 1,788.95 110.00 1,782.42 110.00 1,775.88 110.00 1,769.35 110.00 1,762.82 110.00 1,756.28 $486,000 $486,500 110.00 1,797.36 110.00 1,790.83 110.00 1,784.29 110.00 1,777.76 110.00 1,771.23 110.00 1,764.69 110.00 1,758.16 $486,500 $487,000 110.00 1,799.23 110.00 1,792.70 110.00 1,786.17 110.00 1,779.63 110.00 1,773.10 110.00 1,766.57 110.00 1,760.03 $487,000 $487,500 110.00 1,801.11 110.00 1,794.58 110.00 1,788.04 110.00 1,781.51 110.00 1,774.98 110.00 1,768.44 110.00 1,761.91 $487,500 $488,000 110.00 1,802.98 110.00 1,796.45 110.00 1,789.92 110.00 1,783.38 110.00 1,776.85 110.00 1,770.32 110.00 1,763.78 $488,000 $488,500 110.00 1,804.86 110.00 1,798.33 110.00 1,791.79 110.00 1,785.26 110.00 1,778.73 110.00 1,772.19 110.00 1,765.66 $488,500 $489,000 110.00 1,806.73 110.00 1,800.20 110.00 1,793.67 110.00 1,787.13 110.00 1,780.60 110.00 1,774.07 110.00 1,767.53 $489,000 $489,500 110.00 1,808.61 110.00 1,802.08 110.00 1,795.54 110.00 1,789.01 110.00 1,782.48 110.00 1,775.94 110.00 1,769.41 $489,500 $490,000 110.00 1,810.48 110.00 1,803.95 110.00 1,797.42 110.00 1,790.88 110.00 1,784.35 110.00 1,777.82 110.00 1,771.28 $490,000 $490,500 110.00 1,812.36 110.00 1,805.83 110.00 1,799.29 110.00 1,792.76 110.00 1,786.23 110.00 1,779.69 110.00 1,773.16 $490,500 $491,000 110.00 1,814.23 110.00 1,807.70 110.00 1,801.17 110.00 1,794.63 110.00 1,788.10 110.00 1,781.57 110.00 1,775.03 $491,000 $491,500 110.00 1,816.11 110.00 1,809.58 110.00 1,803.04 110.00 1,796.51 110.00 1,789.98 110.00 1,783.44 110.00 1,776.91 $491,500 $492,000 110.00 1,817.98 110.00 1,811.45 110.00 1,804.92 110.00 1,798.38 110.00 1,791.85 110.00 1,785.32 110.00 1,778.78 $492,000 $492,500 110.00 1,819.86 110.00 1,813.33 110.00 1,806.79 110.00 1,800.26 110.00 1,793.73 110.00 1,787.19 110.00 1,780.66 $492,500 $493,000 110.00 1,821.73 110.00 1,815.20 110.00 1,808.67 110.00 1,802.13 110.00 1,795.60 110.00 1,789.07 110.00 1,782.53 $493,000 $493,500 110.00 1,823.61 110.00 1,817.08 110.00 1,810.54 110.00 1,804.01 110.00 1,797.48 110.00 1,790.94 110.00 1,784.41 $493,500 $494,000 110.00 1,825.48 110.00 1,818.95 110.00 1,812.42 110.00 1,805.88 110.00 1,799.35 110.00 1,792.82 110.00 1,786.28 $494,000 $494,500 110.00 1,827.36 110.00 1,820.83 110.00 1,814.29 110.00 1,807.76 110.00 1,801.23 110.00 1,794.69 110.00 1,788.16 $494,500 $495,000 110.00 1,829.23 110.00 1,822.70 110.00 1,816.17 110.00 1,809.63 110.00 1,803.10 110.00 1,796.57 110.00 1,790.03 $495,000 $495,500 110.00 1,831.11 110.00 1,824.58 110.00 1,818.04 110.00 1,811.51 110.00 1,804.98 110.00 1,798.44 110.00 1,791.91 $495,500 $496,000 110.00 1,832.98 110.00 1,826.45 110.00 1,819.92 110.00 1,813.38 110.00 1,806.85 110.00 1,800.32 110.00 1,793.78 $496,000 $496,500 110.00 1,834.86 110.00 1,828.33 110.00 1,821.79 110.00 1,815.26 110.00 1,808.73 110.00 1,802.19 110.00 1,795.66 $496,500 $497,000 110.00 1,836.73 110.00 1,830.20 110.00 1,823.67 110.00 1,817.13 110.00 1,810.60 110.00 1,804.07 110.00 1,797.53 $497,000 $497,500 110.00 1,838.61 110.00 1,832.08 110.00 1,825.54 110.00 1,819.01 110.00 1,812.48 110.00 1,805.94 110.00 1,799.41 $497,500 $498,000 110.00 1,840.48 110.00 1,833.95 110.00 1,827.42 110.00 1,820.88 110.00 1,814.35 110.00 1,807.82 110.00 1,801.28 $498,000 $498,500 110.00 1,842.36 110.00 1,835.83 110.00 1,829.29 110.00 1,822.76 110.00 1,816.23 110.00 1,809.69 110.00 1,803.16 $498,500 $499,000 110.00 1,844.23 110.00 1,837.70 110.00 1,831.17 110.00 1,824.63 110.00 1,818.10 110.00 1,811.57 110.00 1,805.03 $499,000 $499,500 110.00 1,846.11 110.00 1,839.58 110.00 1,833.04 110.00 1,826.51 110.00 1,819.98 110.00 1,813.44 110.00 1,806.91 $499,500 $500,000 110.00 1,847.98 110.00 1,841.45 110.00 1,834.92 110.00 1,828.38 110.00 1,821.85 110.00 1,815.32 110.00 1,808.78 $500,000 $500,500 110.00 1,849.86 110.00 1,843.33 110.00 1,836.79 110.00 1,830.26 110.00 1,823.73 110.00 1,817.19 110.00 1,810.66 $500,500 $501,000 110.00 1,851.73 110.00 1,845.20 110.00 1,838.67 110.00 1,832.13 110.00 1,825.60 110.00 1,819.07 110.00 1,812.53 $501,000 $501,500 110.00 1,853.61 110.00 1,847.08 110.00 1,840.54 110.00 1,834.01 110.00 1,827.48 110.00 1,820.94 110.00 1,814.41 $501,500 $502,000 110.00 1,855.48 110.00 1,848.95 110.00 1,842.42 110.00 1,835.88 110.00 1,829.35 110.00 1,822.82 110.00 1,816.28 $502,000 $502,500 110.00 1,857.36 110.00 1,850.83 110.00 1,844.29 110.00 1,837.76 110.00 1,831.23 110.00 1,824.69 110.00 1,818.16 $502,500 $503,000 110.00 1,859.23 110.00 1,852.70 110.00 1,846.17 110.00 1,839.63 110.00 1,833.10 110.00 1,826.57 110.00 1,820.03 $503,000 $503,500 110.00 1,861.11 110.00 1,854.58 110.00 1,848.04 110.00 1,841.51 110.00 1,834.98 110.00 1,828.44 110.00 1,821.91 $503,500 $504,000 110.00 1,862.98 110.00 1,856.45 110.00 1,849.92 110.00 1,843.38 110.00 1,836.85 110.00 1,830.32 110.00 1,823.78 $504,000 $504,500 110.00 1,864.86 110.00 1,858.33 110.00 1,851.79 110.00 1,845.26 110.00 1,838.73 110.00 1,832.19 110.00 1,825.66 $504,500 $505,000 110.00 1,866.73 110.00 1,860.20 110.00 1,853.67 110.00 1,847.13 110.00 1,840.60 110.00 1,834.07 110.00 1,827.53 $505,000 $505,500 110.00 1,868.61 110.00 1,862.08 110.00 1,855.54 110.00 1,849.01 110.00 1,842.48 110.00 1,835.94 110.00 1,829.41 $505,500 $506,000 110.00 1,870.48 110.00 1,863.95 110.00 1,857.42 110.00 1,850.88 110.00 1,844.35 110.00 1,837.82 110.00 1,831.28 $506,000 $506,500 110.00 1,872.36 110.00 1,865.83 110.00 1,859.29 110.00 1,852.76 110.00 1,846.23 110.00 1,839.69 110.00 1,833.16 $506,500 $507,000 110.00 1,874.23 110.00 1,867.70 110.00 1,861.17 110.00 1,854.63 110.00 1,848.10 110.00 1,841.57 110.00 1,835.03 $507,000 $507,500 110.00 1,876.11 110.00 1,869.58 110.00 1,863.04 110.00 1,856.51 110.00 1,849.98 110.00 1,843.44 110.00 1,836.91 $507,500 $508,000 110.00 1,877.98 110.00 1,871.45 110.00 1,864.92 110.00 1,858.38 110.00 1,851.85 110.00 1,845.32 110.00 1,838.78 $508,000 $508,500 110.00 1,879.86 110.00 1,873.33 110.00 1,866.79 110.00 1,860.26 110.00 1,853.73 110.00 1,847.19 110.00 1,840.66 $508,500 $509,000 110.00 1,881.73 110.00 1,875.20 110.00 1,868.67 110.00 1,862.13 110.00 1,855.60 110.00 1,849.07 110.00 1,842.53 $509,000 $509,500 110.00 1,883.61 110.00 1,877.08 110.00 1,870.54 110.00 1,864.01 110.00 1,857.48 110.00 1,850.94 110.00 1,844.41 $509,500 $510,000 110.00 1,885.48 110.00 1,878.95 110.00 1,872.42 110.00 1,865.88 110.00 1,859.35 110.00 1,852.82 110.00 1,846.28

NJEIS Family Cost Participation Table Page 13 of 12 Effective July 1, 2015

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

$510,000 $510,500 110.00 1,887.36 110.00 1,880.83 110.00 1,874.29 110.00 1,867.76 110.00 1,861.23 110.00 1,854.69 110.00 1,848.16 $510,500 $511,000 110.00 1,889.23 110.00 1,882.70 110.00 1,876.17 110.00 1,869.63 110.00 1,863.10 110.00 1,856.57 110.00 1,850.03 $511,000 $511,500 110.00 1,891.11 110.00 1,884.58 110.00 1,878.04 110.00 1,871.51 110.00 1,864.98 110.00 1,858.44 110.00 1,851.91 $511,500 $512,000 110.00 1,892.98 110.00 1,886.45 110.00 1,879.92 110.00 1,873.38 110.00 1,866.85 110.00 1,860.32 110.00 1,853.78 $512,000 $512,500 110.00 1,894.86 110.00 1,888.33 110.00 1,881.79 110.00 1,875.26 110.00 1,868.73 110.00 1,862.19 110.00 1,855.66 $512,500 $513,000 110.00 1,896.73 110.00 1,890.20 110.00 1,883.67 110.00 1,877.13 110.00 1,870.60 110.00 1,864.07 110.00 1,857.53 $513,000 $513,500 110.00 1,898.61 110.00 1,892.08 110.00 1,885.54 110.00 1,879.01 110.00 1,872.48 110.00 1,865.94 110.00 1,859.41 $513,500 $514,000 110.00 1,900.48 110.00 1,893.95 110.00 1,887.42 110.00 1,880.88 110.00 1,874.35 110.00 1,867.82 110.00 1,861.28 $514,000 $514,500 110.00 1,902.36 110.00 1,895.83 110.00 1,889.29 110.00 1,882.76 110.00 1,876.23 110.00 1,869.69 110.00 1,863.16 $514,500 $515,000 110.00 1,904.23 110.00 1,897.70 110.00 1,891.17 110.00 1,884.63 110.00 1,878.10 110.00 1,871.57 110.00 1,865.03 $515,000 $515,500 110.00 1,906.11 110.00 1,899.58 110.00 1,893.04 110.00 1,886.51 110.00 1,879.98 110.00 1,873.44 110.00 1,866.91 $515,500 $516,000 110.00 1,907.98 110.00 1,901.45 110.00 1,894.92 110.00 1,888.38 110.00 1,881.85 110.00 1,875.32 110.00 1,868.78 $516,000 $516,500 110.00 1,909.86 110.00 1,903.33 110.00 1,896.79 110.00 1,890.26 110.00 1,883.73 110.00 1,877.19 110.00 1,870.66 $516,500 $517,000 110.00 1,911.73 110.00 1,905.20 110.00 1,898.67 110.00 1,892.13 110.00 1,885.60 110.00 1,879.07 110.00 1,872.53 $517,000 $517,500 110.00 1,913.61 110.00 1,907.08 110.00 1,900.54 110.00 1,894.01 110.00 1,887.48 110.00 1,880.94 110.00 1,874.41 $517,500 $518,000 110.00 1,915.48 110.00 1,908.95 110.00 1,902.42 110.00 1,895.88 110.00 1,889.35 110.00 1,882.82 110.00 1,876.28 $518,000 $518,500 110.00 1,917.36 110.00 1,910.83 110.00 1,904.29 110.00 1,897.76 110.00 1,891.23 110.00 1,884.69 110.00 1,878.16 $518,500 $519,000 110.00 1,919.23 110.00 1,912.70 110.00 1,906.17 110.00 1,899.63 110.00 1,893.10 110.00 1,886.57 110.00 1,880.03 $519,000 $519,500 110.00 1,921.11 110.00 1,914.58 110.00 1,908.04 110.00 1,901.51 110.00 1,894.98 110.00 1,888.44 110.00 1,881.91 $519,500 $520,000 110.00 1,922.98 110.00 1,916.45 110.00 1,909.92 110.00 1,903.38 110.00 1,896.85 110.00 1,890.32 110.00 1,883.78 $520,000 $520,500 110.00 1,924.86 110.00 1,918.33 110.00 1,911.79 110.00 1,905.26 110.00 1,898.73 110.00 1,892.19 110.00 1,885.66 $520,500 $521,000 110.00 1,926.73 110.00 1,920.20 110.00 1,913.67 110.00 1,907.13 110.00 1,900.60 110.00 1,894.07 110.00 1,887.53 $521,000 $521,500 110.00 1,928.61 110.00 1,922.08 110.00 1,915.54 110.00 1,909.01 110.00 1,902.48 110.00 1,895.94 110.00 1,889.41 $521,500 $522,000 110.00 1,930.48 110.00 1,923.95 110.00 1,917.42 110.00 1,910.88 110.00 1,904.35 110.00 1,897.82 110.00 1,891.28 $522,000 $522,500 110.00 1,932.36 110.00 1,925.83 110.00 1,919.29 110.00 1,912.76 110.00 1,906.23 110.00 1,899.69 110.00 1,893.16 $522,500 $523,000 110.00 1,934.23 110.00 1,927.70 110.00 1,921.17 110.00 1,914.63 110.00 1,908.10 110.00 1,901.57 110.00 1,895.03 $523,000 $523,500 110.00 1,936.11 110.00 1,929.58 110.00 1,923.04 110.00 1,916.51 110.00 1,909.98 110.00 1,903.44 110.00 1,896.91 $523,500 $524,000 110.00 1,937.98 110.00 1,931.45 110.00 1,924.92 110.00 1,918.38 110.00 1,911.85 110.00 1,905.32 110.00 1,898.78 $524,000 $524,500 110.00 1,939.86 110.00 1,933.33 110.00 1,926.79 110.00 1,920.26 110.00 1,913.73 110.00 1,907.19 110.00 1,900.66 $524,500 $525,000 110.00 1,941.73 110.00 1,935.20 110.00 1,928.67 110.00 1,922.13 110.00 1,915.60 110.00 1,909.07 110.00 1,902.53 $525,000 $525,500 110.00 1,943.61 110.00 1,937.08 110.00 1,930.54 110.00 1,924.01 110.00 1,917.48 110.00 1,910.94 110.00 1,904.41 $525,500 $526,000 110.00 1,945.48 110.00 1,938.95 110.00 1,932.42 110.00 1,925.88 110.00 1,919.35 110.00 1,912.82 110.00 1,906.28 $526,000 $526,500 110.00 1,947.36 110.00 1,940.83 110.00 1,934.29 110.00 1,927.76 110.00 1,921.23 110.00 1,914.69 110.00 1,908.16 $526,500 $527,000 110.00 1,949.23 110.00 1,942.70 110.00 1,936.17 110.00 1,929.63 110.00 1,923.10 110.00 1,916.57 110.00 1,910.03 $527,000 $527,500 110.00 1,951.11 110.00 1,944.58 110.00 1,938.04 110.00 1,931.51 110.00 1,924.98 110.00 1,918.44 110.00 1,911.91 $527,500 $528,000 110.00 1,952.98 110.00 1,946.45 110.00 1,939.92 110.00 1,933.38 110.00 1,926.85 110.00 1,920.32 110.00 1,913.78 $528,000 $528,500 110.00 1,954.86 110.00 1,948.33 110.00 1,941.79 110.00 1,935.26 110.00 1,928.73 110.00 1,922.19 110.00 1,915.66 $528,500 $529,000 110.00 1,956.73 110.00 1,950.20 110.00 1,943.67 110.00 1,937.13 110.00 1,930.60 110.00 1,924.07 110.00 1,917.53 $529,000 $529,500 110.00 1,958.61 110.00 1,952.08 110.00 1,945.54 110.00 1,939.01 110.00 1,932.48 110.00 1,925.94 110.00 1,919.41 $529,500 $530,000 110.00 1,960.48 110.00 1,953.95 110.00 1,947.42 110.00 1,940.88 110.00 1,934.35 110.00 1,927.82 110.00 1,921.28 $530,000 $530,500 110.00 1,962.36 110.00 1,955.83 110.00 1,949.29 110.00 1,942.76 110.00 1,936.23 110.00 1,929.69 110.00 1,923.16 $530,500 $531,000 110.00 1,964.23 110.00 1,957.70 110.00 1,951.17 110.00 1,944.63 110.00 1,938.10 110.00 1,931.57 110.00 1,925.03 $531,000 $531,500 110.00 1,966.11 110.00 1,959.58 110.00 1,953.04 110.00 1,946.51 110.00 1,939.98 110.00 1,933.44 110.00 1,926.91 $531,500 $532,000 110.00 1,967.98 110.00 1,961.45 110.00 1,954.92 110.00 1,948.38 110.00 1,941.85 110.00 1,935.32 110.00 1,928.78 $532,000 $532,500 110.00 1,969.86 110.00 1,963.33 110.00 1,956.79 110.00 1,950.26 110.00 1,943.73 110.00 1,937.19 110.00 1,930.66 $532,500 $533,000 110.00 1,971.73 110.00 1,965.20 110.00 1,958.67 110.00 1,952.13 110.00 1,945.60 110.00 1,939.07 110.00 1,932.53 $533,000 $533,500 110.00 1,973.61 110.00 1,967.08 110.00 1,960.54 110.00 1,954.01 110.00 1,947.48 110.00 1,940.94 110.00 1,934.41 $533,500 $534,000 110.00 1,975.48 110.00 1,968.95 110.00 1,962.42 110.00 1,955.88 110.00 1,949.35 110.00 1,942.82 110.00 1,936.28 $534,000 $534,500 110.00 1,977.36 110.00 1,970.83 110.00 1,964.29 110.00 1,957.76 110.00 1,951.23 110.00 1,944.69 110.00 1,938.16 $534,500 $535,000 110.00 1,979.23 110.00 1,972.70 110.00 1,966.17 110.00 1,959.63 110.00 1,953.10 110.00 1,946.57 110.00 1,940.03 $535,000 $535,500 110.00 1,981.11 110.00 1,974.58 110.00 1,968.04 110.00 1,961.51 110.00 1,954.98 110.00 1,948.44 110.00 1,941.91 $535,500 $536,000 110.00 1,982.98 110.00 1,976.45 110.00 1,969.92 110.00 1,963.38 110.00 1,956.85 110.00 1,950.32 110.00 1,943.78 $536,000 $536,500 110.00 1,984.86 110.00 1,978.33 110.00 1,971.79 110.00 1,965.26 110.00 1,958.73 110.00 1,952.19 110.00 1,945.66 $536,500 $537,000 110.00 1,986.73 110.00 1,980.20 110.00 1,973.67 110.00 1,967.13 110.00 1,960.60 110.00 1,954.07 110.00 1,947.53 $537,000 $537,500 110.00 1,988.61 110.00 1,982.08 110.00 1,975.54 110.00 1,969.01 110.00 1,962.48 110.00 1,955.94 110.00 1,949.41 $537,500 $538,000 110.00 1,990.48 110.00 1,983.95 110.00 1,977.42 110.00 1,970.88 110.00 1,964.35 110.00 1,957.82 110.00 1,951.28 $538,000 $538,500 110.00 1,992.36 110.00 1,985.83 110.00 1,979.29 110.00 1,972.76 110.00 1,966.23 110.00 1,959.69 110.00 1,953.16 $538,500 $539,000 110.00 1,994.23 110.00 1,987.70 110.00 1,981.17 110.00 1,974.63 110.00 1,968.10 110.00 1,961.57 110.00 1,955.03 $539,000 $539,500 110.00 1,996.11 110.00 1,989.58 110.00 1,983.04 110.00 1,976.51 110.00 1,969.98 110.00 1,963.44 110.00 1,956.91 $539,500 $540,000 110.00 1,997.98 110.00 1,991.45 110.00 1,984.92 110.00 1,978.38 110.00 1,971.85 110.00 1,965.32 110.00 1,958.78 $540,000 $540,500 110.00 1,999.86 110.00 1,993.33 110.00 1,986.79 110.00 1,980.26 110.00 1,973.73 110.00 1,967.19 110.00 1,960.66 $540,500 $541,000 110.00 2,001.73 110.00 1,995.20 110.00 1,988.67 110.00 1,982.13 110.00 1,975.60 110.00 1,969.07 110.00 1,962.53 $541,000 $541,500 110.00 2,003.61 110.00 1,997.08 110.00 1,990.54 110.00 1,984.01 110.00 1,977.48 110.00 1,970.94 110.00 1,964.41 $541,500 $542,000 110.00 2,005.48 110.00 1,998.95 110.00 1,992.42 110.00 1,985.88 110.00 1,979.35 110.00 1,972.82 110.00 1,966.28 $542,000 $542,500 110.00 2,007.36 110.00 2,000.83 110.00 1,994.29 110.00 1,987.76 110.00 1,981.23 110.00 1,974.69 110.00 1,968.16 $542,500 $543,000 110.00 2,009.23 110.00 2,002.70 110.00 1,996.17 110.00 1,989.63 110.00 1,983.10 110.00 1,976.57 110.00 1,970.03 $543,000 $543,500 110.00 2,011.11 110.00 2,004.58 110.00 1,998.04 110.00 1,991.51 110.00 1,984.98 110.00 1,978.44 110.00 1,971.91 $543,500 $544,000 110.00 2,012.98 110.00 2,006.45 110.00 1,999.92 110.00 1,993.38 110.00 1,986.85 110.00 1,980.32 110.00 1,973.78 $544,000 $544,500 110.00 2,014.86 110.00 2,008.33 110.00 2,001.79 110.00 1,995.26 110.00 1,988.73 110.00 1,982.19 110.00 1,975.66 $544,500 $545,000 110.00 2,016.73 110.00 2,010.20 110.00 2,003.67 110.00 1,997.13 110.00 1,990.60 110.00 1,984.07 110.00 1,977.53 $545,000 $545,500 110.00 2,018.61 110.00 2,012.08 110.00 2,005.54 110.00 1,999.01 110.00 1,992.48 110.00 1,985.94 110.00 1,979.41 $545,500 $546,000 110.00 2,020.48 110.00 2,013.95 110.00 2,007.42 110.00 2,000.88 110.00 1,994.35 110.00 1,987.82 110.00 1,981.28 $546,000 $546,500 110.00 2,022.36 110.00 2,015.83 110.00 2,009.29 110.00 2,002.76 110.00 1,996.23 110.00 1,989.69 110.00 1,983.16 $546,500 $547,000 110.00 2,024.23 110.00 2,017.70 110.00 2,011.17 110.00 2,004.63 110.00 1,998.10 110.00 1,991.57 110.00 1,985.03 $547,000 $547,500 110.00 2,026.11 110.00 2,019.58 110.00 2,013.04 110.00 2,006.51 110.00 1,999.98 110.00 1,993.44 110.00 1,986.91 $547,500 $548,000 110.00 2,027.98 110.00 2,021.45 110.00 2,014.92 110.00 2,008.38 110.00 2,001.85 110.00 1,995.32 110.00 1,988.78 $548,000 $548,500 110.00 2,029.86 110.00 2,023.33 110.00 2,016.79 110.00 2,010.26 110.00 2,003.73 110.00 1,997.19 110.00 1,990.66 $548,500 $549,000 110.00 2,031.73 110.00 2,025.20 110.00 2,018.67 110.00 2,012.13 110.00 2,005.60 110.00 1,999.07 110.00 1,992.53 $549,000 $549,500 110.00 2,033.61 110.00 2,027.08 110.00 2,020.54 110.00 2,014.01 110.00 2,007.48 110.00 2,000.94 110.00 1,994.41 $549,500 $550,000 110.00 2,035.48 110.00 2,028.95 110.00 2,022.42 110.00 2,015.88 110.00 2,009.35 110.00 2,002.82 110.00 1,996.28 $550,000 $550,500 110.00 2,037.36 110.00 2,030.83 110.00 2,024.29 110.00 2,017.76 110.00 2,011.23 110.00 2,004.69 110.00 1,998.16 $550,500 $551,000 110.00 2,039.23 110.00 2,032.70 110.00 2,026.17 110.00 2,019.63 110.00 2,013.10 110.00 2,006.57 110.00 2,000.03 $551,000 $551,500 110.00 2,041.11 110.00 2,034.58 110.00 2,028.04 110.00 2,021.51 110.00 2,014.98 110.00 2,008.44 110.00 2,001.91 $551,500 $552,000 110.00 2,042.98 110.00 2,036.45 110.00 2,029.92 110.00 2,023.38 110.00 2,016.85 110.00 2,010.32 110.00 2,003.78 $552,000 $552,500 110.00 2,044.86 110.00 2,038.33 110.00 2,031.79 110.00 2,025.26 110.00 2,018.73 110.00 2,012.19 110.00 2,005.66 $552,500 $553,000 110.00 2,046.73 110.00 2,040.20 110.00 2,033.67 110.00 2,027.13 110.00 2,020.60 110.00 2,014.07 110.00 2,007.53 $553,000 $553,500 110.00 2,048.61 110.00 2,042.08 110.00 2,035.54 110.00 2,029.01 110.00 2,022.48 110.00 2,015.94 110.00 2,009.41 $553,500 $554,000 110.00 2,050.48 110.00 2,043.95 110.00 2,037.42 110.00 2,030.88 110.00 2,024.35 110.00 2,017.82 110.00 2,011.28 $554,000 $554,500 110.00 2,052.36 110.00 2,045.83 110.00 2,039.29 110.00 2,032.76 110.00 2,026.23 110.00 2,019.69 110.00 2,013.16 $554,500 $555,000 110.00 2,054.23 110.00 2,047.70 110.00 2,041.17 110.00 2,034.63 110.00 2,028.10 110.00 2,021.57 110.00 2,015.03 $555,000 $555,500 110.00 2,056.11 110.00 2,049.58 110.00 2,043.04 110.00 2,036.51 110.00 2,029.98 110.00 2,023.44 110.00 2,016.91 $555,500 $556,000 110.00 2,057.98 110.00 2,051.45 110.00 2,044.92 110.00 2,038.38 110.00 2,031.85 110.00 2,025.32 110.00 2,018.78 $556,000 $556,500 110.00 2,059.86 110.00 2,053.33 110.00 2,046.79 110.00 2,040.26 110.00 2,033.73 110.00 2,027.19 110.00 2,020.66 $556,500 $557,000 110.00 2,061.73 110.00 2,055.20 110.00 2,048.67 110.00 2,042.13 110.00 2,035.60 110.00 2,029.07 110.00 2,022.53 $557,000 $557,500 110.00 2,063.61 110.00 2,057.08 110.00 2,050.54 110.00 2,044.01 110.00 2,037.48 110.00 2,030.94 110.00 2,024.41 $557,500 $558,000 110.00 2,065.48 110.00 2,058.95 110.00 2,052.42 110.00 2,045.88 110.00 2,039.35 110.00 2,032.82 110.00 2,026.28 $558,000 $558,500 110.00 2,067.36 110.00 2,060.83 110.00 2,054.29 110.00 2,047.76 110.00 2,041.23 110.00 2,034.69 110.00 2,028.16 $558,500 $559,000 110.00 2,069.23 110.00 2,062.70 110.00 2,056.17 110.00 2,049.63 110.00 2,043.10 110.00 2,036.57 110.00 2,030.03 $559,000 $559,500 110.00 2,071.11 110.00 2,064.58 110.00 2,058.04 110.00 2,051.51 110.00 2,044.98 110.00 2,038.44 110.00 2,031.91 $559,500 $560,000 110.00 2,072.98 110.00 2,066.45 110.00 2,059.92 110.00 2,053.38 110.00 2,046.85 110.00 2,040.32 110.00 2,033.78 $560,000 $560,500 110.00 2,074.86 110.00 2,068.33 110.00 2,061.79 110.00 2,055.26 110.00 2,048.73 110.00 2,042.19 110.00 2,035.66 $560,500 $561,000 110.00 2,076.73 110.00 2,070.20 110.00 2,063.67 110.00 2,057.13 110.00 2,050.60 110.00 2,044.07 110.00 2,037.53

NJEIS Family Cost Participation Table Page 14 of 12 Effective July 1, 2015

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

$561,000 $561,500 110.00 2,078.61 110.00 2,072.08 110.00 2,065.54 110.00 2,059.01 110.00 2,052.48 110.00 2,045.94 110.00 2,039.41 $561,500 $562,000 110.00 2,080.48 110.00 2,073.95 110.00 2,067.42 110.00 2,060.88 110.00 2,054.35 110.00 2,047.82 110.00 2,041.28 $562,000 $562,500 110.00 2,082.36 110.00 2,075.83 110.00 2,069.29 110.00 2,062.76 110.00 2,056.23 110.00 2,049.69 110.00 2,043.16 $562,500 $563,000 110.00 2,084.23 110.00 2,077.70 110.00 2,071.17 110.00 2,064.63 110.00 2,058.10 110.00 2,051.57 110.00 2,045.03 $563,000 $563,500 110.00 2,086.11 110.00 2,079.58 110.00 2,073.04 110.00 2,066.51 110.00 2,059.98 110.00 2,053.44 110.00 2,046.91 $563,500 $564,000 110.00 2,087.98 110.00 2,081.45 110.00 2,074.92 110.00 2,068.38 110.00 2,061.85 110.00 2,055.32 110.00 2,048.78 $564,000 $564,500 110.00 2,089.86 110.00 2,083.33 110.00 2,076.79 110.00 2,070.26 110.00 2,063.73 110.00 2,057.19 110.00 2,050.66 $564,500 $565,000 110.00 2,091.73 110.00 2,085.20 110.00 2,078.67 110.00 2,072.13 110.00 2,065.60 110.00 2,059.07 110.00 2,052.53 $565,000 $565,500 110.00 2,093.61 110.00 2,087.08 110.00 2,080.54 110.00 2,074.01 110.00 2,067.48 110.00 2,060.94 110.00 2,054.41 $565,500 $566,000 110.00 2,095.48 110.00 2,088.95 110.00 2,082.42 110.00 2,075.88 110.00 2,069.35 110.00 2,062.82 110.00 2,056.28 $566,000 $566,500 110.00 2,097.36 110.00 2,090.83 110.00 2,084.29 110.00 2,077.76 110.00 2,071.23 110.00 2,064.69 110.00 2,058.16 $566,500 $567,000 110.00 2,099.23 110.00 2,092.70 110.00 2,086.17 110.00 2,079.63 110.00 2,073.10 110.00 2,066.57 110.00 2,060.03 $567,000 $567,500 110.00 2,101.11 110.00 2,094.58 110.00 2,088.04 110.00 2,081.51 110.00 2,074.98 110.00 2,068.44 110.00 2,061.91 $567,500 $568,000 110.00 2,102.98 110.00 2,096.45 110.00 2,089.92 110.00 2,083.38 110.00 2,076.85 110.00 2,070.32 110.00 2,063.78 $568,000 $568,500 110.00 2,104.86 110.00 2,098.33 110.00 2,091.79 110.00 2,085.26 110.00 2,078.73 110.00 2,072.19 110.00 2,065.66 $568,500 $569,000 110.00 2,106.73 110.00 2,100.20 110.00 2,093.67 110.00 2,087.13 110.00 2,080.60 110.00 2,074.07 110.00 2,067.53 $569,000 $569,500 110.00 2,108.61 110.00 2,102.08 110.00 2,095.54 110.00 2,089.01 110.00 2,082.48 110.00 2,075.94 110.00 2,069.41 $569,500 $570,000 110.00 2,110.48 110.00 2,103.95 110.00 2,097.42 110.00 2,090.88 110.00 2,084.35 110.00 2,077.82 110.00 2,071.28 $570,000 $570,500 110.00 2,112.36 110.00 2,105.83 110.00 2,099.29 110.00 2,092.76 110.00 2,086.23 110.00 2,079.69 110.00 2,073.16 $570,500 $571,000 110.00 2,114.23 110.00 2,107.70 110.00 2,101.17 110.00 2,094.63 110.00 2,088.10 110.00 2,081.57 110.00 2,075.03 $571,000 $571,500 110.00 2,116.11 110.00 2,109.58 110.00 2,103.04 110.00 2,096.51 110.00 2,089.98 110.00 2,083.44 110.00 2,076.91 $571,500 $572,000 110.00 2,117.98 110.00 2,111.45 110.00 2,104.92 110.00 2,098.38 110.00 2,091.85 110.00 2,085.32 110.00 2,078.78 $572,000 $572,500 110.00 2,119.86 110.00 2,113.33 110.00 2,106.79 110.00 2,100.26 110.00 2,093.73 110.00 2,087.19 110.00 2,080.66 $572,500 $573,000 110.00 2,121.73 110.00 2,115.20 110.00 2,108.67 110.00 2,102.13 110.00 2,095.60 110.00 2,089.07 110.00 2,082.53 $573,000 $573,500 110.00 2,123.61 110.00 2,117.08 110.00 2,110.54 110.00 2,104.01 110.00 2,097.48 110.00 2,090.94 110.00 2,084.41 $573,500 $574,000 110.00 2,125.48 110.00 2,118.95 110.00 2,112.42 110.00 2,105.88 110.00 2,099.35 110.00 2,092.82 110.00 2,086.28 $574,000 $574,500 110.00 2,127.36 110.00 2,120.83 110.00 2,114.29 110.00 2,107.76 110.00 2,101.23 110.00 2,094.69 110.00 2,088.16 $574,500 $575,000 110.00 2,129.23 110.00 2,122.70 110.00 2,116.17 110.00 2,109.63 110.00 2,103.10 110.00 2,096.57 110.00 2,090.03 $575,000 $575,500 110.00 2,131.11 110.00 2,124.58 110.00 2,118.04 110.00 2,111.51 110.00 2,104.98 110.00 2,098.44 110.00 2,091.91 $575,500 $576,000 110.00 2,132.98 110.00 2,126.45 110.00 2,119.92 110.00 2,113.38 110.00 2,106.85 110.00 2,100.32 110.00 2,093.78 $576,000 $576,500 110.00 2,134.86 110.00 2,128.33 110.00 2,121.79 110.00 2,115.26 110.00 2,108.73 110.00 2,102.19 110.00 2,095.66 $576,500 $577,000 110.00 2,136.73 110.00 2,130.20 110.00 2,123.67 110.00 2,117.13 110.00 2,110.60 110.00 2,104.07 110.00 2,097.53 $577,000 $577,500 110.00 2,138.61 110.00 2,132.08 110.00 2,125.54 110.00 2,119.01 110.00 2,112.48 110.00 2,105.94 110.00 2,099.41 $577,500 $578,000 110.00 2,140.48 110.00 2,133.95 110.00 2,127.42 110.00 2,120.88 110.00 2,114.35 110.00 2,107.82 110.00 2,101.28 $578,000 $578,500 110.00 2,142.36 110.00 2,135.83 110.00 2,129.29 110.00 2,122.76 110.00 2,116.23 110.00 2,109.69 110.00 2,103.16 $578,500 $579,000 110.00 2,144.23 110.00 2,137.70 110.00 2,131.17 110.00 2,124.63 110.00 2,118.10 110.00 2,111.57 110.00 2,105.03 $579,000 $579,500 110.00 2,146.11 110.00 2,139.58 110.00 2,133.04 110.00 2,126.51 110.00 2,119.98 110.00 2,113.44 110.00 2,106.91 $579,500 $580,000 110.00 2,147.98 110.00 2,141.45 110.00 2,134.92 110.00 2,128.38 110.00 2,121.85 110.00 2,115.32 110.00 2,108.78 $580,000 $580,500 110.00 2,149.86 110.00 2,143.33 110.00 2,136.79 110.00 2,130.26 110.00 2,123.73 110.00 2,117.19 110.00 2,110.66 $580,500 $581,000 110.00 2,151.73 110.00 2,145.20 110.00 2,138.67 110.00 2,132.13 110.00 2,125.60 110.00 2,119.07 110.00 2,112.53 $581,000 $581,500 110.00 2,153.61 110.00 2,147.08 110.00 2,140.54 110.00 2,134.01 110.00 2,127.48 110.00 2,120.94 110.00 2,114.41 $581,500 $582,000 110.00 2,155.48 110.00 2,148.95 110.00 2,142.42 110.00 2,135.88 110.00 2,129.35 110.00 2,122.82 110.00 2,116.28 $582,000 $582,500 110.00 2,157.36 110.00 2,150.83 110.00 2,144.29 110.00 2,137.76 110.00 2,131.23 110.00 2,124.69 110.00 2,118.16 $582,500 $583,000 110.00 2,159.23 110.00 2,152.70 110.00 2,146.17 110.00 2,139.63 110.00 2,133.10 110.00 2,126.57 110.00 2,120.03 $583,000 $583,500 110.00 2,161.11 110.00 2,154.58 110.00 2,148.04 110.00 2,141.51 110.00 2,134.98 110.00 2,128.44 110.00 2,121.91 $583,500 $584,000 110.00 2,162.98 110.00 2,156.45 110.00 2,149.92 110.00 2,143.38 110.00 2,136.85 110.00 2,130.32 110.00 2,123.78 $584,000 $584,500 110.00 2,164.86 110.00 2,158.33 110.00 2,151.79 110.00 2,145.26 110.00 2,138.73 110.00 2,132.19 110.00 2,125.66 $584,500 $585,000 110.00 2,166.73 110.00 2,160.20 110.00 2,153.67 110.00 2,147.13 110.00 2,140.60 110.00 2,134.07 110.00 2,127.53 $585,000 $585,500 110.00 2,168.61 110.00 2,162.08 110.00 2,155.54 110.00 2,149.01 110.00 2,142.48 110.00 2,135.94 110.00 2,129.41 $585,500 $586,000 110.00 2,170.48 110.00 2,163.95 110.00 2,157.42 110.00 2,150.88 110.00 2,144.35 110.00 2,137.82 110.00 2,131.28 $586,000 $586,500 110.00 2,172.36 110.00 2,165.83 110.00 2,159.29 110.00 2,152.76 110.00 2,146.23 110.00 2,139.69 110.00 2,133.16 $586,500 $587,000 110.00 2,174.23 110.00 2,167.70 110.00 2,161.17 110.00 2,154.63 110.00 2,148.10 110.00 2,141.57 110.00 2,135.03 $587,000 $587,500 110.00 2,176.11 110.00 2,169.58 110.00 2,163.04 110.00 2,156.51 110.00 2,149.98 110.00 2,143.44 110.00 2,136.91 $587,500 $588,000 110.00 2,177.98 110.00 2,171.45 110.00 2,164.92 110.00 2,158.38 110.00 2,151.85 110.00 2,145.32 110.00 2,138.78 $588,000 $588,500 110.00 2,179.86 110.00 2,173.33 110.00 2,166.79 110.00 2,160.26 110.00 2,153.73 110.00 2,147.19 110.00 2,140.66 $588,500 $589,000 110.00 2,181.73 110.00 2,175.20 110.00 2,168.67 110.00 2,162.13 110.00 2,155.60 110.00 2,149.07 110.00 2,142.53 $589,000 $589,500 110.00 2,183.61 110.00 2,177.08 110.00 2,170.54 110.00 2,164.01 110.00 2,157.48 110.00 2,150.94 110.00 2,144.41 $589,500 $590,000 110.00 2,185.48 110.00 2,178.95 110.00 2,172.42 110.00 2,165.88 110.00 2,159.35 110.00 2,152.82 110.00 2,146.28 $590,000 $590,500 110.00 2,187.36 110.00 2,180.83 110.00 2,174.29 110.00 2,167.76 110.00 2,161.23 110.00 2,154.69 110.00 2,148.16 $590,500 $591,000 110.00 2,189.23 110.00 2,182.70 110.00 2,176.17 110.00 2,169.63 110.00 2,163.10 110.00 2,156.57 110.00 2,150.03 $591,000 $591,500 110.00 2,191.11 110.00 2,184.58 110.00 2,178.04 110.00 2,171.51 110.00 2,164.98 110.00 2,158.44 110.00 2,151.91 $591,500 $592,000 110.00 2,192.98 110.00 2,186.45 110.00 2,179.92 110.00 2,173.38 110.00 2,166.85 110.00 2,160.32 110.00 2,153.78 $592,000 $592,500 110.00 2,194.86 110.00 2,188.33 110.00 2,181.79 110.00 2,175.26 110.00 2,168.73 110.00 2,162.19 110.00 2,155.66 $592,500 $593,000 110.00 2,196.73 110.00 2,190.20 110.00 2,183.67 110.00 2,177.13 110.00 2,170.60 110.00 2,164.07 110.00 2,157.53 $593,000 $593,500 110.00 2,198.61 110.00 2,192.08 110.00 2,185.54 110.00 2,179.01 110.00 2,172.48 110.00 2,165.94 110.00 2,159.41 $593,500 $594,000 110.00 2,200.48 110.00 2,193.95 110.00 2,187.42 110.00 2,180.88 110.00 2,174.35 110.00 2,167.82 110.00 2,161.28 $594,000 $594,500 110.00 2,202.36 110.00 2,195.83 110.00 2,189.29 110.00 2,182.76 110.00 2,176.23 110.00 2,169.69 110.00 2,163.16 $594,500 $595,000 110.00 2,204.23 110.00 2,197.70 110.00 2,191.17 110.00 2,184.63 110.00 2,178.10 110.00 2,171.57 110.00 2,165.03 $595,000 $595,500 110.00 2,206.11 110.00 2,199.58 110.00 2,193.04 110.00 2,186.51 110.00 2,179.98 110.00 2,173.44 110.00 2,166.91 $595,500 $596,000 110.00 2,207.98 110.00 2,201.45 110.00 2,194.92 110.00 2,188.38 110.00 2,181.85 110.00 2,175.32 110.00 2,168.78 $596,000 $596,500 110.00 2,209.86 110.00 2,203.33 110.00 2,196.79 110.00 2,190.26 110.00 2,183.73 110.00 2,177.19 110.00 2,170.66 $596,500 $597,000 110.00 2,211.73 110.00 2,205.20 110.00 2,198.67 110.00 2,192.13 110.00 2,185.60 110.00 2,179.07 110.00 2,172.53 $597,000 $597,500 110.00 2,213.61 110.00 2,207.08 110.00 2,200.54 110.00 2,194.01 110.00 2,187.48 110.00 2,180.94 110.00 2,174.41 $597,500 $598,000 110.00 2,215.48 110.00 2,208.95 110.00 2,202.42 110.00 2,195.88 110.00 2,189.35 110.00 2,182.82 110.00 2,176.28 $598,000 $598,500 110.00 2,217.36 110.00 2,210.83 110.00 2,204.29 110.00 2,197.76 110.00 2,191.23 110.00 2,184.69 110.00 2,178.16 $598,500 $599,000 110.00 2,219.23 110.00 2,212.70 110.00 2,206.17 110.00 2,199.63 110.00 2,193.10 110.00 2,186.57 110.00 2,180.03 $599,000 $599,500 110.00 2,221.11 110.00 2,214.58 110.00 2,208.04 110.00 2,201.51 110.00 2,194.98 110.00 2,188.44 110.00 2,181.91 $599,500 $600,000 110.00 2,222.98 110.00 2,216.45 110.00 2,209.92 110.00 2,203.38 110.00 2,196.85 110.00 2,190.32 110.00 2,183.78 $600,000 $600,500 110.00 2,224.86 110.00 2,218.33 110.00 2,211.79 110.00 2,205.26 110.00 2,198.73 110.00 2,192.19 110.00 2,185.66 $600,500 $601,000 110.00 2,226.73 110.00 2,220.20 110.00 2,213.67 110.00 2,207.13 110.00 2,200.60 110.00 2,194.07 110.00 2,187.53 $601,000 $601,500 110.00 2,228.61 110.00 2,222.08 110.00 2,215.54 110.00 2,209.01 110.00 2,202.48 110.00 2,195.94 110.00 2,189.41 $601,500 $602,000 110.00 2,230.48 110.00 2,223.95 110.00 2,217.42 110.00 2,210.88 110.00 2,204.35 110.00 2,197.82 110.00 2,191.28 $602,000 $602,500 110.00 2,232.36 110.00 2,225.83 110.00 2,219.29 110.00 2,212.76 110.00 2,206.23 110.00 2,199.69 110.00 2,193.16 $602,500 $603,000 110.00 2,234.23 110.00 2,227.70 110.00 2,221.17 110.00 2,214.63 110.00 2,208.10 110.00 2,201.57 110.00 2,195.03 $603,000 $603,500 110.00 2,236.11 110.00 2,229.58 110.00 2,223.04 110.00 2,216.51 110.00 2,209.98 110.00 2,203.44 110.00 2,196.91 $603,500 $604,000 110.00 2,237.98 110.00 2,231.45 110.00 2,224.92 110.00 2,218.38 110.00 2,211.85 110.00 2,205.32 110.00 2,198.78 $604,000 $604,500 110.00 2,239.86 110.00 2,233.33 110.00 2,226.79 110.00 2,220.26 110.00 2,213.73 110.00 2,207.19 110.00 2,200.66 $604,500 $605,000 110.00 2,241.73 110.00 2,235.20 110.00 2,228.67 110.00 2,222.13 110.00 2,215.60 110.00 2,209.07 110.00 2,202.53 $605,000 $605,500 110.00 2,243.61 110.00 2,237.08 110.00 2,230.54 110.00 2,224.01 110.00 2,217.48 110.00 2,210.94 110.00 2,204.41 $605,500 $606,000 110.00 2,245.48 110.00 2,238.95 110.00 2,232.42 110.00 2,225.88 110.00 2,219.35 110.00 2,212.82 110.00 2,206.28 $606,000 $606,500 110.00 2,247.36 110.00 2,240.83 110.00 2,234.29 110.00 2,227.76 110.00 2,221.23 110.00 2,214.69 110.00 2,208.16 $606,500 $607,000 110.00 2,249.23 110.00 2,242.70 110.00 2,236.17 110.00 2,229.63 110.00 2,223.10 110.00 2,216.57 110.00 2,210.03 $607,000 $607,500 110.00 2,251.11 110.00 2,244.58 110.00 2,238.04 110.00 2,231.51 110.00 2,224.98 110.00 2,218.44 110.00 2,211.91 $607,500 $608,000 110.00 2,252.98 110.00 2,246.45 110.00 2,239.92 110.00 2,233.38 110.00 2,226.85 110.00 2,220.32 110.00 2,213.78 $608,000 $608,500 110.00 2,254.86 110.00 2,248.33 110.00 2,241.79 110.00 2,235.26 110.00 2,228.73 110.00 2,222.19 110.00 2,215.66 $608,500 $609,000 110.00 2,256.73 110.00 2,250.20 110.00 2,243.67 110.00 2,237.13 110.00 2,230.60 110.00 2,224.07 110.00 2,217.53 $609,000 $609,500 110.00 2,258.61 110.00 2,252.08 110.00 2,245.54 110.00 2,239.01 110.00 2,232.48 110.00 2,225.94 110.00 2,219.41 $609,500 $610,000 110.00 2,260.48 110.00 2,253.95 110.00 2,247.42 110.00 2,240.88 110.00 2,234.35 110.00 2,227.82 110.00 2,221.28 $610,000 $610,500 110.00 2,262.36 110.00 2,255.83 110.00 2,249.29 110.00 2,242.76 110.00 2,236.23 110.00 2,229.69 110.00 2,223.16 $610,500 $611,000 110.00 2,264.23 110.00 2,257.70 110.00 2,251.17 110.00 2,244.63 110.00 2,238.10 110.00 2,231.57 110.00 2,225.03 $611,000 $611,500 110.00 2,266.11 110.00 2,259.58 110.00 2,253.04 110.00 2,246.51 110.00 2,239.98 110.00 2,233.44 110.00 2,226.91 $611,500 $612,000 110.00 2,267.98 110.00 2,261.45 110.00 2,254.92 110.00 2,248.38 110.00 2,241.85 110.00 2,235.32 110.00 2,228.78

NJEIS Family Cost Participation Table Page 15 of 12 Effective July 1, 2015

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

$612,000 $612,500 110.00 2,269.86 110.00 2,263.33 110.00 2,256.79 110.00 2,250.26 110.00 2,243.73 110.00 2,237.19 110.00 2,230.66 $612,500 $613,000 110.00 2,271.73 110.00 2,265.20 110.00 2,258.67 110.00 2,252.13 110.00 2,245.60 110.00 2,239.07 110.00 2,232.53 $613,000 $613,500 110.00 2,273.61 110.00 2,267.08 110.00 2,260.54 110.00 2,254.01 110.00 2,247.48 110.00 2,240.94 110.00 2,234.41 $613,500 $614,000 110.00 2,275.48 110.00 2,268.95 110.00 2,262.42 110.00 2,255.88 110.00 2,249.35 110.00 2,242.82 110.00 2,236.28 $614,000 $614,500 110.00 2,277.36 110.00 2,270.83 110.00 2,264.29 110.00 2,257.76 110.00 2,251.23 110.00 2,244.69 110.00 2,238.16 $614,500 $615,000 110.00 2,279.23 110.00 2,272.70 110.00 2,266.17 110.00 2,259.63 110.00 2,253.10 110.00 2,246.57 110.00 2,240.03 $615,000 $615,500 110.00 2,281.11 110.00 2,274.58 110.00 2,268.04 110.00 2,261.51 110.00 2,254.98 110.00 2,248.44 110.00 2,241.91 $615,500 $616,000 110.00 2,282.98 110.00 2,276.45 110.00 2,269.92 110.00 2,263.38 110.00 2,256.85 110.00 2,250.32 110.00 2,243.78 $616,000 $616,500 110.00 2,284.86 110.00 2,278.33 110.00 2,271.79 110.00 2,265.26 110.00 2,258.73 110.00 2,252.19 110.00 2,245.66 $616,500 $617,000 110.00 2,286.73 110.00 2,280.20 110.00 2,273.67 110.00 2,267.13 110.00 2,260.60 110.00 2,254.07 110.00 2,247.53 $617,000 $617,500 110.00 2,288.61 110.00 2,282.08 110.00 2,275.54 110.00 2,269.01 110.00 2,262.48 110.00 2,255.94 110.00 2,249.41 $617,500 $618,000 110.00 2,290.48 110.00 2,283.95 110.00 2,277.42 110.00 2,270.88 110.00 2,264.35 110.00 2,257.82 110.00 2,251.28 $618,000 $618,500 110.00 2,292.36 110.00 2,285.83 110.00 2,279.29 110.00 2,272.76 110.00 2,266.23 110.00 2,259.69 110.00 2,253.16 $618,500 $619,000 110.00 2,294.23 110.00 2,287.70 110.00 2,281.17 110.00 2,274.63 110.00 2,268.10 110.00 2,261.57 110.00 2,255.03 $619,000 $619,500 110.00 2,296.11 110.00 2,289.58 110.00 2,283.04 110.00 2,276.51 110.00 2,269.98 110.00 2,263.44 110.00 2,256.91 $619,500 $620,000 110.00 2,297.98 110.00 2,291.45 110.00 2,284.92 110.00 2,278.38 110.00 2,271.85 110.00 2,265.32 110.00 2,258.78 $620,000 $620,500 110.00 2,299.86 110.00 2,293.33 110.00 2,286.79 110.00 2,280.26 110.00 2,273.73 110.00 2,267.19 110.00 2,260.66 $620,500 $621,000 110.00 2,301.73 110.00 2,295.20 110.00 2,288.67 110.00 2,282.13 110.00 2,275.60 110.00 2,269.07 110.00 2,262.53 $621,000 $621,500 110.00 2,303.61 110.00 2,297.08 110.00 2,290.54 110.00 2,284.01 110.00 2,277.48 110.00 2,270.94 110.00 2,264.41 $621,500 $622,000 110.00 2,305.48 110.00 2,298.95 110.00 2,292.42 110.00 2,285.88 110.00 2,279.35 110.00 2,272.82 110.00 2,266.28 $622,000 $622,500 110.00 2,307.36 110.00 2,300.83 110.00 2,294.29 110.00 2,287.76 110.00 2,281.23 110.00 2,274.69 110.00 2,268.16 $622,500 $623,000 110.00 2,309.23 110.00 2,302.70 110.00 2,296.17 110.00 2,289.63 110.00 2,283.10 110.00 2,276.57 110.00 2,270.03 $623,000 $623,500 110.00 2,311.11 110.00 2,304.58 110.00 2,298.04 110.00 2,291.51 110.00 2,284.98 110.00 2,278.44 110.00 2,271.91 $623,500 $624,000 110.00 2,312.98 110.00 2,306.45 110.00 2,299.92 110.00 2,293.38 110.00 2,286.85 110.00 2,280.32 110.00 2,273.78 $624,000 $624,500 110.00 2,314.86 110.00 2,308.33 110.00 2,301.79 110.00 2,295.26 110.00 2,288.73 110.00 2,282.19 110.00 2,275.66 $624,500 $625,000 110.00 2,316.73 110.00 2,310.20 110.00 2,303.67 110.00 2,297.13 110.00 2,290.60 110.00 2,284.07 110.00 2,277.53 $625,000 $625,500 110.00 2,318.61 110.00 2,312.08 110.00 2,305.54 110.00 2,299.01 110.00 2,292.48 110.00 2,285.94 110.00 2,279.41 $625,500 $626,000 110.00 2,320.48 110.00 2,313.95 110.00 2,307.42 110.00 2,300.88 110.00 2,294.35 110.00 2,287.82 110.00 2,281.28 $626,000 $626,500 110.00 2,322.36 110.00 2,315.83 110.00 2,309.29 110.00 2,302.76 110.00 2,296.23 110.00 2,289.69 110.00 2,283.16 $626,500 $627,000 110.00 2,324.23 110.00 2,317.70 110.00 2,311.17 110.00 2,304.63 110.00 2,298.10 110.00 2,291.57 110.00 2,285.03 $627,000 $627,500 110.00 2,326.11 110.00 2,319.58 110.00 2,313.04 110.00 2,306.51 110.00 2,299.98 110.00 2,293.44 110.00 2,286.91 $627,500 $628,000 110.00 2,327.98 110.00 2,321.45 110.00 2,314.92 110.00 2,308.38 110.00 2,301.85 110.00 2,295.32 110.00 2,288.78 $628,000 $628,500 110.00 2,329.86 110.00 2,323.33 110.00 2,316.79 110.00 2,310.26 110.00 2,303.73 110.00 2,297.19 110.00 2,290.66 $628,500 $629,000 110.00 2,331.73 110.00 2,325.20 110.00 2,318.67 110.00 2,312.13 110.00 2,305.60 110.00 2,299.07 110.00 2,292.53 $629,000 $629,500 110.00 2,333.61 110.00 2,327.08 110.00 2,320.54 110.00 2,314.01 110.00 2,307.48 110.00 2,300.94 110.00 2,294.41 $629,500 $630,000 110.00 2,335.48 110.00 2,328.95 110.00 2,322.42 110.00 2,315.88 110.00 2,309.35 110.00 2,302.82 110.00 2,296.28 $630,000 $630,500 110.00 2,337.36 110.00 2,330.83 110.00 2,324.29 110.00 2,317.76 110.00 2,311.23 110.00 2,304.69 110.00 2,298.16 $630,500 $631,000 110.00 2,339.23 110.00 2,332.70 110.00 2,326.17 110.00 2,319.63 110.00 2,313.10 110.00 2,306.57 110.00 2,300.03 $631,000 $631,500 110.00 2,341.11 110.00 2,334.58 110.00 2,328.04 110.00 2,321.51 110.00 2,314.98 110.00 2,308.44 110.00 2,301.91 $631,500 $632,000 110.00 2,342.98 110.00 2,336.45 110.00 2,329.92 110.00 2,323.38 110.00 2,316.85 110.00 2,310.32 110.00 2,303.78 $632,000 $632,500 110.00 2,344.86 110.00 2,338.33 110.00 2,331.79 110.00 2,325.26 110.00 2,318.73 110.00 2,312.19 110.00 2,305.66 $632,500 $633,000 110.00 2,346.73 110.00 2,340.20 110.00 2,333.67 110.00 2,327.13 110.00 2,320.60 110.00 2,314.07 110.00 2,307.53 $633,000 $633,500 110.00 2,348.61 110.00 2,342.08 110.00 2,335.54 110.00 2,329.01 110.00 2,322.48 110.00 2,315.94 110.00 2,309.41 $633,500 $634,000 110.00 2,350.48 110.00 2,343.95 110.00 2,337.42 110.00 2,330.88 110.00 2,324.35 110.00 2,317.82 110.00 2,311.28 $634,000 $634,500 110.00 2,352.36 110.00 2,345.83 110.00 2,339.29 110.00 2,332.76 110.00 2,326.23 110.00 2,319.69 110.00 2,313.16 $634,500 $635,000 110.00 2,354.23 110.00 2,347.70 110.00 2,341.17 110.00 2,334.63 110.00 2,328.10 110.00 2,321.57 110.00 2,315.03 $635,000 $635,500 110.00 2,356.11 110.00 2,349.58 110.00 2,343.04 110.00 2,336.51 110.00 2,329.98 110.00 2,323.44 110.00 2,316.91 $635,500 $636,000 110.00 2,357.98 110.00 2,351.45 110.00 2,344.92 110.00 2,338.38 110.00 2,331.85 110.00 2,325.32 110.00 2,318.78 $636,000 $636,500 110.00 2,359.86 110.00 2,353.33 110.00 2,346.79 110.00 2,340.26 110.00 2,333.73 110.00 2,327.19 110.00 2,320.66 $636,500 $637,000 110.00 2,361.73 110.00 2,355.20 110.00 2,348.67 110.00 2,342.13 110.00 2,335.60 110.00 2,329.07 110.00 2,322.53 $637,000 $637,500 110.00 2,363.61 110.00 2,357.08 110.00 2,350.54 110.00 2,344.01 110.00 2,337.48 110.00 2,330.94 110.00 2,324.41 $637,500 $638,000 110.00 2,365.48 110.00 2,358.95 110.00 2,352.42 110.00 2,345.88 110.00 2,339.35 110.00 2,332.82 110.00 2,326.28 $638,000 $638,500 110.00 2,367.36 110.00 2,360.83 110.00 2,354.29 110.00 2,347.76 110.00 2,341.23 110.00 2,334.69 110.00 2,328.16 $638,500 $639,000 110.00 2,369.23 110.00 2,362.70 110.00 2,356.17 110.00 2,349.63 110.00 2,343.10 110.00 2,336.57 110.00 2,330.03 $639,000 $639,500 110.00 2,371.11 110.00 2,364.58 110.00 2,358.04 110.00 2,351.51 110.00 2,344.98 110.00 2,338.44 110.00 2,331.91 $639,500 $640,000 110.00 2,372.98 110.00 2,366.45 110.00 2,359.92 110.00 2,353.38 110.00 2,346.85 110.00 2,340.32 110.00 2,333.78 $640,000 $640,500 110.00 2,374.86 110.00 2,368.33 110.00 2,361.79 110.00 2,355.26 110.00 2,348.73 110.00 2,342.19 110.00 2,335.66 $640,500 $641,000 110.00 2,376.73 110.00 2,370.20 110.00 2,363.67 110.00 2,357.13 110.00 2,350.60 110.00 2,344.07 110.00 2,337.53 $641,000 $641,500 110.00 2,378.61 110.00 2,372.08 110.00 2,365.54 110.00 2,359.01 110.00 2,352.48 110.00 2,345.94 110.00 2,339.41 $641,500 $642,000 110.00 2,380.48 110.00 2,373.95 110.00 2,367.42 110.00 2,360.88 110.00 2,354.35 110.00 2,347.82 110.00 2,341.28 $642,000 $642,500 110.00 2,382.36 110.00 2,375.83 110.00 2,369.29 110.00 2,362.76 110.00 2,356.23 110.00 2,349.69 110.00 2,343.16 $642,500 $643,000 110.00 2,384.23 110.00 2,377.70 110.00 2,371.17 110.00 2,364.63 110.00 2,358.10 110.00 2,351.57 110.00 2,345.03 $643,000 $643,500 110.00 2,386.11 110.00 2,379.58 110.00 2,373.04 110.00 2,366.51 110.00 2,359.98 110.00 2,353.44 110.00 2,346.91 $643,500 $644,000 110.00 2,387.98 110.00 2,381.45 110.00 2,374.92 110.00 2,368.38 110.00 2,361.85 110.00 2,355.32 110.00 2,348.78 $644,000 $644,500 110.00 2,389.86 110.00 2,383.33 110.00 2,376.79 110.00 2,370.26 110.00 2,363.73 110.00 2,357.19 110.00 2,350.66 $644,500 $645,000 110.00 2,391.73 110.00 2,385.20 110.00 2,378.67 110.00 2,372.13 110.00 2,365.60 110.00 2,359.07 110.00 2,352.53 $645,000 $645,500 110.00 2,393.61 110.00 2,387.08 110.00 2,380.54 110.00 2,374.01 110.00 2,367.48 110.00 2,360.94 110.00 2,354.41 $645,500 $646,000 110.00 2,395.48 110.00 2,388.95 110.00 2,382.42 110.00 2,375.88 110.00 2,369.35 110.00 2,362.82 110.00 2,356.28 $646,000 $646,500 110.00 2,397.36 110.00 2,390.83 110.00 2,384.29 110.00 2,377.76 110.00 2,371.23 110.00 2,364.69 110.00 2,358.16 $646,500 $647,000 110.00 2,399.23 110.00 2,392.70 110.00 2,386.17 110.00 2,379.63 110.00 2,373.10 110.00 2,366.57 110.00 2,360.03 $647,000 $647,500 110.00 2,401.11 110.00 2,394.58 110.00 2,388.04 110.00 2,381.51 110.00 2,374.98 110.00 2,368.44 110.00 2,361.91 $647,500 $648,000 110.00 2,402.98 110.00 2,396.45 110.00 2,389.92 110.00 2,383.38 110.00 2,376.85 110.00 2,370.32 110.00 2,363.78 $648,000 $648,500 110.00 2,404.86 110.00 2,398.33 110.00 2,391.79 110.00 2,385.26 110.00 2,378.73 110.00 2,372.19 110.00 2,365.66 $648,500 $649,000 110.00 2,406.73 110.00 2,400.20 110.00 2,393.67 110.00 2,387.13 110.00 2,380.60 110.00 2,374.07 110.00 2,367.53 $649,000 $649,500 110.00 2,408.61 110.00 2,402.08 110.00 2,395.54 110.00 2,389.01 110.00 2,382.48 110.00 2,375.94 110.00 2,369.41 $649,500 $650,000 110.00 2,410.48 110.00 2,403.95 110.00 2,397.42 110.00 2,390.88 110.00 2,384.35 110.00 2,377.82 110.00 2,371.28 $650,000 $650,500 110.00 2,412.36 110.00 2,405.83 110.00 2,399.29 110.00 2,392.76 110.00 2,386.23 110.00 2,379.69 110.00 2,373.16 $650,500 $651,000 110.00 2,414.23 110.00 2,407.70 110.00 2,401.17 110.00 2,394.63 110.00 2,388.10 110.00 2,381.57 110.00 2,375.03 $651,000 $651,500 110.00 2,416.11 110.00 2,409.58 110.00 2,403.04 110.00 2,396.51 110.00 2,389.98 110.00 2,383.44 110.00 2,376.91 $651,500 $652,000 110.00 2,417.98 110.00 2,411.45 110.00 2,404.92 110.00 2,398.38 110.00 2,391.85 110.00 2,385.32 110.00 2,378.78 $652,000 $652,500 110.00 2,419.86 110.00 2,413.33 110.00 2,406.79 110.00 2,400.26 110.00 2,393.73 110.00 2,387.19 110.00 2,380.66 $652,500 $653,000 110.00 2,421.73 110.00 2,415.20 110.00 2,408.67 110.00 2,402.13 110.00 2,395.60 110.00 2,389.07 110.00 2,382.53 $653,000 $653,500 110.00 2,423.61 110.00 2,417.08 110.00 2,410.54 110.00 2,404.01 110.00 2,397.48 110.00 2,390.94 110.00 2,384.41 $653,500 $654,000 110.00 2,425.48 110.00 2,418.95 110.00 2,412.42 110.00 2,405.88 110.00 2,399.35 110.00 2,392.82 110.00 2,386.28 $654,000 $654,500 110.00 2,427.36 110.00 2,420.83 110.00 2,414.29 110.00 2,407.76 110.00 2,401.23 110.00 2,394.69 110.00 2,388.16 $654,500 $655,000 110.00 2,429.23 110.00 2,422.70 110.00 2,416.17 110.00 2,409.63 110.00 2,403.10 110.00 2,396.57 110.00 2,390.03 $655,000 $655,500 110.00 2,431.11 110.00 2,424.58 110.00 2,418.04 110.00 2,411.51 110.00 2,404.98 110.00 2,398.44 110.00 2,391.91 $655,500 $656,000 110.00 2,432.98 110.00 2,426.45 110.00 2,419.92 110.00 2,413.38 110.00 2,406.85 110.00 2,400.32 110.00 2,393.78 $656,000 $656,500 110.00 2,434.86 110.00 2,428.33 110.00 2,421.79 110.00 2,415.26 110.00 2,408.73 110.00 2,402.19 110.00 2,395.66 $656,500 $657,000 110.00 2,436.73 110.00 2,430.20 110.00 2,423.67 110.00 2,417.13 110.00 2,410.60 110.00 2,404.07 110.00 2,397.53 $657,000 $657,500 110.00 2,438.61 110.00 2,432.08 110.00 2,425.54 110.00 2,419.01 110.00 2,412.48 110.00 2,405.94 110.00 2,399.41 $657,500 $658,000 110.00 2,440.48 110.00 2,433.95 110.00 2,427.42 110.00 2,420.88 110.00 2,414.35 110.00 2,407.82 110.00 2,401.28 $658,000 $658,500 110.00 2,442.36 110.00 2,435.83 110.00 2,429.29 110.00 2,422.76 110.00 2,416.23 110.00 2,409.69 110.00 2,403.16 $658,500 $659,000 110.00 2,444.23 110.00 2,437.70 110.00 2,431.17 110.00 2,424.63 110.00 2,418.10 110.00 2,411.57 110.00 2,405.03 $659,000 $659,500 110.00 2,446.11 110.00 2,439.58 110.00 2,433.04 110.00 2,426.51 110.00 2,419.98 110.00 2,413.44 110.00 2,406.91 $659,500 $660,000 110.00 2,447.98 110.00 2,441.45 110.00 2,434.92 110.00 2,428.38 110.00 2,421.85 110.00 2,415.32 110.00 2,408.78 $660,000 $660,500 110.00 2,449.86 110.00 2,443.33 110.00 2,436.79 110.00 2,430.26 110.00 2,423.73 110.00 2,417.19 110.00 2,410.66 $660,500 $661,000 110.00 2,451.73 110.00 2,445.20 110.00 2,438.67 110.00 2,432.13 110.00 2,425.60 110.00 2,419.07 110.00 2,412.53 $661,000 $661,500 110.00 2,453.61 110.00 2,447.08 110.00 2,440.54 110.00 2,434.01 110.00 2,427.48 110.00 2,420.94 110.00 2,414.41 $661,500 $662,000 110.00 2,455.48 110.00 2,448.95 110.00 2,442.42 110.00 2,435.88 110.00 2,429.35 110.00 2,422.82 110.00 2,416.28 $662,000 $662,500 110.00 2,457.36 110.00 2,450.83 110.00 2,444.29 110.00 2,437.76 110.00 2,431.23 110.00 2,424.69 110.00 2,418.16 $662,500 $663,000 110.00 2,459.23 110.00 2,452.70 110.00 2,446.17 110.00 2,439.63 110.00 2,433.10 110.00 2,426.57 110.00 2,420.03

NJEIS Family Cost Participation Table Page 16 of 12 Effective July 1, 2015

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

$663,000 $663,500 110.00 2,461.11 110.00 2,454.58 110.00 2,448.04 110.00 2,441.51 110.00 2,434.98 110.00 2,428.44 110.00 2,421.91 $663,500 $664,000 110.00 2,462.98 110.00 2,456.45 110.00 2,449.92 110.00 2,443.38 110.00 2,436.85 110.00 2,430.32 110.00 2,423.78 $664,000 $664,500 110.00 2,464.86 110.00 2,458.33 110.00 2,451.79 110.00 2,445.26 110.00 2,438.73 110.00 2,432.19 110.00 2,425.66 $664,500 $665,000 110.00 2,466.73 110.00 2,460.20 110.00 2,453.67 110.00 2,447.13 110.00 2,440.60 110.00 2,434.07 110.00 2,427.53 $665,000 $665,500 110.00 2,468.61 110.00 2,462.08 110.00 2,455.54 110.00 2,449.01 110.00 2,442.48 110.00 2,435.94 110.00 2,429.41 $665,500 $666,000 110.00 2,470.48 110.00 2,463.95 110.00 2,457.42 110.00 2,450.88 110.00 2,444.35 110.00 2,437.82 110.00 2,431.28 $666,000 $666,500 110.00 2,472.36 110.00 2,465.83 110.00 2,459.29 110.00 2,452.76 110.00 2,446.23 110.00 2,439.69 110.00 2,433.16 $666,500 $667,000 110.00 2,474.23 110.00 2,467.70 110.00 2,461.17 110.00 2,454.63 110.00 2,448.10 110.00 2,441.57 110.00 2,435.03 $667,000 $667,500 110.00 2,476.11 110.00 2,469.58 110.00 2,463.04 110.00 2,456.51 110.00 2,449.98 110.00 2,443.44 110.00 2,436.91 $667,500 $668,000 110.00 2,477.98 110.00 2,471.45 110.00 2,464.92 110.00 2,458.38 110.00 2,451.85 110.00 2,445.32 110.00 2,438.78 $668,000 $668,500 110.00 2,479.86 110.00 2,473.33 110.00 2,466.79 110.00 2,460.26 110.00 2,453.73 110.00 2,447.19 110.00 2,440.66 $668,500 $669,000 110.00 2,481.73 110.00 2,475.20 110.00 2,468.67 110.00 2,462.13 110.00 2,455.60 110.00 2,449.07 110.00 2,442.53 $669,000 $669,500 110.00 2,483.61 110.00 2,477.08 110.00 2,470.54 110.00 2,464.01 110.00 2,457.48 110.00 2,450.94 110.00 2,444.41 $669,500 $670,000 110.00 2,485.48 110.00 2,478.95 110.00 2,472.42 110.00 2,465.88 110.00 2,459.35 110.00 2,452.82 110.00 2,446.28 $670,000 $670,500 110.00 2,487.36 110.00 2,480.83 110.00 2,474.29 110.00 2,467.76 110.00 2,461.23 110.00 2,454.69 110.00 2,448.16 $670,500 $671,000 110.00 2,489.23 110.00 2,482.70 110.00 2,476.17 110.00 2,469.63 110.00 2,463.10 110.00 2,456.57 110.00 2,450.03 $671,000 $671,500 110.00 2,491.11 110.00 2,484.58 110.00 2,478.04 110.00 2,471.51 110.00 2,464.98 110.00 2,458.44 110.00 2,451.91 $671,500 $672,000 110.00 2,492.98 110.00 2,486.45 110.00 2,479.92 110.00 2,473.38 110.00 2,466.85 110.00 2,460.32 110.00 2,453.78 $672,000 $672,500 110.00 2,494.86 110.00 2,488.33 110.00 2,481.79 110.00 2,475.26 110.00 2,468.73 110.00 2,462.19 110.00 2,455.66 $672,500 $673,000 110.00 2,496.73 110.00 2,490.20 110.00 2,483.67 110.00 2,477.13 110.00 2,470.60 110.00 2,464.07 110.00 2,457.53 $673,000 $673,500 110.00 2,498.61 110.00 2,492.08 110.00 2,485.54 110.00 2,479.01 110.00 2,472.48 110.00 2,465.94 110.00 2,459.41 $673,500 $674,000 110.00 2,500.48 110.00 2,493.95 110.00 2,487.42 110.00 2,480.88 110.00 2,474.35 110.00 2,467.82 110.00 2,461.28 $674,000 $674,500 110.00 2,502.36 110.00 2,495.83 110.00 2,489.29 110.00 2,482.76 110.00 2,476.23 110.00 2,469.69 110.00 2,463.16 $674,500 $675,000 110.00 2,504.23 110.00 2,497.70 110.00 2,491.17 110.00 2,484.63 110.00 2,478.10 110.00 2,471.57 110.00 2,465.03 $675,000 $675,500 110.00 2,506.11 110.00 2,499.58 110.00 2,493.04 110.00 2,486.51 110.00 2,479.98 110.00 2,473.44 110.00 2,466.91 $675,500 $676,000 110.00 2,507.98 110.00 2,501.45 110.00 2,494.92 110.00 2,488.38 110.00 2,481.85 110.00 2,475.32 110.00 2,468.78 $676,000 $676,500 110.00 2,509.86 110.00 2,503.33 110.00 2,496.79 110.00 2,490.26 110.00 2,483.73 110.00 2,477.19 110.00 2,470.66 $676,500 $677,000 110.00 2,511.73 110.00 2,505.20 110.00 2,498.67 110.00 2,492.13 110.00 2,485.60 110.00 2,479.07 110.00 2,472.53 $677,000 $677,500 110.00 2,513.61 110.00 2,507.08 110.00 2,500.54 110.00 2,494.01 110.00 2,487.48 110.00 2,480.94 110.00 2,474.41 $677,500 $678,000 110.00 2,515.48 110.00 2,508.95 110.00 2,502.42 110.00 2,495.88 110.00 2,489.35 110.00 2,482.82 110.00 2,476.28 $678,000 $678,500 110.00 2,517.36 110.00 2,510.83 110.00 2,504.29 110.00 2,497.76 110.00 2,491.23 110.00 2,484.69 110.00 2,478.16 $678,500 $679,000 110.00 2,519.23 110.00 2,512.70 110.00 2,506.17 110.00 2,499.63 110.00 2,493.10 110.00 2,486.57 110.00 2,480.03 $679,000 $679,500 110.00 2,521.11 110.00 2,514.58 110.00 2,508.04 110.00 2,501.51 110.00 2,494.98 110.00 2,488.44 110.00 2,481.91 $679,500 $680,000 110.00 2,522.98 110.00 2,516.45 110.00 2,509.92 110.00 2,503.38 110.00 2,496.85 110.00 2,490.32 110.00 2,483.78 $680,000 $680,500 110.00 2,524.86 110.00 2,518.33 110.00 2,511.79 110.00 2,505.26 110.00 2,498.73 110.00 2,492.19 110.00 2,485.66 $680,500 $681,000 110.00 2,526.73 110.00 2,520.20 110.00 2,513.67 110.00 2,507.13 110.00 2,500.60 110.00 2,494.07 110.00 2,487.53 $681,000 $681,500 110.00 2,528.61 110.00 2,522.08 110.00 2,515.54 110.00 2,509.01 110.00 2,502.48 110.00 2,495.94 110.00 2,489.41 $681,500 $682,000 110.00 2,530.48 110.00 2,523.95 110.00 2,517.42 110.00 2,510.88 110.00 2,504.35 110.00 2,497.82 110.00 2,491.28 $682,000 $682,500 110.00 2,532.36 110.00 2,525.83 110.00 2,519.29 110.00 2,512.76 110.00 2,506.23 110.00 2,499.69 110.00 2,493.16 $682,500 $683,000 110.00 2,534.23 110.00 2,527.70 110.00 2,521.17 110.00 2,514.63 110.00 2,508.10 110.00 2,501.57 110.00 2,495.03 $683,000 $683,500 110.00 2,536.11 110.00 2,529.58 110.00 2,523.04 110.00 2,516.51 110.00 2,509.98 110.00 2,503.44 110.00 2,496.91 $683,500 $684,000 110.00 2,537.98 110.00 2,531.45 110.00 2,524.92 110.00 2,518.38 110.00 2,511.85 110.00 2,505.32 110.00 2,498.78 $684,000 $684,500 110.00 2,539.86 110.00 2,533.33 110.00 2,526.79 110.00 2,520.26 110.00 2,513.73 110.00 2,507.19 110.00 2,500.66 $684,500 $685,000 110.00 2,541.73 110.00 2,535.20 110.00 2,528.67 110.00 2,522.13 110.00 2,515.60 110.00 2,509.07 110.00 2,502.53 $685,000 $685,500 110.00 2,543.61 110.00 2,537.08 110.00 2,530.54 110.00 2,524.01 110.00 2,517.48 110.00 2,510.94 110.00 2,504.41 $685,500 $686,000 110.00 2,545.48 110.00 2,538.95 110.00 2,532.42 110.00 2,525.88 110.00 2,519.35 110.00 2,512.82 110.00 2,506.28 $686,000 $686,500 110.00 2,547.36 110.00 2,540.83 110.00 2,534.29 110.00 2,527.76 110.00 2,521.23 110.00 2,514.69 110.00 2,508.16 $686,500 $687,000 110.00 2,549.23 110.00 2,542.70 110.00 2,536.17 110.00 2,529.63 110.00 2,523.10 110.00 2,516.57 110.00 2,510.03 $687,000 $687,500 110.00 2,551.11 110.00 2,544.58 110.00 2,538.04 110.00 2,531.51 110.00 2,524.98 110.00 2,518.44 110.00 2,511.91 $687,500 $688,000 110.00 2,552.98 110.00 2,546.45 110.00 2,539.92 110.00 2,533.38 110.00 2,526.85 110.00 2,520.32 110.00 2,513.78 $688,000 $688,500 110.00 2,554.86 110.00 2,548.33 110.00 2,541.79 110.00 2,535.26 110.00 2,528.73 110.00 2,522.19 110.00 2,515.66 $688,500 $689,000 110.00 2,556.73 110.00 2,550.20 110.00 2,543.67 110.00 2,537.13 110.00 2,530.60 110.00 2,524.07 110.00 2,517.53 $689,000 $689,500 110.00 2,558.61 110.00 2,552.08 110.00 2,545.54 110.00 2,539.01 110.00 2,532.48 110.00 2,525.94 110.00 2,519.41 $689,500 $690,000 110.00 2,560.48 110.00 2,553.95 110.00 2,547.42 110.00 2,540.88 110.00 2,534.35 110.00 2,527.82 110.00 2,521.28 $690,000 $690,500 110.00 2,562.36 110.00 2,555.83 110.00 2,549.29 110.00 2,542.76 110.00 2,536.23 110.00 2,529.69 110.00 2,523.16 $690,500 $691,000 110.00 2,564.23 110.00 2,557.70 110.00 2,551.17 110.00 2,544.63 110.00 2,538.10 110.00 2,531.57 110.00 2,525.03 $691,000 $691,500 110.00 2,566.11 110.00 2,559.58 110.00 2,553.04 110.00 2,546.51 110.00 2,539.98 110.00 2,533.44 110.00 2,526.91 $691,500 $692,000 110.00 2,567.98 110.00 2,561.45 110.00 2,554.92 110.00 2,548.38 110.00 2,541.85 110.00 2,535.32 110.00 2,528.78 $692,000 $692,500 110.00 2,569.86 110.00 2,563.33 110.00 2,556.79 110.00 2,550.26 110.00 2,543.73 110.00 2,537.19 110.00 2,530.66 $692,500 $693,000 110.00 2,571.73 110.00 2,565.20 110.00 2,558.67 110.00 2,552.13 110.00 2,545.60 110.00 2,539.07 110.00 2,532.53 $693,000 $693,500 110.00 2,573.61 110.00 2,567.08 110.00 2,560.54 110.00 2,554.01 110.00 2,547.48 110.00 2,540.94 110.00 2,534.41 $693,500 $694,000 110.00 2,575.48 110.00 2,568.95 110.00 2,562.42 110.00 2,555.88 110.00 2,549.35 110.00 2,542.82 110.00 2,536.28 $694,000 $694,500 110.00 2,577.36 110.00 2,570.83 110.00 2,564.29 110.00 2,557.76 110.00 2,551.23 110.00 2,544.69 110.00 2,538.16 $694,500 $695,000 110.00 2,579.23 110.00 2,572.70 110.00 2,566.17 110.00 2,559.63 110.00 2,553.10 110.00 2,546.57 110.00 2,540.03 $695,000 $695,500 110.00 2,581.11 110.00 2,574.58 110.00 2,568.04 110.00 2,561.51 110.00 2,554.98 110.00 2,548.44 110.00 2,541.91 $695,500 $696,000 110.00 2,582.98 110.00 2,576.45 110.00 2,569.92 110.00 2,563.38 110.00 2,556.85 110.00 2,550.32 110.00 2,543.78 $696,000 $696,500 110.00 2,584.86 110.00 2,578.33 110.00 2,571.79 110.00 2,565.26 110.00 2,558.73 110.00 2,552.19 110.00 2,545.66 $696,500 $697,000 110.00 2,586.73 110.00 2,580.20 110.00 2,573.67 110.00 2,567.13 110.00 2,560.60 110.00 2,554.07 110.00 2,547.53 $697,000 $697,500 110.00 2,588.61 110.00 2,582.08 110.00 2,575.54 110.00 2,569.01 110.00 2,562.48 110.00 2,555.94 110.00 2,549.41 $697,500 $698,000 110.00 2,590.48 110.00 2,583.95 110.00 2,577.42 110.00 2,570.88 110.00 2,564.35 110.00 2,557.82 110.00 2,551.28 $698,000 $698,500 110.00 2,592.36 110.00 2,585.83 110.00 2,579.29 110.00 2,572.76 110.00 2,566.23 110.00 2,559.69 110.00 2,553.16 $698,500 $699,000 110.00 2,594.23 110.00 2,587.70 110.00 2,581.17 110.00 2,574.63 110.00 2,568.10 110.00 2,561.57 110.00 2,555.03 $699,000 $699,500 110.00 2,596.11 110.00 2,589.58 110.00 2,583.04 110.00 2,576.51 110.00 2,569.98 110.00 2,563.44 110.00 2,556.91 $699,500 $700,000 110.00 2,597.98 110.00 2,591.45 110.00 2,584.92 110.00 2,578.38 110.00 2,571.85 110.00 2,565.32 110.00 2,558.78 $700,000 $700,500 110.00 2,599.86 110.00 2,593.33 110.00 2,586.79 110.00 2,580.26 110.00 2,573.73 110.00 2,567.19 110.00 2,560.66 $700,500 $701,000 110.00 2,601.73 110.00 2,595.20 110.00 2,588.67 110.00 2,582.13 110.00 2,575.60 110.00 2,569.07 110.00 2,562.53 $701,000 $701,500 110.00 2,603.61 110.00 2,597.08 110.00 2,590.54 110.00 2,584.01 110.00 2,577.48 110.00 2,570.94 110.00 2,564.41 $701,500 $702,000 110.00 2,605.48 110.00 2,598.95 110.00 2,592.42 110.00 2,585.88 110.00 2,579.35 110.00 2,572.82 110.00 2,566.28 $702,000 $702,500 110.00 2,607.36 110.00 2,600.83 110.00 2,594.29 110.00 2,587.76 110.00 2,581.23 110.00 2,574.69 110.00 2,568.16 $702,500 $703,000 110.00 2,609.23 110.00 2,602.70 110.00 2,596.17 110.00 2,589.63 110.00 2,583.10 110.00 2,576.57 110.00 2,570.03 $703,000 $703,500 110.00 2,611.11 110.00 2,604.58 110.00 2,598.04 110.00 2,591.51 110.00 2,584.98 110.00 2,578.44 110.00 2,571.91 $703,500 $704,000 110.00 2,612.98 110.00 2,606.45 110.00 2,599.92 110.00 2,593.38 110.00 2,586.85 110.00 2,580.32 110.00 2,573.78 $704,000 $704,500 110.00 2,614.86 110.00 2,608.33 110.00 2,601.79 110.00 2,595.26 110.00 2,588.73 110.00 2,582.19 110.00 2,575.66 $704,500 $705,000 110.00 2,616.73 110.00 2,610.20 110.00 2,603.67 110.00 2,597.13 110.00 2,590.60 110.00 2,584.07 110.00 2,577.53 $705,000 $705,500 110.00 2,618.61 110.00 2,612.08 110.00 2,605.54 110.00 2,599.01 110.00 2,592.48 110.00 2,585.94 110.00 2,579.41 $705,500 $706,000 110.00 2,620.48 110.00 2,613.95 110.00 2,607.42 110.00 2,600.88 110.00 2,594.35 110.00 2,587.82 110.00 2,581.28 $706,000 $706,500 110.00 2,622.36 110.00 2,615.83 110.00 2,609.29 110.00 2,602.76 110.00 2,596.23 110.00 2,589.69 110.00 2,583.16 $706,500 $707,000 110.00 2,624.23 110.00 2,617.70 110.00 2,611.17 110.00 2,604.63 110.00 2,598.10 110.00 2,591.57 110.00 2,585.03 $707,000 $707,500 110.00 2,626.11 110.00 2,619.58 110.00 2,613.04 110.00 2,606.51 110.00 2,599.98 110.00 2,593.44 110.00 2,586.91 $707,500 $708,000 110.00 2,627.98 110.00 2,621.45 110.00 2,614.92 110.00 2,608.38 110.00 2,601.85 110.00 2,595.32 110.00 2,588.78 $708,000 $708,500 110.00 2,629.86 110.00 2,623.33 110.00 2,616.79 110.00 2,610.26 110.00 2,603.73 110.00 2,597.19 110.00 2,590.66 $708,500 $709,000 110.00 2,631.73 110.00 2,625.20 110.00 2,618.67 110.00 2,612.13 110.00 2,605.60 110.00 2,599.07 110.00 2,592.53 $709,000 $709,500 110.00 2,633.61 110.00 2,627.08 110.00 2,620.54 110.00 2,614.01 110.00 2,607.48 110.00 2,600.94 110.00 2,594.41 $709,500 $710,000 110.00 2,635.48 110.00 2,628.95 110.00 2,622.42 110.00 2,615.88 110.00 2,609.35 110.00 2,602.82 110.00 2,596.28 $710,000 $710,500 110.00 2,637.36 110.00 2,630.83 110.00 2,624.29 110.00 2,617.76 110.00 2,611.23 110.00 2,604.69 110.00 2,598.16 $710,500 $711,000 110.00 2,639.23 110.00 2,632.70 110.00 2,626.17 110.00 2,619.63 110.00 2,613.10 110.00 2,606.57 110.00 2,600.03 $711,000 $711,500 110.00 2,641.11 110.00 2,634.58 110.00 2,628.04 110.00 2,621.51 110.00 2,614.98 110.00 2,608.44 110.00 2,601.91 $711,500 $712,000 110.00 2,642.98 110.00 2,636.45 110.00 2,629.92 110.00 2,623.38 110.00 2,616.85 110.00 2,610.32 110.00 2,603.78 $712,000 $712,500 110.00 2,644.86 110.00 2,638.33 110.00 2,631.79 110.00 2,625.26 110.00 2,618.73 110.00 2,612.19 110.00 2,605.66 $712,500 $713,000 110.00 2,646.73 110.00 2,640.20 110.00 2,633.67 110.00 2,627.13 110.00 2,620.60 110.00 2,614.07 110.00 2,607.53 $713,000 $713,500 110.00 2,648.61 110.00 2,642.08 110.00 2,635.54 110.00 2,629.01 110.00 2,622.48 110.00 2,615.94 110.00 2,609.41 $713,500 $714,000 110.00 2,650.48 110.00 2,643.95 110.00 2,637.42 110.00 2,630.88 110.00 2,624.35 110.00 2,617.82 110.00 2,611.28

NJEIS Family Cost Participation Table Page 17 of 12 Effective July 1, 2015

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

$714,000 $714,500 110.00 2,652.36 110.00 2,645.83 110.00 2,639.29 110.00 2,632.76 110.00 2,626.23 110.00 2,619.69 110.00 2,613.16 $714,500 $715,000 110.00 2,654.23 110.00 2,647.70 110.00 2,641.17 110.00 2,634.63 110.00 2,628.10 110.00 2,621.57 110.00 2,615.03 $715,000 $715,500 110.00 2,656.11 110.00 2,649.58 110.00 2,643.04 110.00 2,636.51 110.00 2,629.98 110.00 2,623.44 110.00 2,616.91 $715,500 $716,000 110.00 2,657.98 110.00 2,651.45 110.00 2,644.92 110.00 2,638.38 110.00 2,631.85 110.00 2,625.32 110.00 2,618.78 $716,000 $716,500 110.00 2,659.86 110.00 2,653.33 110.00 2,646.79 110.00 2,640.26 110.00 2,633.73 110.00 2,627.19 110.00 2,620.66 $716,500 $717,000 110.00 2,661.73 110.00 2,655.20 110.00 2,648.67 110.00 2,642.13 110.00 2,635.60 110.00 2,629.07 110.00 2,622.53 $717,000 $717,500 110.00 2,663.61 110.00 2,657.08 110.00 2,650.54 110.00 2,644.01 110.00 2,637.48 110.00 2,630.94 110.00 2,624.41 $717,500 $718,000 110.00 2,665.48 110.00 2,658.95 110.00 2,652.42 110.00 2,645.88 110.00 2,639.35 110.00 2,632.82 110.00 2,626.28 $718,000 $718,500 110.00 2,667.36 110.00 2,660.83 110.00 2,654.29 110.00 2,647.76 110.00 2,641.23 110.00 2,634.69 110.00 2,628.16 $718,500 $719,000 110.00 2,669.23 110.00 2,662.70 110.00 2,656.17 110.00 2,649.63 110.00 2,643.10 110.00 2,636.57 110.00 2,630.03 $719,000 $719,500 110.00 2,671.11 110.00 2,664.58 110.00 2,658.04 110.00 2,651.51 110.00 2,644.98 110.00 2,638.44 110.00 2,631.91 $719,500 $720,000 110.00 2,672.98 110.00 2,666.45 110.00 2,659.92 110.00 2,653.38 110.00 2,646.85 110.00 2,640.32 110.00 2,633.78 $720,000 $720,500 110.00 2,674.86 110.00 2,668.33 110.00 2,661.79 110.00 2,655.26 110.00 2,648.73 110.00 2,642.19 110.00 2,635.66 $720,500 $721,000 110.00 2,676.73 110.00 2,670.20 110.00 2,663.67 110.00 2,657.13 110.00 2,650.60 110.00 2,644.07 110.00 2,637.53 $721,000 $721,500 110.00 2,678.61 110.00 2,672.08 110.00 2,665.54 110.00 2,659.01 110.00 2,652.48 110.00 2,645.94 110.00 2,639.41 $721,500 $722,000 110.00 2,680.48 110.00 2,673.95 110.00 2,667.42 110.00 2,660.88 110.00 2,654.35 110.00 2,647.82 110.00 2,641.28 $722,000 $722,500 110.00 2,682.36 110.00 2,675.83 110.00 2,669.29 110.00 2,662.76 110.00 2,656.23 110.00 2,649.69 110.00 2,643.16 $722,500 $723,000 110.00 2,684.23 110.00 2,677.70 110.00 2,671.17 110.00 2,664.63 110.00 2,658.10 110.00 2,651.57 110.00 2,645.03 $723,000 $723,500 110.00 2,686.11 110.00 2,679.58 110.00 2,673.04 110.00 2,666.51 110.00 2,659.98 110.00 2,653.44 110.00 2,646.91 $723,500 $724,000 110.00 2,687.98 110.00 2,681.45 110.00 2,674.92 110.00 2,668.38 110.00 2,661.85 110.00 2,655.32 110.00 2,648.78 $724,000 $724,500 110.00 2,689.86 110.00 2,683.33 110.00 2,676.79 110.00 2,670.26 110.00 2,663.73 110.00 2,657.19 110.00 2,650.66 $724,500 $725,000 110.00 2,691.73 110.00 2,685.20 110.00 2,678.67 110.00 2,672.13 110.00 2,665.60 110.00 2,659.07 110.00 2,652.53 $725,000 $725,500 110.00 2,693.61 110.00 2,687.08 110.00 2,680.54 110.00 2,674.01 110.00 2,667.48 110.00 2,660.94 110.00 2,654.41 $725,500 $726,000 110.00 2,695.48 110.00 2,688.95 110.00 2,682.42 110.00 2,675.88 110.00 2,669.35 110.00 2,662.82 110.00 2,656.28 $726,000 $726,500 110.00 2,697.36 110.00 2,690.83 110.00 2,684.29 110.00 2,677.76 110.00 2,671.23 110.00 2,664.69 110.00 2,658.16 $726,500 $727,000 110.00 2,699.23 110.00 2,692.70 110.00 2,686.17 110.00 2,679.63 110.00 2,673.10 110.00 2,666.57 110.00 2,660.03 $727,000 $727,500 110.00 2,701.11 110.00 2,694.58 110.00 2,688.04 110.00 2,681.51 110.00 2,674.98 110.00 2,668.44 110.00 2,661.91 $727,500 $728,000 110.00 2,702.98 110.00 2,696.45 110.00 2,689.92 110.00 2,683.38 110.00 2,676.85 110.00 2,670.32 110.00 2,663.78 $728,000 $728,500 110.00 2,704.86 110.00 2,698.33 110.00 2,691.79 110.00 2,685.26 110.00 2,678.73 110.00 2,672.19 110.00 2,665.66 $728,500 $729,000 110.00 2,706.73 110.00 2,700.20 110.00 2,693.67 110.00 2,687.13 110.00 2,680.60 110.00 2,674.07 110.00 2,667.53 $729,000 $729,500 110.00 2,708.61 110.00 2,702.08 110.00 2,695.54 110.00 2,689.01 110.00 2,682.48 110.00 2,675.94 110.00 2,669.41 $729,500 $730,000 110.00 2,710.48 110.00 2,703.95 110.00 2,697.42 110.00 2,690.88 110.00 2,684.35 110.00 2,677.82 110.00 2,671.28 $730,000 $730,500 110.00 2,712.36 110.00 2,705.83 110.00 2,699.29 110.00 2,692.76 110.00 2,686.23 110.00 2,679.69 110.00 2,673.16 $730,500 $731,000 110.00 2,714.23 110.00 2,707.70 110.00 2,701.17 110.00 2,694.63 110.00 2,688.10 110.00 2,681.57 110.00 2,675.03 $731,000 $731,500 110.00 2,716.11 110.00 2,709.58 110.00 2,703.04 110.00 2,696.51 110.00 2,689.98 110.00 2,683.44 110.00 2,676.91 $731,500 $732,000 110.00 2,717.98 110.00 2,711.45 110.00 2,704.92 110.00 2,698.38 110.00 2,691.85 110.00 2,685.32 110.00 2,678.78 $732,000 $732,500 110.00 2,719.86 110.00 2,713.33 110.00 2,706.79 110.00 2,700.26 110.00 2,693.73 110.00 2,687.19 110.00 2,680.66 $732,500 $733,000 110.00 2,721.73 110.00 2,715.20 110.00 2,708.67 110.00 2,702.13 110.00 2,695.60 110.00 2,689.07 110.00 2,682.53 $733,000 $733,500 110.00 2,723.61 110.00 2,717.08 110.00 2,710.54 110.00 2,704.01 110.00 2,697.48 110.00 2,690.94 110.00 2,684.41 $733,500 $734,000 110.00 2,725.48 110.00 2,718.95 110.00 2,712.42 110.00 2,705.88 110.00 2,699.35 110.00 2,692.82 110.00 2,686.28 $734,000 $734,500 110.00 2,727.36 110.00 2,720.83 110.00 2,714.29 110.00 2,707.76 110.00 2,701.23 110.00 2,694.69 110.00 2,688.16 $734,500 $735,000 110.00 2,729.23 110.00 2,722.70 110.00 2,716.17 110.00 2,709.63 110.00 2,703.10 110.00 2,696.57 110.00 2,690.03 $735,000 $735,500 110.00 2,731.11 110.00 2,724.58 110.00 2,718.04 110.00 2,711.51 110.00 2,704.98 110.00 2,698.44 110.00 2,691.91 $735,500 $736,000 110.00 2,732.98 110.00 2,726.45 110.00 2,719.92 110.00 2,713.38 110.00 2,706.85 110.00 2,700.32 110.00 2,693.78 $736,000 $736,500 110.00 2,734.86 110.00 2,728.33 110.00 2,721.79 110.00 2,715.26 110.00 2,708.73 110.00 2,702.19 110.00 2,695.66 $736,500 $737,000 110.00 2,736.73 110.00 2,730.20 110.00 2,723.67 110.00 2,717.13 110.00 2,710.60 110.00 2,704.07 110.00 2,697.53 $737,000 $737,500 110.00 2,738.61 110.00 2,732.08 110.00 2,725.54 110.00 2,719.01 110.00 2,712.48 110.00 2,705.94 110.00 2,699.41 $737,500 $738,000 110.00 2,740.48 110.00 2,733.95 110.00 2,727.42 110.00 2,720.88 110.00 2,714.35 110.00 2,707.82 110.00 2,701.28 $738,000 $738,500 110.00 2,742.36 110.00 2,735.83 110.00 2,729.29 110.00 2,722.76 110.00 2,716.23 110.00 2,709.69 110.00 2,703.16 $738,500 $739,000 110.00 2,744.23 110.00 2,737.70 110.00 2,731.17 110.00 2,724.63 110.00 2,718.10 110.00 2,711.57 110.00 2,705.03 $739,000 $739,500 110.00 2,746.11 110.00 2,739.58 110.00 2,733.04 110.00 2,726.51 110.00 2,719.98 110.00 2,713.44 110.00 2,706.91 $739,500 $740,000 110.00 2,747.98 110.00 2,741.45 110.00 2,734.92 110.00 2,728.38 110.00 2,721.85 110.00 2,715.32 110.00 2,708.78 $740,000 $740,500 110.00 2,749.86 110.00 2,743.33 110.00 2,736.79 110.00 2,730.26 110.00 2,723.73 110.00 2,717.19 110.00 2,710.66 $740,500 $741,000 110.00 2,751.73 110.00 2,745.20 110.00 2,738.67 110.00 2,732.13 110.00 2,725.60 110.00 2,719.07 110.00 2,712.53 $741,000 $741,500 110.00 2,753.61 110.00 2,747.08 110.00 2,740.54 110.00 2,734.01 110.00 2,727.48 110.00 2,720.94 110.00 2,714.41 $741,500 $742,000 110.00 2,755.48 110.00 2,748.95 110.00 2,742.42 110.00 2,735.88 110.00 2,729.35 110.00 2,722.82 110.00 2,716.28 $742,000 $742,500 110.00 2,757.36 110.00 2,750.83 110.00 2,744.29 110.00 2,737.76 110.00 2,731.23 110.00 2,724.69 110.00 2,718.16 $742,500 $743,000 110.00 2,759.23 110.00 2,752.70 110.00 2,746.17 110.00 2,739.63 110.00 2,733.10 110.00 2,726.57 110.00 2,720.03 $743,000 $743,500 110.00 2,761.11 110.00 2,754.58 110.00 2,748.04 110.00 2,741.51 110.00 2,734.98 110.00 2,728.44 110.00 2,721.91 $743,500 $744,000 110.00 2,762.98 110.00 2,756.45 110.00 2,749.92 110.00 2,743.38 110.00 2,736.85 110.00 2,730.32 110.00 2,723.78 $744,000 $744,500 110.00 2,764.86 110.00 2,758.33 110.00 2,751.79 110.00 2,745.26 110.00 2,738.73 110.00 2,732.19 110.00 2,725.66 $744,500 $745,000 110.00 2,766.73 110.00 2,760.20 110.00 2,753.67 110.00 2,747.13 110.00 2,740.60 110.00 2,734.07 110.00 2,727.53 $745,000 $745,500 110.00 2,768.61 110.00 2,762.08 110.00 2,755.54 110.00 2,749.01 110.00 2,742.48 110.00 2,735.94 110.00 2,729.41 $745,500 $746,000 110.00 2,770.48 110.00 2,763.95 110.00 2,757.42 110.00 2,750.88 110.00 2,744.35 110.00 2,737.82 110.00 2,731.28 $746,000 $746,500 110.00 2,772.36 110.00 2,765.83 110.00 2,759.29 110.00 2,752.76 110.00 2,746.23 110.00 2,739.69 110.00 2,733.16 $746,500 $747,000 110.00 2,774.23 110.00 2,767.70 110.00 2,761.17 110.00 2,754.63 110.00 2,748.10 110.00 2,741.57 110.00 2,735.03 $747,000 $747,500 110.00 2,776.11 110.00 2,769.58 110.00 2,763.04 110.00 2,756.51 110.00 2,749.98 110.00 2,743.44 110.00 2,736.91 $747,500 $748,000 110.00 2,777.98 110.00 2,771.45 110.00 2,764.92 110.00 2,758.38 110.00 2,751.85 110.00 2,745.32 110.00 2,738.78 $748,000 $748,500 110.00 2,779.86 110.00 2,773.33 110.00 2,766.79 110.00 2,760.26 110.00 2,753.73 110.00 2,747.19 110.00 2,740.66 $748,500 $749,000 110.00 2,781.73 110.00 2,775.20 110.00 2,768.67 110.00 2,762.13 110.00 2,755.60 110.00 2,749.07 110.00 2,742.53 $749,000 $749,500 110.00 2,783.61 110.00 2,777.08 110.00 2,770.54 110.00 2,764.01 110.00 2,757.48 110.00 2,750.94 110.00 2,744.41 $749,500 $750,000 110.00 2,785.48 110.00 2,778.95 110.00 2,772.42 110.00 2,765.88 110.00 2,759.35 110.00 2,752.82 110.00 2,746.28 $750,000 $750,500 110.00 2,787.36 110.00 2,780.83 110.00 2,774.29 110.00 2,767.76 110.00 2,761.23 110.00 2,754.69 110.00 2,748.16 $750,500 $751,000 110.00 2,789.23 110.00 2,782.70 110.00 2,776.17 110.00 2,769.63 110.00 2,763.10 110.00 2,756.57 110.00 2,750.03 $751,000 $751,500 110.00 2,791.11 110.00 2,784.58 110.00 2,778.04 110.00 2,771.51 110.00 2,764.98 110.00 2,758.44 110.00 2,751.91 $751,500 $752,000 110.00 2,792.98 110.00 2,786.45 110.00 2,779.92 110.00 2,773.38 110.00 2,766.85 110.00 2,760.32 110.00 2,753.78 $752,000 $752,500 110.00 2,794.86 110.00 2,788.33 110.00 2,781.79 110.00 2,775.26 110.00 2,768.73 110.00 2,762.19 110.00 2,755.66 $752,500 $753,000 110.00 2,796.73 110.00 2,790.20 110.00 2,783.67 110.00 2,777.13 110.00 2,770.60 110.00 2,764.07 110.00 2,757.53 $753,000 $753,500 110.00 2,798.61 110.00 2,792.08 110.00 2,785.54 110.00 2,779.01 110.00 2,772.48 110.00 2,765.94 110.00 2,759.41 $753,500 $754,000 110.00 2,800.48 110.00 2,793.95 110.00 2,787.42 110.00 2,780.88 110.00 2,774.35 110.00 2,767.82 110.00 2,761.28 $754,000 $754,500 110.00 2,802.36 110.00 2,795.83 110.00 2,789.29 110.00 2,782.76 110.00 2,776.23 110.00 2,769.69 110.00 2,763.16 $754,500 $755,000 110.00 2,804.23 110.00 2,797.70 110.00 2,791.17 110.00 2,784.63 110.00 2,778.10 110.00 2,771.57 110.00 2,765.03 $755,000 $755,500 110.00 2,806.11 110.00 2,799.58 110.00 2,793.04 110.00 2,786.51 110.00 2,779.98 110.00 2,773.44 110.00 2,766.91 $755,500 $756,000 110.00 2,807.98 110.00 2,801.45 110.00 2,794.92 110.00 2,788.38 110.00 2,781.85 110.00 2,775.32 110.00 2,768.78 $756,000 $756,500 110.00 2,809.86 110.00 2,803.33 110.00 2,796.79 110.00 2,790.26 110.00 2,783.73 110.00 2,777.19 110.00 2,770.66 $756,500 $757,000 110.00 2,811.73 110.00 2,805.20 110.00 2,798.67 110.00 2,792.13 110.00 2,785.60 110.00 2,779.07 110.00 2,772.53 $757,000 $757,500 110.00 2,813.61 110.00 2,807.08 110.00 2,800.54 110.00 2,794.01 110.00 2,787.48 110.00 2,780.94 110.00 2,774.41 $757,500 $758,000 110.00 2,815.48 110.00 2,808.95 110.00 2,802.42 110.00 2,795.88 110.00 2,789.35 110.00 2,782.82 110.00 2,776.28 $758,000 $758,500 110.00 2,817.36 110.00 2,810.83 110.00 2,804.29 110.00 2,797.76 110.00 2,791.23 110.00 2,784.69 110.00 2,778.16 $758,500 $759,000 110.00 2,819.23 110.00 2,812.70 110.00 2,806.17 110.00 2,799.63 110.00 2,793.10 110.00 2,786.57 110.00 2,780.03 $759,000 $759,500 110.00 2,821.11 110.00 2,814.58 110.00 2,808.04 110.00 2,801.51 110.00 2,794.98 110.00 2,788.44 110.00 2,781.91 $759,500 $760,000 110.00 2,822.98 110.00 2,816.45 110.00 2,809.92 110.00 2,803.38 110.00 2,796.85 110.00 2,790.32 110.00 2,783.78 $760,000 $760,500 110.00 2,824.86 110.00 2,818.33 110.00 2,811.79 110.00 2,805.26 110.00 2,798.73 110.00 2,792.19 110.00 2,785.66 $760,500 $761,000 110.00 2,826.73 110.00 2,820.20 110.00 2,813.67 110.00 2,807.13 110.00 2,800.60 110.00 2,794.07 110.00 2,787.53 $761,000 $761,500 110.00 2,828.61 110.00 2,822.08 110.00 2,815.54 110.00 2,809.01 110.00 2,802.48 110.00 2,795.94 110.00 2,789.41 $761,500 $762,000 110.00 2,830.48 110.00 2,823.95 110.00 2,817.42 110.00 2,810.88 110.00 2,804.35 110.00 2,797.82 110.00 2,791.28 $762,000 $762,500 110.00 2,832.36 110.00 2,825.83 110.00 2,819.29 110.00 2,812.76 110.00 2,806.23 110.00 2,799.69 110.00 2,793.16 $762,500 $763,000 110.00 2,834.23 110.00 2,827.70 110.00 2,821.17 110.00 2,814.63 110.00 2,808.10 110.00 2,801.57 110.00 2,795.03 $763,000 $763,500 110.00 2,836.11 110.00 2,829.58 110.00 2,823.04 110.00 2,816.51 110.00 2,809.98 110.00 2,803.44 110.00 2,796.91 $763,500 $764,000 110.00 2,837.98 110.00 2,831.45 110.00 2,824.92 110.00 2,818.38 110.00 2,811.85 110.00 2,805.32 110.00 2,798.78 $764,000 $764,500 110.00 2,839.86 110.00 2,833.33 110.00 2,826.79 110.00 2,820.26 110.00 2,813.73 110.00 2,807.19 110.00 2,800.66 $764,500 $765,000 110.00 2,841.73 110.00 2,835.20 110.00 2,828.67 110.00 2,822.13 110.00 2,815.60 110.00 2,809.07 110.00 2,802.53

NJEIS Family Cost Participation Table Page 18 of 12 Effective July 1, 2015

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

$765,000 $765,500 110.00 2,843.61 110.00 2,837.08 110.00 2,830.54 110.00 2,824.01 110.00 2,817.48 110.00 2,810.94 110.00 2,804.41 $765,500 $766,000 110.00 2,845.48 110.00 2,838.95 110.00 2,832.42 110.00 2,825.88 110.00 2,819.35 110.00 2,812.82 110.00 2,806.28 $766,000 $766,500 110.00 2,847.36 110.00 2,840.83 110.00 2,834.29 110.00 2,827.76 110.00 2,821.23 110.00 2,814.69 110.00 2,808.16 $766,500 $767,000 110.00 2,849.23 110.00 2,842.70 110.00 2,836.17 110.00 2,829.63 110.00 2,823.10 110.00 2,816.57 110.00 2,810.03 $767,000 $767,500 110.00 2,851.11 110.00 2,844.58 110.00 2,838.04 110.00 2,831.51 110.00 2,824.98 110.00 2,818.44 110.00 2,811.91 $767,500 $768,000 110.00 2,852.98 110.00 2,846.45 110.00 2,839.92 110.00 2,833.38 110.00 2,826.85 110.00 2,820.32 110.00 2,813.78 $768,000 $768,500 110.00 2,854.86 110.00 2,848.33 110.00 2,841.79 110.00 2,835.26 110.00 2,828.73 110.00 2,822.19 110.00 2,815.66 $768,500 $769,000 110.00 2,856.73 110.00 2,850.20 110.00 2,843.67 110.00 2,837.13 110.00 2,830.60 110.00 2,824.07 110.00 2,817.53 $769,000 $769,500 110.00 2,858.61 110.00 2,852.08 110.00 2,845.54 110.00 2,839.01 110.00 2,832.48 110.00 2,825.94 110.00 2,819.41 $769,500 $770,000 110.00 2,860.48 110.00 2,853.95 110.00 2,847.42 110.00 2,840.88 110.00 2,834.35 110.00 2,827.82 110.00 2,821.28 $770,000 $770,500 110.00 2,862.36 110.00 2,855.83 110.00 2,849.29 110.00 2,842.76 110.00 2,836.23 110.00 2,829.69 110.00 2,823.16 $770,500 $771,000 110.00 2,864.23 110.00 2,857.70 110.00 2,851.17 110.00 2,844.63 110.00 2,838.10 110.00 2,831.57 110.00 2,825.03 $771,000 $771,500 110.00 2,866.11 110.00 2,859.58 110.00 2,853.04 110.00 2,846.51 110.00 2,839.98 110.00 2,833.44 110.00 2,826.91 $771,500 $772,000 110.00 2,867.98 110.00 2,861.45 110.00 2,854.92 110.00 2,848.38 110.00 2,841.85 110.00 2,835.32 110.00 2,828.78 $772,000 $772,500 110.00 2,869.86 110.00 2,863.33 110.00 2,856.79 110.00 2,850.26 110.00 2,843.73 110.00 2,837.19 110.00 2,830.66 $772,500 $773,000 110.00 2,871.73 110.00 2,865.20 110.00 2,858.67 110.00 2,852.13 110.00 2,845.60 110.00 2,839.07 110.00 2,832.53 $773,000 $773,500 110.00 2,873.61 110.00 2,867.08 110.00 2,860.54 110.00 2,854.01 110.00 2,847.48 110.00 2,840.94 110.00 2,834.41 $773,500 $774,000 110.00 2,875.48 110.00 2,868.95 110.00 2,862.42 110.00 2,855.88 110.00 2,849.35 110.00 2,842.82 110.00 2,836.28 $774,000 $774,500 110.00 2,877.36 110.00 2,870.83 110.00 2,864.29 110.00 2,857.76 110.00 2,851.23 110.00 2,844.69 110.00 2,838.16 $774,500 $775,000 110.00 2,879.23 110.00 2,872.70 110.00 2,866.17 110.00 2,859.63 110.00 2,853.10 110.00 2,846.57 110.00 2,840.03 $775,000 $775,500 110.00 2,881.11 110.00 2,874.58 110.00 2,868.04 110.00 2,861.51 110.00 2,854.98 110.00 2,848.44 110.00 2,841.91 $775,500 $776,000 110.00 2,882.98 110.00 2,876.45 110.00 2,869.92 110.00 2,863.38 110.00 2,856.85 110.00 2,850.32 110.00 2,843.78 $776,000 $776,500 110.00 2,884.86 110.00 2,878.33 110.00 2,871.79 110.00 2,865.26 110.00 2,858.73 110.00 2,852.19 110.00 2,845.66 $776,500 $777,000 110.00 2,886.73 110.00 2,880.20 110.00 2,873.67 110.00 2,867.13 110.00 2,860.60 110.00 2,854.07 110.00 2,847.53 $777,000 $777,500 110.00 2,888.61 110.00 2,882.08 110.00 2,875.54 110.00 2,869.01 110.00 2,862.48 110.00 2,855.94 110.00 2,849.41 $777,500 $778,000 110.00 2,890.48 110.00 2,883.95 110.00 2,877.42 110.00 2,870.88 110.00 2,864.35 110.00 2,857.82 110.00 2,851.28 $778,000 $778,500 110.00 2,892.36 110.00 2,885.83 110.00 2,879.29 110.00 2,872.76 110.00 2,866.23 110.00 2,859.69 110.00 2,853.16 $778,500 $779,000 110.00 2,894.23 110.00 2,887.70 110.00 2,881.17 110.00 2,874.63 110.00 2,868.10 110.00 2,861.57 110.00 2,855.03 $779,000 $779,500 110.00 2,896.11 110.00 2,889.58 110.00 2,883.04 110.00 2,876.51 110.00 2,869.98 110.00 2,863.44 110.00 2,856.91 $779,500 $780,000 110.00 2,897.98 110.00 2,891.45 110.00 2,884.92 110.00 2,878.38 110.00 2,871.85 110.00 2,865.32 110.00 2,858.78 $780,000 $780,500 110.00 2,899.86 110.00 2,893.33 110.00 2,886.79 110.00 2,880.26 110.00 2,873.73 110.00 2,867.19 110.00 2,860.66 $780,500 $781,000 110.00 2,901.73 110.00 2,895.20 110.00 2,888.67 110.00 2,882.13 110.00 2,875.60 110.00 2,869.07 110.00 2,862.53 $781,000 $781,500 110.00 2,903.61 110.00 2,897.08 110.00 2,890.54 110.00 2,884.01 110.00 2,877.48 110.00 2,870.94 110.00 2,864.41 $781,500 $782,000 110.00 2,905.48 110.00 2,898.95 110.00 2,892.42 110.00 2,885.88 110.00 2,879.35 110.00 2,872.82 110.00 2,866.28 $782,000 $782,500 110.00 2,907.36 110.00 2,900.83 110.00 2,894.29 110.00 2,887.76 110.00 2,881.23 110.00 2,874.69 110.00 2,868.16 $782,500 $783,000 110.00 2,909.23 110.00 2,902.70 110.00 2,896.17 110.00 2,889.63 110.00 2,883.10 110.00 2,876.57 110.00 2,870.03 $783,000 $783,500 110.00 2,911.11 110.00 2,904.58 110.00 2,898.04 110.00 2,891.51 110.00 2,884.98 110.00 2,878.44 110.00 2,871.91 $783,500 $784,000 110.00 2,912.98 110.00 2,906.45 110.00 2,899.92 110.00 2,893.38 110.00 2,886.85 110.00 2,880.32 110.00 2,873.78 $784,000 $784,500 110.00 2,914.86 110.00 2,908.33 110.00 2,901.79 110.00 2,895.26 110.00 2,888.73 110.00 2,882.19 110.00 2,875.66 $784,500 $785,000 110.00 2,916.73 110.00 2,910.20 110.00 2,903.67 110.00 2,897.13 110.00 2,890.60 110.00 2,884.07 110.00 2,877.53 $785,000 $785,500 110.00 2,918.61 110.00 2,912.08 110.00 2,905.54 110.00 2,899.01 110.00 2,892.48 110.00 2,885.94 110.00 2,879.41 $785,500 $786,000 110.00 2,920.48 110.00 2,913.95 110.00 2,907.42 110.00 2,900.88 110.00 2,894.35 110.00 2,887.82 110.00 2,881.28 $786,000 $786,500 110.00 2,922.36 110.00 2,915.83 110.00 2,909.29 110.00 2,902.76 110.00 2,896.23 110.00 2,889.69 110.00 2,883.16 $786,500 $787,000 110.00 2,924.23 110.00 2,917.70 110.00 2,911.17 110.00 2,904.63 110.00 2,898.10 110.00 2,891.57 110.00 2,885.03 $787,000 $787,500 110.00 2,926.11 110.00 2,919.58 110.00 2,913.04 110.00 2,906.51 110.00 2,899.98 110.00 2,893.44 110.00 2,886.91 $787,500 $788,000 110.00 2,927.98 110.00 2,921.45 110.00 2,914.92 110.00 2,908.38 110.00 2,901.85 110.00 2,895.32 110.00 2,888.78 $788,000 $788,500 110.00 2,929.86 110.00 2,923.33 110.00 2,916.79 110.00 2,910.26 110.00 2,903.73 110.00 2,897.19 110.00 2,890.66 $788,500 $789,000 110.00 2,931.73 110.00 2,925.20 110.00 2,918.67 110.00 2,912.13 110.00 2,905.60 110.00 2,899.07 110.00 2,892.53 $789,000 $789,500 110.00 2,933.61 110.00 2,927.08 110.00 2,920.54 110.00 2,914.01 110.00 2,907.48 110.00 2,900.94 110.00 2,894.41 $789,500 $790,000 110.00 2,935.48 110.00 2,928.95 110.00 2,922.42 110.00 2,915.88 110.00 2,909.35 110.00 2,902.82 110.00 2,896.28 $790,000 $790,500 110.00 2,937.36 110.00 2,930.83 110.00 2,924.29 110.00 2,917.76 110.00 2,911.23 110.00 2,904.69 110.00 2,898.16 $790,500 $791,000 110.00 2,939.23 110.00 2,932.70 110.00 2,926.17 110.00 2,919.63 110.00 2,913.10 110.00 2,906.57 110.00 2,900.03 $791,000 $791,500 110.00 2,941.11 110.00 2,934.58 110.00 2,928.04 110.00 2,921.51 110.00 2,914.98 110.00 2,908.44 110.00 2,901.91 $791,500 $792,000 110.00 2,942.98 110.00 2,936.45 110.00 2,929.92 110.00 2,923.38 110.00 2,916.85 110.00 2,910.32 110.00 2,903.78 $792,000 $792,500 110.00 2,944.86 110.00 2,938.33 110.00 2,931.79 110.00 2,925.26 110.00 2,918.73 110.00 2,912.19 110.00 2,905.66 $792,500 $793,000 110.00 2,946.73 110.00 2,940.20 110.00 2,933.67 110.00 2,927.13 110.00 2,920.60 110.00 2,914.07 110.00 2,907.53 $793,000 $793,500 110.00 2,948.61 110.00 2,942.08 110.00 2,935.54 110.00 2,929.01 110.00 2,922.48 110.00 2,915.94 110.00 2,909.41 $793,500 $794,000 110.00 2,950.48 110.00 2,943.95 110.00 2,937.42 110.00 2,930.88 110.00 2,924.35 110.00 2,917.82 110.00 2,911.28 $794,000 $794,500 110.00 2,952.36 110.00 2,945.83 110.00 2,939.29 110.00 2,932.76 110.00 2,926.23 110.00 2,919.69 110.00 2,913.16 $794,500 $795,000 110.00 2,954.23 110.00 2,947.70 110.00 2,941.17 110.00 2,934.63 110.00 2,928.10 110.00 2,921.57 110.00 2,915.03 $795,000 $795,500 110.00 2,956.11 110.00 2,949.58 110.00 2,943.04 110.00 2,936.51 110.00 2,929.98 110.00 2,923.44 110.00 2,916.91 $795,500 $796,000 110.00 2,957.98 110.00 2,951.45 110.00 2,944.92 110.00 2,938.38 110.00 2,931.85 110.00 2,925.32 110.00 2,918.78 $796,000 $796,500 110.00 2,959.86 110.00 2,953.33 110.00 2,946.79 110.00 2,940.26 110.00 2,933.73 110.00 2,927.19 110.00 2,920.66 $796,500 $797,000 110.00 2,961.73 110.00 2,955.20 110.00 2,948.67 110.00 2,942.13 110.00 2,935.60 110.00 2,929.07 110.00 2,922.53 $797,000 $797,500 110.00 2,963.61 110.00 2,957.08 110.00 2,950.54 110.00 2,944.01 110.00 2,937.48 110.00 2,930.94 110.00 2,924.41 $797,500 $798,000 110.00 2,965.48 110.00 2,958.95 110.00 2,952.42 110.00 2,945.88 110.00 2,939.35 110.00 2,932.82 110.00 2,926.28 $798,000 $798,500 110.00 2,967.36 110.00 2,960.83 110.00 2,954.29 110.00 2,947.76 110.00 2,941.23 110.00 2,934.69 110.00 2,928.16 $798,500 $799,000 110.00 2,969.23 110.00 2,962.70 110.00 2,956.17 110.00 2,949.63 110.00 2,943.10 110.00 2,936.57 110.00 2,930.03 $799,000 $799,500 110.00 2,971.11 110.00 2,964.58 110.00 2,958.04 110.00 2,951.51 110.00 2,944.98 110.00 2,938.44 110.00 2,931.91 $799,500 $800,000 110.00 2,972.98 110.00 2,966.45 110.00 2,959.92 110.00 2,953.38 110.00 2,946.85 110.00 2,940.32 110.00 2,933.78 $800,000 $800,500 110.00 2,974.86 110.00 2,968.33 110.00 2,961.79 110.00 2,955.26 110.00 2,948.73 110.00 2,942.19 110.00 2,935.66 $800,500 $801,000 110.00 2,976.73 110.00 2,970.20 110.00 2,963.67 110.00 2,957.13 110.00 2,950.60 110.00 2,944.07 110.00 2,937.53 $801,000 $801,500 110.00 2,978.61 110.00 2,972.08 110.00 2,965.54 110.00 2,959.01 110.00 2,952.48 110.00 2,945.94 110.00 2,939.41 $801,500 $802,000 110.00 2,980.48 110.00 2,973.95 110.00 2,967.42 110.00 2,960.88 110.00 2,954.35 110.00 2,947.82 110.00 2,941.28 $802,000 $802,500 110.00 2,982.36 110.00 2,975.83 110.00 2,969.29 110.00 2,962.76 110.00 2,956.23 110.00 2,949.69 110.00 2,943.16 $802,500 $803,000 110.00 2,984.23 110.00 2,977.70 110.00 2,971.17 110.00 2,964.63 110.00 2,958.10 110.00 2,951.57 110.00 2,945.03 $803,000 $803,500 110.00 2,986.11 110.00 2,979.58 110.00 2,973.04 110.00 2,966.51 110.00 2,959.98 110.00 2,953.44 110.00 2,946.91 $803,500 $804,000 110.00 2,987.98 110.00 2,981.45 110.00 2,974.92 110.00 2,968.38 110.00 2,961.85 110.00 2,955.32 110.00 2,948.78 $804,000 $804,500 110.00 2,989.86 110.00 2,983.33 110.00 2,976.79 110.00 2,970.26 110.00 2,963.73 110.00 2,957.19 110.00 2,950.66 $804,500 $805,000 110.00 2,991.73 110.00 2,985.20 110.00 2,978.67 110.00 2,972.13 110.00 2,965.60 110.00 2,959.07 110.00 2,952.53 $805,000 $805,500 110.00 2,993.61 110.00 2,987.08 110.00 2,980.54 110.00 2,974.01 110.00 2,967.48 110.00 2,960.94 110.00 2,954.41 $805,500 $806,000 110.00 2,995.48 110.00 2,988.95 110.00 2,982.42 110.00 2,975.88 110.00 2,969.35 110.00 2,962.82 110.00 2,956.28 $806,000 $806,500 110.00 2,997.36 110.00 2,990.83 110.00 2,984.29 110.00 2,977.76 110.00 2,971.23 110.00 2,964.69 110.00 2,958.16 $806,500 $807,000 110.00 2,999.23 110.00 2,992.70 110.00 2,986.17 110.00 2,979.63 110.00 2,973.10 110.00 2,966.57 110.00 2,960.03 $807,000 $807,500 110.00 3,001.11 110.00 2,994.58 110.00 2,988.04 110.00 2,981.51 110.00 2,974.98 110.00 2,968.44 110.00 2,961.91 $807,500 $808,000 110.00 3,002.98 110.00 2,996.45 110.00 2,989.92 110.00 2,983.38 110.00 2,976.85 110.00 2,970.32 110.00 2,963.78 $808,000 $808,500 110.00 3,004.86 110.00 2,998.33 110.00 2,991.79 110.00 2,985.26 110.00 2,978.73 110.00 2,972.19 110.00 2,965.66 $808,500 $809,000 110.00 3,006.73 110.00 3,000.20 110.00 2,993.67 110.00 2,987.13 110.00 2,980.60 110.00 2,974.07 110.00 2,967.53 $809,000 $809,500 110.00 3,008.61 110.00 3,002.08 110.00 2,995.54 110.00 2,989.01 110.00 2,982.48 110.00 2,975.94 110.00 2,969.41 $809,500 $810,000 110.00 3,010.48 110.00 3,003.95 110.00 2,997.42 110.00 2,990.88 110.00 2,984.35 110.00 2,977.82 110.00 2,971.28 $810,000 $810,500 110.00 3,012.36 110.00 3,005.83 110.00 2,999.29 110.00 2,992.76 110.00 2,986.23 110.00 2,979.69 110.00 2,973.16 $810,500 $811,000 110.00 3,014.23 110.00 3,007.70 110.00 3,001.17 110.00 2,994.63 110.00 2,988.10 110.00 2,981.57 110.00 2,975.03 $811,000 $811,500 110.00 3,016.11 110.00 3,009.58 110.00 3,003.04 110.00 2,996.51 110.00 2,989.98 110.00 2,983.44 110.00 2,976.91 $811,500 $812,000 110.00 3,017.98 110.00 3,011.45 110.00 3,004.92 110.00 2,998.38 110.00 2,991.85 110.00 2,985.32 110.00 2,978.78 $812,000 $812,500 110.00 3,019.86 110.00 3,013.33 110.00 3,006.79 110.00 3,000.26 110.00 2,993.73 110.00 2,987.19 110.00 2,980.66 $812,500 $813,000 110.00 3,021.73 110.00 3,015.20 110.00 3,008.67 110.00 3,002.13 110.00 2,995.60 110.00 2,989.07 110.00 2,982.53 $813,000 $813,500 110.00 3,023.61 110.00 3,017.08 110.00 3,010.54 110.00 3,004.01 110.00 2,997.48 110.00 2,990.94 110.00 2,984.41 $813,500 $814,000 110.00 3,025.48 110.00 3,018.95 110.00 3,012.42 110.00 3,005.88 110.00 2,999.35 110.00 2,992.82 110.00 2,986.28 $814,000 $814,500 110.00 3,027.36 110.00 3,020.83 110.00 3,014.29 110.00 3,007.76 110.00 3,001.23 110.00 2,994.69 110.00 2,988.16 $814,500 $815,000 110.00 3,029.23 110.00 3,022.70 110.00 3,016.17 110.00 3,009.63 110.00 3,003.10 110.00 2,996.57 110.00 2,990.03 $815,000 $815,500 110.00 3,031.11 110.00 3,024.58 110.00 3,018.04 110.00 3,011.51 110.00 3,004.98 110.00 2,998.44 110.00 2,991.91 $815,500 $816,000 110.00 3,032.98 110.00 3,026.45 110.00 3,019.92 110.00 3,013.38 110.00 3,006.85 110.00 3,000.32 110.00 2,993.78

NJEIS Family Cost Participation Table Page 19 of 12 Effective July 1, 2015

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

$816,000 $816,500 110.00 3,034.86 110.00 3,028.33 110.00 3,021.79 110.00 3,015.26 110.00 3,008.73 110.00 3,002.19 110.00 2,995.66 $816,500 $817,000 110.00 3,036.73 110.00 3,030.20 110.00 3,023.67 110.00 3,017.13 110.00 3,010.60 110.00 3,004.07 110.00 2,997.53 $817,000 $817,500 110.00 3,038.61 110.00 3,032.08 110.00 3,025.54 110.00 3,019.01 110.00 3,012.48 110.00 3,005.94 110.00 2,999.41 $817,500 $818,000 110.00 3,040.48 110.00 3,033.95 110.00 3,027.42 110.00 3,020.88 110.00 3,014.35 110.00 3,007.82 110.00 3,001.28 $818,000 $818,500 110.00 3,042.36 110.00 3,035.83 110.00 3,029.29 110.00 3,022.76 110.00 3,016.23 110.00 3,009.69 110.00 3,003.16 $818,500 $819,000 110.00 3,044.23 110.00 3,037.70 110.00 3,031.17 110.00 3,024.63 110.00 3,018.10 110.00 3,011.57 110.00 3,005.03 $819,000 $819,500 110.00 3,046.11 110.00 3,039.58 110.00 3,033.04 110.00 3,026.51 110.00 3,019.98 110.00 3,013.44 110.00 3,006.91 $819,500 $820,000 110.00 3,047.98 110.00 3,041.45 110.00 3,034.92 110.00 3,028.38 110.00 3,021.85 110.00 3,015.32 110.00 3,008.78 $820,000 $820,500 110.00 3,049.86 110.00 3,043.33 110.00 3,036.79 110.00 3,030.26 110.00 3,023.73 110.00 3,017.19 110.00 3,010.66 $820,500 $821,000 110.00 3,051.73 110.00 3,045.20 110.00 3,038.67 110.00 3,032.13 110.00 3,025.60 110.00 3,019.07 110.00 3,012.53 $821,000 $821,500 110.00 3,053.61 110.00 3,047.08 110.00 3,040.54 110.00 3,034.01 110.00 3,027.48 110.00 3,020.94 110.00 3,014.41 $821,500 $822,000 110.00 3,055.48 110.00 3,048.95 110.00 3,042.42 110.00 3,035.88 110.00 3,029.35 110.00 3,022.82 110.00 3,016.28 $822,000 $822,500 110.00 3,057.36 110.00 3,050.83 110.00 3,044.29 110.00 3,037.76 110.00 3,031.23 110.00 3,024.69 110.00 3,018.16 $822,500 $823,000 110.00 3,059.23 110.00 3,052.70 110.00 3,046.17 110.00 3,039.63 110.00 3,033.10 110.00 3,026.57 110.00 3,020.03 $823,000 $823,500 110.00 3,061.11 110.00 3,054.58 110.00 3,048.04 110.00 3,041.51 110.00 3,034.98 110.00 3,028.44 110.00 3,021.91 $823,500 $824,000 110.00 3,062.98 110.00 3,056.45 110.00 3,049.92 110.00 3,043.38 110.00 3,036.85 110.00 3,030.32 110.00 3,023.78 $824,000 $824,500 110.00 3,064.86 110.00 3,058.33 110.00 3,051.79 110.00 3,045.26 110.00 3,038.73 110.00 3,032.19 110.00 3,025.66 $824,500 $825,000 110.00 3,066.73 110.00 3,060.20 110.00 3,053.67 110.00 3,047.13 110.00 3,040.60 110.00 3,034.07 110.00 3,027.53 $825,000 $825,500 110.00 3,068.61 110.00 3,062.08 110.00 3,055.54 110.00 3,049.01 110.00 3,042.48 110.00 3,035.94 110.00 3,029.41 $825,500 $826,000 110.00 3,070.48 110.00 3,063.95 110.00 3,057.42 110.00 3,050.88 110.00 3,044.35 110.00 3,037.82 110.00 3,031.28 $826,000 $826,500 110.00 3,072.36 110.00 3,065.83 110.00 3,059.29 110.00 3,052.76 110.00 3,046.23 110.00 3,039.69 110.00 3,033.16 $826,500 $827,000 110.00 3,074.23 110.00 3,067.70 110.00 3,061.17 110.00 3,054.63 110.00 3,048.10 110.00 3,041.57 110.00 3,035.03 $827,000 $827,500 110.00 3,076.11 110.00 3,069.58 110.00 3,063.04 110.00 3,056.51 110.00 3,049.98 110.00 3,043.44 110.00 3,036.91 $827,500 $828,000 110.00 3,077.98 110.00 3,071.45 110.00 3,064.92 110.00 3,058.38 110.00 3,051.85 110.00 3,045.32 110.00 3,038.78 $828,000 $828,500 110.00 3,079.86 110.00 3,073.33 110.00 3,066.79 110.00 3,060.26 110.00 3,053.73 110.00 3,047.19 110.00 3,040.66 $828,500 $829,000 110.00 3,081.73 110.00 3,075.20 110.00 3,068.67 110.00 3,062.13 110.00 3,055.60 110.00 3,049.07 110.00 3,042.53 $829,000 $829,500 110.00 3,083.61 110.00 3,077.08 110.00 3,070.54 110.00 3,064.01 110.00 3,057.48 110.00 3,050.94 110.00 3,044.41 $829,500 $830,000 110.00 3,085.48 110.00 3,078.95 110.00 3,072.42 110.00 3,065.88 110.00 3,059.35 110.00 3,052.82 110.00 3,046.28 $830,000 $830,500 110.00 3,087.36 110.00 3,080.83 110.00 3,074.29 110.00 3,067.76 110.00 3,061.23 110.00 3,054.69 110.00 3,048.16 $830,500 $831,000 110.00 3,089.23 110.00 3,082.70 110.00 3,076.17 110.00 3,069.63 110.00 3,063.10 110.00 3,056.57 110.00 3,050.03 $831,000 $831,500 110.00 3,091.11 110.00 3,084.58 110.00 3,078.04 110.00 3,071.51 110.00 3,064.98 110.00 3,058.44 110.00 3,051.91 $831,500 $832,000 110.00 3,092.98 110.00 3,086.45 110.00 3,079.92 110.00 3,073.38 110.00 3,066.85 110.00 3,060.32 110.00 3,053.78 $832,000 $832,500 110.00 3,094.86 110.00 3,088.33 110.00 3,081.79 110.00 3,075.26 110.00 3,068.73 110.00 3,062.19 110.00 3,055.66 $832,500 $833,000 110.00 3,096.73 110.00 3,090.20 110.00 3,083.67 110.00 3,077.13 110.00 3,070.60 110.00 3,064.07 110.00 3,057.53 $833,000 $833,500 110.00 3,098.61 110.00 3,092.08 110.00 3,085.54 110.00 3,079.01 110.00 3,072.48 110.00 3,065.94 110.00 3,059.41 $833,500 $834,000 110.00 3,100.48 110.00 3,093.95 110.00 3,087.42 110.00 3,080.88 110.00 3,074.35 110.00 3,067.82 110.00 3,061.28 $834,000 $834,500 110.00 3,102.36 110.00 3,095.83 110.00 3,089.29 110.00 3,082.76 110.00 3,076.23 110.00 3,069.69 110.00 3,063.16 $834,500 $835,000 110.00 3,104.23 110.00 3,097.70 110.00 3,091.17 110.00 3,084.63 110.00 3,078.10 110.00 3,071.57 110.00 3,065.03 $835,000 $835,500 110.00 3,106.11 110.00 3,099.58 110.00 3,093.04 110.00 3,086.51 110.00 3,079.98 110.00 3,073.44 110.00 3,066.91 $835,500 $836,000 110.00 3,107.98 110.00 3,101.45 110.00 3,094.92 110.00 3,088.38 110.00 3,081.85 110.00 3,075.32 110.00 3,068.78 $836,000 $836,500 110.00 3,109.86 110.00 3,103.33 110.00 3,096.79 110.00 3,090.26 110.00 3,083.73 110.00 3,077.19 110.00 3,070.66 $836,500 $837,000 110.00 3,111.73 110.00 3,105.20 110.00 3,098.67 110.00 3,092.13 110.00 3,085.60 110.00 3,079.07 110.00 3,072.53 $837,000 $837,500 110.00 3,113.61 110.00 3,107.08 110.00 3,100.54 110.00 3,094.01 110.00 3,087.48 110.00 3,080.94 110.00 3,074.41 $837,500 $838,000 110.00 3,115.48 110.00 3,108.95 110.00 3,102.42 110.00 3,095.88 110.00 3,089.35 110.00 3,082.82 110.00 3,076.28 $838,000 $838,500 110.00 3,117.36 110.00 3,110.83 110.00 3,104.29 110.00 3,097.76 110.00 3,091.23 110.00 3,084.69 110.00 3,078.16 $838,500 $839,000 110.00 3,119.23 110.00 3,112.70 110.00 3,106.17 110.00 3,099.63 110.00 3,093.10 110.00 3,086.57 110.00 3,080.03 $839,000 $839,500 110.00 3,121.11 110.00 3,114.58 110.00 3,108.04 110.00 3,101.51 110.00 3,094.98 110.00 3,088.44 110.00 3,081.91 $839,500 $840,000 110.00 3,122.98 110.00 3,116.45 110.00 3,109.92 110.00 3,103.38 110.00 3,096.85 110.00 3,090.32 110.00 3,083.78 $840,000 $840,500 110.00 3,124.86 110.00 3,118.33 110.00 3,111.79 110.00 3,105.26 110.00 3,098.73 110.00 3,092.19 110.00 3,085.66 $840,500 $841,000 110.00 3,126.73 110.00 3,120.20 110.00 3,113.67 110.00 3,107.13 110.00 3,100.60 110.00 3,094.07 110.00 3,087.53 $841,000 $841,500 110.00 3,128.61 110.00 3,122.08 110.00 3,115.54 110.00 3,109.01 110.00 3,102.48 110.00 3,095.94 110.00 3,089.41 $841,500 $842,000 110.00 3,130.48 110.00 3,123.95 110.00 3,117.42 110.00 3,110.88 110.00 3,104.35 110.00 3,097.82 110.00 3,091.28 $842,000 $842,500 110.00 3,132.36 110.00 3,125.83 110.00 3,119.29 110.00 3,112.76 110.00 3,106.23 110.00 3,099.69 110.00 3,093.16 $842,500 $843,000 110.00 3,134.23 110.00 3,127.70 110.00 3,121.17 110.00 3,114.63 110.00 3,108.10 110.00 3,101.57 110.00 3,095.03 $843,000 $843,500 110.00 3,136.11 110.00 3,129.58 110.00 3,123.04 110.00 3,116.51 110.00 3,109.98 110.00 3,103.44 110.00 3,096.91 $843,500 $844,000 110.00 3,137.98 110.00 3,131.45 110.00 3,124.92 110.00 3,118.38 110.00 3,111.85 110.00 3,105.32 110.00 3,098.78 $844,000 $844,500 110.00 3,139.86 110.00 3,133.33 110.00 3,126.79 110.00 3,120.26 110.00 3,113.73 110.00 3,107.19 110.00 3,100.66 $844,500 $845,000 110.00 3,141.73 110.00 3,135.20 110.00 3,128.67 110.00 3,122.13 110.00 3,115.60 110.00 3,109.07 110.00 3,102.53 $845,000 $845,500 110.00 3,143.61 110.00 3,137.08 110.00 3,130.54 110.00 3,124.01 110.00 3,117.48 110.00 3,110.94 110.00 3,104.41 $845,500 $846,000 110.00 3,145.48 110.00 3,138.95 110.00 3,132.42 110.00 3,125.88 110.00 3,119.35 110.00 3,112.82 110.00 3,106.28 $846,000 $846,500 110.00 3,147.36 110.00 3,140.83 110.00 3,134.29 110.00 3,127.76 110.00 3,121.23 110.00 3,114.69 110.00 3,108.16 $846,500 $847,000 110.00 3,149.23 110.00 3,142.70 110.00 3,136.17 110.00 3,129.63 110.00 3,123.10 110.00 3,116.57 110.00 3,110.03 $847,000 $847,500 110.00 3,151.11 110.00 3,144.58 110.00 3,138.04 110.00 3,131.51 110.00 3,124.98 110.00 3,118.44 110.00 3,111.91 $847,500 $848,000 110.00 3,152.98 110.00 3,146.45 110.00 3,139.92 110.00 3,133.38 110.00 3,126.85 110.00 3,120.32 110.00 3,113.78 $848,000 $848,500 110.00 3,154.86 110.00 3,148.33 110.00 3,141.79 110.00 3,135.26 110.00 3,128.73 110.00 3,122.19 110.00 3,115.66 $848,500 $849,000 110.00 3,156.73 110.00 3,150.20 110.00 3,143.67 110.00 3,137.13 110.00 3,130.60 110.00 3,124.07 110.00 3,117.53 $849,000 $849,500 110.00 3,158.61 110.00 3,152.08 110.00 3,145.54 110.00 3,139.01 110.00 3,132.48 110.00 3,125.94 110.00 3,119.41 $849,500 $850,000 110.00 3,160.48 110.00 3,153.95 110.00 3,147.42 110.00 3,140.88 110.00 3,134.35 110.00 3,127.82 110.00 3,121.28 $850,000 $850,500 110.00 3,162.36 110.00 3,155.83 110.00 3,149.29 110.00 3,142.76 110.00 3,136.23 110.00 3,129.69 110.00 3,123.16 $850,500 $851,000 110.00 3,164.23 110.00 3,157.70 110.00 3,151.17 110.00 3,144.63 110.00 3,138.10 110.00 3,131.57 110.00 3,125.03 $851,000 $851,500 110.00 3,166.11 110.00 3,159.58 110.00 3,153.04 110.00 3,146.51 110.00 3,139.98 110.00 3,133.44 110.00 3,126.91 $851,500 $852,000 110.00 3,167.98 110.00 3,161.45 110.00 3,154.92 110.00 3,148.38 110.00 3,141.85 110.00 3,135.32 110.00 3,128.78 $852,000 $852,500 110.00 3,169.86 110.00 3,163.33 110.00 3,156.79 110.00 3,150.26 110.00 3,143.73 110.00 3,137.19 110.00 3,130.66 $852,500 $853,000 110.00 3,171.73 110.00 3,165.20 110.00 3,158.67 110.00 3,152.13 110.00 3,145.60 110.00 3,139.07 110.00 3,132.53 $853,000 $853,500 110.00 3,173.61 110.00 3,167.08 110.00 3,160.54 110.00 3,154.01 110.00 3,147.48 110.00 3,140.94 110.00 3,134.41 $853,500 $854,000 110.00 3,175.48 110.00 3,168.95 110.00 3,162.42 110.00 3,155.88 110.00 3,149.35 110.00 3,142.82 110.00 3,136.28 $854,000 $854,500 110.00 3,177.36 110.00 3,170.83 110.00 3,164.29 110.00 3,157.76 110.00 3,151.23 110.00 3,144.69 110.00 3,138.16 $854,500 $855,000 110.00 3,179.23 110.00 3,172.70 110.00 3,166.17 110.00 3,159.63 110.00 3,153.10 110.00 3,146.57 110.00 3,140.03 $855,000 $855,500 110.00 3,181.11 110.00 3,174.58 110.00 3,168.04 110.00 3,161.51 110.00 3,154.98 110.00 3,148.44 110.00 3,141.91 $855,500 $856,000 110.00 3,182.98 110.00 3,176.45 110.00 3,169.92 110.00 3,163.38 110.00 3,156.85 110.00 3,150.32 110.00 3,143.78 $856,000 $856,500 110.00 3,184.86 110.00 3,178.33 110.00 3,171.79 110.00 3,165.26 110.00 3,158.73 110.00 3,152.19 110.00 3,145.66 $856,500 $857,000 110.00 3,186.73 110.00 3,180.20 110.00 3,173.67 110.00 3,167.13 110.00 3,160.60 110.00 3,154.07 110.00 3,147.53 $857,000 $857,500 110.00 3,188.61 110.00 3,182.08 110.00 3,175.54 110.00 3,169.01 110.00 3,162.48 110.00 3,155.94 110.00 3,149.41 $857,500 $858,000 110.00 3,190.48 110.00 3,183.95 110.00 3,177.42 110.00 3,170.88 110.00 3,164.35 110.00 3,157.82 110.00 3,151.28 $858,000 $858,500 110.00 3,192.36 110.00 3,185.83 110.00 3,179.29 110.00 3,172.76 110.00 3,166.23 110.00 3,159.69 110.00 3,153.16 $858,500 $859,000 110.00 3,194.23 110.00 3,187.70 110.00 3,181.17 110.00 3,174.63 110.00 3,168.10 110.00 3,161.57 110.00 3,155.03 $859,000 $859,500 110.00 3,196.11 110.00 3,189.58 110.00 3,183.04 110.00 3,176.51 110.00 3,169.98 110.00 3,163.44 110.00 3,156.91 $859,500 $860,000 110.00 3,197.98 110.00 3,191.45 110.00 3,184.92 110.00 3,178.38 110.00 3,171.85 110.00 3,165.32 110.00 3,158.78 $860,000 $860,500 110.00 3,199.86 110.00 3,193.33 110.00 3,186.79 110.00 3,180.26 110.00 3,173.73 110.00 3,167.19 110.00 3,160.66 $860,500 $861,000 110.00 3,201.73 110.00 3,195.20 110.00 3,188.67 110.00 3,182.13 110.00 3,175.60 110.00 3,169.07 110.00 3,162.53 $861,000 $861,500 110.00 3,203.61 110.00 3,197.08 110.00 3,190.54 110.00 3,184.01 110.00 3,177.48 110.00 3,170.94 110.00 3,164.41 $861,500 $862,000 110.00 3,205.48 110.00 3,198.95 110.00 3,192.42 110.00 3,185.88 110.00 3,179.35 110.00 3,172.82 110.00 3,166.28 $862,000 $862,500 110.00 3,207.36 110.00 3,200.83 110.00 3,194.29 110.00 3,187.76 110.00 3,181.23 110.00 3,174.69 110.00 3,168.16 $862,500 $863,000 110.00 3,209.23 110.00 3,202.70 110.00 3,196.17 110.00 3,189.63 110.00 3,183.10 110.00 3,176.57 110.00 3,170.03 $863,000 $863,500 110.00 3,211.11 110.00 3,204.58 110.00 3,198.04 110.00 3,191.51 110.00 3,184.98 110.00 3,178.44 110.00 3,171.91 $863,500 $864,000 110.00 3,212.98 110.00 3,206.45 110.00 3,199.92 110.00 3,193.38 110.00 3,186.85 110.00 3,180.32 110.00 3,173.78 $864,000 $864,500 110.00 3,214.86 110.00 3,208.33 110.00 3,201.79 110.00 3,195.26 110.00 3,188.73 110.00 3,182.19 110.00 3,175.66 $864,500 $865,000 110.00 3,216.73 110.00 3,210.20 110.00 3,203.67 110.00 3,197.13 110.00 3,190.60 110.00 3,184.07 110.00 3,177.53 $865,000 $865,500 110.00 3,218.61 110.00 3,212.08 110.00 3,205.54 110.00 3,199.01 110.00 3,192.48 110.00 3,185.94 110.00 3,179.41 $865,500 $866,000 110.00 3,220.48 110.00 3,213.95 110.00 3,207.42 110.00 3,200.88 110.00 3,194.35 110.00 3,187.82 110.00 3,181.28 $866,000 $866,500 110.00 3,222.36 110.00 3,215.83 110.00 3,209.29 110.00 3,202.76 110.00 3,196.23 110.00 3,189.69 110.00 3,183.16 $866,500 $867,000 110.00 3,224.23 110.00 3,217.70 110.00 3,211.17 110.00 3,204.63 110.00 3,198.10 110.00 3,191.57 110.00 3,185.03

NJEIS Family Cost Participation Table Page 20 of 12 Effective July 1, 2015

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

$867,000 $867,500 110.00 3,226.11 110.00 3,219.58 110.00 3,213.04 110.00 3,206.51 110.00 3,199.98 110.00 3,193.44 110.00 3,186.91 $867,500 $868,000 110.00 3,227.98 110.00 3,221.45 110.00 3,214.92 110.00 3,208.38 110.00 3,201.85 110.00 3,195.32 110.00 3,188.78 $868,000 $868,500 110.00 3,229.86 110.00 3,223.33 110.00 3,216.79 110.00 3,210.26 110.00 3,203.73 110.00 3,197.19 110.00 3,190.66 $868,500 $869,000 110.00 3,231.73 110.00 3,225.20 110.00 3,218.67 110.00 3,212.13 110.00 3,205.60 110.00 3,199.07 110.00 3,192.53 $869,000 $869,500 110.00 3,233.61 110.00 3,227.08 110.00 3,220.54 110.00 3,214.01 110.00 3,207.48 110.00 3,200.94 110.00 3,194.41 $869,500 $870,000 110.00 3,235.48 110.00 3,228.95 110.00 3,222.42 110.00 3,215.88 110.00 3,209.35 110.00 3,202.82 110.00 3,196.28 $870,000 $870,500 110.00 3,237.36 110.00 3,230.83 110.00 3,224.29 110.00 3,217.76 110.00 3,211.23 110.00 3,204.69 110.00 3,198.16 $870,500 $871,000 110.00 3,239.23 110.00 3,232.70 110.00 3,226.17 110.00 3,219.63 110.00 3,213.10 110.00 3,206.57 110.00 3,200.03 $871,000 $871,500 110.00 3,241.11 110.00 3,234.58 110.00 3,228.04 110.00 3,221.51 110.00 3,214.98 110.00 3,208.44 110.00 3,201.91 $871,500 $872,000 110.00 3,242.98 110.00 3,236.45 110.00 3,229.92 110.00 3,223.38 110.00 3,216.85 110.00 3,210.32 110.00 3,203.78 $872,000 $872,500 110.00 3,244.86 110.00 3,238.33 110.00 3,231.79 110.00 3,225.26 110.00 3,218.73 110.00 3,212.19 110.00 3,205.66 $872,500 $873,000 110.00 3,246.73 110.00 3,240.20 110.00 3,233.67 110.00 3,227.13 110.00 3,220.60 110.00 3,214.07 110.00 3,207.53 $873,000 $873,500 110.00 3,248.61 110.00 3,242.08 110.00 3,235.54 110.00 3,229.01 110.00 3,222.48 110.00 3,215.94 110.00 3,209.41 $873,500 $874,000 110.00 3,250.48 110.00 3,243.95 110.00 3,237.42 110.00 3,230.88 110.00 3,224.35 110.00 3,217.82 110.00 3,211.28 $874,000 $874,500 110.00 3,252.36 110.00 3,245.83 110.00 3,239.29 110.00 3,232.76 110.00 3,226.23 110.00 3,219.69 110.00 3,213.16 $874,500 $875,000 110.00 3,254.23 110.00 3,247.70 110.00 3,241.17 110.00 3,234.63 110.00 3,228.10 110.00 3,221.57 110.00 3,215.03 $875,000 $875,500 110.00 3,256.11 110.00 3,249.58 110.00 3,243.04 110.00 3,236.51 110.00 3,229.98 110.00 3,223.44 110.00 3,216.91 $875,500 $876,000 110.00 3,257.98 110.00 3,251.45 110.00 3,244.92 110.00 3,238.38 110.00 3,231.85 110.00 3,225.32 110.00 3,218.78 $876,000 $876,500 110.00 3,259.86 110.00 3,253.33 110.00 3,246.79 110.00 3,240.26 110.00 3,233.73 110.00 3,227.19 110.00 3,220.66 $876,500 $877,000 110.00 3,261.73 110.00 3,255.20 110.00 3,248.67 110.00 3,242.13 110.00 3,235.60 110.00 3,229.07 110.00 3,222.53 $877,000 $877,500 110.00 3,263.61 110.00 3,257.08 110.00 3,250.54 110.00 3,244.01 110.00 3,237.48 110.00 3,230.94 110.00 3,224.41 $877,500 $878,000 110.00 3,265.48 110.00 3,258.95 110.00 3,252.42 110.00 3,245.88 110.00 3,239.35 110.00 3,232.82 110.00 3,226.28 $878,000 $878,500 110.00 3,267.36 110.00 3,260.83 110.00 3,254.29 110.00 3,247.76 110.00 3,241.23 110.00 3,234.69 110.00 3,228.16 $878,500 $879,000 110.00 3,269.23 110.00 3,262.70 110.00 3,256.17 110.00 3,249.63 110.00 3,243.10 110.00 3,236.57 110.00 3,230.03 $879,000 $879,500 110.00 3,271.11 110.00 3,264.58 110.00 3,258.04 110.00 3,251.51 110.00 3,244.98 110.00 3,238.44 110.00 3,231.91 $879,500 $880,000 110.00 3,272.98 110.00 3,266.45 110.00 3,259.92 110.00 3,253.38 110.00 3,246.85 110.00 3,240.32 110.00 3,233.78 $880,000 $880,500 110.00 3,274.86 110.00 3,268.33 110.00 3,261.79 110.00 3,255.26 110.00 3,248.73 110.00 3,242.19 110.00 3,235.66 $880,500 $881,000 110.00 3,276.73 110.00 3,270.20 110.00 3,263.67 110.00 3,257.13 110.00 3,250.60 110.00 3,244.07 110.00 3,237.53 $881,000 $881,500 110.00 3,278.61 110.00 3,272.08 110.00 3,265.54 110.00 3,259.01 110.00 3,252.48 110.00 3,245.94 110.00 3,239.41 $881,500 $882,000 110.00 3,280.48 110.00 3,273.95 110.00 3,267.42 110.00 3,260.88 110.00 3,254.35 110.00 3,247.82 110.00 3,241.28 $882,000 $882,500 110.00 3,282.36 110.00 3,275.83 110.00 3,269.29 110.00 3,262.76 110.00 3,256.23 110.00 3,249.69 110.00 3,243.16 $882,500 $883,000 110.00 3,284.23 110.00 3,277.70 110.00 3,271.17 110.00 3,264.63 110.00 3,258.10 110.00 3,251.57 110.00 3,245.03 $883,000 $883,500 110.00 3,286.11 110.00 3,279.58 110.00 3,273.04 110.00 3,266.51 110.00 3,259.98 110.00 3,253.44 110.00 3,246.91 $883,500 $884,000 110.00 3,287.98 110.00 3,281.45 110.00 3,274.92 110.00 3,268.38 110.00 3,261.85 110.00 3,255.32 110.00 3,248.78 $884,000 $884,500 110.00 3,289.86 110.00 3,283.33 110.00 3,276.79 110.00 3,270.26 110.00 3,263.73 110.00 3,257.19 110.00 3,250.66 $884,500 $885,000 110.00 3,291.73 110.00 3,285.20 110.00 3,278.67 110.00 3,272.13 110.00 3,265.60 110.00 3,259.07 110.00 3,252.53 $885,000 $885,500 110.00 3,293.61 110.00 3,287.08 110.00 3,280.54 110.00 3,274.01 110.00 3,267.48 110.00 3,260.94 110.00 3,254.41 $885,500 $886,000 110.00 3,295.48 110.00 3,288.95 110.00 3,282.42 110.00 3,275.88 110.00 3,269.35 110.00 3,262.82 110.00 3,256.28 $886,000 $886,500 110.00 3,297.36 110.00 3,290.83 110.00 3,284.29 110.00 3,277.76 110.00 3,271.23 110.00 3,264.69 110.00 3,258.16 $886,500 $887,000 110.00 3,299.23 110.00 3,292.70 110.00 3,286.17 110.00 3,279.63 110.00 3,273.10 110.00 3,266.57 110.00 3,260.03 $887,000 $887,500 110.00 3,301.11 110.00 3,294.58 110.00 3,288.04 110.00 3,281.51 110.00 3,274.98 110.00 3,268.44 110.00 3,261.91 $887,500 $888,000 110.00 3,302.98 110.00 3,296.45 110.00 3,289.92 110.00 3,283.38 110.00 3,276.85 110.00 3,270.32 110.00 3,263.78 $888,000 $888,500 110.00 3,304.86 110.00 3,298.33 110.00 3,291.79 110.00 3,285.26 110.00 3,278.73 110.00 3,272.19 110.00 3,265.66 $888,500 $889,000 110.00 3,306.73 110.00 3,300.20 110.00 3,293.67 110.00 3,287.13 110.00 3,280.60 110.00 3,274.07 110.00 3,267.53 $889,000 $889,500 110.00 3,308.61 110.00 3,302.08 110.00 3,295.54 110.00 3,289.01 110.00 3,282.48 110.00 3,275.94 110.00 3,269.41 $889,500 $890,000 110.00 3,310.48 110.00 3,303.95 110.00 3,297.42 110.00 3,290.88 110.00 3,284.35 110.00 3,277.82 110.00 3,271.28 $890,000 $890,500 110.00 3,312.36 110.00 3,305.83 110.00 3,299.29 110.00 3,292.76 110.00 3,286.23 110.00 3,279.69 110.00 3,273.16 $890,500 $891,000 110.00 3,314.23 110.00 3,307.70 110.00 3,301.17 110.00 3,294.63 110.00 3,288.10 110.00 3,281.57 110.00 3,275.03 $891,000 $891,500 110.00 3,316.11 110.00 3,309.58 110.00 3,303.04 110.00 3,296.51 110.00 3,289.98 110.00 3,283.44 110.00 3,276.91 $891,500 $892,000 110.00 3,317.98 110.00 3,311.45 110.00 3,304.92 110.00 3,298.38 110.00 3,291.85 110.00 3,285.32 110.00 3,278.78 $892,000 $892,500 110.00 3,319.86 110.00 3,313.33 110.00 3,306.79 110.00 3,300.26 110.00 3,293.73 110.00 3,287.19 110.00 3,280.66 $892,500 $893,000 110.00 3,321.73 110.00 3,315.20 110.00 3,308.67 110.00 3,302.13 110.00 3,295.60 110.00 3,289.07 110.00 3,282.53 $893,000 $893,500 110.00 3,323.61 110.00 3,317.08 110.00 3,310.54 110.00 3,304.01 110.00 3,297.48 110.00 3,290.94 110.00 3,284.41 $893,500 $894,000 110.00 3,325.48 110.00 3,318.95 110.00 3,312.42 110.00 3,305.88 110.00 3,299.35 110.00 3,292.82 110.00 3,286.28 $894,000 $894,500 110.00 3,327.36 110.00 3,320.83 110.00 3,314.29 110.00 3,307.76 110.00 3,301.23 110.00 3,294.69 110.00 3,288.16 $894,500 $895,000 110.00 3,329.23 110.00 3,322.70 110.00 3,316.17 110.00 3,309.63 110.00 3,303.10 110.00 3,296.57 110.00 3,290.03 $895,000 $895,500 110.00 3,331.11 110.00 3,324.58 110.00 3,318.04 110.00 3,311.51 110.00 3,304.98 110.00 3,298.44 110.00 3,291.91 $895,500 $896,000 110.00 3,332.98 110.00 3,326.45 110.00 3,319.92 110.00 3,313.38 110.00 3,306.85 110.00 3,300.32 110.00 3,293.78 $896,000 $896,500 110.00 3,334.86 110.00 3,328.33 110.00 3,321.79 110.00 3,315.26 110.00 3,308.73 110.00 3,302.19 110.00 3,295.66 $896,500 $897,000 110.00 3,336.73 110.00 3,330.20 110.00 3,323.67 110.00 3,317.13 110.00 3,310.60 110.00 3,304.07 110.00 3,297.53 $897,000 $897,500 110.00 3,338.61 110.00 3,332.08 110.00 3,325.54 110.00 3,319.01 110.00 3,312.48 110.00 3,305.94 110.00 3,299.41 $897,500 $898,000 110.00 3,340.48 110.00 3,333.95 110.00 3,327.42 110.00 3,320.88 110.00 3,314.35 110.00 3,307.82 110.00 3,301.28 $898,000 $898,500 110.00 3,342.36 110.00 3,335.83 110.00 3,329.29 110.00 3,322.76 110.00 3,316.23 110.00 3,309.69 110.00 3,303.16 $898,500 $899,000 110.00 3,344.23 110.00 3,337.70 110.00 3,331.17 110.00 3,324.63 110.00 3,318.10 110.00 3,311.57 110.00 3,305.03 $899,000 $899,500 110.00 3,346.11 110.00 3,339.58 110.00 3,333.04 110.00 3,326.51 110.00 3,319.98 110.00 3,313.44 110.00 3,306.91 $899,500 $900,000 110.00 3,347.98 110.00 3,341.45 110.00 3,334.92 110.00 3,328.38 110.00 3,321.85 110.00 3,315.32 110.00 3,308.78 $900,000 $900,500 110.00 3,349.86 110.00 3,343.33 110.00 3,336.79 110.00 3,330.26 110.00 3,323.73 110.00 3,317.19 110.00 3,310.66 $900,500 $901,000 110.00 3,351.73 110.00 3,345.20 110.00 3,338.67 110.00 3,332.13 110.00 3,325.60 110.00 3,319.07 110.00 3,312.53 $901,000 $901,500 110.00 3,353.61 110.00 3,347.08 110.00 3,340.54 110.00 3,334.01 110.00 3,327.48 110.00 3,320.94 110.00 3,314.41 $901,500 $902,000 110.00 3,355.48 110.00 3,348.95 110.00 3,342.42 110.00 3,335.88 110.00 3,329.35 110.00 3,322.82 110.00 3,316.28 $902,000 $902,500 110.00 3,357.36 110.00 3,350.83 110.00 3,344.29 110.00 3,337.76 110.00 3,331.23 110.00 3,324.69 110.00 3,318.16 $902,500 $903,000 110.00 3,359.23 110.00 3,352.70 110.00 3,346.17 110.00 3,339.63 110.00 3,333.10 110.00 3,326.57 110.00 3,320.03 $903,000 $903,500 110.00 3,361.11 110.00 3,354.58 110.00 3,348.04 110.00 3,341.51 110.00 3,334.98 110.00 3,328.44 110.00 3,321.91 $903,500 $904,000 110.00 3,362.98 110.00 3,356.45 110.00 3,349.92 110.00 3,343.38 110.00 3,336.85 110.00 3,330.32 110.00 3,323.78 $904,000 $904,500 110.00 3,364.86 110.00 3,358.33 110.00 3,351.79 110.00 3,345.26 110.00 3,338.73 110.00 3,332.19 110.00 3,325.66 $904,500 $905,000 110.00 3,366.73 110.00 3,360.20 110.00 3,353.67 110.00 3,347.13 110.00 3,340.60 110.00 3,334.07 110.00 3,327.53 $905,000 $905,500 110.00 3,368.61 110.00 3,362.08 110.00 3,355.54 110.00 3,349.01 110.00 3,342.48 110.00 3,335.94 110.00 3,329.41 $905,500 $906,000 110.00 3,370.48 110.00 3,363.95 110.00 3,357.42 110.00 3,350.88 110.00 3,344.35 110.00 3,337.82 110.00 3,331.28 $906,000 $906,500 110.00 3,372.36 110.00 3,365.83 110.00 3,359.29 110.00 3,352.76 110.00 3,346.23 110.00 3,339.69 110.00 3,333.16 $906,500 $907,000 110.00 3,374.23 110.00 3,367.70 110.00 3,361.17 110.00 3,354.63 110.00 3,348.10 110.00 3,341.57 110.00 3,335.03 $907,000 $907,500 110.00 3,376.11 110.00 3,369.58 110.00 3,363.04 110.00 3,356.51 110.00 3,349.98 110.00 3,343.44 110.00 3,336.91 $907,500 $908,000 110.00 3,377.98 110.00 3,371.45 110.00 3,364.92 110.00 3,358.38 110.00 3,351.85 110.00 3,345.32 110.00 3,338.78 $908,000 $908,500 110.00 3,379.86 110.00 3,373.33 110.00 3,366.79 110.00 3,360.26 110.00 3,353.73 110.00 3,347.19 110.00 3,340.66 $908,500 $909,000 110.00 3,381.73 110.00 3,375.20 110.00 3,368.67 110.00 3,362.13 110.00 3,355.60 110.00 3,349.07 110.00 3,342.53 $909,000 $909,500 110.00 3,383.61 110.00 3,377.08 110.00 3,370.54 110.00 3,364.01 110.00 3,357.48 110.00 3,350.94 110.00 3,344.41 $909,500 $910,000 110.00 3,385.48 110.00 3,378.95 110.00 3,372.42 110.00 3,365.88 110.00 3,359.35 110.00 3,352.82 110.00 3,346.28 $910,000 $910,500 110.00 3,387.36 110.00 3,380.83 110.00 3,374.29 110.00 3,367.76 110.00 3,361.23 110.00 3,354.69 110.00 3,348.16 $910,500 $911,000 110.00 3,389.23 110.00 3,382.70 110.00 3,376.17 110.00 3,369.63 110.00 3,363.10 110.00 3,356.57 110.00 3,350.03 $911,000 $911,500 110.00 3,391.11 110.00 3,384.58 110.00 3,378.04 110.00 3,371.51 110.00 3,364.98 110.00 3,358.44 110.00 3,351.91 $911,500 $912,000 110.00 3,392.98 110.00 3,386.45 110.00 3,379.92 110.00 3,373.38 110.00 3,366.85 110.00 3,360.32 110.00 3,353.78 $912,000 $912,500 110.00 3,394.86 110.00 3,388.33 110.00 3,381.79 110.00 3,375.26 110.00 3,368.73 110.00 3,362.19 110.00 3,355.66 $912,500 $913,000 110.00 3,396.73 110.00 3,390.20 110.00 3,383.67 110.00 3,377.13 110.00 3,370.60 110.00 3,364.07 110.00 3,357.53 $913,000 $913,500 110.00 3,398.61 110.00 3,392.08 110.00 3,385.54 110.00 3,379.01 110.00 3,372.48 110.00 3,365.94 110.00 3,359.41 $913,500 $914,000 110.00 3,400.48 110.00 3,393.95 110.00 3,387.42 110.00 3,380.88 110.00 3,374.35 110.00 3,367.82 110.00 3,361.28 $914,000 $914,500 110.00 3,402.36 110.00 3,395.83 110.00 3,389.29 110.00 3,382.76 110.00 3,376.23 110.00 3,369.69 110.00 3,363.16 $914,500 $915,000 110.00 3,404.23 110.00 3,397.70 110.00 3,391.17 110.00 3,384.63 110.00 3,378.10 110.00 3,371.57 110.00 3,365.03 $915,000 $915,500 110.00 3,406.11 110.00 3,399.58 110.00 3,393.04 110.00 3,386.51 110.00 3,379.98 110.00 3,373.44 110.00 3,366.91 $915,500 $916,000 110.00 3,407.98 110.00 3,401.45 110.00 3,394.92 110.00 3,388.38 110.00 3,381.85 110.00 3,375.32 110.00 3,368.78 $916,000 $916,500 110.00 3,409.86 110.00 3,403.33 110.00 3,396.79 110.00 3,390.26 110.00 3,383.73 110.00 3,377.19 110.00 3,370.66 $916,500 $917,000 110.00 3,411.73 110.00 3,405.20 110.00 3,398.67 110.00 3,392.13 110.00 3,385.60 110.00 3,379.07 110.00 3,372.53 $917,000 $917,500 110.00 3,413.61 110.00 3,407.08 110.00 3,400.54 110.00 3,394.01 110.00 3,387.48 110.00 3,380.94 110.00 3,374.41 $917,500 $918,000 110.00 3,415.48 110.00 3,408.95 110.00 3,402.42 110.00 3,395.88 110.00 3,389.35 110.00 3,382.82 110.00 3,376.28

NJEIS Family Cost Participation Table Page 21 of 12 Effective July 1, 2015

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

$918,000 $918,500 110.00 3,417.36 110.00 3,410.83 110.00 3,404.29 110.00 3,397.76 110.00 3,391.23 110.00 3,384.69 110.00 3,378.16 $918,500 $919,000 110.00 3,419.23 110.00 3,412.70 110.00 3,406.17 110.00 3,399.63 110.00 3,393.10 110.00 3,386.57 110.00 3,380.03 $919,000 $919,500 110.00 3,421.11 110.00 3,414.58 110.00 3,408.04 110.00 3,401.51 110.00 3,394.98 110.00 3,388.44 110.00 3,381.91 $919,500 $920,000 110.00 3,422.98 110.00 3,416.45 110.00 3,409.92 110.00 3,403.38 110.00 3,396.85 110.00 3,390.32 110.00 3,383.78 $920,000 $920,500 110.00 3,424.86 110.00 3,418.33 110.00 3,411.79 110.00 3,405.26 110.00 3,398.73 110.00 3,392.19 110.00 3,385.66 $920,500 $921,000 110.00 3,426.73 110.00 3,420.20 110.00 3,413.67 110.00 3,407.13 110.00 3,400.60 110.00 3,394.07 110.00 3,387.53 $921,000 $921,500 110.00 3,428.61 110.00 3,422.08 110.00 3,415.54 110.00 3,409.01 110.00 3,402.48 110.00 3,395.94 110.00 3,389.41 $921,500 $922,000 110.00 3,430.48 110.00 3,423.95 110.00 3,417.42 110.00 3,410.88 110.00 3,404.35 110.00 3,397.82 110.00 3,391.28 $922,000 $922,500 110.00 3,432.36 110.00 3,425.83 110.00 3,419.29 110.00 3,412.76 110.00 3,406.23 110.00 3,399.69 110.00 3,393.16 $922,500 $923,000 110.00 3,434.23 110.00 3,427.70 110.00 3,421.17 110.00 3,414.63 110.00 3,408.10 110.00 3,401.57 110.00 3,395.03 $923,000 $923,500 110.00 3,436.11 110.00 3,429.58 110.00 3,423.04 110.00 3,416.51 110.00 3,409.98 110.00 3,403.44 110.00 3,396.91 $923,500 $924,000 110.00 3,437.98 110.00 3,431.45 110.00 3,424.92 110.00 3,418.38 110.00 3,411.85 110.00 3,405.32 110.00 3,398.78 $924,000 $924,500 110.00 3,439.86 110.00 3,433.33 110.00 3,426.79 110.00 3,420.26 110.00 3,413.73 110.00 3,407.19 110.00 3,400.66 $924,500 $925,000 110.00 3,441.73 110.00 3,435.20 110.00 3,428.67 110.00 3,422.13 110.00 3,415.60 110.00 3,409.07 110.00 3,402.53 $925,000 $925,500 110.00 3,443.61 110.00 3,437.08 110.00 3,430.54 110.00 3,424.01 110.00 3,417.48 110.00 3,410.94 110.00 3,404.41 $925,500 $926,000 110.00 3,445.48 110.00 3,438.95 110.00 3,432.42 110.00 3,425.88 110.00 3,419.35 110.00 3,412.82 110.00 3,406.28 $926,000 $926,500 110.00 3,447.36 110.00 3,440.83 110.00 3,434.29 110.00 3,427.76 110.00 3,421.23 110.00 3,414.69 110.00 3,408.16 $926,500 $927,000 110.00 3,449.23 110.00 3,442.70 110.00 3,436.17 110.00 3,429.63 110.00 3,423.10 110.00 3,416.57 110.00 3,410.03 $927,000 $927,500 110.00 3,451.11 110.00 3,444.58 110.00 3,438.04 110.00 3,431.51 110.00 3,424.98 110.00 3,418.44 110.00 3,411.91 $927,500 $928,000 110.00 3,452.98 110.00 3,446.45 110.00 3,439.92 110.00 3,433.38 110.00 3,426.85 110.00 3,420.32 110.00 3,413.78 $928,000 $928,500 110.00 3,454.86 110.00 3,448.33 110.00 3,441.79 110.00 3,435.26 110.00 3,428.73 110.00 3,422.19 110.00 3,415.66 $928,500 $929,000 110.00 3,456.73 110.00 3,450.20 110.00 3,443.67 110.00 3,437.13 110.00 3,430.60 110.00 3,424.07 110.00 3,417.53 $929,000 $929,500 110.00 3,458.61 110.00 3,452.08 110.00 3,445.54 110.00 3,439.01 110.00 3,432.48 110.00 3,425.94 110.00 3,419.41 $929,500 $930,000 110.00 3,460.48 110.00 3,453.95 110.00 3,447.42 110.00 3,440.88 110.00 3,434.35 110.00 3,427.82 110.00 3,421.28 $930,000 $930,500 110.00 3,462.36 110.00 3,455.83 110.00 3,449.29 110.00 3,442.76 110.00 3,436.23 110.00 3,429.69 110.00 3,423.16 $930,500 $931,000 110.00 3,464.23 110.00 3,457.70 110.00 3,451.17 110.00 3,444.63 110.00 3,438.10 110.00 3,431.57 110.00 3,425.03 $931,000 $931,500 110.00 3,466.11 110.00 3,459.58 110.00 3,453.04 110.00 3,446.51 110.00 3,439.98 110.00 3,433.44 110.00 3,426.91 $931,500 $932,000 110.00 3,467.98 110.00 3,461.45 110.00 3,454.92 110.00 3,448.38 110.00 3,441.85 110.00 3,435.32 110.00 3,428.78 $932,000 $932,500 110.00 3,469.86 110.00 3,463.33 110.00 3,456.79 110.00 3,450.26 110.00 3,443.73 110.00 3,437.19 110.00 3,430.66 $932,500 $933,000 110.00 3,471.73 110.00 3,465.20 110.00 3,458.67 110.00 3,452.13 110.00 3,445.60 110.00 3,439.07 110.00 3,432.53 $933,000 $933,500 110.00 3,473.61 110.00 3,467.08 110.00 3,460.54 110.00 3,454.01 110.00 3,447.48 110.00 3,440.94 110.00 3,434.41 $933,500 $934,000 110.00 3,475.48 110.00 3,468.95 110.00 3,462.42 110.00 3,455.88 110.00 3,449.35 110.00 3,442.82 110.00 3,436.28 $934,000 $934,500 110.00 3,477.36 110.00 3,470.83 110.00 3,464.29 110.00 3,457.76 110.00 3,451.23 110.00 3,444.69 110.00 3,438.16 $934,500 $935,000 110.00 3,479.23 110.00 3,472.70 110.00 3,466.17 110.00 3,459.63 110.00 3,453.10 110.00 3,446.57 110.00 3,440.03 $935,000 $935,500 110.00 3,481.11 110.00 3,474.58 110.00 3,468.04 110.00 3,461.51 110.00 3,454.98 110.00 3,448.44 110.00 3,441.91 $935,500 $936,000 110.00 3,482.98 110.00 3,476.45 110.00 3,469.92 110.00 3,463.38 110.00 3,456.85 110.00 3,450.32 110.00 3,443.78 $936,000 $936,500 110.00 3,484.86 110.00 3,478.33 110.00 3,471.79 110.00 3,465.26 110.00 3,458.73 110.00 3,452.19 110.00 3,445.66 $936,500 $937,000 110.00 3,486.73 110.00 3,480.20 110.00 3,473.67 110.00 3,467.13 110.00 3,460.60 110.00 3,454.07 110.00 3,447.53 $937,000 $937,500 110.00 3,488.61 110.00 3,482.08 110.00 3,475.54 110.00 3,469.01 110.00 3,462.48 110.00 3,455.94 110.00 3,449.41 $937,500 $938,000 110.00 3,490.48 110.00 3,483.95 110.00 3,477.42 110.00 3,470.88 110.00 3,464.35 110.00 3,457.82 110.00 3,451.28 $938,000 $938,500 110.00 3,492.36 110.00 3,485.83 110.00 3,479.29 110.00 3,472.76 110.00 3,466.23 110.00 3,459.69 110.00 3,453.16 $938,500 $939,000 110.00 3,494.23 110.00 3,487.70 110.00 3,481.17 110.00 3,474.63 110.00 3,468.10 110.00 3,461.57 110.00 3,455.03 $939,000 $939,500 110.00 3,496.11 110.00 3,489.58 110.00 3,483.04 110.00 3,476.51 110.00 3,469.98 110.00 3,463.44 110.00 3,456.91 $939,500 $940,000 110.00 3,497.98 110.00 3,491.45 110.00 3,484.92 110.00 3,478.38 110.00 3,471.85 110.00 3,465.32 110.00 3,458.78 $940,000 $940,500 110.00 3,499.86 110.00 3,493.33 110.00 3,486.79 110.00 3,480.26 110.00 3,473.73 110.00 3,467.19 110.00 3,460.66 $940,500 $941,000 110.00 3,501.73 110.00 3,495.20 110.00 3,488.67 110.00 3,482.13 110.00 3,475.60 110.00 3,469.07 110.00 3,462.53 $941,000 $941,500 110.00 3,503.61 110.00 3,497.08 110.00 3,490.54 110.00 3,484.01 110.00 3,477.48 110.00 3,470.94 110.00 3,464.41 $941,500 $942,000 110.00 3,505.48 110.00 3,498.95 110.00 3,492.42 110.00 3,485.88 110.00 3,479.35 110.00 3,472.82 110.00 3,466.28 $942,000 $942,500 110.00 3,507.36 110.00 3,500.83 110.00 3,494.29 110.00 3,487.76 110.00 3,481.23 110.00 3,474.69 110.00 3,468.16 $942,500 $943,000 110.00 3,509.23 110.00 3,502.70 110.00 3,496.17 110.00 3,489.63 110.00 3,483.10 110.00 3,476.57 110.00 3,470.03 $943,000 $943,500 110.00 3,511.11 110.00 3,504.58 110.00 3,498.04 110.00 3,491.51 110.00 3,484.98 110.00 3,478.44 110.00 3,471.91 $943,500 $944,000 110.00 3,512.98 110.00 3,506.45 110.00 3,499.92 110.00 3,493.38 110.00 3,486.85 110.00 3,480.32 110.00 3,473.78 $944,000 $944,500 110.00 3,514.86 110.00 3,508.33 110.00 3,501.79 110.00 3,495.26 110.00 3,488.73 110.00 3,482.19 110.00 3,475.66 $944,500 $945,000 110.00 3,516.73 110.00 3,510.20 110.00 3,503.67 110.00 3,497.13 110.00 3,490.60 110.00 3,484.07 110.00 3,477.53 $945,000 $945,500 110.00 3,518.61 110.00 3,512.08 110.00 3,505.54 110.00 3,499.01 110.00 3,492.48 110.00 3,485.94 110.00 3,479.41 $945,500 $946,000 110.00 3,520.48 110.00 3,513.95 110.00 3,507.42 110.00 3,500.88 110.00 3,494.35 110.00 3,487.82 110.00 3,481.28 $946,000 $946,500 110.00 3,522.36 110.00 3,515.83 110.00 3,509.29 110.00 3,502.76 110.00 3,496.23 110.00 3,489.69 110.00 3,483.16 $946,500 $947,000 110.00 3,524.23 110.00 3,517.70 110.00 3,511.17 110.00 3,504.63 110.00 3,498.10 110.00 3,491.57 110.00 3,485.03 $947,000 $947,500 110.00 3,526.11 110.00 3,519.58 110.00 3,513.04 110.00 3,506.51 110.00 3,499.98 110.00 3,493.44 110.00 3,486.91 $947,500 $948,000 110.00 3,527.98 110.00 3,521.45 110.00 3,514.92 110.00 3,508.38 110.00 3,501.85 110.00 3,495.32 110.00 3,488.78 $948,000 $948,500 110.00 3,529.86 110.00 3,523.33 110.00 3,516.79 110.00 3,510.26 110.00 3,503.73 110.00 3,497.19 110.00 3,490.66 $948,500 $949,000 110.00 3,531.73 110.00 3,525.20 110.00 3,518.67 110.00 3,512.13 110.00 3,505.60 110.00 3,499.07 110.00 3,492.53 $949,000 $949,500 110.00 3,533.61 110.00 3,527.08 110.00 3,520.54 110.00 3,514.01 110.00 3,507.48 110.00 3,500.94 110.00 3,494.41 $949,500 $950,000 110.00 3,535.48 110.00 3,528.95 110.00 3,522.42 110.00 3,515.88 110.00 3,509.35 110.00 3,502.82 110.00 3,496.28 $950,000 $950,500 110.00 3,537.36 110.00 3,530.83 110.00 3,524.29 110.00 3,517.76 110.00 3,511.23 110.00 3,504.69 110.00 3,498.16 $950,500 $951,000 110.00 3,539.23 110.00 3,532.70 110.00 3,526.17 110.00 3,519.63 110.00 3,513.10 110.00 3,506.57 110.00 3,500.03 $951,000 $951,500 110.00 3,541.11 110.00 3,534.58 110.00 3,528.04 110.00 3,521.51 110.00 3,514.98 110.00 3,508.44 110.00 3,501.91 $951,500 $952,000 110.00 3,542.98 110.00 3,536.45 110.00 3,529.92 110.00 3,523.38 110.00 3,516.85 110.00 3,510.32 110.00 3,503.78 $952,000 $952,500 110.00 3,544.86 110.00 3,538.33 110.00 3,531.79 110.00 3,525.26 110.00 3,518.73 110.00 3,512.19 110.00 3,505.66 $952,500 $953,000 110.00 3,546.73 110.00 3,540.20 110.00 3,533.67 110.00 3,527.13 110.00 3,520.60 110.00 3,514.07 110.00 3,507.53 $953,000 $953,500 110.00 3,548.61 110.00 3,542.08 110.00 3,535.54 110.00 3,529.01 110.00 3,522.48 110.00 3,515.94 110.00 3,509.41 $953,500 $954,000 110.00 3,550.48 110.00 3,543.95 110.00 3,537.42 110.00 3,530.88 110.00 3,524.35 110.00 3,517.82 110.00 3,511.28 $954,000 $954,500 110.00 3,552.36 110.00 3,545.83 110.00 3,539.29 110.00 3,532.76 110.00 3,526.23 110.00 3,519.69 110.00 3,513.16 $954,500 $955,000 110.00 3,554.23 110.00 3,547.70 110.00 3,541.17 110.00 3,534.63 110.00 3,528.10 110.00 3,521.57 110.00 3,515.03 $955,000 $955,500 110.00 3,556.11 110.00 3,549.58 110.00 3,543.04 110.00 3,536.51 110.00 3,529.98 110.00 3,523.44 110.00 3,516.91 $955,500 $956,000 110.00 3,557.98 110.00 3,551.45 110.00 3,544.92 110.00 3,538.38 110.00 3,531.85 110.00 3,525.32 110.00 3,518.78 $956,000 $956,500 110.00 3,559.86 110.00 3,553.33 110.00 3,546.79 110.00 3,540.26 110.00 3,533.73 110.00 3,527.19 110.00 3,520.66 $956,500 $957,000 110.00 3,561.73 110.00 3,555.20 110.00 3,548.67 110.00 3,542.13 110.00 3,535.60 110.00 3,529.07 110.00 3,522.53 $957,000 $957,500 110.00 3,563.61 110.00 3,557.08 110.00 3,550.54 110.00 3,544.01 110.00 3,537.48 110.00 3,530.94 110.00 3,524.41 $957,500 $958,000 110.00 3,565.48 110.00 3,558.95 110.00 3,552.42 110.00 3,545.88 110.00 3,539.35 110.00 3,532.82 110.00 3,526.28 $958,000 $958,500 110.00 3,567.36 110.00 3,560.83 110.00 3,554.29 110.00 3,547.76 110.00 3,541.23 110.00 3,534.69 110.00 3,528.16 $958,500 $959,000 110.00 3,569.23 110.00 3,562.70 110.00 3,556.17 110.00 3,549.63 110.00 3,543.10 110.00 3,536.57 110.00 3,530.03 $959,000 $959,500 110.00 3,571.11 110.00 3,564.58 110.00 3,558.04 110.00 3,551.51 110.00 3,544.98 110.00 3,538.44 110.00 3,531.91 $959,500 $960,000 110.00 3,572.98 110.00 3,566.45 110.00 3,559.92 110.00 3,553.38 110.00 3,546.85 110.00 3,540.32 110.00 3,533.78 $960,000 $960,500 110.00 3,574.86 110.00 3,568.33 110.00 3,561.79 110.00 3,555.26 110.00 3,548.73 110.00 3,542.19 110.00 3,535.66 $960,500 $961,000 110.00 3,576.73 110.00 3,570.20 110.00 3,563.67 110.00 3,557.13 110.00 3,550.60 110.00 3,544.07 110.00 3,537.53 $961,000 $961,500 110.00 3,578.61 110.00 3,572.08 110.00 3,565.54 110.00 3,559.01 110.00 3,552.48 110.00 3,545.94 110.00 3,539.41 $961,500 $962,000 110.00 3,580.48 110.00 3,573.95 110.00 3,567.42 110.00 3,560.88 110.00 3,554.35 110.00 3,547.82 110.00 3,541.28 $962,000 $962,500 110.00 3,582.36 110.00 3,575.83 110.00 3,569.29 110.00 3,562.76 110.00 3,556.23 110.00 3,549.69 110.00 3,543.16 $962,500 $963,000 110.00 3,584.23 110.00 3,577.70 110.00 3,571.17 110.00 3,564.63 110.00 3,558.10 110.00 3,551.57 110.00 3,545.03 $963,000 $963,500 110.00 3,586.11 110.00 3,579.58 110.00 3,573.04 110.00 3,566.51 110.00 3,559.98 110.00 3,553.44 110.00 3,546.91 $963,500 $964,000 110.00 3,587.98 110.00 3,581.45 110.00 3,574.92 110.00 3,568.38 110.00 3,561.85 110.00 3,555.32 110.00 3,548.78 $964,000 $964,500 110.00 3,589.86 110.00 3,583.33 110.00 3,576.79 110.00 3,570.26 110.00 3,563.73 110.00 3,557.19 110.00 3,550.66 $964,500 $965,000 110.00 3,591.73 110.00 3,585.20 110.00 3,578.67 110.00 3,572.13 110.00 3,565.60 110.00 3,559.07 110.00 3,552.53 $965,000 $965,500 110.00 3,593.61 110.00 3,587.08 110.00 3,580.54 110.00 3,574.01 110.00 3,567.48 110.00 3,560.94 110.00 3,554.41 $965,500 $966,000 110.00 3,595.48 110.00 3,588.95 110.00 3,582.42 110.00 3,575.88 110.00 3,569.35 110.00 3,562.82 110.00 3,556.28 $966,000 $966,500 110.00 3,597.36 110.00 3,590.83 110.00 3,584.29 110.00 3,577.76 110.00 3,571.23 110.00 3,564.69 110.00 3,558.16 $966,500 $967,000 110.00 3,599.23 110.00 3,592.70 110.00 3,586.17 110.00 3,579.63 110.00 3,573.10 110.00 3,566.57 110.00 3,560.03 $967,000 $967,500 110.00 3,601.11 110.00 3,594.58 110.00 3,588.04 110.00 3,581.51 110.00 3,574.98 110.00 3,568.44 110.00 3,561.91 $967,500 $968,000 110.00 3,602.98 110.00 3,596.45 110.00 3,589.92 110.00 3,583.38 110.00 3,576.85 110.00 3,570.32 110.00 3,563.78 $968,000 $968,500 110.00 3,604.86 110.00 3,598.33 110.00 3,591.79 110.00 3,585.26 110.00 3,578.73 110.00 3,572.19 110.00 3,565.66 $968,500 $969,000 110.00 3,606.73 110.00 3,600.20 110.00 3,593.67 110.00 3,587.13 110.00 3,580.60 110.00 3,574.07 110.00 3,567.53

NJEIS Family Cost Participation Table Page 22 of 12 Effective July 1, 2015

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

$969,000 $969,500 110.00 3,608.61 110.00 3,602.08 110.00 3,595.54 110.00 3,589.01 110.00 3,582.48 110.00 3,575.94 110.00 3,569.41 $969,500 $970,000 110.00 3,610.48 110.00 3,603.95 110.00 3,597.42 110.00 3,590.88 110.00 3,584.35 110.00 3,577.82 110.00 3,571.28 $970,000 $970,500 110.00 3,612.36 110.00 3,605.83 110.00 3,599.29 110.00 3,592.76 110.00 3,586.23 110.00 3,579.69 110.00 3,573.16 $970,500 $971,000 110.00 3,614.23 110.00 3,607.70 110.00 3,601.17 110.00 3,594.63 110.00 3,588.10 110.00 3,581.57 110.00 3,575.03 $971,000 $971,500 110.00 3,616.11 110.00 3,609.58 110.00 3,603.04 110.00 3,596.51 110.00 3,589.98 110.00 3,583.44 110.00 3,576.91 $971,500 $972,000 110.00 3,617.98 110.00 3,611.45 110.00 3,604.92 110.00 3,598.38 110.00 3,591.85 110.00 3,585.32 110.00 3,578.78 $972,000 $972,500 110.00 3,619.86 110.00 3,613.33 110.00 3,606.79 110.00 3,600.26 110.00 3,593.73 110.00 3,587.19 110.00 3,580.66 $972,500 $973,000 110.00 3,621.73 110.00 3,615.20 110.00 3,608.67 110.00 3,602.13 110.00 3,595.60 110.00 3,589.07 110.00 3,582.53 $973,000 $973,500 110.00 3,623.61 110.00 3,617.08 110.00 3,610.54 110.00 3,604.01 110.00 3,597.48 110.00 3,590.94 110.00 3,584.41 $973,500 $974,000 110.00 3,625.48 110.00 3,618.95 110.00 3,612.42 110.00 3,605.88 110.00 3,599.35 110.00 3,592.82 110.00 3,586.28 $974,000 $974,500 110.00 3,627.36 110.00 3,620.83 110.00 3,614.29 110.00 3,607.76 110.00 3,601.23 110.00 3,594.69 110.00 3,588.16 $974,500 $975,000 110.00 3,629.23 110.00 3,622.70 110.00 3,616.17 110.00 3,609.63 110.00 3,603.10 110.00 3,596.57 110.00 3,590.03 $975,000 $975,500 110.00 3,631.11 110.00 3,624.58 110.00 3,618.04 110.00 3,611.51 110.00 3,604.98 110.00 3,598.44 110.00 3,591.91 $975,500 $976,000 110.00 3,632.98 110.00 3,626.45 110.00 3,619.92 110.00 3,613.38 110.00 3,606.85 110.00 3,600.32 110.00 3,593.78 $976,000 $976,500 110.00 3,634.86 110.00 3,628.33 110.00 3,621.79 110.00 3,615.26 110.00 3,608.73 110.00 3,602.19 110.00 3,595.66 $976,500 $977,000 110.00 3,636.73 110.00 3,630.20 110.00 3,623.67 110.00 3,617.13 110.00 3,610.60 110.00 3,604.07 110.00 3,597.53 $977,000 $977,500 110.00 3,638.61 110.00 3,632.08 110.00 3,625.54 110.00 3,619.01 110.00 3,612.48 110.00 3,605.94 110.00 3,599.41 $977,500 $978,000 110.00 3,640.48 110.00 3,633.95 110.00 3,627.42 110.00 3,620.88 110.00 3,614.35 110.00 3,607.82 110.00 3,601.28 $978,000 $978,500 110.00 3,642.36 110.00 3,635.83 110.00 3,629.29 110.00 3,622.76 110.00 3,616.23 110.00 3,609.69 110.00 3,603.16 $978,500 $979,000 110.00 3,644.23 110.00 3,637.70 110.00 3,631.17 110.00 3,624.63 110.00 3,618.10 110.00 3,611.57 110.00 3,605.03 $979,000 $979,500 110.00 3,646.11 110.00 3,639.58 110.00 3,633.04 110.00 3,626.51 110.00 3,619.98 110.00 3,613.44 110.00 3,606.91 $979,500 $980,000 110.00 3,647.98 110.00 3,641.45 110.00 3,634.92 110.00 3,628.38 110.00 3,621.85 110.00 3,615.32 110.00 3,608.78 $980,000 $980,500 110.00 3,649.86 110.00 3,643.33 110.00 3,636.79 110.00 3,630.26 110.00 3,623.73 110.00 3,617.19 110.00 3,610.66 $980,500 $981,000 110.00 3,651.73 110.00 3,645.20 110.00 3,638.67 110.00 3,632.13 110.00 3,625.60 110.00 3,619.07 110.00 3,612.53 $981,000 $981,500 110.00 3,653.61 110.00 3,647.08 110.00 3,640.54 110.00 3,634.01 110.00 3,627.48 110.00 3,620.94 110.00 3,614.41 $981,500 $982,000 110.00 3,655.48 110.00 3,648.95 110.00 3,642.42 110.00 3,635.88 110.00 3,629.35 110.00 3,622.82 110.00 3,616.28 $982,000 $982,500 110.00 3,657.36 110.00 3,650.83 110.00 3,644.29 110.00 3,637.76 110.00 3,631.23 110.00 3,624.69 110.00 3,618.16 $982,500 $983,000 110.00 3,659.23 110.00 3,652.70 110.00 3,646.17 110.00 3,639.63 110.00 3,633.10 110.00 3,626.57 110.00 3,620.03 $983,000 $983,500 110.00 3,661.11 110.00 3,654.58 110.00 3,648.04 110.00 3,641.51 110.00 3,634.98 110.00 3,628.44 110.00 3,621.91 $983,500 $984,000 110.00 3,662.98 110.00 3,656.45 110.00 3,649.92 110.00 3,643.38 110.00 3,636.85 110.00 3,630.32 110.00 3,623.78 $984,000 $984,500 110.00 3,664.86 110.00 3,658.33 110.00 3,651.79 110.00 3,645.26 110.00 3,638.73 110.00 3,632.19 110.00 3,625.66 $984,500 $985,000 110.00 3,666.73 110.00 3,660.20 110.00 3,653.67 110.00 3,647.13 110.00 3,640.60 110.00 3,634.07 110.00 3,627.53 $985,000 $985,500 110.00 3,668.61 110.00 3,662.08 110.00 3,655.54 110.00 3,649.01 110.00 3,642.48 110.00 3,635.94 110.00 3,629.41 $985,500 $986,000 110.00 3,670.48 110.00 3,663.95 110.00 3,657.42 110.00 3,650.88 110.00 3,644.35 110.00 3,637.82 110.00 3,631.28 $986,000 $986,500 110.00 3,672.36 110.00 3,665.83 110.00 3,659.29 110.00 3,652.76 110.00 3,646.23 110.00 3,639.69 110.00 3,633.16 $986,500 $987,000 110.00 3,674.23 110.00 3,667.70 110.00 3,661.17 110.00 3,654.63 110.00 3,648.10 110.00 3,641.57 110.00 3,635.03 $987,000 $987,500 110.00 3,676.11 110.00 3,669.58 110.00 3,663.04 110.00 3,656.51 110.00 3,649.98 110.00 3,643.44 110.00 3,636.91 $987,500 $988,000 110.00 3,677.98 110.00 3,671.45 110.00 3,664.92 110.00 3,658.38 110.00 3,651.85 110.00 3,645.32 110.00 3,638.78 $988,000 $988,500 110.00 3,679.86 110.00 3,673.33 110.00 3,666.79 110.00 3,660.26 110.00 3,653.73 110.00 3,647.19 110.00 3,640.66 $988,500 $989,000 110.00 3,681.73 110.00 3,675.20 110.00 3,668.67 110.00 3,662.13 110.00 3,655.60 110.00 3,649.07 110.00 3,642.53 $989,000 $989,500 110.00 3,683.61 110.00 3,677.08 110.00 3,670.54 110.00 3,664.01 110.00 3,657.48 110.00 3,650.94 110.00 3,644.41 $989,500 $990,000 110.00 3,685.48 110.00 3,678.95 110.00 3,672.42 110.00 3,665.88 110.00 3,659.35 110.00 3,652.82 110.00 3,646.28 $990,000 $990,500 110.00 3,687.36 110.00 3,680.83 110.00 3,674.29 110.00 3,667.76 110.00 3,661.23 110.00 3,654.69 110.00 3,648.16 $990,500 $991,000 110.00 3,689.23 110.00 3,682.70 110.00 3,676.17 110.00 3,669.63 110.00 3,663.10 110.00 3,656.57 110.00 3,650.03 $991,000 $991,500 110.00 3,691.11 110.00 3,684.58 110.00 3,678.04 110.00 3,671.51 110.00 3,664.98 110.00 3,658.44 110.00 3,651.91 $991,500 $992,000 110.00 3,692.98 110.00 3,686.45 110.00 3,679.92 110.00 3,673.38 110.00 3,666.85 110.00 3,660.32 110.00 3,653.78 $992,000 $992,500 110.00 3,694.86 110.00 3,688.33 110.00 3,681.79 110.00 3,675.26 110.00 3,668.73 110.00 3,662.19 110.00 3,655.66 $992,500 $993,000 110.00 3,696.73 110.00 3,690.20 110.00 3,683.67 110.00 3,677.13 110.00 3,670.60 110.00 3,664.07 110.00 3,657.53 $993,000 $993,500 110.00 3,698.61 110.00 3,692.08 110.00 3,685.54 110.00 3,679.01 110.00 3,672.48 110.00 3,665.94 110.00 3,659.41 $993,500 $994,000 110.00 3,700.48 110.00 3,693.95 110.00 3,687.42 110.00 3,680.88 110.00 3,674.35 110.00 3,667.82 110.00 3,661.28 $994,000 $994,500 110.00 3,702.36 110.00 3,695.83 110.00 3,689.29 110.00 3,682.76 110.00 3,676.23 110.00 3,669.69 110.00 3,663.16 $994,500 $995,000 110.00 3,704.23 110.00 3,697.70 110.00 3,691.17 110.00 3,684.63 110.00 3,678.10 110.00 3,671.57 110.00 3,665.03 $995,000 $995,500 110.00 3,706.11 110.00 3,699.58 110.00 3,693.04 110.00 3,686.51 110.00 3,679.98 110.00 3,673.44 110.00 3,666.91 $995,500 $996,000 110.00 3,707.98 110.00 3,701.45 110.00 3,694.92 110.00 3,688.38 110.00 3,681.85 110.00 3,675.32 110.00 3,668.78 $996,000 $996,500 110.00 3,709.86 110.00 3,703.33 110.00 3,696.79 110.00 3,690.26 110.00 3,683.73 110.00 3,677.19 110.00 3,670.66 $996,500 $997,000 110.00 3,711.73 110.00 3,705.20 110.00 3,698.67 110.00 3,692.13 110.00 3,685.60 110.00 3,679.07 110.00 3,672.53 $997,000 $997,500 110.00 3,713.61 110.00 3,707.08 110.00 3,700.54 110.00 3,694.01 110.00 3,687.48 110.00 3,680.94 110.00 3,674.41 $997,500 $998,000 110.00 3,715.48 110.00 3,708.95 110.00 3,702.42 110.00 3,695.88 110.00 3,689.35 110.00 3,682.82 110.00 3,676.28 $998,000 $998,500 110.00 3,717.36 110.00 3,710.83 110.00 3,704.29 110.00 3,697.76 110.00 3,691.23 110.00 3,684.69 110.00 3,678.16 $998,500 $999,000 110.00 3,719.23 110.00 3,712.70 110.00 3,706.17 110.00 3,699.63 110.00 3,693.10 110.00 3,686.57 110.00 3,680.03 $999,000 $999,500 110.00 3,721.11 110.00 3,714.58 110.00 3,708.04 110.00 3,701.51 110.00 3,694.98 110.00 3,688.44 110.00 3,681.91 $999,500 $1,000,000 110.00 3,722.98 110.00 3,716.45 110.00 3,709.92 110.00 3,703.38 110.00 3,696.85 110.00 3,690.32 110.00 3,683.78

$1,000,000 $1,000,500 110.00 3,724.86 110.00 3,718.33 110.00 3,711.79 110.00 3,705.26 110.00 3,698.73 110.00 3,692.19 110.00 3,685.66 $1,000,500 $1,001,000 110.00 3,726.73 110.00 3,720.20 110.00 3,713.67 110.00 3,707.13 110.00 3,700.60 110.00 3,694.07 110.00 3,687.53 $1,001,000 $1,001,500 110.00 3,728.61 110.00 3,722.08 110.00 3,715.54 110.00 3,709.01 110.00 3,702.48 110.00 3,695.94 110.00 3,689.41 $1,001,500 $1,002,000 110.00 3,730.48 110.00 3,723.95 110.00 3,717.42 110.00 3,710.88 110.00 3,704.35 110.00 3,697.82 110.00 3,691.28 $1,002,000 $1,002,500 110.00 3,732.36 110.00 3,725.83 110.00 3,719.29 110.00 3,712.76 110.00 3,706.23 110.00 3,699.69 110.00 3,693.16 $1,002,500 $1,003,000 110.00 3,734.23 110.00 3,727.70 110.00 3,721.17 110.00 3,714.63 110.00 3,708.10 110.00 3,701.57 110.00 3,695.03 $1,003,000 $1,003,500 110.00 3,736.11 110.00 3,729.58 110.00 3,723.04 110.00 3,716.51 110.00 3,709.98 110.00 3,703.44 110.00 3,696.91 $1,003,500 $1,004,000 110.00 3,737.98 110.00 3,731.45 110.00 3,724.92 110.00 3,718.38 110.00 3,711.85 110.00 3,705.32 110.00 3,698.78 $1,004,000 $1,004,500 110.00 3,739.86 110.00 3,733.33 110.00 3,726.79 110.00 3,720.26 110.00 3,713.73 110.00 3,707.19 110.00 3,700.66 $1,004,500 $1,005,000 110.00 3,741.73 110.00 3,735.20 110.00 3,728.67 110.00 3,722.13 110.00 3,715.60 110.00 3,709.07 110.00 3,702.53 $1,005,000 $1,005,500 110.00 3,743.61 110.00 3,737.08 110.00 3,730.54 110.00 3,724.01 110.00 3,717.48 110.00 3,710.94 110.00 3,704.41 $1,005,500 $1,006,000 110.00 3,745.48 110.00 3,738.95 110.00 3,732.42 110.00 3,725.88 110.00 3,719.35 110.00 3,712.82 110.00 3,706.28 $1,006,000 $1,006,500 110.00 3,747.36 110.00 3,740.83 110.00 3,734.29 110.00 3,727.76 110.00 3,721.23 110.00 3,714.69 110.00 3,708.16 $1,006,500 $1,007,000 110.00 3,749.23 110.00 3,742.70 110.00 3,736.17 110.00 3,729.63 110.00 3,723.10 110.00 3,716.57 110.00 3,710.03 $1,007,000 $1,007,500 110.00 3,751.11 110.00 3,744.58 110.00 3,738.04 110.00 3,731.51 110.00 3,724.98 110.00 3,718.44 110.00 3,711.91 $1,007,500 $1,008,000 110.00 3,752.98 110.00 3,746.45 110.00 3,739.92 110.00 3,733.38 110.00 3,726.85 110.00 3,720.32 110.00 3,713.78 $1,008,000 $1,008,500 110.00 3,754.86 110.00 3,748.33 110.00 3,741.79 110.00 3,735.26 110.00 3,728.73 110.00 3,722.19 110.00 3,715.66 $1,008,500 $1,009,000 110.00 3,756.73 110.00 3,750.20 110.00 3,743.67 110.00 3,737.13 110.00 3,730.60 110.00 3,724.07 110.00 3,717.53 $1,009,000 $1,009,500 110.00 3,758.61 110.00 3,752.08 110.00 3,745.54 110.00 3,739.01 110.00 3,732.48 110.00 3,725.94 110.00 3,719.41 $1,009,500 $1,010,000 110.00 3,760.48 110.00 3,753.95 110.00 3,747.42 110.00 3,740.88 110.00 3,734.35 110.00 3,727.82 110.00 3,721.28 $1,010,000 $1,010,500 110.00 3,762.36 110.00 3,755.83 110.00 3,749.29 110.00 3,742.76 110.00 3,736.23 110.00 3,729.69 110.00 3,723.16 $1,010,500 $1,011,000 110.00 3,764.23 110.00 3,757.70 110.00 3,751.17 110.00 3,744.63 110.00 3,738.10 110.00 3,731.57 110.00 3,725.03 $1,011,000 $1,011,500 110.00 3,766.11 110.00 3,759.58 110.00 3,753.04 110.00 3,746.51 110.00 3,739.98 110.00 3,733.44 110.00 3,726.91 $1,011,500 $1,012,000 110.00 3,767.98 110.00 3,761.45 110.00 3,754.92 110.00 3,748.38 110.00 3,741.85 110.00 3,735.32 110.00 3,728.78 $1,012,000 $1,012,500 110.00 3,769.86 110.00 3,763.33 110.00 3,756.79 110.00 3,750.26 110.00 3,743.73 110.00 3,737.19 110.00 3,730.66 $1,012,500 $1,013,000 110.00 3,771.73 110.00 3,765.20 110.00 3,758.67 110.00 3,752.13 110.00 3,745.60 110.00 3,739.07 110.00 3,732.53 $1,013,000 $1,013,500 110.00 3,773.61 110.00 3,767.08 110.00 3,760.54 110.00 3,754.01 110.00 3,747.48 110.00 3,740.94 110.00 3,734.41 $1,013,500 $1,014,000 110.00 3,775.48 110.00 3,768.95 110.00 3,762.42 110.00 3,755.88 110.00 3,749.35 110.00 3,742.82 110.00 3,736.28 $1,014,000 $1,014,500 110.00 3,777.36 110.00 3,770.83 110.00 3,764.29 110.00 3,757.76 110.00 3,751.23 110.00 3,744.69 110.00 3,738.16 $1,014,500 $1,015,000 110.00 3,779.23 110.00 3,772.70 110.00 3,766.17 110.00 3,759.63 110.00 3,753.10 110.00 3,746.57 110.00 3,740.03 $1,015,000 $1,015,500 110.00 3,781.11 110.00 3,774.58 110.00 3,768.04 110.00 3,761.51 110.00 3,754.98 110.00 3,748.44 110.00 3,741.91 $1,015,500 $1,016,000 110.00 3,782.98 110.00 3,776.45 110.00 3,769.92 110.00 3,763.38 110.00 3,756.85 110.00 3,750.32 110.00 3,743.78 $1,016,000 $1,016,500 110.00 3,784.86 110.00 3,778.33 110.00 3,771.79 110.00 3,765.26 110.00 3,758.73 110.00 3,752.19 110.00 3,745.66 $1,016,500 $1,017,000 110.00 3,786.73 110.00 3,780.20 110.00 3,773.67 110.00 3,767.13 110.00 3,760.60 110.00 3,754.07 110.00 3,747.53 $1,017,000 $1,017,500 110.00 3,788.61 110.00 3,782.08 110.00 3,775.54 110.00 3,769.01 110.00 3,762.48 110.00 3,755.94 110.00 3,749.41 $1,017,500 $1,018,000 110.00 3,790.48 110.00 3,783.95 110.00 3,777.42 110.00 3,770.88 110.00 3,764.35 110.00 3,757.82 110.00 3,751.28 $1,018,000 $1,018,500 110.00 3,792.36 110.00 3,785.83 110.00 3,779.29 110.00 3,772.76 110.00 3,766.23 110.00 3,759.69 110.00 3,753.16 $1,018,500 $1,019,000 110.00 3,794.23 110.00 3,787.70 110.00 3,781.17 110.00 3,774.63 110.00 3,768.10 110.00 3,761.57 110.00 3,755.03 $1,019,000 $1,019,500 110.00 3,796.11 110.00 3,789.58 110.00 3,783.04 110.00 3,776.51 110.00 3,769.98 110.00 3,763.44 110.00 3,756.91 $1,019,500 $1,020,000 110.00 3,797.98 110.00 3,791.45 110.00 3,784.92 110.00 3,778.38 110.00 3,771.85 110.00 3,765.32 110.00 3,758.78

NJEIS Family Cost Participation Table Page 23 of 12 Effective July 1, 2015

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

$1,020,000 $1,020,500 110.00 3,799.86 110.00 3,793.33 110.00 3,786.79 110.00 3,780.26 110.00 3,773.73 110.00 3,767.19 110.00 3,760.66 $1,020,500 $1,021,000 110.00 3,801.73 110.00 3,795.20 110.00 3,788.67 110.00 3,782.13 110.00 3,775.60 110.00 3,769.07 110.00 3,762.53 $1,021,000 $1,021,500 110.00 3,803.61 110.00 3,797.08 110.00 3,790.54 110.00 3,784.01 110.00 3,777.48 110.00 3,770.94 110.00 3,764.41 $1,021,500 $1,022,000 110.00 3,805.48 110.00 3,798.95 110.00 3,792.42 110.00 3,785.88 110.00 3,779.35 110.00 3,772.82 110.00 3,766.28 $1,022,000 $1,022,500 110.00 3,807.36 110.00 3,800.83 110.00 3,794.29 110.00 3,787.76 110.00 3,781.23 110.00 3,774.69 110.00 3,768.16 $1,022,500 $1,023,000 110.00 3,809.23 110.00 3,802.70 110.00 3,796.17 110.00 3,789.63 110.00 3,783.10 110.00 3,776.57 110.00 3,770.03 $1,023,000 $1,023,500 110.00 3,811.11 110.00 3,804.58 110.00 3,798.04 110.00 3,791.51 110.00 3,784.98 110.00 3,778.44 110.00 3,771.91 $1,023,500 $1,024,000 110.00 3,812.98 110.00 3,806.45 110.00 3,799.92 110.00 3,793.38 110.00 3,786.85 110.00 3,780.32 110.00 3,773.78 $1,024,000 $1,024,500 110.00 3,814.86 110.00 3,808.33 110.00 3,801.79 110.00 3,795.26 110.00 3,788.73 110.00 3,782.19 110.00 3,775.66 $1,024,500 $1,025,000 110.00 3,816.73 110.00 3,810.20 110.00 3,803.67 110.00 3,797.13 110.00 3,790.60 110.00 3,784.07 110.00 3,777.53 $1,025,000 $1,025,500 110.00 3,818.61 110.00 3,812.08 110.00 3,805.54 110.00 3,799.01 110.00 3,792.48 110.00 3,785.94 110.00 3,779.41 $1,025,500 $1,026,000 110.00 3,820.48 110.00 3,813.95 110.00 3,807.42 110.00 3,800.88 110.00 3,794.35 110.00 3,787.82 110.00 3,781.28 $1,026,000 $1,026,500 110.00 3,822.36 110.00 3,815.83 110.00 3,809.29 110.00 3,802.76 110.00 3,796.23 110.00 3,789.69 110.00 3,783.16 $1,026,500 $1,027,000 110.00 3,824.23 110.00 3,817.70 110.00 3,811.17 110.00 3,804.63 110.00 3,798.10 110.00 3,791.57 110.00 3,785.03 $1,027,000 $1,027,500 110.00 3,826.11 110.00 3,819.58 110.00 3,813.04 110.00 3,806.51 110.00 3,799.98 110.00 3,793.44 110.00 3,786.91 $1,027,500 $1,028,000 110.00 3,827.98 110.00 3,821.45 110.00 3,814.92 110.00 3,808.38 110.00 3,801.85 110.00 3,795.32 110.00 3,788.78 $1,028,000 $1,028,500 110.00 3,829.86 110.00 3,823.33 110.00 3,816.79 110.00 3,810.26 110.00 3,803.73 110.00 3,797.19 110.00 3,790.66 $1,028,500 $1,029,000 110.00 3,831.73 110.00 3,825.20 110.00 3,818.67 110.00 3,812.13 110.00 3,805.60 110.00 3,799.07 110.00 3,792.53 $1,029,000 $1,029,500 110.00 3,833.61 110.00 3,827.08 110.00 3,820.54 110.00 3,814.01 110.00 3,807.48 110.00 3,800.94 110.00 3,794.41 $1,029,500 $1,030,000 110.00 3,835.48 110.00 3,828.95 110.00 3,822.42 110.00 3,815.88 110.00 3,809.35 110.00 3,802.82 110.00 3,796.28 $1,030,000 $1,030,500 110.00 3,837.36 110.00 3,830.83 110.00 3,824.29 110.00 3,817.76 110.00 3,811.23 110.00 3,804.69 110.00 3,798.16 $1,030,500 $1,031,000 110.00 3,839.23 110.00 3,832.70 110.00 3,826.17 110.00 3,819.63 110.00 3,813.10 110.00 3,806.57 110.00 3,800.03 $1,031,000 $1,031,500 110.00 3,841.11 110.00 3,834.58 110.00 3,828.04 110.00 3,821.51 110.00 3,814.98 110.00 3,808.44 110.00 3,801.91 $1,031,500 $1,032,000 110.00 3,842.98 110.00 3,836.45 110.00 3,829.92 110.00 3,823.38 110.00 3,816.85 110.00 3,810.32 110.00 3,803.78 $1,032,000 $1,032,500 110.00 3,844.86 110.00 3,838.33 110.00 3,831.79 110.00 3,825.26 110.00 3,818.73 110.00 3,812.19 110.00 3,805.66 $1,032,500 $1,033,000 110.00 3,846.73 110.00 3,840.20 110.00 3,833.67 110.00 3,827.13 110.00 3,820.60 110.00 3,814.07 110.00 3,807.53 $1,033,000 $1,033,500 110.00 3,848.61 110.00 3,842.08 110.00 3,835.54 110.00 3,829.01 110.00 3,822.48 110.00 3,815.94 110.00 3,809.41 $1,033,500 $1,034,000 110.00 3,850.48 110.00 3,843.95 110.00 3,837.42 110.00 3,830.88 110.00 3,824.35 110.00 3,817.82 110.00 3,811.28 $1,034,000 $1,034,500 110.00 3,852.36 110.00 3,845.83 110.00 3,839.29 110.00 3,832.76 110.00 3,826.23 110.00 3,819.69 110.00 3,813.16 $1,034,500 $1,035,000 110.00 3,854.23 110.00 3,847.70 110.00 3,841.17 110.00 3,834.63 110.00 3,828.10 110.00 3,821.57 110.00 3,815.03 $1,035,000 $1,035,500 110.00 3,856.11 110.00 3,849.58 110.00 3,843.04 110.00 3,836.51 110.00 3,829.98 110.00 3,823.44 110.00 3,816.91 $1,035,500 $1,036,000 110.00 3,857.98 110.00 3,851.45 110.00 3,844.92 110.00 3,838.38 110.00 3,831.85 110.00 3,825.32 110.00 3,818.78 $1,036,000 $1,036,500 110.00 3,859.86 110.00 3,853.33 110.00 3,846.79 110.00 3,840.26 110.00 3,833.73 110.00 3,827.19 110.00 3,820.66 $1,036,500 $1,037,000 110.00 3,861.73 110.00 3,855.20 110.00 3,848.67 110.00 3,842.13 110.00 3,835.60 110.00 3,829.07 110.00 3,822.53 $1,037,000 $1,037,500 110.00 3,863.61 110.00 3,857.08 110.00 3,850.54 110.00 3,844.01 110.00 3,837.48 110.00 3,830.94 110.00 3,824.41 $1,037,500 $1,038,000 110.00 3,865.48 110.00 3,858.95 110.00 3,852.42 110.00 3,845.88 110.00 3,839.35 110.00 3,832.82 110.00 3,826.28 $1,038,000 $1,038,500 110.00 3,867.36 110.00 3,860.83 110.00 3,854.29 110.00 3,847.76 110.00 3,841.23 110.00 3,834.69 110.00 3,828.16 $1,038,500 $1,039,000 110.00 3,869.23 110.00 3,862.70 110.00 3,856.17 110.00 3,849.63 110.00 3,843.10 110.00 3,836.57 110.00 3,830.03 $1,039,000 $1,039,500 110.00 3,871.11 110.00 3,864.58 110.00 3,858.04 110.00 3,851.51 110.00 3,844.98 110.00 3,838.44 110.00 3,831.91 $1,039,500 $1,040,000 110.00 3,872.98 110.00 3,866.45 110.00 3,859.92 110.00 3,853.38 110.00 3,846.85 110.00 3,840.32 110.00 3,833.78 $1,040,000 $1,040,500 110.00 3,874.86 110.00 3,868.33 110.00 3,861.79 110.00 3,855.26 110.00 3,848.73 110.00 3,842.19 110.00 3,835.66 $1,040,500 $1,041,000 110.00 3,876.73 110.00 3,870.20 110.00 3,863.67 110.00 3,857.13 110.00 3,850.60 110.00 3,844.07 110.00 3,837.53 $1,041,000 $1,041,500 110.00 3,878.61 110.00 3,872.08 110.00 3,865.54 110.00 3,859.01 110.00 3,852.48 110.00 3,845.94 110.00 3,839.41 $1,041,500 $1,042,000 110.00 3,880.48 110.00 3,873.95 110.00 3,867.42 110.00 3,860.88 110.00 3,854.35 110.00 3,847.82 110.00 3,841.28 $1,042,000 $1,042,500 110.00 3,882.36 110.00 3,875.83 110.00 3,869.29 110.00 3,862.76 110.00 3,856.23 110.00 3,849.69 110.00 3,843.16 $1,042,500 $1,043,000 110.00 3,884.23 110.00 3,877.70 110.00 3,871.17 110.00 3,864.63 110.00 3,858.10 110.00 3,851.57 110.00 3,845.03 $1,043,000 $1,043,500 110.00 3,886.11 110.00 3,879.58 110.00 3,873.04 110.00 3,866.51 110.00 3,859.98 110.00 3,853.44 110.00 3,846.91 $1,043,500 $1,044,000 110.00 3,887.98 110.00 3,881.45 110.00 3,874.92 110.00 3,868.38 110.00 3,861.85 110.00 3,855.32 110.00 3,848.78 $1,044,000 $1,044,500 110.00 3,889.86 110.00 3,883.33 110.00 3,876.79 110.00 3,870.26 110.00 3,863.73 110.00 3,857.19 110.00 3,850.66 $1,044,500 $1,045,000 110.00 3,891.73 110.00 3,885.20 110.00 3,878.67 110.00 3,872.13 110.00 3,865.60 110.00 3,859.07 110.00 3,852.53 $1,045,000 $1,045,500 110.00 3,893.61 110.00 3,887.08 110.00 3,880.54 110.00 3,874.01 110.00 3,867.48 110.00 3,860.94 110.00 3,854.41 $1,045,500 $1,046,000 110.00 3,895.48 110.00 3,888.95 110.00 3,882.42 110.00 3,875.88 110.00 3,869.35 110.00 3,862.82 110.00 3,856.28 $1,046,000 $1,046,500 110.00 3,897.36 110.00 3,890.83 110.00 3,884.29 110.00 3,877.76 110.00 3,871.23 110.00 3,864.69 110.00 3,858.16 $1,046,500 $1,047,000 110.00 3,899.23 110.00 3,892.70 110.00 3,886.17 110.00 3,879.63 110.00 3,873.10 110.00 3,866.57 110.00 3,860.03 $1,047,000 $1,047,500 110.00 3,901.11 110.00 3,894.58 110.00 3,888.04 110.00 3,881.51 110.00 3,874.98 110.00 3,868.44 110.00 3,861.91 $1,047,500 $1,048,000 110.00 3,902.98 110.00 3,896.45 110.00 3,889.92 110.00 3,883.38 110.00 3,876.85 110.00 3,870.32 110.00 3,863.78 $1,048,000 $1,048,500 110.00 3,904.86 110.00 3,898.33 110.00 3,891.79 110.00 3,885.26 110.00 3,878.73 110.00 3,872.19 110.00 3,865.66 $1,048,500 $1,049,000 110.00 3,906.73 110.00 3,900.20 110.00 3,893.67 110.00 3,887.13 110.00 3,880.60 110.00 3,874.07 110.00 3,867.53 $1,049,000 $1,049,500 110.00 3,908.61 110.00 3,902.08 110.00 3,895.54 110.00 3,889.01 110.00 3,882.48 110.00 3,875.94 110.00 3,869.41 $1,049,500 $1,050,000 110.00 3,910.48 110.00 3,903.95 110.00 3,897.42 110.00 3,890.88 110.00 3,884.35 110.00 3,877.82 110.00 3,871.28 $1,050,000 $1,050,500 110.00 3,912.36 110.00 3,905.83 110.00 3,899.29 110.00 3,892.76 110.00 3,886.23 110.00 3,879.69 110.00 3,873.16 $1,050,500 $1,051,000 110.00 3,914.23 110.00 3,907.70 110.00 3,901.17 110.00 3,894.63 110.00 3,888.10 110.00 3,881.57 110.00 3,875.03 $1,051,000 $1,051,500 110.00 3,916.11 110.00 3,909.58 110.00 3,903.04 110.00 3,896.51 110.00 3,889.98 110.00 3,883.44 110.00 3,876.91 $1,051,500 $1,052,000 110.00 3,917.98 110.00 3,911.45 110.00 3,904.92 110.00 3,898.38 110.00 3,891.85 110.00 3,885.32 110.00 3,878.78 $1,052,000 $1,052,500 110.00 3,919.86 110.00 3,913.33 110.00 3,906.79 110.00 3,900.26 110.00 3,893.73 110.00 3,887.19 110.00 3,880.66 $1,052,500 $1,053,000 110.00 3,921.73 110.00 3,915.20 110.00 3,908.67 110.00 3,902.13 110.00 3,895.60 110.00 3,889.07 110.00 3,882.53 $1,053,000 $1,053,500 110.00 3,923.61 110.00 3,917.08 110.00 3,910.54 110.00 3,904.01 110.00 3,897.48 110.00 3,890.94 110.00 3,884.41 $1,053,500 $1,054,000 110.00 3,925.48 110.00 3,918.95 110.00 3,912.42 110.00 3,905.88 110.00 3,899.35 110.00 3,892.82 110.00 3,886.28 $1,054,000 $1,054,500 110.00 3,927.36 110.00 3,920.83 110.00 3,914.29 110.00 3,907.76 110.00 3,901.23 110.00 3,894.69 110.00 3,888.16 $1,054,500 $1,055,000 110.00 3,929.23 110.00 3,922.70 110.00 3,916.17 110.00 3,909.63 110.00 3,903.10 110.00 3,896.57 110.00 3,890.03 $1,055,000 $1,055,500 110.00 3,931.11 110.00 3,924.58 110.00 3,918.04 110.00 3,911.51 110.00 3,904.98 110.00 3,898.44 110.00 3,891.91 $1,055,500 $1,056,000 110.00 3,932.98 110.00 3,926.45 110.00 3,919.92 110.00 3,913.38 110.00 3,906.85 110.00 3,900.32 110.00 3,893.78 $1,056,000 $1,056,500 110.00 3,934.86 110.00 3,928.33 110.00 3,921.79 110.00 3,915.26 110.00 3,908.73 110.00 3,902.19 110.00 3,895.66 $1,056,500 $1,057,000 110.00 3,936.73 110.00 3,930.20 110.00 3,923.67 110.00 3,917.13 110.00 3,910.60 110.00 3,904.07 110.00 3,897.53 $1,057,000 $1,057,500 110.00 3,938.61 110.00 3,932.08 110.00 3,925.54 110.00 3,919.01 110.00 3,912.48 110.00 3,905.94 110.00 3,899.41 $1,057,500 $1,058,000 110.00 3,940.48 110.00 3,933.95 110.00 3,927.42 110.00 3,920.88 110.00 3,914.35 110.00 3,907.82 110.00 3,901.28 $1,058,000 $1,058,500 110.00 3,942.36 110.00 3,935.83 110.00 3,929.29 110.00 3,922.76 110.00 3,916.23 110.00 3,909.69 110.00 3,903.16 $1,058,500 $1,059,000 110.00 3,944.23 110.00 3,937.70 110.00 3,931.17 110.00 3,924.63 110.00 3,918.10 110.00 3,911.57 110.00 3,905.03 $1,059,000 $1,059,500 110.00 3,946.11 110.00 3,939.58 110.00 3,933.04 110.00 3,926.51 110.00 3,919.98 110.00 3,913.44 110.00 3,906.91 $1,059,500 $1,060,000 110.00 3,947.98 110.00 3,941.45 110.00 3,934.92 110.00 3,928.38 110.00 3,921.85 110.00 3,915.32 110.00 3,908.78 $1,060,000 $1,060,500 110.00 3,949.86 110.00 3,943.33 110.00 3,936.79 110.00 3,930.26 110.00 3,923.73 110.00 3,917.19 110.00 3,910.66 $1,060,500 $1,061,000 110.00 3,951.73 110.00 3,945.20 110.00 3,938.67 110.00 3,932.13 110.00 3,925.60 110.00 3,919.07 110.00 3,912.53 $1,061,000 $1,061,500 110.00 3,953.61 110.00 3,947.08 110.00 3,940.54 110.00 3,934.01 110.00 3,927.48 110.00 3,920.94 110.00 3,914.41 $1,061,500 $1,062,000 110.00 3,955.48 110.00 3,948.95 110.00 3,942.42 110.00 3,935.88 110.00 3,929.35 110.00 3,922.82 110.00 3,916.28 $1,062,000 $1,062,500 110.00 3,957.36 110.00 3,950.83 110.00 3,944.29 110.00 3,937.76 110.00 3,931.23 110.00 3,924.69 110.00 3,918.16 $1,062,500 $1,063,000 110.00 3,959.23 110.00 3,952.70 110.00 3,946.17 110.00 3,939.63 110.00 3,933.10 110.00 3,926.57 110.00 3,920.03 $1,063,000 $1,063,500 110.00 3,961.11 110.00 3,954.58 110.00 3,948.04 110.00 3,941.51 110.00 3,934.98 110.00 3,928.44 110.00 3,921.91 $1,063,500 $1,064,000 110.00 3,962.98 110.00 3,956.45 110.00 3,949.92 110.00 3,943.38 110.00 3,936.85 110.00 3,930.32 110.00 3,923.78 $1,064,000 $1,064,500 110.00 3,964.86 110.00 3,958.33 110.00 3,951.79 110.00 3,945.26 110.00 3,938.73 110.00 3,932.19 110.00 3,925.66 $1,064,500 $1,065,000 110.00 3,966.73 110.00 3,960.20 110.00 3,953.67 110.00 3,947.13 110.00 3,940.60 110.00 3,934.07 110.00 3,927.53 $1,065,000 $1,065,500 110.00 3,968.61 110.00 3,962.08 110.00 3,955.54 110.00 3,949.01 110.00 3,942.48 110.00 3,935.94 110.00 3,929.41 $1,065,500 $1,066,000 110.00 3,970.48 110.00 3,963.95 110.00 3,957.42 110.00 3,950.88 110.00 3,944.35 110.00 3,937.82 110.00 3,931.28 $1,066,000 $1,066,500 110.00 3,972.36 110.00 3,965.83 110.00 3,959.29 110.00 3,952.76 110.00 3,946.23 110.00 3,939.69 110.00 3,933.16 $1,066,500 $1,067,000 110.00 3,974.23 110.00 3,967.70 110.00 3,961.17 110.00 3,954.63 110.00 3,948.10 110.00 3,941.57 110.00 3,935.03 $1,067,000 $1,067,500 110.00 3,976.11 110.00 3,969.58 110.00 3,963.04 110.00 3,956.51 110.00 3,949.98 110.00 3,943.44 110.00 3,936.91 $1,067,500 $1,068,000 110.00 3,977.98 110.00 3,971.45 110.00 3,964.92 110.00 3,958.38 110.00 3,951.85 110.00 3,945.32 110.00 3,938.78 $1,068,000 $1,068,500 110.00 3,979.86 110.00 3,973.33 110.00 3,966.79 110.00 3,960.26 110.00 3,953.73 110.00 3,947.19 110.00 3,940.66 $1,068,500 $1,069,000 110.00 3,981.73 110.00 3,975.20 110.00 3,968.67 110.00 3,962.13 110.00 3,955.60 110.00 3,949.07 110.00 3,942.53 $1,069,000 $1,069,500 110.00 3,983.61 110.00 3,977.08 110.00 3,970.54 110.00 3,964.01 110.00 3,957.48 110.00 3,950.94 110.00 3,944.41 $1,069,500 $1,070,000 110.00 3,985.48 110.00 3,978.95 110.00 3,972.42 110.00 3,965.88 110.00 3,959.35 110.00 3,952.82 110.00 3,946.28 $1,070,000 $1,070,500 110.00 3,987.36 110.00 3,980.83 110.00 3,974.29 110.00 3,967.76 110.00 3,961.23 110.00 3,954.69 110.00 3,948.16 $1,070,500 $1,071,000 110.00 3,989.23 110.00 3,982.70 110.00 3,976.17 110.00 3,969.63 110.00 3,963.10 110.00 3,956.57 110.00 3,950.03

NJEIS Family Cost Participation Table Page 24 of 12 Effective July 1, 2015

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

$1,071,000 $1,071,500 110.00 3,991.11 110.00 3,984.58 110.00 3,978.04 110.00 3,971.51 110.00 3,964.98 110.00 3,958.44 110.00 3,951.91 $1,071,500 $1,072,000 110.00 3,992.98 110.00 3,986.45 110.00 3,979.92 110.00 3,973.38 110.00 3,966.85 110.00 3,960.32 110.00 3,953.78 $1,072,000 $1,072,500 110.00 3,994.86 110.00 3,988.33 110.00 3,981.79 110.00 3,975.26 110.00 3,968.73 110.00 3,962.19 110.00 3,955.66 $1,072,500 $1,073,000 110.00 3,996.73 110.00 3,990.20 110.00 3,983.67 110.00 3,977.13 110.00 3,970.60 110.00 3,964.07 110.00 3,957.53 $1,073,000 $1,073,500 110.00 3,998.61 110.00 3,992.08 110.00 3,985.54 110.00 3,979.01 110.00 3,972.48 110.00 3,965.94 110.00 3,959.41 $1,073,500 $1,074,000 110.00 4,000.48 110.00 3,993.95 110.00 3,987.42 110.00 3,980.88 110.00 3,974.35 110.00 3,967.82 110.00 3,961.28 $1,074,000 $1,074,500 110.00 4,002.36 110.00 3,995.83 110.00 3,989.29 110.00 3,982.76 110.00 3,976.23 110.00 3,969.69 110.00 3,963.16 $1,074,500 $1,075,000 110.00 4,004.23 110.00 3,997.70 110.00 3,991.17 110.00 3,984.63 110.00 3,978.10 110.00 3,971.57 110.00 3,965.03 $1,075,000 $1,075,500 110.00 4,006.11 110.00 3,999.58 110.00 3,993.04 110.00 3,986.51 110.00 3,979.98 110.00 3,973.44 110.00 3,966.91 $1,075,500 $1,076,000 110.00 4,007.98 110.00 4,001.45 110.00 3,994.92 110.00 3,988.38 110.00 3,981.85 110.00 3,975.32 110.00 3,968.78 $1,076,000 $1,076,500 110.00 4,009.86 110.00 4,003.33 110.00 3,996.79 110.00 3,990.26 110.00 3,983.73 110.00 3,977.19 110.00 3,970.66 $1,076,500 $1,077,000 110.00 4,011.73 110.00 4,005.20 110.00 3,998.67 110.00 3,992.13 110.00 3,985.60 110.00 3,979.07 110.00 3,972.53 $1,077,000 $1,077,500 110.00 4,013.61 110.00 4,007.08 110.00 4,000.54 110.00 3,994.01 110.00 3,987.48 110.00 3,980.94 110.00 3,974.41 $1,077,500 $1,078,000 110.00 4,015.48 110.00 4,008.95 110.00 4,002.42 110.00 3,995.88 110.00 3,989.35 110.00 3,982.82 110.00 3,976.28 $1,078,000 $1,078,500 110.00 4,017.36 110.00 4,010.83 110.00 4,004.29 110.00 3,997.76 110.00 3,991.23 110.00 3,984.69 110.00 3,978.16 $1,078,500 $1,079,000 110.00 4,019.23 110.00 4,012.70 110.00 4,006.17 110.00 3,999.63 110.00 3,993.10 110.00 3,986.57 110.00 3,980.03 $1,079,000 $1,079,500 110.00 4,021.11 110.00 4,014.58 110.00 4,008.04 110.00 4,001.51 110.00 3,994.98 110.00 3,988.44 110.00 3,981.91 $1,079,500 $1,080,000 110.00 4,022.98 110.00 4,016.45 110.00 4,009.92 110.00 4,003.38 110.00 3,996.85 110.00 3,990.32 110.00 3,983.78 $1,080,000 $1,080,500 110.00 4,024.86 110.00 4,018.33 110.00 4,011.79 110.00 4,005.26 110.00 3,998.73 110.00 3,992.19 110.00 3,985.66 $1,080,500 $1,081,000 110.00 4,026.73 110.00 4,020.20 110.00 4,013.67 110.00 4,007.13 110.00 4,000.60 110.00 3,994.07 110.00 3,987.53 $1,081,000 $1,081,500 110.00 4,028.61 110.00 4,022.08 110.00 4,015.54 110.00 4,009.01 110.00 4,002.48 110.00 3,995.94 110.00 3,989.41 $1,081,500 $1,082,000 110.00 4,030.48 110.00 4,023.95 110.00 4,017.42 110.00 4,010.88 110.00 4,004.35 110.00 3,997.82 110.00 3,991.28 $1,082,000 $1,082,500 110.00 4,032.36 110.00 4,025.83 110.00 4,019.29 110.00 4,012.76 110.00 4,006.23 110.00 3,999.69 110.00 3,993.16 $1,082,500 $1,083,000 110.00 4,034.23 110.00 4,027.70 110.00 4,021.17 110.00 4,014.63 110.00 4,008.10 110.00 4,001.57 110.00 3,995.03 $1,083,000 $1,083,500 110.00 4,036.11 110.00 4,029.58 110.00 4,023.04 110.00 4,016.51 110.00 4,009.98 110.00 4,003.44 110.00 3,996.91 $1,083,500 $1,084,000 110.00 4,037.98 110.00 4,031.45 110.00 4,024.92 110.00 4,018.38 110.00 4,011.85 110.00 4,005.32 110.00 3,998.78 $1,084,000 $1,084,500 110.00 4,039.86 110.00 4,033.33 110.00 4,026.79 110.00 4,020.26 110.00 4,013.73 110.00 4,007.19 110.00 4,000.66 $1,084,500 $1,085,000 110.00 4,041.73 110.00 4,035.20 110.00 4,028.67 110.00 4,022.13 110.00 4,015.60 110.00 4,009.07 110.00 4,002.53 $1,085,000 $1,085,500 110.00 4,043.61 110.00 4,037.08 110.00 4,030.54 110.00 4,024.01 110.00 4,017.48 110.00 4,010.94 110.00 4,004.41 $1,085,500 $1,086,000 110.00 4,045.48 110.00 4,038.95 110.00 4,032.42 110.00 4,025.88 110.00 4,019.35 110.00 4,012.82 110.00 4,006.28 $1,086,000 $1,086,500 110.00 4,047.36 110.00 4,040.83 110.00 4,034.29 110.00 4,027.76 110.00 4,021.23 110.00 4,014.69 110.00 4,008.16 $1,086,500 $1,087,000 110.00 4,049.23 110.00 4,042.70 110.00 4,036.17 110.00 4,029.63 110.00 4,023.10 110.00 4,016.57 110.00 4,010.03 $1,087,000 $1,087,500 110.00 4,051.11 110.00 4,044.58 110.00 4,038.04 110.00 4,031.51 110.00 4,024.98 110.00 4,018.44 110.00 4,011.91 $1,087,500 $1,088,000 110.00 4,052.98 110.00 4,046.45 110.00 4,039.92 110.00 4,033.38 110.00 4,026.85 110.00 4,020.32 110.00 4,013.78 $1,088,000 $1,088,500 110.00 4,054.86 110.00 4,048.33 110.00 4,041.79 110.00 4,035.26 110.00 4,028.73 110.00 4,022.19 110.00 4,015.66 $1,088,500 $1,089,000 110.00 4,056.73 110.00 4,050.20 110.00 4,043.67 110.00 4,037.13 110.00 4,030.60 110.00 4,024.07 110.00 4,017.53 $1,089,000 $1,089,500 110.00 4,058.61 110.00 4,052.08 110.00 4,045.54 110.00 4,039.01 110.00 4,032.48 110.00 4,025.94 110.00 4,019.41 $1,089,500 $1,090,000 110.00 4,060.48 110.00 4,053.95 110.00 4,047.42 110.00 4,040.88 110.00 4,034.35 110.00 4,027.82 110.00 4,021.28 $1,090,000 $1,090,500 110.00 4,062.36 110.00 4,055.83 110.00 4,049.29 110.00 4,042.76 110.00 4,036.23 110.00 4,029.69 110.00 4,023.16 $1,090,500 $1,091,000 110.00 4,064.23 110.00 4,057.70 110.00 4,051.17 110.00 4,044.63 110.00 4,038.10 110.00 4,031.57 110.00 4,025.03 $1,091,000 $1,091,500 110.00 4,066.11 110.00 4,059.58 110.00 4,053.04 110.00 4,046.51 110.00 4,039.98 110.00 4,033.44 110.00 4,026.91 $1,091,500 $1,092,000 110.00 4,067.98 110.00 4,061.45 110.00 4,054.92 110.00 4,048.38 110.00 4,041.85 110.00 4,035.32 110.00 4,028.78 $1,092,000 $1,092,500 110.00 4,069.86 110.00 4,063.33 110.00 4,056.79 110.00 4,050.26 110.00 4,043.73 110.00 4,037.19 110.00 4,030.66 $1,092,500 $1,093,000 110.00 4,071.73 110.00 4,065.20 110.00 4,058.67 110.00 4,052.13 110.00 4,045.60 110.00 4,039.07 110.00 4,032.53 $1,093,000 $1,093,500 110.00 4,073.61 110.00 4,067.08 110.00 4,060.54 110.00 4,054.01 110.00 4,047.48 110.00 4,040.94 110.00 4,034.41 $1,093,500 $1,094,000 110.00 4,075.48 110.00 4,068.95 110.00 4,062.42 110.00 4,055.88 110.00 4,049.35 110.00 4,042.82 110.00 4,036.28 $1,094,000 $1,094,500 110.00 4,077.36 110.00 4,070.83 110.00 4,064.29 110.00 4,057.76 110.00 4,051.23 110.00 4,044.69 110.00 4,038.16 $1,094,500 $1,095,000 110.00 4,079.23 110.00 4,072.70 110.00 4,066.17 110.00 4,059.63 110.00 4,053.10 110.00 4,046.57 110.00 4,040.03 $1,095,000 $1,095,500 110.00 4,081.11 110.00 4,074.58 110.00 4,068.04 110.00 4,061.51 110.00 4,054.98 110.00 4,048.44 110.00 4,041.91 $1,095,500 $1,096,000 110.00 4,082.98 110.00 4,076.45 110.00 4,069.92 110.00 4,063.38 110.00 4,056.85 110.00 4,050.32 110.00 4,043.78 $1,096,000 $1,096,500 110.00 4,084.86 110.00 4,078.33 110.00 4,071.79 110.00 4,065.26 110.00 4,058.73 110.00 4,052.19 110.00 4,045.66 $1,096,500 $1,097,000 110.00 4,086.73 110.00 4,080.20 110.00 4,073.67 110.00 4,067.13 110.00 4,060.60 110.00 4,054.07 110.00 4,047.53 $1,097,000 $1,097,500 110.00 4,088.61 110.00 4,082.08 110.00 4,075.54 110.00 4,069.01 110.00 4,062.48 110.00 4,055.94 110.00 4,049.41 $1,097,500 $1,098,000 110.00 4,090.48 110.00 4,083.95 110.00 4,077.42 110.00 4,070.88 110.00 4,064.35 110.00 4,057.82 110.00 4,051.28 $1,098,000 $1,098,500 110.00 4,092.36 110.00 4,085.83 110.00 4,079.29 110.00 4,072.76 110.00 4,066.23 110.00 4,059.69 110.00 4,053.16 $1,098,500 $1,099,000 110.00 4,094.23 110.00 4,087.70 110.00 4,081.17 110.00 4,074.63 110.00 4,068.10 110.00 4,061.57 110.00 4,055.03 $1,099,000 $1,099,500 110.00 4,096.11 110.00 4,089.58 110.00 4,083.04 110.00 4,076.51 110.00 4,069.98 110.00 4,063.44 110.00 4,056.91 $1,099,500 $1,100,000 110.00 4,097.98 110.00 4,091.45 110.00 4,084.92 110.00 4,078.38 110.00 4,071.85 110.00 4,065.32 110.00 4,058.78 $1,100,000 $1,100,500 110.00 4,099.86 110.00 4,093.33 110.00 4,086.79 110.00 4,080.26 110.00 4,073.73 110.00 4,067.19 110.00 4,060.66 $1,100,500 $1,101,000 110.00 4,101.73 110.00 4,095.20 110.00 4,088.67 110.00 4,082.13 110.00 4,075.60 110.00 4,069.07 110.00 4,062.53 $1,101,000 $1,101,500 110.00 4,103.61 110.00 4,097.08 110.00 4,090.54 110.00 4,084.01 110.00 4,077.48 110.00 4,070.94 110.00 4,064.41 $1,101,500 $1,102,000 110.00 4,105.48 110.00 4,098.95 110.00 4,092.42 110.00 4,085.88 110.00 4,079.35 110.00 4,072.82 110.00 4,066.28 $1,102,000 $1,102,500 110.00 4,107.36 110.00 4,100.83 110.00 4,094.29 110.00 4,087.76 110.00 4,081.23 110.00 4,074.69 110.00 4,068.16 $1,102,500 $1,103,000 110.00 4,109.23 110.00 4,102.70 110.00 4,096.17 110.00 4,089.63 110.00 4,083.10 110.00 4,076.57 110.00 4,070.03 $1,103,000 $1,103,500 110.00 4,111.11 110.00 4,104.58 110.00 4,098.04 110.00 4,091.51 110.00 4,084.98 110.00 4,078.44 110.00 4,071.91 $1,103,500 $1,104,000 110.00 4,112.98 110.00 4,106.45 110.00 4,099.92 110.00 4,093.38 110.00 4,086.85 110.00 4,080.32 110.00 4,073.78 $1,104,000 $1,104,500 110.00 4,114.86 110.00 4,108.33 110.00 4,101.79 110.00 4,095.26 110.00 4,088.73 110.00 4,082.19 110.00 4,075.66 $1,104,500 $1,105,000 110.00 4,116.73 110.00 4,110.20 110.00 4,103.67 110.00 4,097.13 110.00 4,090.60 110.00 4,084.07 110.00 4,077.53 $1,105,000 $1,105,500 110.00 4,118.61 110.00 4,112.08 110.00 4,105.54 110.00 4,099.01 110.00 4,092.48 110.00 4,085.94 110.00 4,079.41 $1,105,500 $1,106,000 110.00 4,120.48 110.00 4,113.95 110.00 4,107.42 110.00 4,100.88 110.00 4,094.35 110.00 4,087.82 110.00 4,081.28 $1,106,000 $1,106,500 110.00 4,122.36 110.00 4,115.83 110.00 4,109.29 110.00 4,102.76 110.00 4,096.23 110.00 4,089.69 110.00 4,083.16 $1,106,500 $1,107,000 110.00 4,124.23 110.00 4,117.70 110.00 4,111.17 110.00 4,104.63 110.00 4,098.10 110.00 4,091.57 110.00 4,085.03 $1,107,000 $1,107,500 110.00 4,126.11 110.00 4,119.58 110.00 4,113.04 110.00 4,106.51 110.00 4,099.98 110.00 4,093.44 110.00 4,086.91 $1,107,500 $1,108,000 110.00 4,127.98 110.00 4,121.45 110.00 4,114.92 110.00 4,108.38 110.00 4,101.85 110.00 4,095.32 110.00 4,088.78 $1,108,000 $1,108,500 110.00 4,129.86 110.00 4,123.33 110.00 4,116.79 110.00 4,110.26 110.00 4,103.73 110.00 4,097.19 110.00 4,090.66 $1,108,500 $1,109,000 110.00 4,131.73 110.00 4,125.20 110.00 4,118.67 110.00 4,112.13 110.00 4,105.60 110.00 4,099.07 110.00 4,092.53 $1,109,000 $1,109,500 110.00 4,133.61 110.00 4,127.08 110.00 4,120.54 110.00 4,114.01 110.00 4,107.48 110.00 4,100.94 110.00 4,094.41 $1,109,500 $1,110,000 110.00 4,135.48 110.00 4,128.95 110.00 4,122.42 110.00 4,115.88 110.00 4,109.35 110.00 4,102.82 110.00 4,096.28 $1,110,000 $1,110,500 110.00 4,137.36 110.00 4,130.83 110.00 4,124.29 110.00 4,117.76 110.00 4,111.23 110.00 4,104.69 110.00 4,098.16 $1,110,500 $1,111,000 110.00 4,139.23 110.00 4,132.70 110.00 4,126.17 110.00 4,119.63 110.00 4,113.10 110.00 4,106.57 110.00 4,100.03 $1,111,000 $1,111,500 110.00 4,141.11 110.00 4,134.58 110.00 4,128.04 110.00 4,121.51 110.00 4,114.98 110.00 4,108.44 110.00 4,101.91 $1,111,500 $1,112,000 110.00 4,142.98 110.00 4,136.45 110.00 4,129.92 110.00 4,123.38 110.00 4,116.85 110.00 4,110.32 110.00 4,103.78 $1,112,000 $1,112,500 110.00 4,144.86 110.00 4,138.33 110.00 4,131.79 110.00 4,125.26 110.00 4,118.73 110.00 4,112.19 110.00 4,105.66 $1,112,500 $1,113,000 110.00 4,146.73 110.00 4,140.20 110.00 4,133.67 110.00 4,127.13 110.00 4,120.60 110.00 4,114.07 110.00 4,107.53 $1,113,000 $1,113,500 110.00 4,148.61 110.00 4,142.08 110.00 4,135.54 110.00 4,129.01 110.00 4,122.48 110.00 4,115.94 110.00 4,109.41 $1,113,500 $1,114,000 110.00 4,150.48 110.00 4,143.95 110.00 4,137.42 110.00 4,130.88 110.00 4,124.35 110.00 4,117.82 110.00 4,111.28 $1,114,000 $1,114,500 110.00 4,152.36 110.00 4,145.83 110.00 4,139.29 110.00 4,132.76 110.00 4,126.23 110.00 4,119.69 110.00 4,113.16 $1,114,500 $1,115,000 110.00 4,154.23 110.00 4,147.70 110.00 4,141.17 110.00 4,134.63 110.00 4,128.10 110.00 4,121.57 110.00 4,115.03 $1,115,000 $1,115,500 110.00 4,156.11 110.00 4,149.58 110.00 4,143.04 110.00 4,136.51 110.00 4,129.98 110.00 4,123.44 110.00 4,116.91 $1,115,500 $1,116,000 110.00 4,157.98 110.00 4,151.45 110.00 4,144.92 110.00 4,138.38 110.00 4,131.85 110.00 4,125.32 110.00 4,118.78 $1,116,000 $1,116,500 110.00 4,159.86 110.00 4,153.33 110.00 4,146.79 110.00 4,140.26 110.00 4,133.73 110.00 4,127.19 110.00 4,120.66 $1,116,500 $1,117,000 110.00 4,161.73 110.00 4,155.20 110.00 4,148.67 110.00 4,142.13 110.00 4,135.60 110.00 4,129.07 110.00 4,122.53 $1,117,000 $1,117,500 110.00 4,163.61 110.00 4,157.08 110.00 4,150.54 110.00 4,144.01 110.00 4,137.48 110.00 4,130.94 110.00 4,124.41 $1,117,500 $1,118,000 110.00 4,165.48 110.00 4,158.95 110.00 4,152.42 110.00 4,145.88 110.00 4,139.35 110.00 4,132.82 110.00 4,126.28 $1,118,000 $1,118,500 110.00 4,167.36 110.00 4,160.83 110.00 4,154.29 110.00 4,147.76 110.00 4,141.23 110.00 4,134.69 110.00 4,128.16 $1,118,500 $1,119,000 110.00 4,169.23 110.00 4,162.70 110.00 4,156.17 110.00 4,149.63 110.00 4,143.10 110.00 4,136.57 110.00 4,130.03 $1,119,000 $1,119,500 110.00 4,171.11 110.00 4,164.58 110.00 4,158.04 110.00 4,151.51 110.00 4,144.98 110.00 4,138.44 110.00 4,131.91 $1,119,500 $1,120,000 110.00 4,172.98 110.00 4,166.45 110.00 4,159.92 110.00 4,153.38 110.00 4,146.85 110.00 4,140.32 110.00 4,133.78 $1,120,000 $1,120,500 110.00 4,174.86 110.00 4,168.33 110.00 4,161.79 110.00 4,155.26 110.00 4,148.73 110.00 4,142.19 110.00 4,135.66 $1,120,500 $1,121,000 110.00 4,176.73 110.00 4,170.20 110.00 4,163.67 110.00 4,157.13 110.00 4,150.60 110.00 4,144.07 110.00 4,137.53 $1,121,000 $1,121,500 110.00 4,178.61 110.00 4,172.08 110.00 4,165.54 110.00 4,159.01 110.00 4,152.48 110.00 4,145.94 110.00 4,139.41 $1,121,500 $1,122,000 110.00 4,180.48 110.00 4,173.95 110.00 4,167.42 110.00 4,160.88 110.00 4,154.35 110.00 4,147.82 110.00 4,141.28

NJEIS Family Cost Participation Table Page 25 of 12 Effective July 1, 2015

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

$1,122,000 $1,122,500 110.00 4,182.36 110.00 4,175.83 110.00 4,169.29 110.00 4,162.76 110.00 4,156.23 110.00 4,149.69 110.00 4,143.16 $1,122,500 $1,123,000 110.00 4,184.23 110.00 4,177.70 110.00 4,171.17 110.00 4,164.63 110.00 4,158.10 110.00 4,151.57 110.00 4,145.03 $1,123,000 $1,123,500 110.00 4,186.11 110.00 4,179.58 110.00 4,173.04 110.00 4,166.51 110.00 4,159.98 110.00 4,153.44 110.00 4,146.91 $1,123,500 $1,124,000 110.00 4,187.98 110.00 4,181.45 110.00 4,174.92 110.00 4,168.38 110.00 4,161.85 110.00 4,155.32 110.00 4,148.78 $1,124,000 $1,124,500 110.00 4,189.86 110.00 4,183.33 110.00 4,176.79 110.00 4,170.26 110.00 4,163.73 110.00 4,157.19 110.00 4,150.66 $1,124,500 $1,125,000 110.00 4,191.73 110.00 4,185.20 110.00 4,178.67 110.00 4,172.13 110.00 4,165.60 110.00 4,159.07 110.00 4,152.53 $1,125,000 $1,125,500 110.00 4,193.61 110.00 4,187.08 110.00 4,180.54 110.00 4,174.01 110.00 4,167.48 110.00 4,160.94 110.00 4,154.41 $1,125,500 $1,126,000 110.00 4,195.48 110.00 4,188.95 110.00 4,182.42 110.00 4,175.88 110.00 4,169.35 110.00 4,162.82 110.00 4,156.28 $1,126,000 $1,126,500 110.00 4,197.36 110.00 4,190.83 110.00 4,184.29 110.00 4,177.76 110.00 4,171.23 110.00 4,164.69 110.00 4,158.16 $1,126,500 $1,127,000 110.00 4,199.23 110.00 4,192.70 110.00 4,186.17 110.00 4,179.63 110.00 4,173.10 110.00 4,166.57 110.00 4,160.03 $1,127,000 $1,127,500 110.00 4,201.11 110.00 4,194.58 110.00 4,188.04 110.00 4,181.51 110.00 4,174.98 110.00 4,168.44 110.00 4,161.91 $1,127,500 $1,128,000 110.00 4,202.98 110.00 4,196.45 110.00 4,189.92 110.00 4,183.38 110.00 4,176.85 110.00 4,170.32 110.00 4,163.78 $1,128,000 $1,128,500 110.00 4,204.86 110.00 4,198.33 110.00 4,191.79 110.00 4,185.26 110.00 4,178.73 110.00 4,172.19 110.00 4,165.66 $1,128,500 $1,129,000 110.00 4,206.73 110.00 4,200.20 110.00 4,193.67 110.00 4,187.13 110.00 4,180.60 110.00 4,174.07 110.00 4,167.53 $1,129,000 $1,129,500 110.00 4,208.61 110.00 4,202.08 110.00 4,195.54 110.00 4,189.01 110.00 4,182.48 110.00 4,175.94 110.00 4,169.41 $1,129,500 $1,130,000 110.00 4,210.48 110.00 4,203.95 110.00 4,197.42 110.00 4,190.88 110.00 4,184.35 110.00 4,177.82 110.00 4,171.28 $1,130,000 $1,130,500 110.00 4,212.36 110.00 4,205.83 110.00 4,199.29 110.00 4,192.76 110.00 4,186.23 110.00 4,179.69 110.00 4,173.16 $1,130,500 $1,131,000 110.00 4,214.23 110.00 4,207.70 110.00 4,201.17 110.00 4,194.63 110.00 4,188.10 110.00 4,181.57 110.00 4,175.03 $1,131,000 $1,131,500 110.00 4,216.11 110.00 4,209.58 110.00 4,203.04 110.00 4,196.51 110.00 4,189.98 110.00 4,183.44 110.00 4,176.91 $1,131,500 $1,132,000 110.00 4,217.98 110.00 4,211.45 110.00 4,204.92 110.00 4,198.38 110.00 4,191.85 110.00 4,185.32 110.00 4,178.78 $1,132,000 $1,132,500 110.00 4,219.86 110.00 4,213.33 110.00 4,206.79 110.00 4,200.26 110.00 4,193.73 110.00 4,187.19 110.00 4,180.66 $1,132,500 $1,133,000 110.00 4,221.73 110.00 4,215.20 110.00 4,208.67 110.00 4,202.13 110.00 4,195.60 110.00 4,189.07 110.00 4,182.53 $1,133,000 $1,133,500 110.00 4,223.61 110.00 4,217.08 110.00 4,210.54 110.00 4,204.01 110.00 4,197.48 110.00 4,190.94 110.00 4,184.41 $1,133,500 $1,134,000 110.00 4,225.48 110.00 4,218.95 110.00 4,212.42 110.00 4,205.88 110.00 4,199.35 110.00 4,192.82 110.00 4,186.28 $1,134,000 $1,134,500 110.00 4,227.36 110.00 4,220.83 110.00 4,214.29 110.00 4,207.76 110.00 4,201.23 110.00 4,194.69 110.00 4,188.16 $1,134,500 $1,135,000 110.00 4,229.23 110.00 4,222.70 110.00 4,216.17 110.00 4,209.63 110.00 4,203.10 110.00 4,196.57 110.00 4,190.03 $1,135,000 $1,135,500 110.00 4,231.11 110.00 4,224.58 110.00 4,218.04 110.00 4,211.51 110.00 4,204.98 110.00 4,198.44 110.00 4,191.91 $1,135,500 $1,136,000 110.00 4,232.98 110.00 4,226.45 110.00 4,219.92 110.00 4,213.38 110.00 4,206.85 110.00 4,200.32 110.00 4,193.78 $1,136,000 $1,136,500 110.00 4,234.86 110.00 4,228.33 110.00 4,221.79 110.00 4,215.26 110.00 4,208.73 110.00 4,202.19 110.00 4,195.66 $1,136,500 $1,137,000 110.00 4,236.73 110.00 4,230.20 110.00 4,223.67 110.00 4,217.13 110.00 4,210.60 110.00 4,204.07 110.00 4,197.53 $1,137,000 $1,137,500 110.00 4,238.61 110.00 4,232.08 110.00 4,225.54 110.00 4,219.01 110.00 4,212.48 110.00 4,205.94 110.00 4,199.41 $1,137,500 $1,138,000 110.00 4,240.48 110.00 4,233.95 110.00 4,227.42 110.00 4,220.88 110.00 4,214.35 110.00 4,207.82 110.00 4,201.28 $1,138,000 $1,138,500 110.00 4,242.36 110.00 4,235.83 110.00 4,229.29 110.00 4,222.76 110.00 4,216.23 110.00 4,209.69 110.00 4,203.16 $1,138,500 $1,139,000 110.00 4,244.23 110.00 4,237.70 110.00 4,231.17 110.00 4,224.63 110.00 4,218.10 110.00 4,211.57 110.00 4,205.03 $1,139,000 $1,139,500 110.00 4,246.11 110.00 4,239.58 110.00 4,233.04 110.00 4,226.51 110.00 4,219.98 110.00 4,213.44 110.00 4,206.91 $1,139,500 $1,140,000 110.00 4,247.98 110.00 4,241.45 110.00 4,234.92 110.00 4,228.38 110.00 4,221.85 110.00 4,215.32 110.00 4,208.78 $1,140,000 $1,140,500 110.00 4,249.86 110.00 4,243.33 110.00 4,236.79 110.00 4,230.26 110.00 4,223.73 110.00 4,217.19 110.00 4,210.66 $1,140,500 $1,141,000 110.00 4,251.73 110.00 4,245.20 110.00 4,238.67 110.00 4,232.13 110.00 4,225.60 110.00 4,219.07 110.00 4,212.53 $1,141,000 $1,141,500 110.00 4,253.61 110.00 4,247.08 110.00 4,240.54 110.00 4,234.01 110.00 4,227.48 110.00 4,220.94 110.00 4,214.41 $1,141,500 $1,142,000 110.00 4,255.48 110.00 4,248.95 110.00 4,242.42 110.00 4,235.88 110.00 4,229.35 110.00 4,222.82 110.00 4,216.28 $1,142,000 $1,142,500 110.00 4,257.36 110.00 4,250.83 110.00 4,244.29 110.00 4,237.76 110.00 4,231.23 110.00 4,224.69 110.00 4,218.16 $1,142,500 $1,143,000 110.00 4,259.23 110.00 4,252.70 110.00 4,246.17 110.00 4,239.63 110.00 4,233.10 110.00 4,226.57 110.00 4,220.03 $1,143,000 $1,143,500 110.00 4,261.11 110.00 4,254.58 110.00 4,248.04 110.00 4,241.51 110.00 4,234.98 110.00 4,228.44 110.00 4,221.91 $1,143,500 $1,144,000 110.00 4,262.98 110.00 4,256.45 110.00 4,249.92 110.00 4,243.38 110.00 4,236.85 110.00 4,230.32 110.00 4,223.78 $1,144,000 $1,144,500 110.00 4,264.86 110.00 4,258.33 110.00 4,251.79 110.00 4,245.26 110.00 4,238.73 110.00 4,232.19 110.00 4,225.66 $1,144,500 $1,145,000 110.00 4,266.73 110.00 4,260.20 110.00 4,253.67 110.00 4,247.13 110.00 4,240.60 110.00 4,234.07 110.00 4,227.53 $1,145,000 $1,145,500 110.00 4,268.61 110.00 4,262.08 110.00 4,255.54 110.00 4,249.01 110.00 4,242.48 110.00 4,235.94 110.00 4,229.41 $1,145,500 $1,146,000 110.00 4,270.48 110.00 4,263.95 110.00 4,257.42 110.00 4,250.88 110.00 4,244.35 110.00 4,237.82 110.00 4,231.28 $1,146,000 $1,146,500 110.00 4,272.36 110.00 4,265.83 110.00 4,259.29 110.00 4,252.76 110.00 4,246.23 110.00 4,239.69 110.00 4,233.16 $1,146,500 $1,147,000 110.00 4,274.23 110.00 4,267.70 110.00 4,261.17 110.00 4,254.63 110.00 4,248.10 110.00 4,241.57 110.00 4,235.03 $1,147,000 $1,147,500 110.00 4,276.11 110.00 4,269.58 110.00 4,263.04 110.00 4,256.51 110.00 4,249.98 110.00 4,243.44 110.00 4,236.91 $1,147,500 $1,148,000 110.00 4,277.98 110.00 4,271.45 110.00 4,264.92 110.00 4,258.38 110.00 4,251.85 110.00 4,245.32 110.00 4,238.78 $1,148,000 $1,148,500 110.00 4,279.86 110.00 4,273.33 110.00 4,266.79 110.00 4,260.26 110.00 4,253.73 110.00 4,247.19 110.00 4,240.66 $1,148,500 $1,149,000 110.00 4,281.73 110.00 4,275.20 110.00 4,268.67 110.00 4,262.13 110.00 4,255.60 110.00 4,249.07 110.00 4,242.53 $1,149,000 $1,149,500 110.00 4,283.61 110.00 4,277.08 110.00 4,270.54 110.00 4,264.01 110.00 4,257.48 110.00 4,250.94 110.00 4,244.41 $1,149,500 $1,150,000 110.00 4,285.48 110.00 4,278.95 110.00 4,272.42 110.00 4,265.88 110.00 4,259.35 110.00 4,252.82 110.00 4,246.28 $1,150,000 $1,150,500 110.00 4,287.36 110.00 4,280.83 110.00 4,274.29 110.00 4,267.76 110.00 4,261.23 110.00 4,254.69 110.00 4,248.16 $1,150,500 $1,151,000 110.00 4,289.23 110.00 4,282.70 110.00 4,276.17 110.00 4,269.63 110.00 4,263.10 110.00 4,256.57 110.00 4,250.03 $1,151,000 $1,151,500 110.00 4,291.11 110.00 4,284.58 110.00 4,278.04 110.00 4,271.51 110.00 4,264.98 110.00 4,258.44 110.00 4,251.91 $1,151,500 $1,152,000 110.00 4,292.98 110.00 4,286.45 110.00 4,279.92 110.00 4,273.38 110.00 4,266.85 110.00 4,260.32 110.00 4,253.78 $1,152,000 $1,152,500 110.00 4,294.86 110.00 4,288.33 110.00 4,281.79 110.00 4,275.26 110.00 4,268.73 110.00 4,262.19 110.00 4,255.66 $1,152,500 $1,153,000 110.00 4,296.73 110.00 4,290.20 110.00 4,283.67 110.00 4,277.13 110.00 4,270.60 110.00 4,264.07 110.00 4,257.53 $1,153,000 $1,153,500 110.00 4,298.61 110.00 4,292.08 110.00 4,285.54 110.00 4,279.01 110.00 4,272.48 110.00 4,265.94 110.00 4,259.41 $1,153,500 $1,154,000 110.00 4,300.48 110.00 4,293.95 110.00 4,287.42 110.00 4,280.88 110.00 4,274.35 110.00 4,267.82 110.00 4,261.28 $1,154,000 $1,154,500 110.00 4,302.36 110.00 4,295.83 110.00 4,289.29 110.00 4,282.76 110.00 4,276.23 110.00 4,269.69 110.00 4,263.16 $1,154,500 $1,155,000 110.00 4,304.23 110.00 4,297.70 110.00 4,291.17 110.00 4,284.63 110.00 4,278.10 110.00 4,271.57 110.00 4,265.03 $1,155,000 $1,155,500 110.00 4,306.11 110.00 4,299.58 110.00 4,293.04 110.00 4,286.51 110.00 4,279.98 110.00 4,273.44 110.00 4,266.91 $1,155,500 $1,156,000 110.00 4,307.98 110.00 4,301.45 110.00 4,294.92 110.00 4,288.38 110.00 4,281.85 110.00 4,275.32 110.00 4,268.78 $1,156,000 $1,156,500 110.00 4,309.86 110.00 4,303.33 110.00 4,296.79 110.00 4,290.26 110.00 4,283.73 110.00 4,277.19 110.00 4,270.66 $1,156,500 $1,157,000 110.00 4,311.73 110.00 4,305.20 110.00 4,298.67 110.00 4,292.13 110.00 4,285.60 110.00 4,279.07 110.00 4,272.53 $1,157,000 $1,157,500 110.00 4,313.61 110.00 4,307.08 110.00 4,300.54 110.00 4,294.01 110.00 4,287.48 110.00 4,280.94 110.00 4,274.41 $1,157,500 $1,158,000 110.00 4,315.48 110.00 4,308.95 110.00 4,302.42 110.00 4,295.88 110.00 4,289.35 110.00 4,282.82 110.00 4,276.28 $1,158,000 $1,158,500 110.00 4,317.36 110.00 4,310.83 110.00 4,304.29 110.00 4,297.76 110.00 4,291.23 110.00 4,284.69 110.00 4,278.16 $1,158,500 $1,159,000 110.00 4,319.23 110.00 4,312.70 110.00 4,306.17 110.00 4,299.63 110.00 4,293.10 110.00 4,286.57 110.00 4,280.03 $1,159,000 $1,159,500 110.00 4,321.11 110.00 4,314.58 110.00 4,308.04 110.00 4,301.51 110.00 4,294.98 110.00 4,288.44 110.00 4,281.91 $1,159,500 $1,160,000 110.00 4,322.98 110.00 4,316.45 110.00 4,309.92 110.00 4,303.38 110.00 4,296.85 110.00 4,290.32 110.00 4,283.78 $1,160,000 $1,160,500 110.00 4,324.86 110.00 4,318.33 110.00 4,311.79 110.00 4,305.26 110.00 4,298.73 110.00 4,292.19 110.00 4,285.66 $1,160,500 $1,161,000 110.00 4,326.73 110.00 4,320.20 110.00 4,313.67 110.00 4,307.13 110.00 4,300.60 110.00 4,294.07 110.00 4,287.53 $1,161,000 $1,161,500 110.00 4,328.61 110.00 4,322.08 110.00 4,315.54 110.00 4,309.01 110.00 4,302.48 110.00 4,295.94 110.00 4,289.41 $1,161,500 $1,162,000 110.00 4,330.48 110.00 4,323.95 110.00 4,317.42 110.00 4,310.88 110.00 4,304.35 110.00 4,297.82 110.00 4,291.28 $1,162,000 $1,162,500 110.00 4,332.36 110.00 4,325.83 110.00 4,319.29 110.00 4,312.76 110.00 4,306.23 110.00 4,299.69 110.00 4,293.16 $1,162,500 $1,163,000 110.00 4,334.23 110.00 4,327.70 110.00 4,321.17 110.00 4,314.63 110.00 4,308.10 110.00 4,301.57 110.00 4,295.03 $1,163,000 $1,163,500 110.00 4,336.11 110.00 4,329.58 110.00 4,323.04 110.00 4,316.51 110.00 4,309.98 110.00 4,303.44 110.00 4,296.91 $1,163,500 $1,164,000 110.00 4,337.98 110.00 4,331.45 110.00 4,324.92 110.00 4,318.38 110.00 4,311.85 110.00 4,305.32 110.00 4,298.78 $1,164,000 $1,164,500 110.00 4,339.86 110.00 4,333.33 110.00 4,326.79 110.00 4,320.26 110.00 4,313.73 110.00 4,307.19 110.00 4,300.66 $1,164,500 $1,165,000 110.00 4,341.73 110.00 4,335.20 110.00 4,328.67 110.00 4,322.13 110.00 4,315.60 110.00 4,309.07 110.00 4,302.53 $1,165,000 $1,165,500 110.00 4,343.61 110.00 4,337.08 110.00 4,330.54 110.00 4,324.01 110.00 4,317.48 110.00 4,310.94 110.00 4,304.41 $1,165,500 $1,166,000 110.00 4,345.48 110.00 4,338.95 110.00 4,332.42 110.00 4,325.88 110.00 4,319.35 110.00 4,312.82 110.00 4,306.28 $1,166,000 $1,166,500 110.00 4,347.36 110.00 4,340.83 110.00 4,334.29 110.00 4,327.76 110.00 4,321.23 110.00 4,314.69 110.00 4,308.16 $1,166,500 $1,167,000 110.00 4,349.23 110.00 4,342.70 110.00 4,336.17 110.00 4,329.63 110.00 4,323.10 110.00 4,316.57 110.00 4,310.03 $1,167,000 $1,167,500 110.00 4,351.11 110.00 4,344.58 110.00 4,338.04 110.00 4,331.51 110.00 4,324.98 110.00 4,318.44 110.00 4,311.91 $1,167,500 $1,168,000 110.00 4,352.98 110.00 4,346.45 110.00 4,339.92 110.00 4,333.38 110.00 4,326.85 110.00 4,320.32 110.00 4,313.78 $1,168,000 $1,168,500 110.00 4,354.86 110.00 4,348.33 110.00 4,341.79 110.00 4,335.26 110.00 4,328.73 110.00 4,322.19 110.00 4,315.66 $1,168,500 $1,169,000 110.00 4,356.73 110.00 4,350.20 110.00 4,343.67 110.00 4,337.13 110.00 4,330.60 110.00 4,324.07 110.00 4,317.53 $1,169,000 $1,169,500 110.00 4,358.61 110.00 4,352.08 110.00 4,345.54 110.00 4,339.01 110.00 4,332.48 110.00 4,325.94 110.00 4,319.41 $1,169,500 $1,170,000 110.00 4,360.48 110.00 4,353.95 110.00 4,347.42 110.00 4,340.88 110.00 4,334.35 110.00 4,327.82 110.00 4,321.28 $1,170,000 $1,170,500 110.00 4,362.36 110.00 4,355.83 110.00 4,349.29 110.00 4,342.76 110.00 4,336.23 110.00 4,329.69 110.00 4,323.16 $1,170,500 $1,171,000 110.00 4,364.23 110.00 4,357.70 110.00 4,351.17 110.00 4,344.63 110.00 4,338.10 110.00 4,331.57 110.00 4,325.03 $1,171,000 $1,171,500 110.00 4,366.11 110.00 4,359.58 110.00 4,353.04 110.00 4,346.51 110.00 4,339.98 110.00 4,333.44 110.00 4,326.91 $1,171,500 $1,172,000 110.00 4,367.98 110.00 4,361.45 110.00 4,354.92 110.00 4,348.38 110.00 4,341.85 110.00 4,335.32 110.00 4,328.78 $1,172,000 $1,172,500 110.00 4,369.86 110.00 4,363.33 110.00 4,356.79 110.00 4,350.26 110.00 4,343.73 110.00 4,337.19 110.00 4,330.66 $1,172,500 $1,173,000 110.00 4,371.73 110.00 4,365.20 110.00 4,358.67 110.00 4,352.13 110.00 4,345.60 110.00 4,339.07 110.00 4,332.53

NJEIS Family Cost Participation Table Page 26 of 12 Effective July 1, 2015

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

$1,173,000 $1,173,500 110.00 4,373.61 110.00 4,367.08 110.00 4,360.54 110.00 4,354.01 110.00 4,347.48 110.00 4,340.94 110.00 4,334.41 $1,173,500 $1,174,000 110.00 4,375.48 110.00 4,368.95 110.00 4,362.42 110.00 4,355.88 110.00 4,349.35 110.00 4,342.82 110.00 4,336.28 $1,174,000 $1,174,500 110.00 4,377.36 110.00 4,370.83 110.00 4,364.29 110.00 4,357.76 110.00 4,351.23 110.00 4,344.69 110.00 4,338.16 $1,174,500 $1,175,000 110.00 4,379.23 110.00 4,372.70 110.00 4,366.17 110.00 4,359.63 110.00 4,353.10 110.00 4,346.57 110.00 4,340.03 $1,175,000 $1,175,500 110.00 4,381.11 110.00 4,374.58 110.00 4,368.04 110.00 4,361.51 110.00 4,354.98 110.00 4,348.44 110.00 4,341.91 $1,175,500 $1,176,000 110.00 4,382.98 110.00 4,376.45 110.00 4,369.92 110.00 4,363.38 110.00 4,356.85 110.00 4,350.32 110.00 4,343.78 $1,176,000 $1,176,500 110.00 4,384.86 110.00 4,378.33 110.00 4,371.79 110.00 4,365.26 110.00 4,358.73 110.00 4,352.19 110.00 4,345.66 $1,176,500 $1,177,000 110.00 4,386.73 110.00 4,380.20 110.00 4,373.67 110.00 4,367.13 110.00 4,360.60 110.00 4,354.07 110.00 4,347.53 $1,177,000 $1,177,500 110.00 4,388.61 110.00 4,382.08 110.00 4,375.54 110.00 4,369.01 110.00 4,362.48 110.00 4,355.94 110.00 4,349.41 $1,177,500 $1,178,000 110.00 4,390.48 110.00 4,383.95 110.00 4,377.42 110.00 4,370.88 110.00 4,364.35 110.00 4,357.82 110.00 4,351.28 $1,178,000 $1,178,500 110.00 4,392.36 110.00 4,385.83 110.00 4,379.29 110.00 4,372.76 110.00 4,366.23 110.00 4,359.69 110.00 4,353.16 $1,178,500 $1,179,000 110.00 4,394.23 110.00 4,387.70 110.00 4,381.17 110.00 4,374.63 110.00 4,368.10 110.00 4,361.57 110.00 4,355.03 $1,179,000 $1,179,500 110.00 4,396.11 110.00 4,389.58 110.00 4,383.04 110.00 4,376.51 110.00 4,369.98 110.00 4,363.44 110.00 4,356.91 $1,179,500 $1,180,000 110.00 4,397.98 110.00 4,391.45 110.00 4,384.92 110.00 4,378.38 110.00 4,371.85 110.00 4,365.32 110.00 4,358.78 $1,180,000 $1,180,500 110.00 4,399.86 110.00 4,393.33 110.00 4,386.79 110.00 4,380.26 110.00 4,373.73 110.00 4,367.19 110.00 4,360.66 $1,180,500 $1,181,000 110.00 4,401.73 110.00 4,395.20 110.00 4,388.67 110.00 4,382.13 110.00 4,375.60 110.00 4,369.07 110.00 4,362.53 $1,181,000 $1,181,500 110.00 4,403.61 110.00 4,397.08 110.00 4,390.54 110.00 4,384.01 110.00 4,377.48 110.00 4,370.94 110.00 4,364.41 $1,181,500 $1,182,000 110.00 4,405.48 110.00 4,398.95 110.00 4,392.42 110.00 4,385.88 110.00 4,379.35 110.00 4,372.82 110.00 4,366.28 $1,182,000 $1,182,500 110.00 4,407.36 110.00 4,400.83 110.00 4,394.29 110.00 4,387.76 110.00 4,381.23 110.00 4,374.69 110.00 4,368.16 $1,182,500 $1,183,000 110.00 4,409.23 110.00 4,402.70 110.00 4,396.17 110.00 4,389.63 110.00 4,383.10 110.00 4,376.57 110.00 4,370.03 $1,183,000 $1,183,500 110.00 4,411.11 110.00 4,404.58 110.00 4,398.04 110.00 4,391.51 110.00 4,384.98 110.00 4,378.44 110.00 4,371.91 $1,183,500 $1,184,000 110.00 4,412.98 110.00 4,406.45 110.00 4,399.92 110.00 4,393.38 110.00 4,386.85 110.00 4,380.32 110.00 4,373.78 $1,184,000 $1,184,500 110.00 4,414.86 110.00 4,408.33 110.00 4,401.79 110.00 4,395.26 110.00 4,388.73 110.00 4,382.19 110.00 4,375.66 $1,184,500 $1,185,000 110.00 4,416.73 110.00 4,410.20 110.00 4,403.67 110.00 4,397.13 110.00 4,390.60 110.00 4,384.07 110.00 4,377.53 $1,185,000 $1,185,500 110.00 4,418.61 110.00 4,412.08 110.00 4,405.54 110.00 4,399.01 110.00 4,392.48 110.00 4,385.94 110.00 4,379.41 $1,185,500 $1,186,000 110.00 4,420.48 110.00 4,413.95 110.00 4,407.42 110.00 4,400.88 110.00 4,394.35 110.00 4,387.82 110.00 4,381.28 $1,186,000 $1,186,500 110.00 4,422.36 110.00 4,415.83 110.00 4,409.29 110.00 4,402.76 110.00 4,396.23 110.00 4,389.69 110.00 4,383.16 $1,186,500 $1,187,000 110.00 4,424.23 110.00 4,417.70 110.00 4,411.17 110.00 4,404.63 110.00 4,398.10 110.00 4,391.57 110.00 4,385.03 $1,187,000 $1,187,500 110.00 4,426.11 110.00 4,419.58 110.00 4,413.04 110.00 4,406.51 110.00 4,399.98 110.00 4,393.44 110.00 4,386.91 $1,187,500 $1,188,000 110.00 4,427.98 110.00 4,421.45 110.00 4,414.92 110.00 4,408.38 110.00 4,401.85 110.00 4,395.32 110.00 4,388.78 $1,188,000 $1,188,500 110.00 4,429.86 110.00 4,423.33 110.00 4,416.79 110.00 4,410.26 110.00 4,403.73 110.00 4,397.19 110.00 4,390.66 $1,188,500 $1,189,000 110.00 4,431.73 110.00 4,425.20 110.00 4,418.67 110.00 4,412.13 110.00 4,405.60 110.00 4,399.07 110.00 4,392.53 $1,189,000 $1,189,500 110.00 4,433.61 110.00 4,427.08 110.00 4,420.54 110.00 4,414.01 110.00 4,407.48 110.00 4,400.94 110.00 4,394.41 $1,189,500 $1,190,000 110.00 4,435.48 110.00 4,428.95 110.00 4,422.42 110.00 4,415.88 110.00 4,409.35 110.00 4,402.82 110.00 4,396.28 $1,190,000 $1,190,500 110.00 4,437.36 110.00 4,430.83 110.00 4,424.29 110.00 4,417.76 110.00 4,411.23 110.00 4,404.69 110.00 4,398.16 $1,190,500 $1,191,000 110.00 4,439.23 110.00 4,432.70 110.00 4,426.17 110.00 4,419.63 110.00 4,413.10 110.00 4,406.57 110.00 4,400.03 $1,191,000 $1,191,500 110.00 4,441.11 110.00 4,434.58 110.00 4,428.04 110.00 4,421.51 110.00 4,414.98 110.00 4,408.44 110.00 4,401.91 $1,191,500 $1,192,000 110.00 4,442.98 110.00 4,436.45 110.00 4,429.92 110.00 4,423.38 110.00 4,416.85 110.00 4,410.32 110.00 4,403.78 $1,192,000 $1,192,500 110.00 4,444.86 110.00 4,438.33 110.00 4,431.79 110.00 4,425.26 110.00 4,418.73 110.00 4,412.19 110.00 4,405.66 $1,192,500 $1,193,000 110.00 4,446.73 110.00 4,440.20 110.00 4,433.67 110.00 4,427.13 110.00 4,420.60 110.00 4,414.07 110.00 4,407.53 $1,193,000 $1,193,500 110.00 4,448.61 110.00 4,442.08 110.00 4,435.54 110.00 4,429.01 110.00 4,422.48 110.00 4,415.94 110.00 4,409.41 $1,193,500 $1,194,000 110.00 4,450.48 110.00 4,443.95 110.00 4,437.42 110.00 4,430.88 110.00 4,424.35 110.00 4,417.82 110.00 4,411.28 $1,194,000 $1,194,500 110.00 4,452.36 110.00 4,445.83 110.00 4,439.29 110.00 4,432.76 110.00 4,426.23 110.00 4,419.69 110.00 4,413.16 $1,194,500 $1,195,000 110.00 4,454.23 110.00 4,447.70 110.00 4,441.17 110.00 4,434.63 110.00 4,428.10 110.00 4,421.57 110.00 4,415.03 $1,195,000 $1,195,500 110.00 4,456.11 110.00 4,449.58 110.00 4,443.04 110.00 4,436.51 110.00 4,429.98 110.00 4,423.44 110.00 4,416.91 $1,195,500 $1,196,000 110.00 4,457.98 110.00 4,451.45 110.00 4,444.92 110.00 4,438.38 110.00 4,431.85 110.00 4,425.32 110.00 4,418.78 $1,196,000 $1,196,500 110.00 4,459.86 110.00 4,453.33 110.00 4,446.79 110.00 4,440.26 110.00 4,433.73 110.00 4,427.19 110.00 4,420.66 $1,196,500 $1,197,000 110.00 4,461.73 110.00 4,455.20 110.00 4,448.67 110.00 4,442.13 110.00 4,435.60 110.00 4,429.07 110.00 4,422.53 $1,197,000 $1,197,500 110.00 4,463.61 110.00 4,457.08 110.00 4,450.54 110.00 4,444.01 110.00 4,437.48 110.00 4,430.94 110.00 4,424.41 $1,197,500 $1,198,000 110.00 4,465.48 110.00 4,458.95 110.00 4,452.42 110.00 4,445.88 110.00 4,439.35 110.00 4,432.82 110.00 4,426.28 $1,198,000 $1,198,500 110.00 4,467.36 110.00 4,460.83 110.00 4,454.29 110.00 4,447.76 110.00 4,441.23 110.00 4,434.69 110.00 4,428.16 $1,198,500 $1,199,000 110.00 4,469.23 110.00 4,462.70 110.00 4,456.17 110.00 4,449.63 110.00 4,443.10 110.00 4,436.57 110.00 4,430.03 $1,199,000 $1,199,500 110.00 4,471.11 110.00 4,464.58 110.00 4,458.04 110.00 4,451.51 110.00 4,444.98 110.00 4,438.44 110.00 4,431.91 $1,199,500 $1,200,000 110.00 4,472.98 110.00 4,466.45 110.00 4,459.92 110.00 4,453.38 110.00 4,446.85 110.00 4,440.32 110.00 4,433.78 $1,200,000 $1,200,500 110.00 4,474.86 110.00 4,468.33 110.00 4,461.79 110.00 4,455.26 110.00 4,448.73 110.00 4,442.19 110.00 4,435.66 $1,200,500 $1,201,000 110.00 4,476.73 110.00 4,470.20 110.00 4,463.67 110.00 4,457.13 110.00 4,450.60 110.00 4,444.07 110.00 4,437.53 $1,201,000 $1,201,500 110.00 4,478.61 110.00 4,472.08 110.00 4,465.54 110.00 4,459.01 110.00 4,452.48 110.00 4,445.94 110.00 4,439.41 $1,201,500 $1,202,000 110.00 4,480.48 110.00 4,473.95 110.00 4,467.42 110.00 4,460.88 110.00 4,454.35 110.00 4,447.82 110.00 4,441.28 $1,202,000 $1,202,500 110.00 4,482.36 110.00 4,475.83 110.00 4,469.29 110.00 4,462.76 110.00 4,456.23 110.00 4,449.69 110.00 4,443.16 $1,202,500 $1,203,000 110.00 4,484.23 110.00 4,477.70 110.00 4,471.17 110.00 4,464.63 110.00 4,458.10 110.00 4,451.57 110.00 4,445.03 $1,203,000 $1,203,500 110.00 4,486.11 110.00 4,479.58 110.00 4,473.04 110.00 4,466.51 110.00 4,459.98 110.00 4,453.44 110.00 4,446.91 $1,203,500 $1,204,000 110.00 4,487.98 110.00 4,481.45 110.00 4,474.92 110.00 4,468.38 110.00 4,461.85 110.00 4,455.32 110.00 4,448.78 $1,204,000 $1,204,500 110.00 4,489.86 110.00 4,483.33 110.00 4,476.79 110.00 4,470.26 110.00 4,463.73 110.00 4,457.19 110.00 4,450.66 $1,204,500 $1,205,000 110.00 4,491.73 110.00 4,485.20 110.00 4,478.67 110.00 4,472.13 110.00 4,465.60 110.00 4,459.07 110.00 4,452.53 $1,205,000 $1,205,500 110.00 4,493.61 110.00 4,487.08 110.00 4,480.54 110.00 4,474.01 110.00 4,467.48 110.00 4,460.94 110.00 4,454.41 $1,205,500 $1,206,000 110.00 4,495.48 110.00 4,488.95 110.00 4,482.42 110.00 4,475.88 110.00 4,469.35 110.00 4,462.82 110.00 4,456.28 $1,206,000 $1,206,500 110.00 4,497.36 110.00 4,490.83 110.00 4,484.29 110.00 4,477.76 110.00 4,471.23 110.00 4,464.69 110.00 4,458.16 $1,206,500 $1,207,000 110.00 4,499.23 110.00 4,492.70 110.00 4,486.17 110.00 4,479.63 110.00 4,473.10 110.00 4,466.57 110.00 4,460.03 $1,207,000 $1,207,500 110.00 4,501.11 110.00 4,494.58 110.00 4,488.04 110.00 4,481.51 110.00 4,474.98 110.00 4,468.44 110.00 4,461.91 $1,207,500 $1,208,000 110.00 4,502.98 110.00 4,496.45 110.00 4,489.92 110.00 4,483.38 110.00 4,476.85 110.00 4,470.32 110.00 4,463.78 $1,208,000 $1,208,500 110.00 4,504.86 110.00 4,498.33 110.00 4,491.79 110.00 4,485.26 110.00 4,478.73 110.00 4,472.19 110.00 4,465.66 $1,208,500 $1,209,000 110.00 4,506.73 110.00 4,500.20 110.00 4,493.67 110.00 4,487.13 110.00 4,480.60 110.00 4,474.07 110.00 4,467.53 $1,209,000 $1,209,500 110.00 4,508.61 110.00 4,502.08 110.00 4,495.54 110.00 4,489.01 110.00 4,482.48 110.00 4,475.94 110.00 4,469.41 $1,209,500 $1,210,000 110.00 4,510.48 110.00 4,503.95 110.00 4,497.42 110.00 4,490.88 110.00 4,484.35 110.00 4,477.82 110.00 4,471.28 $1,210,000 $1,210,500 110.00 4,512.36 110.00 4,505.83 110.00 4,499.29 110.00 4,492.76 110.00 4,486.23 110.00 4,479.69 110.00 4,473.16 $1,210,500 $1,211,000 110.00 4,514.23 110.00 4,507.70 110.00 4,501.17 110.00 4,494.63 110.00 4,488.10 110.00 4,481.57 110.00 4,475.03 $1,211,000 $1,211,500 110.00 4,516.11 110.00 4,509.58 110.00 4,503.04 110.00 4,496.51 110.00 4,489.98 110.00 4,483.44 110.00 4,476.91 $1,211,500 $1,212,000 110.00 4,517.98 110.00 4,511.45 110.00 4,504.92 110.00 4,498.38 110.00 4,491.85 110.00 4,485.32 110.00 4,478.78 $1,212,000 $1,212,500 110.00 4,519.86 110.00 4,513.33 110.00 4,506.79 110.00 4,500.26 110.00 4,493.73 110.00 4,487.19 110.00 4,480.66 $1,212,500 $1,213,000 110.00 4,521.73 110.00 4,515.20 110.00 4,508.67 110.00 4,502.13 110.00 4,495.60 110.00 4,489.07 110.00 4,482.53 $1,213,000 $1,213,500 110.00 4,523.61 110.00 4,517.08 110.00 4,510.54 110.00 4,504.01 110.00 4,497.48 110.00 4,490.94 110.00 4,484.41 $1,213,500 $1,214,000 110.00 4,525.48 110.00 4,518.95 110.00 4,512.42 110.00 4,505.88 110.00 4,499.35 110.00 4,492.82 110.00 4,486.28 $1,214,000 $1,214,500 110.00 4,527.36 110.00 4,520.83 110.00 4,514.29 110.00 4,507.76 110.00 4,501.23 110.00 4,494.69 110.00 4,488.16 $1,214,500 $1,215,000 110.00 4,529.23 110.00 4,522.70 110.00 4,516.17 110.00 4,509.63 110.00 4,503.10 110.00 4,496.57 110.00 4,490.03 $1,215,000 $1,215,500 110.00 4,531.11 110.00 4,524.58 110.00 4,518.04 110.00 4,511.51 110.00 4,504.98 110.00 4,498.44 110.00 4,491.91 $1,215,500 $1,216,000 110.00 4,532.98 110.00 4,526.45 110.00 4,519.92 110.00 4,513.38 110.00 4,506.85 110.00 4,500.32 110.00 4,493.78 $1,216,000 $1,216,500 110.00 4,534.86 110.00 4,528.33 110.00 4,521.79 110.00 4,515.26 110.00 4,508.73 110.00 4,502.19 110.00 4,495.66 $1,216,500 $1,217,000 110.00 4,536.73 110.00 4,530.20 110.00 4,523.67 110.00 4,517.13 110.00 4,510.60 110.00 4,504.07 110.00 4,497.53 $1,217,000 $1,217,500 110.00 4,538.61 110.00 4,532.08 110.00 4,525.54 110.00 4,519.01 110.00 4,512.48 110.00 4,505.94 110.00 4,499.41 $1,217,500 $1,218,000 110.00 4,540.48 110.00 4,533.95 110.00 4,527.42 110.00 4,520.88 110.00 4,514.35 110.00 4,507.82 110.00 4,501.28 $1,218,000 $1,218,500 110.00 4,542.36 110.00 4,535.83 110.00 4,529.29 110.00 4,522.76 110.00 4,516.23 110.00 4,509.69 110.00 4,503.16 $1,218,500 $1,219,000 110.00 4,544.23 110.00 4,537.70 110.00 4,531.17 110.00 4,524.63 110.00 4,518.10 110.00 4,511.57 110.00 4,505.03 $1,219,000 $1,219,500 110.00 4,546.11 110.00 4,539.58 110.00 4,533.04 110.00 4,526.51 110.00 4,519.98 110.00 4,513.44 110.00 4,506.91 $1,219,500 $1,220,000 110.00 4,547.98 110.00 4,541.45 110.00 4,534.92 110.00 4,528.38 110.00 4,521.85 110.00 4,515.32 110.00 4,508.78 $1,220,000 $1,220,500 110.00 4,549.86 110.00 4,543.33 110.00 4,536.79 110.00 4,530.26 110.00 4,523.73 110.00 4,517.19 110.00 4,510.66 $1,220,500 $1,221,000 110.00 4,551.73 110.00 4,545.20 110.00 4,538.67 110.00 4,532.13 110.00 4,525.60 110.00 4,519.07 110.00 4,512.53 $1,221,000 $1,221,500 110.00 4,553.61 110.00 4,547.08 110.00 4,540.54 110.00 4,534.01 110.00 4,527.48 110.00 4,520.94 110.00 4,514.41 $1,221,500 $1,222,000 110.00 4,555.48 110.00 4,548.95 110.00 4,542.42 110.00 4,535.88 110.00 4,529.35 110.00 4,522.82 110.00 4,516.28 $1,222,000 $1,222,500 110.00 4,557.36 110.00 4,550.83 110.00 4,544.29 110.00 4,537.76 110.00 4,531.23 110.00 4,524.69 110.00 4,518.16 $1,222,500 $1,223,000 110.00 4,559.23 110.00 4,552.70 110.00 4,546.17 110.00 4,539.63 110.00 4,533.10 110.00 4,526.57 110.00 4,520.03 $1,223,000 $1,223,500 110.00 4,561.11 110.00 4,554.58 110.00 4,548.04 110.00 4,541.51 110.00 4,534.98 110.00 4,528.44 110.00 4,521.91 $1,223,500 $1,224,000 110.00 4,562.98 110.00 4,556.45 110.00 4,549.92 110.00 4,543.38 110.00 4,536.85 110.00 4,530.32 110.00 4,523.78

NJEIS Family Cost Participation Table Page 27 of 12 Effective July 1, 2015

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

$1,224,000 $1,224,500 110.00 4,564.86 110.00 4,558.33 110.00 4,551.79 110.00 4,545.26 110.00 4,538.73 110.00 4,532.19 110.00 4,525.66 $1,224,500 $1,225,000 110.00 4,566.73 110.00 4,560.20 110.00 4,553.67 110.00 4,547.13 110.00 4,540.60 110.00 4,534.07 110.00 4,527.53 $1,225,000 $1,225,500 110.00 4,568.61 110.00 4,562.08 110.00 4,555.54 110.00 4,549.01 110.00 4,542.48 110.00 4,535.94 110.00 4,529.41 $1,225,500 $1,226,000 110.00 4,570.48 110.00 4,563.95 110.00 4,557.42 110.00 4,550.88 110.00 4,544.35 110.00 4,537.82 110.00 4,531.28 $1,226,000 $1,226,500 110.00 4,572.36 110.00 4,565.83 110.00 4,559.29 110.00 4,552.76 110.00 4,546.23 110.00 4,539.69 110.00 4,533.16 $1,226,500 $1,227,000 110.00 4,574.23 110.00 4,567.70 110.00 4,561.17 110.00 4,554.63 110.00 4,548.10 110.00 4,541.57 110.00 4,535.03 $1,227,000 $1,227,500 110.00 4,576.11 110.00 4,569.58 110.00 4,563.04 110.00 4,556.51 110.00 4,549.98 110.00 4,543.44 110.00 4,536.91 $1,227,500 $1,228,000 110.00 4,577.98 110.00 4,571.45 110.00 4,564.92 110.00 4,558.38 110.00 4,551.85 110.00 4,545.32 110.00 4,538.78 $1,228,000 $1,228,500 110.00 4,579.86 110.00 4,573.33 110.00 4,566.79 110.00 4,560.26 110.00 4,553.73 110.00 4,547.19 110.00 4,540.66 $1,228,500 $1,229,000 110.00 4,581.73 110.00 4,575.20 110.00 4,568.67 110.00 4,562.13 110.00 4,555.60 110.00 4,549.07 110.00 4,542.53 $1,229,000 $1,229,500 110.00 4,583.61 110.00 4,577.08 110.00 4,570.54 110.00 4,564.01 110.00 4,557.48 110.00 4,550.94 110.00 4,544.41 $1,229,500 $1,230,000 110.00 4,585.48 110.00 4,578.95 110.00 4,572.42 110.00 4,565.88 110.00 4,559.35 110.00 4,552.82 110.00 4,546.28 $1,230,000 $1,230,500 110.00 4,587.36 110.00 4,580.83 110.00 4,574.29 110.00 4,567.76 110.00 4,561.23 110.00 4,554.69 110.00 4,548.16 $1,230,500 $1,231,000 110.00 4,589.23 110.00 4,582.70 110.00 4,576.17 110.00 4,569.63 110.00 4,563.10 110.00 4,556.57 110.00 4,550.03 $1,231,000 $1,231,500 110.00 4,591.11 110.00 4,584.58 110.00 4,578.04 110.00 4,571.51 110.00 4,564.98 110.00 4,558.44 110.00 4,551.91 $1,231,500 $1,232,000 110.00 4,592.98 110.00 4,586.45 110.00 4,579.92 110.00 4,573.38 110.00 4,566.85 110.00 4,560.32 110.00 4,553.78 $1,232,000 $1,232,500 110.00 4,594.86 110.00 4,588.33 110.00 4,581.79 110.00 4,575.26 110.00 4,568.73 110.00 4,562.19 110.00 4,555.66 $1,232,500 $1,233,000 110.00 4,596.73 110.00 4,590.20 110.00 4,583.67 110.00 4,577.13 110.00 4,570.60 110.00 4,564.07 110.00 4,557.53 $1,233,000 $1,233,500 110.00 4,598.61 110.00 4,592.08 110.00 4,585.54 110.00 4,579.01 110.00 4,572.48 110.00 4,565.94 110.00 4,559.41 $1,233,500 $1,234,000 110.00 4,600.48 110.00 4,593.95 110.00 4,587.42 110.00 4,580.88 110.00 4,574.35 110.00 4,567.82 110.00 4,561.28 $1,234,000 $1,234,500 110.00 4,602.36 110.00 4,595.83 110.00 4,589.29 110.00 4,582.76 110.00 4,576.23 110.00 4,569.69 110.00 4,563.16 $1,234,500 $1,235,000 110.00 4,604.23 110.00 4,597.70 110.00 4,591.17 110.00 4,584.63 110.00 4,578.10 110.00 4,571.57 110.00 4,565.03 $1,235,000 $1,235,500 110.00 4,606.11 110.00 4,599.58 110.00 4,593.04 110.00 4,586.51 110.00 4,579.98 110.00 4,573.44 110.00 4,566.91 $1,235,500 $1,236,000 110.00 4,607.98 110.00 4,601.45 110.00 4,594.92 110.00 4,588.38 110.00 4,581.85 110.00 4,575.32 110.00 4,568.78 $1,236,000 $1,236,500 110.00 4,609.86 110.00 4,603.33 110.00 4,596.79 110.00 4,590.26 110.00 4,583.73 110.00 4,577.19 110.00 4,570.66 $1,236,500 $1,237,000 110.00 4,611.73 110.00 4,605.20 110.00 4,598.67 110.00 4,592.13 110.00 4,585.60 110.00 4,579.07 110.00 4,572.53 $1,237,000 $1,237,500 110.00 4,613.61 110.00 4,607.08 110.00 4,600.54 110.00 4,594.01 110.00 4,587.48 110.00 4,580.94 110.00 4,574.41 $1,237,500 $1,238,000 110.00 4,615.48 110.00 4,608.95 110.00 4,602.42 110.00 4,595.88 110.00 4,589.35 110.00 4,582.82 110.00 4,576.28 $1,238,000 $1,238,500 110.00 4,617.36 110.00 4,610.83 110.00 4,604.29 110.00 4,597.76 110.00 4,591.23 110.00 4,584.69 110.00 4,578.16 $1,238,500 $1,239,000 110.00 4,619.23 110.00 4,612.70 110.00 4,606.17 110.00 4,599.63 110.00 4,593.10 110.00 4,586.57 110.00 4,580.03 $1,239,000 $1,239,500 110.00 4,621.11 110.00 4,614.58 110.00 4,608.04 110.00 4,601.51 110.00 4,594.98 110.00 4,588.44 110.00 4,581.91 $1,239,500 $1,240,000 110.00 4,622.98 110.00 4,616.45 110.00 4,609.92 110.00 4,603.38 110.00 4,596.85 110.00 4,590.32 110.00 4,583.78 $1,240,000 $1,240,500 110.00 4,624.86 110.00 4,618.33 110.00 4,611.79 110.00 4,605.26 110.00 4,598.73 110.00 4,592.19 110.00 4,585.66 $1,240,500 $1,241,000 110.00 4,626.73 110.00 4,620.20 110.00 4,613.67 110.00 4,607.13 110.00 4,600.60 110.00 4,594.07 110.00 4,587.53 $1,241,000 $1,241,500 110.00 4,628.61 110.00 4,622.08 110.00 4,615.54 110.00 4,609.01 110.00 4,602.48 110.00 4,595.94 110.00 4,589.41 $1,241,500 $1,242,000 110.00 4,630.48 110.00 4,623.95 110.00 4,617.42 110.00 4,610.88 110.00 4,604.35 110.00 4,597.82 110.00 4,591.28 $1,242,000 $1,242,500 110.00 4,632.36 110.00 4,625.83 110.00 4,619.29 110.00 4,612.76 110.00 4,606.23 110.00 4,599.69 110.00 4,593.16 $1,242,500 $1,243,000 110.00 4,634.23 110.00 4,627.70 110.00 4,621.17 110.00 4,614.63 110.00 4,608.10 110.00 4,601.57 110.00 4,595.03 $1,243,000 $1,243,500 110.00 4,636.11 110.00 4,629.58 110.00 4,623.04 110.00 4,616.51 110.00 4,609.98 110.00 4,603.44 110.00 4,596.91 $1,243,500 $1,244,000 110.00 4,637.98 110.00 4,631.45 110.00 4,624.92 110.00 4,618.38 110.00 4,611.85 110.00 4,605.32 110.00 4,598.78 $1,244,000 $1,244,500 110.00 4,639.86 110.00 4,633.33 110.00 4,626.79 110.00 4,620.26 110.00 4,613.73 110.00 4,607.19 110.00 4,600.66 $1,244,500 $1,245,000 110.00 4,641.73 110.00 4,635.20 110.00 4,628.67 110.00 4,622.13 110.00 4,615.60 110.00 4,609.07 110.00 4,602.53 $1,245,000 $1,245,500 110.00 4,643.61 110.00 4,637.08 110.00 4,630.54 110.00 4,624.01 110.00 4,617.48 110.00 4,610.94 110.00 4,604.41 $1,245,500 $1,246,000 110.00 4,645.48 110.00 4,638.95 110.00 4,632.42 110.00 4,625.88 110.00 4,619.35 110.00 4,612.82 110.00 4,606.28 $1,246,000 $1,246,500 110.00 4,647.36 110.00 4,640.83 110.00 4,634.29 110.00 4,627.76 110.00 4,621.23 110.00 4,614.69 110.00 4,608.16 $1,246,500 $1,247,000 110.00 4,649.23 110.00 4,642.70 110.00 4,636.17 110.00 4,629.63 110.00 4,623.10 110.00 4,616.57 110.00 4,610.03 $1,247,000 $1,247,500 110.00 4,651.11 110.00 4,644.58 110.00 4,638.04 110.00 4,631.51 110.00 4,624.98 110.00 4,618.44 110.00 4,611.91 $1,247,500 $1,248,000 110.00 4,652.98 110.00 4,646.45 110.00 4,639.92 110.00 4,633.38 110.00 4,626.85 110.00 4,620.32 110.00 4,613.78 $1,248,000 $1,248,500 110.00 4,654.86 110.00 4,648.33 110.00 4,641.79 110.00 4,635.26 110.00 4,628.73 110.00 4,622.19 110.00 4,615.66 $1,248,500 $1,249,000 110.00 4,656.73 110.00 4,650.20 110.00 4,643.67 110.00 4,637.13 110.00 4,630.60 110.00 4,624.07 110.00 4,617.53 $1,249,000 $1,249,500 110.00 4,658.61 110.00 4,652.08 110.00 4,645.54 110.00 4,639.01 110.00 4,632.48 110.00 4,625.94 110.00 4,619.41 $1,249,500 $1,250,000 110.00 4,660.48 110.00 4,653.95 110.00 4,647.42 110.00 4,640.88 110.00 4,634.35 110.00 4,627.82 110.00 4,621.28 $1,250,000 $1,250,500 110.00 4,662.36 110.00 4,655.83 110.00 4,649.29 110.00 4,642.76 110.00 4,636.23 110.00 4,629.69 110.00 4,623.16 $1,250,500 $1,251,000 110.00 4,664.23 110.00 4,657.70 110.00 4,651.17 110.00 4,644.63 110.00 4,638.10 110.00 4,631.57 110.00 4,625.03 $1,251,000 $1,251,500 110.00 4,666.11 110.00 4,659.58 110.00 4,653.04 110.00 4,646.51 110.00 4,639.98 110.00 4,633.44 110.00 4,626.91 $1,251,500 $1,252,000 110.00 4,667.98 110.00 4,661.45 110.00 4,654.92 110.00 4,648.38 110.00 4,641.85 110.00 4,635.32 110.00 4,628.78 $1,252,000 $1,252,500 110.00 4,669.86 110.00 4,663.33 110.00 4,656.79 110.00 4,650.26 110.00 4,643.73 110.00 4,637.19 110.00 4,630.66 $1,252,500 $1,253,000 110.00 4,671.73 110.00 4,665.20 110.00 4,658.67 110.00 4,652.13 110.00 4,645.60 110.00 4,639.07 110.00 4,632.53 $1,253,000 $1,253,500 110.00 4,673.61 110.00 4,667.08 110.00 4,660.54 110.00 4,654.01 110.00 4,647.48 110.00 4,640.94 110.00 4,634.41 $1,253,500 $1,254,000 110.00 4,675.48 110.00 4,668.95 110.00 4,662.42 110.00 4,655.88 110.00 4,649.35 110.00 4,642.82 110.00 4,636.28 $1,254,000 $1,254,500 110.00 4,677.36 110.00 4,670.83 110.00 4,664.29 110.00 4,657.76 110.00 4,651.23 110.00 4,644.69 110.00 4,638.16 $1,254,500 $1,255,000 110.00 4,679.23 110.00 4,672.70 110.00 4,666.17 110.00 4,659.63 110.00 4,653.10 110.00 4,646.57 110.00 4,640.03 $1,255,000 $1,255,500 110.00 4,681.11 110.00 4,674.58 110.00 4,668.04 110.00 4,661.51 110.00 4,654.98 110.00 4,648.44 110.00 4,641.91 $1,255,500 $1,256,000 110.00 4,682.98 110.00 4,676.45 110.00 4,669.92 110.00 4,663.38 110.00 4,656.85 110.00 4,650.32 110.00 4,643.78 $1,256,000 $1,256,500 110.00 4,684.86 110.00 4,678.33 110.00 4,671.79 110.00 4,665.26 110.00 4,658.73 110.00 4,652.19 110.00 4,645.66 $1,256,500 $1,257,000 110.00 4,686.73 110.00 4,680.20 110.00 4,673.67 110.00 4,667.13 110.00 4,660.60 110.00 4,654.07 110.00 4,647.53 $1,257,000 $1,257,500 110.00 4,688.61 110.00 4,682.08 110.00 4,675.54 110.00 4,669.01 110.00 4,662.48 110.00 4,655.94 110.00 4,649.41 $1,257,500 $1,258,000 110.00 4,690.48 110.00 4,683.95 110.00 4,677.42 110.00 4,670.88 110.00 4,664.35 110.00 4,657.82 110.00 4,651.28 $1,258,000 $1,258,500 110.00 4,692.36 110.00 4,685.83 110.00 4,679.29 110.00 4,672.76 110.00 4,666.23 110.00 4,659.69 110.00 4,653.16 $1,258,500 $1,259,000 110.00 4,694.23 110.00 4,687.70 110.00 4,681.17 110.00 4,674.63 110.00 4,668.10 110.00 4,661.57 110.00 4,655.03 $1,259,000 $1,259,500 110.00 4,696.11 110.00 4,689.58 110.00 4,683.04 110.00 4,676.51 110.00 4,669.98 110.00 4,663.44 110.00 4,656.91 $1,259,500 $1,260,000 110.00 4,697.98 110.00 4,691.45 110.00 4,684.92 110.00 4,678.38 110.00 4,671.85 110.00 4,665.32 110.00 4,658.78 $1,260,000 $1,260,500 110.00 4,699.86 110.00 4,693.33 110.00 4,686.79 110.00 4,680.26 110.00 4,673.73 110.00 4,667.19 110.00 4,660.66 $1,260,500 $1,261,000 110.00 4,701.73 110.00 4,695.20 110.00 4,688.67 110.00 4,682.13 110.00 4,675.60 110.00 4,669.07 110.00 4,662.53 $1,261,000 $1,261,500 110.00 4,703.61 110.00 4,697.08 110.00 4,690.54 110.00 4,684.01 110.00 4,677.48 110.00 4,670.94 110.00 4,664.41 $1,261,500 $1,262,000 110.00 4,705.48 110.00 4,698.95 110.00 4,692.42 110.00 4,685.88 110.00 4,679.35 110.00 4,672.82 110.00 4,666.28 $1,262,000 $1,262,500 110.00 4,707.36 110.00 4,700.83 110.00 4,694.29 110.00 4,687.76 110.00 4,681.23 110.00 4,674.69 110.00 4,668.16 $1,262,500 $1,263,000 110.00 4,709.23 110.00 4,702.70 110.00 4,696.17 110.00 4,689.63 110.00 4,683.10 110.00 4,676.57 110.00 4,670.03 $1,263,000 $1,263,500 110.00 4,711.11 110.00 4,704.58 110.00 4,698.04 110.00 4,691.51 110.00 4,684.98 110.00 4,678.44 110.00 4,671.91 $1,263,500 $1,264,000 110.00 4,712.98 110.00 4,706.45 110.00 4,699.92 110.00 4,693.38 110.00 4,686.85 110.00 4,680.32 110.00 4,673.78 $1,264,000 $1,264,500 110.00 4,714.86 110.00 4,708.33 110.00 4,701.79 110.00 4,695.26 110.00 4,688.73 110.00 4,682.19 110.00 4,675.66 $1,264,500 $1,265,000 110.00 4,716.73 110.00 4,710.20 110.00 4,703.67 110.00 4,697.13 110.00 4,690.60 110.00 4,684.07 110.00 4,677.53 $1,265,000 $1,265,500 110.00 4,718.61 110.00 4,712.08 110.00 4,705.54 110.00 4,699.01 110.00 4,692.48 110.00 4,685.94 110.00 4,679.41 $1,265,500 $1,266,000 110.00 4,720.48 110.00 4,713.95 110.00 4,707.42 110.00 4,700.88 110.00 4,694.35 110.00 4,687.82 110.00 4,681.28 $1,266,000 $1,266,500 110.00 4,722.36 110.00 4,715.83 110.00 4,709.29 110.00 4,702.76 110.00 4,696.23 110.00 4,689.69 110.00 4,683.16 $1,266,500 $1,267,000 110.00 4,724.23 110.00 4,717.70 110.00 4,711.17 110.00 4,704.63 110.00 4,698.10 110.00 4,691.57 110.00 4,685.03 $1,267,000 $1,267,500 110.00 4,726.11 110.00 4,719.58 110.00 4,713.04 110.00 4,706.51 110.00 4,699.98 110.00 4,693.44 110.00 4,686.91 $1,267,500 $1,268,000 110.00 4,727.98 110.00 4,721.45 110.00 4,714.92 110.00 4,708.38 110.00 4,701.85 110.00 4,695.32 110.00 4,688.78 $1,268,000 $1,268,500 110.00 4,729.86 110.00 4,723.33 110.00 4,716.79 110.00 4,710.26 110.00 4,703.73 110.00 4,697.19 110.00 4,690.66 $1,268,500 $1,269,000 110.00 4,731.73 110.00 4,725.20 110.00 4,718.67 110.00 4,712.13 110.00 4,705.60 110.00 4,699.07 110.00 4,692.53 $1,269,000 $1,269,500 110.00 4,733.61 110.00 4,727.08 110.00 4,720.54 110.00 4,714.01 110.00 4,707.48 110.00 4,700.94 110.00 4,694.41 $1,269,500 $1,270,000 110.00 4,735.48 110.00 4,728.95 110.00 4,722.42 110.00 4,715.88 110.00 4,709.35 110.00 4,702.82 110.00 4,696.28 $1,270,000 $1,270,500 110.00 4,737.36 110.00 4,730.83 110.00 4,724.29 110.00 4,717.76 110.00 4,711.23 110.00 4,704.69 110.00 4,698.16 $1,270,500 $1,271,000 110.00 4,739.23 110.00 4,732.70 110.00 4,726.17 110.00 4,719.63 110.00 4,713.10 110.00 4,706.57 110.00 4,700.03 $1,271,000 $1,271,500 110.00 4,741.11 110.00 4,734.58 110.00 4,728.04 110.00 4,721.51 110.00 4,714.98 110.00 4,708.44 110.00 4,701.91 $1,271,500 $1,272,000 110.00 4,742.98 110.00 4,736.45 110.00 4,729.92 110.00 4,723.38 110.00 4,716.85 110.00 4,710.32 110.00 4,703.78 $1,272,000 $1,272,500 110.00 4,744.86 110.00 4,738.33 110.00 4,731.79 110.00 4,725.26 110.00 4,718.73 110.00 4,712.19 110.00 4,705.66 $1,272,500 $1,273,000 110.00 4,746.73 110.00 4,740.20 110.00 4,733.67 110.00 4,727.13 110.00 4,720.60 110.00 4,714.07 110.00 4,707.53 $1,273,000 $1,273,500 110.00 4,748.61 110.00 4,742.08 110.00 4,735.54 110.00 4,729.01 110.00 4,722.48 110.00 4,715.94 110.00 4,709.41 $1,273,500 $1,274,000 110.00 4,750.48 110.00 4,743.95 110.00 4,737.42 110.00 4,730.88 110.00 4,724.35 110.00 4,717.82 110.00 4,711.28 $1,274,000 $1,274,500 110.00 4,752.36 110.00 4,745.83 110.00 4,739.29 110.00 4,732.76 110.00 4,726.23 110.00 4,719.69 110.00 4,713.16 $1,274,500 $1,275,000 110.00 4,754.23 110.00 4,747.70 110.00 4,741.17 110.00 4,734.63 110.00 4,728.10 110.00 4,721.57 110.00 4,715.03

NJEIS Family Cost Participation Table Page 28 of 12 Effective July 1, 2015

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

$1,275,000 $1,275,500 110.00 4,756.11 110.00 4,749.58 110.00 4,743.04 110.00 4,736.51 110.00 4,729.98 110.00 4,723.44 110.00 4,716.91 $1,275,500 $1,276,000 110.00 4,757.98 110.00 4,751.45 110.00 4,744.92 110.00 4,738.38 110.00 4,731.85 110.00 4,725.32 110.00 4,718.78 $1,276,000 $1,276,500 110.00 4,759.86 110.00 4,753.33 110.00 4,746.79 110.00 4,740.26 110.00 4,733.73 110.00 4,727.19 110.00 4,720.66 $1,276,500 $1,277,000 110.00 4,761.73 110.00 4,755.20 110.00 4,748.67 110.00 4,742.13 110.00 4,735.60 110.00 4,729.07 110.00 4,722.53 $1,277,000 $1,277,500 110.00 4,763.61 110.00 4,757.08 110.00 4,750.54 110.00 4,744.01 110.00 4,737.48 110.00 4,730.94 110.00 4,724.41 $1,277,500 $1,278,000 110.00 4,765.48 110.00 4,758.95 110.00 4,752.42 110.00 4,745.88 110.00 4,739.35 110.00 4,732.82 110.00 4,726.28 $1,278,000 $1,278,500 110.00 4,767.36 110.00 4,760.83 110.00 4,754.29 110.00 4,747.76 110.00 4,741.23 110.00 4,734.69 110.00 4,728.16 $1,278,500 $1,279,000 110.00 4,769.23 110.00 4,762.70 110.00 4,756.17 110.00 4,749.63 110.00 4,743.10 110.00 4,736.57 110.00 4,730.03 $1,279,000 $1,279,500 110.00 4,771.11 110.00 4,764.58 110.00 4,758.04 110.00 4,751.51 110.00 4,744.98 110.00 4,738.44 110.00 4,731.91 $1,279,500 $1,280,000 110.00 4,772.98 110.00 4,766.45 110.00 4,759.92 110.00 4,753.38 110.00 4,746.85 110.00 4,740.32 110.00 4,733.78 $1,280,000 $1,280,500 110.00 4,774.86 110.00 4,768.33 110.00 4,761.79 110.00 4,755.26 110.00 4,748.73 110.00 4,742.19 110.00 4,735.66 $1,280,500 $1,281,000 110.00 4,776.73 110.00 4,770.20 110.00 4,763.67 110.00 4,757.13 110.00 4,750.60 110.00 4,744.07 110.00 4,737.53 $1,281,000 $1,281,500 110.00 4,778.61 110.00 4,772.08 110.00 4,765.54 110.00 4,759.01 110.00 4,752.48 110.00 4,745.94 110.00 4,739.41 $1,281,500 $1,282,000 110.00 4,780.48 110.00 4,773.95 110.00 4,767.42 110.00 4,760.88 110.00 4,754.35 110.00 4,747.82 110.00 4,741.28 $1,282,000 $1,282,500 110.00 4,782.36 110.00 4,775.83 110.00 4,769.29 110.00 4,762.76 110.00 4,756.23 110.00 4,749.69 110.00 4,743.16 $1,282,500 $1,283,000 110.00 4,784.23 110.00 4,777.70 110.00 4,771.17 110.00 4,764.63 110.00 4,758.10 110.00 4,751.57 110.00 4,745.03 $1,283,000 $1,283,500 110.00 4,786.11 110.00 4,779.58 110.00 4,773.04 110.00 4,766.51 110.00 4,759.98 110.00 4,753.44 110.00 4,746.91 $1,283,500 $1,284,000 110.00 4,787.98 110.00 4,781.45 110.00 4,774.92 110.00 4,768.38 110.00 4,761.85 110.00 4,755.32 110.00 4,748.78 $1,284,000 $1,284,500 110.00 4,789.86 110.00 4,783.33 110.00 4,776.79 110.00 4,770.26 110.00 4,763.73 110.00 4,757.19 110.00 4,750.66 $1,284,500 $1,285,000 110.00 4,791.73 110.00 4,785.20 110.00 4,778.67 110.00 4,772.13 110.00 4,765.60 110.00 4,759.07 110.00 4,752.53 $1,285,000 $1,285,500 110.00 4,793.61 110.00 4,787.08 110.00 4,780.54 110.00 4,774.01 110.00 4,767.48 110.00 4,760.94 110.00 4,754.41 $1,285,500 $1,286,000 110.00 4,795.48 110.00 4,788.95 110.00 4,782.42 110.00 4,775.88 110.00 4,769.35 110.00 4,762.82 110.00 4,756.28 $1,286,000 $1,286,500 110.00 4,797.36 110.00 4,790.83 110.00 4,784.29 110.00 4,777.76 110.00 4,771.23 110.00 4,764.69 110.00 4,758.16 $1,286,500 $1,287,000 110.00 4,799.23 110.00 4,792.70 110.00 4,786.17 110.00 4,779.63 110.00 4,773.10 110.00 4,766.57 110.00 4,760.03 $1,287,000 $1,287,500 110.00 4,801.11 110.00 4,794.58 110.00 4,788.04 110.00 4,781.51 110.00 4,774.98 110.00 4,768.44 110.00 4,761.91 $1,287,500 $1,288,000 110.00 4,802.98 110.00 4,796.45 110.00 4,789.92 110.00 4,783.38 110.00 4,776.85 110.00 4,770.32 110.00 4,763.78 $1,288,000 $1,288,500 110.00 4,804.86 110.00 4,798.33 110.00 4,791.79 110.00 4,785.26 110.00 4,778.73 110.00 4,772.19 110.00 4,765.66 $1,288,500 $1,289,000 110.00 4,806.73 110.00 4,800.20 110.00 4,793.67 110.00 4,787.13 110.00 4,780.60 110.00 4,774.07 110.00 4,767.53 $1,289,000 $1,289,500 110.00 4,808.61 110.00 4,802.08 110.00 4,795.54 110.00 4,789.01 110.00 4,782.48 110.00 4,775.94 110.00 4,769.41 $1,289,500 $1,290,000 110.00 4,810.48 110.00 4,803.95 110.00 4,797.42 110.00 4,790.88 110.00 4,784.35 110.00 4,777.82 110.00 4,771.28 $1,290,000 $1,290,500 110.00 4,812.36 110.00 4,805.83 110.00 4,799.29 110.00 4,792.76 110.00 4,786.23 110.00 4,779.69 110.00 4,773.16 $1,290,500 $1,291,000 110.00 4,814.23 110.00 4,807.70 110.00 4,801.17 110.00 4,794.63 110.00 4,788.10 110.00 4,781.57 110.00 4,775.03 $1,291,000 $1,291,500 110.00 4,816.11 110.00 4,809.58 110.00 4,803.04 110.00 4,796.51 110.00 4,789.98 110.00 4,783.44 110.00 4,776.91 $1,291,500 $1,292,000 110.00 4,817.98 110.00 4,811.45 110.00 4,804.92 110.00 4,798.38 110.00 4,791.85 110.00 4,785.32 110.00 4,778.78 $1,292,000 $1,292,500 110.00 4,819.86 110.00 4,813.33 110.00 4,806.79 110.00 4,800.26 110.00 4,793.73 110.00 4,787.19 110.00 4,780.66 $1,292,500 $1,293,000 110.00 4,821.73 110.00 4,815.20 110.00 4,808.67 110.00 4,802.13 110.00 4,795.60 110.00 4,789.07 110.00 4,782.53 $1,293,000 $1,293,500 110.00 4,823.61 110.00 4,817.08 110.00 4,810.54 110.00 4,804.01 110.00 4,797.48 110.00 4,790.94 110.00 4,784.41 $1,293,500 $1,294,000 110.00 4,825.48 110.00 4,818.95 110.00 4,812.42 110.00 4,805.88 110.00 4,799.35 110.00 4,792.82 110.00 4,786.28 $1,294,000 $1,294,500 110.00 4,827.36 110.00 4,820.83 110.00 4,814.29 110.00 4,807.76 110.00 4,801.23 110.00 4,794.69 110.00 4,788.16 $1,294,500 $1,295,000 110.00 4,829.23 110.00 4,822.70 110.00 4,816.17 110.00 4,809.63 110.00 4,803.10 110.00 4,796.57 110.00 4,790.03 $1,295,000 $1,295,500 110.00 4,831.11 110.00 4,824.58 110.00 4,818.04 110.00 4,811.51 110.00 4,804.98 110.00 4,798.44 110.00 4,791.91 $1,295,500 $1,296,000 110.00 4,832.98 110.00 4,826.45 110.00 4,819.92 110.00 4,813.38 110.00 4,806.85 110.00 4,800.32 110.00 4,793.78 $1,296,000 $1,296,500 110.00 4,834.86 110.00 4,828.33 110.00 4,821.79 110.00 4,815.26 110.00 4,808.73 110.00 4,802.19 110.00 4,795.66 $1,296,500 $1,297,000 110.00 4,836.73 110.00 4,830.20 110.00 4,823.67 110.00 4,817.13 110.00 4,810.60 110.00 4,804.07 110.00 4,797.53 $1,297,000 $1,297,500 110.00 4,838.61 110.00 4,832.08 110.00 4,825.54 110.00 4,819.01 110.00 4,812.48 110.00 4,805.94 110.00 4,799.41 $1,297,500 $1,298,000 110.00 4,840.48 110.00 4,833.95 110.00 4,827.42 110.00 4,820.88 110.00 4,814.35 110.00 4,807.82 110.00 4,801.28 $1,298,000 $1,298,500 110.00 4,842.36 110.00 4,835.83 110.00 4,829.29 110.00 4,822.76 110.00 4,816.23 110.00 4,809.69 110.00 4,803.16 $1,298,500 $1,299,000 110.00 4,844.23 110.00 4,837.70 110.00 4,831.17 110.00 4,824.63 110.00 4,818.10 110.00 4,811.57 110.00 4,805.03 $1,299,000 $1,299,500 110.00 4,846.11 110.00 4,839.58 110.00 4,833.04 110.00 4,826.51 110.00 4,819.98 110.00 4,813.44 110.00 4,806.91 $1,299,500 $1,300,000 110.00 4,847.98 110.00 4,841.45 110.00 4,834.92 110.00 4,828.38 110.00 4,821.85 110.00 4,815.32 110.00 4,808.78 $1,300,000 $1,300,500 110.00 4,849.86 110.00 4,843.33 110.00 4,836.79 110.00 4,830.26 110.00 4,823.73 110.00 4,817.19 110.00 4,810.66 $1,300,500 $1,301,000 110.00 4,851.73 110.00 4,845.20 110.00 4,838.67 110.00 4,832.13 110.00 4,825.60 110.00 4,819.07 110.00 4,812.53 $1,301,000 $1,301,500 110.00 4,853.61 110.00 4,847.08 110.00 4,840.54 110.00 4,834.01 110.00 4,827.48 110.00 4,820.94 110.00 4,814.41 $1,301,500 $1,302,000 110.00 4,855.48 110.00 4,848.95 110.00 4,842.42 110.00 4,835.88 110.00 4,829.35 110.00 4,822.82 110.00 4,816.28 $1,302,000 $1,302,500 110.00 4,857.36 110.00 4,850.83 110.00 4,844.29 110.00 4,837.76 110.00 4,831.23 110.00 4,824.69 110.00 4,818.16 $1,302,500 $1,303,000 110.00 4,859.23 110.00 4,852.70 110.00 4,846.17 110.00 4,839.63 110.00 4,833.10 110.00 4,826.57 110.00 4,820.03 $1,303,000 $1,303,500 110.00 4,861.11 110.00 4,854.58 110.00 4,848.04 110.00 4,841.51 110.00 4,834.98 110.00 4,828.44 110.00 4,821.91 $1,303,500 $1,304,000 110.00 4,862.98 110.00 4,856.45 110.00 4,849.92 110.00 4,843.38 110.00 4,836.85 110.00 4,830.32 110.00 4,823.78 $1,304,000 $1,304,500 110.00 4,864.86 110.00 4,858.33 110.00 4,851.79 110.00 4,845.26 110.00 4,838.73 110.00 4,832.19 110.00 4,825.66 $1,304,500 $1,305,000 110.00 4,866.73 110.00 4,860.20 110.00 4,853.67 110.00 4,847.13 110.00 4,840.60 110.00 4,834.07 110.00 4,827.53 $1,305,000 $1,305,500 110.00 4,868.61 110.00 4,862.08 110.00 4,855.54 110.00 4,849.01 110.00 4,842.48 110.00 4,835.94 110.00 4,829.41 $1,305,500 $1,306,000 110.00 4,870.48 110.00 4,863.95 110.00 4,857.42 110.00 4,850.88 110.00 4,844.35 110.00 4,837.82 110.00 4,831.28 $1,306,000 $1,306,500 110.00 4,872.36 110.00 4,865.83 110.00 4,859.29 110.00 4,852.76 110.00 4,846.23 110.00 4,839.69 110.00 4,833.16 $1,306,500 $1,307,000 110.00 4,874.23 110.00 4,867.70 110.00 4,861.17 110.00 4,854.63 110.00 4,848.10 110.00 4,841.57 110.00 4,835.03 $1,307,000 $1,307,500 110.00 4,876.11 110.00 4,869.58 110.00 4,863.04 110.00 4,856.51 110.00 4,849.98 110.00 4,843.44 110.00 4,836.91 $1,307,500 $1,308,000 110.00 4,877.98 110.00 4,871.45 110.00 4,864.92 110.00 4,858.38 110.00 4,851.85 110.00 4,845.32 110.00 4,838.78 $1,308,000 $1,308,500 110.00 4,879.86 110.00 4,873.33 110.00 4,866.79 110.00 4,860.26 110.00 4,853.73 110.00 4,847.19 110.00 4,840.66 $1,308,500 $1,309,000 110.00 4,881.73 110.00 4,875.20 110.00 4,868.67 110.00 4,862.13 110.00 4,855.60 110.00 4,849.07 110.00 4,842.53 $1,309,000 $1,309,500 110.00 4,883.61 110.00 4,877.08 110.00 4,870.54 110.00 4,864.01 110.00 4,857.48 110.00 4,850.94 110.00 4,844.41 $1,309,500 $1,310,000 110.00 4,885.48 110.00 4,878.95 110.00 4,872.42 110.00 4,865.88 110.00 4,859.35 110.00 4,852.82 110.00 4,846.28 $1,310,000 $1,310,500 110.00 4,887.36 110.00 4,880.83 110.00 4,874.29 110.00 4,867.76 110.00 4,861.23 110.00 4,854.69 110.00 4,848.16 $1,310,500 $1,311,000 110.00 4,889.23 110.00 4,882.70 110.00 4,876.17 110.00 4,869.63 110.00 4,863.10 110.00 4,856.57 110.00 4,850.03 $1,311,000 $1,311,500 110.00 4,891.11 110.00 4,884.58 110.00 4,878.04 110.00 4,871.51 110.00 4,864.98 110.00 4,858.44 110.00 4,851.91 $1,311,500 $1,312,000 110.00 4,892.98 110.00 4,886.45 110.00 4,879.92 110.00 4,873.38 110.00 4,866.85 110.00 4,860.32 110.00 4,853.78 $1,312,000 $1,312,500 110.00 4,894.86 110.00 4,888.33 110.00 4,881.79 110.00 4,875.26 110.00 4,868.73 110.00 4,862.19 110.00 4,855.66 $1,312,500 $1,313,000 110.00 4,896.73 110.00 4,890.20 110.00 4,883.67 110.00 4,877.13 110.00 4,870.60 110.00 4,864.07 110.00 4,857.53 $1,313,000 $1,313,500 110.00 4,898.61 110.00 4,892.08 110.00 4,885.54 110.00 4,879.01 110.00 4,872.48 110.00 4,865.94 110.00 4,859.41 $1,313,500 $1,314,000 110.00 4,900.48 110.00 4,893.95 110.00 4,887.42 110.00 4,880.88 110.00 4,874.35 110.00 4,867.82 110.00 4,861.28 $1,314,000 $1,314,500 110.00 4,902.36 110.00 4,895.83 110.00 4,889.29 110.00 4,882.76 110.00 4,876.23 110.00 4,869.69 110.00 4,863.16 $1,314,500 $1,315,000 110.00 4,904.23 110.00 4,897.70 110.00 4,891.17 110.00 4,884.63 110.00 4,878.10 110.00 4,871.57 110.00 4,865.03 $1,315,000 $1,315,500 110.00 4,906.11 110.00 4,899.58 110.00 4,893.04 110.00 4,886.51 110.00 4,879.98 110.00 4,873.44 110.00 4,866.91 $1,315,500 $1,316,000 110.00 4,907.98 110.00 4,901.45 110.00 4,894.92 110.00 4,888.38 110.00 4,881.85 110.00 4,875.32 110.00 4,868.78 $1,316,000 $1,316,500 110.00 4,909.86 110.00 4,903.33 110.00 4,896.79 110.00 4,890.26 110.00 4,883.73 110.00 4,877.19 110.00 4,870.66 $1,316,500 $1,317,000 110.00 4,911.73 110.00 4,905.20 110.00 4,898.67 110.00 4,892.13 110.00 4,885.60 110.00 4,879.07 110.00 4,872.53 $1,317,000 $1,317,500 110.00 4,913.61 110.00 4,907.08 110.00 4,900.54 110.00 4,894.01 110.00 4,887.48 110.00 4,880.94 110.00 4,874.41 $1,317,500 $1,318,000 110.00 4,915.48 110.00 4,908.95 110.00 4,902.42 110.00 4,895.88 110.00 4,889.35 110.00 4,882.82 110.00 4,876.28 $1,318,000 $1,318,500 110.00 4,917.36 110.00 4,910.83 110.00 4,904.29 110.00 4,897.76 110.00 4,891.23 110.00 4,884.69 110.00 4,878.16 $1,318,500 $1,319,000 110.00 4,919.23 110.00 4,912.70 110.00 4,906.17 110.00 4,899.63 110.00 4,893.10 110.00 4,886.57 110.00 4,880.03 $1,319,000 $1,319,500 110.00 4,921.11 110.00 4,914.58 110.00 4,908.04 110.00 4,901.51 110.00 4,894.98 110.00 4,888.44 110.00 4,881.91 $1,319,500 $1,320,000 110.00 4,922.98 110.00 4,916.45 110.00 4,909.92 110.00 4,903.38 110.00 4,896.85 110.00 4,890.32 110.00 4,883.78 $1,320,000 $1,320,500 110.00 4,924.86 110.00 4,918.33 110.00 4,911.79 110.00 4,905.26 110.00 4,898.73 110.00 4,892.19 110.00 4,885.66 $1,320,500 $1,321,000 110.00 4,926.73 110.00 4,920.20 110.00 4,913.67 110.00 4,907.13 110.00 4,900.60 110.00 4,894.07 110.00 4,887.53 $1,321,000 $1,321,500 110.00 4,928.61 110.00 4,922.08 110.00 4,915.54 110.00 4,909.01 110.00 4,902.48 110.00 4,895.94 110.00 4,889.41 $1,321,500 $1,322,000 110.00 4,930.48 110.00 4,923.95 110.00 4,917.42 110.00 4,910.88 110.00 4,904.35 110.00 4,897.82 110.00 4,891.28 $1,322,000 $1,322,500 110.00 4,932.36 110.00 4,925.83 110.00 4,919.29 110.00 4,912.76 110.00 4,906.23 110.00 4,899.69 110.00 4,893.16 $1,322,500 $1,323,000 110.00 4,934.23 110.00 4,927.70 110.00 4,921.17 110.00 4,914.63 110.00 4,908.10 110.00 4,901.57 110.00 4,895.03 $1,323,000 $1,323,500 110.00 4,936.11 110.00 4,929.58 110.00 4,923.04 110.00 4,916.51 110.00 4,909.98 110.00 4,903.44 110.00 4,896.91 $1,323,500 $1,324,000 110.00 4,937.98 110.00 4,931.45 110.00 4,924.92 110.00 4,918.38 110.00 4,911.85 110.00 4,905.32 110.00 4,898.78 $1,324,000 $1,324,500 110.00 4,939.86 110.00 4,933.33 110.00 4,926.79 110.00 4,920.26 110.00 4,913.73 110.00 4,907.19 110.00 4,900.66 $1,324,500 $1,325,000 110.00 4,941.73 110.00 4,935.20 110.00 4,928.67 110.00 4,922.13 110.00 4,915.60 110.00 4,909.07 110.00 4,902.53 $1,325,000 $1,325,500 110.00 4,943.61 110.00 4,937.08 110.00 4,930.54 110.00 4,924.01 110.00 4,917.48 110.00 4,910.94 110.00 4,904.41 $1,325,500 $1,326,000 110.00 4,945.48 110.00 4,938.95 110.00 4,932.42 110.00 4,925.88 110.00 4,919.35 110.00 4,912.82 110.00 4,906.28

NJEIS Family Cost Participation Table Page 29 of 12 Effective July 1, 2015

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

$1,326,000 $1,326,500 110.00 4,947.36 110.00 4,940.83 110.00 4,934.29 110.00 4,927.76 110.00 4,921.23 110.00 4,914.69 110.00 4,908.16 $1,326,500 $1,327,000 110.00 4,949.23 110.00 4,942.70 110.00 4,936.17 110.00 4,929.63 110.00 4,923.10 110.00 4,916.57 110.00 4,910.03 $1,327,000 $1,327,500 110.00 4,951.11 110.00 4,944.58 110.00 4,938.04 110.00 4,931.51 110.00 4,924.98 110.00 4,918.44 110.00 4,911.91 $1,327,500 $1,328,000 110.00 4,952.98 110.00 4,946.45 110.00 4,939.92 110.00 4,933.38 110.00 4,926.85 110.00 4,920.32 110.00 4,913.78 $1,328,000 $1,328,500 110.00 4,954.86 110.00 4,948.33 110.00 4,941.79 110.00 4,935.26 110.00 4,928.73 110.00 4,922.19 110.00 4,915.66 $1,328,500 $1,329,000 110.00 4,956.73 110.00 4,950.20 110.00 4,943.67 110.00 4,937.13 110.00 4,930.60 110.00 4,924.07 110.00 4,917.53 $1,329,000 $1,329,500 110.00 4,958.61 110.00 4,952.08 110.00 4,945.54 110.00 4,939.01 110.00 4,932.48 110.00 4,925.94 110.00 4,919.41 $1,329,500 $1,330,000 110.00 4,960.48 110.00 4,953.95 110.00 4,947.42 110.00 4,940.88 110.00 4,934.35 110.00 4,927.82 110.00 4,921.28 $1,330,000 $1,330,500 110.00 4,962.36 110.00 4,955.83 110.00 4,949.29 110.00 4,942.76 110.00 4,936.23 110.00 4,929.69 110.00 4,923.16 $1,330,500 $1,331,000 110.00 4,964.23 110.00 4,957.70 110.00 4,951.17 110.00 4,944.63 110.00 4,938.10 110.00 4,931.57 110.00 4,925.03 $1,331,000 $1,331,500 110.00 4,966.11 110.00 4,959.58 110.00 4,953.04 110.00 4,946.51 110.00 4,939.98 110.00 4,933.44 110.00 4,926.91 $1,331,500 $1,332,000 110.00 4,967.98 110.00 4,961.45 110.00 4,954.92 110.00 4,948.38 110.00 4,941.85 110.00 4,935.32 110.00 4,928.78 $1,332,000 $1,332,500 110.00 4,969.86 110.00 4,963.33 110.00 4,956.79 110.00 4,950.26 110.00 4,943.73 110.00 4,937.19 110.00 4,930.66 $1,332,500 $1,333,000 110.00 4,971.73 110.00 4,965.20 110.00 4,958.67 110.00 4,952.13 110.00 4,945.60 110.00 4,939.07 110.00 4,932.53 $1,333,000 $1,333,500 110.00 4,973.61 110.00 4,967.08 110.00 4,960.54 110.00 4,954.01 110.00 4,947.48 110.00 4,940.94 110.00 4,934.41 $1,333,500 $1,334,000 110.00 4,975.48 110.00 4,968.95 110.00 4,962.42 110.00 4,955.88 110.00 4,949.35 110.00 4,942.82 110.00 4,936.28 $1,334,000 $1,334,500 110.00 4,977.36 110.00 4,970.83 110.00 4,964.29 110.00 4,957.76 110.00 4,951.23 110.00 4,944.69 110.00 4,938.16 $1,334,500 $1,335,000 110.00 4,979.23 110.00 4,972.70 110.00 4,966.17 110.00 4,959.63 110.00 4,953.10 110.00 4,946.57 110.00 4,940.03 $1,335,000 $1,335,500 110.00 4,981.11 110.00 4,974.58 110.00 4,968.04 110.00 4,961.51 110.00 4,954.98 110.00 4,948.44 110.00 4,941.91 $1,335,500 $1,336,000 110.00 4,982.98 110.00 4,976.45 110.00 4,969.92 110.00 4,963.38 110.00 4,956.85 110.00 4,950.32 110.00 4,943.78 $1,336,000 $1,336,500 110.00 4,984.86 110.00 4,978.33 110.00 4,971.79 110.00 4,965.26 110.00 4,958.73 110.00 4,952.19 110.00 4,945.66 $1,336,500 $1,337,000 110.00 4,986.73 110.00 4,980.20 110.00 4,973.67 110.00 4,967.13 110.00 4,960.60 110.00 4,954.07 110.00 4,947.53 $1,337,000 $1,337,500 110.00 4,988.61 110.00 4,982.08 110.00 4,975.54 110.00 4,969.01 110.00 4,962.48 110.00 4,955.94 110.00 4,949.41 $1,337,500 $1,338,000 110.00 4,990.48 110.00 4,983.95 110.00 4,977.42 110.00 4,970.88 110.00 4,964.35 110.00 4,957.82 110.00 4,951.28 $1,338,000 $1,338,500 110.00 4,992.36 110.00 4,985.83 110.00 4,979.29 110.00 4,972.76 110.00 4,966.23 110.00 4,959.69 110.00 4,953.16 $1,338,500 $1,339,000 110.00 4,994.23 110.00 4,987.70 110.00 4,981.17 110.00 4,974.63 110.00 4,968.10 110.00 4,961.57 110.00 4,955.03 $1,339,000 $1,339,500 110.00 4,996.11 110.00 4,989.58 110.00 4,983.04 110.00 4,976.51 110.00 4,969.98 110.00 4,963.44 110.00 4,956.91 $1,339,500 $1,340,000 110.00 4,997.98 110.00 4,991.45 110.00 4,984.92 110.00 4,978.38 110.00 4,971.85 110.00 4,965.32 110.00 4,958.78 $1,340,000 $1,340,500 110.00 4,999.86 110.00 4,993.33 110.00 4,986.79 110.00 4,980.26 110.00 4,973.73 110.00 4,967.19 110.00 4,960.66 $1,340,500 $1,341,000 110.00 5,001.73 110.00 4,995.20 110.00 4,988.67 110.00 4,982.13 110.00 4,975.60 110.00 4,969.07 110.00 4,962.53 $1,341,000 $1,341,500 110.00 5,003.61 110.00 4,997.08 110.00 4,990.54 110.00 4,984.01 110.00 4,977.48 110.00 4,970.94 110.00 4,964.41 $1,341,500 $1,342,000 110.00 5,005.48 110.00 4,998.95 110.00 4,992.42 110.00 4,985.88 110.00 4,979.35 110.00 4,972.82 110.00 4,966.28 $1,342,000 $1,342,500 110.00 5,007.36 110.00 5,000.83 110.00 4,994.29 110.00 4,987.76 110.00 4,981.23 110.00 4,974.69 110.00 4,968.16 $1,342,500 $1,343,000 110.00 5,009.23 110.00 5,002.70 110.00 4,996.17 110.00 4,989.63 110.00 4,983.10 110.00 4,976.57 110.00 4,970.03 $1,343,000 $1,343,500 110.00 5,011.11 110.00 5,004.58 110.00 4,998.04 110.00 4,991.51 110.00 4,984.98 110.00 4,978.44 110.00 4,971.91 $1,343,500 $1,344,000 110.00 5,012.98 110.00 5,006.45 110.00 4,999.92 110.00 4,993.38 110.00 4,986.85 110.00 4,980.32 110.00 4,973.78 $1,344,000 $1,344,500 110.00 5,014.86 110.00 5,008.33 110.00 5,001.79 110.00 4,995.26 110.00 4,988.73 110.00 4,982.19 110.00 4,975.66 $1,344,500 $1,345,000 110.00 5,016.73 110.00 5,010.20 110.00 5,003.67 110.00 4,997.13 110.00 4,990.60 110.00 4,984.07 110.00 4,977.53 $1,345,000 $1,345,500 110.00 5,018.61 110.00 5,012.08 110.00 5,005.54 110.00 4,999.01 110.00 4,992.48 110.00 4,985.94 110.00 4,979.41 $1,345,500 $1,346,000 110.00 5,020.48 110.00 5,013.95 110.00 5,007.42 110.00 5,000.88 110.00 4,994.35 110.00 4,987.82 110.00 4,981.28 $1,346,000 $1,346,500 110.00 5,022.36 110.00 5,015.83 110.00 5,009.29 110.00 5,002.76 110.00 4,996.23 110.00 4,989.69 110.00 4,983.16 $1,346,500 $1,347,000 110.00 5,024.23 110.00 5,017.70 110.00 5,011.17 110.00 5,004.63 110.00 4,998.10 110.00 4,991.57 110.00 4,985.03 $1,347,000 $1,347,500 110.00 5,026.11 110.00 5,019.58 110.00 5,013.04 110.00 5,006.51 110.00 4,999.98 110.00 4,993.44 110.00 4,986.91 $1,347,500 $1,348,000 110.00 5,027.98 110.00 5,021.45 110.00 5,014.92 110.00 5,008.38 110.00 5,001.85 110.00 4,995.32 110.00 4,988.78 $1,348,000 $1,348,500 110.00 5,029.86 110.00 5,023.33 110.00 5,016.79 110.00 5,010.26 110.00 5,003.73 110.00 4,997.19 110.00 4,990.66 $1,348,500 $1,349,000 110.00 5,031.73 110.00 5,025.20 110.00 5,018.67 110.00 5,012.13 110.00 5,005.60 110.00 4,999.07 110.00 4,992.53 $1,349,000 $1,349,500 110.00 5,033.61 110.00 5,027.08 110.00 5,020.54 110.00 5,014.01 110.00 5,007.48 110.00 5,000.94 110.00 4,994.41 $1,349,500 $1,350,000 110.00 5,035.48 110.00 5,028.95 110.00 5,022.42 110.00 5,015.88 110.00 5,009.35 110.00 5,002.82 110.00 4,996.28 $1,350,000 $1,350,500 110.00 5,037.36 110.00 5,030.83 110.00 5,024.29 110.00 5,017.76 110.00 5,011.23 110.00 5,004.69 110.00 4,998.16 $1,350,500 $1,351,000 110.00 5,039.23 110.00 5,032.70 110.00 5,026.17 110.00 5,019.63 110.00 5,013.10 110.00 5,006.57 110.00 5,000.03 $1,351,000 $1,351,500 110.00 5,041.11 110.00 5,034.58 110.00 5,028.04 110.00 5,021.51 110.00 5,014.98 110.00 5,008.44 110.00 5,001.91 $1,351,500 $1,352,000 110.00 5,042.98 110.00 5,036.45 110.00 5,029.92 110.00 5,023.38 110.00 5,016.85 110.00 5,010.32 110.00 5,003.78 $1,352,000 $1,352,500 110.00 5,044.86 110.00 5,038.33 110.00 5,031.79 110.00 5,025.26 110.00 5,018.73 110.00 5,012.19 110.00 5,005.66 $1,352,500 $1,353,000 110.00 5,046.73 110.00 5,040.20 110.00 5,033.67 110.00 5,027.13 110.00 5,020.60 110.00 5,014.07 110.00 5,007.53 $1,353,000 $1,353,500 110.00 5,048.61 110.00 5,042.08 110.00 5,035.54 110.00 5,029.01 110.00 5,022.48 110.00 5,015.94 110.00 5,009.41 $1,353,500 $1,354,000 110.00 5,050.48 110.00 5,043.95 110.00 5,037.42 110.00 5,030.88 110.00 5,024.35 110.00 5,017.82 110.00 5,011.28 $1,354,000 $1,354,500 110.00 5,052.36 110.00 5,045.83 110.00 5,039.29 110.00 5,032.76 110.00 5,026.23 110.00 5,019.69 110.00 5,013.16 $1,354,500 $1,355,000 110.00 5,054.23 110.00 5,047.70 110.00 5,041.17 110.00 5,034.63 110.00 5,028.10 110.00 5,021.57 110.00 5,015.03 $1,355,000 $1,355,500 110.00 5,056.11 110.00 5,049.58 110.00 5,043.04 110.00 5,036.51 110.00 5,029.98 110.00 5,023.44 110.00 5,016.91 $1,355,500 $1,356,000 110.00 5,057.98 110.00 5,051.45 110.00 5,044.92 110.00 5,038.38 110.00 5,031.85 110.00 5,025.32 110.00 5,018.78 $1,356,000 $1,356,500 110.00 5,059.86 110.00 5,053.33 110.00 5,046.79 110.00 5,040.26 110.00 5,033.73 110.00 5,027.19 110.00 5,020.66 $1,356,500 $1,357,000 110.00 5,061.73 110.00 5,055.20 110.00 5,048.67 110.00 5,042.13 110.00 5,035.60 110.00 5,029.07 110.00 5,022.53 $1,357,000 $1,357,500 110.00 5,063.61 110.00 5,057.08 110.00 5,050.54 110.00 5,044.01 110.00 5,037.48 110.00 5,030.94 110.00 5,024.41 $1,357,500 $1,358,000 110.00 5,065.48 110.00 5,058.95 110.00 5,052.42 110.00 5,045.88 110.00 5,039.35 110.00 5,032.82 110.00 5,026.28 $1,358,000 $1,358,500 110.00 5,067.36 110.00 5,060.83 110.00 5,054.29 110.00 5,047.76 110.00 5,041.23 110.00 5,034.69 110.00 5,028.16 $1,358,500 $1,359,000 110.00 5,069.23 110.00 5,062.70 110.00 5,056.17 110.00 5,049.63 110.00 5,043.10 110.00 5,036.57 110.00 5,030.03 $1,359,000 $1,359,500 110.00 5,071.11 110.00 5,064.58 110.00 5,058.04 110.00 5,051.51 110.00 5,044.98 110.00 5,038.44 110.00 5,031.91 $1,359,500 $1,360,000 110.00 5,072.98 110.00 5,066.45 110.00 5,059.92 110.00 5,053.38 110.00 5,046.85 110.00 5,040.32 110.00 5,033.78 $1,360,000 $1,360,500 110.00 5,074.86 110.00 5,068.33 110.00 5,061.79 110.00 5,055.26 110.00 5,048.73 110.00 5,042.19 110.00 5,035.66 $1,360,500 $1,361,000 110.00 5,076.73 110.00 5,070.20 110.00 5,063.67 110.00 5,057.13 110.00 5,050.60 110.00 5,044.07 110.00 5,037.53 $1,361,000 $1,361,500 110.00 5,078.61 110.00 5,072.08 110.00 5,065.54 110.00 5,059.01 110.00 5,052.48 110.00 5,045.94 110.00 5,039.41 $1,361,500 $1,362,000 110.00 5,080.48 110.00 5,073.95 110.00 5,067.42 110.00 5,060.88 110.00 5,054.35 110.00 5,047.82 110.00 5,041.28 $1,362,000 $1,362,500 110.00 5,082.36 110.00 5,075.83 110.00 5,069.29 110.00 5,062.76 110.00 5,056.23 110.00 5,049.69 110.00 5,043.16 $1,362,500 $1,363,000 110.00 5,084.23 110.00 5,077.70 110.00 5,071.17 110.00 5,064.63 110.00 5,058.10 110.00 5,051.57 110.00 5,045.03 $1,363,000 $1,363,500 110.00 5,086.11 110.00 5,079.58 110.00 5,073.04 110.00 5,066.51 110.00 5,059.98 110.00 5,053.44 110.00 5,046.91 $1,363,500 $1,364,000 110.00 5,087.98 110.00 5,081.45 110.00 5,074.92 110.00 5,068.38 110.00 5,061.85 110.00 5,055.32 110.00 5,048.78 $1,364,000 $1,364,500 110.00 5,089.86 110.00 5,083.33 110.00 5,076.79 110.00 5,070.26 110.00 5,063.73 110.00 5,057.19 110.00 5,050.66 $1,364,500 $1,365,000 110.00 5,091.73 110.00 5,085.20 110.00 5,078.67 110.00 5,072.13 110.00 5,065.60 110.00 5,059.07 110.00 5,052.53 $1,365,000 $1,365,500 110.00 5,093.61 110.00 5,087.08 110.00 5,080.54 110.00 5,074.01 110.00 5,067.48 110.00 5,060.94 110.00 5,054.41 $1,365,500 $1,366,000 110.00 5,095.48 110.00 5,088.95 110.00 5,082.42 110.00 5,075.88 110.00 5,069.35 110.00 5,062.82 110.00 5,056.28 $1,366,000 $1,366,500 110.00 5,097.36 110.00 5,090.83 110.00 5,084.29 110.00 5,077.76 110.00 5,071.23 110.00 5,064.69 110.00 5,058.16 $1,366,500 $1,367,000 110.00 5,099.23 110.00 5,092.70 110.00 5,086.17 110.00 5,079.63 110.00 5,073.10 110.00 5,066.57 110.00 5,060.03 $1,367,000 $1,367,500 110.00 5,101.11 110.00 5,094.58 110.00 5,088.04 110.00 5,081.51 110.00 5,074.98 110.00 5,068.44 110.00 5,061.91 $1,367,500 $1,368,000 110.00 5,102.98 110.00 5,096.45 110.00 5,089.92 110.00 5,083.38 110.00 5,076.85 110.00 5,070.32 110.00 5,063.78 $1,368,000 $1,368,500 110.00 5,104.86 110.00 5,098.33 110.00 5,091.79 110.00 5,085.26 110.00 5,078.73 110.00 5,072.19 110.00 5,065.66 $1,368,500 $1,369,000 110.00 5,106.73 110.00 5,100.20 110.00 5,093.67 110.00 5,087.13 110.00 5,080.60 110.00 5,074.07 110.00 5,067.53 $1,369,000 $1,369,500 110.00 5,108.61 110.00 5,102.08 110.00 5,095.54 110.00 5,089.01 110.00 5,082.48 110.00 5,075.94 110.00 5,069.41 $1,369,500 $1,370,000 110.00 5,110.48 110.00 5,103.95 110.00 5,097.42 110.00 5,090.88 110.00 5,084.35 110.00 5,077.82 110.00 5,071.28 $1,370,000 $1,370,500 110.00 5,112.36 110.00 5,105.83 110.00 5,099.29 110.00 5,092.76 110.00 5,086.23 110.00 5,079.69 110.00 5,073.16 $1,370,500 $1,371,000 110.00 5,114.23 110.00 5,107.70 110.00 5,101.17 110.00 5,094.63 110.00 5,088.10 110.00 5,081.57 110.00 5,075.03 $1,371,000 $1,371,500 110.00 5,116.11 110.00 5,109.58 110.00 5,103.04 110.00 5,096.51 110.00 5,089.98 110.00 5,083.44 110.00 5,076.91 $1,371,500 $1,372,000 110.00 5,117.98 110.00 5,111.45 110.00 5,104.92 110.00 5,098.38 110.00 5,091.85 110.00 5,085.32 110.00 5,078.78 $1,372,000 $1,372,500 110.00 5,119.86 110.00 5,113.33 110.00 5,106.79 110.00 5,100.26 110.00 5,093.73 110.00 5,087.19 110.00 5,080.66 $1,372,500 $1,373,000 110.00 5,121.73 110.00 5,115.20 110.00 5,108.67 110.00 5,102.13 110.00 5,095.60 110.00 5,089.07 110.00 5,082.53 $1,373,000 $1,373,500 110.00 5,123.61 110.00 5,117.08 110.00 5,110.54 110.00 5,104.01 110.00 5,097.48 110.00 5,090.94 110.00 5,084.41 $1,373,500 $1,374,000 110.00 5,125.48 110.00 5,118.95 110.00 5,112.42 110.00 5,105.88 110.00 5,099.35 110.00 5,092.82 110.00 5,086.28 $1,374,000 $1,374,500 110.00 5,127.36 110.00 5,120.83 110.00 5,114.29 110.00 5,107.76 110.00 5,101.23 110.00 5,094.69 110.00 5,088.16 $1,374,500 $1,375,000 110.00 5,129.23 110.00 5,122.70 110.00 5,116.17 110.00 5,109.63 110.00 5,103.10 110.00 5,096.57 110.00 5,090.03 $1,375,000 $1,375,500 110.00 5,131.11 110.00 5,124.58 110.00 5,118.04 110.00 5,111.51 110.00 5,104.98 110.00 5,098.44 110.00 5,091.91 $1,375,500 $1,376,000 110.00 5,132.98 110.00 5,126.45 110.00 5,119.92 110.00 5,113.38 110.00 5,106.85 110.00 5,100.32 110.00 5,093.78 $1,376,000 $1,376,500 110.00 5,134.86 110.00 5,128.33 110.00 5,121.79 110.00 5,115.26 110.00 5,108.73 110.00 5,102.19 110.00 5,095.66 $1,376,500 $1,377,000 110.00 5,136.73 110.00 5,130.20 110.00 5,123.67 110.00 5,117.13 110.00 5,110.60 110.00 5,104.07 110.00 5,097.53

NJEIS Family Cost Participation Table Page 30 of 12 Effective July 1, 2015

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

$1,377,000 $1,377,500 110.00 5,138.61 110.00 5,132.08 110.00 5,125.54 110.00 5,119.01 110.00 5,112.48 110.00 5,105.94 110.00 5,099.41 $1,377,500 $1,378,000 110.00 5,140.48 110.00 5,133.95 110.00 5,127.42 110.00 5,120.88 110.00 5,114.35 110.00 5,107.82 110.00 5,101.28 $1,378,000 $1,378,500 110.00 5,142.36 110.00 5,135.83 110.00 5,129.29 110.00 5,122.76 110.00 5,116.23 110.00 5,109.69 110.00 5,103.16 $1,378,500 $1,379,000 110.00 5,144.23 110.00 5,137.70 110.00 5,131.17 110.00 5,124.63 110.00 5,118.10 110.00 5,111.57 110.00 5,105.03 $1,379,000 $1,379,500 110.00 5,146.11 110.00 5,139.58 110.00 5,133.04 110.00 5,126.51 110.00 5,119.98 110.00 5,113.44 110.00 5,106.91 $1,379,500 $1,380,000 110.00 5,147.98 110.00 5,141.45 110.00 5,134.92 110.00 5,128.38 110.00 5,121.85 110.00 5,115.32 110.00 5,108.78 $1,380,000 $1,380,500 110.00 5,149.86 110.00 5,143.33 110.00 5,136.79 110.00 5,130.26 110.00 5,123.73 110.00 5,117.19 110.00 5,110.66 $1,380,500 $1,381,000 110.00 5,151.73 110.00 5,145.20 110.00 5,138.67 110.00 5,132.13 110.00 5,125.60 110.00 5,119.07 110.00 5,112.53 $1,381,000 $1,381,500 110.00 5,153.61 110.00 5,147.08 110.00 5,140.54 110.00 5,134.01 110.00 5,127.48 110.00 5,120.94 110.00 5,114.41 $1,381,500 $1,382,000 110.00 5,155.48 110.00 5,148.95 110.00 5,142.42 110.00 5,135.88 110.00 5,129.35 110.00 5,122.82 110.00 5,116.28 $1,382,000 $1,382,500 110.00 5,157.36 110.00 5,150.83 110.00 5,144.29 110.00 5,137.76 110.00 5,131.23 110.00 5,124.69 110.00 5,118.16 $1,382,500 $1,383,000 110.00 5,159.23 110.00 5,152.70 110.00 5,146.17 110.00 5,139.63 110.00 5,133.10 110.00 5,126.57 110.00 5,120.03 $1,383,000 $1,383,500 110.00 5,161.11 110.00 5,154.58 110.00 5,148.04 110.00 5,141.51 110.00 5,134.98 110.00 5,128.44 110.00 5,121.91 $1,383,500 $1,384,000 110.00 5,162.98 110.00 5,156.45 110.00 5,149.92 110.00 5,143.38 110.00 5,136.85 110.00 5,130.32 110.00 5,123.78 $1,384,000 $1,384,500 110.00 5,164.86 110.00 5,158.33 110.00 5,151.79 110.00 5,145.26 110.00 5,138.73 110.00 5,132.19 110.00 5,125.66 $1,384,500 $1,385,000 110.00 5,166.73 110.00 5,160.20 110.00 5,153.67 110.00 5,147.13 110.00 5,140.60 110.00 5,134.07 110.00 5,127.53 $1,385,000 $1,385,500 110.00 5,168.61 110.00 5,162.08 110.00 5,155.54 110.00 5,149.01 110.00 5,142.48 110.00 5,135.94 110.00 5,129.41 $1,385,500 $1,386,000 110.00 5,170.48 110.00 5,163.95 110.00 5,157.42 110.00 5,150.88 110.00 5,144.35 110.00 5,137.82 110.00 5,131.28 $1,386,000 $1,386,500 110.00 5,172.36 110.00 5,165.83 110.00 5,159.29 110.00 5,152.76 110.00 5,146.23 110.00 5,139.69 110.00 5,133.16 $1,386,500 $1,387,000 110.00 5,174.23 110.00 5,167.70 110.00 5,161.17 110.00 5,154.63 110.00 5,148.10 110.00 5,141.57 110.00 5,135.03 $1,387,000 $1,387,500 110.00 5,176.11 110.00 5,169.58 110.00 5,163.04 110.00 5,156.51 110.00 5,149.98 110.00 5,143.44 110.00 5,136.91 $1,387,500 $1,388,000 110.00 5,177.98 110.00 5,171.45 110.00 5,164.92 110.00 5,158.38 110.00 5,151.85 110.00 5,145.32 110.00 5,138.78 $1,388,000 $1,388,500 110.00 5,179.86 110.00 5,173.33 110.00 5,166.79 110.00 5,160.26 110.00 5,153.73 110.00 5,147.19 110.00 5,140.66 $1,388,500 $1,389,000 110.00 5,181.73 110.00 5,175.20 110.00 5,168.67 110.00 5,162.13 110.00 5,155.60 110.00 5,149.07 110.00 5,142.53 $1,389,000 $1,389,500 110.00 5,183.61 110.00 5,177.08 110.00 5,170.54 110.00 5,164.01 110.00 5,157.48 110.00 5,150.94 110.00 5,144.41 $1,389,500 $1,390,000 110.00 5,185.48 110.00 5,178.95 110.00 5,172.42 110.00 5,165.88 110.00 5,159.35 110.00 5,152.82 110.00 5,146.28 $1,390,000 $1,390,500 110.00 5,187.36 110.00 5,180.83 110.00 5,174.29 110.00 5,167.76 110.00 5,161.23 110.00 5,154.69 110.00 5,148.16 $1,390,500 $1,391,000 110.00 5,189.23 110.00 5,182.70 110.00 5,176.17 110.00 5,169.63 110.00 5,163.10 110.00 5,156.57 110.00 5,150.03 $1,391,000 $1,391,500 110.00 5,191.11 110.00 5,184.58 110.00 5,178.04 110.00 5,171.51 110.00 5,164.98 110.00 5,158.44 110.00 5,151.91 $1,391,500 $1,392,000 110.00 5,192.98 110.00 5,186.45 110.00 5,179.92 110.00 5,173.38 110.00 5,166.85 110.00 5,160.32 110.00 5,153.78 $1,392,000 $1,392,500 110.00 5,194.86 110.00 5,188.33 110.00 5,181.79 110.00 5,175.26 110.00 5,168.73 110.00 5,162.19 110.00 5,155.66 $1,392,500 $1,393,000 110.00 5,196.73 110.00 5,190.20 110.00 5,183.67 110.00 5,177.13 110.00 5,170.60 110.00 5,164.07 110.00 5,157.53 $1,393,000 $1,393,500 110.00 5,198.61 110.00 5,192.08 110.00 5,185.54 110.00 5,179.01 110.00 5,172.48 110.00 5,165.94 110.00 5,159.41 $1,393,500 $1,394,000 110.00 5,200.48 110.00 5,193.95 110.00 5,187.42 110.00 5,180.88 110.00 5,174.35 110.00 5,167.82 110.00 5,161.28 $1,394,000 $1,394,500 110.00 5,202.36 110.00 5,195.83 110.00 5,189.29 110.00 5,182.76 110.00 5,176.23 110.00 5,169.69 110.00 5,163.16 $1,394,500 $1,395,000 110.00 5,204.23 110.00 5,197.70 110.00 5,191.17 110.00 5,184.63 110.00 5,178.10 110.00 5,171.57 110.00 5,165.03 $1,395,000 $1,395,500 110.00 5,206.11 110.00 5,199.58 110.00 5,193.04 110.00 5,186.51 110.00 5,179.98 110.00 5,173.44 110.00 5,166.91 $1,395,500 $1,396,000 110.00 5,207.98 110.00 5,201.45 110.00 5,194.92 110.00 5,188.38 110.00 5,181.85 110.00 5,175.32 110.00 5,168.78 $1,396,000 $1,396,500 110.00 5,209.86 110.00 5,203.33 110.00 5,196.79 110.00 5,190.26 110.00 5,183.73 110.00 5,177.19 110.00 5,170.66 $1,396,500 $1,397,000 110.00 5,211.73 110.00 5,205.20 110.00 5,198.67 110.00 5,192.13 110.00 5,185.60 110.00 5,179.07 110.00 5,172.53 $1,397,000 $1,397,500 110.00 5,213.61 110.00 5,207.08 110.00 5,200.54 110.00 5,194.01 110.00 5,187.48 110.00 5,180.94 110.00 5,174.41 $1,397,500 $1,398,000 110.00 5,215.48 110.00 5,208.95 110.00 5,202.42 110.00 5,195.88 110.00 5,189.35 110.00 5,182.82 110.00 5,176.28 $1,398,000 $1,398,500 110.00 5,217.36 110.00 5,210.83 110.00 5,204.29 110.00 5,197.76 110.00 5,191.23 110.00 5,184.69 110.00 5,178.16 $1,398,500 $1,399,000 110.00 5,219.23 110.00 5,212.70 110.00 5,206.17 110.00 5,199.63 110.00 5,193.10 110.00 5,186.57 110.00 5,180.03 $1,399,000 $1,399,500 110.00 5,221.11 110.00 5,214.58 110.00 5,208.04 110.00 5,201.51 110.00 5,194.98 110.00 5,188.44 110.00 5,181.91 $1,399,500 $1,400,000 110.00 5,222.98 110.00 5,216.45 110.00 5,209.92 110.00 5,203.38 110.00 5,196.85 110.00 5,190.32 110.00 5,183.78 $1,400,000 $1,400,500 110.00 5,224.86 110.00 5,218.33 110.00 5,211.79 110.00 5,205.26 110.00 5,198.73 110.00 5,192.19 110.00 5,185.66 $1,400,500 $1,401,000 110.00 5,226.73 110.00 5,220.20 110.00 5,213.67 110.00 5,207.13 110.00 5,200.60 110.00 5,194.07 110.00 5,187.53 $1,401,000 $1,401,500 110.00 5,228.61 110.00 5,222.08 110.00 5,215.54 110.00 5,209.01 110.00 5,202.48 110.00 5,195.94 110.00 5,189.41 $1,401,500 $1,402,000 110.00 5,230.48 110.00 5,223.95 110.00 5,217.42 110.00 5,210.88 110.00 5,204.35 110.00 5,197.82 110.00 5,191.28 $1,402,000 $1,402,500 110.00 5,232.36 110.00 5,225.83 110.00 5,219.29 110.00 5,212.76 110.00 5,206.23 110.00 5,199.69 110.00 5,193.16 $1,402,500 $1,403,000 110.00 5,234.23 110.00 5,227.70 110.00 5,221.17 110.00 5,214.63 110.00 5,208.10 110.00 5,201.57 110.00 5,195.03 $1,403,000 $1,403,500 110.00 5,236.11 110.00 5,229.58 110.00 5,223.04 110.00 5,216.51 110.00 5,209.98 110.00 5,203.44 110.00 5,196.91 $1,403,500 $1,404,000 110.00 5,237.98 110.00 5,231.45 110.00 5,224.92 110.00 5,218.38 110.00 5,211.85 110.00 5,205.32 110.00 5,198.78 $1,404,000 $1,404,500 110.00 5,239.86 110.00 5,233.33 110.00 5,226.79 110.00 5,220.26 110.00 5,213.73 110.00 5,207.19 110.00 5,200.66 $1,404,500 $1,405,000 110.00 5,241.73 110.00 5,235.20 110.00 5,228.67 110.00 5,222.13 110.00 5,215.60 110.00 5,209.07 110.00 5,202.53 $1,405,000 $1,405,500 110.00 5,243.61 110.00 5,237.08 110.00 5,230.54 110.00 5,224.01 110.00 5,217.48 110.00 5,210.94 110.00 5,204.41 $1,405,500 $1,406,000 110.00 5,245.48 110.00 5,238.95 110.00 5,232.42 110.00 5,225.88 110.00 5,219.35 110.00 5,212.82 110.00 5,206.28 $1,406,000 $1,406,500 110.00 5,247.36 110.00 5,240.83 110.00 5,234.29 110.00 5,227.76 110.00 5,221.23 110.00 5,214.69 110.00 5,208.16 $1,406,500 $1,407,000 110.00 5,249.23 110.00 5,242.70 110.00 5,236.17 110.00 5,229.63 110.00 5,223.10 110.00 5,216.57 110.00 5,210.03 $1,407,000 $1,407,500 110.00 5,251.11 110.00 5,244.58 110.00 5,238.04 110.00 5,231.51 110.00 5,224.98 110.00 5,218.44 110.00 5,211.91 $1,407,500 $1,408,000 110.00 5,252.98 110.00 5,246.45 110.00 5,239.92 110.00 5,233.38 110.00 5,226.85 110.00 5,220.32 110.00 5,213.78 $1,408,000 $1,408,500 110.00 5,254.86 110.00 5,248.33 110.00 5,241.79 110.00 5,235.26 110.00 5,228.73 110.00 5,222.19 110.00 5,215.66 $1,408,500 $1,409,000 110.00 5,256.73 110.00 5,250.20 110.00 5,243.67 110.00 5,237.13 110.00 5,230.60 110.00 5,224.07 110.00 5,217.53 $1,409,000 $1,409,500 110.00 5,258.61 110.00 5,252.08 110.00 5,245.54 110.00 5,239.01 110.00 5,232.48 110.00 5,225.94 110.00 5,219.41 $1,409,500 $1,410,000 110.00 5,260.48 110.00 5,253.95 110.00 5,247.42 110.00 5,240.88 110.00 5,234.35 110.00 5,227.82 110.00 5,221.28 $1,410,000 $1,410,500 110.00 5,262.36 110.00 5,255.83 110.00 5,249.29 110.00 5,242.76 110.00 5,236.23 110.00 5,229.69 110.00 5,223.16 $1,410,500 $1,411,000 110.00 5,264.23 110.00 5,257.70 110.00 5,251.17 110.00 5,244.63 110.00 5,238.10 110.00 5,231.57 110.00 5,225.03 $1,411,000 $1,411,500 110.00 5,266.11 110.00 5,259.58 110.00 5,253.04 110.00 5,246.51 110.00 5,239.98 110.00 5,233.44 110.00 5,226.91 $1,411,500 $1,412,000 110.00 5,267.98 110.00 5,261.45 110.00 5,254.92 110.00 5,248.38 110.00 5,241.85 110.00 5,235.32 110.00 5,228.78 $1,412,000 $1,412,500 110.00 5,269.86 110.00 5,263.33 110.00 5,256.79 110.00 5,250.26 110.00 5,243.73 110.00 5,237.19 110.00 5,230.66 $1,412,500 $1,413,000 110.00 5,271.73 110.00 5,265.20 110.00 5,258.67 110.00 5,252.13 110.00 5,245.60 110.00 5,239.07 110.00 5,232.53 $1,413,000 $1,413,500 110.00 5,273.61 110.00 5,267.08 110.00 5,260.54 110.00 5,254.01 110.00 5,247.48 110.00 5,240.94 110.00 5,234.41 $1,413,500 $1,414,000 110.00 5,275.48 110.00 5,268.95 110.00 5,262.42 110.00 5,255.88 110.00 5,249.35 110.00 5,242.82 110.00 5,236.28 $1,414,000 $1,414,500 110.00 5,277.36 110.00 5,270.83 110.00 5,264.29 110.00 5,257.76 110.00 5,251.23 110.00 5,244.69 110.00 5,238.16 $1,414,500 $1,415,000 110.00 5,279.23 110.00 5,272.70 110.00 5,266.17 110.00 5,259.63 110.00 5,253.10 110.00 5,246.57 110.00 5,240.03 $1,415,000 $1,415,500 110.00 5,281.11 110.00 5,274.58 110.00 5,268.04 110.00 5,261.51 110.00 5,254.98 110.00 5,248.44 110.00 5,241.91 $1,415,500 $1,416,000 110.00 5,282.98 110.00 5,276.45 110.00 5,269.92 110.00 5,263.38 110.00 5,256.85 110.00 5,250.32 110.00 5,243.78 $1,416,000 $1,416,500 110.00 5,284.86 110.00 5,278.33 110.00 5,271.79 110.00 5,265.26 110.00 5,258.73 110.00 5,252.19 110.00 5,245.66 $1,416,500 $1,417,000 110.00 5,286.73 110.00 5,280.20 110.00 5,273.67 110.00 5,267.13 110.00 5,260.60 110.00 5,254.07 110.00 5,247.53 $1,417,000 $1,417,500 110.00 5,288.61 110.00 5,282.08 110.00 5,275.54 110.00 5,269.01 110.00 5,262.48 110.00 5,255.94 110.00 5,249.41 $1,417,500 $1,418,000 110.00 5,290.48 110.00 5,283.95 110.00 5,277.42 110.00 5,270.88 110.00 5,264.35 110.00 5,257.82 110.00 5,251.28 $1,418,000 $1,418,500 110.00 5,292.36 110.00 5,285.83 110.00 5,279.29 110.00 5,272.76 110.00 5,266.23 110.00 5,259.69 110.00 5,253.16 $1,418,500 $1,419,000 110.00 5,294.23 110.00 5,287.70 110.00 5,281.17 110.00 5,274.63 110.00 5,268.10 110.00 5,261.57 110.00 5,255.03 $1,419,000 $1,419,500 110.00 5,296.11 110.00 5,289.58 110.00 5,283.04 110.00 5,276.51 110.00 5,269.98 110.00 5,263.44 110.00 5,256.91 $1,419,500 $1,420,000 110.00 5,297.98 110.00 5,291.45 110.00 5,284.92 110.00 5,278.38 110.00 5,271.85 110.00 5,265.32 110.00 5,258.78 $1,420,000 $1,420,500 110.00 5,299.86 110.00 5,293.33 110.00 5,286.79 110.00 5,280.26 110.00 5,273.73 110.00 5,267.19 110.00 5,260.66 $1,420,500 $1,421,000 110.00 5,301.73 110.00 5,295.20 110.00 5,288.67 110.00 5,282.13 110.00 5,275.60 110.00 5,269.07 110.00 5,262.53 $1,421,000 $1,421,500 110.00 5,303.61 110.00 5,297.08 110.00 5,290.54 110.00 5,284.01 110.00 5,277.48 110.00 5,270.94 110.00 5,264.41 $1,421,500 $1,422,000 110.00 5,305.48 110.00 5,298.95 110.00 5,292.42 110.00 5,285.88 110.00 5,279.35 110.00 5,272.82 110.00 5,266.28 $1,422,000 $1,422,500 110.00 5,307.36 110.00 5,300.83 110.00 5,294.29 110.00 5,287.76 110.00 5,281.23 110.00 5,274.69 110.00 5,268.16 $1,422,500 $1,423,000 110.00 5,309.23 110.00 5,302.70 110.00 5,296.17 110.00 5,289.63 110.00 5,283.10 110.00 5,276.57 110.00 5,270.03 $1,423,000 $1,423,500 110.00 5,311.11 110.00 5,304.58 110.00 5,298.04 110.00 5,291.51 110.00 5,284.98 110.00 5,278.44 110.00 5,271.91 $1,423,500 $1,424,000 110.00 5,312.98 110.00 5,306.45 110.00 5,299.92 110.00 5,293.38 110.00 5,286.85 110.00 5,280.32 110.00 5,273.78 $1,424,000 $1,424,500 110.00 5,314.86 110.00 5,308.33 110.00 5,301.79 110.00 5,295.26 110.00 5,288.73 110.00 5,282.19 110.00 5,275.66 $1,424,500 $1,425,000 110.00 5,316.73 110.00 5,310.20 110.00 5,303.67 110.00 5,297.13 110.00 5,290.60 110.00 5,284.07 110.00 5,277.53 $1,425,000 $1,425,500 110.00 5,318.61 110.00 5,312.08 110.00 5,305.54 110.00 5,299.01 110.00 5,292.48 110.00 5,285.94 110.00 5,279.41 $1,425,500 $1,426,000 110.00 5,320.48 110.00 5,313.95 110.00 5,307.42 110.00 5,300.88 110.00 5,294.35 110.00 5,287.82 110.00 5,281.28 $1,426,000 $1,426,500 110.00 5,322.36 110.00 5,315.83 110.00 5,309.29 110.00 5,302.76 110.00 5,296.23 110.00 5,289.69 110.00 5,283.16 $1,426,500 $1,427,000 110.00 5,324.23 110.00 5,317.70 110.00 5,311.17 110.00 5,304.63 110.00 5,298.10 110.00 5,291.57 110.00 5,285.03 $1,427,000 $1,427,500 110.00 5,326.11 110.00 5,319.58 110.00 5,313.04 110.00 5,306.51 110.00 5,299.98 110.00 5,293.44 110.00 5,286.91 $1,427,500 $1,428,000 110.00 5,327.98 110.00 5,321.45 110.00 5,314.92 110.00 5,308.38 110.00 5,301.85 110.00 5,295.32 110.00 5,288.78

NJEIS Family Cost Participation Table Page 31 of 12 Effective July 1, 2015

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

$1,428,000 $1,428,500 110.00 5,329.86 110.00 5,323.33 110.00 5,316.79 110.00 5,310.26 110.00 5,303.73 110.00 5,297.19 110.00 5,290.66 $1,428,500 $1,429,000 110.00 5,331.73 110.00 5,325.20 110.00 5,318.67 110.00 5,312.13 110.00 5,305.60 110.00 5,299.07 110.00 5,292.53 $1,429,000 $1,429,500 110.00 5,333.61 110.00 5,327.08 110.00 5,320.54 110.00 5,314.01 110.00 5,307.48 110.00 5,300.94 110.00 5,294.41 $1,429,500 $1,430,000 110.00 5,335.48 110.00 5,328.95 110.00 5,322.42 110.00 5,315.88 110.00 5,309.35 110.00 5,302.82 110.00 5,296.28 $1,430,000 $1,430,500 110.00 5,337.36 110.00 5,330.83 110.00 5,324.29 110.00 5,317.76 110.00 5,311.23 110.00 5,304.69 110.00 5,298.16 $1,430,500 $1,431,000 110.00 5,339.23 110.00 5,332.70 110.00 5,326.17 110.00 5,319.63 110.00 5,313.10 110.00 5,306.57 110.00 5,300.03 $1,431,000 $1,431,500 110.00 5,341.11 110.00 5,334.58 110.00 5,328.04 110.00 5,321.51 110.00 5,314.98 110.00 5,308.44 110.00 5,301.91 $1,431,500 $1,432,000 110.00 5,342.98 110.00 5,336.45 110.00 5,329.92 110.00 5,323.38 110.00 5,316.85 110.00 5,310.32 110.00 5,303.78 $1,432,000 $1,432,500 110.00 5,344.86 110.00 5,338.33 110.00 5,331.79 110.00 5,325.26 110.00 5,318.73 110.00 5,312.19 110.00 5,305.66 $1,432,500 $1,433,000 110.00 5,346.73 110.00 5,340.20 110.00 5,333.67 110.00 5,327.13 110.00 5,320.60 110.00 5,314.07 110.00 5,307.53 $1,433,000 $1,433,500 110.00 5,348.61 110.00 5,342.08 110.00 5,335.54 110.00 5,329.01 110.00 5,322.48 110.00 5,315.94 110.00 5,309.41 $1,433,500 $1,434,000 110.00 5,350.48 110.00 5,343.95 110.00 5,337.42 110.00 5,330.88 110.00 5,324.35 110.00 5,317.82 110.00 5,311.28 $1,434,000 $1,434,500 110.00 5,352.36 110.00 5,345.83 110.00 5,339.29 110.00 5,332.76 110.00 5,326.23 110.00 5,319.69 110.00 5,313.16 $1,434,500 $1,435,000 110.00 5,354.23 110.00 5,347.70 110.00 5,341.17 110.00 5,334.63 110.00 5,328.10 110.00 5,321.57 110.00 5,315.03 $1,435,000 $1,435,500 110.00 5,356.11 110.00 5,349.58 110.00 5,343.04 110.00 5,336.51 110.00 5,329.98 110.00 5,323.44 110.00 5,316.91 $1,435,500 $1,436,000 110.00 5,357.98 110.00 5,351.45 110.00 5,344.92 110.00 5,338.38 110.00 5,331.85 110.00 5,325.32 110.00 5,318.78 $1,436,000 $1,436,500 110.00 5,359.86 110.00 5,353.33 110.00 5,346.79 110.00 5,340.26 110.00 5,333.73 110.00 5,327.19 110.00 5,320.66 $1,436,500 $1,437,000 110.00 5,361.73 110.00 5,355.20 110.00 5,348.67 110.00 5,342.13 110.00 5,335.60 110.00 5,329.07 110.00 5,322.53 $1,437,000 $1,437,500 110.00 5,363.61 110.00 5,357.08 110.00 5,350.54 110.00 5,344.01 110.00 5,337.48 110.00 5,330.94 110.00 5,324.41 $1,437,500 $1,438,000 110.00 5,365.48 110.00 5,358.95 110.00 5,352.42 110.00 5,345.88 110.00 5,339.35 110.00 5,332.82 110.00 5,326.28 $1,438,000 $1,438,500 110.00 5,367.36 110.00 5,360.83 110.00 5,354.29 110.00 5,347.76 110.00 5,341.23 110.00 5,334.69 110.00 5,328.16 $1,438,500 $1,439,000 110.00 5,369.23 110.00 5,362.70 110.00 5,356.17 110.00 5,349.63 110.00 5,343.10 110.00 5,336.57 110.00 5,330.03 $1,439,000 $1,439,500 110.00 5,371.11 110.00 5,364.58 110.00 5,358.04 110.00 5,351.51 110.00 5,344.98 110.00 5,338.44 110.00 5,331.91 $1,439,500 $1,440,000 110.00 5,372.98 110.00 5,366.45 110.00 5,359.92 110.00 5,353.38 110.00 5,346.85 110.00 5,340.32 110.00 5,333.78 $1,440,000 $1,440,500 110.00 5,374.86 110.00 5,368.33 110.00 5,361.79 110.00 5,355.26 110.00 5,348.73 110.00 5,342.19 110.00 5,335.66 $1,440,500 $1,441,000 110.00 5,376.73 110.00 5,370.20 110.00 5,363.67 110.00 5,357.13 110.00 5,350.60 110.00 5,344.07 110.00 5,337.53 $1,441,000 $1,441,500 110.00 5,378.61 110.00 5,372.08 110.00 5,365.54 110.00 5,359.01 110.00 5,352.48 110.00 5,345.94 110.00 5,339.41 $1,441,500 $1,442,000 110.00 5,380.48 110.00 5,373.95 110.00 5,367.42 110.00 5,360.88 110.00 5,354.35 110.00 5,347.82 110.00 5,341.28 $1,442,000 $1,442,500 110.00 5,382.36 110.00 5,375.83 110.00 5,369.29 110.00 5,362.76 110.00 5,356.23 110.00 5,349.69 110.00 5,343.16 $1,442,500 $1,443,000 110.00 5,384.23 110.00 5,377.70 110.00 5,371.17 110.00 5,364.63 110.00 5,358.10 110.00 5,351.57 110.00 5,345.03 $1,443,000 $1,443,500 110.00 5,386.11 110.00 5,379.58 110.00 5,373.04 110.00 5,366.51 110.00 5,359.98 110.00 5,353.44 110.00 5,346.91 $1,443,500 $1,444,000 110.00 5,387.98 110.00 5,381.45 110.00 5,374.92 110.00 5,368.38 110.00 5,361.85 110.00 5,355.32 110.00 5,348.78 $1,444,000 $1,444,500 110.00 5,389.86 110.00 5,383.33 110.00 5,376.79 110.00 5,370.26 110.00 5,363.73 110.00 5,357.19 110.00 5,350.66 $1,444,500 $1,445,000 110.00 5,391.73 110.00 5,385.20 110.00 5,378.67 110.00 5,372.13 110.00 5,365.60 110.00 5,359.07 110.00 5,352.53 $1,445,000 $1,445,500 110.00 5,393.61 110.00 5,387.08 110.00 5,380.54 110.00 5,374.01 110.00 5,367.48 110.00 5,360.94 110.00 5,354.41 $1,445,500 $1,446,000 110.00 5,395.48 110.00 5,388.95 110.00 5,382.42 110.00 5,375.88 110.00 5,369.35 110.00 5,362.82 110.00 5,356.28 $1,446,000 $1,446,500 110.00 5,397.36 110.00 5,390.83 110.00 5,384.29 110.00 5,377.76 110.00 5,371.23 110.00 5,364.69 110.00 5,358.16 $1,446,500 $1,447,000 110.00 5,399.23 110.00 5,392.70 110.00 5,386.17 110.00 5,379.63 110.00 5,373.10 110.00 5,366.57 110.00 5,360.03 $1,447,000 $1,447,500 110.00 5,401.11 110.00 5,394.58 110.00 5,388.04 110.00 5,381.51 110.00 5,374.98 110.00 5,368.44 110.00 5,361.91 $1,447,500 $1,448,000 110.00 5,402.98 110.00 5,396.45 110.00 5,389.92 110.00 5,383.38 110.00 5,376.85 110.00 5,370.32 110.00 5,363.78 $1,448,000 $1,448,500 110.00 5,404.86 110.00 5,398.33 110.00 5,391.79 110.00 5,385.26 110.00 5,378.73 110.00 5,372.19 110.00 5,365.66 $1,448,500 $1,449,000 110.00 5,406.73 110.00 5,400.20 110.00 5,393.67 110.00 5,387.13 110.00 5,380.60 110.00 5,374.07 110.00 5,367.53 $1,449,000 $1,449,500 110.00 5,408.61 110.00 5,402.08 110.00 5,395.54 110.00 5,389.01 110.00 5,382.48 110.00 5,375.94 110.00 5,369.41 $1,449,500 $1,450,000 110.00 5,410.48 110.00 5,403.95 110.00 5,397.42 110.00 5,390.88 110.00 5,384.35 110.00 5,377.82 110.00 5,371.28 $1,450,000 $1,450,500 110.00 5,412.36 110.00 5,405.83 110.00 5,399.29 110.00 5,392.76 110.00 5,386.23 110.00 5,379.69 110.00 5,373.16 $1,450,500 $1,451,000 110.00 5,414.23 110.00 5,407.70 110.00 5,401.17 110.00 5,394.63 110.00 5,388.10 110.00 5,381.57 110.00 5,375.03 $1,451,000 $1,451,500 110.00 5,416.11 110.00 5,409.58 110.00 5,403.04 110.00 5,396.51 110.00 5,389.98 110.00 5,383.44 110.00 5,376.91 $1,451,500 $1,452,000 110.00 5,417.98 110.00 5,411.45 110.00 5,404.92 110.00 5,398.38 110.00 5,391.85 110.00 5,385.32 110.00 5,378.78 $1,452,000 $1,452,500 110.00 5,419.86 110.00 5,413.33 110.00 5,406.79 110.00 5,400.26 110.00 5,393.73 110.00 5,387.19 110.00 5,380.66 $1,452,500 $1,453,000 110.00 5,421.73 110.00 5,415.20 110.00 5,408.67 110.00 5,402.13 110.00 5,395.60 110.00 5,389.07 110.00 5,382.53 $1,453,000 $1,453,500 110.00 5,423.61 110.00 5,417.08 110.00 5,410.54 110.00 5,404.01 110.00 5,397.48 110.00 5,390.94 110.00 5,384.41 $1,453,500 $1,454,000 110.00 5,425.48 110.00 5,418.95 110.00 5,412.42 110.00 5,405.88 110.00 5,399.35 110.00 5,392.82 110.00 5,386.28 $1,454,000 $1,454,500 110.00 5,427.36 110.00 5,420.83 110.00 5,414.29 110.00 5,407.76 110.00 5,401.23 110.00 5,394.69 110.00 5,388.16 $1,454,500 $1,455,000 110.00 5,429.23 110.00 5,422.70 110.00 5,416.17 110.00 5,409.63 110.00 5,403.10 110.00 5,396.57 110.00 5,390.03 $1,455,000 $1,455,500 110.00 5,431.11 110.00 5,424.58 110.00 5,418.04 110.00 5,411.51 110.00 5,404.98 110.00 5,398.44 110.00 5,391.91 $1,455,500 $1,456,000 110.00 5,432.98 110.00 5,426.45 110.00 5,419.92 110.00 5,413.38 110.00 5,406.85 110.00 5,400.32 110.00 5,393.78 $1,456,000 $1,456,500 110.00 5,434.86 110.00 5,428.33 110.00 5,421.79 110.00 5,415.26 110.00 5,408.73 110.00 5,402.19 110.00 5,395.66 $1,456,500 $1,457,000 110.00 5,436.73 110.00 5,430.20 110.00 5,423.67 110.00 5,417.13 110.00 5,410.60 110.00 5,404.07 110.00 5,397.53 $1,457,000 $1,457,500 110.00 5,438.61 110.00 5,432.08 110.00 5,425.54 110.00 5,419.01 110.00 5,412.48 110.00 5,405.94 110.00 5,399.41 $1,457,500 $1,458,000 110.00 5,440.48 110.00 5,433.95 110.00 5,427.42 110.00 5,420.88 110.00 5,414.35 110.00 5,407.82 110.00 5,401.28 $1,458,000 $1,458,500 110.00 5,442.36 110.00 5,435.83 110.00 5,429.29 110.00 5,422.76 110.00 5,416.23 110.00 5,409.69 110.00 5,403.16 $1,458,500 $1,459,000 110.00 5,444.23 110.00 5,437.70 110.00 5,431.17 110.00 5,424.63 110.00 5,418.10 110.00 5,411.57 110.00 5,405.03 $1,459,000 $1,459,500 110.00 5,446.11 110.00 5,439.58 110.00 5,433.04 110.00 5,426.51 110.00 5,419.98 110.00 5,413.44 110.00 5,406.91 $1,459,500 $1,460,000 110.00 5,447.98 110.00 5,441.45 110.00 5,434.92 110.00 5,428.38 110.00 5,421.85 110.00 5,415.32 110.00 5,408.78 $1,460,000 $1,460,500 110.00 5,449.86 110.00 5,443.33 110.00 5,436.79 110.00 5,430.26 110.00 5,423.73 110.00 5,417.19 110.00 5,410.66 $1,460,500 $1,461,000 110.00 5,451.73 110.00 5,445.20 110.00 5,438.67 110.00 5,432.13 110.00 5,425.60 110.00 5,419.07 110.00 5,412.53 $1,461,000 $1,461,500 110.00 5,453.61 110.00 5,447.08 110.00 5,440.54 110.00 5,434.01 110.00 5,427.48 110.00 5,420.94 110.00 5,414.41 $1,461,500 $1,462,000 110.00 5,455.48 110.00 5,448.95 110.00 5,442.42 110.00 5,435.88 110.00 5,429.35 110.00 5,422.82 110.00 5,416.28 $1,462,000 $1,462,500 110.00 5,457.36 110.00 5,450.83 110.00 5,444.29 110.00 5,437.76 110.00 5,431.23 110.00 5,424.69 110.00 5,418.16 $1,462,500 $1,463,000 110.00 5,459.23 110.00 5,452.70 110.00 5,446.17 110.00 5,439.63 110.00 5,433.10 110.00 5,426.57 110.00 5,420.03 $1,463,000 $1,463,500 110.00 5,461.11 110.00 5,454.58 110.00 5,448.04 110.00 5,441.51 110.00 5,434.98 110.00 5,428.44 110.00 5,421.91 $1,463,500 $1,464,000 110.00 5,462.98 110.00 5,456.45 110.00 5,449.92 110.00 5,443.38 110.00 5,436.85 110.00 5,430.32 110.00 5,423.78 $1,464,000 $1,464,500 110.00 5,464.86 110.00 5,458.33 110.00 5,451.79 110.00 5,445.26 110.00 5,438.73 110.00 5,432.19 110.00 5,425.66 $1,464,500 $1,465,000 110.00 5,466.73 110.00 5,460.20 110.00 5,453.67 110.00 5,447.13 110.00 5,440.60 110.00 5,434.07 110.00 5,427.53 $1,465,000 $1,465,500 110.00 5,468.61 110.00 5,462.08 110.00 5,455.54 110.00 5,449.01 110.00 5,442.48 110.00 5,435.94 110.00 5,429.41 $1,465,500 $1,466,000 110.00 5,470.48 110.00 5,463.95 110.00 5,457.42 110.00 5,450.88 110.00 5,444.35 110.00 5,437.82 110.00 5,431.28 $1,466,000 $1,466,500 110.00 5,472.36 110.00 5,465.83 110.00 5,459.29 110.00 5,452.76 110.00 5,446.23 110.00 5,439.69 110.00 5,433.16 $1,466,500 $1,467,000 110.00 5,474.23 110.00 5,467.70 110.00 5,461.17 110.00 5,454.63 110.00 5,448.10 110.00 5,441.57 110.00 5,435.03 $1,467,000 $1,467,500 110.00 5,476.11 110.00 5,469.58 110.00 5,463.04 110.00 5,456.51 110.00 5,449.98 110.00 5,443.44 110.00 5,436.91 $1,467,500 $1,468,000 110.00 5,477.98 110.00 5,471.45 110.00 5,464.92 110.00 5,458.38 110.00 5,451.85 110.00 5,445.32 110.00 5,438.78 $1,468,000 $1,468,500 110.00 5,479.86 110.00 5,473.33 110.00 5,466.79 110.00 5,460.26 110.00 5,453.73 110.00 5,447.19 110.00 5,440.66 $1,468,500 $1,469,000 110.00 5,481.73 110.00 5,475.20 110.00 5,468.67 110.00 5,462.13 110.00 5,455.60 110.00 5,449.07 110.00 5,442.53 $1,469,000 $1,469,500 110.00 5,483.61 110.00 5,477.08 110.00 5,470.54 110.00 5,464.01 110.00 5,457.48 110.00 5,450.94 110.00 5,444.41 $1,469,500 $1,470,000 110.00 5,485.48 110.00 5,478.95 110.00 5,472.42 110.00 5,465.88 110.00 5,459.35 110.00 5,452.82 110.00 5,446.28 $1,470,000 $1,470,500 110.00 5,487.36 110.00 5,480.83 110.00 5,474.29 110.00 5,467.76 110.00 5,461.23 110.00 5,454.69 110.00 5,448.16 $1,470,500 $1,471,000 110.00 5,489.23 110.00 5,482.70 110.00 5,476.17 110.00 5,469.63 110.00 5,463.10 110.00 5,456.57 110.00 5,450.03 $1,471,000 $1,471,500 110.00 5,491.11 110.00 5,484.58 110.00 5,478.04 110.00 5,471.51 110.00 5,464.98 110.00 5,458.44 110.00 5,451.91 $1,471,500 $1,472,000 110.00 5,492.98 110.00 5,486.45 110.00 5,479.92 110.00 5,473.38 110.00 5,466.85 110.00 5,460.32 110.00 5,453.78 $1,472,000 $1,472,500 110.00 5,494.86 110.00 5,488.33 110.00 5,481.79 110.00 5,475.26 110.00 5,468.73 110.00 5,462.19 110.00 5,455.66 $1,472,500 $1,473,000 110.00 5,496.73 110.00 5,490.20 110.00 5,483.67 110.00 5,477.13 110.00 5,470.60 110.00 5,464.07 110.00 5,457.53 $1,473,000 $1,473,500 110.00 5,498.61 110.00 5,492.08 110.00 5,485.54 110.00 5,479.01 110.00 5,472.48 110.00 5,465.94 110.00 5,459.41 $1,473,500 $1,474,000 110.00 5,500.48 110.00 5,493.95 110.00 5,487.42 110.00 5,480.88 110.00 5,474.35 110.00 5,467.82 110.00 5,461.28 $1,474,000 $1,474,500 110.00 5,502.36 110.00 5,495.83 110.00 5,489.29 110.00 5,482.76 110.00 5,476.23 110.00 5,469.69 110.00 5,463.16 $1,474,500 $1,475,000 110.00 5,504.23 110.00 5,497.70 110.00 5,491.17 110.00 5,484.63 110.00 5,478.10 110.00 5,471.57 110.00 5,465.03 $1,475,000 $1,475,500 110.00 5,506.11 110.00 5,499.58 110.00 5,493.04 110.00 5,486.51 110.00 5,479.98 110.00 5,473.44 110.00 5,466.91 $1,475,500 $1,476,000 110.00 5,507.98 110.00 5,501.45 110.00 5,494.92 110.00 5,488.38 110.00 5,481.85 110.00 5,475.32 110.00 5,468.78 $1,476,000 $1,476,500 110.00 5,509.86 110.00 5,503.33 110.00 5,496.79 110.00 5,490.26 110.00 5,483.73 110.00 5,477.19 110.00 5,470.66 $1,476,500 $1,477,000 110.00 5,511.73 110.00 5,505.20 110.00 5,498.67 110.00 5,492.13 110.00 5,485.60 110.00 5,479.07 110.00 5,472.53 $1,477,000 $1,477,500 110.00 5,513.61 110.00 5,507.08 110.00 5,500.54 110.00 5,494.01 110.00 5,487.48 110.00 5,480.94 110.00 5,474.41 $1,477,500 $1,478,000 110.00 5,515.48 110.00 5,508.95 110.00 5,502.42 110.00 5,495.88 110.00 5,489.35 110.00 5,482.82 110.00 5,476.28 $1,478,000 $1,478,500 110.00 5,517.36 110.00 5,510.83 110.00 5,504.29 110.00 5,497.76 110.00 5,491.23 110.00 5,484.69 110.00 5,478.16 $1,478,500 $1,479,000 110.00 5,519.23 110.00 5,512.70 110.00 5,506.17 110.00 5,499.63 110.00 5,493.10 110.00 5,486.57 110.00 5,480.03

NJEIS Family Cost Participation Table Page 32 of 12 Effective July 1, 2015

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

$1,479,000 $1,479,500 110.00 5,521.11 110.00 5,514.58 110.00 5,508.04 110.00 5,501.51 110.00 5,494.98 110.00 5,488.44 110.00 5,481.91 $1,479,500 $1,480,000 110.00 5,522.98 110.00 5,516.45 110.00 5,509.92 110.00 5,503.38 110.00 5,496.85 110.00 5,490.32 110.00 5,483.78 $1,480,000 $1,480,500 110.00 5,524.86 110.00 5,518.33 110.00 5,511.79 110.00 5,505.26 110.00 5,498.73 110.00 5,492.19 110.00 5,485.66 $1,480,500 $1,481,000 110.00 5,526.73 110.00 5,520.20 110.00 5,513.67 110.00 5,507.13 110.00 5,500.60 110.00 5,494.07 110.00 5,487.53 $1,481,000 $1,481,500 110.00 5,528.61 110.00 5,522.08 110.00 5,515.54 110.00 5,509.01 110.00 5,502.48 110.00 5,495.94 110.00 5,489.41 $1,481,500 $1,482,000 110.00 5,530.48 110.00 5,523.95 110.00 5,517.42 110.00 5,510.88 110.00 5,504.35 110.00 5,497.82 110.00 5,491.28 $1,482,000 $1,482,500 110.00 5,532.36 110.00 5,525.83 110.00 5,519.29 110.00 5,512.76 110.00 5,506.23 110.00 5,499.69 110.00 5,493.16 $1,482,500 $1,483,000 110.00 5,534.23 110.00 5,527.70 110.00 5,521.17 110.00 5,514.63 110.00 5,508.10 110.00 5,501.57 110.00 5,495.03 $1,483,000 $1,483,500 110.00 5,536.11 110.00 5,529.58 110.00 5,523.04 110.00 5,516.51 110.00 5,509.98 110.00 5,503.44 110.00 5,496.91 $1,483,500 $1,484,000 110.00 5,537.98 110.00 5,531.45 110.00 5,524.92 110.00 5,518.38 110.00 5,511.85 110.00 5,505.32 110.00 5,498.78 $1,484,000 $1,484,500 110.00 5,539.86 110.00 5,533.33 110.00 5,526.79 110.00 5,520.26 110.00 5,513.73 110.00 5,507.19 110.00 5,500.66 $1,484,500 $1,485,000 110.00 5,541.73 110.00 5,535.20 110.00 5,528.67 110.00 5,522.13 110.00 5,515.60 110.00 5,509.07 110.00 5,502.53 $1,485,000 $1,485,500 110.00 5,543.61 110.00 5,537.08 110.00 5,530.54 110.00 5,524.01 110.00 5,517.48 110.00 5,510.94 110.00 5,504.41 $1,485,500 $1,486,000 110.00 5,545.48 110.00 5,538.95 110.00 5,532.42 110.00 5,525.88 110.00 5,519.35 110.00 5,512.82 110.00 5,506.28 $1,486,000 $1,486,500 110.00 5,547.36 110.00 5,540.83 110.00 5,534.29 110.00 5,527.76 110.00 5,521.23 110.00 5,514.69 110.00 5,508.16 $1,486,500 $1,487,000 110.00 5,549.23 110.00 5,542.70 110.00 5,536.17 110.00 5,529.63 110.00 5,523.10 110.00 5,516.57 110.00 5,510.03 $1,487,000 $1,487,500 110.00 5,551.11 110.00 5,544.58 110.00 5,538.04 110.00 5,531.51 110.00 5,524.98 110.00 5,518.44 110.00 5,511.91 $1,487,500 $1,488,000 110.00 5,552.98 110.00 5,546.45 110.00 5,539.92 110.00 5,533.38 110.00 5,526.85 110.00 5,520.32 110.00 5,513.78 $1,488,000 $1,488,500 110.00 5,554.86 110.00 5,548.33 110.00 5,541.79 110.00 5,535.26 110.00 5,528.73 110.00 5,522.19 110.00 5,515.66 $1,488,500 $1,489,000 110.00 5,556.73 110.00 5,550.20 110.00 5,543.67 110.00 5,537.13 110.00 5,530.60 110.00 5,524.07 110.00 5,517.53 $1,489,000 $1,489,500 110.00 5,558.61 110.00 5,552.08 110.00 5,545.54 110.00 5,539.01 110.00 5,532.48 110.00 5,525.94 110.00 5,519.41 $1,489,500 $1,490,000 110.00 5,560.48 110.00 5,553.95 110.00 5,547.42 110.00 5,540.88 110.00 5,534.35 110.00 5,527.82 110.00 5,521.28 $1,490,000 $1,490,500 110.00 5,562.36 110.00 5,555.83 110.00 5,549.29 110.00 5,542.76 110.00 5,536.23 110.00 5,529.69 110.00 5,523.16 $1,490,500 $1,491,000 110.00 5,564.23 110.00 5,557.70 110.00 5,551.17 110.00 5,544.63 110.00 5,538.10 110.00 5,531.57 110.00 5,525.03 $1,491,000 $1,491,500 110.00 5,566.11 110.00 5,559.58 110.00 5,553.04 110.00 5,546.51 110.00 5,539.98 110.00 5,533.44 110.00 5,526.91 $1,491,500 $1,492,000 110.00 5,567.98 110.00 5,561.45 110.00 5,554.92 110.00 5,548.38 110.00 5,541.85 110.00 5,535.32 110.00 5,528.78 $1,492,000 $1,492,500 110.00 5,569.86 110.00 5,563.33 110.00 5,556.79 110.00 5,550.26 110.00 5,543.73 110.00 5,537.19 110.00 5,530.66 $1,492,500 $1,493,000 110.00 5,571.73 110.00 5,565.20 110.00 5,558.67 110.00 5,552.13 110.00 5,545.60 110.00 5,539.07 110.00 5,532.53 $1,493,000 $1,493,500 110.00 5,573.61 110.00 5,567.08 110.00 5,560.54 110.00 5,554.01 110.00 5,547.48 110.00 5,540.94 110.00 5,534.41 $1,493,500 $1,494,000 110.00 5,575.48 110.00 5,568.95 110.00 5,562.42 110.00 5,555.88 110.00 5,549.35 110.00 5,542.82 110.00 5,536.28 $1,494,000 $1,494,500 110.00 5,577.36 110.00 5,570.83 110.00 5,564.29 110.00 5,557.76 110.00 5,551.23 110.00 5,544.69 110.00 5,538.16 $1,494,500 $1,495,000 110.00 5,579.23 110.00 5,572.70 110.00 5,566.17 110.00 5,559.63 110.00 5,553.10 110.00 5,546.57 110.00 5,540.03 $1,495,000 $1,495,500 110.00 5,581.11 110.00 5,574.58 110.00 5,568.04 110.00 5,561.51 110.00 5,554.98 110.00 5,548.44 110.00 5,541.91 $1,495,500 $1,496,000 110.00 5,582.98 110.00 5,576.45 110.00 5,569.92 110.00 5,563.38 110.00 5,556.85 110.00 5,550.32 110.00 5,543.78 $1,496,000 $1,496,500 110.00 5,584.86 110.00 5,578.33 110.00 5,571.79 110.00 5,565.26 110.00 5,558.73 110.00 5,552.19 110.00 5,545.66 $1,496,500 $1,497,000 110.00 5,586.73 110.00 5,580.20 110.00 5,573.67 110.00 5,567.13 110.00 5,560.60 110.00 5,554.07 110.00 5,547.53 $1,497,000 $1,497,500 110.00 5,588.61 110.00 5,582.08 110.00 5,575.54 110.00 5,569.01 110.00 5,562.48 110.00 5,555.94 110.00 5,549.41 $1,497,500 $1,498,000 110.00 5,590.48 110.00 5,583.95 110.00 5,577.42 110.00 5,570.88 110.00 5,564.35 110.00 5,557.82 110.00 5,551.28 $1,498,000 $1,498,500 110.00 5,592.36 110.00 5,585.83 110.00 5,579.29 110.00 5,572.76 110.00 5,566.23 110.00 5,559.69 110.00 5,553.16 $1,498,500 $1,499,000 110.00 5,594.23 110.00 5,587.70 110.00 5,581.17 110.00 5,574.63 110.00 5,568.10 110.00 5,561.57 110.00 5,555.03 $1,499,000 $1,499,500 110.00 5,596.11 110.00 5,589.58 110.00 5,583.04 110.00 5,576.51 110.00 5,569.98 110.00 5,563.44 110.00 5,556.91 $1,499,500 $1,500,000 110.00 5,597.98 110.00 5,591.45 110.00 5,584.92 110.00 5,578.38 110.00 5,571.85 110.00 5,565.32 110.00 5,558.78 $1,500,000 $1,500,500 110.00 5,599.86 110.00 5,593.33 110.00 5,586.79 110.00 5,580.26 110.00 5,573.73 110.00 5,567.19 110.00 5,560.66 $1,500,500 $1,501,000 110.00 5,601.73 110.00 5,595.20 110.00 5,588.67 110.00 5,582.13 110.00 5,575.60 110.00 5,569.07 110.00 5,562.53 $1,501,000 $1,501,500 110.00 5,603.61 110.00 5,597.08 110.00 5,590.54 110.00 5,584.01 110.00 5,577.48 110.00 5,570.94 110.00 5,564.41 $1,501,500 $1,502,000 110.00 5,605.48 110.00 5,598.95 110.00 5,592.42 110.00 5,585.88 110.00 5,579.35 110.00 5,572.82 110.00 5,566.28 $1,502,000 $1,502,500 110.00 5,607.36 110.00 5,600.83 110.00 5,594.29 110.00 5,587.76 110.00 5,581.23 110.00 5,574.69 110.00 5,568.16 $1,502,500 $1,503,000 110.00 5,609.23 110.00 5,602.70 110.00 5,596.17 110.00 5,589.63 110.00 5,583.10 110.00 5,576.57 110.00 5,570.03 $1,503,000 $1,503,500 110.00 5,611.11 110.00 5,604.58 110.00 5,598.04 110.00 5,591.51 110.00 5,584.98 110.00 5,578.44 110.00 5,571.91 $1,503,500 $1,504,000 110.00 5,612.98 110.00 5,606.45 110.00 5,599.92 110.00 5,593.38 110.00 5,586.85 110.00 5,580.32 110.00 5,573.78 $1,504,000 $1,504,500 110.00 5,614.86 110.00 5,608.33 110.00 5,601.79 110.00 5,595.26 110.00 5,588.73 110.00 5,582.19 110.00 5,575.66 $1,504,500 $1,505,000 110.00 5,616.73 110.00 5,610.20 110.00 5,603.67 110.00 5,597.13 110.00 5,590.60 110.00 5,584.07 110.00 5,577.53 $1,505,000 $1,505,500 110.00 5,618.61 110.00 5,612.08 110.00 5,605.54 110.00 5,599.01 110.00 5,592.48 110.00 5,585.94 110.00 5,579.41 $1,505,500 $1,506,000 110.00 5,620.48 110.00 5,613.95 110.00 5,607.42 110.00 5,600.88 110.00 5,594.35 110.00 5,587.82 110.00 5,581.28 $1,506,000 $1,506,500 110.00 5,622.36 110.00 5,615.83 110.00 5,609.29 110.00 5,602.76 110.00 5,596.23 110.00 5,589.69 110.00 5,583.16 $1,506,500 $1,507,000 110.00 5,624.23 110.00 5,617.70 110.00 5,611.17 110.00 5,604.63 110.00 5,598.10 110.00 5,591.57 110.00 5,585.03 $1,507,000 $1,507,500 110.00 5,626.11 110.00 5,619.58 110.00 5,613.04 110.00 5,606.51 110.00 5,599.98 110.00 5,593.44 110.00 5,586.91 $1,507,500 $1,508,000 110.00 5,627.98 110.00 5,621.45 110.00 5,614.92 110.00 5,608.38 110.00 5,601.85 110.00 5,595.32 110.00 5,588.78 $1,508,000 $1,508,500 110.00 5,629.86 110.00 5,623.33 110.00 5,616.79 110.00 5,610.26 110.00 5,603.73 110.00 5,597.19 110.00 5,590.66 $1,508,500 $1,509,000 110.00 5,631.73 110.00 5,625.20 110.00 5,618.67 110.00 5,612.13 110.00 5,605.60 110.00 5,599.07 110.00 5,592.53 $1,509,000 $1,509,500 110.00 5,633.61 110.00 5,627.08 110.00 5,620.54 110.00 5,614.01 110.00 5,607.48 110.00 5,600.94 110.00 5,594.41 $1,509,500 $1,510,000 110.00 5,635.48 110.00 5,628.95 110.00 5,622.42 110.00 5,615.88 110.00 5,609.35 110.00 5,602.82 110.00 5,596.28 $1,510,000 $1,510,500 110.00 5,637.36 110.00 5,630.83 110.00 5,624.29 110.00 5,617.76 110.00 5,611.23 110.00 5,604.69 110.00 5,598.16 $1,510,500 $1,511,000 110.00 5,639.23 110.00 5,632.70 110.00 5,626.17 110.00 5,619.63 110.00 5,613.10 110.00 5,606.57 110.00 5,600.03 $1,511,000 $1,511,500 110.00 5,641.11 110.00 5,634.58 110.00 5,628.04 110.00 5,621.51 110.00 5,614.98 110.00 5,608.44 110.00 5,601.91 $1,511,500 $1,512,000 110.00 5,642.98 110.00 5,636.45 110.00 5,629.92 110.00 5,623.38 110.00 5,616.85 110.00 5,610.32 110.00 5,603.78 $1,512,000 $1,512,500 110.00 5,644.86 110.00 5,638.33 110.00 5,631.79 110.00 5,625.26 110.00 5,618.73 110.00 5,612.19 110.00 5,605.66 $1,512,500 $1,513,000 110.00 5,646.73 110.00 5,640.20 110.00 5,633.67 110.00 5,627.13 110.00 5,620.60 110.00 5,614.07 110.00 5,607.53 $1,513,000 $1,513,500 110.00 5,648.61 110.00 5,642.08 110.00 5,635.54 110.00 5,629.01 110.00 5,622.48 110.00 5,615.94 110.00 5,609.41 $1,513,500 $1,514,000 110.00 5,650.48 110.00 5,643.95 110.00 5,637.42 110.00 5,630.88 110.00 5,624.35 110.00 5,617.82 110.00 5,611.28 $1,514,000 $1,514,500 110.00 5,652.36 110.00 5,645.83 110.00 5,639.29 110.00 5,632.76 110.00 5,626.23 110.00 5,619.69 110.00 5,613.16 $1,514,500 $1,515,000 110.00 5,654.23 110.00 5,647.70 110.00 5,641.17 110.00 5,634.63 110.00 5,628.10 110.00 5,621.57 110.00 5,615.03 $1,515,000 $1,515,500 110.00 5,656.11 110.00 5,649.58 110.00 5,643.04 110.00 5,636.51 110.00 5,629.98 110.00 5,623.44 110.00 5,616.91 $1,515,500 $1,516,000 110.00 5,657.98 110.00 5,651.45 110.00 5,644.92 110.00 5,638.38 110.00 5,631.85 110.00 5,625.32 110.00 5,618.78 $1,516,000 $1,516,500 110.00 5,659.86 110.00 5,653.33 110.00 5,646.79 110.00 5,640.26 110.00 5,633.73 110.00 5,627.19 110.00 5,620.66 $1,516,500 $1,517,000 110.00 5,661.73 110.00 5,655.20 110.00 5,648.67 110.00 5,642.13 110.00 5,635.60 110.00 5,629.07 110.00 5,622.53 $1,517,000 $1,517,500 110.00 5,663.61 110.00 5,657.08 110.00 5,650.54 110.00 5,644.01 110.00 5,637.48 110.00 5,630.94 110.00 5,624.41 $1,517,500 $1,518,000 110.00 5,665.48 110.00 5,658.95 110.00 5,652.42 110.00 5,645.88 110.00 5,639.35 110.00 5,632.82 110.00 5,626.28 $1,518,000 $1,518,500 110.00 5,667.36 110.00 5,660.83 110.00 5,654.29 110.00 5,647.76 110.00 5,641.23 110.00 5,634.69 110.00 5,628.16 $1,518,500 $1,519,000 110.00 5,669.23 110.00 5,662.70 110.00 5,656.17 110.00 5,649.63 110.00 5,643.10 110.00 5,636.57 110.00 5,630.03 $1,519,000 $1,519,500 110.00 5,671.11 110.00 5,664.58 110.00 5,658.04 110.00 5,651.51 110.00 5,644.98 110.00 5,638.44 110.00 5,631.91 $1,519,500 $1,520,000 110.00 5,672.98 110.00 5,666.45 110.00 5,659.92 110.00 5,653.38 110.00 5,646.85 110.00 5,640.32 110.00 5,633.78 $1,520,000 $1,520,500 110.00 5,674.86 110.00 5,668.33 110.00 5,661.79 110.00 5,655.26 110.00 5,648.73 110.00 5,642.19 110.00 5,635.66 $1,520,500 $1,521,000 110.00 5,676.73 110.00 5,670.20 110.00 5,663.67 110.00 5,657.13 110.00 5,650.60 110.00 5,644.07 110.00 5,637.53 $1,521,000 $1,521,500 110.00 5,678.61 110.00 5,672.08 110.00 5,665.54 110.00 5,659.01 110.00 5,652.48 110.00 5,645.94 110.00 5,639.41 $1,521,500 $1,522,000 110.00 5,680.48 110.00 5,673.95 110.00 5,667.42 110.00 5,660.88 110.00 5,654.35 110.00 5,647.82 110.00 5,641.28 $1,522,000 $1,522,500 110.00 5,682.36 110.00 5,675.83 110.00 5,669.29 110.00 5,662.76 110.00 5,656.23 110.00 5,649.69 110.00 5,643.16 $1,522,500 $1,523,000 110.00 5,684.23 110.00 5,677.70 110.00 5,671.17 110.00 5,664.63 110.00 5,658.10 110.00 5,651.57 110.00 5,645.03 $1,523,000 $1,523,500 110.00 5,686.11 110.00 5,679.58 110.00 5,673.04 110.00 5,666.51 110.00 5,659.98 110.00 5,653.44 110.00 5,646.91 $1,523,500 $1,524,000 110.00 5,687.98 110.00 5,681.45 110.00 5,674.92 110.00 5,668.38 110.00 5,661.85 110.00 5,655.32 110.00 5,648.78 $1,524,000 $1,524,500 110.00 5,689.86 110.00 5,683.33 110.00 5,676.79 110.00 5,670.26 110.00 5,663.73 110.00 5,657.19 110.00 5,650.66 $1,524,500 $1,525,000 110.00 5,691.73 110.00 5,685.20 110.00 5,678.67 110.00 5,672.13 110.00 5,665.60 110.00 5,659.07 110.00 5,652.53 $1,525,000 $1,525,500 110.00 5,693.61 110.00 5,687.08 110.00 5,680.54 110.00 5,674.01 110.00 5,667.48 110.00 5,660.94 110.00 5,654.41 $1,525,500 $1,526,000 110.00 5,695.48 110.00 5,688.95 110.00 5,682.42 110.00 5,675.88 110.00 5,669.35 110.00 5,662.82 110.00 5,656.28 $1,526,000 $1,526,500 110.00 5,697.36 110.00 5,690.83 110.00 5,684.29 110.00 5,677.76 110.00 5,671.23 110.00 5,664.69 110.00 5,658.16 $1,526,500 $1,527,000 110.00 5,699.23 110.00 5,692.70 110.00 5,686.17 110.00 5,679.63 110.00 5,673.10 110.00 5,666.57 110.00 5,660.03 $1,527,000 $1,527,500 110.00 5,701.11 110.00 5,694.58 110.00 5,688.04 110.00 5,681.51 110.00 5,674.98 110.00 5,668.44 110.00 5,661.91 $1,527,500 $1,528,000 110.00 5,702.98 110.00 5,696.45 110.00 5,689.92 110.00 5,683.38 110.00 5,676.85 110.00 5,670.32 110.00 5,663.78 $1,528,000 $1,528,500 110.00 5,704.86 110.00 5,698.33 110.00 5,691.79 110.00 5,685.26 110.00 5,678.73 110.00 5,672.19 110.00 5,665.66 $1,528,500 $1,529,000 110.00 5,706.73 110.00 5,700.20 110.00 5,693.67 110.00 5,687.13 110.00 5,680.60 110.00 5,674.07 110.00 5,667.53 $1,529,000 $1,529,500 110.00 5,708.61 110.00 5,702.08 110.00 5,695.54 110.00 5,689.01 110.00 5,682.48 110.00 5,675.94 110.00 5,669.41 $1,529,500 $1,530,000 110.00 5,710.48 110.00 5,703.95 110.00 5,697.42 110.00 5,690.88 110.00 5,684.35 110.00 5,677.82 110.00 5,671.28

NJEIS Family Cost Participation Table Page 33 of 12 Effective July 1, 2015

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

$1,530,000 $1,530,500 110.00 5,712.36 110.00 5,705.83 110.00 5,699.29 110.00 5,692.76 110.00 5,686.23 110.00 5,679.69 110.00 5,673.16 $1,530,500 $1,531,000 110.00 5,714.23 110.00 5,707.70 110.00 5,701.17 110.00 5,694.63 110.00 5,688.10 110.00 5,681.57 110.00 5,675.03 $1,531,000 $1,531,500 110.00 5,716.11 110.00 5,709.58 110.00 5,703.04 110.00 5,696.51 110.00 5,689.98 110.00 5,683.44 110.00 5,676.91 $1,531,500 $1,532,000 110.00 5,717.98 110.00 5,711.45 110.00 5,704.92 110.00 5,698.38 110.00 5,691.85 110.00 5,685.32 110.00 5,678.78 $1,532,000 $1,532,500 110.00 5,719.86 110.00 5,713.33 110.00 5,706.79 110.00 5,700.26 110.00 5,693.73 110.00 5,687.19 110.00 5,680.66 $1,532,500 $1,533,000 110.00 5,721.73 110.00 5,715.20 110.00 5,708.67 110.00 5,702.13 110.00 5,695.60 110.00 5,689.07 110.00 5,682.53 $1,533,000 $1,533,500 110.00 5,723.61 110.00 5,717.08 110.00 5,710.54 110.00 5,704.01 110.00 5,697.48 110.00 5,690.94 110.00 5,684.41 $1,533,500 $1,534,000 110.00 5,725.48 110.00 5,718.95 110.00 5,712.42 110.00 5,705.88 110.00 5,699.35 110.00 5,692.82 110.00 5,686.28 $1,534,000 $1,534,500 110.00 5,727.36 110.00 5,720.83 110.00 5,714.29 110.00 5,707.76 110.00 5,701.23 110.00 5,694.69 110.00 5,688.16 $1,534,500 $1,535,000 110.00 5,729.23 110.00 5,722.70 110.00 5,716.17 110.00 5,709.63 110.00 5,703.10 110.00 5,696.57 110.00 5,690.03 $1,535,000 $1,535,500 110.00 5,731.11 110.00 5,724.58 110.00 5,718.04 110.00 5,711.51 110.00 5,704.98 110.00 5,698.44 110.00 5,691.91 $1,535,500 $1,536,000 110.00 5,732.98 110.00 5,726.45 110.00 5,719.92 110.00 5,713.38 110.00 5,706.85 110.00 5,700.32 110.00 5,693.78 $1,536,000 $1,536,500 110.00 5,734.86 110.00 5,728.33 110.00 5,721.79 110.00 5,715.26 110.00 5,708.73 110.00 5,702.19 110.00 5,695.66 $1,536,500 $1,537,000 110.00 5,736.73 110.00 5,730.20 110.00 5,723.67 110.00 5,717.13 110.00 5,710.60 110.00 5,704.07 110.00 5,697.53 $1,537,000 $1,537,500 110.00 5,738.61 110.00 5,732.08 110.00 5,725.54 110.00 5,719.01 110.00 5,712.48 110.00 5,705.94 110.00 5,699.41 $1,537,500 $1,538,000 110.00 5,740.48 110.00 5,733.95 110.00 5,727.42 110.00 5,720.88 110.00 5,714.35 110.00 5,707.82 110.00 5,701.28 $1,538,000 $1,538,500 110.00 5,742.36 110.00 5,735.83 110.00 5,729.29 110.00 5,722.76 110.00 5,716.23 110.00 5,709.69 110.00 5,703.16 $1,538,500 $1,539,000 110.00 5,744.23 110.00 5,737.70 110.00 5,731.17 110.00 5,724.63 110.00 5,718.10 110.00 5,711.57 110.00 5,705.03 $1,539,000 $1,539,500 110.00 5,746.11 110.00 5,739.58 110.00 5,733.04 110.00 5,726.51 110.00 5,719.98 110.00 5,713.44 110.00 5,706.91 $1,539,500 $1,540,000 110.00 5,747.98 110.00 5,741.45 110.00 5,734.92 110.00 5,728.38 110.00 5,721.85 110.00 5,715.32 110.00 5,708.78 $1,540,000 $1,540,500 110.00 5,749.86 110.00 5,743.33 110.00 5,736.79 110.00 5,730.26 110.00 5,723.73 110.00 5,717.19 110.00 5,710.66 $1,540,500 $1,541,000 110.00 5,751.73 110.00 5,745.20 110.00 5,738.67 110.00 5,732.13 110.00 5,725.60 110.00 5,719.07 110.00 5,712.53 $1,541,000 $1,541,500 110.00 5,753.61 110.00 5,747.08 110.00 5,740.54 110.00 5,734.01 110.00 5,727.48 110.00 5,720.94 110.00 5,714.41 $1,541,500 $1,542,000 110.00 5,755.48 110.00 5,748.95 110.00 5,742.42 110.00 5,735.88 110.00 5,729.35 110.00 5,722.82 110.00 5,716.28 $1,542,000 $1,542,500 110.00 5,757.36 110.00 5,750.83 110.00 5,744.29 110.00 5,737.76 110.00 5,731.23 110.00 5,724.69 110.00 5,718.16 $1,542,500 $1,543,000 110.00 5,759.23 110.00 5,752.70 110.00 5,746.17 110.00 5,739.63 110.00 5,733.10 110.00 5,726.57 110.00 5,720.03 $1,543,000 $1,543,500 110.00 5,761.11 110.00 5,754.58 110.00 5,748.04 110.00 5,741.51 110.00 5,734.98 110.00 5,728.44 110.00 5,721.91 $1,543,500 $1,544,000 110.00 5,762.98 110.00 5,756.45 110.00 5,749.92 110.00 5,743.38 110.00 5,736.85 110.00 5,730.32 110.00 5,723.78 $1,544,000 $1,544,500 110.00 5,764.86 110.00 5,758.33 110.00 5,751.79 110.00 5,745.26 110.00 5,738.73 110.00 5,732.19 110.00 5,725.66 $1,544,500 $1,545,000 110.00 5,766.73 110.00 5,760.20 110.00 5,753.67 110.00 5,747.13 110.00 5,740.60 110.00 5,734.07 110.00 5,727.53 $1,545,000 $1,545,500 110.00 5,768.61 110.00 5,762.08 110.00 5,755.54 110.00 5,749.01 110.00 5,742.48 110.00 5,735.94 110.00 5,729.41 $1,545,500 $1,546,000 110.00 5,770.48 110.00 5,763.95 110.00 5,757.42 110.00 5,750.88 110.00 5,744.35 110.00 5,737.82 110.00 5,731.28 $1,546,000 $1,546,500 110.00 5,772.36 110.00 5,765.83 110.00 5,759.29 110.00 5,752.76 110.00 5,746.23 110.00 5,739.69 110.00 5,733.16 $1,546,500 $1,547,000 110.00 5,774.23 110.00 5,767.70 110.00 5,761.17 110.00 5,754.63 110.00 5,748.10 110.00 5,741.57 110.00 5,735.03 $1,547,000 $1,547,500 110.00 5,776.11 110.00 5,769.58 110.00 5,763.04 110.00 5,756.51 110.00 5,749.98 110.00 5,743.44 110.00 5,736.91 $1,547,500 $1,548,000 110.00 5,777.98 110.00 5,771.45 110.00 5,764.92 110.00 5,758.38 110.00 5,751.85 110.00 5,745.32 110.00 5,738.78 $1,548,000 $1,548,500 110.00 5,779.86 110.00 5,773.33 110.00 5,766.79 110.00 5,760.26 110.00 5,753.73 110.00 5,747.19 110.00 5,740.66 $1,548,500 $1,549,000 110.00 5,781.73 110.00 5,775.20 110.00 5,768.67 110.00 5,762.13 110.00 5,755.60 110.00 5,749.07 110.00 5,742.53 $1,549,000 $1,549,500 110.00 5,783.61 110.00 5,777.08 110.00 5,770.54 110.00 5,764.01 110.00 5,757.48 110.00 5,750.94 110.00 5,744.41 $1,549,500 $1,550,000 110.00 5,785.48 110.00 5,778.95 110.00 5,772.42 110.00 5,765.88 110.00 5,759.35 110.00 5,752.82 110.00 5,746.28 $1,550,000 $1,550,500 110.00 5,787.36 110.00 5,780.83 110.00 5,774.29 110.00 5,767.76 110.00 5,761.23 110.00 5,754.69 110.00 5,748.16 $1,550,500 $1,551,000 110.00 5,789.23 110.00 5,782.70 110.00 5,776.17 110.00 5,769.63 110.00 5,763.10 110.00 5,756.57 110.00 5,750.03 $1,551,000 $1,551,500 110.00 5,791.11 110.00 5,784.58 110.00 5,778.04 110.00 5,771.51 110.00 5,764.98 110.00 5,758.44 110.00 5,751.91 $1,551,500 $1,552,000 110.00 5,792.98 110.00 5,786.45 110.00 5,779.92 110.00 5,773.38 110.00 5,766.85 110.00 5,760.32 110.00 5,753.78 $1,552,000 $1,552,500 110.00 5,794.86 110.00 5,788.33 110.00 5,781.79 110.00 5,775.26 110.00 5,768.73 110.00 5,762.19 110.00 5,755.66 $1,552,500 $1,553,000 110.00 5,796.73 110.00 5,790.20 110.00 5,783.67 110.00 5,777.13 110.00 5,770.60 110.00 5,764.07 110.00 5,757.53 $1,553,000 $1,553,500 110.00 5,798.61 110.00 5,792.08 110.00 5,785.54 110.00 5,779.01 110.00 5,772.48 110.00 5,765.94 110.00 5,759.41 $1,553,500 $1,554,000 110.00 5,800.48 110.00 5,793.95 110.00 5,787.42 110.00 5,780.88 110.00 5,774.35 110.00 5,767.82 110.00 5,761.28 $1,554,000 $1,554,500 110.00 5,802.36 110.00 5,795.83 110.00 5,789.29 110.00 5,782.76 110.00 5,776.23 110.00 5,769.69 110.00 5,763.16 $1,554,500 $1,555,000 110.00 5,804.23 110.00 5,797.70 110.00 5,791.17 110.00 5,784.63 110.00 5,778.10 110.00 5,771.57 110.00 5,765.03 $1,555,000 $1,555,500 110.00 5,806.11 110.00 5,799.58 110.00 5,793.04 110.00 5,786.51 110.00 5,779.98 110.00 5,773.44 110.00 5,766.91 $1,555,500 $1,556,000 110.00 5,807.98 110.00 5,801.45 110.00 5,794.92 110.00 5,788.38 110.00 5,781.85 110.00 5,775.32 110.00 5,768.78 $1,556,000 $1,556,500 110.00 5,809.86 110.00 5,803.33 110.00 5,796.79 110.00 5,790.26 110.00 5,783.73 110.00 5,777.19 110.00 5,770.66 $1,556,500 $1,557,000 110.00 5,811.73 110.00 5,805.20 110.00 5,798.67 110.00 5,792.13 110.00 5,785.60 110.00 5,779.07 110.00 5,772.53 $1,557,000 $1,557,500 110.00 5,813.61 110.00 5,807.08 110.00 5,800.54 110.00 5,794.01 110.00 5,787.48 110.00 5,780.94 110.00 5,774.41 $1,557,500 $1,558,000 110.00 5,815.48 110.00 5,808.95 110.00 5,802.42 110.00 5,795.88 110.00 5,789.35 110.00 5,782.82 110.00 5,776.28 $1,558,000 $1,558,500 110.00 5,817.36 110.00 5,810.83 110.00 5,804.29 110.00 5,797.76 110.00 5,791.23 110.00 5,784.69 110.00 5,778.16 $1,558,500 $1,559,000 110.00 5,819.23 110.00 5,812.70 110.00 5,806.17 110.00 5,799.63 110.00 5,793.10 110.00 5,786.57 110.00 5,780.03 $1,559,000 $1,559,500 110.00 5,821.11 110.00 5,814.58 110.00 5,808.04 110.00 5,801.51 110.00 5,794.98 110.00 5,788.44 110.00 5,781.91 $1,559,500 $1,560,000 110.00 5,822.98 110.00 5,816.45 110.00 5,809.92 110.00 5,803.38 110.00 5,796.85 110.00 5,790.32 110.00 5,783.78 $1,560,000 $1,560,500 110.00 5,824.86 110.00 5,818.33 110.00 5,811.79 110.00 5,805.26 110.00 5,798.73 110.00 5,792.19 110.00 5,785.66 $1,560,500 $1,561,000 110.00 5,826.73 110.00 5,820.20 110.00 5,813.67 110.00 5,807.13 110.00 5,800.60 110.00 5,794.07 110.00 5,787.53 $1,561,000 $1,561,500 110.00 5,828.61 110.00 5,822.08 110.00 5,815.54 110.00 5,809.01 110.00 5,802.48 110.00 5,795.94 110.00 5,789.41 $1,561,500 $1,562,000 110.00 5,830.48 110.00 5,823.95 110.00 5,817.42 110.00 5,810.88 110.00 5,804.35 110.00 5,797.82 110.00 5,791.28 $1,562,000 $1,562,500 110.00 5,832.36 110.00 5,825.83 110.00 5,819.29 110.00 5,812.76 110.00 5,806.23 110.00 5,799.69 110.00 5,793.16 $1,562,500 $1,563,000 110.00 5,834.23 110.00 5,827.70 110.00 5,821.17 110.00 5,814.63 110.00 5,808.10 110.00 5,801.57 110.00 5,795.03 $1,563,000 $1,563,500 110.00 5,836.11 110.00 5,829.58 110.00 5,823.04 110.00 5,816.51 110.00 5,809.98 110.00 5,803.44 110.00 5,796.91 $1,563,500 $1,564,000 110.00 5,837.98 110.00 5,831.45 110.00 5,824.92 110.00 5,818.38 110.00 5,811.85 110.00 5,805.32 110.00 5,798.78 $1,564,000 $1,564,500 110.00 5,839.86 110.00 5,833.33 110.00 5,826.79 110.00 5,820.26 110.00 5,813.73 110.00 5,807.19 110.00 5,800.66 $1,564,500 $1,565,000 110.00 5,841.73 110.00 5,835.20 110.00 5,828.67 110.00 5,822.13 110.00 5,815.60 110.00 5,809.07 110.00 5,802.53 $1,565,000 $1,565,500 110.00 5,843.61 110.00 5,837.08 110.00 5,830.54 110.00 5,824.01 110.00 5,817.48 110.00 5,810.94 110.00 5,804.41 $1,565,500 $1,566,000 110.00 5,845.48 110.00 5,838.95 110.00 5,832.42 110.00 5,825.88 110.00 5,819.35 110.00 5,812.82 110.00 5,806.28 $1,566,000 $1,566,500 110.00 5,847.36 110.00 5,840.83 110.00 5,834.29 110.00 5,827.76 110.00 5,821.23 110.00 5,814.69 110.00 5,808.16 $1,566,500 $1,567,000 110.00 5,849.23 110.00 5,842.70 110.00 5,836.17 110.00 5,829.63 110.00 5,823.10 110.00 5,816.57 110.00 5,810.03 $1,567,000 $1,567,500 110.00 5,851.11 110.00 5,844.58 110.00 5,838.04 110.00 5,831.51 110.00 5,824.98 110.00 5,818.44 110.00 5,811.91 $1,567,500 $1,568,000 110.00 5,852.98 110.00 5,846.45 110.00 5,839.92 110.00 5,833.38 110.00 5,826.85 110.00 5,820.32 110.00 5,813.78 $1,568,000 $1,568,500 110.00 5,854.86 110.00 5,848.33 110.00 5,841.79 110.00 5,835.26 110.00 5,828.73 110.00 5,822.19 110.00 5,815.66 $1,568,500 $1,569,000 110.00 5,856.73 110.00 5,850.20 110.00 5,843.67 110.00 5,837.13 110.00 5,830.60 110.00 5,824.07 110.00 5,817.53 $1,569,000 $1,569,500 110.00 5,858.61 110.00 5,852.08 110.00 5,845.54 110.00 5,839.01 110.00 5,832.48 110.00 5,825.94 110.00 5,819.41 $1,569,500 $1,570,000 110.00 5,860.48 110.00 5,853.95 110.00 5,847.42 110.00 5,840.88 110.00 5,834.35 110.00 5,827.82 110.00 5,821.28 $1,570,000 $1,570,500 110.00 5,862.36 110.00 5,855.83 110.00 5,849.29 110.00 5,842.76 110.00 5,836.23 110.00 5,829.69 110.00 5,823.16 $1,570,500 $1,571,000 110.00 5,864.23 110.00 5,857.70 110.00 5,851.17 110.00 5,844.63 110.00 5,838.10 110.00 5,831.57 110.00 5,825.03 $1,571,000 $1,571,500 110.00 5,866.11 110.00 5,859.58 110.00 5,853.04 110.00 5,846.51 110.00 5,839.98 110.00 5,833.44 110.00 5,826.91 $1,571,500 $1,572,000 110.00 5,867.98 110.00 5,861.45 110.00 5,854.92 110.00 5,848.38 110.00 5,841.85 110.00 5,835.32 110.00 5,828.78 $1,572,000 $1,572,500 110.00 5,869.86 110.00 5,863.33 110.00 5,856.79 110.00 5,850.26 110.00 5,843.73 110.00 5,837.19 110.00 5,830.66 $1,572,500 $1,573,000 110.00 5,871.73 110.00 5,865.20 110.00 5,858.67 110.00 5,852.13 110.00 5,845.60 110.00 5,839.07 110.00 5,832.53 $1,573,000 $1,573,500 110.00 5,873.61 110.00 5,867.08 110.00 5,860.54 110.00 5,854.01 110.00 5,847.48 110.00 5,840.94 110.00 5,834.41 $1,573,500 $1,574,000 110.00 5,875.48 110.00 5,868.95 110.00 5,862.42 110.00 5,855.88 110.00 5,849.35 110.00 5,842.82 110.00 5,836.28 $1,574,000 $1,574,500 110.00 5,877.36 110.00 5,870.83 110.00 5,864.29 110.00 5,857.76 110.00 5,851.23 110.00 5,844.69 110.00 5,838.16 $1,574,500 $1,575,000 110.00 5,879.23 110.00 5,872.70 110.00 5,866.17 110.00 5,859.63 110.00 5,853.10 110.00 5,846.57 110.00 5,840.03 $1,575,000 $1,575,500 110.00 5,881.11 110.00 5,874.58 110.00 5,868.04 110.00 5,861.51 110.00 5,854.98 110.00 5,848.44 110.00 5,841.91 $1,575,500 $1,576,000 110.00 5,882.98 110.00 5,876.45 110.00 5,869.92 110.00 5,863.38 110.00 5,856.85 110.00 5,850.32 110.00 5,843.78 $1,576,000 $1,576,500 110.00 5,884.86 110.00 5,878.33 110.00 5,871.79 110.00 5,865.26 110.00 5,858.73 110.00 5,852.19 110.00 5,845.66 $1,576,500 $1,577,000 110.00 5,886.73 110.00 5,880.20 110.00 5,873.67 110.00 5,867.13 110.00 5,860.60 110.00 5,854.07 110.00 5,847.53 $1,577,000 $1,577,500 110.00 5,888.61 110.00 5,882.08 110.00 5,875.54 110.00 5,869.01 110.00 5,862.48 110.00 5,855.94 110.00 5,849.41 $1,577,500 $1,578,000 110.00 5,890.48 110.00 5,883.95 110.00 5,877.42 110.00 5,870.88 110.00 5,864.35 110.00 5,857.82 110.00 5,851.28 $1,578,000 $1,578,500 110.00 5,892.36 110.00 5,885.83 110.00 5,879.29 110.00 5,872.76 110.00 5,866.23 110.00 5,859.69 110.00 5,853.16 $1,578,500 $1,579,000 110.00 5,894.23 110.00 5,887.70 110.00 5,881.17 110.00 5,874.63 110.00 5,868.10 110.00 5,861.57 110.00 5,855.03 $1,579,000 $1,579,500 110.00 5,896.11 110.00 5,889.58 110.00 5,883.04 110.00 5,876.51 110.00 5,869.98 110.00 5,863.44 110.00 5,856.91 $1,579,500 $1,580,000 110.00 5,897.98 110.00 5,891.45 110.00 5,884.92 110.00 5,878.38 110.00 5,871.85 110.00 5,865.32 110.00 5,858.78 $1,580,000 $1,580,500 110.00 5,899.86 110.00 5,893.33 110.00 5,886.79 110.00 5,880.26 110.00 5,873.73 110.00 5,867.19 110.00 5,860.66 $1,580,500 $1,581,000 110.00 5,901.73 110.00 5,895.20 110.00 5,888.67 110.00 5,882.13 110.00 5,875.60 110.00 5,869.07 110.00 5,862.53

NJEIS Family Cost Participation Table Page 34 of 12 Effective July 1, 2015

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

$1,581,000 $1,581,500 110.00 5,903.61 110.00 5,897.08 110.00 5,890.54 110.00 5,884.01 110.00 5,877.48 110.00 5,870.94 110.00 5,864.41 $1,581,500 $1,582,000 110.00 5,905.48 110.00 5,898.95 110.00 5,892.42 110.00 5,885.88 110.00 5,879.35 110.00 5,872.82 110.00 5,866.28 $1,582,000 $1,582,500 110.00 5,907.36 110.00 5,900.83 110.00 5,894.29 110.00 5,887.76 110.00 5,881.23 110.00 5,874.69 110.00 5,868.16 $1,582,500 $1,583,000 110.00 5,909.23 110.00 5,902.70 110.00 5,896.17 110.00 5,889.63 110.00 5,883.10 110.00 5,876.57 110.00 5,870.03 $1,583,000 $1,583,500 110.00 5,911.11 110.00 5,904.58 110.00 5,898.04 110.00 5,891.51 110.00 5,884.98 110.00 5,878.44 110.00 5,871.91 $1,583,500 $1,584,000 110.00 5,912.98 110.00 5,906.45 110.00 5,899.92 110.00 5,893.38 110.00 5,886.85 110.00 5,880.32 110.00 5,873.78 $1,584,000 $1,584,500 110.00 5,914.86 110.00 5,908.33 110.00 5,901.79 110.00 5,895.26 110.00 5,888.73 110.00 5,882.19 110.00 5,875.66 $1,584,500 $1,585,000 110.00 5,916.73 110.00 5,910.20 110.00 5,903.67 110.00 5,897.13 110.00 5,890.60 110.00 5,884.07 110.00 5,877.53 $1,585,000 $1,585,500 110.00 5,918.61 110.00 5,912.08 110.00 5,905.54 110.00 5,899.01 110.00 5,892.48 110.00 5,885.94 110.00 5,879.41 $1,585,500 $1,586,000 110.00 5,920.48 110.00 5,913.95 110.00 5,907.42 110.00 5,900.88 110.00 5,894.35 110.00 5,887.82 110.00 5,881.28 $1,586,000 $1,586,500 110.00 5,922.36 110.00 5,915.83 110.00 5,909.29 110.00 5,902.76 110.00 5,896.23 110.00 5,889.69 110.00 5,883.16 $1,586,500 $1,587,000 110.00 5,924.23 110.00 5,917.70 110.00 5,911.17 110.00 5,904.63 110.00 5,898.10 110.00 5,891.57 110.00 5,885.03 $1,587,000 $1,587,500 110.00 5,926.11 110.00 5,919.58 110.00 5,913.04 110.00 5,906.51 110.00 5,899.98 110.00 5,893.44 110.00 5,886.91 $1,587,500 $1,588,000 110.00 5,927.98 110.00 5,921.45 110.00 5,914.92 110.00 5,908.38 110.00 5,901.85 110.00 5,895.32 110.00 5,888.78 $1,588,000 $1,588,500 110.00 5,929.86 110.00 5,923.33 110.00 5,916.79 110.00 5,910.26 110.00 5,903.73 110.00 5,897.19 110.00 5,890.66 $1,588,500 $1,589,000 110.00 5,931.73 110.00 5,925.20 110.00 5,918.67 110.00 5,912.13 110.00 5,905.60 110.00 5,899.07 110.00 5,892.53 $1,589,000 $1,589,500 110.00 5,933.61 110.00 5,927.08 110.00 5,920.54 110.00 5,914.01 110.00 5,907.48 110.00 5,900.94 110.00 5,894.41 $1,589,500 $1,590,000 110.00 5,935.48 110.00 5,928.95 110.00 5,922.42 110.00 5,915.88 110.00 5,909.35 110.00 5,902.82 110.00 5,896.28 $1,590,000 $1,590,500 110.00 5,937.36 110.00 5,930.83 110.00 5,924.29 110.00 5,917.76 110.00 5,911.23 110.00 5,904.69 110.00 5,898.16 $1,590,500 $1,591,000 110.00 5,939.23 110.00 5,932.70 110.00 5,926.17 110.00 5,919.63 110.00 5,913.10 110.00 5,906.57 110.00 5,900.03 $1,591,000 $1,591,500 110.00 5,941.11 110.00 5,934.58 110.00 5,928.04 110.00 5,921.51 110.00 5,914.98 110.00 5,908.44 110.00 5,901.91 $1,591,500 $1,592,000 110.00 5,942.98 110.00 5,936.45 110.00 5,929.92 110.00 5,923.38 110.00 5,916.85 110.00 5,910.32 110.00 5,903.78 $1,592,000 $1,592,500 110.00 5,944.86 110.00 5,938.33 110.00 5,931.79 110.00 5,925.26 110.00 5,918.73 110.00 5,912.19 110.00 5,905.66 $1,592,500 $1,593,000 110.00 5,946.73 110.00 5,940.20 110.00 5,933.67 110.00 5,927.13 110.00 5,920.60 110.00 5,914.07 110.00 5,907.53 $1,593,000 $1,593,500 110.00 5,948.61 110.00 5,942.08 110.00 5,935.54 110.00 5,929.01 110.00 5,922.48 110.00 5,915.94 110.00 5,909.41 $1,593,500 $1,594,000 110.00 5,950.48 110.00 5,943.95 110.00 5,937.42 110.00 5,930.88 110.00 5,924.35 110.00 5,917.82 110.00 5,911.28 $1,594,000 $1,594,500 110.00 5,952.36 110.00 5,945.83 110.00 5,939.29 110.00 5,932.76 110.00 5,926.23 110.00 5,919.69 110.00 5,913.16 $1,594,500 $1,595,000 110.00 5,954.23 110.00 5,947.70 110.00 5,941.17 110.00 5,934.63 110.00 5,928.10 110.00 5,921.57 110.00 5,915.03 $1,595,000 $1,595,500 110.00 5,956.11 110.00 5,949.58 110.00 5,943.04 110.00 5,936.51 110.00 5,929.98 110.00 5,923.44 110.00 5,916.91 $1,595,500 $1,596,000 110.00 5,957.98 110.00 5,951.45 110.00 5,944.92 110.00 5,938.38 110.00 5,931.85 110.00 5,925.32 110.00 5,918.78 $1,596,000 $1,596,500 110.00 5,959.86 110.00 5,953.33 110.00 5,946.79 110.00 5,940.26 110.00 5,933.73 110.00 5,927.19 110.00 5,920.66 $1,596,500 $1,597,000 110.00 5,961.73 110.00 5,955.20 110.00 5,948.67 110.00 5,942.13 110.00 5,935.60 110.00 5,929.07 110.00 5,922.53 $1,597,000 $1,597,500 110.00 5,963.61 110.00 5,957.08 110.00 5,950.54 110.00 5,944.01 110.00 5,937.48 110.00 5,930.94 110.00 5,924.41 $1,597,500 $1,598,000 110.00 5,965.48 110.00 5,958.95 110.00 5,952.42 110.00 5,945.88 110.00 5,939.35 110.00 5,932.82 110.00 5,926.28 $1,598,000 $1,598,500 110.00 5,967.36 110.00 5,960.83 110.00 5,954.29 110.00 5,947.76 110.00 5,941.23 110.00 5,934.69 110.00 5,928.16 $1,598,500 $1,599,000 110.00 5,969.23 110.00 5,962.70 110.00 5,956.17 110.00 5,949.63 110.00 5,943.10 110.00 5,936.57 110.00 5,930.03 $1,599,000 $1,599,500 110.00 5,971.11 110.00 5,964.58 110.00 5,958.04 110.00 5,951.51 110.00 5,944.98 110.00 5,938.44 110.00 5,931.91 $1,599,500 $1,600,000 110.00 5,972.98 110.00 5,966.45 110.00 5,959.92 110.00 5,953.38 110.00 5,946.85 110.00 5,940.32 110.00 5,933.78 $1,600,000 $1,600,500 110.00 5,974.86 110.00 5,968.33 110.00 5,961.79 110.00 5,955.26 110.00 5,948.73 110.00 5,942.19 110.00 5,935.66 $1,600,500 $1,601,000 110.00 5,976.73 110.00 5,970.20 110.00 5,963.67 110.00 5,957.13 110.00 5,950.60 110.00 5,944.07 110.00 5,937.53 $1,601,000 $1,601,500 110.00 5,978.61 110.00 5,972.08 110.00 5,965.54 110.00 5,959.01 110.00 5,952.48 110.00 5,945.94 110.00 5,939.41 $1,601,500 $1,602,000 110.00 5,980.48 110.00 5,973.95 110.00 5,967.42 110.00 5,960.88 110.00 5,954.35 110.00 5,947.82 110.00 5,941.28 $1,602,000 $1,602,500 110.00 5,982.36 110.00 5,975.83 110.00 5,969.29 110.00 5,962.76 110.00 5,956.23 110.00 5,949.69 110.00 5,943.16 $1,602,500 $1,603,000 110.00 5,984.23 110.00 5,977.70 110.00 5,971.17 110.00 5,964.63 110.00 5,958.10 110.00 5,951.57 110.00 5,945.03 $1,603,000 $1,603,500 110.00 5,986.11 110.00 5,979.58 110.00 5,973.04 110.00 5,966.51 110.00 5,959.98 110.00 5,953.44 110.00 5,946.91 $1,603,500 $1,604,000 110.00 5,987.98 110.00 5,981.45 110.00 5,974.92 110.00 5,968.38 110.00 5,961.85 110.00 5,955.32 110.00 5,948.78 $1,604,000 $1,604,500 110.00 5,989.86 110.00 5,983.33 110.00 5,976.79 110.00 5,970.26 110.00 5,963.73 110.00 5,957.19 110.00 5,950.66 $1,604,500 $1,605,000 110.00 5,991.73 110.00 5,985.20 110.00 5,978.67 110.00 5,972.13 110.00 5,965.60 110.00 5,959.07 110.00 5,952.53 $1,605,000 $1,605,500 110.00 5,993.61 110.00 5,987.08 110.00 5,980.54 110.00 5,974.01 110.00 5,967.48 110.00 5,960.94 110.00 5,954.41 $1,605,500 $1,606,000 110.00 5,995.48 110.00 5,988.95 110.00 5,982.42 110.00 5,975.88 110.00 5,969.35 110.00 5,962.82 110.00 5,956.28 $1,606,000 $1,606,500 110.00 5,997.36 110.00 5,990.83 110.00 5,984.29 110.00 5,977.76 110.00 5,971.23 110.00 5,964.69 110.00 5,958.16 $1,606,500 $1,607,000 110.00 5,999.23 110.00 5,992.70 110.00 5,986.17 110.00 5,979.63 110.00 5,973.10 110.00 5,966.57 110.00 5,960.03 $1,607,000 $1,607,500 110.00 6,001.11 110.00 5,994.58 110.00 5,988.04 110.00 5,981.51 110.00 5,974.98 110.00 5,968.44 110.00 5,961.91 $1,607,500 $1,608,000 110.00 6,002.98 110.00 5,996.45 110.00 5,989.92 110.00 5,983.38 110.00 5,976.85 110.00 5,970.32 110.00 5,963.78 $1,608,000 $1,608,500 110.00 6,004.86 110.00 5,998.33 110.00 5,991.79 110.00 5,985.26 110.00 5,978.73 110.00 5,972.19 110.00 5,965.66 $1,608,500 $1,609,000 110.00 6,006.73 110.00 6,000.20 110.00 5,993.67 110.00 5,987.13 110.00 5,980.60 110.00 5,974.07 110.00 5,967.53 $1,609,000 $1,609,500 110.00 6,008.61 110.00 6,002.08 110.00 5,995.54 110.00 5,989.01 110.00 5,982.48 110.00 5,975.94 110.00 5,969.41 $1,609,500 $1,610,000 110.00 6,010.48 110.00 6,003.95 110.00 5,997.42 110.00 5,990.88 110.00 5,984.35 110.00 5,977.82 110.00 5,971.28 $1,610,000 $1,610,500 110.00 6,012.36 110.00 6,005.83 110.00 5,999.29 110.00 5,992.76 110.00 5,986.23 110.00 5,979.69 110.00 5,973.16 $1,610,500 $1,611,000 110.00 6,014.23 110.00 6,007.70 110.00 6,001.17 110.00 5,994.63 110.00 5,988.10 110.00 5,981.57 110.00 5,975.03 $1,611,000 $1,611,500 110.00 6,016.11 110.00 6,009.58 110.00 6,003.04 110.00 5,996.51 110.00 5,989.98 110.00 5,983.44 110.00 5,976.91 $1,611,500 $1,612,000 110.00 6,017.98 110.00 6,011.45 110.00 6,004.92 110.00 5,998.38 110.00 5,991.85 110.00 5,985.32 110.00 5,978.78 $1,612,000 $1,612,500 110.00 6,019.86 110.00 6,013.33 110.00 6,006.79 110.00 6,000.26 110.00 5,993.73 110.00 5,987.19 110.00 5,980.66 $1,612,500 $1,613,000 110.00 6,021.73 110.00 6,015.20 110.00 6,008.67 110.00 6,002.13 110.00 5,995.60 110.00 5,989.07 110.00 5,982.53 $1,613,000 $1,613,500 110.00 6,023.61 110.00 6,017.08 110.00 6,010.54 110.00 6,004.01 110.00 5,997.48 110.00 5,990.94 110.00 5,984.41 $1,613,500 $1,614,000 110.00 6,025.48 110.00 6,018.95 110.00 6,012.42 110.00 6,005.88 110.00 5,999.35 110.00 5,992.82 110.00 5,986.28 $1,614,000 $1,614,500 110.00 6,027.36 110.00 6,020.83 110.00 6,014.29 110.00 6,007.76 110.00 6,001.23 110.00 5,994.69 110.00 5,988.16 $1,614,500 $1,615,000 110.00 6,029.23 110.00 6,022.70 110.00 6,016.17 110.00 6,009.63 110.00 6,003.10 110.00 5,996.57 110.00 5,990.03 $1,615,000 $1,615,500 110.00 6,031.11 110.00 6,024.58 110.00 6,018.04 110.00 6,011.51 110.00 6,004.98 110.00 5,998.44 110.00 5,991.91 $1,615,500 $1,616,000 110.00 6,032.98 110.00 6,026.45 110.00 6,019.92 110.00 6,013.38 110.00 6,006.85 110.00 6,000.32 110.00 5,993.78 $1,616,000 $1,616,500 110.00 6,034.86 110.00 6,028.33 110.00 6,021.79 110.00 6,015.26 110.00 6,008.73 110.00 6,002.19 110.00 5,995.66 $1,616,500 $1,617,000 110.00 6,036.73 110.00 6,030.20 110.00 6,023.67 110.00 6,017.13 110.00 6,010.60 110.00 6,004.07 110.00 5,997.53 $1,617,000 $1,617,500 110.00 6,038.61 110.00 6,032.08 110.00 6,025.54 110.00 6,019.01 110.00 6,012.48 110.00 6,005.94 110.00 5,999.41 $1,617,500 $1,618,000 110.00 6,040.48 110.00 6,033.95 110.00 6,027.42 110.00 6,020.88 110.00 6,014.35 110.00 6,007.82 110.00 6,001.28 $1,618,000 $1,618,500 110.00 6,042.36 110.00 6,035.83 110.00 6,029.29 110.00 6,022.76 110.00 6,016.23 110.00 6,009.69 110.00 6,003.16 $1,618,500 $1,619,000 110.00 6,044.23 110.00 6,037.70 110.00 6,031.17 110.00 6,024.63 110.00 6,018.10 110.00 6,011.57 110.00 6,005.03 $1,619,000 $1,619,500 110.00 6,046.11 110.00 6,039.58 110.00 6,033.04 110.00 6,026.51 110.00 6,019.98 110.00 6,013.44 110.00 6,006.91 $1,619,500 $1,620,000 110.00 6,047.98 110.00 6,041.45 110.00 6,034.92 110.00 6,028.38 110.00 6,021.85 110.00 6,015.32 110.00 6,008.78 $1,620,000 $1,620,500 110.00 6,049.86 110.00 6,043.33 110.00 6,036.79 110.00 6,030.26 110.00 6,023.73 110.00 6,017.19 110.00 6,010.66 $1,620,500 $1,621,000 110.00 6,051.73 110.00 6,045.20 110.00 6,038.67 110.00 6,032.13 110.00 6,025.60 110.00 6,019.07 110.00 6,012.53 $1,621,000 $1,621,500 110.00 6,053.61 110.00 6,047.08 110.00 6,040.54 110.00 6,034.01 110.00 6,027.48 110.00 6,020.94 110.00 6,014.41 $1,621,500 $1,622,000 110.00 6,055.48 110.00 6,048.95 110.00 6,042.42 110.00 6,035.88 110.00 6,029.35 110.00 6,022.82 110.00 6,016.28 $1,622,000 $1,622,500 110.00 6,057.36 110.00 6,050.83 110.00 6,044.29 110.00 6,037.76 110.00 6,031.23 110.00 6,024.69 110.00 6,018.16 $1,622,500 $1,623,000 110.00 6,059.23 110.00 6,052.70 110.00 6,046.17 110.00 6,039.63 110.00 6,033.10 110.00 6,026.57 110.00 6,020.03 $1,623,000 $1,623,500 110.00 6,061.11 110.00 6,054.58 110.00 6,048.04 110.00 6,041.51 110.00 6,034.98 110.00 6,028.44 110.00 6,021.91 $1,623,500 $1,624,000 110.00 6,062.98 110.00 6,056.45 110.00 6,049.92 110.00 6,043.38 110.00 6,036.85 110.00 6,030.32 110.00 6,023.78 $1,624,000 $1,624,500 110.00 6,064.86 110.00 6,058.33 110.00 6,051.79 110.00 6,045.26 110.00 6,038.73 110.00 6,032.19 110.00 6,025.66 $1,624,500 $1,625,000 110.00 6,066.73 110.00 6,060.20 110.00 6,053.67 110.00 6,047.13 110.00 6,040.60 110.00 6,034.07 110.00 6,027.53 $1,625,000 $1,625,500 110.00 6,068.61 110.00 6,062.08 110.00 6,055.54 110.00 6,049.01 110.00 6,042.48 110.00 6,035.94 110.00 6,029.41 $1,625,500 $1,626,000 110.00 6,070.48 110.00 6,063.95 110.00 6,057.42 110.00 6,050.88 110.00 6,044.35 110.00 6,037.82 110.00 6,031.28 $1,626,000 $1,626,500 110.00 6,072.36 110.00 6,065.83 110.00 6,059.29 110.00 6,052.76 110.00 6,046.23 110.00 6,039.69 110.00 6,033.16 $1,626,500 $1,627,000 110.00 6,074.23 110.00 6,067.70 110.00 6,061.17 110.00 6,054.63 110.00 6,048.10 110.00 6,041.57 110.00 6,035.03 $1,627,000 $1,627,500 110.00 6,076.11 110.00 6,069.58 110.00 6,063.04 110.00 6,056.51 110.00 6,049.98 110.00 6,043.44 110.00 6,036.91 $1,627,500 $1,628,000 110.00 6,077.98 110.00 6,071.45 110.00 6,064.92 110.00 6,058.38 110.00 6,051.85 110.00 6,045.32 110.00 6,038.78 $1,628,000 $1,628,500 110.00 6,079.86 110.00 6,073.33 110.00 6,066.79 110.00 6,060.26 110.00 6,053.73 110.00 6,047.19 110.00 6,040.66 $1,628,500 $1,629,000 110.00 6,081.73 110.00 6,075.20 110.00 6,068.67 110.00 6,062.13 110.00 6,055.60 110.00 6,049.07 110.00 6,042.53 $1,629,000 $1,629,500 110.00 6,083.61 110.00 6,077.08 110.00 6,070.54 110.00 6,064.01 110.00 6,057.48 110.00 6,050.94 110.00 6,044.41 $1,629,500 $1,630,000 110.00 6,085.48 110.00 6,078.95 110.00 6,072.42 110.00 6,065.88 110.00 6,059.35 110.00 6,052.82 110.00 6,046.28 $1,630,000 $1,630,500 110.00 6,087.36 110.00 6,080.83 110.00 6,074.29 110.00 6,067.76 110.00 6,061.23 110.00 6,054.69 110.00 6,048.16 $1,630,500 $1,631,000 110.00 6,089.23 110.00 6,082.70 110.00 6,076.17 110.00 6,069.63 110.00 6,063.10 110.00 6,056.57 110.00 6,050.03 $1,631,000 $1,631,500 110.00 6,091.11 110.00 6,084.58 110.00 6,078.04 110.00 6,071.51 110.00 6,064.98 110.00 6,058.44 110.00 6,051.91 $1,631,500 $1,632,000 110.00 6,092.98 110.00 6,086.45 110.00 6,079.92 110.00 6,073.38 110.00 6,066.85 110.00 6,060.32 110.00 6,053.78

NJEIS Family Cost Participation Table Page 35 of 12 Effective July 1, 2015

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

$1,632,000 $1,632,500 110.00 6,094.86 110.00 6,088.33 110.00 6,081.79 110.00 6,075.26 110.00 6,068.73 110.00 6,062.19 110.00 6,055.66 $1,632,500 $1,633,000 110.00 6,096.73 110.00 6,090.20 110.00 6,083.67 110.00 6,077.13 110.00 6,070.60 110.00 6,064.07 110.00 6,057.53 $1,633,000 $1,633,500 110.00 6,098.61 110.00 6,092.08 110.00 6,085.54 110.00 6,079.01 110.00 6,072.48 110.00 6,065.94 110.00 6,059.41 $1,633,500 $1,634,000 110.00 6,100.48 110.00 6,093.95 110.00 6,087.42 110.00 6,080.88 110.00 6,074.35 110.00 6,067.82 110.00 6,061.28 $1,634,000 $1,634,500 110.00 6,102.36 110.00 6,095.83 110.00 6,089.29 110.00 6,082.76 110.00 6,076.23 110.00 6,069.69 110.00 6,063.16 $1,634,500 $1,635,000 110.00 6,104.23 110.00 6,097.70 110.00 6,091.17 110.00 6,084.63 110.00 6,078.10 110.00 6,071.57 110.00 6,065.03 $1,635,000 $1,635,500 110.00 6,106.11 110.00 6,099.58 110.00 6,093.04 110.00 6,086.51 110.00 6,079.98 110.00 6,073.44 110.00 6,066.91 $1,635,500 $1,636,000 110.00 6,107.98 110.00 6,101.45 110.00 6,094.92 110.00 6,088.38 110.00 6,081.85 110.00 6,075.32 110.00 6,068.78 $1,636,000 $1,636,500 110.00 6,109.86 110.00 6,103.33 110.00 6,096.79 110.00 6,090.26 110.00 6,083.73 110.00 6,077.19 110.00 6,070.66 $1,636,500 $1,637,000 110.00 6,111.73 110.00 6,105.20 110.00 6,098.67 110.00 6,092.13 110.00 6,085.60 110.00 6,079.07 110.00 6,072.53 $1,637,000 $1,637,500 110.00 6,113.61 110.00 6,107.08 110.00 6,100.54 110.00 6,094.01 110.00 6,087.48 110.00 6,080.94 110.00 6,074.41 $1,637,500 $1,638,000 110.00 6,115.48 110.00 6,108.95 110.00 6,102.42 110.00 6,095.88 110.00 6,089.35 110.00 6,082.82 110.00 6,076.28 $1,638,000 $1,638,500 110.00 6,117.36 110.00 6,110.83 110.00 6,104.29 110.00 6,097.76 110.00 6,091.23 110.00 6,084.69 110.00 6,078.16 $1,638,500 $1,639,000 110.00 6,119.23 110.00 6,112.70 110.00 6,106.17 110.00 6,099.63 110.00 6,093.10 110.00 6,086.57 110.00 6,080.03 $1,639,000 $1,639,500 110.00 6,121.11 110.00 6,114.58 110.00 6,108.04 110.00 6,101.51 110.00 6,094.98 110.00 6,088.44 110.00 6,081.91 $1,639,500 $1,640,000 110.00 6,122.98 110.00 6,116.45 110.00 6,109.92 110.00 6,103.38 110.00 6,096.85 110.00 6,090.32 110.00 6,083.78 $1,640,000 $1,640,500 110.00 6,124.86 110.00 6,118.33 110.00 6,111.79 110.00 6,105.26 110.00 6,098.73 110.00 6,092.19 110.00 6,085.66 $1,640,500 $1,641,000 110.00 6,126.73 110.00 6,120.20 110.00 6,113.67 110.00 6,107.13 110.00 6,100.60 110.00 6,094.07 110.00 6,087.53 $1,641,000 $1,641,500 110.00 6,128.61 110.00 6,122.08 110.00 6,115.54 110.00 6,109.01 110.00 6,102.48 110.00 6,095.94 110.00 6,089.41 $1,641,500 $1,642,000 110.00 6,130.48 110.00 6,123.95 110.00 6,117.42 110.00 6,110.88 110.00 6,104.35 110.00 6,097.82 110.00 6,091.28 $1,642,000 $1,642,500 110.00 6,132.36 110.00 6,125.83 110.00 6,119.29 110.00 6,112.76 110.00 6,106.23 110.00 6,099.69 110.00 6,093.16 $1,642,500 $1,643,000 110.00 6,134.23 110.00 6,127.70 110.00 6,121.17 110.00 6,114.63 110.00 6,108.10 110.00 6,101.57 110.00 6,095.03 $1,643,000 $1,643,500 110.00 6,136.11 110.00 6,129.58 110.00 6,123.04 110.00 6,116.51 110.00 6,109.98 110.00 6,103.44 110.00 6,096.91 $1,643,500 $1,644,000 110.00 6,137.98 110.00 6,131.45 110.00 6,124.92 110.00 6,118.38 110.00 6,111.85 110.00 6,105.32 110.00 6,098.78 $1,644,000 $1,644,500 110.00 6,139.86 110.00 6,133.33 110.00 6,126.79 110.00 6,120.26 110.00 6,113.73 110.00 6,107.19 110.00 6,100.66 $1,644,500 $1,645,000 110.00 6,141.73 110.00 6,135.20 110.00 6,128.67 110.00 6,122.13 110.00 6,115.60 110.00 6,109.07 110.00 6,102.53 $1,645,000 $1,645,500 110.00 6,143.61 110.00 6,137.08 110.00 6,130.54 110.00 6,124.01 110.00 6,117.48 110.00 6,110.94 110.00 6,104.41 $1,645,500 $1,646,000 110.00 6,145.48 110.00 6,138.95 110.00 6,132.42 110.00 6,125.88 110.00 6,119.35 110.00 6,112.82 110.00 6,106.28 $1,646,000 $1,646,500 110.00 6,147.36 110.00 6,140.83 110.00 6,134.29 110.00 6,127.76 110.00 6,121.23 110.00 6,114.69 110.00 6,108.16 $1,646,500 $1,647,000 110.00 6,149.23 110.00 6,142.70 110.00 6,136.17 110.00 6,129.63 110.00 6,123.10 110.00 6,116.57 110.00 6,110.03 $1,647,000 $1,647,500 110.00 6,151.11 110.00 6,144.58 110.00 6,138.04 110.00 6,131.51 110.00 6,124.98 110.00 6,118.44 110.00 6,111.91 $1,647,500 $1,648,000 110.00 6,152.98 110.00 6,146.45 110.00 6,139.92 110.00 6,133.38 110.00 6,126.85 110.00 6,120.32 110.00 6,113.78 $1,648,000 $1,648,500 110.00 6,154.86 110.00 6,148.33 110.00 6,141.79 110.00 6,135.26 110.00 6,128.73 110.00 6,122.19 110.00 6,115.66 $1,648,500 $1,649,000 110.00 6,156.73 110.00 6,150.20 110.00 6,143.67 110.00 6,137.13 110.00 6,130.60 110.00 6,124.07 110.00 6,117.53 $1,649,000 $1,649,500 110.00 6,158.61 110.00 6,152.08 110.00 6,145.54 110.00 6,139.01 110.00 6,132.48 110.00 6,125.94 110.00 6,119.41 $1,649,500 $1,650,000 110.00 6,160.48 110.00 6,153.95 110.00 6,147.42 110.00 6,140.88 110.00 6,134.35 110.00 6,127.82 110.00 6,121.28 $1,650,000 $1,650,500 110.00 6,162.36 110.00 6,155.83 110.00 6,149.29 110.00 6,142.76 110.00 6,136.23 110.00 6,129.69 110.00 6,123.16 $1,650,500 $1,651,000 110.00 6,164.23 110.00 6,157.70 110.00 6,151.17 110.00 6,144.63 110.00 6,138.10 110.00 6,131.57 110.00 6,125.03 $1,651,000 $1,651,500 110.00 6,166.11 110.00 6,159.58 110.00 6,153.04 110.00 6,146.51 110.00 6,139.98 110.00 6,133.44 110.00 6,126.91 $1,651,500 $1,652,000 110.00 6,167.98 110.00 6,161.45 110.00 6,154.92 110.00 6,148.38 110.00 6,141.85 110.00 6,135.32 110.00 6,128.78 $1,652,000 $1,652,500 110.00 6,169.86 110.00 6,163.33 110.00 6,156.79 110.00 6,150.26 110.00 6,143.73 110.00 6,137.19 110.00 6,130.66 $1,652,500 $1,653,000 110.00 6,171.73 110.00 6,165.20 110.00 6,158.67 110.00 6,152.13 110.00 6,145.60 110.00 6,139.07 110.00 6,132.53 $1,653,000 $1,653,500 110.00 6,173.61 110.00 6,167.08 110.00 6,160.54 110.00 6,154.01 110.00 6,147.48 110.00 6,140.94 110.00 6,134.41 $1,653,500 $1,654,000 110.00 6,175.48 110.00 6,168.95 110.00 6,162.42 110.00 6,155.88 110.00 6,149.35 110.00 6,142.82 110.00 6,136.28 $1,654,000 $1,654,500 110.00 6,177.36 110.00 6,170.83 110.00 6,164.29 110.00 6,157.76 110.00 6,151.23 110.00 6,144.69 110.00 6,138.16 $1,654,500 $1,655,000 110.00 6,179.23 110.00 6,172.70 110.00 6,166.17 110.00 6,159.63 110.00 6,153.10 110.00 6,146.57 110.00 6,140.03 $1,655,000 $1,655,500 110.00 6,181.11 110.00 6,174.58 110.00 6,168.04 110.00 6,161.51 110.00 6,154.98 110.00 6,148.44 110.00 6,141.91 $1,655,500 $1,656,000 110.00 6,182.98 110.00 6,176.45 110.00 6,169.92 110.00 6,163.38 110.00 6,156.85 110.00 6,150.32 110.00 6,143.78 $1,656,000 $1,656,500 110.00 6,184.86 110.00 6,178.33 110.00 6,171.79 110.00 6,165.26 110.00 6,158.73 110.00 6,152.19 110.00 6,145.66 $1,656,500 $1,657,000 110.00 6,186.73 110.00 6,180.20 110.00 6,173.67 110.00 6,167.13 110.00 6,160.60 110.00 6,154.07 110.00 6,147.53 $1,657,000 $1,657,500 110.00 6,188.61 110.00 6,182.08 110.00 6,175.54 110.00 6,169.01 110.00 6,162.48 110.00 6,155.94 110.00 6,149.41 $1,657,500 $1,658,000 110.00 6,190.48 110.00 6,183.95 110.00 6,177.42 110.00 6,170.88 110.00 6,164.35 110.00 6,157.82 110.00 6,151.28 $1,658,000 $1,658,500 110.00 6,192.36 110.00 6,185.83 110.00 6,179.29 110.00 6,172.76 110.00 6,166.23 110.00 6,159.69 110.00 6,153.16 $1,658,500 $1,659,000 110.00 6,194.23 110.00 6,187.70 110.00 6,181.17 110.00 6,174.63 110.00 6,168.10 110.00 6,161.57 110.00 6,155.03 $1,659,000 $1,659,500 110.00 6,196.11 110.00 6,189.58 110.00 6,183.04 110.00 6,176.51 110.00 6,169.98 110.00 6,163.44 110.00 6,156.91 $1,659,500 $1,660,000 110.00 6,197.98 110.00 6,191.45 110.00 6,184.92 110.00 6,178.38 110.00 6,171.85 110.00 6,165.32 110.00 6,158.78 $1,660,000 $1,660,500 110.00 6,199.86 110.00 6,193.33 110.00 6,186.79 110.00 6,180.26 110.00 6,173.73 110.00 6,167.19 110.00 6,160.66 $1,660,500 $1,661,000 110.00 6,201.73 110.00 6,195.20 110.00 6,188.67 110.00 6,182.13 110.00 6,175.60 110.00 6,169.07 110.00 6,162.53 $1,661,000 $1,661,500 110.00 6,203.61 110.00 6,197.08 110.00 6,190.54 110.00 6,184.01 110.00 6,177.48 110.00 6,170.94 110.00 6,164.41 $1,661,500 $1,662,000 110.00 6,205.48 110.00 6,198.95 110.00 6,192.42 110.00 6,185.88 110.00 6,179.35 110.00 6,172.82 110.00 6,166.28 $1,662,000 $1,662,500 110.00 6,207.36 110.00 6,200.83 110.00 6,194.29 110.00 6,187.76 110.00 6,181.23 110.00 6,174.69 110.00 6,168.16 $1,662,500 $1,663,000 110.00 6,209.23 110.00 6,202.70 110.00 6,196.17 110.00 6,189.63 110.00 6,183.10 110.00 6,176.57 110.00 6,170.03 $1,663,000 $1,663,500 110.00 6,211.11 110.00 6,204.58 110.00 6,198.04 110.00 6,191.51 110.00 6,184.98 110.00 6,178.44 110.00 6,171.91 $1,663,500 $1,664,000 110.00 6,212.98 110.00 6,206.45 110.00 6,199.92 110.00 6,193.38 110.00 6,186.85 110.00 6,180.32 110.00 6,173.78 $1,664,000 $1,664,500 110.00 6,214.86 110.00 6,208.33 110.00 6,201.79 110.00 6,195.26 110.00 6,188.73 110.00 6,182.19 110.00 6,175.66 $1,664,500 $1,665,000 110.00 6,216.73 110.00 6,210.20 110.00 6,203.67 110.00 6,197.13 110.00 6,190.60 110.00 6,184.07 110.00 6,177.53 $1,665,000 $1,665,500 110.00 6,218.61 110.00 6,212.08 110.00 6,205.54 110.00 6,199.01 110.00 6,192.48 110.00 6,185.94 110.00 6,179.41 $1,665,500 $1,666,000 110.00 6,220.48 110.00 6,213.95 110.00 6,207.42 110.00 6,200.88 110.00 6,194.35 110.00 6,187.82 110.00 6,181.28 $1,666,000 $1,666,500 110.00 6,222.36 110.00 6,215.83 110.00 6,209.29 110.00 6,202.76 110.00 6,196.23 110.00 6,189.69 110.00 6,183.16 $1,666,500 $1,667,000 110.00 6,224.23 110.00 6,217.70 110.00 6,211.17 110.00 6,204.63 110.00 6,198.10 110.00 6,191.57 110.00 6,185.03 $1,667,000 $1,667,500 110.00 6,226.11 110.00 6,219.58 110.00 6,213.04 110.00 6,206.51 110.00 6,199.98 110.00 6,193.44 110.00 6,186.91 $1,667,500 $1,668,000 110.00 6,227.98 110.00 6,221.45 110.00 6,214.92 110.00 6,208.38 110.00 6,201.85 110.00 6,195.32 110.00 6,188.78 $1,668,000 $1,668,500 110.00 6,229.86 110.00 6,223.33 110.00 6,216.79 110.00 6,210.26 110.00 6,203.73 110.00 6,197.19 110.00 6,190.66 $1,668,500 $1,669,000 110.00 6,231.73 110.00 6,225.20 110.00 6,218.67 110.00 6,212.13 110.00 6,205.60 110.00 6,199.07 110.00 6,192.53 $1,669,000 $1,669,500 110.00 6,233.61 110.00 6,227.08 110.00 6,220.54 110.00 6,214.01 110.00 6,207.48 110.00 6,200.94 110.00 6,194.41 $1,669,500 $1,670,000 110.00 6,235.48 110.00 6,228.95 110.00 6,222.42 110.00 6,215.88 110.00 6,209.35 110.00 6,202.82 110.00 6,196.28 $1,670,000 $1,670,500 110.00 6,237.36 110.00 6,230.83 110.00 6,224.29 110.00 6,217.76 110.00 6,211.23 110.00 6,204.69 110.00 6,198.16 $1,670,500 $1,671,000 110.00 6,239.23 110.00 6,232.70 110.00 6,226.17 110.00 6,219.63 110.00 6,213.10 110.00 6,206.57 110.00 6,200.03 $1,671,000 $1,671,500 110.00 6,241.11 110.00 6,234.58 110.00 6,228.04 110.00 6,221.51 110.00 6,214.98 110.00 6,208.44 110.00 6,201.91 $1,671,500 $1,672,000 110.00 6,242.98 110.00 6,236.45 110.00 6,229.92 110.00 6,223.38 110.00 6,216.85 110.00 6,210.32 110.00 6,203.78 $1,672,000 $1,672,500 110.00 6,244.86 110.00 6,238.33 110.00 6,231.79 110.00 6,225.26 110.00 6,218.73 110.00 6,212.19 110.00 6,205.66 $1,672,500 $1,673,000 110.00 6,246.73 110.00 6,240.20 110.00 6,233.67 110.00 6,227.13 110.00 6,220.60 110.00 6,214.07 110.00 6,207.53 $1,673,000 $1,673,500 110.00 6,248.61 110.00 6,242.08 110.00 6,235.54 110.00 6,229.01 110.00 6,222.48 110.00 6,215.94 110.00 6,209.41 $1,673,500 $1,674,000 110.00 6,250.48 110.00 6,243.95 110.00 6,237.42 110.00 6,230.88 110.00 6,224.35 110.00 6,217.82 110.00 6,211.28 $1,674,000 $1,674,500 110.00 6,252.36 110.00 6,245.83 110.00 6,239.29 110.00 6,232.76 110.00 6,226.23 110.00 6,219.69 110.00 6,213.16 $1,674,500 $1,675,000 110.00 6,254.23 110.00 6,247.70 110.00 6,241.17 110.00 6,234.63 110.00 6,228.10 110.00 6,221.57 110.00 6,215.03 $1,675,000 $1,675,500 110.00 6,256.11 110.00 6,249.58 110.00 6,243.04 110.00 6,236.51 110.00 6,229.98 110.00 6,223.44 110.00 6,216.91 $1,675,500 $1,676,000 110.00 6,257.98 110.00 6,251.45 110.00 6,244.92 110.00 6,238.38 110.00 6,231.85 110.00 6,225.32 110.00 6,218.78 $1,676,000 $1,676,500 110.00 6,259.86 110.00 6,253.33 110.00 6,246.79 110.00 6,240.26 110.00 6,233.73 110.00 6,227.19 110.00 6,220.66 $1,676,500 $1,677,000 110.00 6,261.73 110.00 6,255.20 110.00 6,248.67 110.00 6,242.13 110.00 6,235.60 110.00 6,229.07 110.00 6,222.53 $1,677,000 $1,677,500 110.00 6,263.61 110.00 6,257.08 110.00 6,250.54 110.00 6,244.01 110.00 6,237.48 110.00 6,230.94 110.00 6,224.41 $1,677,500 $1,678,000 110.00 6,265.48 110.00 6,258.95 110.00 6,252.42 110.00 6,245.88 110.00 6,239.35 110.00 6,232.82 110.00 6,226.28 $1,678,000 $1,678,500 110.00 6,267.36 110.00 6,260.83 110.00 6,254.29 110.00 6,247.76 110.00 6,241.23 110.00 6,234.69 110.00 6,228.16 $1,678,500 $1,679,000 110.00 6,269.23 110.00 6,262.70 110.00 6,256.17 110.00 6,249.63 110.00 6,243.10 110.00 6,236.57 110.00 6,230.03 $1,679,000 $1,679,500 110.00 6,271.11 110.00 6,264.58 110.00 6,258.04 110.00 6,251.51 110.00 6,244.98 110.00 6,238.44 110.00 6,231.91 $1,679,500 $1,680,000 110.00 6,272.98 110.00 6,266.45 110.00 6,259.92 110.00 6,253.38 110.00 6,246.85 110.00 6,240.32 110.00 6,233.78 $1,680,000 $1,680,500 110.00 6,274.86 110.00 6,268.33 110.00 6,261.79 110.00 6,255.26 110.00 6,248.73 110.00 6,242.19 110.00 6,235.66 $1,680,500 $1,681,000 110.00 6,276.73 110.00 6,270.20 110.00 6,263.67 110.00 6,257.13 110.00 6,250.60 110.00 6,244.07 110.00 6,237.53 $1,681,000 $1,681,500 110.00 6,278.61 110.00 6,272.08 110.00 6,265.54 110.00 6,259.01 110.00 6,252.48 110.00 6,245.94 110.00 6,239.41 $1,681,500 $1,682,000 110.00 6,280.48 110.00 6,273.95 110.00 6,267.42 110.00 6,260.88 110.00 6,254.35 110.00 6,247.82 110.00 6,241.28 $1,682,000 $1,682,500 110.00 6,282.36 110.00 6,275.83 110.00 6,269.29 110.00 6,262.76 110.00 6,256.23 110.00 6,249.69 110.00 6,243.16 $1,682,500 $1,683,000 110.00 6,284.23 110.00 6,277.70 110.00 6,271.17 110.00 6,264.63 110.00 6,258.10 110.00 6,251.57 110.00 6,245.03

NJEIS Family Cost Participation Table Page 36 of 12 Effective July 1, 2015

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

$1,683,000 $1,683,500 110.00 6,286.11 110.00 6,279.58 110.00 6,273.04 110.00 6,266.51 110.00 6,259.98 110.00 6,253.44 110.00 6,246.91 $1,683,500 $1,684,000 110.00 6,287.98 110.00 6,281.45 110.00 6,274.92 110.00 6,268.38 110.00 6,261.85 110.00 6,255.32 110.00 6,248.78 $1,684,000 $1,684,500 110.00 6,289.86 110.00 6,283.33 110.00 6,276.79 110.00 6,270.26 110.00 6,263.73 110.00 6,257.19 110.00 6,250.66 $1,684,500 $1,685,000 110.00 6,291.73 110.00 6,285.20 110.00 6,278.67 110.00 6,272.13 110.00 6,265.60 110.00 6,259.07 110.00 6,252.53 $1,685,000 $1,685,500 110.00 6,293.61 110.00 6,287.08 110.00 6,280.54 110.00 6,274.01 110.00 6,267.48 110.00 6,260.94 110.00 6,254.41 $1,685,500 $1,686,000 110.00 6,295.48 110.00 6,288.95 110.00 6,282.42 110.00 6,275.88 110.00 6,269.35 110.00 6,262.82 110.00 6,256.28 $1,686,000 $1,686,500 110.00 6,297.36 110.00 6,290.83 110.00 6,284.29 110.00 6,277.76 110.00 6,271.23 110.00 6,264.69 110.00 6,258.16 $1,686,500 $1,687,000 110.00 6,299.23 110.00 6,292.70 110.00 6,286.17 110.00 6,279.63 110.00 6,273.10 110.00 6,266.57 110.00 6,260.03 $1,687,000 $1,687,500 110.00 6,301.11 110.00 6,294.58 110.00 6,288.04 110.00 6,281.51 110.00 6,274.98 110.00 6,268.44 110.00 6,261.91 $1,687,500 $1,688,000 110.00 6,302.98 110.00 6,296.45 110.00 6,289.92 110.00 6,283.38 110.00 6,276.85 110.00 6,270.32 110.00 6,263.78 $1,688,000 $1,688,500 110.00 6,304.86 110.00 6,298.33 110.00 6,291.79 110.00 6,285.26 110.00 6,278.73 110.00 6,272.19 110.00 6,265.66 $1,688,500 $1,689,000 110.00 6,306.73 110.00 6,300.20 110.00 6,293.67 110.00 6,287.13 110.00 6,280.60 110.00 6,274.07 110.00 6,267.53 $1,689,000 $1,689,500 110.00 6,308.61 110.00 6,302.08 110.00 6,295.54 110.00 6,289.01 110.00 6,282.48 110.00 6,275.94 110.00 6,269.41 $1,689,500 $1,690,000 110.00 6,310.48 110.00 6,303.95 110.00 6,297.42 110.00 6,290.88 110.00 6,284.35 110.00 6,277.82 110.00 6,271.28 $1,690,000 $1,690,500 110.00 6,312.36 110.00 6,305.83 110.00 6,299.29 110.00 6,292.76 110.00 6,286.23 110.00 6,279.69 110.00 6,273.16 $1,690,500 $1,691,000 110.00 6,314.23 110.00 6,307.70 110.00 6,301.17 110.00 6,294.63 110.00 6,288.10 110.00 6,281.57 110.00 6,275.03 $1,691,000 $1,691,500 110.00 6,316.11 110.00 6,309.58 110.00 6,303.04 110.00 6,296.51 110.00 6,289.98 110.00 6,283.44 110.00 6,276.91 $1,691,500 $1,692,000 110.00 6,317.98 110.00 6,311.45 110.00 6,304.92 110.00 6,298.38 110.00 6,291.85 110.00 6,285.32 110.00 6,278.78 $1,692,000 $1,692,500 110.00 6,319.86 110.00 6,313.33 110.00 6,306.79 110.00 6,300.26 110.00 6,293.73 110.00 6,287.19 110.00 6,280.66 $1,692,500 $1,693,000 110.00 6,321.73 110.00 6,315.20 110.00 6,308.67 110.00 6,302.13 110.00 6,295.60 110.00 6,289.07 110.00 6,282.53 $1,693,000 $1,693,500 110.00 6,323.61 110.00 6,317.08 110.00 6,310.54 110.00 6,304.01 110.00 6,297.48 110.00 6,290.94 110.00 6,284.41 $1,693,500 $1,694,000 110.00 6,325.48 110.00 6,318.95 110.00 6,312.42 110.00 6,305.88 110.00 6,299.35 110.00 6,292.82 110.00 6,286.28 $1,694,000 $1,694,500 110.00 6,327.36 110.00 6,320.83 110.00 6,314.29 110.00 6,307.76 110.00 6,301.23 110.00 6,294.69 110.00 6,288.16 $1,694,500 $1,695,000 110.00 6,329.23 110.00 6,322.70 110.00 6,316.17 110.00 6,309.63 110.00 6,303.10 110.00 6,296.57 110.00 6,290.03 $1,695,000 $1,695,500 110.00 6,331.11 110.00 6,324.58 110.00 6,318.04 110.00 6,311.51 110.00 6,304.98 110.00 6,298.44 110.00 6,291.91 $1,695,500 $1,696,000 110.00 6,332.98 110.00 6,326.45 110.00 6,319.92 110.00 6,313.38 110.00 6,306.85 110.00 6,300.32 110.00 6,293.78 $1,696,000 $1,696,500 110.00 6,334.86 110.00 6,328.33 110.00 6,321.79 110.00 6,315.26 110.00 6,308.73 110.00 6,302.19 110.00 6,295.66 $1,696,500 $1,697,000 110.00 6,336.73 110.00 6,330.20 110.00 6,323.67 110.00 6,317.13 110.00 6,310.60 110.00 6,304.07 110.00 6,297.53 $1,697,000 $1,697,500 110.00 6,338.61 110.00 6,332.08 110.00 6,325.54 110.00 6,319.01 110.00 6,312.48 110.00 6,305.94 110.00 6,299.41 $1,697,500 $1,698,000 110.00 6,340.48 110.00 6,333.95 110.00 6,327.42 110.00 6,320.88 110.00 6,314.35 110.00 6,307.82 110.00 6,301.28 $1,698,000 $1,698,500 110.00 6,342.36 110.00 6,335.83 110.00 6,329.29 110.00 6,322.76 110.00 6,316.23 110.00 6,309.69 110.00 6,303.16 $1,698,500 $1,699,000 110.00 6,344.23 110.00 6,337.70 110.00 6,331.17 110.00 6,324.63 110.00 6,318.10 110.00 6,311.57 110.00 6,305.03 $1,699,000 $1,699,500 110.00 6,346.11 110.00 6,339.58 110.00 6,333.04 110.00 6,326.51 110.00 6,319.98 110.00 6,313.44 110.00 6,306.91 $1,699,500 $1,700,000 110.00 6,347.98 110.00 6,341.45 110.00 6,334.92 110.00 6,328.38 110.00 6,321.85 110.00 6,315.32 110.00 6,308.78 $1,700,000 $1,700,500 110.00 6,349.86 110.00 6,343.33 110.00 6,336.79 110.00 6,330.26 110.00 6,323.73 110.00 6,317.19 110.00 6,310.66 $1,700,500 $1,701,000 110.00 6,351.73 110.00 6,345.20 110.00 6,338.67 110.00 6,332.13 110.00 6,325.60 110.00 6,319.07 110.00 6,312.53 $1,701,000 $1,701,500 110.00 6,353.61 110.00 6,347.08 110.00 6,340.54 110.00 6,334.01 110.00 6,327.48 110.00 6,320.94 110.00 6,314.41 $1,701,500 $1,702,000 110.00 6,355.48 110.00 6,348.95 110.00 6,342.42 110.00 6,335.88 110.00 6,329.35 110.00 6,322.82 110.00 6,316.28 $1,702,000 $1,702,500 110.00 6,357.36 110.00 6,350.83 110.00 6,344.29 110.00 6,337.76 110.00 6,331.23 110.00 6,324.69 110.00 6,318.16 $1,702,500 $1,703,000 110.00 6,359.23 110.00 6,352.70 110.00 6,346.17 110.00 6,339.63 110.00 6,333.10 110.00 6,326.57 110.00 6,320.03 $1,703,000 $1,703,500 110.00 6,361.11 110.00 6,354.58 110.00 6,348.04 110.00 6,341.51 110.00 6,334.98 110.00 6,328.44 110.00 6,321.91 $1,703,500 $1,704,000 110.00 6,362.98 110.00 6,356.45 110.00 6,349.92 110.00 6,343.38 110.00 6,336.85 110.00 6,330.32 110.00 6,323.78 $1,704,000 $1,704,500 110.00 6,364.86 110.00 6,358.33 110.00 6,351.79 110.00 6,345.26 110.00 6,338.73 110.00 6,332.19 110.00 6,325.66 $1,704,500 $1,705,000 110.00 6,366.73 110.00 6,360.20 110.00 6,353.67 110.00 6,347.13 110.00 6,340.60 110.00 6,334.07 110.00 6,327.53 $1,705,000 $1,705,500 110.00 6,368.61 110.00 6,362.08 110.00 6,355.54 110.00 6,349.01 110.00 6,342.48 110.00 6,335.94 110.00 6,329.41 $1,705,500 $1,706,000 110.00 6,370.48 110.00 6,363.95 110.00 6,357.42 110.00 6,350.88 110.00 6,344.35 110.00 6,337.82 110.00 6,331.28 $1,706,000 $1,706,500 110.00 6,372.36 110.00 6,365.83 110.00 6,359.29 110.00 6,352.76 110.00 6,346.23 110.00 6,339.69 110.00 6,333.16 $1,706,500 $1,707,000 110.00 6,374.23 110.00 6,367.70 110.00 6,361.17 110.00 6,354.63 110.00 6,348.10 110.00 6,341.57 110.00 6,335.03 $1,707,000 $1,707,500 110.00 6,376.11 110.00 6,369.58 110.00 6,363.04 110.00 6,356.51 110.00 6,349.98 110.00 6,343.44 110.00 6,336.91 $1,707,500 $1,708,000 110.00 6,377.98 110.00 6,371.45 110.00 6,364.92 110.00 6,358.38 110.00 6,351.85 110.00 6,345.32 110.00 6,338.78 $1,708,000 $1,708,500 110.00 6,379.86 110.00 6,373.33 110.00 6,366.79 110.00 6,360.26 110.00 6,353.73 110.00 6,347.19 110.00 6,340.66 $1,708,500 $1,709,000 110.00 6,381.73 110.00 6,375.20 110.00 6,368.67 110.00 6,362.13 110.00 6,355.60 110.00 6,349.07 110.00 6,342.53 $1,709,000 $1,709,500 110.00 6,383.61 110.00 6,377.08 110.00 6,370.54 110.00 6,364.01 110.00 6,357.48 110.00 6,350.94 110.00 6,344.41 $1,709,500 $1,710,000 110.00 6,385.48 110.00 6,378.95 110.00 6,372.42 110.00 6,365.88 110.00 6,359.35 110.00 6,352.82 110.00 6,346.28 $1,710,000 $1,710,500 110.00 6,387.36 110.00 6,380.83 110.00 6,374.29 110.00 6,367.76 110.00 6,361.23 110.00 6,354.69 110.00 6,348.16 $1,710,500 $1,711,000 110.00 6,389.23 110.00 6,382.70 110.00 6,376.17 110.00 6,369.63 110.00 6,363.10 110.00 6,356.57 110.00 6,350.03 $1,711,000 $1,711,500 110.00 6,391.11 110.00 6,384.58 110.00 6,378.04 110.00 6,371.51 110.00 6,364.98 110.00 6,358.44 110.00 6,351.91 $1,711,500 $1,712,000 110.00 6,392.98 110.00 6,386.45 110.00 6,379.92 110.00 6,373.38 110.00 6,366.85 110.00 6,360.32 110.00 6,353.78 $1,712,000 $1,712,500 110.00 6,394.86 110.00 6,388.33 110.00 6,381.79 110.00 6,375.26 110.00 6,368.73 110.00 6,362.19 110.00 6,355.66 $1,712,500 $1,713,000 110.00 6,396.73 110.00 6,390.20 110.00 6,383.67 110.00 6,377.13 110.00 6,370.60 110.00 6,364.07 110.00 6,357.53 $1,713,000 $1,713,500 110.00 6,398.61 110.00 6,392.08 110.00 6,385.54 110.00 6,379.01 110.00 6,372.48 110.00 6,365.94 110.00 6,359.41 $1,713,500 $1,714,000 110.00 6,400.48 110.00 6,393.95 110.00 6,387.42 110.00 6,380.88 110.00 6,374.35 110.00 6,367.82 110.00 6,361.28 $1,714,000 $1,714,500 110.00 6,402.36 110.00 6,395.83 110.00 6,389.29 110.00 6,382.76 110.00 6,376.23 110.00 6,369.69 110.00 6,363.16 $1,714,500 $1,715,000 110.00 6,404.23 110.00 6,397.70 110.00 6,391.17 110.00 6,384.63 110.00 6,378.10 110.00 6,371.57 110.00 6,365.03 $1,715,000 $1,715,500 110.00 6,406.11 110.00 6,399.58 110.00 6,393.04 110.00 6,386.51 110.00 6,379.98 110.00 6,373.44 110.00 6,366.91 $1,715,500 $1,716,000 110.00 6,407.98 110.00 6,401.45 110.00 6,394.92 110.00 6,388.38 110.00 6,381.85 110.00 6,375.32 110.00 6,368.78 $1,716,000 $1,716,500 110.00 6,409.86 110.00 6,403.33 110.00 6,396.79 110.00 6,390.26 110.00 6,383.73 110.00 6,377.19 110.00 6,370.66 $1,716,500 $1,717,000 110.00 6,411.73 110.00 6,405.20 110.00 6,398.67 110.00 6,392.13 110.00 6,385.60 110.00 6,379.07 110.00 6,372.53 $1,717,000 $1,717,500 110.00 6,413.61 110.00 6,407.08 110.00 6,400.54 110.00 6,394.01 110.00 6,387.48 110.00 6,380.94 110.00 6,374.41 $1,717,500 $1,718,000 110.00 6,415.48 110.00 6,408.95 110.00 6,402.42 110.00 6,395.88 110.00 6,389.35 110.00 6,382.82 110.00 6,376.28 $1,718,000 $1,718,500 110.00 6,417.36 110.00 6,410.83 110.00 6,404.29 110.00 6,397.76 110.00 6,391.23 110.00 6,384.69 110.00 6,378.16 $1,718,500 $1,719,000 110.00 6,419.23 110.00 6,412.70 110.00 6,406.17 110.00 6,399.63 110.00 6,393.10 110.00 6,386.57 110.00 6,380.03 $1,719,000 $1,719,500 110.00 6,421.11 110.00 6,414.58 110.00 6,408.04 110.00 6,401.51 110.00 6,394.98 110.00 6,388.44 110.00 6,381.91 $1,719,500 $1,720,000 110.00 6,422.98 110.00 6,416.45 110.00 6,409.92 110.00 6,403.38 110.00 6,396.85 110.00 6,390.32 110.00 6,383.78 $1,720,000 $1,720,500 110.00 6,424.86 110.00 6,418.33 110.00 6,411.79 110.00 6,405.26 110.00 6,398.73 110.00 6,392.19 110.00 6,385.66 $1,720,500 $1,721,000 110.00 6,426.73 110.00 6,420.20 110.00 6,413.67 110.00 6,407.13 110.00 6,400.60 110.00 6,394.07 110.00 6,387.53 $1,721,000 $1,721,500 110.00 6,428.61 110.00 6,422.08 110.00 6,415.54 110.00 6,409.01 110.00 6,402.48 110.00 6,395.94 110.00 6,389.41 $1,721,500 $1,722,000 110.00 6,430.48 110.00 6,423.95 110.00 6,417.42 110.00 6,410.88 110.00 6,404.35 110.00 6,397.82 110.00 6,391.28 $1,722,000 $1,722,500 110.00 6,432.36 110.00 6,425.83 110.00 6,419.29 110.00 6,412.76 110.00 6,406.23 110.00 6,399.69 110.00 6,393.16 $1,722,500 $1,723,000 110.00 6,434.23 110.00 6,427.70 110.00 6,421.17 110.00 6,414.63 110.00 6,408.10 110.00 6,401.57 110.00 6,395.03 $1,723,000 $1,723,500 110.00 6,436.11 110.00 6,429.58 110.00 6,423.04 110.00 6,416.51 110.00 6,409.98 110.00 6,403.44 110.00 6,396.91 $1,723,500 $1,724,000 110.00 6,437.98 110.00 6,431.45 110.00 6,424.92 110.00 6,418.38 110.00 6,411.85 110.00 6,405.32 110.00 6,398.78 $1,724,000 $1,724,500 110.00 6,439.86 110.00 6,433.33 110.00 6,426.79 110.00 6,420.26 110.00 6,413.73 110.00 6,407.19 110.00 6,400.66 $1,724,500 $1,725,000 110.00 6,441.73 110.00 6,435.20 110.00 6,428.67 110.00 6,422.13 110.00 6,415.60 110.00 6,409.07 110.00 6,402.53 $1,725,000 $1,725,500 110.00 6,443.61 110.00 6,437.08 110.00 6,430.54 110.00 6,424.01 110.00 6,417.48 110.00 6,410.94 110.00 6,404.41 $1,725,500 $1,726,000 110.00 6,445.48 110.00 6,438.95 110.00 6,432.42 110.00 6,425.88 110.00 6,419.35 110.00 6,412.82 110.00 6,406.28 $1,726,000 $1,726,500 110.00 6,447.36 110.00 6,440.83 110.00 6,434.29 110.00 6,427.76 110.00 6,421.23 110.00 6,414.69 110.00 6,408.16 $1,726,500 $1,727,000 110.00 6,449.23 110.00 6,442.70 110.00 6,436.17 110.00 6,429.63 110.00 6,423.10 110.00 6,416.57 110.00 6,410.03 $1,727,000 $1,727,500 110.00 6,451.11 110.00 6,444.58 110.00 6,438.04 110.00 6,431.51 110.00 6,424.98 110.00 6,418.44 110.00 6,411.91 $1,727,500 $1,728,000 110.00 6,452.98 110.00 6,446.45 110.00 6,439.92 110.00 6,433.38 110.00 6,426.85 110.00 6,420.32 110.00 6,413.78 $1,728,000 $1,728,500 110.00 6,454.86 110.00 6,448.33 110.00 6,441.79 110.00 6,435.26 110.00 6,428.73 110.00 6,422.19 110.00 6,415.66 $1,728,500 $1,729,000 110.00 6,456.73 110.00 6,450.20 110.00 6,443.67 110.00 6,437.13 110.00 6,430.60 110.00 6,424.07 110.00 6,417.53 $1,729,000 $1,729,500 110.00 6,458.61 110.00 6,452.08 110.00 6,445.54 110.00 6,439.01 110.00 6,432.48 110.00 6,425.94 110.00 6,419.41 $1,729,500 $1,730,000 110.00 6,460.48 110.00 6,453.95 110.00 6,447.42 110.00 6,440.88 110.00 6,434.35 110.00 6,427.82 110.00 6,421.28 $1,730,000 $1,730,500 110.00 6,462.36 110.00 6,455.83 110.00 6,449.29 110.00 6,442.76 110.00 6,436.23 110.00 6,429.69 110.00 6,423.16 $1,730,500 $1,731,000 110.00 6,464.23 110.00 6,457.70 110.00 6,451.17 110.00 6,444.63 110.00 6,438.10 110.00 6,431.57 110.00 6,425.03 $1,731,000 $1,731,500 110.00 6,466.11 110.00 6,459.58 110.00 6,453.04 110.00 6,446.51 110.00 6,439.98 110.00 6,433.44 110.00 6,426.91 $1,731,500 $1,732,000 110.00 6,467.98 110.00 6,461.45 110.00 6,454.92 110.00 6,448.38 110.00 6,441.85 110.00 6,435.32 110.00 6,428.78 $1,732,000 $1,732,500 110.00 6,469.86 110.00 6,463.33 110.00 6,456.79 110.00 6,450.26 110.00 6,443.73 110.00 6,437.19 110.00 6,430.66 $1,732,500 $1,733,000 110.00 6,471.73 110.00 6,465.20 110.00 6,458.67 110.00 6,452.13 110.00 6,445.60 110.00 6,439.07 110.00 6,432.53 $1,733,000 $1,733,500 110.00 6,473.61 110.00 6,467.08 110.00 6,460.54 110.00 6,454.01 110.00 6,447.48 110.00 6,440.94 110.00 6,434.41 $1,733,500 $1,734,000 110.00 6,475.48 110.00 6,468.95 110.00 6,462.42 110.00 6,455.88 110.00 6,449.35 110.00 6,442.82 110.00 6,436.28

NJEIS Family Cost Participation Table Page 37 of 12 Effective July 1, 2015

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

$1,734,000 $1,734,500 110.00 6,477.36 110.00 6,470.83 110.00 6,464.29 110.00 6,457.76 110.00 6,451.23 110.00 6,444.69 110.00 6,438.16 $1,734,500 $1,735,000 110.00 6,479.23 110.00 6,472.70 110.00 6,466.17 110.00 6,459.63 110.00 6,453.10 110.00 6,446.57 110.00 6,440.03 $1,735,000 $1,735,500 110.00 6,481.11 110.00 6,474.58 110.00 6,468.04 110.00 6,461.51 110.00 6,454.98 110.00 6,448.44 110.00 6,441.91 $1,735,500 $1,736,000 110.00 6,482.98 110.00 6,476.45 110.00 6,469.92 110.00 6,463.38 110.00 6,456.85 110.00 6,450.32 110.00 6,443.78 $1,736,000 $1,736,500 110.00 6,484.86 110.00 6,478.33 110.00 6,471.79 110.00 6,465.26 110.00 6,458.73 110.00 6,452.19 110.00 6,445.66 $1,736,500 $1,737,000 110.00 6,486.73 110.00 6,480.20 110.00 6,473.67 110.00 6,467.13 110.00 6,460.60 110.00 6,454.07 110.00 6,447.53 $1,737,000 $1,737,500 110.00 6,488.61 110.00 6,482.08 110.00 6,475.54 110.00 6,469.01 110.00 6,462.48 110.00 6,455.94 110.00 6,449.41 $1,737,500 $1,738,000 110.00 6,490.48 110.00 6,483.95 110.00 6,477.42 110.00 6,470.88 110.00 6,464.35 110.00 6,457.82 110.00 6,451.28 $1,738,000 $1,738,500 110.00 6,492.36 110.00 6,485.83 110.00 6,479.29 110.00 6,472.76 110.00 6,466.23 110.00 6,459.69 110.00 6,453.16 $1,738,500 $1,739,000 110.00 6,494.23 110.00 6,487.70 110.00 6,481.17 110.00 6,474.63 110.00 6,468.10 110.00 6,461.57 110.00 6,455.03 $1,739,000 $1,739,500 110.00 6,496.11 110.00 6,489.58 110.00 6,483.04 110.00 6,476.51 110.00 6,469.98 110.00 6,463.44 110.00 6,456.91 $1,739,500 $1,740,000 110.00 6,497.98 110.00 6,491.45 110.00 6,484.92 110.00 6,478.38 110.00 6,471.85 110.00 6,465.32 110.00 6,458.78 $1,740,000 $1,740,500 110.00 6,499.86 110.00 6,493.33 110.00 6,486.79 110.00 6,480.26 110.00 6,473.73 110.00 6,467.19 110.00 6,460.66 $1,740,500 $1,741,000 110.00 6,501.73 110.00 6,495.20 110.00 6,488.67 110.00 6,482.13 110.00 6,475.60 110.00 6,469.07 110.00 6,462.53 $1,741,000 $1,741,500 110.00 6,503.61 110.00 6,497.08 110.00 6,490.54 110.00 6,484.01 110.00 6,477.48 110.00 6,470.94 110.00 6,464.41 $1,741,500 $1,742,000 110.00 6,505.48 110.00 6,498.95 110.00 6,492.42 110.00 6,485.88 110.00 6,479.35 110.00 6,472.82 110.00 6,466.28 $1,742,000 $1,742,500 110.00 6,507.36 110.00 6,500.83 110.00 6,494.29 110.00 6,487.76 110.00 6,481.23 110.00 6,474.69 110.00 6,468.16 $1,742,500 $1,743,000 110.00 6,509.23 110.00 6,502.70 110.00 6,496.17 110.00 6,489.63 110.00 6,483.10 110.00 6,476.57 110.00 6,470.03 $1,743,000 $1,743,500 110.00 6,511.11 110.00 6,504.58 110.00 6,498.04 110.00 6,491.51 110.00 6,484.98 110.00 6,478.44 110.00 6,471.91 $1,743,500 $1,744,000 110.00 6,512.98 110.00 6,506.45 110.00 6,499.92 110.00 6,493.38 110.00 6,486.85 110.00 6,480.32 110.00 6,473.78 $1,744,000 $1,744,500 110.00 6,514.86 110.00 6,508.33 110.00 6,501.79 110.00 6,495.26 110.00 6,488.73 110.00 6,482.19 110.00 6,475.66 $1,744,500 $1,745,000 110.00 6,516.73 110.00 6,510.20 110.00 6,503.67 110.00 6,497.13 110.00 6,490.60 110.00 6,484.07 110.00 6,477.53 $1,745,000 $1,745,500 110.00 6,518.61 110.00 6,512.08 110.00 6,505.54 110.00 6,499.01 110.00 6,492.48 110.00 6,485.94 110.00 6,479.41 $1,745,500 $1,746,000 110.00 6,520.48 110.00 6,513.95 110.00 6,507.42 110.00 6,500.88 110.00 6,494.35 110.00 6,487.82 110.00 6,481.28 $1,746,000 $1,746,500 110.00 6,522.36 110.00 6,515.83 110.00 6,509.29 110.00 6,502.76 110.00 6,496.23 110.00 6,489.69 110.00 6,483.16 $1,746,500 $1,747,000 110.00 6,524.23 110.00 6,517.70 110.00 6,511.17 110.00 6,504.63 110.00 6,498.10 110.00 6,491.57 110.00 6,485.03 $1,747,000 $1,747,500 110.00 6,526.11 110.00 6,519.58 110.00 6,513.04 110.00 6,506.51 110.00 6,499.98 110.00 6,493.44 110.00 6,486.91 $1,747,500 $1,748,000 110.00 6,527.98 110.00 6,521.45 110.00 6,514.92 110.00 6,508.38 110.00 6,501.85 110.00 6,495.32 110.00 6,488.78 $1,748,000 $1,748,500 110.00 6,529.86 110.00 6,523.33 110.00 6,516.79 110.00 6,510.26 110.00 6,503.73 110.00 6,497.19 110.00 6,490.66 $1,748,500 $1,749,000 110.00 6,531.73 110.00 6,525.20 110.00 6,518.67 110.00 6,512.13 110.00 6,505.60 110.00 6,499.07 110.00 6,492.53 $1,749,000 $1,749,500 110.00 6,533.61 110.00 6,527.08 110.00 6,520.54 110.00 6,514.01 110.00 6,507.48 110.00 6,500.94 110.00 6,494.41 $1,749,500 $1,750,000 110.00 6,535.48 110.00 6,528.95 110.00 6,522.42 110.00 6,515.88 110.00 6,509.35 110.00 6,502.82 110.00 6,496.28 $1,750,000 $1,750,500 110.00 6,537.36 110.00 6,530.83 110.00 6,524.29 110.00 6,517.76 110.00 6,511.23 110.00 6,504.69 110.00 6,498.16 $1,750,500 $1,751,000 110.00 6,539.23 110.00 6,532.70 110.00 6,526.17 110.00 6,519.63 110.00 6,513.10 110.00 6,506.57 110.00 6,500.03 $1,751,000 $1,751,500 110.00 6,541.11 110.00 6,534.58 110.00 6,528.04 110.00 6,521.51 110.00 6,514.98 110.00 6,508.44 110.00 6,501.91 $1,751,500 $1,752,000 110.00 6,542.98 110.00 6,536.45 110.00 6,529.92 110.00 6,523.38 110.00 6,516.85 110.00 6,510.32 110.00 6,503.78 $1,752,000 $1,752,500 110.00 6,544.86 110.00 6,538.33 110.00 6,531.79 110.00 6,525.26 110.00 6,518.73 110.00 6,512.19 110.00 6,505.66 $1,752,500 $1,753,000 110.00 6,546.73 110.00 6,540.20 110.00 6,533.67 110.00 6,527.13 110.00 6,520.60 110.00 6,514.07 110.00 6,507.53 $1,753,000 $1,753,500 110.00 6,548.61 110.00 6,542.08 110.00 6,535.54 110.00 6,529.01 110.00 6,522.48 110.00 6,515.94 110.00 6,509.41 $1,753,500 $1,754,000 110.00 6,550.48 110.00 6,543.95 110.00 6,537.42 110.00 6,530.88 110.00 6,524.35 110.00 6,517.82 110.00 6,511.28 $1,754,000 $1,754,500 110.00 6,552.36 110.00 6,545.83 110.00 6,539.29 110.00 6,532.76 110.00 6,526.23 110.00 6,519.69 110.00 6,513.16 $1,754,500 $1,755,000 110.00 6,554.23 110.00 6,547.70 110.00 6,541.17 110.00 6,534.63 110.00 6,528.10 110.00 6,521.57 110.00 6,515.03 $1,755,000 $1,755,500 110.00 6,556.11 110.00 6,549.58 110.00 6,543.04 110.00 6,536.51 110.00 6,529.98 110.00 6,523.44 110.00 6,516.91 $1,755,500 $1,756,000 110.00 6,557.98 110.00 6,551.45 110.00 6,544.92 110.00 6,538.38 110.00 6,531.85 110.00 6,525.32 110.00 6,518.78 $1,756,000 $1,756,500 110.00 6,559.86 110.00 6,553.33 110.00 6,546.79 110.00 6,540.26 110.00 6,533.73 110.00 6,527.19 110.00 6,520.66 $1,756,500 $1,757,000 110.00 6,561.73 110.00 6,555.20 110.00 6,548.67 110.00 6,542.13 110.00 6,535.60 110.00 6,529.07 110.00 6,522.53 $1,757,000 $1,757,500 110.00 6,563.61 110.00 6,557.08 110.00 6,550.54 110.00 6,544.01 110.00 6,537.48 110.00 6,530.94 110.00 6,524.41 $1,757,500 $1,758,000 110.00 6,565.48 110.00 6,558.95 110.00 6,552.42 110.00 6,545.88 110.00 6,539.35 110.00 6,532.82 110.00 6,526.28 $1,758,000 $1,758,500 110.00 6,567.36 110.00 6,560.83 110.00 6,554.29 110.00 6,547.76 110.00 6,541.23 110.00 6,534.69 110.00 6,528.16 $1,758,500 $1,759,000 110.00 6,569.23 110.00 6,562.70 110.00 6,556.17 110.00 6,549.63 110.00 6,543.10 110.00 6,536.57 110.00 6,530.03 $1,759,000 $1,759,500 110.00 6,571.11 110.00 6,564.58 110.00 6,558.04 110.00 6,551.51 110.00 6,544.98 110.00 6,538.44 110.00 6,531.91 $1,759,500 $1,760,000 110.00 6,572.98 110.00 6,566.45 110.00 6,559.92 110.00 6,553.38 110.00 6,546.85 110.00 6,540.32 110.00 6,533.78 $1,760,000 $1,760,500 110.00 6,574.86 110.00 6,568.33 110.00 6,561.79 110.00 6,555.26 110.00 6,548.73 110.00 6,542.19 110.00 6,535.66 $1,760,500 $1,761,000 110.00 6,576.73 110.00 6,570.20 110.00 6,563.67 110.00 6,557.13 110.00 6,550.60 110.00 6,544.07 110.00 6,537.53 $1,761,000 $1,761,500 110.00 6,578.61 110.00 6,572.08 110.00 6,565.54 110.00 6,559.01 110.00 6,552.48 110.00 6,545.94 110.00 6,539.41 $1,761,500 $1,762,000 110.00 6,580.48 110.00 6,573.95 110.00 6,567.42 110.00 6,560.88 110.00 6,554.35 110.00 6,547.82 110.00 6,541.28 $1,762,000 $1,762,500 110.00 6,582.36 110.00 6,575.83 110.00 6,569.29 110.00 6,562.76 110.00 6,556.23 110.00 6,549.69 110.00 6,543.16 $1,762,500 $1,763,000 110.00 6,584.23 110.00 6,577.70 110.00 6,571.17 110.00 6,564.63 110.00 6,558.10 110.00 6,551.57 110.00 6,545.03 $1,763,000 $1,763,500 110.00 6,586.11 110.00 6,579.58 110.00 6,573.04 110.00 6,566.51 110.00 6,559.98 110.00 6,553.44 110.00 6,546.91 $1,763,500 $1,764,000 110.00 6,587.98 110.00 6,581.45 110.00 6,574.92 110.00 6,568.38 110.00 6,561.85 110.00 6,555.32 110.00 6,548.78 $1,764,000 $1,764,500 110.00 6,589.86 110.00 6,583.33 110.00 6,576.79 110.00 6,570.26 110.00 6,563.73 110.00 6,557.19 110.00 6,550.66 $1,764,500 $1,765,000 110.00 6,591.73 110.00 6,585.20 110.00 6,578.67 110.00 6,572.13 110.00 6,565.60 110.00 6,559.07 110.00 6,552.53 $1,765,000 $1,765,500 110.00 6,593.61 110.00 6,587.08 110.00 6,580.54 110.00 6,574.01 110.00 6,567.48 110.00 6,560.94 110.00 6,554.41 $1,765,500 $1,766,000 110.00 6,595.48 110.00 6,588.95 110.00 6,582.42 110.00 6,575.88 110.00 6,569.35 110.00 6,562.82 110.00 6,556.28 $1,766,000 $1,766,500 110.00 6,597.36 110.00 6,590.83 110.00 6,584.29 110.00 6,577.76 110.00 6,571.23 110.00 6,564.69 110.00 6,558.16 $1,766,500 $1,767,000 110.00 6,599.23 110.00 6,592.70 110.00 6,586.17 110.00 6,579.63 110.00 6,573.10 110.00 6,566.57 110.00 6,560.03 $1,767,000 $1,767,500 110.00 6,601.11 110.00 6,594.58 110.00 6,588.04 110.00 6,581.51 110.00 6,574.98 110.00 6,568.44 110.00 6,561.91 $1,767,500 $1,768,000 110.00 6,602.98 110.00 6,596.45 110.00 6,589.92 110.00 6,583.38 110.00 6,576.85 110.00 6,570.32 110.00 6,563.78 $1,768,000 $1,768,500 110.00 6,604.86 110.00 6,598.33 110.00 6,591.79 110.00 6,585.26 110.00 6,578.73 110.00 6,572.19 110.00 6,565.66 $1,768,500 $1,769,000 110.00 6,606.73 110.00 6,600.20 110.00 6,593.67 110.00 6,587.13 110.00 6,580.60 110.00 6,574.07 110.00 6,567.53 $1,769,000 $1,769,500 110.00 6,608.61 110.00 6,602.08 110.00 6,595.54 110.00 6,589.01 110.00 6,582.48 110.00 6,575.94 110.00 6,569.41 $1,769,500 $1,770,000 110.00 6,610.48 110.00 6,603.95 110.00 6,597.42 110.00 6,590.88 110.00 6,584.35 110.00 6,577.82 110.00 6,571.28 $1,770,000 $1,770,500 110.00 6,612.36 110.00 6,605.83 110.00 6,599.29 110.00 6,592.76 110.00 6,586.23 110.00 6,579.69 110.00 6,573.16 $1,770,500 $1,771,000 110.00 6,614.23 110.00 6,607.70 110.00 6,601.17 110.00 6,594.63 110.00 6,588.10 110.00 6,581.57 110.00 6,575.03 $1,771,000 $1,771,500 110.00 6,616.11 110.00 6,609.58 110.00 6,603.04 110.00 6,596.51 110.00 6,589.98 110.00 6,583.44 110.00 6,576.91 $1,771,500 $1,772,000 110.00 6,617.98 110.00 6,611.45 110.00 6,604.92 110.00 6,598.38 110.00 6,591.85 110.00 6,585.32 110.00 6,578.78 $1,772,000 $1,772,500 110.00 6,619.86 110.00 6,613.33 110.00 6,606.79 110.00 6,600.26 110.00 6,593.73 110.00 6,587.19 110.00 6,580.66 $1,772,500 $1,773,000 110.00 6,621.73 110.00 6,615.20 110.00 6,608.67 110.00 6,602.13 110.00 6,595.60 110.00 6,589.07 110.00 6,582.53 $1,773,000 $1,773,500 110.00 6,623.61 110.00 6,617.08 110.00 6,610.54 110.00 6,604.01 110.00 6,597.48 110.00 6,590.94 110.00 6,584.41 $1,773,500 $1,774,000 110.00 6,625.48 110.00 6,618.95 110.00 6,612.42 110.00 6,605.88 110.00 6,599.35 110.00 6,592.82 110.00 6,586.28 $1,774,000 $1,774,500 110.00 6,627.36 110.00 6,620.83 110.00 6,614.29 110.00 6,607.76 110.00 6,601.23 110.00 6,594.69 110.00 6,588.16 $1,774,500 $1,775,000 110.00 6,629.23 110.00 6,622.70 110.00 6,616.17 110.00 6,609.63 110.00 6,603.10 110.00 6,596.57 110.00 6,590.03 $1,775,000 $1,775,500 110.00 6,631.11 110.00 6,624.58 110.00 6,618.04 110.00 6,611.51 110.00 6,604.98 110.00 6,598.44 110.00 6,591.91 $1,775,500 $1,776,000 110.00 6,632.98 110.00 6,626.45 110.00 6,619.92 110.00 6,613.38 110.00 6,606.85 110.00 6,600.32 110.00 6,593.78 $1,776,000 $1,776,500 110.00 6,634.86 110.00 6,628.33 110.00 6,621.79 110.00 6,615.26 110.00 6,608.73 110.00 6,602.19 110.00 6,595.66 $1,776,500 $1,777,000 110.00 6,636.73 110.00 6,630.20 110.00 6,623.67 110.00 6,617.13 110.00 6,610.60 110.00 6,604.07 110.00 6,597.53 $1,777,000 $1,777,500 110.00 6,638.61 110.00 6,632.08 110.00 6,625.54 110.00 6,619.01 110.00 6,612.48 110.00 6,605.94 110.00 6,599.41 $1,777,500 $1,778,000 110.00 6,640.48 110.00 6,633.95 110.00 6,627.42 110.00 6,620.88 110.00 6,614.35 110.00 6,607.82 110.00 6,601.28 $1,778,000 $1,778,500 110.00 6,642.36 110.00 6,635.83 110.00 6,629.29 110.00 6,622.76 110.00 6,616.23 110.00 6,609.69 110.00 6,603.16 $1,778,500 $1,779,000 110.00 6,644.23 110.00 6,637.70 110.00 6,631.17 110.00 6,624.63 110.00 6,618.10 110.00 6,611.57 110.00 6,605.03 $1,779,000 $1,779,500 110.00 6,646.11 110.00 6,639.58 110.00 6,633.04 110.00 6,626.51 110.00 6,619.98 110.00 6,613.44 110.00 6,606.91 $1,779,500 $1,780,000 110.00 6,647.98 110.00 6,641.45 110.00 6,634.92 110.00 6,628.38 110.00 6,621.85 110.00 6,615.32 110.00 6,608.78 $1,780,000 $1,780,500 110.00 6,649.86 110.00 6,643.33 110.00 6,636.79 110.00 6,630.26 110.00 6,623.73 110.00 6,617.19 110.00 6,610.66 $1,780,500 $1,781,000 110.00 6,651.73 110.00 6,645.20 110.00 6,638.67 110.00 6,632.13 110.00 6,625.60 110.00 6,619.07 110.00 6,612.53 $1,781,000 $1,781,500 110.00 6,653.61 110.00 6,647.08 110.00 6,640.54 110.00 6,634.01 110.00 6,627.48 110.00 6,620.94 110.00 6,614.41 $1,781,500 $1,782,000 110.00 6,655.48 110.00 6,648.95 110.00 6,642.42 110.00 6,635.88 110.00 6,629.35 110.00 6,622.82 110.00 6,616.28 $1,782,000 $1,782,500 110.00 6,657.36 110.00 6,650.83 110.00 6,644.29 110.00 6,637.76 110.00 6,631.23 110.00 6,624.69 110.00 6,618.16 $1,782,500 $1,783,000 110.00 6,659.23 110.00 6,652.70 110.00 6,646.17 110.00 6,639.63 110.00 6,633.10 110.00 6,626.57 110.00 6,620.03 $1,783,000 $1,783,500 110.00 6,661.11 110.00 6,654.58 110.00 6,648.04 110.00 6,641.51 110.00 6,634.98 110.00 6,628.44 110.00 6,621.91 $1,783,500 $1,784,000 110.00 6,662.98 110.00 6,656.45 110.00 6,649.92 110.00 6,643.38 110.00 6,636.85 110.00 6,630.32 110.00 6,623.78 $1,784,000 $1,784,500 110.00 6,664.86 110.00 6,658.33 110.00 6,651.79 110.00 6,645.26 110.00 6,638.73 110.00 6,632.19 110.00 6,625.66 $1,784,500 $1,785,000 110.00 6,666.73 110.00 6,660.20 110.00 6,653.67 110.00 6,647.13 110.00 6,640.60 110.00 6,634.07 110.00 6,627.53

NJEIS Family Cost Participation Table Page 38 of 12 Effective July 1, 2015

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

$1,785,000 $1,785,500 110.00 6,668.61 110.00 6,662.08 110.00 6,655.54 110.00 6,649.01 110.00 6,642.48 110.00 6,635.94 110.00 6,629.41 $1,785,500 $1,786,000 110.00 6,670.48 110.00 6,663.95 110.00 6,657.42 110.00 6,650.88 110.00 6,644.35 110.00 6,637.82 110.00 6,631.28 $1,786,000 $1,786,500 110.00 6,672.36 110.00 6,665.83 110.00 6,659.29 110.00 6,652.76 110.00 6,646.23 110.00 6,639.69 110.00 6,633.16 $1,786,500 $1,787,000 110.00 6,674.23 110.00 6,667.70 110.00 6,661.17 110.00 6,654.63 110.00 6,648.10 110.00 6,641.57 110.00 6,635.03 $1,787,000 $1,787,500 110.00 6,676.11 110.00 6,669.58 110.00 6,663.04 110.00 6,656.51 110.00 6,649.98 110.00 6,643.44 110.00 6,636.91 $1,787,500 $1,788,000 110.00 6,677.98 110.00 6,671.45 110.00 6,664.92 110.00 6,658.38 110.00 6,651.85 110.00 6,645.32 110.00 6,638.78 $1,788,000 $1,788,500 110.00 6,679.86 110.00 6,673.33 110.00 6,666.79 110.00 6,660.26 110.00 6,653.73 110.00 6,647.19 110.00 6,640.66 $1,788,500 $1,789,000 110.00 6,681.73 110.00 6,675.20 110.00 6,668.67 110.00 6,662.13 110.00 6,655.60 110.00 6,649.07 110.00 6,642.53 $1,789,000 $1,789,500 110.00 6,683.61 110.00 6,677.08 110.00 6,670.54 110.00 6,664.01 110.00 6,657.48 110.00 6,650.94 110.00 6,644.41 $1,789,500 $1,790,000 110.00 6,685.48 110.00 6,678.95 110.00 6,672.42 110.00 6,665.88 110.00 6,659.35 110.00 6,652.82 110.00 6,646.28 $1,790,000 $1,790,500 110.00 6,687.36 110.00 6,680.83 110.00 6,674.29 110.00 6,667.76 110.00 6,661.23 110.00 6,654.69 110.00 6,648.16 $1,790,500 $1,791,000 110.00 6,689.23 110.00 6,682.70 110.00 6,676.17 110.00 6,669.63 110.00 6,663.10 110.00 6,656.57 110.00 6,650.03 $1,791,000 $1,791,500 110.00 6,691.11 110.00 6,684.58 110.00 6,678.04 110.00 6,671.51 110.00 6,664.98 110.00 6,658.44 110.00 6,651.91 $1,791,500 $1,792,000 110.00 6,692.98 110.00 6,686.45 110.00 6,679.92 110.00 6,673.38 110.00 6,666.85 110.00 6,660.32 110.00 6,653.78 $1,792,000 $1,792,500 110.00 6,694.86 110.00 6,688.33 110.00 6,681.79 110.00 6,675.26 110.00 6,668.73 110.00 6,662.19 110.00 6,655.66 $1,792,500 $1,793,000 110.00 6,696.73 110.00 6,690.20 110.00 6,683.67 110.00 6,677.13 110.00 6,670.60 110.00 6,664.07 110.00 6,657.53 $1,793,000 $1,793,500 110.00 6,698.61 110.00 6,692.08 110.00 6,685.54 110.00 6,679.01 110.00 6,672.48 110.00 6,665.94 110.00 6,659.41 $1,793,500 $1,794,000 110.00 6,700.48 110.00 6,693.95 110.00 6,687.42 110.00 6,680.88 110.00 6,674.35 110.00 6,667.82 110.00 6,661.28 $1,794,000 $1,794,500 110.00 6,702.36 110.00 6,695.83 110.00 6,689.29 110.00 6,682.76 110.00 6,676.23 110.00 6,669.69 110.00 6,663.16 $1,794,500 $1,795,000 110.00 6,704.23 110.00 6,697.70 110.00 6,691.17 110.00 6,684.63 110.00 6,678.10 110.00 6,671.57 110.00 6,665.03 $1,795,000 $1,795,500 110.00 6,706.11 110.00 6,699.58 110.00 6,693.04 110.00 6,686.51 110.00 6,679.98 110.00 6,673.44 110.00 6,666.91 $1,795,500 $1,796,000 110.00 6,707.98 110.00 6,701.45 110.00 6,694.92 110.00 6,688.38 110.00 6,681.85 110.00 6,675.32 110.00 6,668.78 $1,796,000 $1,796,500 110.00 6,709.86 110.00 6,703.33 110.00 6,696.79 110.00 6,690.26 110.00 6,683.73 110.00 6,677.19 110.00 6,670.66 $1,796,500 $1,797,000 110.00 6,711.73 110.00 6,705.20 110.00 6,698.67 110.00 6,692.13 110.00 6,685.60 110.00 6,679.07 110.00 6,672.53 $1,797,000 $1,797,500 110.00 6,713.61 110.00 6,707.08 110.00 6,700.54 110.00 6,694.01 110.00 6,687.48 110.00 6,680.94 110.00 6,674.41 $1,797,500 $1,798,000 110.00 6,715.48 110.00 6,708.95 110.00 6,702.42 110.00 6,695.88 110.00 6,689.35 110.00 6,682.82 110.00 6,676.28 $1,798,000 $1,798,500 110.00 6,717.36 110.00 6,710.83 110.00 6,704.29 110.00 6,697.76 110.00 6,691.23 110.00 6,684.69 110.00 6,678.16 $1,798,500 $1,799,000 110.00 6,719.23 110.00 6,712.70 110.00 6,706.17 110.00 6,699.63 110.00 6,693.10 110.00 6,686.57 110.00 6,680.03 $1,799,000 $1,799,500 110.00 6,721.11 110.00 6,714.58 110.00 6,708.04 110.00 6,701.51 110.00 6,694.98 110.00 6,688.44 110.00 6,681.91 $1,799,500 $1,800,000 110.00 6,722.98 110.00 6,716.45 110.00 6,709.92 110.00 6,703.38 110.00 6,696.85 110.00 6,690.32 110.00 6,683.78 $1,800,000 $1,800,500 110.00 6,724.86 110.00 6,718.33 110.00 6,711.79 110.00 6,705.26 110.00 6,698.73 110.00 6,692.19 110.00 6,685.66 $1,800,500 $1,801,000 110.00 6,726.73 110.00 6,720.20 110.00 6,713.67 110.00 6,707.13 110.00 6,700.60 110.00 6,694.07 110.00 6,687.53 $1,801,000 $1,801,500 110.00 6,728.61 110.00 6,722.08 110.00 6,715.54 110.00 6,709.01 110.00 6,702.48 110.00 6,695.94 110.00 6,689.41 $1,801,500 $1,802,000 110.00 6,730.48 110.00 6,723.95 110.00 6,717.42 110.00 6,710.88 110.00 6,704.35 110.00 6,697.82 110.00 6,691.28 $1,802,000 $1,802,500 110.00 6,732.36 110.00 6,725.83 110.00 6,719.29 110.00 6,712.76 110.00 6,706.23 110.00 6,699.69 110.00 6,693.16 $1,802,500 $1,803,000 110.00 6,734.23 110.00 6,727.70 110.00 6,721.17 110.00 6,714.63 110.00 6,708.10 110.00 6,701.57 110.00 6,695.03 $1,803,000 $1,803,500 110.00 6,736.11 110.00 6,729.58 110.00 6,723.04 110.00 6,716.51 110.00 6,709.98 110.00 6,703.44 110.00 6,696.91 $1,803,500 $1,804,000 110.00 6,737.98 110.00 6,731.45 110.00 6,724.92 110.00 6,718.38 110.00 6,711.85 110.00 6,705.32 110.00 6,698.78 $1,804,000 $1,804,500 110.00 6,739.86 110.00 6,733.33 110.00 6,726.79 110.00 6,720.26 110.00 6,713.73 110.00 6,707.19 110.00 6,700.66 $1,804,500 $1,805,000 110.00 6,741.73 110.00 6,735.20 110.00 6,728.67 110.00 6,722.13 110.00 6,715.60 110.00 6,709.07 110.00 6,702.53 $1,805,000 $1,805,500 110.00 6,743.61 110.00 6,737.08 110.00 6,730.54 110.00 6,724.01 110.00 6,717.48 110.00 6,710.94 110.00 6,704.41 $1,805,500 $1,806,000 110.00 6,745.48 110.00 6,738.95 110.00 6,732.42 110.00 6,725.88 110.00 6,719.35 110.00 6,712.82 110.00 6,706.28 $1,806,000 $1,806,500 110.00 6,747.36 110.00 6,740.83 110.00 6,734.29 110.00 6,727.76 110.00 6,721.23 110.00 6,714.69 110.00 6,708.16 $1,806,500 $1,807,000 110.00 6,749.23 110.00 6,742.70 110.00 6,736.17 110.00 6,729.63 110.00 6,723.10 110.00 6,716.57 110.00 6,710.03 $1,807,000 $1,807,500 110.00 6,751.11 110.00 6,744.58 110.00 6,738.04 110.00 6,731.51 110.00 6,724.98 110.00 6,718.44 110.00 6,711.91 $1,807,500 $1,808,000 110.00 6,752.98 110.00 6,746.45 110.00 6,739.92 110.00 6,733.38 110.00 6,726.85 110.00 6,720.32 110.00 6,713.78 $1,808,000 $1,808,500 110.00 6,754.86 110.00 6,748.33 110.00 6,741.79 110.00 6,735.26 110.00 6,728.73 110.00 6,722.19 110.00 6,715.66 $1,808,500 $1,809,000 110.00 6,756.73 110.00 6,750.20 110.00 6,743.67 110.00 6,737.13 110.00 6,730.60 110.00 6,724.07 110.00 6,717.53 $1,809,000 $1,809,500 110.00 6,758.61 110.00 6,752.08 110.00 6,745.54 110.00 6,739.01 110.00 6,732.48 110.00 6,725.94 110.00 6,719.41 $1,809,500 $1,810,000 110.00 6,760.48 110.00 6,753.95 110.00 6,747.42 110.00 6,740.88 110.00 6,734.35 110.00 6,727.82 110.00 6,721.28 $1,810,000 $1,810,500 110.00 6,762.36 110.00 6,755.83 110.00 6,749.29 110.00 6,742.76 110.00 6,736.23 110.00 6,729.69 110.00 6,723.16 $1,810,500 $1,811,000 110.00 6,764.23 110.00 6,757.70 110.00 6,751.17 110.00 6,744.63 110.00 6,738.10 110.00 6,731.57 110.00 6,725.03 $1,811,000 $1,811,500 110.00 6,766.11 110.00 6,759.58 110.00 6,753.04 110.00 6,746.51 110.00 6,739.98 110.00 6,733.44 110.00 6,726.91 $1,811,500 $1,812,000 110.00 6,767.98 110.00 6,761.45 110.00 6,754.92 110.00 6,748.38 110.00 6,741.85 110.00 6,735.32 110.00 6,728.78 $1,812,000 $1,812,500 110.00 6,769.86 110.00 6,763.33 110.00 6,756.79 110.00 6,750.26 110.00 6,743.73 110.00 6,737.19 110.00 6,730.66 $1,812,500 $1,813,000 110.00 6,771.73 110.00 6,765.20 110.00 6,758.67 110.00 6,752.13 110.00 6,745.60 110.00 6,739.07 110.00 6,732.53 $1,813,000 $1,813,500 110.00 6,773.61 110.00 6,767.08 110.00 6,760.54 110.00 6,754.01 110.00 6,747.48 110.00 6,740.94 110.00 6,734.41 $1,813,500 $1,814,000 110.00 6,775.48 110.00 6,768.95 110.00 6,762.42 110.00 6,755.88 110.00 6,749.35 110.00 6,742.82 110.00 6,736.28 $1,814,000 $1,814,500 110.00 6,777.36 110.00 6,770.83 110.00 6,764.29 110.00 6,757.76 110.00 6,751.23 110.00 6,744.69 110.00 6,738.16 $1,814,500 $1,815,000 110.00 6,779.23 110.00 6,772.70 110.00 6,766.17 110.00 6,759.63 110.00 6,753.10 110.00 6,746.57 110.00 6,740.03 $1,815,000 $1,815,500 110.00 6,781.11 110.00 6,774.58 110.00 6,768.04 110.00 6,761.51 110.00 6,754.98 110.00 6,748.44 110.00 6,741.91 $1,815,500 $1,816,000 110.00 6,782.98 110.00 6,776.45 110.00 6,769.92 110.00 6,763.38 110.00 6,756.85 110.00 6,750.32 110.00 6,743.78 $1,816,000 $1,816,500 110.00 6,784.86 110.00 6,778.33 110.00 6,771.79 110.00 6,765.26 110.00 6,758.73 110.00 6,752.19 110.00 6,745.66 $1,816,500 $1,817,000 110.00 6,786.73 110.00 6,780.20 110.00 6,773.67 110.00 6,767.13 110.00 6,760.60 110.00 6,754.07 110.00 6,747.53 $1,817,000 $1,817,500 110.00 6,788.61 110.00 6,782.08 110.00 6,775.54 110.00 6,769.01 110.00 6,762.48 110.00 6,755.94 110.00 6,749.41 $1,817,500 $1,818,000 110.00 6,790.48 110.00 6,783.95 110.00 6,777.42 110.00 6,770.88 110.00 6,764.35 110.00 6,757.82 110.00 6,751.28 $1,818,000 $1,818,500 110.00 6,792.36 110.00 6,785.83 110.00 6,779.29 110.00 6,772.76 110.00 6,766.23 110.00 6,759.69 110.00 6,753.16 $1,818,500 $1,819,000 110.00 6,794.23 110.00 6,787.70 110.00 6,781.17 110.00 6,774.63 110.00 6,768.10 110.00 6,761.57 110.00 6,755.03 $1,819,000 $1,819,500 110.00 6,796.11 110.00 6,789.58 110.00 6,783.04 110.00 6,776.51 110.00 6,769.98 110.00 6,763.44 110.00 6,756.91 $1,819,500 $1,820,000 110.00 6,797.98 110.00 6,791.45 110.00 6,784.92 110.00 6,778.38 110.00 6,771.85 110.00 6,765.32 110.00 6,758.78 $1,820,000 $1,820,500 110.00 6,799.86 110.00 6,793.33 110.00 6,786.79 110.00 6,780.26 110.00 6,773.73 110.00 6,767.19 110.00 6,760.66 $1,820,500 $1,821,000 110.00 6,801.73 110.00 6,795.20 110.00 6,788.67 110.00 6,782.13 110.00 6,775.60 110.00 6,769.07 110.00 6,762.53 $1,821,000 $1,821,500 110.00 6,803.61 110.00 6,797.08 110.00 6,790.54 110.00 6,784.01 110.00 6,777.48 110.00 6,770.94 110.00 6,764.41 $1,821,500 $1,822,000 110.00 6,805.48 110.00 6,798.95 110.00 6,792.42 110.00 6,785.88 110.00 6,779.35 110.00 6,772.82 110.00 6,766.28 $1,822,000 $1,822,500 110.00 6,807.36 110.00 6,800.83 110.00 6,794.29 110.00 6,787.76 110.00 6,781.23 110.00 6,774.69 110.00 6,768.16 $1,822,500 $1,823,000 110.00 6,809.23 110.00 6,802.70 110.00 6,796.17 110.00 6,789.63 110.00 6,783.10 110.00 6,776.57 110.00 6,770.03 $1,823,000 $1,823,500 110.00 6,811.11 110.00 6,804.58 110.00 6,798.04 110.00 6,791.51 110.00 6,784.98 110.00 6,778.44 110.00 6,771.91 $1,823,500 $1,824,000 110.00 6,812.98 110.00 6,806.45 110.00 6,799.92 110.00 6,793.38 110.00 6,786.85 110.00 6,780.32 110.00 6,773.78 $1,824,000 $1,824,500 110.00 6,814.86 110.00 6,808.33 110.00 6,801.79 110.00 6,795.26 110.00 6,788.73 110.00 6,782.19 110.00 6,775.66 $1,824,500 $1,825,000 110.00 6,816.73 110.00 6,810.20 110.00 6,803.67 110.00 6,797.13 110.00 6,790.60 110.00 6,784.07 110.00 6,777.53 $1,825,000 $1,825,500 110.00 6,818.61 110.00 6,812.08 110.00 6,805.54 110.00 6,799.01 110.00 6,792.48 110.00 6,785.94 110.00 6,779.41 $1,825,500 $1,826,000 110.00 6,820.48 110.00 6,813.95 110.00 6,807.42 110.00 6,800.88 110.00 6,794.35 110.00 6,787.82 110.00 6,781.28 $1,826,000 $1,826,500 110.00 6,822.36 110.00 6,815.83 110.00 6,809.29 110.00 6,802.76 110.00 6,796.23 110.00 6,789.69 110.00 6,783.16 $1,826,500 $1,827,000 110.00 6,824.23 110.00 6,817.70 110.00 6,811.17 110.00 6,804.63 110.00 6,798.10 110.00 6,791.57 110.00 6,785.03 $1,827,000 $1,827,500 110.00 6,826.11 110.00 6,819.58 110.00 6,813.04 110.00 6,806.51 110.00 6,799.98 110.00 6,793.44 110.00 6,786.91 $1,827,500 $1,828,000 110.00 6,827.98 110.00 6,821.45 110.00 6,814.92 110.00 6,808.38 110.00 6,801.85 110.00 6,795.32 110.00 6,788.78 $1,828,000 $1,828,500 110.00 6,829.86 110.00 6,823.33 110.00 6,816.79 110.00 6,810.26 110.00 6,803.73 110.00 6,797.19 110.00 6,790.66 $1,828,500 $1,829,000 110.00 6,831.73 110.00 6,825.20 110.00 6,818.67 110.00 6,812.13 110.00 6,805.60 110.00 6,799.07 110.00 6,792.53 $1,829,000 $1,829,500 110.00 6,833.61 110.00 6,827.08 110.00 6,820.54 110.00 6,814.01 110.00 6,807.48 110.00 6,800.94 110.00 6,794.41 $1,829,500 $1,830,000 110.00 6,835.48 110.00 6,828.95 110.00 6,822.42 110.00 6,815.88 110.00 6,809.35 110.00 6,802.82 110.00 6,796.28 $1,830,000 $1,830,500 110.00 6,837.36 110.00 6,830.83 110.00 6,824.29 110.00 6,817.76 110.00 6,811.23 110.00 6,804.69 110.00 6,798.16 $1,830,500 $1,831,000 110.00 6,839.23 110.00 6,832.70 110.00 6,826.17 110.00 6,819.63 110.00 6,813.10 110.00 6,806.57 110.00 6,800.03 $1,831,000 $1,831,500 110.00 6,841.11 110.00 6,834.58 110.00 6,828.04 110.00 6,821.51 110.00 6,814.98 110.00 6,808.44 110.00 6,801.91 $1,831,500 $1,832,000 110.00 6,842.98 110.00 6,836.45 110.00 6,829.92 110.00 6,823.38 110.00 6,816.85 110.00 6,810.32 110.00 6,803.78 $1,832,000 $1,832,500 110.00 6,844.86 110.00 6,838.33 110.00 6,831.79 110.00 6,825.26 110.00 6,818.73 110.00 6,812.19 110.00 6,805.66 $1,832,500 $1,833,000 110.00 6,846.73 110.00 6,840.20 110.00 6,833.67 110.00 6,827.13 110.00 6,820.60 110.00 6,814.07 110.00 6,807.53 $1,833,000 $1,833,500 110.00 6,848.61 110.00 6,842.08 110.00 6,835.54 110.00 6,829.01 110.00 6,822.48 110.00 6,815.94 110.00 6,809.41 $1,833,500 $1,834,000 110.00 6,850.48 110.00 6,843.95 110.00 6,837.42 110.00 6,830.88 110.00 6,824.35 110.00 6,817.82 110.00 6,811.28 $1,834,000 $1,834,500 110.00 6,852.36 110.00 6,845.83 110.00 6,839.29 110.00 6,832.76 110.00 6,826.23 110.00 6,819.69 110.00 6,813.16 $1,834,500 $1,835,000 110.00 6,854.23 110.00 6,847.70 110.00 6,841.17 110.00 6,834.63 110.00 6,828.10 110.00 6,821.57 110.00 6,815.03 $1,835,000 $1,835,500 110.00 6,856.11 110.00 6,849.58 110.00 6,843.04 110.00 6,836.51 110.00 6,829.98 110.00 6,823.44 110.00 6,816.91 $1,835,500 $1,836,000 110.00 6,857.98 110.00 6,851.45 110.00 6,844.92 110.00 6,838.38 110.00 6,831.85 110.00 6,825.32 110.00 6,818.78

NJEIS Family Cost Participation Table Page 39 of 12 Effective July 1, 2015

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

$1,836,000 $1,836,500 110.00 6,859.86 110.00 6,853.33 110.00 6,846.79 110.00 6,840.26 110.00 6,833.73 110.00 6,827.19 110.00 6,820.66 $1,836,500 $1,837,000 110.00 6,861.73 110.00 6,855.20 110.00 6,848.67 110.00 6,842.13 110.00 6,835.60 110.00 6,829.07 110.00 6,822.53 $1,837,000 $1,837,500 110.00 6,863.61 110.00 6,857.08 110.00 6,850.54 110.00 6,844.01 110.00 6,837.48 110.00 6,830.94 110.00 6,824.41 $1,837,500 $1,838,000 110.00 6,865.48 110.00 6,858.95 110.00 6,852.42 110.00 6,845.88 110.00 6,839.35 110.00 6,832.82 110.00 6,826.28 $1,838,000 $1,838,500 110.00 6,867.36 110.00 6,860.83 110.00 6,854.29 110.00 6,847.76 110.00 6,841.23 110.00 6,834.69 110.00 6,828.16 $1,838,500 $1,839,000 110.00 6,869.23 110.00 6,862.70 110.00 6,856.17 110.00 6,849.63 110.00 6,843.10 110.00 6,836.57 110.00 6,830.03 $1,839,000 $1,839,500 110.00 6,871.11 110.00 6,864.58 110.00 6,858.04 110.00 6,851.51 110.00 6,844.98 110.00 6,838.44 110.00 6,831.91 $1,839,500 $1,840,000 110.00 6,872.98 110.00 6,866.45 110.00 6,859.92 110.00 6,853.38 110.00 6,846.85 110.00 6,840.32 110.00 6,833.78 $1,840,000 $1,840,500 110.00 6,874.86 110.00 6,868.33 110.00 6,861.79 110.00 6,855.26 110.00 6,848.73 110.00 6,842.19 110.00 6,835.66 $1,840,500 $1,841,000 110.00 6,876.73 110.00 6,870.20 110.00 6,863.67 110.00 6,857.13 110.00 6,850.60 110.00 6,844.07 110.00 6,837.53 $1,841,000 $1,841,500 110.00 6,878.61 110.00 6,872.08 110.00 6,865.54 110.00 6,859.01 110.00 6,852.48 110.00 6,845.94 110.00 6,839.41 $1,841,500 $1,842,000 110.00 6,880.48 110.00 6,873.95 110.00 6,867.42 110.00 6,860.88 110.00 6,854.35 110.00 6,847.82 110.00 6,841.28 $1,842,000 $1,842,500 110.00 6,882.36 110.00 6,875.83 110.00 6,869.29 110.00 6,862.76 110.00 6,856.23 110.00 6,849.69 110.00 6,843.16 $1,842,500 $1,843,000 110.00 6,884.23 110.00 6,877.70 110.00 6,871.17 110.00 6,864.63 110.00 6,858.10 110.00 6,851.57 110.00 6,845.03 $1,843,000 $1,843,500 110.00 6,886.11 110.00 6,879.58 110.00 6,873.04 110.00 6,866.51 110.00 6,859.98 110.00 6,853.44 110.00 6,846.91 $1,843,500 $1,844,000 110.00 6,887.98 110.00 6,881.45 110.00 6,874.92 110.00 6,868.38 110.00 6,861.85 110.00 6,855.32 110.00 6,848.78 $1,844,000 $1,844,500 110.00 6,889.86 110.00 6,883.33 110.00 6,876.79 110.00 6,870.26 110.00 6,863.73 110.00 6,857.19 110.00 6,850.66 $1,844,500 $1,845,000 110.00 6,891.73 110.00 6,885.20 110.00 6,878.67 110.00 6,872.13 110.00 6,865.60 110.00 6,859.07 110.00 6,852.53 $1,845,000 $1,845,500 110.00 6,893.61 110.00 6,887.08 110.00 6,880.54 110.00 6,874.01 110.00 6,867.48 110.00 6,860.94 110.00 6,854.41 $1,845,500 $1,846,000 110.00 6,895.48 110.00 6,888.95 110.00 6,882.42 110.00 6,875.88 110.00 6,869.35 110.00 6,862.82 110.00 6,856.28 $1,846,000 $1,846,500 110.00 6,897.36 110.00 6,890.83 110.00 6,884.29 110.00 6,877.76 110.00 6,871.23 110.00 6,864.69 110.00 6,858.16 $1,846,500 $1,847,000 110.00 6,899.23 110.00 6,892.70 110.00 6,886.17 110.00 6,879.63 110.00 6,873.10 110.00 6,866.57 110.00 6,860.03 $1,847,000 $1,847,500 110.00 6,901.11 110.00 6,894.58 110.00 6,888.04 110.00 6,881.51 110.00 6,874.98 110.00 6,868.44 110.00 6,861.91 $1,847,500 $1,848,000 110.00 6,902.98 110.00 6,896.45 110.00 6,889.92 110.00 6,883.38 110.00 6,876.85 110.00 6,870.32 110.00 6,863.78 $1,848,000 $1,848,500 110.00 6,904.86 110.00 6,898.33 110.00 6,891.79 110.00 6,885.26 110.00 6,878.73 110.00 6,872.19 110.00 6,865.66 $1,848,500 $1,849,000 110.00 6,906.73 110.00 6,900.20 110.00 6,893.67 110.00 6,887.13 110.00 6,880.60 110.00 6,874.07 110.00 6,867.53 $1,849,000 $1,849,500 110.00 6,908.61 110.00 6,902.08 110.00 6,895.54 110.00 6,889.01 110.00 6,882.48 110.00 6,875.94 110.00 6,869.41 $1,849,500 $1,850,000 110.00 6,910.48 110.00 6,903.95 110.00 6,897.42 110.00 6,890.88 110.00 6,884.35 110.00 6,877.82 110.00 6,871.28 $1,850,000 $1,850,500 110.00 6,912.36 110.00 6,905.83 110.00 6,899.29 110.00 6,892.76 110.00 6,886.23 110.00 6,879.69 110.00 6,873.16 $1,850,500 $1,851,000 110.00 6,914.23 110.00 6,907.70 110.00 6,901.17 110.00 6,894.63 110.00 6,888.10 110.00 6,881.57 110.00 6,875.03 $1,851,000 $1,851,500 110.00 6,916.11 110.00 6,909.58 110.00 6,903.04 110.00 6,896.51 110.00 6,889.98 110.00 6,883.44 110.00 6,876.91 $1,851,500 $1,852,000 110.00 6,917.98 110.00 6,911.45 110.00 6,904.92 110.00 6,898.38 110.00 6,891.85 110.00 6,885.32 110.00 6,878.78 $1,852,000 $1,852,500 110.00 6,919.86 110.00 6,913.33 110.00 6,906.79 110.00 6,900.26 110.00 6,893.73 110.00 6,887.19 110.00 6,880.66 $1,852,500 $1,853,000 110.00 6,921.73 110.00 6,915.20 110.00 6,908.67 110.00 6,902.13 110.00 6,895.60 110.00 6,889.07 110.00 6,882.53 $1,853,000 $1,853,500 110.00 6,923.61 110.00 6,917.08 110.00 6,910.54 110.00 6,904.01 110.00 6,897.48 110.00 6,890.94 110.00 6,884.41 $1,853,500 $1,854,000 110.00 6,925.48 110.00 6,918.95 110.00 6,912.42 110.00 6,905.88 110.00 6,899.35 110.00 6,892.82 110.00 6,886.28 $1,854,000 $1,854,500 110.00 6,927.36 110.00 6,920.83 110.00 6,914.29 110.00 6,907.76 110.00 6,901.23 110.00 6,894.69 110.00 6,888.16 $1,854,500 $1,855,000 110.00 6,929.23 110.00 6,922.70 110.00 6,916.17 110.00 6,909.63 110.00 6,903.10 110.00 6,896.57 110.00 6,890.03 $1,855,000 $1,855,500 110.00 6,931.11 110.00 6,924.58 110.00 6,918.04 110.00 6,911.51 110.00 6,904.98 110.00 6,898.44 110.00 6,891.91 $1,855,500 $1,856,000 110.00 6,932.98 110.00 6,926.45 110.00 6,919.92 110.00 6,913.38 110.00 6,906.85 110.00 6,900.32 110.00 6,893.78 $1,856,000 $1,856,500 110.00 6,934.86 110.00 6,928.33 110.00 6,921.79 110.00 6,915.26 110.00 6,908.73 110.00 6,902.19 110.00 6,895.66 $1,856,500 $1,857,000 110.00 6,936.73 110.00 6,930.20 110.00 6,923.67 110.00 6,917.13 110.00 6,910.60 110.00 6,904.07 110.00 6,897.53 $1,857,000 $1,857,500 110.00 6,938.61 110.00 6,932.08 110.00 6,925.54 110.00 6,919.01 110.00 6,912.48 110.00 6,905.94 110.00 6,899.41 $1,857,500 $1,858,000 110.00 6,940.48 110.00 6,933.95 110.00 6,927.42 110.00 6,920.88 110.00 6,914.35 110.00 6,907.82 110.00 6,901.28 $1,858,000 $1,858,500 110.00 6,942.36 110.00 6,935.83 110.00 6,929.29 110.00 6,922.76 110.00 6,916.23 110.00 6,909.69 110.00 6,903.16 $1,858,500 $1,859,000 110.00 6,944.23 110.00 6,937.70 110.00 6,931.17 110.00 6,924.63 110.00 6,918.10 110.00 6,911.57 110.00 6,905.03 $1,859,000 $1,859,500 110.00 6,946.11 110.00 6,939.58 110.00 6,933.04 110.00 6,926.51 110.00 6,919.98 110.00 6,913.44 110.00 6,906.91 $1,859,500 $1,860,000 110.00 6,947.98 110.00 6,941.45 110.00 6,934.92 110.00 6,928.38 110.00 6,921.85 110.00 6,915.32 110.00 6,908.78 $1,860,000 $1,860,500 110.00 6,949.86 110.00 6,943.33 110.00 6,936.79 110.00 6,930.26 110.00 6,923.73 110.00 6,917.19 110.00 6,910.66 $1,860,500 $1,861,000 110.00 6,951.73 110.00 6,945.20 110.00 6,938.67 110.00 6,932.13 110.00 6,925.60 110.00 6,919.07 110.00 6,912.53 $1,861,000 $1,861,500 110.00 6,953.61 110.00 6,947.08 110.00 6,940.54 110.00 6,934.01 110.00 6,927.48 110.00 6,920.94 110.00 6,914.41 $1,861,500 $1,862,000 110.00 6,955.48 110.00 6,948.95 110.00 6,942.42 110.00 6,935.88 110.00 6,929.35 110.00 6,922.82 110.00 6,916.28 $1,862,000 $1,862,500 110.00 6,957.36 110.00 6,950.83 110.00 6,944.29 110.00 6,937.76 110.00 6,931.23 110.00 6,924.69 110.00 6,918.16 $1,862,500 $1,863,000 110.00 6,959.23 110.00 6,952.70 110.00 6,946.17 110.00 6,939.63 110.00 6,933.10 110.00 6,926.57 110.00 6,920.03 $1,863,000 $1,863,500 110.00 6,961.11 110.00 6,954.58 110.00 6,948.04 110.00 6,941.51 110.00 6,934.98 110.00 6,928.44 110.00 6,921.91 $1,863,500 $1,864,000 110.00 6,962.98 110.00 6,956.45 110.00 6,949.92 110.00 6,943.38 110.00 6,936.85 110.00 6,930.32 110.00 6,923.78 $1,864,000 $1,864,500 110.00 6,964.86 110.00 6,958.33 110.00 6,951.79 110.00 6,945.26 110.00 6,938.73 110.00 6,932.19 110.00 6,925.66 $1,864,500 $1,865,000 110.00 6,966.73 110.00 6,960.20 110.00 6,953.67 110.00 6,947.13 110.00 6,940.60 110.00 6,934.07 110.00 6,927.53 $1,865,000 $1,865,500 110.00 6,968.61 110.00 6,962.08 110.00 6,955.54 110.00 6,949.01 110.00 6,942.48 110.00 6,935.94 110.00 6,929.41 $1,865,500 $1,866,000 110.00 6,970.48 110.00 6,963.95 110.00 6,957.42 110.00 6,950.88 110.00 6,944.35 110.00 6,937.82 110.00 6,931.28 $1,866,000 $1,866,500 110.00 6,972.36 110.00 6,965.83 110.00 6,959.29 110.00 6,952.76 110.00 6,946.23 110.00 6,939.69 110.00 6,933.16 $1,866,500 $1,867,000 110.00 6,974.23 110.00 6,967.70 110.00 6,961.17 110.00 6,954.63 110.00 6,948.10 110.00 6,941.57 110.00 6,935.03 $1,867,000 $1,867,500 110.00 6,976.11 110.00 6,969.58 110.00 6,963.04 110.00 6,956.51 110.00 6,949.98 110.00 6,943.44 110.00 6,936.91 $1,867,500 $1,868,000 110.00 6,977.98 110.00 6,971.45 110.00 6,964.92 110.00 6,958.38 110.00 6,951.85 110.00 6,945.32 110.00 6,938.78 $1,868,000 $1,868,500 110.00 6,979.86 110.00 6,973.33 110.00 6,966.79 110.00 6,960.26 110.00 6,953.73 110.00 6,947.19 110.00 6,940.66 $1,868,500 $1,869,000 110.00 6,981.73 110.00 6,975.20 110.00 6,968.67 110.00 6,962.13 110.00 6,955.60 110.00 6,949.07 110.00 6,942.53 $1,869,000 $1,869,500 110.00 6,983.61 110.00 6,977.08 110.00 6,970.54 110.00 6,964.01 110.00 6,957.48 110.00 6,950.94 110.00 6,944.41 $1,869,500 $1,870,000 110.00 6,985.48 110.00 6,978.95 110.00 6,972.42 110.00 6,965.88 110.00 6,959.35 110.00 6,952.82 110.00 6,946.28 $1,870,000 $1,870,500 110.00 6,987.36 110.00 6,980.83 110.00 6,974.29 110.00 6,967.76 110.00 6,961.23 110.00 6,954.69 110.00 6,948.16 $1,870,500 $1,871,000 110.00 6,989.23 110.00 6,982.70 110.00 6,976.17 110.00 6,969.63 110.00 6,963.10 110.00 6,956.57 110.00 6,950.03 $1,871,000 $1,871,500 110.00 6,991.11 110.00 6,984.58 110.00 6,978.04 110.00 6,971.51 110.00 6,964.98 110.00 6,958.44 110.00 6,951.91 $1,871,500 $1,872,000 110.00 6,992.98 110.00 6,986.45 110.00 6,979.92 110.00 6,973.38 110.00 6,966.85 110.00 6,960.32 110.00 6,953.78 $1,872,000 $1,872,500 110.00 6,994.86 110.00 6,988.33 110.00 6,981.79 110.00 6,975.26 110.00 6,968.73 110.00 6,962.19 110.00 6,955.66 $1,872,500 $1,873,000 110.00 6,996.73 110.00 6,990.20 110.00 6,983.67 110.00 6,977.13 110.00 6,970.60 110.00 6,964.07 110.00 6,957.53 $1,873,000 $1,873,500 110.00 6,998.61 110.00 6,992.08 110.00 6,985.54 110.00 6,979.01 110.00 6,972.48 110.00 6,965.94 110.00 6,959.41 $1,873,500 $1,874,000 110.00 7,000.48 110.00 6,993.95 110.00 6,987.42 110.00 6,980.88 110.00 6,974.35 110.00 6,967.82 110.00 6,961.28 $1,874,000 $1,874,500 110.00 7,002.36 110.00 6,995.83 110.00 6,989.29 110.00 6,982.76 110.00 6,976.23 110.00 6,969.69 110.00 6,963.16 $1,874,500 $1,875,000 110.00 7,004.23 110.00 6,997.70 110.00 6,991.17 110.00 6,984.63 110.00 6,978.10 110.00 6,971.57 110.00 6,965.03 $1,875,000 $1,875,500 110.00 7,006.11 110.00 6,999.58 110.00 6,993.04 110.00 6,986.51 110.00 6,979.98 110.00 6,973.44 110.00 6,966.91 $1,875,500 $1,876,000 110.00 7,007.98 110.00 7,001.45 110.00 6,994.92 110.00 6,988.38 110.00 6,981.85 110.00 6,975.32 110.00 6,968.78 $1,876,000 $1,876,500 110.00 7,009.86 110.00 7,003.33 110.00 6,996.79 110.00 6,990.26 110.00 6,983.73 110.00 6,977.19 110.00 6,970.66 $1,876,500 $1,877,000 110.00 7,011.73 110.00 7,005.20 110.00 6,998.67 110.00 6,992.13 110.00 6,985.60 110.00 6,979.07 110.00 6,972.53 $1,877,000 $1,877,500 110.00 7,013.61 110.00 7,007.08 110.00 7,000.54 110.00 6,994.01 110.00 6,987.48 110.00 6,980.94 110.00 6,974.41 $1,877,500 $1,878,000 110.00 7,015.48 110.00 7,008.95 110.00 7,002.42 110.00 6,995.88 110.00 6,989.35 110.00 6,982.82 110.00 6,976.28 $1,878,000 $1,878,500 110.00 7,017.36 110.00 7,010.83 110.00 7,004.29 110.00 6,997.76 110.00 6,991.23 110.00 6,984.69 110.00 6,978.16 $1,878,500 $1,879,000 110.00 7,019.23 110.00 7,012.70 110.00 7,006.17 110.00 6,999.63 110.00 6,993.10 110.00 6,986.57 110.00 6,980.03 $1,879,000 $1,879,500 110.00 7,021.11 110.00 7,014.58 110.00 7,008.04 110.00 7,001.51 110.00 6,994.98 110.00 6,988.44 110.00 6,981.91 $1,879,500 $1,880,000 110.00 7,022.98 110.00 7,016.45 110.00 7,009.92 110.00 7,003.38 110.00 6,996.85 110.00 6,990.32 110.00 6,983.78 $1,880,000 $1,880,500 110.00 7,024.86 110.00 7,018.33 110.00 7,011.79 110.00 7,005.26 110.00 6,998.73 110.00 6,992.19 110.00 6,985.66 $1,880,500 $1,881,000 110.00 7,026.73 110.00 7,020.20 110.00 7,013.67 110.00 7,007.13 110.00 7,000.60 110.00 6,994.07 110.00 6,987.53 $1,881,000 $1,881,500 110.00 7,028.61 110.00 7,022.08 110.00 7,015.54 110.00 7,009.01 110.00 7,002.48 110.00 6,995.94 110.00 6,989.41 $1,881,500 $1,882,000 110.00 7,030.48 110.00 7,023.95 110.00 7,017.42 110.00 7,010.88 110.00 7,004.35 110.00 6,997.82 110.00 6,991.28 $1,882,000 $1,882,500 110.00 7,032.36 110.00 7,025.83 110.00 7,019.29 110.00 7,012.76 110.00 7,006.23 110.00 6,999.69 110.00 6,993.16 $1,882,500 $1,883,000 110.00 7,034.23 110.00 7,027.70 110.00 7,021.17 110.00 7,014.63 110.00 7,008.10 110.00 7,001.57 110.00 6,995.03 $1,883,000 $1,883,500 110.00 7,036.11 110.00 7,029.58 110.00 7,023.04 110.00 7,016.51 110.00 7,009.98 110.00 7,003.44 110.00 6,996.91 $1,883,500 $1,884,000 110.00 7,037.98 110.00 7,031.45 110.00 7,024.92 110.00 7,018.38 110.00 7,011.85 110.00 7,005.32 110.00 6,998.78 $1,884,000 $1,884,500 110.00 7,039.86 110.00 7,033.33 110.00 7,026.79 110.00 7,020.26 110.00 7,013.73 110.00 7,007.19 110.00 7,000.66 $1,884,500 $1,885,000 110.00 7,041.73 110.00 7,035.20 110.00 7,028.67 110.00 7,022.13 110.00 7,015.60 110.00 7,009.07 110.00 7,002.53 $1,885,000 $1,885,500 110.00 7,043.61 110.00 7,037.08 110.00 7,030.54 110.00 7,024.01 110.00 7,017.48 110.00 7,010.94 110.00 7,004.41 $1,885,500 $1,886,000 110.00 7,045.48 110.00 7,038.95 110.00 7,032.42 110.00 7,025.88 110.00 7,019.35 110.00 7,012.82 110.00 7,006.28 $1,886,000 $1,886,500 110.00 7,047.36 110.00 7,040.83 110.00 7,034.29 110.00 7,027.76 110.00 7,021.23 110.00 7,014.69 110.00 7,008.16 $1,886,500 $1,887,000 110.00 7,049.23 110.00 7,042.70 110.00 7,036.17 110.00 7,029.63 110.00 7,023.10 110.00 7,016.57 110.00 7,010.03

NJEIS Family Cost Participation Table Page 40 of 12 Effective July 1, 2015

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

$1,887,000 $1,887,500 110.00 7,051.11 110.00 7,044.58 110.00 7,038.04 110.00 7,031.51 110.00 7,024.98 110.00 7,018.44 110.00 7,011.91 $1,887,500 $1,888,000 110.00 7,052.98 110.00 7,046.45 110.00 7,039.92 110.00 7,033.38 110.00 7,026.85 110.00 7,020.32 110.00 7,013.78 $1,888,000 $1,888,500 110.00 7,054.86 110.00 7,048.33 110.00 7,041.79 110.00 7,035.26 110.00 7,028.73 110.00 7,022.19 110.00 7,015.66 $1,888,500 $1,889,000 110.00 7,056.73 110.00 7,050.20 110.00 7,043.67 110.00 7,037.13 110.00 7,030.60 110.00 7,024.07 110.00 7,017.53 $1,889,000 $1,889,500 110.00 7,058.61 110.00 7,052.08 110.00 7,045.54 110.00 7,039.01 110.00 7,032.48 110.00 7,025.94 110.00 7,019.41 $1,889,500 $1,890,000 110.00 7,060.48 110.00 7,053.95 110.00 7,047.42 110.00 7,040.88 110.00 7,034.35 110.00 7,027.82 110.00 7,021.28 $1,890,000 $1,890,500 110.00 7,062.36 110.00 7,055.83 110.00 7,049.29 110.00 7,042.76 110.00 7,036.23 110.00 7,029.69 110.00 7,023.16 $1,890,500 $1,891,000 110.00 7,064.23 110.00 7,057.70 110.00 7,051.17 110.00 7,044.63 110.00 7,038.10 110.00 7,031.57 110.00 7,025.03 $1,891,000 $1,891,500 110.00 7,066.11 110.00 7,059.58 110.00 7,053.04 110.00 7,046.51 110.00 7,039.98 110.00 7,033.44 110.00 7,026.91 $1,891,500 $1,892,000 110.00 7,067.98 110.00 7,061.45 110.00 7,054.92 110.00 7,048.38 110.00 7,041.85 110.00 7,035.32 110.00 7,028.78 $1,892,000 $1,892,500 110.00 7,069.86 110.00 7,063.33 110.00 7,056.79 110.00 7,050.26 110.00 7,043.73 110.00 7,037.19 110.00 7,030.66 $1,892,500 $1,893,000 110.00 7,071.73 110.00 7,065.20 110.00 7,058.67 110.00 7,052.13 110.00 7,045.60 110.00 7,039.07 110.00 7,032.53 $1,893,000 $1,893,500 110.00 7,073.61 110.00 7,067.08 110.00 7,060.54 110.00 7,054.01 110.00 7,047.48 110.00 7,040.94 110.00 7,034.41 $1,893,500 $1,894,000 110.00 7,075.48 110.00 7,068.95 110.00 7,062.42 110.00 7,055.88 110.00 7,049.35 110.00 7,042.82 110.00 7,036.28 $1,894,000 $1,894,500 110.00 7,077.36 110.00 7,070.83 110.00 7,064.29 110.00 7,057.76 110.00 7,051.23 110.00 7,044.69 110.00 7,038.16 $1,894,500 $1,895,000 110.00 7,079.23 110.00 7,072.70 110.00 7,066.17 110.00 7,059.63 110.00 7,053.10 110.00 7,046.57 110.00 7,040.03 $1,895,000 $1,895,500 110.00 7,081.11 110.00 7,074.58 110.00 7,068.04 110.00 7,061.51 110.00 7,054.98 110.00 7,048.44 110.00 7,041.91 $1,895,500 $1,896,000 110.00 7,082.98 110.00 7,076.45 110.00 7,069.92 110.00 7,063.38 110.00 7,056.85 110.00 7,050.32 110.00 7,043.78 $1,896,000 $1,896,500 110.00 7,084.86 110.00 7,078.33 110.00 7,071.79 110.00 7,065.26 110.00 7,058.73 110.00 7,052.19 110.00 7,045.66 $1,896,500 $1,897,000 110.00 7,086.73 110.00 7,080.20 110.00 7,073.67 110.00 7,067.13 110.00 7,060.60 110.00 7,054.07 110.00 7,047.53 $1,897,000 $1,897,500 110.00 7,088.61 110.00 7,082.08 110.00 7,075.54 110.00 7,069.01 110.00 7,062.48 110.00 7,055.94 110.00 7,049.41 $1,897,500 $1,898,000 110.00 7,090.48 110.00 7,083.95 110.00 7,077.42 110.00 7,070.88 110.00 7,064.35 110.00 7,057.82 110.00 7,051.28 $1,898,000 $1,898,500 110.00 7,092.36 110.00 7,085.83 110.00 7,079.29 110.00 7,072.76 110.00 7,066.23 110.00 7,059.69 110.00 7,053.16 $1,898,500 $1,899,000 110.00 7,094.23 110.00 7,087.70 110.00 7,081.17 110.00 7,074.63 110.00 7,068.10 110.00 7,061.57 110.00 7,055.03 $1,899,000 $1,899,500 110.00 7,096.11 110.00 7,089.58 110.00 7,083.04 110.00 7,076.51 110.00 7,069.98 110.00 7,063.44 110.00 7,056.91 $1,899,500 $1,900,000 110.00 7,097.98 110.00 7,091.45 110.00 7,084.92 110.00 7,078.38 110.00 7,071.85 110.00 7,065.32 110.00 7,058.78 $1,900,000 $1,900,500 110.00 7,099.86 110.00 7,093.33 110.00 7,086.79 110.00 7,080.26 110.00 7,073.73 110.00 7,067.19 110.00 7,060.66 $1,900,500 $1,901,000 110.00 7,101.73 110.00 7,095.20 110.00 7,088.67 110.00 7,082.13 110.00 7,075.60 110.00 7,069.07 110.00 7,062.53 $1,901,000 $1,901,500 110.00 7,103.61 110.00 7,097.08 110.00 7,090.54 110.00 7,084.01 110.00 7,077.48 110.00 7,070.94 110.00 7,064.41 $1,901,500 $1,902,000 110.00 7,105.48 110.00 7,098.95 110.00 7,092.42 110.00 7,085.88 110.00 7,079.35 110.00 7,072.82 110.00 7,066.28 $1,902,000 $1,902,500 110.00 7,107.36 110.00 7,100.83 110.00 7,094.29 110.00 7,087.76 110.00 7,081.23 110.00 7,074.69 110.00 7,068.16 $1,902,500 $1,903,000 110.00 7,109.23 110.00 7,102.70 110.00 7,096.17 110.00 7,089.63 110.00 7,083.10 110.00 7,076.57 110.00 7,070.03 $1,903,000 $1,903,500 110.00 7,111.11 110.00 7,104.58 110.00 7,098.04 110.00 7,091.51 110.00 7,084.98 110.00 7,078.44 110.00 7,071.91 $1,903,500 $1,904,000 110.00 7,112.98 110.00 7,106.45 110.00 7,099.92 110.00 7,093.38 110.00 7,086.85 110.00 7,080.32 110.00 7,073.78 $1,904,000 $1,904,500 110.00 7,114.86 110.00 7,108.33 110.00 7,101.79 110.00 7,095.26 110.00 7,088.73 110.00 7,082.19 110.00 7,075.66 $1,904,500 $1,905,000 110.00 7,116.73 110.00 7,110.20 110.00 7,103.67 110.00 7,097.13 110.00 7,090.60 110.00 7,084.07 110.00 7,077.53 $1,905,000 $1,905,500 110.00 7,118.61 110.00 7,112.08 110.00 7,105.54 110.00 7,099.01 110.00 7,092.48 110.00 7,085.94 110.00 7,079.41 $1,905,500 $1,906,000 110.00 7,120.48 110.00 7,113.95 110.00 7,107.42 110.00 7,100.88 110.00 7,094.35 110.00 7,087.82 110.00 7,081.28 $1,906,000 $1,906,500 110.00 7,122.36 110.00 7,115.83 110.00 7,109.29 110.00 7,102.76 110.00 7,096.23 110.00 7,089.69 110.00 7,083.16 $1,906,500 $1,907,000 110.00 7,124.23 110.00 7,117.70 110.00 7,111.17 110.00 7,104.63 110.00 7,098.10 110.00 7,091.57 110.00 7,085.03 $1,907,000 $1,907,500 110.00 7,126.11 110.00 7,119.58 110.00 7,113.04 110.00 7,106.51 110.00 7,099.98 110.00 7,093.44 110.00 7,086.91 $1,907,500 $1,908,000 110.00 7,127.98 110.00 7,121.45 110.00 7,114.92 110.00 7,108.38 110.00 7,101.85 110.00 7,095.32 110.00 7,088.78 $1,908,000 $1,908,500 110.00 7,129.86 110.00 7,123.33 110.00 7,116.79 110.00 7,110.26 110.00 7,103.73 110.00 7,097.19 110.00 7,090.66 $1,908,500 $1,909,000 110.00 7,131.73 110.00 7,125.20 110.00 7,118.67 110.00 7,112.13 110.00 7,105.60 110.00 7,099.07 110.00 7,092.53 $1,909,000 $1,909,500 110.00 7,133.61 110.00 7,127.08 110.00 7,120.54 110.00 7,114.01 110.00 7,107.48 110.00 7,100.94 110.00 7,094.41 $1,909,500 $1,910,000 110.00 7,135.48 110.00 7,128.95 110.00 7,122.42 110.00 7,115.88 110.00 7,109.35 110.00 7,102.82 110.00 7,096.28 $1,910,000 $1,910,500 110.00 7,137.36 110.00 7,130.83 110.00 7,124.29 110.00 7,117.76 110.00 7,111.23 110.00 7,104.69 110.00 7,098.16 $1,910,500 $1,911,000 110.00 7,139.23 110.00 7,132.70 110.00 7,126.17 110.00 7,119.63 110.00 7,113.10 110.00 7,106.57 110.00 7,100.03 $1,911,000 $1,911,500 110.00 7,141.11 110.00 7,134.58 110.00 7,128.04 110.00 7,121.51 110.00 7,114.98 110.00 7,108.44 110.00 7,101.91 $1,911,500 $1,912,000 110.00 7,142.98 110.00 7,136.45 110.00 7,129.92 110.00 7,123.38 110.00 7,116.85 110.00 7,110.32 110.00 7,103.78 $1,912,000 $1,912,500 110.00 7,144.86 110.00 7,138.33 110.00 7,131.79 110.00 7,125.26 110.00 7,118.73 110.00 7,112.19 110.00 7,105.66 $1,912,500 $1,913,000 110.00 7,146.73 110.00 7,140.20 110.00 7,133.67 110.00 7,127.13 110.00 7,120.60 110.00 7,114.07 110.00 7,107.53 $1,913,000 $1,913,500 110.00 7,148.61 110.00 7,142.08 110.00 7,135.54 110.00 7,129.01 110.00 7,122.48 110.00 7,115.94 110.00 7,109.41 $1,913,500 $1,914,000 110.00 7,150.48 110.00 7,143.95 110.00 7,137.42 110.00 7,130.88 110.00 7,124.35 110.00 7,117.82 110.00 7,111.28 $1,914,000 $1,914,500 110.00 7,152.36 110.00 7,145.83 110.00 7,139.29 110.00 7,132.76 110.00 7,126.23 110.00 7,119.69 110.00 7,113.16 $1,914,500 $1,915,000 110.00 7,154.23 110.00 7,147.70 110.00 7,141.17 110.00 7,134.63 110.00 7,128.10 110.00 7,121.57 110.00 7,115.03 $1,915,000 $1,915,500 110.00 7,156.11 110.00 7,149.58 110.00 7,143.04 110.00 7,136.51 110.00 7,129.98 110.00 7,123.44 110.00 7,116.91 $1,915,500 $1,916,000 110.00 7,157.98 110.00 7,151.45 110.00 7,144.92 110.00 7,138.38 110.00 7,131.85 110.00 7,125.32 110.00 7,118.78 $1,916,000 $1,916,500 110.00 7,159.86 110.00 7,153.33 110.00 7,146.79 110.00 7,140.26 110.00 7,133.73 110.00 7,127.19 110.00 7,120.66 $1,916,500 $1,917,000 110.00 7,161.73 110.00 7,155.20 110.00 7,148.67 110.00 7,142.13 110.00 7,135.60 110.00 7,129.07 110.00 7,122.53 $1,917,000 $1,917,500 110.00 7,163.61 110.00 7,157.08 110.00 7,150.54 110.00 7,144.01 110.00 7,137.48 110.00 7,130.94 110.00 7,124.41 $1,917,500 $1,918,000 110.00 7,165.48 110.00 7,158.95 110.00 7,152.42 110.00 7,145.88 110.00 7,139.35 110.00 7,132.82 110.00 7,126.28 $1,918,000 $1,918,500 110.00 7,167.36 110.00 7,160.83 110.00 7,154.29 110.00 7,147.76 110.00 7,141.23 110.00 7,134.69 110.00 7,128.16 $1,918,500 $1,919,000 110.00 7,169.23 110.00 7,162.70 110.00 7,156.17 110.00 7,149.63 110.00 7,143.10 110.00 7,136.57 110.00 7,130.03 $1,919,000 $1,919,500 110.00 7,171.11 110.00 7,164.58 110.00 7,158.04 110.00 7,151.51 110.00 7,144.98 110.00 7,138.44 110.00 7,131.91 $1,919,500 $1,920,000 110.00 7,172.98 110.00 7,166.45 110.00 7,159.92 110.00 7,153.38 110.00 7,146.85 110.00 7,140.32 110.00 7,133.78 $1,920,000 $1,920,500 110.00 7,174.86 110.00 7,168.33 110.00 7,161.79 110.00 7,155.26 110.00 7,148.73 110.00 7,142.19 110.00 7,135.66 $1,920,500 $1,921,000 110.00 7,176.73 110.00 7,170.20 110.00 7,163.67 110.00 7,157.13 110.00 7,150.60 110.00 7,144.07 110.00 7,137.53 $1,921,000 $1,921,500 110.00 7,178.61 110.00 7,172.08 110.00 7,165.54 110.00 7,159.01 110.00 7,152.48 110.00 7,145.94 110.00 7,139.41 $1,921,500 $1,922,000 110.00 7,180.48 110.00 7,173.95 110.00 7,167.42 110.00 7,160.88 110.00 7,154.35 110.00 7,147.82 110.00 7,141.28 $1,922,000 $1,922,500 110.00 7,182.36 110.00 7,175.83 110.00 7,169.29 110.00 7,162.76 110.00 7,156.23 110.00 7,149.69 110.00 7,143.16 $1,922,500 $1,923,000 110.00 7,184.23 110.00 7,177.70 110.00 7,171.17 110.00 7,164.63 110.00 7,158.10 110.00 7,151.57 110.00 7,145.03 $1,923,000 $1,923,500 110.00 7,186.11 110.00 7,179.58 110.00 7,173.04 110.00 7,166.51 110.00 7,159.98 110.00 7,153.44 110.00 7,146.91 $1,923,500 $1,924,000 110.00 7,187.98 110.00 7,181.45 110.00 7,174.92 110.00 7,168.38 110.00 7,161.85 110.00 7,155.32 110.00 7,148.78 $1,924,000 $1,924,500 110.00 7,189.86 110.00 7,183.33 110.00 7,176.79 110.00 7,170.26 110.00 7,163.73 110.00 7,157.19 110.00 7,150.66 $1,924,500 $1,925,000 110.00 7,191.73 110.00 7,185.20 110.00 7,178.67 110.00 7,172.13 110.00 7,165.60 110.00 7,159.07 110.00 7,152.53 $1,925,000 $1,925,500 110.00 7,193.61 110.00 7,187.08 110.00 7,180.54 110.00 7,174.01 110.00 7,167.48 110.00 7,160.94 110.00 7,154.41 $1,925,500 $1,926,000 110.00 7,195.48 110.00 7,188.95 110.00 7,182.42 110.00 7,175.88 110.00 7,169.35 110.00 7,162.82 110.00 7,156.28 $1,926,000 $1,926,500 110.00 7,197.36 110.00 7,190.83 110.00 7,184.29 110.00 7,177.76 110.00 7,171.23 110.00 7,164.69 110.00 7,158.16 $1,926,500 $1,927,000 110.00 7,199.23 110.00 7,192.70 110.00 7,186.17 110.00 7,179.63 110.00 7,173.10 110.00 7,166.57 110.00 7,160.03 $1,927,000 $1,927,500 110.00 7,201.11 110.00 7,194.58 110.00 7,188.04 110.00 7,181.51 110.00 7,174.98 110.00 7,168.44 110.00 7,161.91 $1,927,500 $1,928,000 110.00 7,202.98 110.00 7,196.45 110.00 7,189.92 110.00 7,183.38 110.00 7,176.85 110.00 7,170.32 110.00 7,163.78 $1,928,000 $1,928,500 110.00 7,204.86 110.00 7,198.33 110.00 7,191.79 110.00 7,185.26 110.00 7,178.73 110.00 7,172.19 110.00 7,165.66 $1,928,500 $1,929,000 110.00 7,206.73 110.00 7,200.20 110.00 7,193.67 110.00 7,187.13 110.00 7,180.60 110.00 7,174.07 110.00 7,167.53 $1,929,000 $1,929,500 110.00 7,208.61 110.00 7,202.08 110.00 7,195.54 110.00 7,189.01 110.00 7,182.48 110.00 7,175.94 110.00 7,169.41 $1,929,500 $1,930,000 110.00 7,210.48 110.00 7,203.95 110.00 7,197.42 110.00 7,190.88 110.00 7,184.35 110.00 7,177.82 110.00 7,171.28 $1,930,000 $1,930,500 110.00 7,212.36 110.00 7,205.83 110.00 7,199.29 110.00 7,192.76 110.00 7,186.23 110.00 7,179.69 110.00 7,173.16 $1,930,500 $1,931,000 110.00 7,214.23 110.00 7,207.70 110.00 7,201.17 110.00 7,194.63 110.00 7,188.10 110.00 7,181.57 110.00 7,175.03 $1,931,000 $1,931,500 110.00 7,216.11 110.00 7,209.58 110.00 7,203.04 110.00 7,196.51 110.00 7,189.98 110.00 7,183.44 110.00 7,176.91 $1,931,500 $1,932,000 110.00 7,217.98 110.00 7,211.45 110.00 7,204.92 110.00 7,198.38 110.00 7,191.85 110.00 7,185.32 110.00 7,178.78 $1,932,000 $1,932,500 110.00 7,219.86 110.00 7,213.33 110.00 7,206.79 110.00 7,200.26 110.00 7,193.73 110.00 7,187.19 110.00 7,180.66 $1,932,500 $1,933,000 110.00 7,221.73 110.00 7,215.20 110.00 7,208.67 110.00 7,202.13 110.00 7,195.60 110.00 7,189.07 110.00 7,182.53 $1,933,000 $1,933,500 110.00 7,223.61 110.00 7,217.08 110.00 7,210.54 110.00 7,204.01 110.00 7,197.48 110.00 7,190.94 110.00 7,184.41 $1,933,500 $1,934,000 110.00 7,225.48 110.00 7,218.95 110.00 7,212.42 110.00 7,205.88 110.00 7,199.35 110.00 7,192.82 110.00 7,186.28 $1,934,000 $1,934,500 110.00 7,227.36 110.00 7,220.83 110.00 7,214.29 110.00 7,207.76 110.00 7,201.23 110.00 7,194.69 110.00 7,188.16 $1,934,500 $1,935,000 110.00 7,229.23 110.00 7,222.70 110.00 7,216.17 110.00 7,209.63 110.00 7,203.10 110.00 7,196.57 110.00 7,190.03 $1,935,000 $1,935,500 110.00 7,231.11 110.00 7,224.58 110.00 7,218.04 110.00 7,211.51 110.00 7,204.98 110.00 7,198.44 110.00 7,191.91 $1,935,500 $1,936,000 110.00 7,232.98 110.00 7,226.45 110.00 7,219.92 110.00 7,213.38 110.00 7,206.85 110.00 7,200.32 110.00 7,193.78 $1,936,000 $1,936,500 110.00 7,234.86 110.00 7,228.33 110.00 7,221.79 110.00 7,215.26 110.00 7,208.73 110.00 7,202.19 110.00 7,195.66 $1,936,500 $1,937,000 110.00 7,236.73 110.00 7,230.20 110.00 7,223.67 110.00 7,217.13 110.00 7,210.60 110.00 7,204.07 110.00 7,197.53 $1,937,000 $1,937,500 110.00 7,238.61 110.00 7,232.08 110.00 7,225.54 110.00 7,219.01 110.00 7,212.48 110.00 7,205.94 110.00 7,199.41 $1,937,500 $1,938,000 110.00 7,240.48 110.00 7,233.95 110.00 7,227.42 110.00 7,220.88 110.00 7,214.35 110.00 7,207.82 110.00 7,201.28

NJEIS Family Cost Participation Table Page 41 of 12 Effective July 1, 2015

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

$1,938,000 $1,938,500 110.00 7,242.36 110.00 7,235.83 110.00 7,229.29 110.00 7,222.76 110.00 7,216.23 110.00 7,209.69 110.00 7,203.16 $1,938,500 $1,939,000 110.00 7,244.23 110.00 7,237.70 110.00 7,231.17 110.00 7,224.63 110.00 7,218.10 110.00 7,211.57 110.00 7,205.03 $1,939,000 $1,939,500 110.00 7,246.11 110.00 7,239.58 110.00 7,233.04 110.00 7,226.51 110.00 7,219.98 110.00 7,213.44 110.00 7,206.91 $1,939,500 $1,940,000 110.00 7,247.98 110.00 7,241.45 110.00 7,234.92 110.00 7,228.38 110.00 7,221.85 110.00 7,215.32 110.00 7,208.78 $1,940,000 $1,940,500 110.00 7,249.86 110.00 7,243.33 110.00 7,236.79 110.00 7,230.26 110.00 7,223.73 110.00 7,217.19 110.00 7,210.66 $1,940,500 $1,941,000 110.00 7,251.73 110.00 7,245.20 110.00 7,238.67 110.00 7,232.13 110.00 7,225.60 110.00 7,219.07 110.00 7,212.53 $1,941,000 $1,941,500 110.00 7,253.61 110.00 7,247.08 110.00 7,240.54 110.00 7,234.01 110.00 7,227.48 110.00 7,220.94 110.00 7,214.41 $1,941,500 $1,942,000 110.00 7,255.48 110.00 7,248.95 110.00 7,242.42 110.00 7,235.88 110.00 7,229.35 110.00 7,222.82 110.00 7,216.28 $1,942,000 $1,942,500 110.00 7,257.36 110.00 7,250.83 110.00 7,244.29 110.00 7,237.76 110.00 7,231.23 110.00 7,224.69 110.00 7,218.16 $1,942,500 $1,943,000 110.00 7,259.23 110.00 7,252.70 110.00 7,246.17 110.00 7,239.63 110.00 7,233.10 110.00 7,226.57 110.00 7,220.03 $1,943,000 $1,943,500 110.00 7,261.11 110.00 7,254.58 110.00 7,248.04 110.00 7,241.51 110.00 7,234.98 110.00 7,228.44 110.00 7,221.91 $1,943,500 $1,944,000 110.00 7,262.98 110.00 7,256.45 110.00 7,249.92 110.00 7,243.38 110.00 7,236.85 110.00 7,230.32 110.00 7,223.78 $1,944,000 $1,944,500 110.00 7,264.86 110.00 7,258.33 110.00 7,251.79 110.00 7,245.26 110.00 7,238.73 110.00 7,232.19 110.00 7,225.66 $1,944,500 $1,945,000 110.00 7,266.73 110.00 7,260.20 110.00 7,253.67 110.00 7,247.13 110.00 7,240.60 110.00 7,234.07 110.00 7,227.53 $1,945,000 $1,945,500 110.00 7,268.61 110.00 7,262.08 110.00 7,255.54 110.00 7,249.01 110.00 7,242.48 110.00 7,235.94 110.00 7,229.41 $1,945,500 $1,946,000 110.00 7,270.48 110.00 7,263.95 110.00 7,257.42 110.00 7,250.88 110.00 7,244.35 110.00 7,237.82 110.00 7,231.28 $1,946,000 $1,946,500 110.00 7,272.36 110.00 7,265.83 110.00 7,259.29 110.00 7,252.76 110.00 7,246.23 110.00 7,239.69 110.00 7,233.16 $1,946,500 $1,947,000 110.00 7,274.23 110.00 7,267.70 110.00 7,261.17 110.00 7,254.63 110.00 7,248.10 110.00 7,241.57 110.00 7,235.03 $1,947,000 $1,947,500 110.00 7,276.11 110.00 7,269.58 110.00 7,263.04 110.00 7,256.51 110.00 7,249.98 110.00 7,243.44 110.00 7,236.91 $1,947,500 $1,948,000 110.00 7,277.98 110.00 7,271.45 110.00 7,264.92 110.00 7,258.38 110.00 7,251.85 110.00 7,245.32 110.00 7,238.78 $1,948,000 $1,948,500 110.00 7,279.86 110.00 7,273.33 110.00 7,266.79 110.00 7,260.26 110.00 7,253.73 110.00 7,247.19 110.00 7,240.66 $1,948,500 $1,949,000 110.00 7,281.73 110.00 7,275.20 110.00 7,268.67 110.00 7,262.13 110.00 7,255.60 110.00 7,249.07 110.00 7,242.53 $1,949,000 $1,949,500 110.00 7,283.61 110.00 7,277.08 110.00 7,270.54 110.00 7,264.01 110.00 7,257.48 110.00 7,250.94 110.00 7,244.41 $1,949,500 $1,950,000 110.00 7,285.48 110.00 7,278.95 110.00 7,272.42 110.00 7,265.88 110.00 7,259.35 110.00 7,252.82 110.00 7,246.28 $1,950,000 $1,950,500 110.00 7,287.36 110.00 7,280.83 110.00 7,274.29 110.00 7,267.76 110.00 7,261.23 110.00 7,254.69 110.00 7,248.16 $1,950,500 $1,951,000 110.00 7,289.23 110.00 7,282.70 110.00 7,276.17 110.00 7,269.63 110.00 7,263.10 110.00 7,256.57 110.00 7,250.03 $1,951,000 $1,951,500 110.00 7,291.11 110.00 7,284.58 110.00 7,278.04 110.00 7,271.51 110.00 7,264.98 110.00 7,258.44 110.00 7,251.91 $1,951,500 $1,952,000 110.00 7,292.98 110.00 7,286.45 110.00 7,279.92 110.00 7,273.38 110.00 7,266.85 110.00 7,260.32 110.00 7,253.78 $1,952,000 $1,952,500 110.00 7,294.86 110.00 7,288.33 110.00 7,281.79 110.00 7,275.26 110.00 7,268.73 110.00 7,262.19 110.00 7,255.66 $1,952,500 $1,953,000 110.00 7,296.73 110.00 7,290.20 110.00 7,283.67 110.00 7,277.13 110.00 7,270.60 110.00 7,264.07 110.00 7,257.53 $1,953,000 $1,953,500 110.00 7,298.61 110.00 7,292.08 110.00 7,285.54 110.00 7,279.01 110.00 7,272.48 110.00 7,265.94 110.00 7,259.41 $1,953,500 $1,954,000 110.00 7,300.48 110.00 7,293.95 110.00 7,287.42 110.00 7,280.88 110.00 7,274.35 110.00 7,267.82 110.00 7,261.28 $1,954,000 $1,954,500 110.00 7,302.36 110.00 7,295.83 110.00 7,289.29 110.00 7,282.76 110.00 7,276.23 110.00 7,269.69 110.00 7,263.16 $1,954,500 $1,955,000 110.00 7,304.23 110.00 7,297.70 110.00 7,291.17 110.00 7,284.63 110.00 7,278.10 110.00 7,271.57 110.00 7,265.03 $1,955,000 $1,955,500 110.00 7,306.11 110.00 7,299.58 110.00 7,293.04 110.00 7,286.51 110.00 7,279.98 110.00 7,273.44 110.00 7,266.91 $1,955,500 $1,956,000 110.00 7,307.98 110.00 7,301.45 110.00 7,294.92 110.00 7,288.38 110.00 7,281.85 110.00 7,275.32 110.00 7,268.78 $1,956,000 $1,956,500 110.00 7,309.86 110.00 7,303.33 110.00 7,296.79 110.00 7,290.26 110.00 7,283.73 110.00 7,277.19 110.00 7,270.66 $1,956,500 $1,957,000 110.00 7,311.73 110.00 7,305.20 110.00 7,298.67 110.00 7,292.13 110.00 7,285.60 110.00 7,279.07 110.00 7,272.53 $1,957,000 $1,957,500 110.00 7,313.61 110.00 7,307.08 110.00 7,300.54 110.00 7,294.01 110.00 7,287.48 110.00 7,280.94 110.00 7,274.41 $1,957,500 $1,958,000 110.00 7,315.48 110.00 7,308.95 110.00 7,302.42 110.00 7,295.88 110.00 7,289.35 110.00 7,282.82 110.00 7,276.28 $1,958,000 $1,958,500 110.00 7,317.36 110.00 7,310.83 110.00 7,304.29 110.00 7,297.76 110.00 7,291.23 110.00 7,284.69 110.00 7,278.16 $1,958,500 $1,959,000 110.00 7,319.23 110.00 7,312.70 110.00 7,306.17 110.00 7,299.63 110.00 7,293.10 110.00 7,286.57 110.00 7,280.03 $1,959,000 $1,959,500 110.00 7,321.11 110.00 7,314.58 110.00 7,308.04 110.00 7,301.51 110.00 7,294.98 110.00 7,288.44 110.00 7,281.91 $1,959,500 $1,960,000 110.00 7,322.98 110.00 7,316.45 110.00 7,309.92 110.00 7,303.38 110.00 7,296.85 110.00 7,290.32 110.00 7,283.78 $1,960,000 $1,960,500 110.00 7,324.86 110.00 7,318.33 110.00 7,311.79 110.00 7,305.26 110.00 7,298.73 110.00 7,292.19 110.00 7,285.66 $1,960,500 $1,961,000 110.00 7,326.73 110.00 7,320.20 110.00 7,313.67 110.00 7,307.13 110.00 7,300.60 110.00 7,294.07 110.00 7,287.53 $1,961,000 $1,961,500 110.00 7,328.61 110.00 7,322.08 110.00 7,315.54 110.00 7,309.01 110.00 7,302.48 110.00 7,295.94 110.00 7,289.41 $1,961,500 $1,962,000 110.00 7,330.48 110.00 7,323.95 110.00 7,317.42 110.00 7,310.88 110.00 7,304.35 110.00 7,297.82 110.00 7,291.28 $1,962,000 $1,962,500 110.00 7,332.36 110.00 7,325.83 110.00 7,319.29 110.00 7,312.76 110.00 7,306.23 110.00 7,299.69 110.00 7,293.16 $1,962,500 $1,963,000 110.00 7,334.23 110.00 7,327.70 110.00 7,321.17 110.00 7,314.63 110.00 7,308.10 110.00 7,301.57 110.00 7,295.03 $1,963,000 $1,963,500 110.00 7,336.11 110.00 7,329.58 110.00 7,323.04 110.00 7,316.51 110.00 7,309.98 110.00 7,303.44 110.00 7,296.91 $1,963,500 $1,964,000 110.00 7,337.98 110.00 7,331.45 110.00 7,324.92 110.00 7,318.38 110.00 7,311.85 110.00 7,305.32 110.00 7,298.78 $1,964,000 $1,964,500 110.00 7,339.86 110.00 7,333.33 110.00 7,326.79 110.00 7,320.26 110.00 7,313.73 110.00 7,307.19 110.00 7,300.66 $1,964,500 $1,965,000 110.00 7,341.73 110.00 7,335.20 110.00 7,328.67 110.00 7,322.13 110.00 7,315.60 110.00 7,309.07 110.00 7,302.53 $1,965,000 $1,965,500 110.00 7,343.61 110.00 7,337.08 110.00 7,330.54 110.00 7,324.01 110.00 7,317.48 110.00 7,310.94 110.00 7,304.41 $1,965,500 $1,966,000 110.00 7,345.48 110.00 7,338.95 110.00 7,332.42 110.00 7,325.88 110.00 7,319.35 110.00 7,312.82 110.00 7,306.28 $1,966,000 $1,966,500 110.00 7,347.36 110.00 7,340.83 110.00 7,334.29 110.00 7,327.76 110.00 7,321.23 110.00 7,314.69 110.00 7,308.16 $1,966,500 $1,967,000 110.00 7,349.23 110.00 7,342.70 110.00 7,336.17 110.00 7,329.63 110.00 7,323.10 110.00 7,316.57 110.00 7,310.03 $1,967,000 $1,967,500 110.00 7,351.11 110.00 7,344.58 110.00 7,338.04 110.00 7,331.51 110.00 7,324.98 110.00 7,318.44 110.00 7,311.91 $1,967,500 $1,968,000 110.00 7,352.98 110.00 7,346.45 110.00 7,339.92 110.00 7,333.38 110.00 7,326.85 110.00 7,320.32 110.00 7,313.78 $1,968,000 $1,968,500 110.00 7,354.86 110.00 7,348.33 110.00 7,341.79 110.00 7,335.26 110.00 7,328.73 110.00 7,322.19 110.00 7,315.66 $1,968,500 $1,969,000 110.00 7,356.73 110.00 7,350.20 110.00 7,343.67 110.00 7,337.13 110.00 7,330.60 110.00 7,324.07 110.00 7,317.53 $1,969,000 $1,969,500 110.00 7,358.61 110.00 7,352.08 110.00 7,345.54 110.00 7,339.01 110.00 7,332.48 110.00 7,325.94 110.00 7,319.41 $1,969,500 $1,970,000 110.00 7,360.48 110.00 7,353.95 110.00 7,347.42 110.00 7,340.88 110.00 7,334.35 110.00 7,327.82 110.00 7,321.28 $1,970,000 $1,970,500 110.00 7,362.36 110.00 7,355.83 110.00 7,349.29 110.00 7,342.76 110.00 7,336.23 110.00 7,329.69 110.00 7,323.16 $1,970,500 $1,971,000 110.00 7,364.23 110.00 7,357.70 110.00 7,351.17 110.00 7,344.63 110.00 7,338.10 110.00 7,331.57 110.00 7,325.03 $1,971,000 $1,971,500 110.00 7,366.11 110.00 7,359.58 110.00 7,353.04 110.00 7,346.51 110.00 7,339.98 110.00 7,333.44 110.00 7,326.91 $1,971,500 $1,972,000 110.00 7,367.98 110.00 7,361.45 110.00 7,354.92 110.00 7,348.38 110.00 7,341.85 110.00 7,335.32 110.00 7,328.78 $1,972,000 $1,972,500 110.00 7,369.86 110.00 7,363.33 110.00 7,356.79 110.00 7,350.26 110.00 7,343.73 110.00 7,337.19 110.00 7,330.66 $1,972,500 $1,973,000 110.00 7,371.73 110.00 7,365.20 110.00 7,358.67 110.00 7,352.13 110.00 7,345.60 110.00 7,339.07 110.00 7,332.53 $1,973,000 $1,973,500 110.00 7,373.61 110.00 7,367.08 110.00 7,360.54 110.00 7,354.01 110.00 7,347.48 110.00 7,340.94 110.00 7,334.41 $1,973,500 $1,974,000 110.00 7,375.48 110.00 7,368.95 110.00 7,362.42 110.00 7,355.88 110.00 7,349.35 110.00 7,342.82 110.00 7,336.28 $1,974,000 $1,974,500 110.00 7,377.36 110.00 7,370.83 110.00 7,364.29 110.00 7,357.76 110.00 7,351.23 110.00 7,344.69 110.00 7,338.16 $1,974,500 $1,975,000 110.00 7,379.23 110.00 7,372.70 110.00 7,366.17 110.00 7,359.63 110.00 7,353.10 110.00 7,346.57 110.00 7,340.03 $1,975,000 $1,975,500 110.00 7,381.11 110.00 7,374.58 110.00 7,368.04 110.00 7,361.51 110.00 7,354.98 110.00 7,348.44 110.00 7,341.91 $1,975,500 $1,976,000 110.00 7,382.98 110.00 7,376.45 110.00 7,369.92 110.00 7,363.38 110.00 7,356.85 110.00 7,350.32 110.00 7,343.78 $1,976,000 $1,976,500 110.00 7,384.86 110.00 7,378.33 110.00 7,371.79 110.00 7,365.26 110.00 7,358.73 110.00 7,352.19 110.00 7,345.66 $1,976,500 $1,977,000 110.00 7,386.73 110.00 7,380.20 110.00 7,373.67 110.00 7,367.13 110.00 7,360.60 110.00 7,354.07 110.00 7,347.53 $1,977,000 $1,977,500 110.00 7,388.61 110.00 7,382.08 110.00 7,375.54 110.00 7,369.01 110.00 7,362.48 110.00 7,355.94 110.00 7,349.41 $1,977,500 $1,978,000 110.00 7,390.48 110.00 7,383.95 110.00 7,377.42 110.00 7,370.88 110.00 7,364.35 110.00 7,357.82 110.00 7,351.28 $1,978,000 $1,978,500 110.00 7,392.36 110.00 7,385.83 110.00 7,379.29 110.00 7,372.76 110.00 7,366.23 110.00 7,359.69 110.00 7,353.16 $1,978,500 $1,979,000 110.00 7,394.23 110.00 7,387.70 110.00 7,381.17 110.00 7,374.63 110.00 7,368.10 110.00 7,361.57 110.00 7,355.03 $1,979,000 $1,979,500 110.00 7,396.11 110.00 7,389.58 110.00 7,383.04 110.00 7,376.51 110.00 7,369.98 110.00 7,363.44 110.00 7,356.91 $1,979,500 $1,980,000 110.00 7,397.98 110.00 7,391.45 110.00 7,384.92 110.00 7,378.38 110.00 7,371.85 110.00 7,365.32 110.00 7,358.78 $1,980,000 $1,980,500 110.00 7,399.86 110.00 7,393.33 110.00 7,386.79 110.00 7,380.26 110.00 7,373.73 110.00 7,367.19 110.00 7,360.66 $1,980,500 $1,981,000 110.00 7,401.73 110.00 7,395.20 110.00 7,388.67 110.00 7,382.13 110.00 7,375.60 110.00 7,369.07 110.00 7,362.53 $1,981,000 $1,981,500 110.00 7,403.61 110.00 7,397.08 110.00 7,390.54 110.00 7,384.01 110.00 7,377.48 110.00 7,370.94 110.00 7,364.41 $1,981,500 $1,982,000 110.00 7,405.48 110.00 7,398.95 110.00 7,392.42 110.00 7,385.88 110.00 7,379.35 110.00 7,372.82 110.00 7,366.28 $1,982,000 $1,982,500 110.00 7,407.36 110.00 7,400.83 110.00 7,394.29 110.00 7,387.76 110.00 7,381.23 110.00 7,374.69 110.00 7,368.16 $1,982,500 $1,983,000 110.00 7,409.23 110.00 7,402.70 110.00 7,396.17 110.00 7,389.63 110.00 7,383.10 110.00 7,376.57 110.00 7,370.03 $1,983,000 $1,983,500 110.00 7,411.11 110.00 7,404.58 110.00 7,398.04 110.00 7,391.51 110.00 7,384.98 110.00 7,378.44 110.00 7,371.91 $1,983,500 $1,984,000 110.00 7,412.98 110.00 7,406.45 110.00 7,399.92 110.00 7,393.38 110.00 7,386.85 110.00 7,380.32 110.00 7,373.78 $1,984,000 $1,984,500 110.00 7,414.86 110.00 7,408.33 110.00 7,401.79 110.00 7,395.26 110.00 7,388.73 110.00 7,382.19 110.00 7,375.66 $1,984,500 $1,985,000 110.00 7,416.73 110.00 7,410.20 110.00 7,403.67 110.00 7,397.13 110.00 7,390.60 110.00 7,384.07 110.00 7,377.53 $1,985,000 $1,985,500 110.00 7,418.61 110.00 7,412.08 110.00 7,405.54 110.00 7,399.01 110.00 7,392.48 110.00 7,385.94 110.00 7,379.41 $1,985,500 $1,986,000 110.00 7,420.48 110.00 7,413.95 110.00 7,407.42 110.00 7,400.88 110.00 7,394.35 110.00 7,387.82 110.00 7,381.28 $1,986,000 $1,986,500 110.00 7,422.36 110.00 7,415.83 110.00 7,409.29 110.00 7,402.76 110.00 7,396.23 110.00 7,389.69 110.00 7,383.16 $1,986,500 $1,987,000 110.00 7,424.23 110.00 7,417.70 110.00 7,411.17 110.00 7,404.63 110.00 7,398.10 110.00 7,391.57 110.00 7,385.03 $1,987,000 $1,987,500 110.00 7,426.11 110.00 7,419.58 110.00 7,413.04 110.00 7,406.51 110.00 7,399.98 110.00 7,393.44 110.00 7,386.91 $1,987,500 $1,988,000 110.00 7,427.98 110.00 7,421.45 110.00 7,414.92 110.00 7,408.38 110.00 7,401.85 110.00 7,395.32 110.00 7,388.78 $1,988,000 $1,988,500 110.00 7,429.86 110.00 7,423.33 110.00 7,416.79 110.00 7,410.26 110.00 7,403.73 110.00 7,397.19 110.00 7,390.66 $1,988,500 $1,989,000 110.00 7,431.73 110.00 7,425.20 110.00 7,418.67 110.00 7,412.13 110.00 7,405.60 110.00 7,399.07 110.00 7,392.53

NJEIS Family Cost Participation Table Page 42 of 12 Effective July 1, 2015

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

$1,989,000 $1,989,500 110.00 7,433.61 110.00 7,427.08 110.00 7,420.54 110.00 7,414.01 110.00 7,407.48 110.00 7,400.94 110.00 7,394.41 $1,989,500 $1,990,000 110.00 7,435.48 110.00 7,428.95 110.00 7,422.42 110.00 7,415.88 110.00 7,409.35 110.00 7,402.82 110.00 7,396.28 $1,990,000 $1,990,500 110.00 7,437.36 110.00 7,430.83 110.00 7,424.29 110.00 7,417.76 110.00 7,411.23 110.00 7,404.69 110.00 7,398.16 $1,990,500 $1,991,000 110.00 7,439.23 110.00 7,432.70 110.00 7,426.17 110.00 7,419.63 110.00 7,413.10 110.00 7,406.57 110.00 7,400.03 $1,991,000 $1,991,500 110.00 7,441.11 110.00 7,434.58 110.00 7,428.04 110.00 7,421.51 110.00 7,414.98 110.00 7,408.44 110.00 7,401.91 $1,991,500 $1,992,000 110.00 7,442.98 110.00 7,436.45 110.00 7,429.92 110.00 7,423.38 110.00 7,416.85 110.00 7,410.32 110.00 7,403.78 $1,992,000 $1,992,500 110.00 7,444.86 110.00 7,438.33 110.00 7,431.79 110.00 7,425.26 110.00 7,418.73 110.00 7,412.19 110.00 7,405.66 $1,992,500 $1,993,000 110.00 7,446.73 110.00 7,440.20 110.00 7,433.67 110.00 7,427.13 110.00 7,420.60 110.00 7,414.07 110.00 7,407.53 $1,993,000 $1,993,500 110.00 7,448.61 110.00 7,442.08 110.00 7,435.54 110.00 7,429.01 110.00 7,422.48 110.00 7,415.94 110.00 7,409.41 $1,993,500 $1,994,000 110.00 7,450.48 110.00 7,443.95 110.00 7,437.42 110.00 7,430.88 110.00 7,424.35 110.00 7,417.82 110.00 7,411.28 $1,994,000 $1,994,500 110.00 7,452.36 110.00 7,445.83 110.00 7,439.29 110.00 7,432.76 110.00 7,426.23 110.00 7,419.69 110.00 7,413.16 $1,994,500 $1,995,000 110.00 7,454.23 110.00 7,447.70 110.00 7,441.17 110.00 7,434.63 110.00 7,428.10 110.00 7,421.57 110.00 7,415.03 $1,995,000 $1,995,500 110.00 7,456.11 110.00 7,449.58 110.00 7,443.04 110.00 7,436.51 110.00 7,429.98 110.00 7,423.44 110.00 7,416.91 $1,995,500 $1,996,000 110.00 7,457.98 110.00 7,451.45 110.00 7,444.92 110.00 7,438.38 110.00 7,431.85 110.00 7,425.32 110.00 7,418.78 $1,996,000 $1,996,500 110.00 7,459.86 110.00 7,453.33 110.00 7,446.79 110.00 7,440.26 110.00 7,433.73 110.00 7,427.19 110.00 7,420.66 $1,996,500 $1,997,000 110.00 7,461.73 110.00 7,455.20 110.00 7,448.67 110.00 7,442.13 110.00 7,435.60 110.00 7,429.07 110.00 7,422.53 $1,997,000 $1,997,500 110.00 7,463.61 110.00 7,457.08 110.00 7,450.54 110.00 7,444.01 110.00 7,437.48 110.00 7,430.94 110.00 7,424.41 $1,997,500 $1,998,000 110.00 7,465.48 110.00 7,458.95 110.00 7,452.42 110.00 7,445.88 110.00 7,439.35 110.00 7,432.82 110.00 7,426.28 $1,998,000 $1,998,500 110.00 7,467.36 110.00 7,460.83 110.00 7,454.29 110.00 7,447.76 110.00 7,441.23 110.00 7,434.69 110.00 7,428.16 $1,998,500 $1,999,000 110.00 7,469.23 110.00 7,462.70 110.00 7,456.17 110.00 7,449.63 110.00 7,443.10 110.00 7,436.57 110.00 7,430.03 $1,999,000 $1,999,500 110.00 7,471.11 110.00 7,464.58 110.00 7,458.04 110.00 7,451.51 110.00 7,444.98 110.00 7,438.44 110.00 7,431.91 $1,999,500 $2,000,000 110.00 7,472.98 110.00 7,466.45 110.00 7,459.92 110.00 7,453.38 110.00 7,446.85 110.00 7,440.32 110.00 7,433.78 $2,000,000 $2,000,500 110.00 7,474.86 110.00 7,468.33 110.00 7,461.79 110.00 7,455.26 110.00 7,448.73 110.00 7,442.19 110.00 7,435.66 $2,000,500 $2,001,000 110.00 7,476.73 110.00 7,470.20 110.00 7,463.67 110.00 7,457.13 110.00 7,450.60 110.00 7,444.07 110.00 7,437.53 $2,001,000 $2,001,500 110.00 7,478.61 110.00 7,472.08 110.00 7,465.54 110.00 7,459.01 110.00 7,452.48 110.00 7,445.94 110.00 7,439.41 $2,001,500 $2,002,000 110.00 7,480.48 110.00 7,473.95 110.00 7,467.42 110.00 7,460.88 110.00 7,454.35 110.00 7,447.82 110.00 7,441.28 $2,002,000 $2,002,500 110.00 7,482.36 110.00 7,475.83 110.00 7,469.29 110.00 7,462.76 110.00 7,456.23 110.00 7,449.69 110.00 7,443.16 $2,002,500 $2,003,000 110.00 7,484.23 110.00 7,477.70 110.00 7,471.17 110.00 7,464.63 110.00 7,458.10 110.00 7,451.57 110.00 7,445.03 $2,003,000 $2,003,500 110.00 7,486.11 110.00 7,479.58 110.00 7,473.04 110.00 7,466.51 110.00 7,459.98 110.00 7,453.44 110.00 7,446.91 $2,003,500 $2,004,000 110.00 7,487.98 110.00 7,481.45 110.00 7,474.92 110.00 7,468.38 110.00 7,461.85 110.00 7,455.32 110.00 7,448.78 $2,004,000 $2,004,500 110.00 7,489.86 110.00 7,483.33 110.00 7,476.79 110.00 7,470.26 110.00 7,463.73 110.00 7,457.19 110.00 7,450.66 $2,004,500 $2,005,000 110.00 7,491.73 110.00 7,485.20 110.00 7,478.67 110.00 7,472.13 110.00 7,465.60 110.00 7,459.07 110.00 7,452.53 $2,005,000 $2,005,500 110.00 7,493.61 110.00 7,487.08 110.00 7,480.54 110.00 7,474.01 110.00 7,467.48 110.00 7,460.94 110.00 7,454.41 $2,005,500 $2,006,000 110.00 7,495.48 110.00 7,488.95 110.00 7,482.42 110.00 7,475.88 110.00 7,469.35 110.00 7,462.82 110.00 7,456.28 $2,006,000 $2,006,500 110.00 7,497.36 110.00 7,490.83 110.00 7,484.29 110.00 7,477.76 110.00 7,471.23 110.00 7,464.69 110.00 7,458.16 $2,006,500 $2,007,000 110.00 7,499.23 110.00 7,492.70 110.00 7,486.17 110.00 7,479.63 110.00 7,473.10 110.00 7,466.57 110.00 7,460.03 $2,007,000 $2,007,500 110.00 7,501.11 110.00 7,494.58 110.00 7,488.04 110.00 7,481.51 110.00 7,474.98 110.00 7,468.44 110.00 7,461.91 $2,007,500 $2,008,000 110.00 7,502.98 110.00 7,496.45 110.00 7,489.92 110.00 7,483.38 110.00 7,476.85 110.00 7,470.32 110.00 7,463.78 $2,008,000 $2,008,500 110.00 7,504.86 110.00 7,498.33 110.00 7,491.79 110.00 7,485.26 110.00 7,478.73 110.00 7,472.19 110.00 7,465.66 $2,008,500 $2,009,000 110.00 7,506.73 110.00 7,500.20 110.00 7,493.67 110.00 7,487.13 110.00 7,480.60 110.00 7,474.07 110.00 7,467.53 $2,009,000 $2,009,500 110.00 7,508.61 110.00 7,502.08 110.00 7,495.54 110.00 7,489.01 110.00 7,482.48 110.00 7,475.94 110.00 7,469.41 $2,009,500 $2,010,000 110.00 7,510.48 110.00 7,503.95 110.00 7,497.42 110.00 7,490.88 110.00 7,484.35 110.00 7,477.82 110.00 7,471.28 $2,010,000 $2,010,500 110.00 7,512.36 110.00 7,505.83 110.00 7,499.29 110.00 7,492.76 110.00 7,486.23 110.00 7,479.69 110.00 7,473.16 $2,010,500 $2,011,000 110.00 7,514.23 110.00 7,507.70 110.00 7,501.17 110.00 7,494.63 110.00 7,488.10 110.00 7,481.57 110.00 7,475.03 $2,011,000 $2,011,500 110.00 7,516.11 110.00 7,509.58 110.00 7,503.04 110.00 7,496.51 110.00 7,489.98 110.00 7,483.44 110.00 7,476.91 $2,011,500 $2,012,000 110.00 7,517.98 110.00 7,511.45 110.00 7,504.92 110.00 7,498.38 110.00 7,491.85 110.00 7,485.32 110.00 7,478.78 $2,012,000 $2,012,500 110.00 7,519.86 110.00 7,513.33 110.00 7,506.79 110.00 7,500.26 110.00 7,493.73 110.00 7,487.19 110.00 7,480.66 $2,012,500 $2,013,000 110.00 7,521.73 110.00 7,515.20 110.00 7,508.67 110.00 7,502.13 110.00 7,495.60 110.00 7,489.07 110.00 7,482.53 $2,013,000 $2,013,500 110.00 7,523.61 110.00 7,517.08 110.00 7,510.54 110.00 7,504.01 110.00 7,497.48 110.00 7,490.94 110.00 7,484.41 $2,013,500 $2,014,000 110.00 7,525.48 110.00 7,518.95 110.00 7,512.42 110.00 7,505.88 110.00 7,499.35 110.00 7,492.82 110.00 7,486.28 $2,014,000 $2,014,500 110.00 7,527.36 110.00 7,520.83 110.00 7,514.29 110.00 7,507.76 110.00 7,501.23 110.00 7,494.69 110.00 7,488.16 $2,014,500 $2,015,000 110.00 7,529.23 110.00 7,522.70 110.00 7,516.17 110.00 7,509.63 110.00 7,503.10 110.00 7,496.57 110.00 7,490.03 $2,015,000 $2,015,500 110.00 7,531.11 110.00 7,524.58 110.00 7,518.04 110.00 7,511.51 110.00 7,504.98 110.00 7,498.44 110.00 7,491.91 $2,015,500 $2,016,000 110.00 7,532.98 110.00 7,526.45 110.00 7,519.92 110.00 7,513.38 110.00 7,506.85 110.00 7,500.32 110.00 7,493.78 $2,016,000 $2,016,500 110.00 7,534.86 110.00 7,528.33 110.00 7,521.79 110.00 7,515.26 110.00 7,508.73 110.00 7,502.19 110.00 7,495.66 $2,016,500 $2,017,000 110.00 7,536.73 110.00 7,530.20 110.00 7,523.67 110.00 7,517.13 110.00 7,510.60 110.00 7,504.07 110.00 7,497.53 $2,017,000 $2,017,500 110.00 7,538.61 110.00 7,532.08 110.00 7,525.54 110.00 7,519.01 110.00 7,512.48 110.00 7,505.94 110.00 7,499.41 $2,017,500 $2,018,000 110.00 7,540.48 110.00 7,533.95 110.00 7,527.42 110.00 7,520.88 110.00 7,514.35 110.00 7,507.82 110.00 7,501.28 $2,018,000 $2,018,500 110.00 7,542.36 110.00 7,535.83 110.00 7,529.29 110.00 7,522.76 110.00 7,516.23 110.00 7,509.69 110.00 7,503.16 $2,018,500 $2,019,000 110.00 7,544.23 110.00 7,537.70 110.00 7,531.17 110.00 7,524.63 110.00 7,518.10 110.00 7,511.57 110.00 7,505.03 $2,019,000 $2,019,500 110.00 7,546.11 110.00 7,539.58 110.00 7,533.04 110.00 7,526.51 110.00 7,519.98 110.00 7,513.44 110.00 7,506.91 $2,019,500 $2,020,000 110.00 7,547.98 110.00 7,541.45 110.00 7,534.92 110.00 7,528.38 110.00 7,521.85 110.00 7,515.32 110.00 7,508.78 $2,020,000 $2,020,500 110.00 7,549.86 110.00 7,543.33 110.00 7,536.79 110.00 7,530.26 110.00 7,523.73 110.00 7,517.19 110.00 7,510.66 $2,020,500 $2,021,000 110.00 7,551.73 110.00 7,545.20 110.00 7,538.67 110.00 7,532.13 110.00 7,525.60 110.00 7,519.07 110.00 7,512.53 $2,021,000 $2,021,500 110.00 7,553.61 110.00 7,547.08 110.00 7,540.54 110.00 7,534.01 110.00 7,527.48 110.00 7,520.94 110.00 7,514.41 $2,021,500 $2,022,000 110.00 7,555.48 110.00 7,548.95 110.00 7,542.42 110.00 7,535.88 110.00 7,529.35 110.00 7,522.82 110.00 7,516.28 $2,022,000 $2,022,500 110.00 7,557.36 110.00 7,550.83 110.00 7,544.29 110.00 7,537.76 110.00 7,531.23 110.00 7,524.69 110.00 7,518.16 $2,022,500 $2,023,000 110.00 7,559.23 110.00 7,552.70 110.00 7,546.17 110.00 7,539.63 110.00 7,533.10 110.00 7,526.57 110.00 7,520.03 $2,023,000 $2,023,500 110.00 7,561.11 110.00 7,554.58 110.00 7,548.04 110.00 7,541.51 110.00 7,534.98 110.00 7,528.44 110.00 7,521.91 $2,023,500 $2,024,000 110.00 7,562.98 110.00 7,556.45 110.00 7,549.92 110.00 7,543.38 110.00 7,536.85 110.00 7,530.32 110.00 7,523.78 $2,024,000 $2,024,500 110.00 7,564.86 110.00 7,558.33 110.00 7,551.79 110.00 7,545.26 110.00 7,538.73 110.00 7,532.19 110.00 7,525.66 $2,024,500 $2,025,000 110.00 7,566.73 110.00 7,560.20 110.00 7,553.67 110.00 7,547.13 110.00 7,540.60 110.00 7,534.07 110.00 7,527.53 $2,025,000 $2,025,500 110.00 7,568.61 110.00 7,562.08 110.00 7,555.54 110.00 7,549.01 110.00 7,542.48 110.00 7,535.94 110.00 7,529.41 $2,025,500 $2,026,000 110.00 7,570.48 110.00 7,563.95 110.00 7,557.42 110.00 7,550.88 110.00 7,544.35 110.00 7,537.82 110.00 7,531.28 $2,026,000 $2,026,500 110.00 7,572.36 110.00 7,565.83 110.00 7,559.29 110.00 7,552.76 110.00 7,546.23 110.00 7,539.69 110.00 7,533.16 $2,026,500 $2,027,000 110.00 7,574.23 110.00 7,567.70 110.00 7,561.17 110.00 7,554.63 110.00 7,548.10 110.00 7,541.57 110.00 7,535.03 $2,027,000 $2,027,500 110.00 7,576.11 110.00 7,569.58 110.00 7,563.04 110.00 7,556.51 110.00 7,549.98 110.00 7,543.44 110.00 7,536.91 $2,027,500 $2,028,000 110.00 7,577.98 110.00 7,571.45 110.00 7,564.92 110.00 7,558.38 110.00 7,551.85 110.00 7,545.32 110.00 7,538.78 $2,028,000 $2,028,500 110.00 7,579.86 110.00 7,573.33 110.00 7,566.79 110.00 7,560.26 110.00 7,553.73 110.00 7,547.19 110.00 7,540.66 $2,028,500 $2,029,000 110.00 7,581.73 110.00 7,575.20 110.00 7,568.67 110.00 7,562.13 110.00 7,555.60 110.00 7,549.07 110.00 7,542.53 $2,029,000 $2,029,500 110.00 7,583.61 110.00 7,577.08 110.00 7,570.54 110.00 7,564.01 110.00 7,557.48 110.00 7,550.94 110.00 7,544.41 $2,029,500 $2,030,000 110.00 7,585.48 110.00 7,578.95 110.00 7,572.42 110.00 7,565.88 110.00 7,559.35 110.00 7,552.82 110.00 7,546.28 $2,030,000 $2,030,500 110.00 7,587.36 110.00 7,580.83 110.00 7,574.29 110.00 7,567.76 110.00 7,561.23 110.00 7,554.69 110.00 7,548.16 $2,030,500 $2,031,000 110.00 7,589.23 110.00 7,582.70 110.00 7,576.17 110.00 7,569.63 110.00 7,563.10 110.00 7,556.57 110.00 7,550.03 $2,031,000 $2,031,500 110.00 7,591.11 110.00 7,584.58 110.00 7,578.04 110.00 7,571.51 110.00 7,564.98 110.00 7,558.44 110.00 7,551.91 $2,031,500 $2,032,000 110.00 7,592.98 110.00 7,586.45 110.00 7,579.92 110.00 7,573.38 110.00 7,566.85 110.00 7,560.32 110.00 7,553.78 $2,032,000 $2,032,500 110.00 7,594.86 110.00 7,588.33 110.00 7,581.79 110.00 7,575.26 110.00 7,568.73 110.00 7,562.19 110.00 7,555.66 $2,032,500 $2,033,000 110.00 7,596.73 110.00 7,590.20 110.00 7,583.67 110.00 7,577.13 110.00 7,570.60 110.00 7,564.07 110.00 7,557.53 $2,033,000 $2,033,500 110.00 7,598.61 110.00 7,592.08 110.00 7,585.54 110.00 7,579.01 110.00 7,572.48 110.00 7,565.94 110.00 7,559.41 $2,033,500 $2,034,000 110.00 7,600.48 110.00 7,593.95 110.00 7,587.42 110.00 7,580.88 110.00 7,574.35 110.00 7,567.82 110.00 7,561.28 $2,034,000 $2,034,500 110.00 7,602.36 110.00 7,595.83 110.00 7,589.29 110.00 7,582.76 110.00 7,576.23 110.00 7,569.69 110.00 7,563.16 $2,034,500 $2,035,000 110.00 7,604.23 110.00 7,597.70 110.00 7,591.17 110.00 7,584.63 110.00 7,578.10 110.00 7,571.57 110.00 7,565.03 $2,035,000 $2,035,500 110.00 7,606.11 110.00 7,599.58 110.00 7,593.04 110.00 7,586.51 110.00 7,579.98 110.00 7,573.44 110.00 7,566.91 $2,035,500 $2,036,000 110.00 7,607.98 110.00 7,601.45 110.00 7,594.92 110.00 7,588.38 110.00 7,581.85 110.00 7,575.32 110.00 7,568.78 $2,036,000 $2,036,500 110.00 7,609.86 110.00 7,603.33 110.00 7,596.79 110.00 7,590.26 110.00 7,583.73 110.00 7,577.19 110.00 7,570.66 $2,036,500 $2,037,000 110.00 7,611.73 110.00 7,605.20 110.00 7,598.67 110.00 7,592.13 110.00 7,585.60 110.00 7,579.07 110.00 7,572.53 $2,037,000 $2,037,500 110.00 7,613.61 110.00 7,607.08 110.00 7,600.54 110.00 7,594.01 110.00 7,587.48 110.00 7,580.94 110.00 7,574.41 $2,037,500 $2,038,000 110.00 7,615.48 110.00 7,608.95 110.00 7,602.42 110.00 7,595.88 110.00 7,589.35 110.00 7,582.82 110.00 7,576.28 $2,038,000 $2,038,500 110.00 7,617.36 110.00 7,610.83 110.00 7,604.29 110.00 7,597.76 110.00 7,591.23 110.00 7,584.69 110.00 7,578.16 $2,038,500 $2,039,000 110.00 7,619.23 110.00 7,612.70 110.00 7,606.17 110.00 7,599.63 110.00 7,593.10 110.00 7,586.57 110.00 7,580.03 $2,039,000 $2,039,500 110.00 7,621.11 110.00 7,614.58 110.00 7,608.04 110.00 7,601.51 110.00 7,594.98 110.00 7,588.44 110.00 7,581.91 $2,039,500 $2,040,000 110.00 7,622.98 110.00 7,616.45 110.00 7,609.92 110.00 7,603.38 110.00 7,596.85 110.00 7,590.32 110.00 7,583.78

NJEIS Family Cost Participation Table Page 43 of 12 Effective July 1, 2015

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

$2,040,000 $2,040,500 110.00 7,624.86 110.00 7,618.33 110.00 7,611.79 110.00 7,605.26 110.00 7,598.73 110.00 7,592.19 110.00 7,585.66 $2,040,500 $2,041,000 110.00 7,626.73 110.00 7,620.20 110.00 7,613.67 110.00 7,607.13 110.00 7,600.60 110.00 7,594.07 110.00 7,587.53 $2,041,000 $2,041,500 110.00 7,628.61 110.00 7,622.08 110.00 7,615.54 110.00 7,609.01 110.00 7,602.48 110.00 7,595.94 110.00 7,589.41 $2,041,500 $2,042,000 110.00 7,630.48 110.00 7,623.95 110.00 7,617.42 110.00 7,610.88 110.00 7,604.35 110.00 7,597.82 110.00 7,591.28 $2,042,000 $2,042,500 110.00 7,632.36 110.00 7,625.83 110.00 7,619.29 110.00 7,612.76 110.00 7,606.23 110.00 7,599.69 110.00 7,593.16 $2,042,500 $2,043,000 110.00 7,634.23 110.00 7,627.70 110.00 7,621.17 110.00 7,614.63 110.00 7,608.10 110.00 7,601.57 110.00 7,595.03 $2,043,000 $2,043,500 110.00 7,636.11 110.00 7,629.58 110.00 7,623.04 110.00 7,616.51 110.00 7,609.98 110.00 7,603.44 110.00 7,596.91 $2,043,500 $2,044,000 110.00 7,637.98 110.00 7,631.45 110.00 7,624.92 110.00 7,618.38 110.00 7,611.85 110.00 7,605.32 110.00 7,598.78 $2,044,000 $2,044,500 110.00 7,639.86 110.00 7,633.33 110.00 7,626.79 110.00 7,620.26 110.00 7,613.73 110.00 7,607.19 110.00 7,600.66 $2,044,500 $2,045,000 110.00 7,641.73 110.00 7,635.20 110.00 7,628.67 110.00 7,622.13 110.00 7,615.60 110.00 7,609.07 110.00 7,602.53 $2,045,000 $2,045,500 110.00 7,643.61 110.00 7,637.08 110.00 7,630.54 110.00 7,624.01 110.00 7,617.48 110.00 7,610.94 110.00 7,604.41 $2,045,500 $2,046,000 110.00 7,645.48 110.00 7,638.95 110.00 7,632.42 110.00 7,625.88 110.00 7,619.35 110.00 7,612.82 110.00 7,606.28 $2,046,000 $2,046,500 110.00 7,647.36 110.00 7,640.83 110.00 7,634.29 110.00 7,627.76 110.00 7,621.23 110.00 7,614.69 110.00 7,608.16 $2,046,500 $2,047,000 110.00 7,649.23 110.00 7,642.70 110.00 7,636.17 110.00 7,629.63 110.00 7,623.10 110.00 7,616.57 110.00 7,610.03 $2,047,000 $2,047,500 110.00 7,651.11 110.00 7,644.58 110.00 7,638.04 110.00 7,631.51 110.00 7,624.98 110.00 7,618.44 110.00 7,611.91 $2,047,500 $2,048,000 110.00 7,652.98 110.00 7,646.45 110.00 7,639.92 110.00 7,633.38 110.00 7,626.85 110.00 7,620.32 110.00 7,613.78 $2,048,000 $2,048,500 110.00 7,654.86 110.00 7,648.33 110.00 7,641.79 110.00 7,635.26 110.00 7,628.73 110.00 7,622.19 110.00 7,615.66 $2,048,500 $2,049,000 110.00 7,656.73 110.00 7,650.20 110.00 7,643.67 110.00 7,637.13 110.00 7,630.60 110.00 7,624.07 110.00 7,617.53 $2,049,000 $2,049,500 110.00 7,658.61 110.00 7,652.08 110.00 7,645.54 110.00 7,639.01 110.00 7,632.48 110.00 7,625.94 110.00 7,619.41 $2,049,500 $2,050,000 110.00 7,660.48 110.00 7,653.95 110.00 7,647.42 110.00 7,640.88 110.00 7,634.35 110.00 7,627.82 110.00 7,621.28 $2,050,000 $2,050,500 110.00 7,662.36 110.00 7,655.83 110.00 7,649.29 110.00 7,642.76 110.00 7,636.23 110.00 7,629.69 110.00 7,623.16 $2,050,500 $2,051,000 110.00 7,664.23 110.00 7,657.70 110.00 7,651.17 110.00 7,644.63 110.00 7,638.10 110.00 7,631.57 110.00 7,625.03 $2,051,000 $2,051,500 110.00 7,666.11 110.00 7,659.58 110.00 7,653.04 110.00 7,646.51 110.00 7,639.98 110.00 7,633.44 110.00 7,626.91 $2,051,500 $2,052,000 110.00 7,667.98 110.00 7,661.45 110.00 7,654.92 110.00 7,648.38 110.00 7,641.85 110.00 7,635.32 110.00 7,628.78 $2,052,000 $2,052,500 110.00 7,669.86 110.00 7,663.33 110.00 7,656.79 110.00 7,650.26 110.00 7,643.73 110.00 7,637.19 110.00 7,630.66 $2,052,500 $2,053,000 110.00 7,671.73 110.00 7,665.20 110.00 7,658.67 110.00 7,652.13 110.00 7,645.60 110.00 7,639.07 110.00 7,632.53 $2,053,000 $2,053,500 110.00 7,673.61 110.00 7,667.08 110.00 7,660.54 110.00 7,654.01 110.00 7,647.48 110.00 7,640.94 110.00 7,634.41 $2,053,500 $2,054,000 110.00 7,675.48 110.00 7,668.95 110.00 7,662.42 110.00 7,655.88 110.00 7,649.35 110.00 7,642.82 110.00 7,636.28 $2,054,000 $2,054,500 110.00 7,677.36 110.00 7,670.83 110.00 7,664.29 110.00 7,657.76 110.00 7,651.23 110.00 7,644.69 110.00 7,638.16 $2,054,500 $2,055,000 110.00 7,679.23 110.00 7,672.70 110.00 7,666.17 110.00 7,659.63 110.00 7,653.10 110.00 7,646.57 110.00 7,640.03 $2,055,000 $2,055,500 110.00 7,681.11 110.00 7,674.58 110.00 7,668.04 110.00 7,661.51 110.00 7,654.98 110.00 7,648.44 110.00 7,641.91 $2,055,500 $2,056,000 110.00 7,682.98 110.00 7,676.45 110.00 7,669.92 110.00 7,663.38 110.00 7,656.85 110.00 7,650.32 110.00 7,643.78 $2,056,000 $2,056,500 110.00 7,684.86 110.00 7,678.33 110.00 7,671.79 110.00 7,665.26 110.00 7,658.73 110.00 7,652.19 110.00 7,645.66 $2,056,500 $2,057,000 110.00 7,686.73 110.00 7,680.20 110.00 7,673.67 110.00 7,667.13 110.00 7,660.60 110.00 7,654.07 110.00 7,647.53 $2,057,000 $2,057,500 110.00 7,688.61 110.00 7,682.08 110.00 7,675.54 110.00 7,669.01 110.00 7,662.48 110.00 7,655.94 110.00 7,649.41 $2,057,500 $2,058,000 110.00 7,690.48 110.00 7,683.95 110.00 7,677.42 110.00 7,670.88 110.00 7,664.35 110.00 7,657.82 110.00 7,651.28 $2,058,000 $2,058,500 110.00 7,692.36 110.00 7,685.83 110.00 7,679.29 110.00 7,672.76 110.00 7,666.23 110.00 7,659.69 110.00 7,653.16 $2,058,500 $2,059,000 110.00 7,694.23 110.00 7,687.70 110.00 7,681.17 110.00 7,674.63 110.00 7,668.10 110.00 7,661.57 110.00 7,655.03 $2,059,000 $2,059,500 110.00 7,696.11 110.00 7,689.58 110.00 7,683.04 110.00 7,676.51 110.00 7,669.98 110.00 7,663.44 110.00 7,656.91 $2,059,500 $2,060,000 110.00 7,697.98 110.00 7,691.45 110.00 7,684.92 110.00 7,678.38 110.00 7,671.85 110.00 7,665.32 110.00 7,658.78 $2,060,000 $2,060,500 110.00 7,699.86 110.00 7,693.33 110.00 7,686.79 110.00 7,680.26 110.00 7,673.73 110.00 7,667.19 110.00 7,660.66 $2,060,500 $2,061,000 110.00 7,701.73 110.00 7,695.20 110.00 7,688.67 110.00 7,682.13 110.00 7,675.60 110.00 7,669.07 110.00 7,662.53 $2,061,000 $2,061,500 110.00 7,703.61 110.00 7,697.08 110.00 7,690.54 110.00 7,684.01 110.00 7,677.48 110.00 7,670.94 110.00 7,664.41 $2,061,500 $2,062,000 110.00 7,705.48 110.00 7,698.95 110.00 7,692.42 110.00 7,685.88 110.00 7,679.35 110.00 7,672.82 110.00 7,666.28 $2,062,000 $2,062,500 110.00 7,707.36 110.00 7,700.83 110.00 7,694.29 110.00 7,687.76 110.00 7,681.23 110.00 7,674.69 110.00 7,668.16 $2,062,500 $2,063,000 110.00 7,709.23 110.00 7,702.70 110.00 7,696.17 110.00 7,689.63 110.00 7,683.10 110.00 7,676.57 110.00 7,670.03 $2,063,000 $2,063,500 110.00 7,711.11 110.00 7,704.58 110.00 7,698.04 110.00 7,691.51 110.00 7,684.98 110.00 7,678.44 110.00 7,671.91 $2,063,500 $2,064,000 110.00 7,712.98 110.00 7,706.45 110.00 7,699.92 110.00 7,693.38 110.00 7,686.85 110.00 7,680.32 110.00 7,673.78 $2,064,000 $2,064,500 110.00 7,714.86 110.00 7,708.33 110.00 7,701.79 110.00 7,695.26 110.00 7,688.73 110.00 7,682.19 110.00 7,675.66 $2,064,500 $2,065,000 110.00 7,716.73 110.00 7,710.20 110.00 7,703.67 110.00 7,697.13 110.00 7,690.60 110.00 7,684.07 110.00 7,677.53 $2,065,000 $2,065,500 110.00 7,718.61 110.00 7,712.08 110.00 7,705.54 110.00 7,699.01 110.00 7,692.48 110.00 7,685.94 110.00 7,679.41 $2,065,500 $2,066,000 110.00 7,720.48 110.00 7,713.95 110.00 7,707.42 110.00 7,700.88 110.00 7,694.35 110.00 7,687.82 110.00 7,681.28 $2,066,000 $2,066,500 110.00 7,722.36 110.00 7,715.83 110.00 7,709.29 110.00 7,702.76 110.00 7,696.23 110.00 7,689.69 110.00 7,683.16 $2,066,500 $2,067,000 110.00 7,724.23 110.00 7,717.70 110.00 7,711.17 110.00 7,704.63 110.00 7,698.10 110.00 7,691.57 110.00 7,685.03 $2,067,000 $2,067,500 110.00 7,726.11 110.00 7,719.58 110.00 7,713.04 110.00 7,706.51 110.00 7,699.98 110.00 7,693.44 110.00 7,686.91 $2,067,500 $2,068,000 110.00 7,727.98 110.00 7,721.45 110.00 7,714.92 110.00 7,708.38 110.00 7,701.85 110.00 7,695.32 110.00 7,688.78 $2,068,000 $2,068,500 110.00 7,729.86 110.00 7,723.33 110.00 7,716.79 110.00 7,710.26 110.00 7,703.73 110.00 7,697.19 110.00 7,690.66 $2,068,500 $2,069,000 110.00 7,731.73 110.00 7,725.20 110.00 7,718.67 110.00 7,712.13 110.00 7,705.60 110.00 7,699.07 110.00 7,692.53 $2,069,000 $2,069,500 110.00 7,733.61 110.00 7,727.08 110.00 7,720.54 110.00 7,714.01 110.00 7,707.48 110.00 7,700.94 110.00 7,694.41 $2,069,500 $2,070,000 110.00 7,735.48 110.00 7,728.95 110.00 7,722.42 110.00 7,715.88 110.00 7,709.35 110.00 7,702.82 110.00 7,696.28 $2,070,000 $2,070,500 110.00 7,737.36 110.00 7,730.83 110.00 7,724.29 110.00 7,717.76 110.00 7,711.23 110.00 7,704.69 110.00 7,698.16 $2,070,500 $2,071,000 110.00 7,739.23 110.00 7,732.70 110.00 7,726.17 110.00 7,719.63 110.00 7,713.10 110.00 7,706.57 110.00 7,700.03 $2,071,000 $2,071,500 110.00 7,741.11 110.00 7,734.58 110.00 7,728.04 110.00 7,721.51 110.00 7,714.98 110.00 7,708.44 110.00 7,701.91 $2,071,500 $2,072,000 110.00 7,742.98 110.00 7,736.45 110.00 7,729.92 110.00 7,723.38 110.00 7,716.85 110.00 7,710.32 110.00 7,703.78 $2,072,000 $2,072,500 110.00 7,744.86 110.00 7,738.33 110.00 7,731.79 110.00 7,725.26 110.00 7,718.73 110.00 7,712.19 110.00 7,705.66 $2,072,500 $2,073,000 110.00 7,746.73 110.00 7,740.20 110.00 7,733.67 110.00 7,727.13 110.00 7,720.60 110.00 7,714.07 110.00 7,707.53 $2,073,000 $2,073,500 110.00 7,748.61 110.00 7,742.08 110.00 7,735.54 110.00 7,729.01 110.00 7,722.48 110.00 7,715.94 110.00 7,709.41 $2,073,500 $2,074,000 110.00 7,750.48 110.00 7,743.95 110.00 7,737.42 110.00 7,730.88 110.00 7,724.35 110.00 7,717.82 110.00 7,711.28 $2,074,000 $2,074,500 110.00 7,752.36 110.00 7,745.83 110.00 7,739.29 110.00 7,732.76 110.00 7,726.23 110.00 7,719.69 110.00 7,713.16 $2,074,500 $2,075,000 110.00 7,754.23 110.00 7,747.70 110.00 7,741.17 110.00 7,734.63 110.00 7,728.10 110.00 7,721.57 110.00 7,715.03 $2,075,000 $2,075,500 110.00 7,756.11 110.00 7,749.58 110.00 7,743.04 110.00 7,736.51 110.00 7,729.98 110.00 7,723.44 110.00 7,716.91 $2,075,500 $2,076,000 110.00 7,757.98 110.00 7,751.45 110.00 7,744.92 110.00 7,738.38 110.00 7,731.85 110.00 7,725.32 110.00 7,718.78 $2,076,000 $2,076,500 110.00 7,759.86 110.00 7,753.33 110.00 7,746.79 110.00 7,740.26 110.00 7,733.73 110.00 7,727.19 110.00 7,720.66 $2,076,500 $2,077,000 110.00 7,761.73 110.00 7,755.20 110.00 7,748.67 110.00 7,742.13 110.00 7,735.60 110.00 7,729.07 110.00 7,722.53 $2,077,000 $2,077,500 110.00 7,763.61 110.00 7,757.08 110.00 7,750.54 110.00 7,744.01 110.00 7,737.48 110.00 7,730.94 110.00 7,724.41 $2,077,500 $2,078,000 110.00 7,765.48 110.00 7,758.95 110.00 7,752.42 110.00 7,745.88 110.00 7,739.35 110.00 7,732.82 110.00 7,726.28 $2,078,000 $2,078,500 110.00 7,767.36 110.00 7,760.83 110.00 7,754.29 110.00 7,747.76 110.00 7,741.23 110.00 7,734.69 110.00 7,728.16 $2,078,500 $2,079,000 110.00 7,769.23 110.00 7,762.70 110.00 7,756.17 110.00 7,749.63 110.00 7,743.10 110.00 7,736.57 110.00 7,730.03 $2,079,000 $2,079,500 110.00 7,771.11 110.00 7,764.58 110.00 7,758.04 110.00 7,751.51 110.00 7,744.98 110.00 7,738.44 110.00 7,731.91 $2,079,500 $2,080,000 110.00 7,772.98 110.00 7,766.45 110.00 7,759.92 110.00 7,753.38 110.00 7,746.85 110.00 7,740.32 110.00 7,733.78 $2,080,000 $2,080,500 110.00 7,774.86 110.00 7,768.33 110.00 7,761.79 110.00 7,755.26 110.00 7,748.73 110.00 7,742.19 110.00 7,735.66 $2,080,500 $2,081,000 110.00 7,776.73 110.00 7,770.20 110.00 7,763.67 110.00 7,757.13 110.00 7,750.60 110.00 7,744.07 110.00 7,737.53 $2,081,000 $2,081,500 110.00 7,778.61 110.00 7,772.08 110.00 7,765.54 110.00 7,759.01 110.00 7,752.48 110.00 7,745.94 110.00 7,739.41 $2,081,500 $2,082,000 110.00 7,780.48 110.00 7,773.95 110.00 7,767.42 110.00 7,760.88 110.00 7,754.35 110.00 7,747.82 110.00 7,741.28 $2,082,000 $2,082,500 110.00 7,782.36 110.00 7,775.83 110.00 7,769.29 110.00 7,762.76 110.00 7,756.23 110.00 7,749.69 110.00 7,743.16 $2,082,500 $2,083,000 110.00 7,784.23 110.00 7,777.70 110.00 7,771.17 110.00 7,764.63 110.00 7,758.10 110.00 7,751.57 110.00 7,745.03 $2,083,000 $2,083,500 110.00 7,786.11 110.00 7,779.58 110.00 7,773.04 110.00 7,766.51 110.00 7,759.98 110.00 7,753.44 110.00 7,746.91 $2,083,500 $2,084,000 110.00 7,787.98 110.00 7,781.45 110.00 7,774.92 110.00 7,768.38 110.00 7,761.85 110.00 7,755.32 110.00 7,748.78 $2,084,000 $2,084,500 110.00 7,789.86 110.00 7,783.33 110.00 7,776.79 110.00 7,770.26 110.00 7,763.73 110.00 7,757.19 110.00 7,750.66 $2,084,500 $2,085,000 110.00 7,791.73 110.00 7,785.20 110.00 7,778.67 110.00 7,772.13 110.00 7,765.60 110.00 7,759.07 110.00 7,752.53 $2,085,000 $2,085,500 110.00 7,793.61 110.00 7,787.08 110.00 7,780.54 110.00 7,774.01 110.00 7,767.48 110.00 7,760.94 110.00 7,754.41 $2,085,500 $2,086,000 110.00 7,795.48 110.00 7,788.95 110.00 7,782.42 110.00 7,775.88 110.00 7,769.35 110.00 7,762.82 110.00 7,756.28 $2,086,000 $2,086,500 110.00 7,797.36 110.00 7,790.83 110.00 7,784.29 110.00 7,777.76 110.00 7,771.23 110.00 7,764.69 110.00 7,758.16 $2,086,500 $2,087,000 110.00 7,799.23 110.00 7,792.70 110.00 7,786.17 110.00 7,779.63 110.00 7,773.10 110.00 7,766.57 110.00 7,760.03 $2,087,000 $2,087,500 110.00 7,801.11 110.00 7,794.58 110.00 7,788.04 110.00 7,781.51 110.00 7,774.98 110.00 7,768.44 110.00 7,761.91 $2,087,500 $2,088,000 110.00 7,802.98 110.00 7,796.45 110.00 7,789.92 110.00 7,783.38 110.00 7,776.85 110.00 7,770.32 110.00 7,763.78 $2,088,000 $2,088,500 110.00 7,804.86 110.00 7,798.33 110.00 7,791.79 110.00 7,785.26 110.00 7,778.73 110.00 7,772.19 110.00 7,765.66 $2,088,500 $2,089,000 110.00 7,806.73 110.00 7,800.20 110.00 7,793.67 110.00 7,787.13 110.00 7,780.60 110.00 7,774.07 110.00 7,767.53 $2,089,000 $2,089,500 110.00 7,808.61 110.00 7,802.08 110.00 7,795.54 110.00 7,789.01 110.00 7,782.48 110.00 7,775.94 110.00 7,769.41 $2,089,500 $2,090,000 110.00 7,810.48 110.00 7,803.95 110.00 7,797.42 110.00 7,790.88 110.00 7,784.35 110.00 7,777.82 110.00 7,771.28 $2,090,000 $2,090,500 110.00 7,812.36 110.00 7,805.83 110.00 7,799.29 110.00 7,792.76 110.00 7,786.23 110.00 7,779.69 110.00 7,773.16 $2,090,500 $2,091,000 110.00 7,814.23 110.00 7,807.70 110.00 7,801.17 110.00 7,794.63 110.00 7,788.10 110.00 7,781.57 110.00 7,775.03

NJEIS Family Cost Participation Table Page 44 of 12 Effective July 1, 2015

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

$2,091,000 $2,091,500 110.00 7,816.11 110.00 7,809.58 110.00 7,803.04 110.00 7,796.51 110.00 7,789.98 110.00 7,783.44 110.00 7,776.91 $2,091,500 $2,092,000 110.00 7,817.98 110.00 7,811.45 110.00 7,804.92 110.00 7,798.38 110.00 7,791.85 110.00 7,785.32 110.00 7,778.78 $2,092,000 $2,092,500 110.00 7,819.86 110.00 7,813.33 110.00 7,806.79 110.00 7,800.26 110.00 7,793.73 110.00 7,787.19 110.00 7,780.66 $2,092,500 $2,093,000 110.00 7,821.73 110.00 7,815.20 110.00 7,808.67 110.00 7,802.13 110.00 7,795.60 110.00 7,789.07 110.00 7,782.53 $2,093,000 $2,093,500 110.00 7,823.61 110.00 7,817.08 110.00 7,810.54 110.00 7,804.01 110.00 7,797.48 110.00 7,790.94 110.00 7,784.41 $2,093,500 $2,094,000 110.00 7,825.48 110.00 7,818.95 110.00 7,812.42 110.00 7,805.88 110.00 7,799.35 110.00 7,792.82 110.00 7,786.28 $2,094,000 $2,094,500 110.00 7,827.36 110.00 7,820.83 110.00 7,814.29 110.00 7,807.76 110.00 7,801.23 110.00 7,794.69 110.00 7,788.16 $2,094,500 $2,095,000 110.00 7,829.23 110.00 7,822.70 110.00 7,816.17 110.00 7,809.63 110.00 7,803.10 110.00 7,796.57 110.00 7,790.03 $2,095,000 $2,095,500 110.00 7,831.11 110.00 7,824.58 110.00 7,818.04 110.00 7,811.51 110.00 7,804.98 110.00 7,798.44 110.00 7,791.91 $2,095,500 $2,096,000 110.00 7,832.98 110.00 7,826.45 110.00 7,819.92 110.00 7,813.38 110.00 7,806.85 110.00 7,800.32 110.00 7,793.78 $2,096,000 $2,096,500 110.00 7,834.86 110.00 7,828.33 110.00 7,821.79 110.00 7,815.26 110.00 7,808.73 110.00 7,802.19 110.00 7,795.66 $2,096,500 $2,097,000 110.00 7,836.73 110.00 7,830.20 110.00 7,823.67 110.00 7,817.13 110.00 7,810.60 110.00 7,804.07 110.00 7,797.53 $2,097,000 $2,097,500 110.00 7,838.61 110.00 7,832.08 110.00 7,825.54 110.00 7,819.01 110.00 7,812.48 110.00 7,805.94 110.00 7,799.41 $2,097,500 $2,098,000 110.00 7,840.48 110.00 7,833.95 110.00 7,827.42 110.00 7,820.88 110.00 7,814.35 110.00 7,807.82 110.00 7,801.28 $2,098,000 $2,098,500 110.00 7,842.36 110.00 7,835.83 110.00 7,829.29 110.00 7,822.76 110.00 7,816.23 110.00 7,809.69 110.00 7,803.16 $2,098,500 $2,099,000 110.00 7,844.23 110.00 7,837.70 110.00 7,831.17 110.00 7,824.63 110.00 7,818.10 110.00 7,811.57 110.00 7,805.03 $2,099,000 $2,099,500 110.00 7,846.11 110.00 7,839.58 110.00 7,833.04 110.00 7,826.51 110.00 7,819.98 110.00 7,813.44 110.00 7,806.91 $2,099,500 $2,100,000 110.00 7,847.98 110.00 7,841.45 110.00 7,834.92 110.00 7,828.38 110.00 7,821.85 110.00 7,815.32 110.00 7,808.78 $2,100,000 $2,100,500 110.00 7,849.86 110.00 7,843.33 110.00 7,836.79 110.00 7,830.26 110.00 7,823.73 110.00 7,817.19 110.00 7,810.66 $2,100,500 $2,101,000 110.00 7,851.73 110.00 7,845.20 110.00 7,838.67 110.00 7,832.13 110.00 7,825.60 110.00 7,819.07 110.00 7,812.53 $2,101,000 $2,101,500 110.00 7,853.61 110.00 7,847.08 110.00 7,840.54 110.00 7,834.01 110.00 7,827.48 110.00 7,820.94 110.00 7,814.41 $2,101,500 $2,102,000 110.00 7,855.48 110.00 7,848.95 110.00 7,842.42 110.00 7,835.88 110.00 7,829.35 110.00 7,822.82 110.00 7,816.28 $2,102,000 $2,102,500 110.00 7,857.36 110.00 7,850.83 110.00 7,844.29 110.00 7,837.76 110.00 7,831.23 110.00 7,824.69 110.00 7,818.16 $2,102,500 $2,103,000 110.00 7,859.23 110.00 7,852.70 110.00 7,846.17 110.00 7,839.63 110.00 7,833.10 110.00 7,826.57 110.00 7,820.03 $2,103,000 $2,103,500 110.00 7,861.11 110.00 7,854.58 110.00 7,848.04 110.00 7,841.51 110.00 7,834.98 110.00 7,828.44 110.00 7,821.91 $2,103,500 $2,104,000 110.00 7,862.98 110.00 7,856.45 110.00 7,849.92 110.00 7,843.38 110.00 7,836.85 110.00 7,830.32 110.00 7,823.78 $2,104,000 $2,104,500 110.00 7,864.86 110.00 7,858.33 110.00 7,851.79 110.00 7,845.26 110.00 7,838.73 110.00 7,832.19 110.00 7,825.66 $2,104,500 $2,105,000 110.00 7,866.73 110.00 7,860.20 110.00 7,853.67 110.00 7,847.13 110.00 7,840.60 110.00 7,834.07 110.00 7,827.53 $2,105,000 $2,105,500 110.00 7,868.61 110.00 7,862.08 110.00 7,855.54 110.00 7,849.01 110.00 7,842.48 110.00 7,835.94 110.00 7,829.41 $2,105,500 $2,106,000 110.00 7,870.48 110.00 7,863.95 110.00 7,857.42 110.00 7,850.88 110.00 7,844.35 110.00 7,837.82 110.00 7,831.28 $2,106,000 $2,106,500 110.00 7,872.36 110.00 7,865.83 110.00 7,859.29 110.00 7,852.76 110.00 7,846.23 110.00 7,839.69 110.00 7,833.16 $2,106,500 $2,107,000 110.00 7,874.23 110.00 7,867.70 110.00 7,861.17 110.00 7,854.63 110.00 7,848.10 110.00 7,841.57 110.00 7,835.03 $2,107,000 $2,107,500 110.00 7,876.11 110.00 7,869.58 110.00 7,863.04 110.00 7,856.51 110.00 7,849.98 110.00 7,843.44 110.00 7,836.91 $2,107,500 $2,108,000 110.00 7,877.98 110.00 7,871.45 110.00 7,864.92 110.00 7,858.38 110.00 7,851.85 110.00 7,845.32 110.00 7,838.78 $2,108,000 $2,108,500 110.00 7,879.86 110.00 7,873.33 110.00 7,866.79 110.00 7,860.26 110.00 7,853.73 110.00 7,847.19 110.00 7,840.66 $2,108,500 $2,109,000 110.00 7,881.73 110.00 7,875.20 110.00 7,868.67 110.00 7,862.13 110.00 7,855.60 110.00 7,849.07 110.00 7,842.53 $2,109,000 $2,109,500 110.00 7,883.61 110.00 7,877.08 110.00 7,870.54 110.00 7,864.01 110.00 7,857.48 110.00 7,850.94 110.00 7,844.41 $2,109,500 $2,110,000 110.00 7,885.48 110.00 7,878.95 110.00 7,872.42 110.00 7,865.88 110.00 7,859.35 110.00 7,852.82 110.00 7,846.28 $2,110,000 $2,110,500 110.00 7,887.36 110.00 7,880.83 110.00 7,874.29 110.00 7,867.76 110.00 7,861.23 110.00 7,854.69 110.00 7,848.16 $2,110,500 $2,111,000 110.00 7,889.23 110.00 7,882.70 110.00 7,876.17 110.00 7,869.63 110.00 7,863.10 110.00 7,856.57 110.00 7,850.03 $2,111,000 $2,111,500 110.00 7,891.11 110.00 7,884.58 110.00 7,878.04 110.00 7,871.51 110.00 7,864.98 110.00 7,858.44 110.00 7,851.91 $2,111,500 $2,112,000 110.00 7,892.98 110.00 7,886.45 110.00 7,879.92 110.00 7,873.38 110.00 7,866.85 110.00 7,860.32 110.00 7,853.78 $2,112,000 $2,112,500 110.00 7,894.86 110.00 7,888.33 110.00 7,881.79 110.00 7,875.26 110.00 7,868.73 110.00 7,862.19 110.00 7,855.66 $2,112,500 $2,113,000 110.00 7,896.73 110.00 7,890.20 110.00 7,883.67 110.00 7,877.13 110.00 7,870.60 110.00 7,864.07 110.00 7,857.53 $2,113,000 $2,113,500 110.00 7,898.61 110.00 7,892.08 110.00 7,885.54 110.00 7,879.01 110.00 7,872.48 110.00 7,865.94 110.00 7,859.41 $2,113,500 $2,114,000 110.00 7,900.48 110.00 7,893.95 110.00 7,887.42 110.00 7,880.88 110.00 7,874.35 110.00 7,867.82 110.00 7,861.28 $2,114,000 $2,114,500 110.00 7,902.36 110.00 7,895.83 110.00 7,889.29 110.00 7,882.76 110.00 7,876.23 110.00 7,869.69 110.00 7,863.16 $2,114,500 $2,115,000 110.00 7,904.23 110.00 7,897.70 110.00 7,891.17 110.00 7,884.63 110.00 7,878.10 110.00 7,871.57 110.00 7,865.03 $2,115,000 $2,115,500 110.00 7,906.11 110.00 7,899.58 110.00 7,893.04 110.00 7,886.51 110.00 7,879.98 110.00 7,873.44 110.00 7,866.91 $2,115,500 $2,116,000 110.00 7,907.98 110.00 7,901.45 110.00 7,894.92 110.00 7,888.38 110.00 7,881.85 110.00 7,875.32 110.00 7,868.78 $2,116,000 $2,116,500 110.00 7,909.86 110.00 7,903.33 110.00 7,896.79 110.00 7,890.26 110.00 7,883.73 110.00 7,877.19 110.00 7,870.66 $2,116,500 $2,117,000 110.00 7,911.73 110.00 7,905.20 110.00 7,898.67 110.00 7,892.13 110.00 7,885.60 110.00 7,879.07 110.00 7,872.53 $2,117,000 $2,117,500 110.00 7,913.61 110.00 7,907.08 110.00 7,900.54 110.00 7,894.01 110.00 7,887.48 110.00 7,880.94 110.00 7,874.41 $2,117,500 $2,118,000 110.00 7,915.48 110.00 7,908.95 110.00 7,902.42 110.00 7,895.88 110.00 7,889.35 110.00 7,882.82 110.00 7,876.28 $2,118,000 $2,118,500 110.00 7,917.36 110.00 7,910.83 110.00 7,904.29 110.00 7,897.76 110.00 7,891.23 110.00 7,884.69 110.00 7,878.16 $2,118,500 $2,119,000 110.00 7,919.23 110.00 7,912.70 110.00 7,906.17 110.00 7,899.63 110.00 7,893.10 110.00 7,886.57 110.00 7,880.03 $2,119,000 $2,119,500 110.00 7,921.11 110.00 7,914.58 110.00 7,908.04 110.00 7,901.51 110.00 7,894.98 110.00 7,888.44 110.00 7,881.91 $2,119,500 $2,120,000 110.00 7,922.98 110.00 7,916.45 110.00 7,909.92 110.00 7,903.38 110.00 7,896.85 110.00 7,890.32 110.00 7,883.78 $2,120,000 $2,120,500 110.00 7,924.86 110.00 7,918.33 110.00 7,911.79 110.00 7,905.26 110.00 7,898.73 110.00 7,892.19 110.00 7,885.66 $2,120,500 $2,121,000 110.00 7,926.73 110.00 7,920.20 110.00 7,913.67 110.00 7,907.13 110.00 7,900.60 110.00 7,894.07 110.00 7,887.53 $2,121,000 $2,121,500 110.00 7,928.61 110.00 7,922.08 110.00 7,915.54 110.00 7,909.01 110.00 7,902.48 110.00 7,895.94 110.00 7,889.41 $2,121,500 $2,122,000 110.00 7,930.48 110.00 7,923.95 110.00 7,917.42 110.00 7,910.88 110.00 7,904.35 110.00 7,897.82 110.00 7,891.28 $2,122,000 $2,122,500 110.00 7,932.36 110.00 7,925.83 110.00 7,919.29 110.00 7,912.76 110.00 7,906.23 110.00 7,899.69 110.00 7,893.16 $2,122,500 $2,123,000 110.00 7,934.23 110.00 7,927.70 110.00 7,921.17 110.00 7,914.63 110.00 7,908.10 110.00 7,901.57 110.00 7,895.03 $2,123,000 $2,123,500 110.00 7,936.11 110.00 7,929.58 110.00 7,923.04 110.00 7,916.51 110.00 7,909.98 110.00 7,903.44 110.00 7,896.91 $2,123,500 $2,124,000 110.00 7,937.98 110.00 7,931.45 110.00 7,924.92 110.00 7,918.38 110.00 7,911.85 110.00 7,905.32 110.00 7,898.78 $2,124,000 $2,124,500 110.00 7,939.86 110.00 7,933.33 110.00 7,926.79 110.00 7,920.26 110.00 7,913.73 110.00 7,907.19 110.00 7,900.66 $2,124,500 $2,125,000 110.00 7,941.73 110.00 7,935.20 110.00 7,928.67 110.00 7,922.13 110.00 7,915.60 110.00 7,909.07 110.00 7,902.53 $2,125,000 $2,125,500 110.00 7,943.61 110.00 7,937.08 110.00 7,930.54 110.00 7,924.01 110.00 7,917.48 110.00 7,910.94 110.00 7,904.41 $2,125,500 $2,126,000 110.00 7,945.48 110.00 7,938.95 110.00 7,932.42 110.00 7,925.88 110.00 7,919.35 110.00 7,912.82 110.00 7,906.28 $2,126,000 $2,126,500 110.00 7,947.36 110.00 7,940.83 110.00 7,934.29 110.00 7,927.76 110.00 7,921.23 110.00 7,914.69 110.00 7,908.16 $2,126,500 $2,127,000 110.00 7,949.23 110.00 7,942.70 110.00 7,936.17 110.00 7,929.63 110.00 7,923.10 110.00 7,916.57 110.00 7,910.03 $2,127,000 $2,127,500 110.00 7,951.11 110.00 7,944.58 110.00 7,938.04 110.00 7,931.51 110.00 7,924.98 110.00 7,918.44 110.00 7,911.91 $2,127,500 $2,128,000 110.00 7,952.98 110.00 7,946.45 110.00 7,939.92 110.00 7,933.38 110.00 7,926.85 110.00 7,920.32 110.00 7,913.78 $2,128,000 $2,128,500 110.00 7,954.86 110.00 7,948.33 110.00 7,941.79 110.00 7,935.26 110.00 7,928.73 110.00 7,922.19 110.00 7,915.66 $2,128,500 $2,129,000 110.00 7,956.73 110.00 7,950.20 110.00 7,943.67 110.00 7,937.13 110.00 7,930.60 110.00 7,924.07 110.00 7,917.53 $2,129,000 $2,129,500 110.00 7,958.61 110.00 7,952.08 110.00 7,945.54 110.00 7,939.01 110.00 7,932.48 110.00 7,925.94 110.00 7,919.41 $2,129,500 $2,130,000 110.00 7,960.48 110.00 7,953.95 110.00 7,947.42 110.00 7,940.88 110.00 7,934.35 110.00 7,927.82 110.00 7,921.28 $2,130,000 $2,130,500 110.00 7,962.36 110.00 7,955.83 110.00 7,949.29 110.00 7,942.76 110.00 7,936.23 110.00 7,929.69 110.00 7,923.16 $2,130,500 $2,131,000 110.00 7,964.23 110.00 7,957.70 110.00 7,951.17 110.00 7,944.63 110.00 7,938.10 110.00 7,931.57 110.00 7,925.03 $2,131,000 $2,131,500 110.00 7,966.11 110.00 7,959.58 110.00 7,953.04 110.00 7,946.51 110.00 7,939.98 110.00 7,933.44 110.00 7,926.91 $2,131,500 $2,132,000 110.00 7,967.98 110.00 7,961.45 110.00 7,954.92 110.00 7,948.38 110.00 7,941.85 110.00 7,935.32 110.00 7,928.78 $2,132,000 $2,132,500 110.00 7,969.86 110.00 7,963.33 110.00 7,956.79 110.00 7,950.26 110.00 7,943.73 110.00 7,937.19 110.00 7,930.66 $2,132,500 $2,133,000 110.00 7,971.73 110.00 7,965.20 110.00 7,958.67 110.00 7,952.13 110.00 7,945.60 110.00 7,939.07 110.00 7,932.53 $2,133,000 $2,133,500 110.00 7,973.61 110.00 7,967.08 110.00 7,960.54 110.00 7,954.01 110.00 7,947.48 110.00 7,940.94 110.00 7,934.41 $2,133,500 $2,134,000 110.00 7,975.48 110.00 7,968.95 110.00 7,962.42 110.00 7,955.88 110.00 7,949.35 110.00 7,942.82 110.00 7,936.28 $2,134,000 $2,134,500 110.00 7,977.36 110.00 7,970.83 110.00 7,964.29 110.00 7,957.76 110.00 7,951.23 110.00 7,944.69 110.00 7,938.16 $2,134,500 $2,135,000 110.00 7,979.23 110.00 7,972.70 110.00 7,966.17 110.00 7,959.63 110.00 7,953.10 110.00 7,946.57 110.00 7,940.03 $2,135,000 $2,135,500 110.00 7,981.11 110.00 7,974.58 110.00 7,968.04 110.00 7,961.51 110.00 7,954.98 110.00 7,948.44 110.00 7,941.91 $2,135,500 $2,136,000 110.00 7,982.98 110.00 7,976.45 110.00 7,969.92 110.00 7,963.38 110.00 7,956.85 110.00 7,950.32 110.00 7,943.78 $2,136,000 $2,136,500 110.00 7,984.86 110.00 7,978.33 110.00 7,971.79 110.00 7,965.26 110.00 7,958.73 110.00 7,952.19 110.00 7,945.66 $2,136,500 $2,137,000 110.00 7,986.73 110.00 7,980.20 110.00 7,973.67 110.00 7,967.13 110.00 7,960.60 110.00 7,954.07 110.00 7,947.53 $2,137,000 $2,137,500 110.00 7,988.61 110.00 7,982.08 110.00 7,975.54 110.00 7,969.01 110.00 7,962.48 110.00 7,955.94 110.00 7,949.41 $2,137,500 $2,138,000 110.00 7,990.48 110.00 7,983.95 110.00 7,977.42 110.00 7,970.88 110.00 7,964.35 110.00 7,957.82 110.00 7,951.28 $2,138,000 $2,138,500 110.00 7,992.36 110.00 7,985.83 110.00 7,979.29 110.00 7,972.76 110.00 7,966.23 110.00 7,959.69 110.00 7,953.16 $2,138,500 $2,139,000 110.00 7,994.23 110.00 7,987.70 110.00 7,981.17 110.00 7,974.63 110.00 7,968.10 110.00 7,961.57 110.00 7,955.03 $2,139,000 $2,139,500 110.00 7,996.11 110.00 7,989.58 110.00 7,983.04 110.00 7,976.51 110.00 7,969.98 110.00 7,963.44 110.00 7,956.91 $2,139,500 $2,140,000 110.00 7,997.98 110.00 7,991.45 110.00 7,984.92 110.00 7,978.38 110.00 7,971.85 110.00 7,965.32 110.00 7,958.78 $2,140,000 $2,140,500 110.00 7,999.86 110.00 7,993.33 110.00 7,986.79 110.00 7,980.26 110.00 7,973.73 110.00 7,967.19 110.00 7,960.66 $2,140,500 $2,141,000 110.00 8,001.73 110.00 7,995.20 110.00 7,988.67 110.00 7,982.13 110.00 7,975.60 110.00 7,969.07 110.00 7,962.53 $2,141,000 $2,141,500 110.00 8,003.61 110.00 7,997.08 110.00 7,990.54 110.00 7,984.01 110.00 7,977.48 110.00 7,970.94 110.00 7,964.41 $2,141,500 $2,142,000 110.00 8,005.48 110.00 7,998.95 110.00 7,992.42 110.00 7,985.88 110.00 7,979.35 110.00 7,972.82 110.00 7,966.28

NJEIS Family Cost Participation Table Page 45 of 12 Effective July 1, 2015

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

$2,142,000 $2,142,500 110.00 8,007.36 110.00 8,000.83 110.00 7,994.29 110.00 7,987.76 110.00 7,981.23 110.00 7,974.69 110.00 7,968.16 $2,142,500 $2,143,000 110.00 8,009.23 110.00 8,002.70 110.00 7,996.17 110.00 7,989.63 110.00 7,983.10 110.00 7,976.57 110.00 7,970.03 $2,143,000 $2,143,500 110.00 8,011.11 110.00 8,004.58 110.00 7,998.04 110.00 7,991.51 110.00 7,984.98 110.00 7,978.44 110.00 7,971.91 $2,143,500 $2,144,000 110.00 8,012.98 110.00 8,006.45 110.00 7,999.92 110.00 7,993.38 110.00 7,986.85 110.00 7,980.32 110.00 7,973.78 $2,144,000 $2,144,500 110.00 8,014.86 110.00 8,008.33 110.00 8,001.79 110.00 7,995.26 110.00 7,988.73 110.00 7,982.19 110.00 7,975.66 $2,144,500 $2,145,000 110.00 8,016.73 110.00 8,010.20 110.00 8,003.67 110.00 7,997.13 110.00 7,990.60 110.00 7,984.07 110.00 7,977.53 $2,145,000 $2,145,500 110.00 8,018.61 110.00 8,012.08 110.00 8,005.54 110.00 7,999.01 110.00 7,992.48 110.00 7,985.94 110.00 7,979.41 $2,145,500 $2,146,000 110.00 8,020.48 110.00 8,013.95 110.00 8,007.42 110.00 8,000.88 110.00 7,994.35 110.00 7,987.82 110.00 7,981.28 $2,146,000 $2,146,500 110.00 8,022.36 110.00 8,015.83 110.00 8,009.29 110.00 8,002.76 110.00 7,996.23 110.00 7,989.69 110.00 7,983.16 $2,146,500 $2,147,000 110.00 8,024.23 110.00 8,017.70 110.00 8,011.17 110.00 8,004.63 110.00 7,998.10 110.00 7,991.57 110.00 7,985.03 $2,147,000 $2,147,500 110.00 8,026.11 110.00 8,019.58 110.00 8,013.04 110.00 8,006.51 110.00 7,999.98 110.00 7,993.44 110.00 7,986.91 $2,147,500 $2,148,000 110.00 8,027.98 110.00 8,021.45 110.00 8,014.92 110.00 8,008.38 110.00 8,001.85 110.00 7,995.32 110.00 7,988.78 $2,148,000 $2,148,500 110.00 8,029.86 110.00 8,023.33 110.00 8,016.79 110.00 8,010.26 110.00 8,003.73 110.00 7,997.19 110.00 7,990.66 $2,148,500 $2,149,000 110.00 8,031.73 110.00 8,025.20 110.00 8,018.67 110.00 8,012.13 110.00 8,005.60 110.00 7,999.07 110.00 7,992.53 $2,149,000 $2,149,500 110.00 8,033.61 110.00 8,027.08 110.00 8,020.54 110.00 8,014.01 110.00 8,007.48 110.00 8,000.94 110.00 7,994.41 $2,149,500 $2,150,000 110.00 8,035.48 110.00 8,028.95 110.00 8,022.42 110.00 8,015.88 110.00 8,009.35 110.00 8,002.82 110.00 7,996.28 $2,150,000 $2,150,500 110.00 8,037.36 110.00 8,030.83 110.00 8,024.29 110.00 8,017.76 110.00 8,011.23 110.00 8,004.69 110.00 7,998.16 $2,150,500 $2,151,000 110.00 8,039.23 110.00 8,032.70 110.00 8,026.17 110.00 8,019.63 110.00 8,013.10 110.00 8,006.57 110.00 8,000.03 $2,151,000 $2,151,500 110.00 8,041.11 110.00 8,034.58 110.00 8,028.04 110.00 8,021.51 110.00 8,014.98 110.00 8,008.44 110.00 8,001.91 $2,151,500 $2,152,000 110.00 8,042.98 110.00 8,036.45 110.00 8,029.92 110.00 8,023.38 110.00 8,016.85 110.00 8,010.32 110.00 8,003.78 $2,152,000 $2,152,500 110.00 8,044.86 110.00 8,038.33 110.00 8,031.79 110.00 8,025.26 110.00 8,018.73 110.00 8,012.19 110.00 8,005.66 $2,152,500 $2,153,000 110.00 8,046.73 110.00 8,040.20 110.00 8,033.67 110.00 8,027.13 110.00 8,020.60 110.00 8,014.07 110.00 8,007.53 $2,153,000 $2,153,500 110.00 8,048.61 110.00 8,042.08 110.00 8,035.54 110.00 8,029.01 110.00 8,022.48 110.00 8,015.94 110.00 8,009.41 $2,153,500 $2,154,000 110.00 8,050.48 110.00 8,043.95 110.00 8,037.42 110.00 8,030.88 110.00 8,024.35 110.00 8,017.82 110.00 8,011.28 $2,154,000 $2,154,500 110.00 8,052.36 110.00 8,045.83 110.00 8,039.29 110.00 8,032.76 110.00 8,026.23 110.00 8,019.69 110.00 8,013.16 $2,154,500 $2,155,000 110.00 8,054.23 110.00 8,047.70 110.00 8,041.17 110.00 8,034.63 110.00 8,028.10 110.00 8,021.57 110.00 8,015.03 $2,155,000 $2,155,500 110.00 8,056.11 110.00 8,049.58 110.00 8,043.04 110.00 8,036.51 110.00 8,029.98 110.00 8,023.44 110.00 8,016.91 $2,155,500 $2,156,000 110.00 8,057.98 110.00 8,051.45 110.00 8,044.92 110.00 8,038.38 110.00 8,031.85 110.00 8,025.32 110.00 8,018.78 $2,156,000 $2,156,500 110.00 8,059.86 110.00 8,053.33 110.00 8,046.79 110.00 8,040.26 110.00 8,033.73 110.00 8,027.19 110.00 8,020.66 $2,156,500 $2,157,000 110.00 8,061.73 110.00 8,055.20 110.00 8,048.67 110.00 8,042.13 110.00 8,035.60 110.00 8,029.07 110.00 8,022.53 $2,157,000 $2,157,500 110.00 8,063.61 110.00 8,057.08 110.00 8,050.54 110.00 8,044.01 110.00 8,037.48 110.00 8,030.94 110.00 8,024.41 $2,157,500 $2,158,000 110.00 8,065.48 110.00 8,058.95 110.00 8,052.42 110.00 8,045.88 110.00 8,039.35 110.00 8,032.82 110.00 8,026.28 $2,158,000 $2,158,500 110.00 8,067.36 110.00 8,060.83 110.00 8,054.29 110.00 8,047.76 110.00 8,041.23 110.00 8,034.69 110.00 8,028.16 $2,158,500 $2,159,000 110.00 8,069.23 110.00 8,062.70 110.00 8,056.17 110.00 8,049.63 110.00 8,043.10 110.00 8,036.57 110.00 8,030.03 $2,159,000 $2,159,500 110.00 8,071.11 110.00 8,064.58 110.00 8,058.04 110.00 8,051.51 110.00 8,044.98 110.00 8,038.44 110.00 8,031.91 $2,159,500 $2,160,000 110.00 8,072.98 110.00 8,066.45 110.00 8,059.92 110.00 8,053.38 110.00 8,046.85 110.00 8,040.32 110.00 8,033.78 $2,160,000 $2,160,500 110.00 8,074.86 110.00 8,068.33 110.00 8,061.79 110.00 8,055.26 110.00 8,048.73 110.00 8,042.19 110.00 8,035.66 $2,160,500 $2,161,000 110.00 8,076.73 110.00 8,070.20 110.00 8,063.67 110.00 8,057.13 110.00 8,050.60 110.00 8,044.07 110.00 8,037.53 $2,161,000 $2,161,500 110.00 8,078.61 110.00 8,072.08 110.00 8,065.54 110.00 8,059.01 110.00 8,052.48 110.00 8,045.94 110.00 8,039.41 $2,161,500 $2,162,000 110.00 8,080.48 110.00 8,073.95 110.00 8,067.42 110.00 8,060.88 110.00 8,054.35 110.00 8,047.82 110.00 8,041.28 $2,162,000 $2,162,500 110.00 8,082.36 110.00 8,075.83 110.00 8,069.29 110.00 8,062.76 110.00 8,056.23 110.00 8,049.69 110.00 8,043.16 $2,162,500 $2,163,000 110.00 8,084.23 110.00 8,077.70 110.00 8,071.17 110.00 8,064.63 110.00 8,058.10 110.00 8,051.57 110.00 8,045.03 $2,163,000 $2,163,500 110.00 8,086.11 110.00 8,079.58 110.00 8,073.04 110.00 8,066.51 110.00 8,059.98 110.00 8,053.44 110.00 8,046.91 $2,163,500 $2,164,000 110.00 8,087.98 110.00 8,081.45 110.00 8,074.92 110.00 8,068.38 110.00 8,061.85 110.00 8,055.32 110.00 8,048.78 $2,164,000 $2,164,500 110.00 8,089.86 110.00 8,083.33 110.00 8,076.79 110.00 8,070.26 110.00 8,063.73 110.00 8,057.19 110.00 8,050.66 $2,164,500 $2,165,000 110.00 8,091.73 110.00 8,085.20 110.00 8,078.67 110.00 8,072.13 110.00 8,065.60 110.00 8,059.07 110.00 8,052.53 $2,165,000 $2,165,500 110.00 8,093.61 110.00 8,087.08 110.00 8,080.54 110.00 8,074.01 110.00 8,067.48 110.00 8,060.94 110.00 8,054.41 $2,165,500 $2,166,000 110.00 8,095.48 110.00 8,088.95 110.00 8,082.42 110.00 8,075.88 110.00 8,069.35 110.00 8,062.82 110.00 8,056.28 $2,166,000 $2,166,500 110.00 8,097.36 110.00 8,090.83 110.00 8,084.29 110.00 8,077.76 110.00 8,071.23 110.00 8,064.69 110.00 8,058.16 $2,166,500 $2,167,000 110.00 8,099.23 110.00 8,092.70 110.00 8,086.17 110.00 8,079.63 110.00 8,073.10 110.00 8,066.57 110.00 8,060.03 $2,167,000 $2,167,500 110.00 8,101.11 110.00 8,094.58 110.00 8,088.04 110.00 8,081.51 110.00 8,074.98 110.00 8,068.44 110.00 8,061.91 $2,167,500 $2,168,000 110.00 8,102.98 110.00 8,096.45 110.00 8,089.92 110.00 8,083.38 110.00 8,076.85 110.00 8,070.32 110.00 8,063.78 $2,168,000 $2,168,500 110.00 8,104.86 110.00 8,098.33 110.00 8,091.79 110.00 8,085.26 110.00 8,078.73 110.00 8,072.19 110.00 8,065.66 $2,168,500 $2,169,000 110.00 8,106.73 110.00 8,100.20 110.00 8,093.67 110.00 8,087.13 110.00 8,080.60 110.00 8,074.07 110.00 8,067.53 $2,169,000 $2,169,500 110.00 8,108.61 110.00 8,102.08 110.00 8,095.54 110.00 8,089.01 110.00 8,082.48 110.00 8,075.94 110.00 8,069.41 $2,169,500 $2,170,000 110.00 8,110.48 110.00 8,103.95 110.00 8,097.42 110.00 8,090.88 110.00 8,084.35 110.00 8,077.82 110.00 8,071.28 $2,170,000 $2,170,500 110.00 8,112.36 110.00 8,105.83 110.00 8,099.29 110.00 8,092.76 110.00 8,086.23 110.00 8,079.69 110.00 8,073.16 $2,170,500 $2,171,000 110.00 8,114.23 110.00 8,107.70 110.00 8,101.17 110.00 8,094.63 110.00 8,088.10 110.00 8,081.57 110.00 8,075.03 $2,171,000 $2,171,500 110.00 8,116.11 110.00 8,109.58 110.00 8,103.04 110.00 8,096.51 110.00 8,089.98 110.00 8,083.44 110.00 8,076.91 $2,171,500 $2,172,000 110.00 8,117.98 110.00 8,111.45 110.00 8,104.92 110.00 8,098.38 110.00 8,091.85 110.00 8,085.32 110.00 8,078.78 $2,172,000 $2,172,500 110.00 8,119.86 110.00 8,113.33 110.00 8,106.79 110.00 8,100.26 110.00 8,093.73 110.00 8,087.19 110.00 8,080.66 $2,172,500 $2,173,000 110.00 8,121.73 110.00 8,115.20 110.00 8,108.67 110.00 8,102.13 110.00 8,095.60 110.00 8,089.07 110.00 8,082.53 $2,173,000 $2,173,500 110.00 8,123.61 110.00 8,117.08 110.00 8,110.54 110.00 8,104.01 110.00 8,097.48 110.00 8,090.94 110.00 8,084.41 $2,173,500 $2,174,000 110.00 8,125.48 110.00 8,118.95 110.00 8,112.42 110.00 8,105.88 110.00 8,099.35 110.00 8,092.82 110.00 8,086.28 $2,174,000 $2,174,500 110.00 8,127.36 110.00 8,120.83 110.00 8,114.29 110.00 8,107.76 110.00 8,101.23 110.00 8,094.69 110.00 8,088.16 $2,174,500 $2,175,000 110.00 8,129.23 110.00 8,122.70 110.00 8,116.17 110.00 8,109.63 110.00 8,103.10 110.00 8,096.57 110.00 8,090.03 $2,175,000 $2,175,500 110.00 8,131.11 110.00 8,124.58 110.00 8,118.04 110.00 8,111.51 110.00 8,104.98 110.00 8,098.44 110.00 8,091.91 $2,175,500 $2,176,000 110.00 8,132.98 110.00 8,126.45 110.00 8,119.92 110.00 8,113.38 110.00 8,106.85 110.00 8,100.32 110.00 8,093.78 $2,176,000 $2,176,500 110.00 8,134.86 110.00 8,128.33 110.00 8,121.79 110.00 8,115.26 110.00 8,108.73 110.00 8,102.19 110.00 8,095.66 $2,176,500 $2,177,000 110.00 8,136.73 110.00 8,130.20 110.00 8,123.67 110.00 8,117.13 110.00 8,110.60 110.00 8,104.07 110.00 8,097.53 $2,177,000 $2,177,500 110.00 8,138.61 110.00 8,132.08 110.00 8,125.54 110.00 8,119.01 110.00 8,112.48 110.00 8,105.94 110.00 8,099.41 $2,177,500 $2,178,000 110.00 8,140.48 110.00 8,133.95 110.00 8,127.42 110.00 8,120.88 110.00 8,114.35 110.00 8,107.82 110.00 8,101.28 $2,178,000 $2,178,500 110.00 8,142.36 110.00 8,135.83 110.00 8,129.29 110.00 8,122.76 110.00 8,116.23 110.00 8,109.69 110.00 8,103.16 $2,178,500 $2,179,000 110.00 8,144.23 110.00 8,137.70 110.00 8,131.17 110.00 8,124.63 110.00 8,118.10 110.00 8,111.57 110.00 8,105.03 $2,179,000 $2,179,500 110.00 8,146.11 110.00 8,139.58 110.00 8,133.04 110.00 8,126.51 110.00 8,119.98 110.00 8,113.44 110.00 8,106.91 $2,179,500 $2,180,000 110.00 8,147.98 110.00 8,141.45 110.00 8,134.92 110.00 8,128.38 110.00 8,121.85 110.00 8,115.32 110.00 8,108.78 $2,180,000 $2,180,500 110.00 8,149.86 110.00 8,143.33 110.00 8,136.79 110.00 8,130.26 110.00 8,123.73 110.00 8,117.19 110.00 8,110.66 $2,180,500 $2,181,000 110.00 8,151.73 110.00 8,145.20 110.00 8,138.67 110.00 8,132.13 110.00 8,125.60 110.00 8,119.07 110.00 8,112.53 $2,181,000 $2,181,500 110.00 8,153.61 110.00 8,147.08 110.00 8,140.54 110.00 8,134.01 110.00 8,127.48 110.00 8,120.94 110.00 8,114.41 $2,181,500 $2,182,000 110.00 8,155.48 110.00 8,148.95 110.00 8,142.42 110.00 8,135.88 110.00 8,129.35 110.00 8,122.82 110.00 8,116.28 $2,182,000 $2,182,500 110.00 8,157.36 110.00 8,150.83 110.00 8,144.29 110.00 8,137.76 110.00 8,131.23 110.00 8,124.69 110.00 8,118.16 $2,182,500 $2,183,000 110.00 8,159.23 110.00 8,152.70 110.00 8,146.17 110.00 8,139.63 110.00 8,133.10 110.00 8,126.57 110.00 8,120.03 $2,183,000 $2,183,500 110.00 8,161.11 110.00 8,154.58 110.00 8,148.04 110.00 8,141.51 110.00 8,134.98 110.00 8,128.44 110.00 8,121.91 $2,183,500 $2,184,000 110.00 8,162.98 110.00 8,156.45 110.00 8,149.92 110.00 8,143.38 110.00 8,136.85 110.00 8,130.32 110.00 8,123.78 $2,184,000 $2,184,500 110.00 8,164.86 110.00 8,158.33 110.00 8,151.79 110.00 8,145.26 110.00 8,138.73 110.00 8,132.19 110.00 8,125.66 $2,184,500 $2,185,000 110.00 8,166.73 110.00 8,160.20 110.00 8,153.67 110.00 8,147.13 110.00 8,140.60 110.00 8,134.07 110.00 8,127.53 $2,185,000 $2,185,500 110.00 8,168.61 110.00 8,162.08 110.00 8,155.54 110.00 8,149.01 110.00 8,142.48 110.00 8,135.94 110.00 8,129.41 $2,185,500 $2,186,000 110.00 8,170.48 110.00 8,163.95 110.00 8,157.42 110.00 8,150.88 110.00 8,144.35 110.00 8,137.82 110.00 8,131.28 $2,186,000 $2,186,500 110.00 8,172.36 110.00 8,165.83 110.00 8,159.29 110.00 8,152.76 110.00 8,146.23 110.00 8,139.69 110.00 8,133.16 $2,186,500 $2,187,000 110.00 8,174.23 110.00 8,167.70 110.00 8,161.17 110.00 8,154.63 110.00 8,148.10 110.00 8,141.57 110.00 8,135.03 $2,187,000 $2,187,500 110.00 8,176.11 110.00 8,169.58 110.00 8,163.04 110.00 8,156.51 110.00 8,149.98 110.00 8,143.44 110.00 8,136.91 $2,187,500 $2,188,000 110.00 8,177.98 110.00 8,171.45 110.00 8,164.92 110.00 8,158.38 110.00 8,151.85 110.00 8,145.32 110.00 8,138.78 $2,188,000 $2,188,500 110.00 8,179.86 110.00 8,173.33 110.00 8,166.79 110.00 8,160.26 110.00 8,153.73 110.00 8,147.19 110.00 8,140.66 $2,188,500 $2,189,000 110.00 8,181.73 110.00 8,175.20 110.00 8,168.67 110.00 8,162.13 110.00 8,155.60 110.00 8,149.07 110.00 8,142.53 $2,189,000 $2,189,500 110.00 8,183.61 110.00 8,177.08 110.00 8,170.54 110.00 8,164.01 110.00 8,157.48 110.00 8,150.94 110.00 8,144.41 $2,189,500 $2,190,000 110.00 8,185.48 110.00 8,178.95 110.00 8,172.42 110.00 8,165.88 110.00 8,159.35 110.00 8,152.82 110.00 8,146.28 $2,190,000 $2,190,500 110.00 8,187.36 110.00 8,180.83 110.00 8,174.29 110.00 8,167.76 110.00 8,161.23 110.00 8,154.69 110.00 8,148.16 $2,190,500 $2,191,000 110.00 8,189.23 110.00 8,182.70 110.00 8,176.17 110.00 8,169.63 110.00 8,163.10 110.00 8,156.57 110.00 8,150.03 $2,191,000 $2,191,500 110.00 8,191.11 110.00 8,184.58 110.00 8,178.04 110.00 8,171.51 110.00 8,164.98 110.00 8,158.44 110.00 8,151.91 $2,191,500 $2,192,000 110.00 8,192.98 110.00 8,186.45 110.00 8,179.92 110.00 8,173.38 110.00 8,166.85 110.00 8,160.32 110.00 8,153.78 $2,192,000 $2,192,500 110.00 8,194.86 110.00 8,188.33 110.00 8,181.79 110.00 8,175.26 110.00 8,168.73 110.00 8,162.19 110.00 8,155.66 $2,192,500 $2,193,000 110.00 8,196.73 110.00 8,190.20 110.00 8,183.67 110.00 8,177.13 110.00 8,170.60 110.00 8,164.07 110.00 8,157.53

NJEIS Family Cost Participation Table Page 46 of 12 Effective July 1, 2015

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

$2,193,000 $2,193,500 110.00 8,198.61 110.00 8,192.08 110.00 8,185.54 110.00 8,179.01 110.00 8,172.48 110.00 8,165.94 110.00 8,159.41 $2,193,500 $2,194,000 110.00 8,200.48 110.00 8,193.95 110.00 8,187.42 110.00 8,180.88 110.00 8,174.35 110.00 8,167.82 110.00 8,161.28 $2,194,000 $2,194,500 110.00 8,202.36 110.00 8,195.83 110.00 8,189.29 110.00 8,182.76 110.00 8,176.23 110.00 8,169.69 110.00 8,163.16 $2,194,500 $2,195,000 110.00 8,204.23 110.00 8,197.70 110.00 8,191.17 110.00 8,184.63 110.00 8,178.10 110.00 8,171.57 110.00 8,165.03 $2,195,000 $2,195,500 110.00 8,206.11 110.00 8,199.58 110.00 8,193.04 110.00 8,186.51 110.00 8,179.98 110.00 8,173.44 110.00 8,166.91 $2,195,500 $2,196,000 110.00 8,207.98 110.00 8,201.45 110.00 8,194.92 110.00 8,188.38 110.00 8,181.85 110.00 8,175.32 110.00 8,168.78 $2,196,000 $2,196,500 110.00 8,209.86 110.00 8,203.33 110.00 8,196.79 110.00 8,190.26 110.00 8,183.73 110.00 8,177.19 110.00 8,170.66 $2,196,500 $2,197,000 110.00 8,211.73 110.00 8,205.20 110.00 8,198.67 110.00 8,192.13 110.00 8,185.60 110.00 8,179.07 110.00 8,172.53 $2,197,000 $2,197,500 110.00 8,213.61 110.00 8,207.08 110.00 8,200.54 110.00 8,194.01 110.00 8,187.48 110.00 8,180.94 110.00 8,174.41 $2,197,500 $2,198,000 110.00 8,215.48 110.00 8,208.95 110.00 8,202.42 110.00 8,195.88 110.00 8,189.35 110.00 8,182.82 110.00 8,176.28 $2,198,000 $2,198,500 110.00 8,217.36 110.00 8,210.83 110.00 8,204.29 110.00 8,197.76 110.00 8,191.23 110.00 8,184.69 110.00 8,178.16 $2,198,500 $2,199,000 110.00 8,219.23 110.00 8,212.70 110.00 8,206.17 110.00 8,199.63 110.00 8,193.10 110.00 8,186.57 110.00 8,180.03 $2,199,000 $2,199,500 110.00 8,221.11 110.00 8,214.58 110.00 8,208.04 110.00 8,201.51 110.00 8,194.98 110.00 8,188.44 110.00 8,181.91 $2,199,500 $2,200,000 110.00 8,222.98 110.00 8,216.45 110.00 8,209.92 110.00 8,203.38 110.00 8,196.85 110.00 8,190.32 110.00 8,183.78 $2,200,000 $2,200,500 110.00 8,224.86 110.00 8,218.33 110.00 8,211.79 110.00 8,205.26 110.00 8,198.73 110.00 8,192.19 110.00 8,185.66 $2,200,500 $2,201,000 110.00 8,226.73 110.00 8,220.20 110.00 8,213.67 110.00 8,207.13 110.00 8,200.60 110.00 8,194.07 110.00 8,187.53 $2,201,000 $2,201,500 110.00 8,228.61 110.00 8,222.08 110.00 8,215.54 110.00 8,209.01 110.00 8,202.48 110.00 8,195.94 110.00 8,189.41 $2,201,500 $2,202,000 110.00 8,230.48 110.00 8,223.95 110.00 8,217.42 110.00 8,210.88 110.00 8,204.35 110.00 8,197.82 110.00 8,191.28 $2,202,000 $2,202,500 110.00 8,232.36 110.00 8,225.83 110.00 8,219.29 110.00 8,212.76 110.00 8,206.23 110.00 8,199.69 110.00 8,193.16 $2,202,500 $2,203,000 110.00 8,234.23 110.00 8,227.70 110.00 8,221.17 110.00 8,214.63 110.00 8,208.10 110.00 8,201.57 110.00 8,195.03 $2,203,000 $2,203,500 110.00 8,236.11 110.00 8,229.58 110.00 8,223.04 110.00 8,216.51 110.00 8,209.98 110.00 8,203.44 110.00 8,196.91 $2,203,500 $2,204,000 110.00 8,237.98 110.00 8,231.45 110.00 8,224.92 110.00 8,218.38 110.00 8,211.85 110.00 8,205.32 110.00 8,198.78 $2,204,000 $2,204,500 110.00 8,239.86 110.00 8,233.33 110.00 8,226.79 110.00 8,220.26 110.00 8,213.73 110.00 8,207.19 110.00 8,200.66 $2,204,500 $2,205,000 110.00 8,241.73 110.00 8,235.20 110.00 8,228.67 110.00 8,222.13 110.00 8,215.60 110.00 8,209.07 110.00 8,202.53 $2,205,000 $2,205,500 110.00 8,243.61 110.00 8,237.08 110.00 8,230.54 110.00 8,224.01 110.00 8,217.48 110.00 8,210.94 110.00 8,204.41 $2,205,500 $2,206,000 110.00 8,245.48 110.00 8,238.95 110.00 8,232.42 110.00 8,225.88 110.00 8,219.35 110.00 8,212.82 110.00 8,206.28 $2,206,000 $2,206,500 110.00 8,247.36 110.00 8,240.83 110.00 8,234.29 110.00 8,227.76 110.00 8,221.23 110.00 8,214.69 110.00 8,208.16 $2,206,500 $2,207,000 110.00 8,249.23 110.00 8,242.70 110.00 8,236.17 110.00 8,229.63 110.00 8,223.10 110.00 8,216.57 110.00 8,210.03 $2,207,000 $2,207,500 110.00 8,251.11 110.00 8,244.58 110.00 8,238.04 110.00 8,231.51 110.00 8,224.98 110.00 8,218.44 110.00 8,211.91 $2,207,500 $2,208,000 110.00 8,252.98 110.00 8,246.45 110.00 8,239.92 110.00 8,233.38 110.00 8,226.85 110.00 8,220.32 110.00 8,213.78 $2,208,000 $2,208,500 110.00 8,254.86 110.00 8,248.33 110.00 8,241.79 110.00 8,235.26 110.00 8,228.73 110.00 8,222.19 110.00 8,215.66 $2,208,500 $2,209,000 110.00 8,256.73 110.00 8,250.20 110.00 8,243.67 110.00 8,237.13 110.00 8,230.60 110.00 8,224.07 110.00 8,217.53 $2,209,000 $2,209,500 110.00 8,258.61 110.00 8,252.08 110.00 8,245.54 110.00 8,239.01 110.00 8,232.48 110.00 8,225.94 110.00 8,219.41 $2,209,500 $2,210,000 110.00 8,260.48 110.00 8,253.95 110.00 8,247.42 110.00 8,240.88 110.00 8,234.35 110.00 8,227.82 110.00 8,221.28 $2,210,000 $2,210,500 110.00 8,262.36 110.00 8,255.83 110.00 8,249.29 110.00 8,242.76 110.00 8,236.23 110.00 8,229.69 110.00 8,223.16 $2,210,500 $2,211,000 110.00 8,264.23 110.00 8,257.70 110.00 8,251.17 110.00 8,244.63 110.00 8,238.10 110.00 8,231.57 110.00 8,225.03 $2,211,000 $2,211,500 110.00 8,266.11 110.00 8,259.58 110.00 8,253.04 110.00 8,246.51 110.00 8,239.98 110.00 8,233.44 110.00 8,226.91 $2,211,500 $2,212,000 110.00 8,267.98 110.00 8,261.45 110.00 8,254.92 110.00 8,248.38 110.00 8,241.85 110.00 8,235.32 110.00 8,228.78 $2,212,000 $2,212,500 110.00 8,269.86 110.00 8,263.33 110.00 8,256.79 110.00 8,250.26 110.00 8,243.73 110.00 8,237.19 110.00 8,230.66 $2,212,500 $2,213,000 110.00 8,271.73 110.00 8,265.20 110.00 8,258.67 110.00 8,252.13 110.00 8,245.60 110.00 8,239.07 110.00 8,232.53 $2,213,000 $2,213,500 110.00 8,273.61 110.00 8,267.08 110.00 8,260.54 110.00 8,254.01 110.00 8,247.48 110.00 8,240.94 110.00 8,234.41 $2,213,500 $2,214,000 110.00 8,275.48 110.00 8,268.95 110.00 8,262.42 110.00 8,255.88 110.00 8,249.35 110.00 8,242.82 110.00 8,236.28 $2,214,000 $2,214,500 110.00 8,277.36 110.00 8,270.83 110.00 8,264.29 110.00 8,257.76 110.00 8,251.23 110.00 8,244.69 110.00 8,238.16 $2,214,500 $2,215,000 110.00 8,279.23 110.00 8,272.70 110.00 8,266.17 110.00 8,259.63 110.00 8,253.10 110.00 8,246.57 110.00 8,240.03 $2,215,000 $2,215,500 110.00 8,281.11 110.00 8,274.58 110.00 8,268.04 110.00 8,261.51 110.00 8,254.98 110.00 8,248.44 110.00 8,241.91 $2,215,500 $2,216,000 110.00 8,282.98 110.00 8,276.45 110.00 8,269.92 110.00 8,263.38 110.00 8,256.85 110.00 8,250.32 110.00 8,243.78 $2,216,000 $2,216,500 110.00 8,284.86 110.00 8,278.33 110.00 8,271.79 110.00 8,265.26 110.00 8,258.73 110.00 8,252.19 110.00 8,245.66 $2,216,500 $2,217,000 110.00 8,286.73 110.00 8,280.20 110.00 8,273.67 110.00 8,267.13 110.00 8,260.60 110.00 8,254.07 110.00 8,247.53 $2,217,000 $2,217,500 110.00 8,288.61 110.00 8,282.08 110.00 8,275.54 110.00 8,269.01 110.00 8,262.48 110.00 8,255.94 110.00 8,249.41 $2,217,500 $2,218,000 110.00 8,290.48 110.00 8,283.95 110.00 8,277.42 110.00 8,270.88 110.00 8,264.35 110.00 8,257.82 110.00 8,251.28 $2,218,000 $2,218,500 110.00 8,292.36 110.00 8,285.83 110.00 8,279.29 110.00 8,272.76 110.00 8,266.23 110.00 8,259.69 110.00 8,253.16 $2,218,500 $2,219,000 110.00 8,294.23 110.00 8,287.70 110.00 8,281.17 110.00 8,274.63 110.00 8,268.10 110.00 8,261.57 110.00 8,255.03 $2,219,000 $2,219,500 110.00 8,296.11 110.00 8,289.58 110.00 8,283.04 110.00 8,276.51 110.00 8,269.98 110.00 8,263.44 110.00 8,256.91 $2,219,500 $2,220,000 110.00 8,297.98 110.00 8,291.45 110.00 8,284.92 110.00 8,278.38 110.00 8,271.85 110.00 8,265.32 110.00 8,258.78 $2,220,000 $2,220,500 110.00 8,299.86 110.00 8,293.33 110.00 8,286.79 110.00 8,280.26 110.00 8,273.73 110.00 8,267.19 110.00 8,260.66 $2,220,500 $2,221,000 110.00 8,301.73 110.00 8,295.20 110.00 8,288.67 110.00 8,282.13 110.00 8,275.60 110.00 8,269.07 110.00 8,262.53 $2,221,000 $2,221,500 110.00 8,303.61 110.00 8,297.08 110.00 8,290.54 110.00 8,284.01 110.00 8,277.48 110.00 8,270.94 110.00 8,264.41 $2,221,500 $2,222,000 110.00 8,305.48 110.00 8,298.95 110.00 8,292.42 110.00 8,285.88 110.00 8,279.35 110.00 8,272.82 110.00 8,266.28 $2,222,000 $2,222,500 110.00 8,307.36 110.00 8,300.83 110.00 8,294.29 110.00 8,287.76 110.00 8,281.23 110.00 8,274.69 110.00 8,268.16 $2,222,500 $2,223,000 110.00 8,309.23 110.00 8,302.70 110.00 8,296.17 110.00 8,289.63 110.00 8,283.10 110.00 8,276.57 110.00 8,270.03 $2,223,000 $2,223,500 110.00 8,311.11 110.00 8,304.58 110.00 8,298.04 110.00 8,291.51 110.00 8,284.98 110.00 8,278.44 110.00 8,271.91 $2,223,500 $2,224,000 110.00 8,312.98 110.00 8,306.45 110.00 8,299.92 110.00 8,293.38 110.00 8,286.85 110.00 8,280.32 110.00 8,273.78 $2,224,000 $2,224,500 110.00 8,314.86 110.00 8,308.33 110.00 8,301.79 110.00 8,295.26 110.00 8,288.73 110.00 8,282.19 110.00 8,275.66 $2,224,500 $2,225,000 110.00 8,316.73 110.00 8,310.20 110.00 8,303.67 110.00 8,297.13 110.00 8,290.60 110.00 8,284.07 110.00 8,277.53 $2,225,000 $2,225,500 110.00 8,318.61 110.00 8,312.08 110.00 8,305.54 110.00 8,299.01 110.00 8,292.48 110.00 8,285.94 110.00 8,279.41 $2,225,500 $2,226,000 110.00 8,320.48 110.00 8,313.95 110.00 8,307.42 110.00 8,300.88 110.00 8,294.35 110.00 8,287.82 110.00 8,281.28 $2,226,000 $2,226,500 110.00 8,322.36 110.00 8,315.83 110.00 8,309.29 110.00 8,302.76 110.00 8,296.23 110.00 8,289.69 110.00 8,283.16 $2,226,500 $2,227,000 110.00 8,324.23 110.00 8,317.70 110.00 8,311.17 110.00 8,304.63 110.00 8,298.10 110.00 8,291.57 110.00 8,285.03 $2,227,000 $2,227,500 110.00 8,326.11 110.00 8,319.58 110.00 8,313.04 110.00 8,306.51 110.00 8,299.98 110.00 8,293.44 110.00 8,286.91 $2,227,500 $2,228,000 110.00 8,327.98 110.00 8,321.45 110.00 8,314.92 110.00 8,308.38 110.00 8,301.85 110.00 8,295.32 110.00 8,288.78 $2,228,000 $2,228,500 110.00 8,329.86 110.00 8,323.33 110.00 8,316.79 110.00 8,310.26 110.00 8,303.73 110.00 8,297.19 110.00 8,290.66 $2,228,500 $2,229,000 110.00 8,331.73 110.00 8,325.20 110.00 8,318.67 110.00 8,312.13 110.00 8,305.60 110.00 8,299.07 110.00 8,292.53 $2,229,000 $2,229,500 110.00 8,333.61 110.00 8,327.08 110.00 8,320.54 110.00 8,314.01 110.00 8,307.48 110.00 8,300.94 110.00 8,294.41 $2,229,500 $2,230,000 110.00 8,335.48 110.00 8,328.95 110.00 8,322.42 110.00 8,315.88 110.00 8,309.35 110.00 8,302.82 110.00 8,296.28 $2,230,000 $2,230,500 110.00 8,337.36 110.00 8,330.83 110.00 8,324.29 110.00 8,317.76 110.00 8,311.23 110.00 8,304.69 110.00 8,298.16 $2,230,500 $2,231,000 110.00 8,339.23 110.00 8,332.70 110.00 8,326.17 110.00 8,319.63 110.00 8,313.10 110.00 8,306.57 110.00 8,300.03 $2,231,000 $2,231,500 110.00 8,341.11 110.00 8,334.58 110.00 8,328.04 110.00 8,321.51 110.00 8,314.98 110.00 8,308.44 110.00 8,301.91 $2,231,500 $2,232,000 110.00 8,342.98 110.00 8,336.45 110.00 8,329.92 110.00 8,323.38 110.00 8,316.85 110.00 8,310.32 110.00 8,303.78 $2,232,000 $2,232,500 110.00 8,344.86 110.00 8,338.33 110.00 8,331.79 110.00 8,325.26 110.00 8,318.73 110.00 8,312.19 110.00 8,305.66 $2,232,500 $2,233,000 110.00 8,346.73 110.00 8,340.20 110.00 8,333.67 110.00 8,327.13 110.00 8,320.60 110.00 8,314.07 110.00 8,307.53 $2,233,000 $2,233,500 110.00 8,348.61 110.00 8,342.08 110.00 8,335.54 110.00 8,329.01 110.00 8,322.48 110.00 8,315.94 110.00 8,309.41 $2,233,500 $2,234,000 110.00 8,350.48 110.00 8,343.95 110.00 8,337.42 110.00 8,330.88 110.00 8,324.35 110.00 8,317.82 110.00 8,311.28 $2,234,000 $2,234,500 110.00 8,352.36 110.00 8,345.83 110.00 8,339.29 110.00 8,332.76 110.00 8,326.23 110.00 8,319.69 110.00 8,313.16 $2,234,500 $2,235,000 110.00 8,354.23 110.00 8,347.70 110.00 8,341.17 110.00 8,334.63 110.00 8,328.10 110.00 8,321.57 110.00 8,315.03 $2,235,000 $2,235,500 110.00 8,356.11 110.00 8,349.58 110.00 8,343.04 110.00 8,336.51 110.00 8,329.98 110.00 8,323.44 110.00 8,316.91 $2,235,500 $2,236,000 110.00 8,357.98 110.00 8,351.45 110.00 8,344.92 110.00 8,338.38 110.00 8,331.85 110.00 8,325.32 110.00 8,318.78 $2,236,000 $2,236,500 110.00 8,359.86 110.00 8,353.33 110.00 8,346.79 110.00 8,340.26 110.00 8,333.73 110.00 8,327.19 110.00 8,320.66 $2,236,500 $2,237,000 110.00 8,361.73 110.00 8,355.20 110.00 8,348.67 110.00 8,342.13 110.00 8,335.60 110.00 8,329.07 110.00 8,322.53 $2,237,000 $2,237,500 110.00 8,363.61 110.00 8,357.08 110.00 8,350.54 110.00 8,344.01 110.00 8,337.48 110.00 8,330.94 110.00 8,324.41 $2,237,500 $2,238,000 110.00 8,365.48 110.00 8,358.95 110.00 8,352.42 110.00 8,345.88 110.00 8,339.35 110.00 8,332.82 110.00 8,326.28 $2,238,000 $2,238,500 110.00 8,367.36 110.00 8,360.83 110.00 8,354.29 110.00 8,347.76 110.00 8,341.23 110.00 8,334.69 110.00 8,328.16 $2,238,500 $2,239,000 110.00 8,369.23 110.00 8,362.70 110.00 8,356.17 110.00 8,349.63 110.00 8,343.10 110.00 8,336.57 110.00 8,330.03 $2,239,000 $2,239,500 110.00 8,371.11 110.00 8,364.58 110.00 8,358.04 110.00 8,351.51 110.00 8,344.98 110.00 8,338.44 110.00 8,331.91 $2,239,500 $2,240,000 110.00 8,372.98 110.00 8,366.45 110.00 8,359.92 110.00 8,353.38 110.00 8,346.85 110.00 8,340.32 110.00 8,333.78 $2,240,000 $2,240,500 110.00 8,374.86 110.00 8,368.33 110.00 8,361.79 110.00 8,355.26 110.00 8,348.73 110.00 8,342.19 110.00 8,335.66 $2,240,500 $2,241,000 110.00 8,376.73 110.00 8,370.20 110.00 8,363.67 110.00 8,357.13 110.00 8,350.60 110.00 8,344.07 110.00 8,337.53 $2,241,000 $2,241,500 110.00 8,378.61 110.00 8,372.08 110.00 8,365.54 110.00 8,359.01 110.00 8,352.48 110.00 8,345.94 110.00 8,339.41 $2,241,500 $2,242,000 110.00 8,380.48 110.00 8,373.95 110.00 8,367.42 110.00 8,360.88 110.00 8,354.35 110.00 8,347.82 110.00 8,341.28 $2,242,000 $2,242,500 110.00 8,382.36 110.00 8,375.83 110.00 8,369.29 110.00 8,362.76 110.00 8,356.23 110.00 8,349.69 110.00 8,343.16 $2,242,500 $2,243,000 110.00 8,384.23 110.00 8,377.70 110.00 8,371.17 110.00 8,364.63 110.00 8,358.10 110.00 8,351.57 110.00 8,345.03 $2,243,000 $2,243,500 110.00 8,386.11 110.00 8,379.58 110.00 8,373.04 110.00 8,366.51 110.00 8,359.98 110.00 8,353.44 110.00 8,346.91 $2,243,500 $2,244,000 110.00 8,387.98 110.00 8,381.45 110.00 8,374.92 110.00 8,368.38 110.00 8,361.85 110.00 8,355.32 110.00 8,348.78

NJEIS Family Cost Participation Table Page 47 of 12 Effective July 1, 2015

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

$2,244,000 $2,244,500 110.00 8,389.86 110.00 8,383.33 110.00 8,376.79 110.00 8,370.26 110.00 8,363.73 110.00 8,357.19 110.00 8,350.66 $2,244,500 $2,245,000 110.00 8,391.73 110.00 8,385.20 110.00 8,378.67 110.00 8,372.13 110.00 8,365.60 110.00 8,359.07 110.00 8,352.53 $2,245,000 $2,245,500 110.00 8,393.61 110.00 8,387.08 110.00 8,380.54 110.00 8,374.01 110.00 8,367.48 110.00 8,360.94 110.00 8,354.41 $2,245,500 $2,246,000 110.00 8,395.48 110.00 8,388.95 110.00 8,382.42 110.00 8,375.88 110.00 8,369.35 110.00 8,362.82 110.00 8,356.28 $2,246,000 $2,246,500 110.00 8,397.36 110.00 8,390.83 110.00 8,384.29 110.00 8,377.76 110.00 8,371.23 110.00 8,364.69 110.00 8,358.16 $2,246,500 $2,247,000 110.00 8,399.23 110.00 8,392.70 110.00 8,386.17 110.00 8,379.63 110.00 8,373.10 110.00 8,366.57 110.00 8,360.03 $2,247,000 $2,247,500 110.00 8,401.11 110.00 8,394.58 110.00 8,388.04 110.00 8,381.51 110.00 8,374.98 110.00 8,368.44 110.00 8,361.91 $2,247,500 $2,248,000 110.00 8,402.98 110.00 8,396.45 110.00 8,389.92 110.00 8,383.38 110.00 8,376.85 110.00 8,370.32 110.00 8,363.78 $2,248,000 $2,248,500 110.00 8,404.86 110.00 8,398.33 110.00 8,391.79 110.00 8,385.26 110.00 8,378.73 110.00 8,372.19 110.00 8,365.66 $2,248,500 $2,249,000 110.00 8,406.73 110.00 8,400.20 110.00 8,393.67 110.00 8,387.13 110.00 8,380.60 110.00 8,374.07 110.00 8,367.53 $2,249,000 $2,249,500 110.00 8,408.61 110.00 8,402.08 110.00 8,395.54 110.00 8,389.01 110.00 8,382.48 110.00 8,375.94 110.00 8,369.41 $2,249,500 $2,250,000 110.00 8,410.48 110.00 8,403.95 110.00 8,397.42 110.00 8,390.88 110.00 8,384.35 110.00 8,377.82 110.00 8,371.28 $2,250,000 $2,250,500 110.00 8,412.36 110.00 8,405.83 110.00 8,399.29 110.00 8,392.76 110.00 8,386.23 110.00 8,379.69 110.00 8,373.16 $2,250,500 $2,251,000 110.00 8,414.23 110.00 8,407.70 110.00 8,401.17 110.00 8,394.63 110.00 8,388.10 110.00 8,381.57 110.00 8,375.03 $2,251,000 $2,251,500 110.00 8,416.11 110.00 8,409.58 110.00 8,403.04 110.00 8,396.51 110.00 8,389.98 110.00 8,383.44 110.00 8,376.91 $2,251,500 $2,252,000 110.00 8,417.98 110.00 8,411.45 110.00 8,404.92 110.00 8,398.38 110.00 8,391.85 110.00 8,385.32 110.00 8,378.78 $2,252,000 $2,252,500 110.00 8,419.86 110.00 8,413.33 110.00 8,406.79 110.00 8,400.26 110.00 8,393.73 110.00 8,387.19 110.00 8,380.66 $2,252,500 $2,253,000 110.00 8,421.73 110.00 8,415.20 110.00 8,408.67 110.00 8,402.13 110.00 8,395.60 110.00 8,389.07 110.00 8,382.53 $2,253,000 $2,253,500 110.00 8,423.61 110.00 8,417.08 110.00 8,410.54 110.00 8,404.01 110.00 8,397.48 110.00 8,390.94 110.00 8,384.41 $2,253,500 $2,254,000 110.00 8,425.48 110.00 8,418.95 110.00 8,412.42 110.00 8,405.88 110.00 8,399.35 110.00 8,392.82 110.00 8,386.28 $2,254,000 $2,254,500 110.00 8,427.36 110.00 8,420.83 110.00 8,414.29 110.00 8,407.76 110.00 8,401.23 110.00 8,394.69 110.00 8,388.16 $2,254,500 $2,255,000 110.00 8,429.23 110.00 8,422.70 110.00 8,416.17 110.00 8,409.63 110.00 8,403.10 110.00 8,396.57 110.00 8,390.03 $2,255,000 $2,255,500 110.00 8,431.11 110.00 8,424.58 110.00 8,418.04 110.00 8,411.51 110.00 8,404.98 110.00 8,398.44 110.00 8,391.91 $2,255,500 $2,256,000 110.00 8,432.98 110.00 8,426.45 110.00 8,419.92 110.00 8,413.38 110.00 8,406.85 110.00 8,400.32 110.00 8,393.78 $2,256,000 $2,256,500 110.00 8,434.86 110.00 8,428.33 110.00 8,421.79 110.00 8,415.26 110.00 8,408.73 110.00 8,402.19 110.00 8,395.66 $2,256,500 $2,257,000 110.00 8,436.73 110.00 8,430.20 110.00 8,423.67 110.00 8,417.13 110.00 8,410.60 110.00 8,404.07 110.00 8,397.53 $2,257,000 $2,257,500 110.00 8,438.61 110.00 8,432.08 110.00 8,425.54 110.00 8,419.01 110.00 8,412.48 110.00 8,405.94 110.00 8,399.41 $2,257,500 $2,258,000 110.00 8,440.48 110.00 8,433.95 110.00 8,427.42 110.00 8,420.88 110.00 8,414.35 110.00 8,407.82 110.00 8,401.28 $2,258,000 $2,258,500 110.00 8,442.36 110.00 8,435.83 110.00 8,429.29 110.00 8,422.76 110.00 8,416.23 110.00 8,409.69 110.00 8,403.16 $2,258,500 $2,259,000 110.00 8,444.23 110.00 8,437.70 110.00 8,431.17 110.00 8,424.63 110.00 8,418.10 110.00 8,411.57 110.00 8,405.03 $2,259,000 $2,259,500 110.00 8,446.11 110.00 8,439.58 110.00 8,433.04 110.00 8,426.51 110.00 8,419.98 110.00 8,413.44 110.00 8,406.91 $2,259,500 $2,260,000 110.00 8,447.98 110.00 8,441.45 110.00 8,434.92 110.00 8,428.38 110.00 8,421.85 110.00 8,415.32 110.00 8,408.78 $2,260,000 $2,260,500 110.00 8,449.86 110.00 8,443.33 110.00 8,436.79 110.00 8,430.26 110.00 8,423.73 110.00 8,417.19 110.00 8,410.66 $2,260,500 $2,261,000 110.00 8,451.73 110.00 8,445.20 110.00 8,438.67 110.00 8,432.13 110.00 8,425.60 110.00 8,419.07 110.00 8,412.53 $2,261,000 $2,261,500 110.00 8,453.61 110.00 8,447.08 110.00 8,440.54 110.00 8,434.01 110.00 8,427.48 110.00 8,420.94 110.00 8,414.41 $2,261,500 $2,262,000 110.00 8,455.48 110.00 8,448.95 110.00 8,442.42 110.00 8,435.88 110.00 8,429.35 110.00 8,422.82 110.00 8,416.28 $2,262,000 $2,262,500 110.00 8,457.36 110.00 8,450.83 110.00 8,444.29 110.00 8,437.76 110.00 8,431.23 110.00 8,424.69 110.00 8,418.16 $2,262,500 $2,263,000 110.00 8,459.23 110.00 8,452.70 110.00 8,446.17 110.00 8,439.63 110.00 8,433.10 110.00 8,426.57 110.00 8,420.03 $2,263,000 $2,263,500 110.00 8,461.11 110.00 8,454.58 110.00 8,448.04 110.00 8,441.51 110.00 8,434.98 110.00 8,428.44 110.00 8,421.91 $2,263,500 $2,264,000 110.00 8,462.98 110.00 8,456.45 110.00 8,449.92 110.00 8,443.38 110.00 8,436.85 110.00 8,430.32 110.00 8,423.78 $2,264,000 $2,264,500 110.00 8,464.86 110.00 8,458.33 110.00 8,451.79 110.00 8,445.26 110.00 8,438.73 110.00 8,432.19 110.00 8,425.66 $2,264,500 $2,265,000 110.00 8,466.73 110.00 8,460.20 110.00 8,453.67 110.00 8,447.13 110.00 8,440.60 110.00 8,434.07 110.00 8,427.53 $2,265,000 $2,265,500 110.00 8,468.61 110.00 8,462.08 110.00 8,455.54 110.00 8,449.01 110.00 8,442.48 110.00 8,435.94 110.00 8,429.41 $2,265,500 $2,266,000 110.00 8,470.48 110.00 8,463.95 110.00 8,457.42 110.00 8,450.88 110.00 8,444.35 110.00 8,437.82 110.00 8,431.28 $2,266,000 $2,266,500 110.00 8,472.36 110.00 8,465.83 110.00 8,459.29 110.00 8,452.76 110.00 8,446.23 110.00 8,439.69 110.00 8,433.16 $2,266,500 $2,267,000 110.00 8,474.23 110.00 8,467.70 110.00 8,461.17 110.00 8,454.63 110.00 8,448.10 110.00 8,441.57 110.00 8,435.03 $2,267,000 $2,267,500 110.00 8,476.11 110.00 8,469.58 110.00 8,463.04 110.00 8,456.51 110.00 8,449.98 110.00 8,443.44 110.00 8,436.91 $2,267,500 $2,268,000 110.00 8,477.98 110.00 8,471.45 110.00 8,464.92 110.00 8,458.38 110.00 8,451.85 110.00 8,445.32 110.00 8,438.78 $2,268,000 $2,268,500 110.00 8,479.86 110.00 8,473.33 110.00 8,466.79 110.00 8,460.26 110.00 8,453.73 110.00 8,447.19 110.00 8,440.66 $2,268,500 $2,269,000 110.00 8,481.73 110.00 8,475.20 110.00 8,468.67 110.00 8,462.13 110.00 8,455.60 110.00 8,449.07 110.00 8,442.53 $2,269,000 $2,269,500 110.00 8,483.61 110.00 8,477.08 110.00 8,470.54 110.00 8,464.01 110.00 8,457.48 110.00 8,450.94 110.00 8,444.41 $2,269,500 $2,270,000 110.00 8,485.48 110.00 8,478.95 110.00 8,472.42 110.00 8,465.88 110.00 8,459.35 110.00 8,452.82 110.00 8,446.28 $2,270,000 $2,270,500 110.00 8,487.36 110.00 8,480.83 110.00 8,474.29 110.00 8,467.76 110.00 8,461.23 110.00 8,454.69 110.00 8,448.16 $2,270,500 $2,271,000 110.00 8,489.23 110.00 8,482.70 110.00 8,476.17 110.00 8,469.63 110.00 8,463.10 110.00 8,456.57 110.00 8,450.03 $2,271,000 $2,271,500 110.00 8,491.11 110.00 8,484.58 110.00 8,478.04 110.00 8,471.51 110.00 8,464.98 110.00 8,458.44 110.00 8,451.91 $2,271,500 $2,272,000 110.00 8,492.98 110.00 8,486.45 110.00 8,479.92 110.00 8,473.38 110.00 8,466.85 110.00 8,460.32 110.00 8,453.78 $2,272,000 $2,272,500 110.00 8,494.86 110.00 8,488.33 110.00 8,481.79 110.00 8,475.26 110.00 8,468.73 110.00 8,462.19 110.00 8,455.66 $2,272,500 $2,273,000 110.00 8,496.73 110.00 8,490.20 110.00 8,483.67 110.00 8,477.13 110.00 8,470.60 110.00 8,464.07 110.00 8,457.53 $2,273,000 $2,273,500 110.00 8,498.61 110.00 8,492.08 110.00 8,485.54 110.00 8,479.01 110.00 8,472.48 110.00 8,465.94 110.00 8,459.41 $2,273,500 $2,274,000 110.00 8,500.48 110.00 8,493.95 110.00 8,487.42 110.00 8,480.88 110.00 8,474.35 110.00 8,467.82 110.00 8,461.28 $2,274,000 $2,274,500 110.00 8,502.36 110.00 8,495.83 110.00 8,489.29 110.00 8,482.76 110.00 8,476.23 110.00 8,469.69 110.00 8,463.16 $2,274,500 $2,275,000 110.00 8,504.23 110.00 8,497.70 110.00 8,491.17 110.00 8,484.63 110.00 8,478.10 110.00 8,471.57 110.00 8,465.03 $2,275,000 $2,275,500 110.00 8,506.11 110.00 8,499.58 110.00 8,493.04 110.00 8,486.51 110.00 8,479.98 110.00 8,473.44 110.00 8,466.91 $2,275,500 $2,276,000 110.00 8,507.98 110.00 8,501.45 110.00 8,494.92 110.00 8,488.38 110.00 8,481.85 110.00 8,475.32 110.00 8,468.78 $2,276,000 $2,276,500 110.00 8,509.86 110.00 8,503.33 110.00 8,496.79 110.00 8,490.26 110.00 8,483.73 110.00 8,477.19 110.00 8,470.66 $2,276,500 $2,277,000 110.00 8,511.73 110.00 8,505.20 110.00 8,498.67 110.00 8,492.13 110.00 8,485.60 110.00 8,479.07 110.00 8,472.53 $2,277,000 $2,277,500 110.00 8,513.61 110.00 8,507.08 110.00 8,500.54 110.00 8,494.01 110.00 8,487.48 110.00 8,480.94 110.00 8,474.41 $2,277,500 $2,278,000 110.00 8,515.48 110.00 8,508.95 110.00 8,502.42 110.00 8,495.88 110.00 8,489.35 110.00 8,482.82 110.00 8,476.28 $2,278,000 $2,278,500 110.00 8,517.36 110.00 8,510.83 110.00 8,504.29 110.00 8,497.76 110.00 8,491.23 110.00 8,484.69 110.00 8,478.16 $2,278,500 $2,279,000 110.00 8,519.23 110.00 8,512.70 110.00 8,506.17 110.00 8,499.63 110.00 8,493.10 110.00 8,486.57 110.00 8,480.03 $2,279,000 $2,279,500 110.00 8,521.11 110.00 8,514.58 110.00 8,508.04 110.00 8,501.51 110.00 8,494.98 110.00 8,488.44 110.00 8,481.91 $2,279,500 $2,280,000 110.00 8,522.98 110.00 8,516.45 110.00 8,509.92 110.00 8,503.38 110.00 8,496.85 110.00 8,490.32 110.00 8,483.78 $2,280,000 $2,280,500 110.00 8,524.86 110.00 8,518.33 110.00 8,511.79 110.00 8,505.26 110.00 8,498.73 110.00 8,492.19 110.00 8,485.66 $2,280,500 $2,281,000 110.00 8,526.73 110.00 8,520.20 110.00 8,513.67 110.00 8,507.13 110.00 8,500.60 110.00 8,494.07 110.00 8,487.53 $2,281,000 $2,281,500 110.00 8,528.61 110.00 8,522.08 110.00 8,515.54 110.00 8,509.01 110.00 8,502.48 110.00 8,495.94 110.00 8,489.41 $2,281,500 $2,282,000 110.00 8,530.48 110.00 8,523.95 110.00 8,517.42 110.00 8,510.88 110.00 8,504.35 110.00 8,497.82 110.00 8,491.28 $2,282,000 $2,282,500 110.00 8,532.36 110.00 8,525.83 110.00 8,519.29 110.00 8,512.76 110.00 8,506.23 110.00 8,499.69 110.00 8,493.16 $2,282,500 $2,283,000 110.00 8,534.23 110.00 8,527.70 110.00 8,521.17 110.00 8,514.63 110.00 8,508.10 110.00 8,501.57 110.00 8,495.03 $2,283,000 $2,283,500 110.00 8,536.11 110.00 8,529.58 110.00 8,523.04 110.00 8,516.51 110.00 8,509.98 110.00 8,503.44 110.00 8,496.91 $2,283,500 $2,284,000 110.00 8,537.98 110.00 8,531.45 110.00 8,524.92 110.00 8,518.38 110.00 8,511.85 110.00 8,505.32 110.00 8,498.78 $2,284,000 $2,284,500 110.00 8,539.86 110.00 8,533.33 110.00 8,526.79 110.00 8,520.26 110.00 8,513.73 110.00 8,507.19 110.00 8,500.66 $2,284,500 $2,285,000 110.00 8,541.73 110.00 8,535.20 110.00 8,528.67 110.00 8,522.13 110.00 8,515.60 110.00 8,509.07 110.00 8,502.53 $2,285,000 $2,285,500 110.00 8,543.61 110.00 8,537.08 110.00 8,530.54 110.00 8,524.01 110.00 8,517.48 110.00 8,510.94 110.00 8,504.41 $2,285,500 $2,286,000 110.00 8,545.48 110.00 8,538.95 110.00 8,532.42 110.00 8,525.88 110.00 8,519.35 110.00 8,512.82 110.00 8,506.28 $2,286,000 $2,286,500 110.00 8,547.36 110.00 8,540.83 110.00 8,534.29 110.00 8,527.76 110.00 8,521.23 110.00 8,514.69 110.00 8,508.16 $2,286,500 $2,287,000 110.00 8,549.23 110.00 8,542.70 110.00 8,536.17 110.00 8,529.63 110.00 8,523.10 110.00 8,516.57 110.00 8,510.03 $2,287,000 $2,287,500 110.00 8,551.11 110.00 8,544.58 110.00 8,538.04 110.00 8,531.51 110.00 8,524.98 110.00 8,518.44 110.00 8,511.91 $2,287,500 $2,288,000 110.00 8,552.98 110.00 8,546.45 110.00 8,539.92 110.00 8,533.38 110.00 8,526.85 110.00 8,520.32 110.00 8,513.78 $2,288,000 $2,288,500 110.00 8,554.86 110.00 8,548.33 110.00 8,541.79 110.00 8,535.26 110.00 8,528.73 110.00 8,522.19 110.00 8,515.66 $2,288,500 $2,289,000 110.00 8,556.73 110.00 8,550.20 110.00 8,543.67 110.00 8,537.13 110.00 8,530.60 110.00 8,524.07 110.00 8,517.53 $2,289,000 $2,289,500 110.00 8,558.61 110.00 8,552.08 110.00 8,545.54 110.00 8,539.01 110.00 8,532.48 110.00 8,525.94 110.00 8,519.41 $2,289,500 $2,290,000 110.00 8,560.48 110.00 8,553.95 110.00 8,547.42 110.00 8,540.88 110.00 8,534.35 110.00 8,527.82 110.00 8,521.28 $2,290,000 $2,290,500 110.00 8,562.36 110.00 8,555.83 110.00 8,549.29 110.00 8,542.76 110.00 8,536.23 110.00 8,529.69 110.00 8,523.16 $2,290,500 $2,291,000 110.00 8,564.23 110.00 8,557.70 110.00 8,551.17 110.00 8,544.63 110.00 8,538.10 110.00 8,531.57 110.00 8,525.03 $2,291,000 $2,291,500 110.00 8,566.11 110.00 8,559.58 110.00 8,553.04 110.00 8,546.51 110.00 8,539.98 110.00 8,533.44 110.00 8,526.91 $2,291,500 $2,292,000 110.00 8,567.98 110.00 8,561.45 110.00 8,554.92 110.00 8,548.38 110.00 8,541.85 110.00 8,535.32 110.00 8,528.78 $2,292,000 $2,292,500 110.00 8,569.86 110.00 8,563.33 110.00 8,556.79 110.00 8,550.26 110.00 8,543.73 110.00 8,537.19 110.00 8,530.66 $2,292,500 $2,293,000 110.00 8,571.73 110.00 8,565.20 110.00 8,558.67 110.00 8,552.13 110.00 8,545.60 110.00 8,539.07 110.00 8,532.53 $2,293,000 $2,293,500 110.00 8,573.61 110.00 8,567.08 110.00 8,560.54 110.00 8,554.01 110.00 8,547.48 110.00 8,540.94 110.00 8,534.41 $2,293,500 $2,294,000 110.00 8,575.48 110.00 8,568.95 110.00 8,562.42 110.00 8,555.88 110.00 8,549.35 110.00 8,542.82 110.00 8,536.28 $2,294,000 $2,294,500 110.00 8,577.36 110.00 8,570.83 110.00 8,564.29 110.00 8,557.76 110.00 8,551.23 110.00 8,544.69 110.00 8,538.16 $2,294,500 $2,295,000 110.00 8,579.23 110.00 8,572.70 110.00 8,566.17 110.00 8,559.63 110.00 8,553.10 110.00 8,546.57 110.00 8,540.03

NJEIS Family Cost Participation Table Page 48 of 12 Effective July 1, 2015

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

$2,295,000 $2,295,500 110.00 8,581.11 110.00 8,574.58 110.00 8,568.04 110.00 8,561.51 110.00 8,554.98 110.00 8,548.44 110.00 8,541.91 $2,295,500 $2,296,000 110.00 8,582.98 110.00 8,576.45 110.00 8,569.92 110.00 8,563.38 110.00 8,556.85 110.00 8,550.32 110.00 8,543.78 $2,296,000 $2,296,500 110.00 8,584.86 110.00 8,578.33 110.00 8,571.79 110.00 8,565.26 110.00 8,558.73 110.00 8,552.19 110.00 8,545.66 $2,296,500 $2,297,000 110.00 8,586.73 110.00 8,580.20 110.00 8,573.67 110.00 8,567.13 110.00 8,560.60 110.00 8,554.07 110.00 8,547.53 $2,297,000 $2,297,500 110.00 8,588.61 110.00 8,582.08 110.00 8,575.54 110.00 8,569.01 110.00 8,562.48 110.00 8,555.94 110.00 8,549.41 $2,297,500 $2,298,000 110.00 8,590.48 110.00 8,583.95 110.00 8,577.42 110.00 8,570.88 110.00 8,564.35 110.00 8,557.82 110.00 8,551.28 $2,298,000 $2,298,500 110.00 8,592.36 110.00 8,585.83 110.00 8,579.29 110.00 8,572.76 110.00 8,566.23 110.00 8,559.69 110.00 8,553.16 $2,298,500 $2,299,000 110.00 8,594.23 110.00 8,587.70 110.00 8,581.17 110.00 8,574.63 110.00 8,568.10 110.00 8,561.57 110.00 8,555.03 $2,299,000 $2,299,500 110.00 8,596.11 110.00 8,589.58 110.00 8,583.04 110.00 8,576.51 110.00 8,569.98 110.00 8,563.44 110.00 8,556.91 $2,299,500 $2,300,000 110.00 8,597.98 110.00 8,591.45 110.00 8,584.92 110.00 8,578.38 110.00 8,571.85 110.00 8,565.32 110.00 8,558.78 $2,300,000 $2,300,500 110.00 8,599.86 110.00 8,593.33 110.00 8,586.79 110.00 8,580.26 110.00 8,573.73 110.00 8,567.19 110.00 8,560.66 $2,300,500 $2,301,000 110.00 8,601.73 110.00 8,595.20 110.00 8,588.67 110.00 8,582.13 110.00 8,575.60 110.00 8,569.07 110.00 8,562.53 $2,301,000 $2,301,500 110.00 8,603.61 110.00 8,597.08 110.00 8,590.54 110.00 8,584.01 110.00 8,577.48 110.00 8,570.94 110.00 8,564.41 $2,301,500 $2,302,000 110.00 8,605.48 110.00 8,598.95 110.00 8,592.42 110.00 8,585.88 110.00 8,579.35 110.00 8,572.82 110.00 8,566.28 $2,302,000 $2,302,500 110.00 8,607.36 110.00 8,600.83 110.00 8,594.29 110.00 8,587.76 110.00 8,581.23 110.00 8,574.69 110.00 8,568.16 $2,302,500 $2,303,000 110.00 8,609.23 110.00 8,602.70 110.00 8,596.17 110.00 8,589.63 110.00 8,583.10 110.00 8,576.57 110.00 8,570.03 $2,303,000 $2,303,500 110.00 8,611.11 110.00 8,604.58 110.00 8,598.04 110.00 8,591.51 110.00 8,584.98 110.00 8,578.44 110.00 8,571.91 $2,303,500 $2,304,000 110.00 8,612.98 110.00 8,606.45 110.00 8,599.92 110.00 8,593.38 110.00 8,586.85 110.00 8,580.32 110.00 8,573.78 $2,304,000 $2,304,500 110.00 8,614.86 110.00 8,608.33 110.00 8,601.79 110.00 8,595.26 110.00 8,588.73 110.00 8,582.19 110.00 8,575.66 $2,304,500 $2,305,000 110.00 8,616.73 110.00 8,610.20 110.00 8,603.67 110.00 8,597.13 110.00 8,590.60 110.00 8,584.07 110.00 8,577.53 $2,305,000 $2,305,500 110.00 8,618.61 110.00 8,612.08 110.00 8,605.54 110.00 8,599.01 110.00 8,592.48 110.00 8,585.94 110.00 8,579.41 $2,305,500 $2,306,000 110.00 8,620.48 110.00 8,613.95 110.00 8,607.42 110.00 8,600.88 110.00 8,594.35 110.00 8,587.82 110.00 8,581.28 $2,306,000 $2,306,500 110.00 8,622.36 110.00 8,615.83 110.00 8,609.29 110.00 8,602.76 110.00 8,596.23 110.00 8,589.69 110.00 8,583.16 $2,306,500 $2,307,000 110.00 8,624.23 110.00 8,617.70 110.00 8,611.17 110.00 8,604.63 110.00 8,598.10 110.00 8,591.57 110.00 8,585.03 $2,307,000 $2,307,500 110.00 8,626.11 110.00 8,619.58 110.00 8,613.04 110.00 8,606.51 110.00 8,599.98 110.00 8,593.44 110.00 8,586.91 $2,307,500 $2,308,000 110.00 8,627.98 110.00 8,621.45 110.00 8,614.92 110.00 8,608.38 110.00 8,601.85 110.00 8,595.32 110.00 8,588.78 $2,308,000 $2,308,500 110.00 8,629.86 110.00 8,623.33 110.00 8,616.79 110.00 8,610.26 110.00 8,603.73 110.00 8,597.19 110.00 8,590.66 $2,308,500 $2,309,000 110.00 8,631.73 110.00 8,625.20 110.00 8,618.67 110.00 8,612.13 110.00 8,605.60 110.00 8,599.07 110.00 8,592.53 $2,309,000 $2,309,500 110.00 8,633.61 110.00 8,627.08 110.00 8,620.54 110.00 8,614.01 110.00 8,607.48 110.00 8,600.94 110.00 8,594.41 $2,309,500 $2,310,000 110.00 8,635.48 110.00 8,628.95 110.00 8,622.42 110.00 8,615.88 110.00 8,609.35 110.00 8,602.82 110.00 8,596.28 $2,310,000 $2,310,500 110.00 8,637.36 110.00 8,630.83 110.00 8,624.29 110.00 8,617.76 110.00 8,611.23 110.00 8,604.69 110.00 8,598.16 $2,310,500 $2,311,000 110.00 8,639.23 110.00 8,632.70 110.00 8,626.17 110.00 8,619.63 110.00 8,613.10 110.00 8,606.57 110.00 8,600.03 $2,311,000 $2,311,500 110.00 8,641.11 110.00 8,634.58 110.00 8,628.04 110.00 8,621.51 110.00 8,614.98 110.00 8,608.44 110.00 8,601.91 $2,311,500 $2,312,000 110.00 8,642.98 110.00 8,636.45 110.00 8,629.92 110.00 8,623.38 110.00 8,616.85 110.00 8,610.32 110.00 8,603.78 $2,312,000 $2,312,500 110.00 8,644.86 110.00 8,638.33 110.00 8,631.79 110.00 8,625.26 110.00 8,618.73 110.00 8,612.19 110.00 8,605.66 $2,312,500 $2,313,000 110.00 8,646.73 110.00 8,640.20 110.00 8,633.67 110.00 8,627.13 110.00 8,620.60 110.00 8,614.07 110.00 8,607.53 $2,313,000 $2,313,500 110.00 8,648.61 110.00 8,642.08 110.00 8,635.54 110.00 8,629.01 110.00 8,622.48 110.00 8,615.94 110.00 8,609.41 $2,313,500 $2,314,000 110.00 8,650.48 110.00 8,643.95 110.00 8,637.42 110.00 8,630.88 110.00 8,624.35 110.00 8,617.82 110.00 8,611.28 $2,314,000 $2,314,500 110.00 8,652.36 110.00 8,645.83 110.00 8,639.29 110.00 8,632.76 110.00 8,626.23 110.00 8,619.69 110.00 8,613.16 $2,314,500 $2,315,000 110.00 8,654.23 110.00 8,647.70 110.00 8,641.17 110.00 8,634.63 110.00 8,628.10 110.00 8,621.57 110.00 8,615.03 $2,315,000 $2,315,500 110.00 8,656.11 110.00 8,649.58 110.00 8,643.04 110.00 8,636.51 110.00 8,629.98 110.00 8,623.44 110.00 8,616.91 $2,315,500 $2,316,000 110.00 8,657.98 110.00 8,651.45 110.00 8,644.92 110.00 8,638.38 110.00 8,631.85 110.00 8,625.32 110.00 8,618.78 $2,316,000 $2,316,500 110.00 8,659.86 110.00 8,653.33 110.00 8,646.79 110.00 8,640.26 110.00 8,633.73 110.00 8,627.19 110.00 8,620.66 $2,316,500 $2,317,000 110.00 8,661.73 110.00 8,655.20 110.00 8,648.67 110.00 8,642.13 110.00 8,635.60 110.00 8,629.07 110.00 8,622.53 $2,317,000 $2,317,500 110.00 8,663.61 110.00 8,657.08 110.00 8,650.54 110.00 8,644.01 110.00 8,637.48 110.00 8,630.94 110.00 8,624.41 $2,317,500 $2,318,000 110.00 8,665.48 110.00 8,658.95 110.00 8,652.42 110.00 8,645.88 110.00 8,639.35 110.00 8,632.82 110.00 8,626.28 $2,318,000 $2,318,500 110.00 8,667.36 110.00 8,660.83 110.00 8,654.29 110.00 8,647.76 110.00 8,641.23 110.00 8,634.69 110.00 8,628.16 $2,318,500 $2,319,000 110.00 8,669.23 110.00 8,662.70 110.00 8,656.17 110.00 8,649.63 110.00 8,643.10 110.00 8,636.57 110.00 8,630.03 $2,319,000 $2,319,500 110.00 8,671.11 110.00 8,664.58 110.00 8,658.04 110.00 8,651.51 110.00 8,644.98 110.00 8,638.44 110.00 8,631.91 $2,319,500 $2,320,000 110.00 8,672.98 110.00 8,666.45 110.00 8,659.92 110.00 8,653.38 110.00 8,646.85 110.00 8,640.32 110.00 8,633.78 $2,320,000 $2,320,500 110.00 8,674.86 110.00 8,668.33 110.00 8,661.79 110.00 8,655.26 110.00 8,648.73 110.00 8,642.19 110.00 8,635.66 $2,320,500 $2,321,000 110.00 8,676.73 110.00 8,670.20 110.00 8,663.67 110.00 8,657.13 110.00 8,650.60 110.00 8,644.07 110.00 8,637.53 $2,321,000 $2,321,500 110.00 8,678.61 110.00 8,672.08 110.00 8,665.54 110.00 8,659.01 110.00 8,652.48 110.00 8,645.94 110.00 8,639.41 $2,321,500 $2,322,000 110.00 8,680.48 110.00 8,673.95 110.00 8,667.42 110.00 8,660.88 110.00 8,654.35 110.00 8,647.82 110.00 8,641.28 $2,322,000 $2,322,500 110.00 8,682.36 110.00 8,675.83 110.00 8,669.29 110.00 8,662.76 110.00 8,656.23 110.00 8,649.69 110.00 8,643.16 $2,322,500 $2,323,000 110.00 8,684.23 110.00 8,677.70 110.00 8,671.17 110.00 8,664.63 110.00 8,658.10 110.00 8,651.57 110.00 8,645.03 $2,323,000 $2,323,500 110.00 8,686.11 110.00 8,679.58 110.00 8,673.04 110.00 8,666.51 110.00 8,659.98 110.00 8,653.44 110.00 8,646.91 $2,323,500 $2,324,000 110.00 8,687.98 110.00 8,681.45 110.00 8,674.92 110.00 8,668.38 110.00 8,661.85 110.00 8,655.32 110.00 8,648.78 $2,324,000 $2,324,500 110.00 8,689.86 110.00 8,683.33 110.00 8,676.79 110.00 8,670.26 110.00 8,663.73 110.00 8,657.19 110.00 8,650.66 $2,324,500 $2,325,000 110.00 8,691.73 110.00 8,685.20 110.00 8,678.67 110.00 8,672.13 110.00 8,665.60 110.00 8,659.07 110.00 8,652.53 $2,325,000 $2,325,500 110.00 8,693.61 110.00 8,687.08 110.00 8,680.54 110.00 8,674.01 110.00 8,667.48 110.00 8,660.94 110.00 8,654.41 $2,325,500 $2,326,000 110.00 8,695.48 110.00 8,688.95 110.00 8,682.42 110.00 8,675.88 110.00 8,669.35 110.00 8,662.82 110.00 8,656.28 $2,326,000 $2,326,500 110.00 8,697.36 110.00 8,690.83 110.00 8,684.29 110.00 8,677.76 110.00 8,671.23 110.00 8,664.69 110.00 8,658.16 $2,326,500 $2,327,000 110.00 8,699.23 110.00 8,692.70 110.00 8,686.17 110.00 8,679.63 110.00 8,673.10 110.00 8,666.57 110.00 8,660.03 $2,327,000 $2,327,500 110.00 8,701.11 110.00 8,694.58 110.00 8,688.04 110.00 8,681.51 110.00 8,674.98 110.00 8,668.44 110.00 8,661.91 $2,327,500 $2,328,000 110.00 8,702.98 110.00 8,696.45 110.00 8,689.92 110.00 8,683.38 110.00 8,676.85 110.00 8,670.32 110.00 8,663.78 $2,328,000 $2,328,500 110.00 8,704.86 110.00 8,698.33 110.00 8,691.79 110.00 8,685.26 110.00 8,678.73 110.00 8,672.19 110.00 8,665.66 $2,328,500 $2,329,000 110.00 8,706.73 110.00 8,700.20 110.00 8,693.67 110.00 8,687.13 110.00 8,680.60 110.00 8,674.07 110.00 8,667.53 $2,329,000 $2,329,500 110.00 8,708.61 110.00 8,702.08 110.00 8,695.54 110.00 8,689.01 110.00 8,682.48 110.00 8,675.94 110.00 8,669.41 $2,329,500 $2,330,000 110.00 8,710.48 110.00 8,703.95 110.00 8,697.42 110.00 8,690.88 110.00 8,684.35 110.00 8,677.82 110.00 8,671.28 $2,330,000 $2,330,500 110.00 8,712.36 110.00 8,705.83 110.00 8,699.29 110.00 8,692.76 110.00 8,686.23 110.00 8,679.69 110.00 8,673.16 $2,330,500 $2,331,000 110.00 8,714.23 110.00 8,707.70 110.00 8,701.17 110.00 8,694.63 110.00 8,688.10 110.00 8,681.57 110.00 8,675.03 $2,331,000 $2,331,500 110.00 8,716.11 110.00 8,709.58 110.00 8,703.04 110.00 8,696.51 110.00 8,689.98 110.00 8,683.44 110.00 8,676.91 $2,331,500 $2,332,000 110.00 8,717.98 110.00 8,711.45 110.00 8,704.92 110.00 8,698.38 110.00 8,691.85 110.00 8,685.32 110.00 8,678.78 $2,332,000 $2,332,500 110.00 8,719.86 110.00 8,713.33 110.00 8,706.79 110.00 8,700.26 110.00 8,693.73 110.00 8,687.19 110.00 8,680.66 $2,332,500 $2,333,000 110.00 8,721.73 110.00 8,715.20 110.00 8,708.67 110.00 8,702.13 110.00 8,695.60 110.00 8,689.07 110.00 8,682.53 $2,333,000 $2,333,500 110.00 8,723.61 110.00 8,717.08 110.00 8,710.54 110.00 8,704.01 110.00 8,697.48 110.00 8,690.94 110.00 8,684.41 $2,333,500 $2,334,000 110.00 8,725.48 110.00 8,718.95 110.00 8,712.42 110.00 8,705.88 110.00 8,699.35 110.00 8,692.82 110.00 8,686.28 $2,334,000 $2,334,500 110.00 8,727.36 110.00 8,720.83 110.00 8,714.29 110.00 8,707.76 110.00 8,701.23 110.00 8,694.69 110.00 8,688.16 $2,334,500 $2,335,000 110.00 8,729.23 110.00 8,722.70 110.00 8,716.17 110.00 8,709.63 110.00 8,703.10 110.00 8,696.57 110.00 8,690.03 $2,335,000 $2,335,500 110.00 8,731.11 110.00 8,724.58 110.00 8,718.04 110.00 8,711.51 110.00 8,704.98 110.00 8,698.44 110.00 8,691.91 $2,335,500 $2,336,000 110.00 8,732.98 110.00 8,726.45 110.00 8,719.92 110.00 8,713.38 110.00 8,706.85 110.00 8,700.32 110.00 8,693.78 $2,336,000 $2,336,500 110.00 8,734.86 110.00 8,728.33 110.00 8,721.79 110.00 8,715.26 110.00 8,708.73 110.00 8,702.19 110.00 8,695.66 $2,336,500 $2,337,000 110.00 8,736.73 110.00 8,730.20 110.00 8,723.67 110.00 8,717.13 110.00 8,710.60 110.00 8,704.07 110.00 8,697.53 $2,337,000 $2,337,500 110.00 8,738.61 110.00 8,732.08 110.00 8,725.54 110.00 8,719.01 110.00 8,712.48 110.00 8,705.94 110.00 8,699.41 $2,337,500 $2,338,000 110.00 8,740.48 110.00 8,733.95 110.00 8,727.42 110.00 8,720.88 110.00 8,714.35 110.00 8,707.82 110.00 8,701.28 $2,338,000 $2,338,500 110.00 8,742.36 110.00 8,735.83 110.00 8,729.29 110.00 8,722.76 110.00 8,716.23 110.00 8,709.69 110.00 8,703.16 $2,338,500 $2,339,000 110.00 8,744.23 110.00 8,737.70 110.00 8,731.17 110.00 8,724.63 110.00 8,718.10 110.00 8,711.57 110.00 8,705.03 $2,339,000 $2,339,500 110.00 8,746.11 110.00 8,739.58 110.00 8,733.04 110.00 8,726.51 110.00 8,719.98 110.00 8,713.44 110.00 8,706.91 $2,339,500 $2,340,000 110.00 8,747.98 110.00 8,741.45 110.00 8,734.92 110.00 8,728.38 110.00 8,721.85 110.00 8,715.32 110.00 8,708.78 $2,340,000 $2,340,500 110.00 8,749.86 110.00 8,743.33 110.00 8,736.79 110.00 8,730.26 110.00 8,723.73 110.00 8,717.19 110.00 8,710.66 $2,340,500 $2,341,000 110.00 8,751.73 110.00 8,745.20 110.00 8,738.67 110.00 8,732.13 110.00 8,725.60 110.00 8,719.07 110.00 8,712.53 $2,341,000 $2,341,500 110.00 8,753.61 110.00 8,747.08 110.00 8,740.54 110.00 8,734.01 110.00 8,727.48 110.00 8,720.94 110.00 8,714.41 $2,341,500 $2,342,000 110.00 8,755.48 110.00 8,748.95 110.00 8,742.42 110.00 8,735.88 110.00 8,729.35 110.00 8,722.82 110.00 8,716.28 $2,342,000 $2,342,500 110.00 8,757.36 110.00 8,750.83 110.00 8,744.29 110.00 8,737.76 110.00 8,731.23 110.00 8,724.69 110.00 8,718.16 $2,342,500 $2,343,000 110.00 8,759.23 110.00 8,752.70 110.00 8,746.17 110.00 8,739.63 110.00 8,733.10 110.00 8,726.57 110.00 8,720.03 $2,343,000 $2,343,500 110.00 8,761.11 110.00 8,754.58 110.00 8,748.04 110.00 8,741.51 110.00 8,734.98 110.00 8,728.44 110.00 8,721.91 $2,343,500 $2,344,000 110.00 8,762.98 110.00 8,756.45 110.00 8,749.92 110.00 8,743.38 110.00 8,736.85 110.00 8,730.32 110.00 8,723.78 $2,344,000 $2,344,500 110.00 8,764.86 110.00 8,758.33 110.00 8,751.79 110.00 8,745.26 110.00 8,738.73 110.00 8,732.19 110.00 8,725.66 $2,344,500 $2,345,000 110.00 8,766.73 110.00 8,760.20 110.00 8,753.67 110.00 8,747.13 110.00 8,740.60 110.00 8,734.07 110.00 8,727.53 $2,345,000 $2,345,500 110.00 8,768.61 110.00 8,762.08 110.00 8,755.54 110.00 8,749.01 110.00 8,742.48 110.00 8,735.94 110.00 8,729.41 $2,345,500 $2,346,000 110.00 8,770.48 110.00 8,763.95 110.00 8,757.42 110.00 8,750.88 110.00 8,744.35 110.00 8,737.82 110.00 8,731.28

NJEIS Family Cost Participation Table Page 49 of 12 Effective July 1, 2015

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

$2,346,000 $2,346,500 110.00 8,772.36 110.00 8,765.83 110.00 8,759.29 110.00 8,752.76 110.00 8,746.23 110.00 8,739.69 110.00 8,733.16 $2,346,500 $2,347,000 110.00 8,774.23 110.00 8,767.70 110.00 8,761.17 110.00 8,754.63 110.00 8,748.10 110.00 8,741.57 110.00 8,735.03 $2,347,000 $2,347,500 110.00 8,776.11 110.00 8,769.58 110.00 8,763.04 110.00 8,756.51 110.00 8,749.98 110.00 8,743.44 110.00 8,736.91 $2,347,500 $2,348,000 110.00 8,777.98 110.00 8,771.45 110.00 8,764.92 110.00 8,758.38 110.00 8,751.85 110.00 8,745.32 110.00 8,738.78 $2,348,000 $2,348,500 110.00 8,779.86 110.00 8,773.33 110.00 8,766.79 110.00 8,760.26 110.00 8,753.73 110.00 8,747.19 110.00 8,740.66 $2,348,500 $2,349,000 110.00 8,781.73 110.00 8,775.20 110.00 8,768.67 110.00 8,762.13 110.00 8,755.60 110.00 8,749.07 110.00 8,742.53 $2,349,000 $2,349,500 110.00 8,783.61 110.00 8,777.08 110.00 8,770.54 110.00 8,764.01 110.00 8,757.48 110.00 8,750.94 110.00 8,744.41 $2,349,500 $2,350,000 110.00 8,785.48 110.00 8,778.95 110.00 8,772.42 110.00 8,765.88 110.00 8,759.35 110.00 8,752.82 110.00 8,746.28 $2,350,000 $2,350,500 110.00 8,787.36 110.00 8,780.83 110.00 8,774.29 110.00 8,767.76 110.00 8,761.23 110.00 8,754.69 110.00 8,748.16 $2,350,500 $2,351,000 110.00 8,789.23 110.00 8,782.70 110.00 8,776.17 110.00 8,769.63 110.00 8,763.10 110.00 8,756.57 110.00 8,750.03 $2,351,000 $2,351,500 110.00 8,791.11 110.00 8,784.58 110.00 8,778.04 110.00 8,771.51 110.00 8,764.98 110.00 8,758.44 110.00 8,751.91 $2,351,500 $2,352,000 110.00 8,792.98 110.00 8,786.45 110.00 8,779.92 110.00 8,773.38 110.00 8,766.85 110.00 8,760.32 110.00 8,753.78 $2,352,000 $2,352,500 110.00 8,794.86 110.00 8,788.33 110.00 8,781.79 110.00 8,775.26 110.00 8,768.73 110.00 8,762.19 110.00 8,755.66 $2,352,500 $2,353,000 110.00 8,796.73 110.00 8,790.20 110.00 8,783.67 110.00 8,777.13 110.00 8,770.60 110.00 8,764.07 110.00 8,757.53 $2,353,000 $2,353,500 110.00 8,798.61 110.00 8,792.08 110.00 8,785.54 110.00 8,779.01 110.00 8,772.48 110.00 8,765.94 110.00 8,759.41 $2,353,500 $2,354,000 110.00 8,800.48 110.00 8,793.95 110.00 8,787.42 110.00 8,780.88 110.00 8,774.35 110.00 8,767.82 110.00 8,761.28 $2,354,000 $2,354,500 110.00 8,802.36 110.00 8,795.83 110.00 8,789.29 110.00 8,782.76 110.00 8,776.23 110.00 8,769.69 110.00 8,763.16 $2,354,500 $2,355,000 110.00 8,804.23 110.00 8,797.70 110.00 8,791.17 110.00 8,784.63 110.00 8,778.10 110.00 8,771.57 110.00 8,765.03 $2,355,000 $2,355,500 110.00 8,806.11 110.00 8,799.58 110.00 8,793.04 110.00 8,786.51 110.00 8,779.98 110.00 8,773.44 110.00 8,766.91 $2,355,500 $2,356,000 110.00 8,807.98 110.00 8,801.45 110.00 8,794.92 110.00 8,788.38 110.00 8,781.85 110.00 8,775.32 110.00 8,768.78 $2,356,000 $2,356,500 110.00 8,809.86 110.00 8,803.33 110.00 8,796.79 110.00 8,790.26 110.00 8,783.73 110.00 8,777.19 110.00 8,770.66 $2,356,500 $2,357,000 110.00 8,811.73 110.00 8,805.20 110.00 8,798.67 110.00 8,792.13 110.00 8,785.60 110.00 8,779.07 110.00 8,772.53 $2,357,000 $2,357,500 110.00 8,813.61 110.00 8,807.08 110.00 8,800.54 110.00 8,794.01 110.00 8,787.48 110.00 8,780.94 110.00 8,774.41 $2,357,500 $2,358,000 110.00 8,815.48 110.00 8,808.95 110.00 8,802.42 110.00 8,795.88 110.00 8,789.35 110.00 8,782.82 110.00 8,776.28 $2,358,000 $2,358,500 110.00 8,817.36 110.00 8,810.83 110.00 8,804.29 110.00 8,797.76 110.00 8,791.23 110.00 8,784.69 110.00 8,778.16 $2,358,500 $2,359,000 110.00 8,819.23 110.00 8,812.70 110.00 8,806.17 110.00 8,799.63 110.00 8,793.10 110.00 8,786.57 110.00 8,780.03 $2,359,000 $2,359,500 110.00 8,821.11 110.00 8,814.58 110.00 8,808.04 110.00 8,801.51 110.00 8,794.98 110.00 8,788.44 110.00 8,781.91 $2,359,500 $2,360,000 110.00 8,822.98 110.00 8,816.45 110.00 8,809.92 110.00 8,803.38 110.00 8,796.85 110.00 8,790.32 110.00 8,783.78 $2,360,000 $2,360,500 110.00 8,824.86 110.00 8,818.33 110.00 8,811.79 110.00 8,805.26 110.00 8,798.73 110.00 8,792.19 110.00 8,785.66 $2,360,500 $2,361,000 110.00 8,826.73 110.00 8,820.20 110.00 8,813.67 110.00 8,807.13 110.00 8,800.60 110.00 8,794.07 110.00 8,787.53 $2,361,000 $2,361,500 110.00 8,828.61 110.00 8,822.08 110.00 8,815.54 110.00 8,809.01 110.00 8,802.48 110.00 8,795.94 110.00 8,789.41 $2,361,500 $2,362,000 110.00 8,830.48 110.00 8,823.95 110.00 8,817.42 110.00 8,810.88 110.00 8,804.35 110.00 8,797.82 110.00 8,791.28 $2,362,000 $2,362,500 110.00 8,832.36 110.00 8,825.83 110.00 8,819.29 110.00 8,812.76 110.00 8,806.23 110.00 8,799.69 110.00 8,793.16 $2,362,500 $2,363,000 110.00 8,834.23 110.00 8,827.70 110.00 8,821.17 110.00 8,814.63 110.00 8,808.10 110.00 8,801.57 110.00 8,795.03 $2,363,000 $2,363,500 110.00 8,836.11 110.00 8,829.58 110.00 8,823.04 110.00 8,816.51 110.00 8,809.98 110.00 8,803.44 110.00 8,796.91 $2,363,500 $2,364,000 110.00 8,837.98 110.00 8,831.45 110.00 8,824.92 110.00 8,818.38 110.00 8,811.85 110.00 8,805.32 110.00 8,798.78 $2,364,000 $2,364,500 110.00 8,839.86 110.00 8,833.33 110.00 8,826.79 110.00 8,820.26 110.00 8,813.73 110.00 8,807.19 110.00 8,800.66 $2,364,500 $2,365,000 110.00 8,841.73 110.00 8,835.20 110.00 8,828.67 110.00 8,822.13 110.00 8,815.60 110.00 8,809.07 110.00 8,802.53 $2,365,000 $2,365,500 110.00 8,843.61 110.00 8,837.08 110.00 8,830.54 110.00 8,824.01 110.00 8,817.48 110.00 8,810.94 110.00 8,804.41 $2,365,500 $2,366,000 110.00 8,845.48 110.00 8,838.95 110.00 8,832.42 110.00 8,825.88 110.00 8,819.35 110.00 8,812.82 110.00 8,806.28 $2,366,000 $2,366,500 110.00 8,847.36 110.00 8,840.83 110.00 8,834.29 110.00 8,827.76 110.00 8,821.23 110.00 8,814.69 110.00 8,808.16 $2,366,500 $2,367,000 110.00 8,849.23 110.00 8,842.70 110.00 8,836.17 110.00 8,829.63 110.00 8,823.10 110.00 8,816.57 110.00 8,810.03 $2,367,000 $2,367,500 110.00 8,851.11 110.00 8,844.58 110.00 8,838.04 110.00 8,831.51 110.00 8,824.98 110.00 8,818.44 110.00 8,811.91 $2,367,500 $2,368,000 110.00 8,852.98 110.00 8,846.45 110.00 8,839.92 110.00 8,833.38 110.00 8,826.85 110.00 8,820.32 110.00 8,813.78 $2,368,000 $2,368,500 110.00 8,854.86 110.00 8,848.33 110.00 8,841.79 110.00 8,835.26 110.00 8,828.73 110.00 8,822.19 110.00 8,815.66 $2,368,500 $2,369,000 110.00 8,856.73 110.00 8,850.20 110.00 8,843.67 110.00 8,837.13 110.00 8,830.60 110.00 8,824.07 110.00 8,817.53 $2,369,000 $2,369,500 110.00 8,858.61 110.00 8,852.08 110.00 8,845.54 110.00 8,839.01 110.00 8,832.48 110.00 8,825.94 110.00 8,819.41 $2,369,500 $2,370,000 110.00 8,860.48 110.00 8,853.95 110.00 8,847.42 110.00 8,840.88 110.00 8,834.35 110.00 8,827.82 110.00 8,821.28 $2,370,000 $2,370,500 110.00 8,862.36 110.00 8,855.83 110.00 8,849.29 110.00 8,842.76 110.00 8,836.23 110.00 8,829.69 110.00 8,823.16 $2,370,500 $2,371,000 110.00 8,864.23 110.00 8,857.70 110.00 8,851.17 110.00 8,844.63 110.00 8,838.10 110.00 8,831.57 110.00 8,825.03 $2,371,000 $2,371,500 110.00 8,866.11 110.00 8,859.58 110.00 8,853.04 110.00 8,846.51 110.00 8,839.98 110.00 8,833.44 110.00 8,826.91 $2,371,500 $2,372,000 110.00 8,867.98 110.00 8,861.45 110.00 8,854.92 110.00 8,848.38 110.00 8,841.85 110.00 8,835.32 110.00 8,828.78 $2,372,000 $2,372,500 110.00 8,869.86 110.00 8,863.33 110.00 8,856.79 110.00 8,850.26 110.00 8,843.73 110.00 8,837.19 110.00 8,830.66 $2,372,500 $2,373,000 110.00 8,871.73 110.00 8,865.20 110.00 8,858.67 110.00 8,852.13 110.00 8,845.60 110.00 8,839.07 110.00 8,832.53 $2,373,000 $2,373,500 110.00 8,873.61 110.00 8,867.08 110.00 8,860.54 110.00 8,854.01 110.00 8,847.48 110.00 8,840.94 110.00 8,834.41 $2,373,500 $2,374,000 110.00 8,875.48 110.00 8,868.95 110.00 8,862.42 110.00 8,855.88 110.00 8,849.35 110.00 8,842.82 110.00 8,836.28 $2,374,000 $2,374,500 110.00 8,877.36 110.00 8,870.83 110.00 8,864.29 110.00 8,857.76 110.00 8,851.23 110.00 8,844.69 110.00 8,838.16 $2,374,500 $2,375,000 110.00 8,879.23 110.00 8,872.70 110.00 8,866.17 110.00 8,859.63 110.00 8,853.10 110.00 8,846.57 110.00 8,840.03 $2,375,000 $2,375,500 110.00 8,881.11 110.00 8,874.58 110.00 8,868.04 110.00 8,861.51 110.00 8,854.98 110.00 8,848.44 110.00 8,841.91 $2,375,500 $2,376,000 110.00 8,882.98 110.00 8,876.45 110.00 8,869.92 110.00 8,863.38 110.00 8,856.85 110.00 8,850.32 110.00 8,843.78 $2,376,000 $2,376,500 110.00 8,884.86 110.00 8,878.33 110.00 8,871.79 110.00 8,865.26 110.00 8,858.73 110.00 8,852.19 110.00 8,845.66 $2,376,500 $2,377,000 110.00 8,886.73 110.00 8,880.20 110.00 8,873.67 110.00 8,867.13 110.00 8,860.60 110.00 8,854.07 110.00 8,847.53 $2,377,000 $2,377,500 110.00 8,888.61 110.00 8,882.08 110.00 8,875.54 110.00 8,869.01 110.00 8,862.48 110.00 8,855.94 110.00 8,849.41 $2,377,500 $2,378,000 110.00 8,890.48 110.00 8,883.95 110.00 8,877.42 110.00 8,870.88 110.00 8,864.35 110.00 8,857.82 110.00 8,851.28 $2,378,000 $2,378,500 110.00 8,892.36 110.00 8,885.83 110.00 8,879.29 110.00 8,872.76 110.00 8,866.23 110.00 8,859.69 110.00 8,853.16 $2,378,500 $2,379,000 110.00 8,894.23 110.00 8,887.70 110.00 8,881.17 110.00 8,874.63 110.00 8,868.10 110.00 8,861.57 110.00 8,855.03 $2,379,000 $2,379,500 110.00 8,896.11 110.00 8,889.58 110.00 8,883.04 110.00 8,876.51 110.00 8,869.98 110.00 8,863.44 110.00 8,856.91 $2,379,500 $2,380,000 110.00 8,897.98 110.00 8,891.45 110.00 8,884.92 110.00 8,878.38 110.00 8,871.85 110.00 8,865.32 110.00 8,858.78 $2,380,000 $2,380,500 110.00 8,899.86 110.00 8,893.33 110.00 8,886.79 110.00 8,880.26 110.00 8,873.73 110.00 8,867.19 110.00 8,860.66 $2,380,500 $2,381,000 110.00 8,901.73 110.00 8,895.20 110.00 8,888.67 110.00 8,882.13 110.00 8,875.60 110.00 8,869.07 110.00 8,862.53 $2,381,000 $2,381,500 110.00 8,903.61 110.00 8,897.08 110.00 8,890.54 110.00 8,884.01 110.00 8,877.48 110.00 8,870.94 110.00 8,864.41 $2,381,500 $2,382,000 110.00 8,905.48 110.00 8,898.95 110.00 8,892.42 110.00 8,885.88 110.00 8,879.35 110.00 8,872.82 110.00 8,866.28 $2,382,000 $2,382,500 110.00 8,907.36 110.00 8,900.83 110.00 8,894.29 110.00 8,887.76 110.00 8,881.23 110.00 8,874.69 110.00 8,868.16 $2,382,500 $2,383,000 110.00 8,909.23 110.00 8,902.70 110.00 8,896.17 110.00 8,889.63 110.00 8,883.10 110.00 8,876.57 110.00 8,870.03 $2,383,000 $2,383,500 110.00 8,911.11 110.00 8,904.58 110.00 8,898.04 110.00 8,891.51 110.00 8,884.98 110.00 8,878.44 110.00 8,871.91 $2,383,500 $2,384,000 110.00 8,912.98 110.00 8,906.45 110.00 8,899.92 110.00 8,893.38 110.00 8,886.85 110.00 8,880.32 110.00 8,873.78 $2,384,000 $2,384,500 110.00 8,914.86 110.00 8,908.33 110.00 8,901.79 110.00 8,895.26 110.00 8,888.73 110.00 8,882.19 110.00 8,875.66 $2,384,500 $2,385,000 110.00 8,916.73 110.00 8,910.20 110.00 8,903.67 110.00 8,897.13 110.00 8,890.60 110.00 8,884.07 110.00 8,877.53 $2,385,000 $2,385,500 110.00 8,918.61 110.00 8,912.08 110.00 8,905.54 110.00 8,899.01 110.00 8,892.48 110.00 8,885.94 110.00 8,879.41 $2,385,500 $2,386,000 110.00 8,920.48 110.00 8,913.95 110.00 8,907.42 110.00 8,900.88 110.00 8,894.35 110.00 8,887.82 110.00 8,881.28 $2,386,000 $2,386,500 110.00 8,922.36 110.00 8,915.83 110.00 8,909.29 110.00 8,902.76 110.00 8,896.23 110.00 8,889.69 110.00 8,883.16 $2,386,500 $2,387,000 110.00 8,924.23 110.00 8,917.70 110.00 8,911.17 110.00 8,904.63 110.00 8,898.10 110.00 8,891.57 110.00 8,885.03 $2,387,000 $2,387,500 110.00 8,926.11 110.00 8,919.58 110.00 8,913.04 110.00 8,906.51 110.00 8,899.98 110.00 8,893.44 110.00 8,886.91 $2,387,500 $2,388,000 110.00 8,927.98 110.00 8,921.45 110.00 8,914.92 110.00 8,908.38 110.00 8,901.85 110.00 8,895.32 110.00 8,888.78 $2,388,000 $2,388,500 110.00 8,929.86 110.00 8,923.33 110.00 8,916.79 110.00 8,910.26 110.00 8,903.73 110.00 8,897.19 110.00 8,890.66 $2,388,500 $2,389,000 110.00 8,931.73 110.00 8,925.20 110.00 8,918.67 110.00 8,912.13 110.00 8,905.60 110.00 8,899.07 110.00 8,892.53 $2,389,000 $2,389,500 110.00 8,933.61 110.00 8,927.08 110.00 8,920.54 110.00 8,914.01 110.00 8,907.48 110.00 8,900.94 110.00 8,894.41 $2,389,500 $2,390,000 110.00 8,935.48 110.00 8,928.95 110.00 8,922.42 110.00 8,915.88 110.00 8,909.35 110.00 8,902.82 110.00 8,896.28 $2,390,000 $2,390,500 110.00 8,937.36 110.00 8,930.83 110.00 8,924.29 110.00 8,917.76 110.00 8,911.23 110.00 8,904.69 110.00 8,898.16 $2,390,500 $2,391,000 110.00 8,939.23 110.00 8,932.70 110.00 8,926.17 110.00 8,919.63 110.00 8,913.10 110.00 8,906.57 110.00 8,900.03 $2,391,000 $2,391,500 110.00 8,941.11 110.00 8,934.58 110.00 8,928.04 110.00 8,921.51 110.00 8,914.98 110.00 8,908.44 110.00 8,901.91 $2,391,500 $2,392,000 110.00 8,942.98 110.00 8,936.45 110.00 8,929.92 110.00 8,923.38 110.00 8,916.85 110.00 8,910.32 110.00 8,903.78 $2,392,000 $2,392,500 110.00 8,944.86 110.00 8,938.33 110.00 8,931.79 110.00 8,925.26 110.00 8,918.73 110.00 8,912.19 110.00 8,905.66 $2,392,500 $2,393,000 110.00 8,946.73 110.00 8,940.20 110.00 8,933.67 110.00 8,927.13 110.00 8,920.60 110.00 8,914.07 110.00 8,907.53 $2,393,000 $2,393,500 110.00 8,948.61 110.00 8,942.08 110.00 8,935.54 110.00 8,929.01 110.00 8,922.48 110.00 8,915.94 110.00 8,909.41 $2,393,500 $2,394,000 110.00 8,950.48 110.00 8,943.95 110.00 8,937.42 110.00 8,930.88 110.00 8,924.35 110.00 8,917.82 110.00 8,911.28 $2,394,000 $2,394,500 110.00 8,952.36 110.00 8,945.83 110.00 8,939.29 110.00 8,932.76 110.00 8,926.23 110.00 8,919.69 110.00 8,913.16 $2,394,500 $2,395,000 110.00 8,954.23 110.00 8,947.70 110.00 8,941.17 110.00 8,934.63 110.00 8,928.10 110.00 8,921.57 110.00 8,915.03 $2,395,000 $2,395,500 110.00 8,956.11 110.00 8,949.58 110.00 8,943.04 110.00 8,936.51 110.00 8,929.98 110.00 8,923.44 110.00 8,916.91 $2,395,500 $2,396,000 110.00 8,957.98 110.00 8,951.45 110.00 8,944.92 110.00 8,938.38 110.00 8,931.85 110.00 8,925.32 110.00 8,918.78 $2,396,000 $2,396,500 110.00 8,959.86 110.00 8,953.33 110.00 8,946.79 110.00 8,940.26 110.00 8,933.73 110.00 8,927.19 110.00 8,920.66 $2,396,500 $2,397,000 110.00 8,961.73 110.00 8,955.20 110.00 8,948.67 110.00 8,942.13 110.00 8,935.60 110.00 8,929.07 110.00 8,922.53

NJEIS Family Cost Participation Table Page 50 of 12 Effective July 1, 2015

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

$2,397,000 $2,397,500 110.00 8,963.61 110.00 8,957.08 110.00 8,950.54 110.00 8,944.01 110.00 8,937.48 110.00 8,930.94 110.00 8,924.41 $2,397,500 $2,398,000 110.00 8,965.48 110.00 8,958.95 110.00 8,952.42 110.00 8,945.88 110.00 8,939.35 110.00 8,932.82 110.00 8,926.28 $2,398,000 $2,398,500 110.00 8,967.36 110.00 8,960.83 110.00 8,954.29 110.00 8,947.76 110.00 8,941.23 110.00 8,934.69 110.00 8,928.16 $2,398,500 $2,399,000 110.00 8,969.23 110.00 8,962.70 110.00 8,956.17 110.00 8,949.63 110.00 8,943.10 110.00 8,936.57 110.00 8,930.03 $2,399,000 $2,399,500 110.00 8,971.11 110.00 8,964.58 110.00 8,958.04 110.00 8,951.51 110.00 8,944.98 110.00 8,938.44 110.00 8,931.91 $2,399,500 $2,400,000 110.00 8,972.98 110.00 8,966.45 110.00 8,959.92 110.00 8,953.38 110.00 8,946.85 110.00 8,940.32 110.00 8,933.78 $2,400,000 $2,400,500 110.00 8,974.86 110.00 8,968.33 110.00 8,961.79 110.00 8,955.26 110.00 8,948.73 110.00 8,942.19 110.00 8,935.66 $2,400,500 $2,401,000 110.00 8,976.73 110.00 8,970.20 110.00 8,963.67 110.00 8,957.13 110.00 8,950.60 110.00 8,944.07 110.00 8,937.53 $2,401,000 $2,401,500 110.00 8,978.61 110.00 8,972.08 110.00 8,965.54 110.00 8,959.01 110.00 8,952.48 110.00 8,945.94 110.00 8,939.41 $2,401,500 $2,402,000 110.00 8,980.48 110.00 8,973.95 110.00 8,967.42 110.00 8,960.88 110.00 8,954.35 110.00 8,947.82 110.00 8,941.28 $2,402,000 $2,402,500 110.00 8,982.36 110.00 8,975.83 110.00 8,969.29 110.00 8,962.76 110.00 8,956.23 110.00 8,949.69 110.00 8,943.16 $2,402,500 $2,403,000 110.00 8,984.23 110.00 8,977.70 110.00 8,971.17 110.00 8,964.63 110.00 8,958.10 110.00 8,951.57 110.00 8,945.03 $2,403,000 $2,403,500 110.00 8,986.11 110.00 8,979.58 110.00 8,973.04 110.00 8,966.51 110.00 8,959.98 110.00 8,953.44 110.00 8,946.91 $2,403,500 $2,404,000 110.00 8,987.98 110.00 8,981.45 110.00 8,974.92 110.00 8,968.38 110.00 8,961.85 110.00 8,955.32 110.00 8,948.78 $2,404,000 $2,404,500 110.00 8,989.86 110.00 8,983.33 110.00 8,976.79 110.00 8,970.26 110.00 8,963.73 110.00 8,957.19 110.00 8,950.66 $2,404,500 $2,405,000 110.00 8,991.73 110.00 8,985.20 110.00 8,978.67 110.00 8,972.13 110.00 8,965.60 110.00 8,959.07 110.00 8,952.53 $2,405,000 $2,405,500 110.00 8,993.61 110.00 8,987.08 110.00 8,980.54 110.00 8,974.01 110.00 8,967.48 110.00 8,960.94 110.00 8,954.41 $2,405,500 $2,406,000 110.00 8,995.48 110.00 8,988.95 110.00 8,982.42 110.00 8,975.88 110.00 8,969.35 110.00 8,962.82 110.00 8,956.28 $2,406,000 $2,406,500 110.00 8,997.36 110.00 8,990.83 110.00 8,984.29 110.00 8,977.76 110.00 8,971.23 110.00 8,964.69 110.00 8,958.16 $2,406,500 $2,407,000 110.00 8,999.23 110.00 8,992.70 110.00 8,986.17 110.00 8,979.63 110.00 8,973.10 110.00 8,966.57 110.00 8,960.03 $2,407,000 $2,407,500 110.00 9,001.11 110.00 8,994.58 110.00 8,988.04 110.00 8,981.51 110.00 8,974.98 110.00 8,968.44 110.00 8,961.91 $2,407,500 $2,408,000 110.00 9,002.98 110.00 8,996.45 110.00 8,989.92 110.00 8,983.38 110.00 8,976.85 110.00 8,970.32 110.00 8,963.78 $2,408,000 $2,408,500 110.00 9,004.86 110.00 8,998.33 110.00 8,991.79 110.00 8,985.26 110.00 8,978.73 110.00 8,972.19 110.00 8,965.66 $2,408,500 $2,409,000 110.00 9,006.73 110.00 9,000.20 110.00 8,993.67 110.00 8,987.13 110.00 8,980.60 110.00 8,974.07 110.00 8,967.53 $2,409,000 $2,409,500 110.00 9,008.61 110.00 9,002.08 110.00 8,995.54 110.00 8,989.01 110.00 8,982.48 110.00 8,975.94 110.00 8,969.41 $2,409,500 $2,410,000 110.00 9,010.48 110.00 9,003.95 110.00 8,997.42 110.00 8,990.88 110.00 8,984.35 110.00 8,977.82 110.00 8,971.28 $2,410,000 $2,410,500 110.00 9,012.36 110.00 9,005.83 110.00 8,999.29 110.00 8,992.76 110.00 8,986.23 110.00 8,979.69 110.00 8,973.16 $2,410,500 $2,411,000 110.00 9,014.23 110.00 9,007.70 110.00 9,001.17 110.00 8,994.63 110.00 8,988.10 110.00 8,981.57 110.00 8,975.03 $2,411,000 $2,411,500 110.00 9,016.11 110.00 9,009.58 110.00 9,003.04 110.00 8,996.51 110.00 8,989.98 110.00 8,983.44 110.00 8,976.91 $2,411,500 $2,412,000 110.00 9,017.98 110.00 9,011.45 110.00 9,004.92 110.00 8,998.38 110.00 8,991.85 110.00 8,985.32 110.00 8,978.78 $2,412,000 $2,412,500 110.00 9,019.86 110.00 9,013.33 110.00 9,006.79 110.00 9,000.26 110.00 8,993.73 110.00 8,987.19 110.00 8,980.66 $2,412,500 $2,413,000 110.00 9,021.73 110.00 9,015.20 110.00 9,008.67 110.00 9,002.13 110.00 8,995.60 110.00 8,989.07 110.00 8,982.53 $2,413,000 $2,413,500 110.00 9,023.61 110.00 9,017.08 110.00 9,010.54 110.00 9,004.01 110.00 8,997.48 110.00 8,990.94 110.00 8,984.41 $2,413,500 $2,414,000 110.00 9,025.48 110.00 9,018.95 110.00 9,012.42 110.00 9,005.88 110.00 8,999.35 110.00 8,992.82 110.00 8,986.28 $2,414,000 $2,414,500 110.00 9,027.36 110.00 9,020.83 110.00 9,014.29 110.00 9,007.76 110.00 9,001.23 110.00 8,994.69 110.00 8,988.16 $2,414,500 $2,415,000 110.00 9,029.23 110.00 9,022.70 110.00 9,016.17 110.00 9,009.63 110.00 9,003.10 110.00 8,996.57 110.00 8,990.03 $2,415,000 $2,415,500 110.00 9,031.11 110.00 9,024.58 110.00 9,018.04 110.00 9,011.51 110.00 9,004.98 110.00 8,998.44 110.00 8,991.91 $2,415,500 $2,416,000 110.00 9,032.98 110.00 9,026.45 110.00 9,019.92 110.00 9,013.38 110.00 9,006.85 110.00 9,000.32 110.00 8,993.78 $2,416,000 $2,416,500 110.00 9,034.86 110.00 9,028.33 110.00 9,021.79 110.00 9,015.26 110.00 9,008.73 110.00 9,002.19 110.00 8,995.66 $2,416,500 $2,417,000 110.00 9,036.73 110.00 9,030.20 110.00 9,023.67 110.00 9,017.13 110.00 9,010.60 110.00 9,004.07 110.00 8,997.53 $2,417,000 $2,417,500 110.00 9,038.61 110.00 9,032.08 110.00 9,025.54 110.00 9,019.01 110.00 9,012.48 110.00 9,005.94 110.00 8,999.41 $2,417,500 $2,418,000 110.00 9,040.48 110.00 9,033.95 110.00 9,027.42 110.00 9,020.88 110.00 9,014.35 110.00 9,007.82 110.00 9,001.28 $2,418,000 $2,418,500 110.00 9,042.36 110.00 9,035.83 110.00 9,029.29 110.00 9,022.76 110.00 9,016.23 110.00 9,009.69 110.00 9,003.16 $2,418,500 $2,419,000 110.00 9,044.23 110.00 9,037.70 110.00 9,031.17 110.00 9,024.63 110.00 9,018.10 110.00 9,011.57 110.00 9,005.03 $2,419,000 $2,419,500 110.00 9,046.11 110.00 9,039.58 110.00 9,033.04 110.00 9,026.51 110.00 9,019.98 110.00 9,013.44 110.00 9,006.91 $2,419,500 $2,420,000 110.00 9,047.98 110.00 9,041.45 110.00 9,034.92 110.00 9,028.38 110.00 9,021.85 110.00 9,015.32 110.00 9,008.78 $2,420,000 $2,420,500 110.00 9,049.86 110.00 9,043.33 110.00 9,036.79 110.00 9,030.26 110.00 9,023.73 110.00 9,017.19 110.00 9,010.66 $2,420,500 $2,421,000 110.00 9,051.73 110.00 9,045.20 110.00 9,038.67 110.00 9,032.13 110.00 9,025.60 110.00 9,019.07 110.00 9,012.53 $2,421,000 $2,421,500 110.00 9,053.61 110.00 9,047.08 110.00 9,040.54 110.00 9,034.01 110.00 9,027.48 110.00 9,020.94 110.00 9,014.41 $2,421,500 $2,422,000 110.00 9,055.48 110.00 9,048.95 110.00 9,042.42 110.00 9,035.88 110.00 9,029.35 110.00 9,022.82 110.00 9,016.28 $2,422,000 $2,422,500 110.00 9,057.36 110.00 9,050.83 110.00 9,044.29 110.00 9,037.76 110.00 9,031.23 110.00 9,024.69 110.00 9,018.16 $2,422,500 $2,423,000 110.00 9,059.23 110.00 9,052.70 110.00 9,046.17 110.00 9,039.63 110.00 9,033.10 110.00 9,026.57 110.00 9,020.03 $2,423,000 $2,423,500 110.00 9,061.11 110.00 9,054.58 110.00 9,048.04 110.00 9,041.51 110.00 9,034.98 110.00 9,028.44 110.00 9,021.91 $2,423,500 $2,424,000 110.00 9,062.98 110.00 9,056.45 110.00 9,049.92 110.00 9,043.38 110.00 9,036.85 110.00 9,030.32 110.00 9,023.78 $2,424,000 $2,424,500 110.00 9,064.86 110.00 9,058.33 110.00 9,051.79 110.00 9,045.26 110.00 9,038.73 110.00 9,032.19 110.00 9,025.66 $2,424,500 $2,425,000 110.00 9,066.73 110.00 9,060.20 110.00 9,053.67 110.00 9,047.13 110.00 9,040.60 110.00 9,034.07 110.00 9,027.53 $2,425,000 $2,425,500 110.00 9,068.61 110.00 9,062.08 110.00 9,055.54 110.00 9,049.01 110.00 9,042.48 110.00 9,035.94 110.00 9,029.41 $2,425,500 $2,426,000 110.00 9,070.48 110.00 9,063.95 110.00 9,057.42 110.00 9,050.88 110.00 9,044.35 110.00 9,037.82 110.00 9,031.28 $2,426,000 $2,426,500 110.00 9,072.36 110.00 9,065.83 110.00 9,059.29 110.00 9,052.76 110.00 9,046.23 110.00 9,039.69 110.00 9,033.16 $2,426,500 $2,427,000 110.00 9,074.23 110.00 9,067.70 110.00 9,061.17 110.00 9,054.63 110.00 9,048.10 110.00 9,041.57 110.00 9,035.03 $2,427,000 $2,427,500 110.00 9,076.11 110.00 9,069.58 110.00 9,063.04 110.00 9,056.51 110.00 9,049.98 110.00 9,043.44 110.00 9,036.91 $2,427,500 $2,428,000 110.00 9,077.98 110.00 9,071.45 110.00 9,064.92 110.00 9,058.38 110.00 9,051.85 110.00 9,045.32 110.00 9,038.78 $2,428,000 $2,428,500 110.00 9,079.86 110.00 9,073.33 110.00 9,066.79 110.00 9,060.26 110.00 9,053.73 110.00 9,047.19 110.00 9,040.66 $2,428,500 $2,429,000 110.00 9,081.73 110.00 9,075.20 110.00 9,068.67 110.00 9,062.13 110.00 9,055.60 110.00 9,049.07 110.00 9,042.53 $2,429,000 $2,429,500 110.00 9,083.61 110.00 9,077.08 110.00 9,070.54 110.00 9,064.01 110.00 9,057.48 110.00 9,050.94 110.00 9,044.41 $2,429,500 $2,430,000 110.00 9,085.48 110.00 9,078.95 110.00 9,072.42 110.00 9,065.88 110.00 9,059.35 110.00 9,052.82 110.00 9,046.28 $2,430,000 $2,430,500 110.00 9,087.36 110.00 9,080.83 110.00 9,074.29 110.00 9,067.76 110.00 9,061.23 110.00 9,054.69 110.00 9,048.16 $2,430,500 $2,431,000 110.00 9,089.23 110.00 9,082.70 110.00 9,076.17 110.00 9,069.63 110.00 9,063.10 110.00 9,056.57 110.00 9,050.03 $2,431,000 $2,431,500 110.00 9,091.11 110.00 9,084.58 110.00 9,078.04 110.00 9,071.51 110.00 9,064.98 110.00 9,058.44 110.00 9,051.91 $2,431,500 $2,432,000 110.00 9,092.98 110.00 9,086.45 110.00 9,079.92 110.00 9,073.38 110.00 9,066.85 110.00 9,060.32 110.00 9,053.78 $2,432,000 $2,432,500 110.00 9,094.86 110.00 9,088.33 110.00 9,081.79 110.00 9,075.26 110.00 9,068.73 110.00 9,062.19 110.00 9,055.66 $2,432,500 $2,433,000 110.00 9,096.73 110.00 9,090.20 110.00 9,083.67 110.00 9,077.13 110.00 9,070.60 110.00 9,064.07 110.00 9,057.53 $2,433,000 $2,433,500 110.00 9,098.61 110.00 9,092.08 110.00 9,085.54 110.00 9,079.01 110.00 9,072.48 110.00 9,065.94 110.00 9,059.41 $2,433,500 $2,434,000 110.00 9,100.48 110.00 9,093.95 110.00 9,087.42 110.00 9,080.88 110.00 9,074.35 110.00 9,067.82 110.00 9,061.28 $2,434,000 $2,434,500 110.00 9,102.36 110.00 9,095.83 110.00 9,089.29 110.00 9,082.76 110.00 9,076.23 110.00 9,069.69 110.00 9,063.16 $2,434,500 $2,435,000 110.00 9,104.23 110.00 9,097.70 110.00 9,091.17 110.00 9,084.63 110.00 9,078.10 110.00 9,071.57 110.00 9,065.03 $2,435,000 $2,435,500 110.00 9,106.11 110.00 9,099.58 110.00 9,093.04 110.00 9,086.51 110.00 9,079.98 110.00 9,073.44 110.00 9,066.91 $2,435,500 $2,436,000 110.00 9,107.98 110.00 9,101.45 110.00 9,094.92 110.00 9,088.38 110.00 9,081.85 110.00 9,075.32 110.00 9,068.78 $2,436,000 $2,436,500 110.00 9,109.86 110.00 9,103.33 110.00 9,096.79 110.00 9,090.26 110.00 9,083.73 110.00 9,077.19 110.00 9,070.66 $2,436,500 $2,437,000 110.00 9,111.73 110.00 9,105.20 110.00 9,098.67 110.00 9,092.13 110.00 9,085.60 110.00 9,079.07 110.00 9,072.53 $2,437,000 $2,437,500 110.00 9,113.61 110.00 9,107.08 110.00 9,100.54 110.00 9,094.01 110.00 9,087.48 110.00 9,080.94 110.00 9,074.41 $2,437,500 $2,438,000 110.00 9,115.48 110.00 9,108.95 110.00 9,102.42 110.00 9,095.88 110.00 9,089.35 110.00 9,082.82 110.00 9,076.28 $2,438,000 $2,438,500 110.00 9,117.36 110.00 9,110.83 110.00 9,104.29 110.00 9,097.76 110.00 9,091.23 110.00 9,084.69 110.00 9,078.16 $2,438,500 $2,439,000 110.00 9,119.23 110.00 9,112.70 110.00 9,106.17 110.00 9,099.63 110.00 9,093.10 110.00 9,086.57 110.00 9,080.03 $2,439,000 $2,439,500 110.00 9,121.11 110.00 9,114.58 110.00 9,108.04 110.00 9,101.51 110.00 9,094.98 110.00 9,088.44 110.00 9,081.91 $2,439,500 $2,440,000 110.00 9,122.98 110.00 9,116.45 110.00 9,109.92 110.00 9,103.38 110.00 9,096.85 110.00 9,090.32 110.00 9,083.78 $2,440,000 $2,440,500 110.00 9,124.86 110.00 9,118.33 110.00 9,111.79 110.00 9,105.26 110.00 9,098.73 110.00 9,092.19 110.00 9,085.66 $2,440,500 $2,441,000 110.00 9,126.73 110.00 9,120.20 110.00 9,113.67 110.00 9,107.13 110.00 9,100.60 110.00 9,094.07 110.00 9,087.53 $2,441,000 $2,441,500 110.00 9,128.61 110.00 9,122.08 110.00 9,115.54 110.00 9,109.01 110.00 9,102.48 110.00 9,095.94 110.00 9,089.41 $2,441,500 $2,442,000 110.00 9,130.48 110.00 9,123.95 110.00 9,117.42 110.00 9,110.88 110.00 9,104.35 110.00 9,097.82 110.00 9,091.28 $2,442,000 $2,442,500 110.00 9,132.36 110.00 9,125.83 110.00 9,119.29 110.00 9,112.76 110.00 9,106.23 110.00 9,099.69 110.00 9,093.16 $2,442,500 $2,443,000 110.00 9,134.23 110.00 9,127.70 110.00 9,121.17 110.00 9,114.63 110.00 9,108.10 110.00 9,101.57 110.00 9,095.03 $2,443,000 $2,443,500 110.00 9,136.11 110.00 9,129.58 110.00 9,123.04 110.00 9,116.51 110.00 9,109.98 110.00 9,103.44 110.00 9,096.91 $2,443,500 $2,444,000 110.00 9,137.98 110.00 9,131.45 110.00 9,124.92 110.00 9,118.38 110.00 9,111.85 110.00 9,105.32 110.00 9,098.78 $2,444,000 $2,444,500 110.00 9,139.86 110.00 9,133.33 110.00 9,126.79 110.00 9,120.26 110.00 9,113.73 110.00 9,107.19 110.00 9,100.66 $2,444,500 $2,445,000 110.00 9,141.73 110.00 9,135.20 110.00 9,128.67 110.00 9,122.13 110.00 9,115.60 110.00 9,109.07 110.00 9,102.53 $2,445,000 $2,445,500 110.00 9,143.61 110.00 9,137.08 110.00 9,130.54 110.00 9,124.01 110.00 9,117.48 110.00 9,110.94 110.00 9,104.41 $2,445,500 $2,446,000 110.00 9,145.48 110.00 9,138.95 110.00 9,132.42 110.00 9,125.88 110.00 9,119.35 110.00 9,112.82 110.00 9,106.28 $2,446,000 $2,446,500 110.00 9,147.36 110.00 9,140.83 110.00 9,134.29 110.00 9,127.76 110.00 9,121.23 110.00 9,114.69 110.00 9,108.16 $2,446,500 $2,447,000 110.00 9,149.23 110.00 9,142.70 110.00 9,136.17 110.00 9,129.63 110.00 9,123.10 110.00 9,116.57 110.00 9,110.03 $2,447,000 $2,447,500 110.00 9,151.11 110.00 9,144.58 110.00 9,138.04 110.00 9,131.51 110.00 9,124.98 110.00 9,118.44 110.00 9,111.91 $2,447,500 $2,448,000 110.00 9,152.98 110.00 9,146.45 110.00 9,139.92 110.00 9,133.38 110.00 9,126.85 110.00 9,120.32 110.00 9,113.78

NJEIS Family Cost Participation Table Page 51 of 12 Effective July 1, 2015

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

$2,448,000 $2,448,500 110.00 9,154.86 110.00 9,148.33 110.00 9,141.79 110.00 9,135.26 110.00 9,128.73 110.00 9,122.19 110.00 9,115.66 $2,448,500 $2,449,000 110.00 9,156.73 110.00 9,150.20 110.00 9,143.67 110.00 9,137.13 110.00 9,130.60 110.00 9,124.07 110.00 9,117.53 $2,449,000 $2,449,500 110.00 9,158.61 110.00 9,152.08 110.00 9,145.54 110.00 9,139.01 110.00 9,132.48 110.00 9,125.94 110.00 9,119.41 $2,449,500 $2,450,000 110.00 9,160.48 110.00 9,153.95 110.00 9,147.42 110.00 9,140.88 110.00 9,134.35 110.00 9,127.82 110.00 9,121.28 $2,450,000 $2,450,500 110.00 9,162.36 110.00 9,155.83 110.00 9,149.29 110.00 9,142.76 110.00 9,136.23 110.00 9,129.69 110.00 9,123.16 $2,450,500 $2,451,000 110.00 9,164.23 110.00 9,157.70 110.00 9,151.17 110.00 9,144.63 110.00 9,138.10 110.00 9,131.57 110.00 9,125.03 $2,451,000 $2,451,500 110.00 9,166.11 110.00 9,159.58 110.00 9,153.04 110.00 9,146.51 110.00 9,139.98 110.00 9,133.44 110.00 9,126.91 $2,451,500 $2,452,000 110.00 9,167.98 110.00 9,161.45 110.00 9,154.92 110.00 9,148.38 110.00 9,141.85 110.00 9,135.32 110.00 9,128.78 $2,452,000 $2,452,500 110.00 9,169.86 110.00 9,163.33 110.00 9,156.79 110.00 9,150.26 110.00 9,143.73 110.00 9,137.19 110.00 9,130.66 $2,452,500 $2,453,000 110.00 9,171.73 110.00 9,165.20 110.00 9,158.67 110.00 9,152.13 110.00 9,145.60 110.00 9,139.07 110.00 9,132.53 $2,453,000 $2,453,500 110.00 9,173.61 110.00 9,167.08 110.00 9,160.54 110.00 9,154.01 110.00 9,147.48 110.00 9,140.94 110.00 9,134.41 $2,453,500 $2,454,000 110.00 9,175.48 110.00 9,168.95 110.00 9,162.42 110.00 9,155.88 110.00 9,149.35 110.00 9,142.82 110.00 9,136.28 $2,454,000 $2,454,500 110.00 9,177.36 110.00 9,170.83 110.00 9,164.29 110.00 9,157.76 110.00 9,151.23 110.00 9,144.69 110.00 9,138.16 $2,454,500 $2,455,000 110.00 9,179.23 110.00 9,172.70 110.00 9,166.17 110.00 9,159.63 110.00 9,153.10 110.00 9,146.57 110.00 9,140.03 $2,455,000 $2,455,500 110.00 9,181.11 110.00 9,174.58 110.00 9,168.04 110.00 9,161.51 110.00 9,154.98 110.00 9,148.44 110.00 9,141.91 $2,455,500 $2,456,000 110.00 9,182.98 110.00 9,176.45 110.00 9,169.92 110.00 9,163.38 110.00 9,156.85 110.00 9,150.32 110.00 9,143.78 $2,456,000 $2,456,500 110.00 9,184.86 110.00 9,178.33 110.00 9,171.79 110.00 9,165.26 110.00 9,158.73 110.00 9,152.19 110.00 9,145.66 $2,456,500 $2,457,000 110.00 9,186.73 110.00 9,180.20 110.00 9,173.67 110.00 9,167.13 110.00 9,160.60 110.00 9,154.07 110.00 9,147.53 $2,457,000 $2,457,500 110.00 9,188.61 110.00 9,182.08 110.00 9,175.54 110.00 9,169.01 110.00 9,162.48 110.00 9,155.94 110.00 9,149.41 $2,457,500 $2,458,000 110.00 9,190.48 110.00 9,183.95 110.00 9,177.42 110.00 9,170.88 110.00 9,164.35 110.00 9,157.82 110.00 9,151.28 $2,458,000 $2,458,500 110.00 9,192.36 110.00 9,185.83 110.00 9,179.29 110.00 9,172.76 110.00 9,166.23 110.00 9,159.69 110.00 9,153.16 $2,458,500 $2,459,000 110.00 9,194.23 110.00 9,187.70 110.00 9,181.17 110.00 9,174.63 110.00 9,168.10 110.00 9,161.57 110.00 9,155.03 $2,459,000 $2,459,500 110.00 9,196.11 110.00 9,189.58 110.00 9,183.04 110.00 9,176.51 110.00 9,169.98 110.00 9,163.44 110.00 9,156.91 $2,459,500 $2,460,000 110.00 9,197.98 110.00 9,191.45 110.00 9,184.92 110.00 9,178.38 110.00 9,171.85 110.00 9,165.32 110.00 9,158.78 $2,460,000 $2,460,500 110.00 9,199.86 110.00 9,193.33 110.00 9,186.79 110.00 9,180.26 110.00 9,173.73 110.00 9,167.19 110.00 9,160.66 $2,460,500 $2,461,000 110.00 9,201.73 110.00 9,195.20 110.00 9,188.67 110.00 9,182.13 110.00 9,175.60 110.00 9,169.07 110.00 9,162.53 $2,461,000 $2,461,500 110.00 9,203.61 110.00 9,197.08 110.00 9,190.54 110.00 9,184.01 110.00 9,177.48 110.00 9,170.94 110.00 9,164.41 $2,461,500 $2,462,000 110.00 9,205.48 110.00 9,198.95 110.00 9,192.42 110.00 9,185.88 110.00 9,179.35 110.00 9,172.82 110.00 9,166.28 $2,462,000 $2,462,500 110.00 9,207.36 110.00 9,200.83 110.00 9,194.29 110.00 9,187.76 110.00 9,181.23 110.00 9,174.69 110.00 9,168.16 $2,462,500 $2,463,000 110.00 9,209.23 110.00 9,202.70 110.00 9,196.17 110.00 9,189.63 110.00 9,183.10 110.00 9,176.57 110.00 9,170.03 $2,463,000 $2,463,500 110.00 9,211.11 110.00 9,204.58 110.00 9,198.04 110.00 9,191.51 110.00 9,184.98 110.00 9,178.44 110.00 9,171.91 $2,463,500 $2,464,000 110.00 9,212.98 110.00 9,206.45 110.00 9,199.92 110.00 9,193.38 110.00 9,186.85 110.00 9,180.32 110.00 9,173.78 $2,464,000 $2,464,500 110.00 9,214.86 110.00 9,208.33 110.00 9,201.79 110.00 9,195.26 110.00 9,188.73 110.00 9,182.19 110.00 9,175.66 $2,464,500 $2,465,000 110.00 9,216.73 110.00 9,210.20 110.00 9,203.67 110.00 9,197.13 110.00 9,190.60 110.00 9,184.07 110.00 9,177.53 $2,465,000 $2,465,500 110.00 9,218.61 110.00 9,212.08 110.00 9,205.54 110.00 9,199.01 110.00 9,192.48 110.00 9,185.94 110.00 9,179.41 $2,465,500 $2,466,000 110.00 9,220.48 110.00 9,213.95 110.00 9,207.42 110.00 9,200.88 110.00 9,194.35 110.00 9,187.82 110.00 9,181.28 $2,466,000 $2,466,500 110.00 9,222.36 110.00 9,215.83 110.00 9,209.29 110.00 9,202.76 110.00 9,196.23 110.00 9,189.69 110.00 9,183.16 $2,466,500 $2,467,000 110.00 9,224.23 110.00 9,217.70 110.00 9,211.17 110.00 9,204.63 110.00 9,198.10 110.00 9,191.57 110.00 9,185.03 $2,467,000 $2,467,500 110.00 9,226.11 110.00 9,219.58 110.00 9,213.04 110.00 9,206.51 110.00 9,199.98 110.00 9,193.44 110.00 9,186.91 $2,467,500 $2,468,000 110.00 9,227.98 110.00 9,221.45 110.00 9,214.92 110.00 9,208.38 110.00 9,201.85 110.00 9,195.32 110.00 9,188.78 $2,468,000 $2,468,500 110.00 9,229.86 110.00 9,223.33 110.00 9,216.79 110.00 9,210.26 110.00 9,203.73 110.00 9,197.19 110.00 9,190.66 $2,468,500 $2,469,000 110.00 9,231.73 110.00 9,225.20 110.00 9,218.67 110.00 9,212.13 110.00 9,205.60 110.00 9,199.07 110.00 9,192.53 $2,469,000 $2,469,500 110.00 9,233.61 110.00 9,227.08 110.00 9,220.54 110.00 9,214.01 110.00 9,207.48 110.00 9,200.94 110.00 9,194.41 $2,469,500 $2,470,000 110.00 9,235.48 110.00 9,228.95 110.00 9,222.42 110.00 9,215.88 110.00 9,209.35 110.00 9,202.82 110.00 9,196.28 $2,470,000 $2,470,500 110.00 9,237.36 110.00 9,230.83 110.00 9,224.29 110.00 9,217.76 110.00 9,211.23 110.00 9,204.69 110.00 9,198.16 $2,470,500 $2,471,000 110.00 9,239.23 110.00 9,232.70 110.00 9,226.17 110.00 9,219.63 110.00 9,213.10 110.00 9,206.57 110.00 9,200.03 $2,471,000 $2,471,500 110.00 9,241.11 110.00 9,234.58 110.00 9,228.04 110.00 9,221.51 110.00 9,214.98 110.00 9,208.44 110.00 9,201.91 $2,471,500 $2,472,000 110.00 9,242.98 110.00 9,236.45 110.00 9,229.92 110.00 9,223.38 110.00 9,216.85 110.00 9,210.32 110.00 9,203.78 $2,472,000 $2,472,500 110.00 9,244.86 110.00 9,238.33 110.00 9,231.79 110.00 9,225.26 110.00 9,218.73 110.00 9,212.19 110.00 9,205.66 $2,472,500 $2,473,000 110.00 9,246.73 110.00 9,240.20 110.00 9,233.67 110.00 9,227.13 110.00 9,220.60 110.00 9,214.07 110.00 9,207.53 $2,473,000 $2,473,500 110.00 9,248.61 110.00 9,242.08 110.00 9,235.54 110.00 9,229.01 110.00 9,222.48 110.00 9,215.94 110.00 9,209.41 $2,473,500 $2,474,000 110.00 9,250.48 110.00 9,243.95 110.00 9,237.42 110.00 9,230.88 110.00 9,224.35 110.00 9,217.82 110.00 9,211.28 $2,474,000 $2,474,500 110.00 9,252.36 110.00 9,245.83 110.00 9,239.29 110.00 9,232.76 110.00 9,226.23 110.00 9,219.69 110.00 9,213.16 $2,474,500 $2,475,000 110.00 9,254.23 110.00 9,247.70 110.00 9,241.17 110.00 9,234.63 110.00 9,228.10 110.00 9,221.57 110.00 9,215.03 $2,475,000 $2,475,500 110.00 9,256.11 110.00 9,249.58 110.00 9,243.04 110.00 9,236.51 110.00 9,229.98 110.00 9,223.44 110.00 9,216.91 $2,475,500 $2,476,000 110.00 9,257.98 110.00 9,251.45 110.00 9,244.92 110.00 9,238.38 110.00 9,231.85 110.00 9,225.32 110.00 9,218.78 $2,476,000 $2,476,500 110.00 9,259.86 110.00 9,253.33 110.00 9,246.79 110.00 9,240.26 110.00 9,233.73 110.00 9,227.19 110.00 9,220.66 $2,476,500 $2,477,000 110.00 9,261.73 110.00 9,255.20 110.00 9,248.67 110.00 9,242.13 110.00 9,235.60 110.00 9,229.07 110.00 9,222.53 $2,477,000 $2,477,500 110.00 9,263.61 110.00 9,257.08 110.00 9,250.54 110.00 9,244.01 110.00 9,237.48 110.00 9,230.94 110.00 9,224.41 $2,477,500 $2,478,000 110.00 9,265.48 110.00 9,258.95 110.00 9,252.42 110.00 9,245.88 110.00 9,239.35 110.00 9,232.82 110.00 9,226.28 $2,478,000 $2,478,500 110.00 9,267.36 110.00 9,260.83 110.00 9,254.29 110.00 9,247.76 110.00 9,241.23 110.00 9,234.69 110.00 9,228.16 $2,478,500 $2,479,000 110.00 9,269.23 110.00 9,262.70 110.00 9,256.17 110.00 9,249.63 110.00 9,243.10 110.00 9,236.57 110.00 9,230.03 $2,479,000 $2,479,500 110.00 9,271.11 110.00 9,264.58 110.00 9,258.04 110.00 9,251.51 110.00 9,244.98 110.00 9,238.44 110.00 9,231.91 $2,479,500 $2,480,000 110.00 9,272.98 110.00 9,266.45 110.00 9,259.92 110.00 9,253.38 110.00 9,246.85 110.00 9,240.32 110.00 9,233.78 $2,480,000 $2,480,500 110.00 9,274.86 110.00 9,268.33 110.00 9,261.79 110.00 9,255.26 110.00 9,248.73 110.00 9,242.19 110.00 9,235.66 $2,480,500 $2,481,000 110.00 9,276.73 110.00 9,270.20 110.00 9,263.67 110.00 9,257.13 110.00 9,250.60 110.00 9,244.07 110.00 9,237.53 $2,481,000 $2,481,500 110.00 9,278.61 110.00 9,272.08 110.00 9,265.54 110.00 9,259.01 110.00 9,252.48 110.00 9,245.94 110.00 9,239.41 $2,481,500 $2,482,000 110.00 9,280.48 110.00 9,273.95 110.00 9,267.42 110.00 9,260.88 110.00 9,254.35 110.00 9,247.82 110.00 9,241.28 $2,482,000 $2,482,500 110.00 9,282.36 110.00 9,275.83 110.00 9,269.29 110.00 9,262.76 110.00 9,256.23 110.00 9,249.69 110.00 9,243.16 $2,482,500 $2,483,000 110.00 9,284.23 110.00 9,277.70 110.00 9,271.17 110.00 9,264.63 110.00 9,258.10 110.00 9,251.57 110.00 9,245.03 $2,483,000 $2,483,500 110.00 9,286.11 110.00 9,279.58 110.00 9,273.04 110.00 9,266.51 110.00 9,259.98 110.00 9,253.44 110.00 9,246.91 $2,483,500 $2,484,000 110.00 9,287.98 110.00 9,281.45 110.00 9,274.92 110.00 9,268.38 110.00 9,261.85 110.00 9,255.32 110.00 9,248.78 $2,484,000 $2,484,500 110.00 9,289.86 110.00 9,283.33 110.00 9,276.79 110.00 9,270.26 110.00 9,263.73 110.00 9,257.19 110.00 9,250.66 $2,484,500 $2,485,000 110.00 9,291.73 110.00 9,285.20 110.00 9,278.67 110.00 9,272.13 110.00 9,265.60 110.00 9,259.07 110.00 9,252.53 $2,485,000 $2,485,500 110.00 9,293.61 110.00 9,287.08 110.00 9,280.54 110.00 9,274.01 110.00 9,267.48 110.00 9,260.94 110.00 9,254.41 $2,485,500 $2,486,000 110.00 9,295.48 110.00 9,288.95 110.00 9,282.42 110.00 9,275.88 110.00 9,269.35 110.00 9,262.82 110.00 9,256.28 $2,486,000 $2,486,500 110.00 9,297.36 110.00 9,290.83 110.00 9,284.29 110.00 9,277.76 110.00 9,271.23 110.00 9,264.69 110.00 9,258.16 $2,486,500 $2,487,000 110.00 9,299.23 110.00 9,292.70 110.00 9,286.17 110.00 9,279.63 110.00 9,273.10 110.00 9,266.57 110.00 9,260.03 $2,487,000 $2,487,500 110.00 9,301.11 110.00 9,294.58 110.00 9,288.04 110.00 9,281.51 110.00 9,274.98 110.00 9,268.44 110.00 9,261.91 $2,487,500 $2,488,000 110.00 9,302.98 110.00 9,296.45 110.00 9,289.92 110.00 9,283.38 110.00 9,276.85 110.00 9,270.32 110.00 9,263.78 $2,488,000 $2,488,500 110.00 9,304.86 110.00 9,298.33 110.00 9,291.79 110.00 9,285.26 110.00 9,278.73 110.00 9,272.19 110.00 9,265.66 $2,488,500 $2,489,000 110.00 9,306.73 110.00 9,300.20 110.00 9,293.67 110.00 9,287.13 110.00 9,280.60 110.00 9,274.07 110.00 9,267.53 $2,489,000 $2,489,500 110.00 9,308.61 110.00 9,302.08 110.00 9,295.54 110.00 9,289.01 110.00 9,282.48 110.00 9,275.94 110.00 9,269.41 $2,489,500 $2,490,000 110.00 9,310.48 110.00 9,303.95 110.00 9,297.42 110.00 9,290.88 110.00 9,284.35 110.00 9,277.82 110.00 9,271.28 $2,490,000 $2,490,500 110.00 9,312.36 110.00 9,305.83 110.00 9,299.29 110.00 9,292.76 110.00 9,286.23 110.00 9,279.69 110.00 9,273.16 $2,490,500 $2,491,000 110.00 9,314.23 110.00 9,307.70 110.00 9,301.17 110.00 9,294.63 110.00 9,288.10 110.00 9,281.57 110.00 9,275.03 $2,491,000 $2,491,500 110.00 9,316.11 110.00 9,309.58 110.00 9,303.04 110.00 9,296.51 110.00 9,289.98 110.00 9,283.44 110.00 9,276.91 $2,491,500 $2,492,000 110.00 9,317.98 110.00 9,311.45 110.00 9,304.92 110.00 9,298.38 110.00 9,291.85 110.00 9,285.32 110.00 9,278.78 $2,492,000 $2,492,500 110.00 9,319.86 110.00 9,313.33 110.00 9,306.79 110.00 9,300.26 110.00 9,293.73 110.00 9,287.19 110.00 9,280.66 $2,492,500 $2,493,000 110.00 9,321.73 110.00 9,315.20 110.00 9,308.67 110.00 9,302.13 110.00 9,295.60 110.00 9,289.07 110.00 9,282.53 $2,493,000 $2,493,500 110.00 9,323.61 110.00 9,317.08 110.00 9,310.54 110.00 9,304.01 110.00 9,297.48 110.00 9,290.94 110.00 9,284.41 $2,493,500 $2,494,000 110.00 9,325.48 110.00 9,318.95 110.00 9,312.42 110.00 9,305.88 110.00 9,299.35 110.00 9,292.82 110.00 9,286.28 $2,494,000 $2,494,500 110.00 9,327.36 110.00 9,320.83 110.00 9,314.29 110.00 9,307.76 110.00 9,301.23 110.00 9,294.69 110.00 9,288.16 $2,494,500 $2,495,000 110.00 9,329.23 110.00 9,322.70 110.00 9,316.17 110.00 9,309.63 110.00 9,303.10 110.00 9,296.57 110.00 9,290.03 $2,495,000 $2,495,500 110.00 9,331.11 110.00 9,324.58 110.00 9,318.04 110.00 9,311.51 110.00 9,304.98 110.00 9,298.44 110.00 9,291.91 $2,495,500 $2,496,000 110.00 9,332.98 110.00 9,326.45 110.00 9,319.92 110.00 9,313.38 110.00 9,306.85 110.00 9,300.32 110.00 9,293.78 $2,496,000 $2,496,500 110.00 9,334.86 110.00 9,328.33 110.00 9,321.79 110.00 9,315.26 110.00 9,308.73 110.00 9,302.19 110.00 9,295.66 $2,496,500 $2,497,000 110.00 9,336.73 110.00 9,330.20 110.00 9,323.67 110.00 9,317.13 110.00 9,310.60 110.00 9,304.07 110.00 9,297.53 $2,497,000 $2,497,500 110.00 9,338.61 110.00 9,332.08 110.00 9,325.54 110.00 9,319.01 110.00 9,312.48 110.00 9,305.94 110.00 9,299.41 $2,497,500 $2,498,000 110.00 9,340.48 110.00 9,333.95 110.00 9,327.42 110.00 9,320.88 110.00 9,314.35 110.00 9,307.82 110.00 9,301.28 $2,498,000 $2,498,500 110.00 9,342.36 110.00 9,335.83 110.00 9,329.29 110.00 9,322.76 110.00 9,316.23 110.00 9,309.69 110.00 9,303.16 $2,498,500 $2,499,000 110.00 9,344.23 110.00 9,337.70 110.00 9,331.17 110.00 9,324.63 110.00 9,318.10 110.00 9,311.57 110.00 9,305.03

NJEIS Family Cost Participation Table Page 52 of 12 Effective July 1, 2015

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

$2,499,000 $2,499,500 110.00 9,346.11 110.00 9,339.58 110.00 9,333.04 110.00 9,326.51 110.00 9,319.98 110.00 9,313.44 110.00 9,306.91 $2,499,500 $2,500,000 110.00 9,347.98 110.00 9,341.45 110.00 9,334.92 110.00 9,328.38 110.00 9,321.85 110.00 9,315.32 110.00 9,308.78 $2,500,000 $2,500,500 110.00 9,349.86 110.00 9,343.33 110.00 9,336.79 110.00 9,330.26 110.00 9,323.73 110.00 9,317.19 110.00 9,310.66 $2,500,500 $2,501,000 110.00 9,351.73 110.00 9,345.20 110.00 9,338.67 110.00 9,332.13 110.00 9,325.60 110.00 9,319.07 110.00 9,312.53 $2,501,000 $2,501,500 110.00 9,353.61 110.00 9,347.08 110.00 9,340.54 110.00 9,334.01 110.00 9,327.48 110.00 9,320.94 110.00 9,314.41 $2,501,500 $2,502,000 110.00 9,355.48 110.00 9,348.95 110.00 9,342.42 110.00 9,335.88 110.00 9,329.35 110.00 9,322.82 110.00 9,316.28 $2,502,000 $2,502,500 110.00 9,357.36 110.00 9,350.83 110.00 9,344.29 110.00 9,337.76 110.00 9,331.23 110.00 9,324.69 110.00 9,318.16 $2,502,500 $2,503,000 110.00 9,359.23 110.00 9,352.70 110.00 9,346.17 110.00 9,339.63 110.00 9,333.10 110.00 9,326.57 110.00 9,320.03 $2,503,000 $2,503,500 110.00 9,361.11 110.00 9,354.58 110.00 9,348.04 110.00 9,341.51 110.00 9,334.98 110.00 9,328.44 110.00 9,321.91 $2,503,500 $2,504,000 110.00 9,362.98 110.00 9,356.45 110.00 9,349.92 110.00 9,343.38 110.00 9,336.85 110.00 9,330.32 110.00 9,323.78 $2,504,000 $2,504,500 110.00 9,364.86 110.00 9,358.33 110.00 9,351.79 110.00 9,345.26 110.00 9,338.73 110.00 9,332.19 110.00 9,325.66 $2,504,500 $2,505,000 110.00 9,366.73 110.00 9,360.20 110.00 9,353.67 110.00 9,347.13 110.00 9,340.60 110.00 9,334.07 110.00 9,327.53 $2,505,000 $2,505,500 110.00 9,368.61 110.00 9,362.08 110.00 9,355.54 110.00 9,349.01 110.00 9,342.48 110.00 9,335.94 110.00 9,329.41 $2,505,500 $2,506,000 110.00 9,370.48 110.00 9,363.95 110.00 9,357.42 110.00 9,350.88 110.00 9,344.35 110.00 9,337.82 110.00 9,331.28 $2,506,000 $2,506,500 110.00 9,372.36 110.00 9,365.83 110.00 9,359.29 110.00 9,352.76 110.00 9,346.23 110.00 9,339.69 110.00 9,333.16 $2,506,500 $2,507,000 110.00 9,374.23 110.00 9,367.70 110.00 9,361.17 110.00 9,354.63 110.00 9,348.10 110.00 9,341.57 110.00 9,335.03 $2,507,000 $2,507,500 110.00 9,376.11 110.00 9,369.58 110.00 9,363.04 110.00 9,356.51 110.00 9,349.98 110.00 9,343.44 110.00 9,336.91 $2,507,500 $2,508,000 110.00 9,377.98 110.00 9,371.45 110.00 9,364.92 110.00 9,358.38 110.00 9,351.85 110.00 9,345.32 110.00 9,338.78 $2,508,000 $2,508,500 110.00 9,379.86 110.00 9,373.33 110.00 9,366.79 110.00 9,360.26 110.00 9,353.73 110.00 9,347.19 110.00 9,340.66 $2,508,500 $2,509,000 110.00 9,381.73 110.00 9,375.20 110.00 9,368.67 110.00 9,362.13 110.00 9,355.60 110.00 9,349.07 110.00 9,342.53 $2,509,000 $2,509,500 110.00 9,383.61 110.00 9,377.08 110.00 9,370.54 110.00 9,364.01 110.00 9,357.48 110.00 9,350.94 110.00 9,344.41 $2,509,500 $2,510,000 110.00 9,385.48 110.00 9,378.95 110.00 9,372.42 110.00 9,365.88 110.00 9,359.35 110.00 9,352.82 110.00 9,346.28 $2,510,000 $2,510,500 110.00 9,387.36 110.00 9,380.83 110.00 9,374.29 110.00 9,367.76 110.00 9,361.23 110.00 9,354.69 110.00 9,348.16 $2,510,500 $2,511,000 110.00 9,389.23 110.00 9,382.70 110.00 9,376.17 110.00 9,369.63 110.00 9,363.10 110.00 9,356.57 110.00 9,350.03 $2,511,000 $2,511,500 110.00 9,391.11 110.00 9,384.58 110.00 9,378.04 110.00 9,371.51 110.00 9,364.98 110.00 9,358.44 110.00 9,351.91 $2,511,500 $2,512,000 110.00 9,392.98 110.00 9,386.45 110.00 9,379.92 110.00 9,373.38 110.00 9,366.85 110.00 9,360.32 110.00 9,353.78 $2,512,000 $2,512,500 110.00 9,394.86 110.00 9,388.33 110.00 9,381.79 110.00 9,375.26 110.00 9,368.73 110.00 9,362.19 110.00 9,355.66 $2,512,500 $2,513,000 110.00 9,396.73 110.00 9,390.20 110.00 9,383.67 110.00 9,377.13 110.00 9,370.60 110.00 9,364.07 110.00 9,357.53 $2,513,000 $2,513,500 110.00 9,398.61 110.00 9,392.08 110.00 9,385.54 110.00 9,379.01 110.00 9,372.48 110.00 9,365.94 110.00 9,359.41 $2,513,500 $2,514,000 110.00 9,400.48 110.00 9,393.95 110.00 9,387.42 110.00 9,380.88 110.00 9,374.35 110.00 9,367.82 110.00 9,361.28 $2,514,000 $2,514,500 110.00 9,402.36 110.00 9,395.83 110.00 9,389.29 110.00 9,382.76 110.00 9,376.23 110.00 9,369.69 110.00 9,363.16 $2,514,500 $2,515,000 110.00 9,404.23 110.00 9,397.70 110.00 9,391.17 110.00 9,384.63 110.00 9,378.10 110.00 9,371.57 110.00 9,365.03 $2,515,000 $2,515,500 110.00 9,406.11 110.00 9,399.58 110.00 9,393.04 110.00 9,386.51 110.00 9,379.98 110.00 9,373.44 110.00 9,366.91 $2,515,500 $2,516,000 110.00 9,407.98 110.00 9,401.45 110.00 9,394.92 110.00 9,388.38 110.00 9,381.85 110.00 9,375.32 110.00 9,368.78 $2,516,000 $2,516,500 110.00 9,409.86 110.00 9,403.33 110.00 9,396.79 110.00 9,390.26 110.00 9,383.73 110.00 9,377.19 110.00 9,370.66 $2,516,500 $2,517,000 110.00 9,411.73 110.00 9,405.20 110.00 9,398.67 110.00 9,392.13 110.00 9,385.60 110.00 9,379.07 110.00 9,372.53 $2,517,000 $2,517,500 110.00 9,413.61 110.00 9,407.08 110.00 9,400.54 110.00 9,394.01 110.00 9,387.48 110.00 9,380.94 110.00 9,374.41 $2,517,500 $2,518,000 110.00 9,415.48 110.00 9,408.95 110.00 9,402.42 110.00 9,395.88 110.00 9,389.35 110.00 9,382.82 110.00 9,376.28 $2,518,000 $2,518,500 110.00 9,417.36 110.00 9,410.83 110.00 9,404.29 110.00 9,397.76 110.00 9,391.23 110.00 9,384.69 110.00 9,378.16 $2,518,500 $2,519,000 110.00 9,419.23 110.00 9,412.70 110.00 9,406.17 110.00 9,399.63 110.00 9,393.10 110.00 9,386.57 110.00 9,380.03 $2,519,000 $2,519,500 110.00 9,421.11 110.00 9,414.58 110.00 9,408.04 110.00 9,401.51 110.00 9,394.98 110.00 9,388.44 110.00 9,381.91 $2,519,500 $2,520,000 110.00 9,422.98 110.00 9,416.45 110.00 9,409.92 110.00 9,403.38 110.00 9,396.85 110.00 9,390.32 110.00 9,383.78 $2,520,000 $2,520,500 110.00 9,424.86 110.00 9,418.33 110.00 9,411.79 110.00 9,405.26 110.00 9,398.73 110.00 9,392.19 110.00 9,385.66 $2,520,500 $2,521,000 110.00 9,426.73 110.00 9,420.20 110.00 9,413.67 110.00 9,407.13 110.00 9,400.60 110.00 9,394.07 110.00 9,387.53 $2,521,000 $2,521,500 110.00 9,428.61 110.00 9,422.08 110.00 9,415.54 110.00 9,409.01 110.00 9,402.48 110.00 9,395.94 110.00 9,389.41 $2,521,500 $2,522,000 110.00 9,430.48 110.00 9,423.95 110.00 9,417.42 110.00 9,410.88 110.00 9,404.35 110.00 9,397.82 110.00 9,391.28 $2,522,000 $2,522,500 110.00 9,432.36 110.00 9,425.83 110.00 9,419.29 110.00 9,412.76 110.00 9,406.23 110.00 9,399.69 110.00 9,393.16 $2,522,500 $2,523,000 110.00 9,434.23 110.00 9,427.70 110.00 9,421.17 110.00 9,414.63 110.00 9,408.10 110.00 9,401.57 110.00 9,395.03 $2,523,000 $2,523,500 110.00 9,436.11 110.00 9,429.58 110.00 9,423.04 110.00 9,416.51 110.00 9,409.98 110.00 9,403.44 110.00 9,396.91 $2,523,500 $2,524,000 110.00 9,437.98 110.00 9,431.45 110.00 9,424.92 110.00 9,418.38 110.00 9,411.85 110.00 9,405.32 110.00 9,398.78 $2,524,000 $2,524,500 110.00 9,439.86 110.00 9,433.33 110.00 9,426.79 110.00 9,420.26 110.00 9,413.73 110.00 9,407.19 110.00 9,400.66 $2,524,500 $2,525,000 110.00 9,441.73 110.00 9,435.20 110.00 9,428.67 110.00 9,422.13 110.00 9,415.60 110.00 9,409.07 110.00 9,402.53 $2,525,000 $2,525,500 110.00 9,443.61 110.00 9,437.08 110.00 9,430.54 110.00 9,424.01 110.00 9,417.48 110.00 9,410.94 110.00 9,404.41 $2,525,500 $2,526,000 110.00 9,445.48 110.00 9,438.95 110.00 9,432.42 110.00 9,425.88 110.00 9,419.35 110.00 9,412.82 110.00 9,406.28 $2,526,000 $2,526,500 110.00 9,447.36 110.00 9,440.83 110.00 9,434.29 110.00 9,427.76 110.00 9,421.23 110.00 9,414.69 110.00 9,408.16 $2,526,500 $2,527,000 110.00 9,449.23 110.00 9,442.70 110.00 9,436.17 110.00 9,429.63 110.00 9,423.10 110.00 9,416.57 110.00 9,410.03 $2,527,000 $2,527,500 110.00 9,451.11 110.00 9,444.58 110.00 9,438.04 110.00 9,431.51 110.00 9,424.98 110.00 9,418.44 110.00 9,411.91 $2,527,500 $2,528,000 110.00 9,452.98 110.00 9,446.45 110.00 9,439.92 110.00 9,433.38 110.00 9,426.85 110.00 9,420.32 110.00 9,413.78 $2,528,000 $2,528,500 110.00 9,454.86 110.00 9,448.33 110.00 9,441.79 110.00 9,435.26 110.00 9,428.73 110.00 9,422.19 110.00 9,415.66 $2,528,500 $2,529,000 110.00 9,456.73 110.00 9,450.20 110.00 9,443.67 110.00 9,437.13 110.00 9,430.60 110.00 9,424.07 110.00 9,417.53 $2,529,000 $2,529,500 110.00 9,458.61 110.00 9,452.08 110.00 9,445.54 110.00 9,439.01 110.00 9,432.48 110.00 9,425.94 110.00 9,419.41 $2,529,500 $2,530,000 110.00 9,460.48 110.00 9,453.95 110.00 9,447.42 110.00 9,440.88 110.00 9,434.35 110.00 9,427.82 110.00 9,421.28 $2,530,000 $2,530,500 110.00 9,462.36 110.00 9,455.83 110.00 9,449.29 110.00 9,442.76 110.00 9,436.23 110.00 9,429.69 110.00 9,423.16 $2,530,500 $2,531,000 110.00 9,464.23 110.00 9,457.70 110.00 9,451.17 110.00 9,444.63 110.00 9,438.10 110.00 9,431.57 110.00 9,425.03 $2,531,000 $2,531,500 110.00 9,466.11 110.00 9,459.58 110.00 9,453.04 110.00 9,446.51 110.00 9,439.98 110.00 9,433.44 110.00 9,426.91 $2,531,500 $2,532,000 110.00 9,467.98 110.00 9,461.45 110.00 9,454.92 110.00 9,448.38 110.00 9,441.85 110.00 9,435.32 110.00 9,428.78 $2,532,000 $2,532,500 110.00 9,469.86 110.00 9,463.33 110.00 9,456.79 110.00 9,450.26 110.00 9,443.73 110.00 9,437.19 110.00 9,430.66 $2,532,500 $2,533,000 110.00 9,471.73 110.00 9,465.20 110.00 9,458.67 110.00 9,452.13 110.00 9,445.60 110.00 9,439.07 110.00 9,432.53 $2,533,000 $2,533,500 110.00 9,473.61 110.00 9,467.08 110.00 9,460.54 110.00 9,454.01 110.00 9,447.48 110.00 9,440.94 110.00 9,434.41 $2,533,500 $2,534,000 110.00 9,475.48 110.00 9,468.95 110.00 9,462.42 110.00 9,455.88 110.00 9,449.35 110.00 9,442.82 110.00 9,436.28 $2,534,000 $2,534,500 110.00 9,477.36 110.00 9,470.83 110.00 9,464.29 110.00 9,457.76 110.00 9,451.23 110.00 9,444.69 110.00 9,438.16 $2,534,500 $2,535,000 110.00 9,479.23 110.00 9,472.70 110.00 9,466.17 110.00 9,459.63 110.00 9,453.10 110.00 9,446.57 110.00 9,440.03 $2,535,000 $2,535,500 110.00 9,481.11 110.00 9,474.58 110.00 9,468.04 110.00 9,461.51 110.00 9,454.98 110.00 9,448.44 110.00 9,441.91 $2,535,500 $2,536,000 110.00 9,482.98 110.00 9,476.45 110.00 9,469.92 110.00 9,463.38 110.00 9,456.85 110.00 9,450.32 110.00 9,443.78 $2,536,000 $2,536,500 110.00 9,484.86 110.00 9,478.33 110.00 9,471.79 110.00 9,465.26 110.00 9,458.73 110.00 9,452.19 110.00 9,445.66 $2,536,500 $2,537,000 110.00 9,486.73 110.00 9,480.20 110.00 9,473.67 110.00 9,467.13 110.00 9,460.60 110.00 9,454.07 110.00 9,447.53 $2,537,000 $2,537,500 110.00 9,488.61 110.00 9,482.08 110.00 9,475.54 110.00 9,469.01 110.00 9,462.48 110.00 9,455.94 110.00 9,449.41 $2,537,500 $2,538,000 110.00 9,490.48 110.00 9,483.95 110.00 9,477.42 110.00 9,470.88 110.00 9,464.35 110.00 9,457.82 110.00 9,451.28 $2,538,000 $2,538,500 110.00 9,492.36 110.00 9,485.83 110.00 9,479.29 110.00 9,472.76 110.00 9,466.23 110.00 9,459.69 110.00 9,453.16 $2,538,500 $2,539,000 110.00 9,494.23 110.00 9,487.70 110.00 9,481.17 110.00 9,474.63 110.00 9,468.10 110.00 9,461.57 110.00 9,455.03 $2,539,000 $2,539,500 110.00 9,496.11 110.00 9,489.58 110.00 9,483.04 110.00 9,476.51 110.00 9,469.98 110.00 9,463.44 110.00 9,456.91 $2,539,500 $2,540,000 110.00 9,497.98 110.00 9,491.45 110.00 9,484.92 110.00 9,478.38 110.00 9,471.85 110.00 9,465.32 110.00 9,458.78 $2,540,000 $2,540,500 110.00 9,499.86 110.00 9,493.33 110.00 9,486.79 110.00 9,480.26 110.00 9,473.73 110.00 9,467.19 110.00 9,460.66 $2,540,500 $2,541,000 110.00 9,501.73 110.00 9,495.20 110.00 9,488.67 110.00 9,482.13 110.00 9,475.60 110.00 9,469.07 110.00 9,462.53 $2,541,000 $2,541,500 110.00 9,503.61 110.00 9,497.08 110.00 9,490.54 110.00 9,484.01 110.00 9,477.48 110.00 9,470.94 110.00 9,464.41 $2,541,500 $2,542,000 110.00 9,505.48 110.00 9,498.95 110.00 9,492.42 110.00 9,485.88 110.00 9,479.35 110.00 9,472.82 110.00 9,466.28 $2,542,000 $2,542,500 110.00 9,507.36 110.00 9,500.83 110.00 9,494.29 110.00 9,487.76 110.00 9,481.23 110.00 9,474.69 110.00 9,468.16 $2,542,500 $2,543,000 110.00 9,509.23 110.00 9,502.70 110.00 9,496.17 110.00 9,489.63 110.00 9,483.10 110.00 9,476.57 110.00 9,470.03 $2,543,000 $2,543,500 110.00 9,511.11 110.00 9,504.58 110.00 9,498.04 110.00 9,491.51 110.00 9,484.98 110.00 9,478.44 110.00 9,471.91 $2,543,500 $2,544,000 110.00 9,512.98 110.00 9,506.45 110.00 9,499.92 110.00 9,493.38 110.00 9,486.85 110.00 9,480.32 110.00 9,473.78 $2,544,000 $2,544,500 110.00 9,514.86 110.00 9,508.33 110.00 9,501.79 110.00 9,495.26 110.00 9,488.73 110.00 9,482.19 110.00 9,475.66 $2,544,500 $2,545,000 110.00 9,516.73 110.00 9,510.20 110.00 9,503.67 110.00 9,497.13 110.00 9,490.60 110.00 9,484.07 110.00 9,477.53 $2,545,000 $2,545,500 110.00 9,518.61 110.00 9,512.08 110.00 9,505.54 110.00 9,499.01 110.00 9,492.48 110.00 9,485.94 110.00 9,479.41 $2,545,500 $2,546,000 110.00 9,520.48 110.00 9,513.95 110.00 9,507.42 110.00 9,500.88 110.00 9,494.35 110.00 9,487.82 110.00 9,481.28 $2,546,000 $2,546,500 110.00 9,522.36 110.00 9,515.83 110.00 9,509.29 110.00 9,502.76 110.00 9,496.23 110.00 9,489.69 110.00 9,483.16 $2,546,500 $2,547,000 110.00 9,524.23 110.00 9,517.70 110.00 9,511.17 110.00 9,504.63 110.00 9,498.10 110.00 9,491.57 110.00 9,485.03 $2,547,000 $2,547,500 110.00 9,526.11 110.00 9,519.58 110.00 9,513.04 110.00 9,506.51 110.00 9,499.98 110.00 9,493.44 110.00 9,486.91 $2,547,500 $2,548,000 110.00 9,527.98 110.00 9,521.45 110.00 9,514.92 110.00 9,508.38 110.00 9,501.85 110.00 9,495.32 110.00 9,488.78 $2,548,000 $2,548,500 110.00 9,529.86 110.00 9,523.33 110.00 9,516.79 110.00 9,510.26 110.00 9,503.73 110.00 9,497.19 110.00 9,490.66 $2,548,500 $2,549,000 110.00 9,531.73 110.00 9,525.20 110.00 9,518.67 110.00 9,512.13 110.00 9,505.60 110.00 9,499.07 110.00 9,492.53 $2,549,000 $2,549,500 110.00 9,533.61 110.00 9,527.08 110.00 9,520.54 110.00 9,514.01 110.00 9,507.48 110.00 9,500.94 110.00 9,494.41 $2,549,500 $2,550,000 110.00 9,535.48 110.00 9,528.95 110.00 9,522.42 110.00 9,515.88 110.00 9,509.35 110.00 9,502.82 110.00 9,496.28

NJEIS Family Cost Participation Table Page 53 of 12 Effective July 1, 2015

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

$2,550,000 $2,550,500 110.00 9,537.36 110.00 9,530.83 110.00 9,524.29 110.00 9,517.76 110.00 9,511.23 110.00 9,504.69 110.00 9,498.16 $2,550,500 $2,551,000 110.00 9,539.23 110.00 9,532.70 110.00 9,526.17 110.00 9,519.63 110.00 9,513.10 110.00 9,506.57 110.00 9,500.03 $2,551,000 $2,551,500 110.00 9,541.11 110.00 9,534.58 110.00 9,528.04 110.00 9,521.51 110.00 9,514.98 110.00 9,508.44 110.00 9,501.91 $2,551,500 $2,552,000 110.00 9,542.98 110.00 9,536.45 110.00 9,529.92 110.00 9,523.38 110.00 9,516.85 110.00 9,510.32 110.00 9,503.78 $2,552,000 $2,552,500 110.00 9,544.86 110.00 9,538.33 110.00 9,531.79 110.00 9,525.26 110.00 9,518.73 110.00 9,512.19 110.00 9,505.66 $2,552,500 $2,553,000 110.00 9,546.73 110.00 9,540.20 110.00 9,533.67 110.00 9,527.13 110.00 9,520.60 110.00 9,514.07 110.00 9,507.53 $2,553,000 $2,553,500 110.00 9,548.61 110.00 9,542.08 110.00 9,535.54 110.00 9,529.01 110.00 9,522.48 110.00 9,515.94 110.00 9,509.41 $2,553,500 $2,554,000 110.00 9,550.48 110.00 9,543.95 110.00 9,537.42 110.00 9,530.88 110.00 9,524.35 110.00 9,517.82 110.00 9,511.28 $2,554,000 $2,554,500 110.00 9,552.36 110.00 9,545.83 110.00 9,539.29 110.00 9,532.76 110.00 9,526.23 110.00 9,519.69 110.00 9,513.16 $2,554,500 $2,555,000 110.00 9,554.23 110.00 9,547.70 110.00 9,541.17 110.00 9,534.63 110.00 9,528.10 110.00 9,521.57 110.00 9,515.03 $2,555,000 $2,555,500 110.00 9,556.11 110.00 9,549.58 110.00 9,543.04 110.00 9,536.51 110.00 9,529.98 110.00 9,523.44 110.00 9,516.91 $2,555,500 $2,556,000 110.00 9,557.98 110.00 9,551.45 110.00 9,544.92 110.00 9,538.38 110.00 9,531.85 110.00 9,525.32 110.00 9,518.78 $2,556,000 $2,556,500 110.00 9,559.86 110.00 9,553.33 110.00 9,546.79 110.00 9,540.26 110.00 9,533.73 110.00 9,527.19 110.00 9,520.66 $2,556,500 $2,557,000 110.00 9,561.73 110.00 9,555.20 110.00 9,548.67 110.00 9,542.13 110.00 9,535.60 110.00 9,529.07 110.00 9,522.53 $2,557,000 $2,557,500 110.00 9,563.61 110.00 9,557.08 110.00 9,550.54 110.00 9,544.01 110.00 9,537.48 110.00 9,530.94 110.00 9,524.41 $2,557,500 $2,558,000 110.00 9,565.48 110.00 9,558.95 110.00 9,552.42 110.00 9,545.88 110.00 9,539.35 110.00 9,532.82 110.00 9,526.28 $2,558,000 $2,558,500 110.00 9,567.36 110.00 9,560.83 110.00 9,554.29 110.00 9,547.76 110.00 9,541.23 110.00 9,534.69 110.00 9,528.16 $2,558,500 $2,559,000 110.00 9,569.23 110.00 9,562.70 110.00 9,556.17 110.00 9,549.63 110.00 9,543.10 110.00 9,536.57 110.00 9,530.03 $2,559,000 $2,559,500 110.00 9,571.11 110.00 9,564.58 110.00 9,558.04 110.00 9,551.51 110.00 9,544.98 110.00 9,538.44 110.00 9,531.91 $2,559,500 $2,560,000 110.00 9,572.98 110.00 9,566.45 110.00 9,559.92 110.00 9,553.38 110.00 9,546.85 110.00 9,540.32 110.00 9,533.78 $2,560,000 $2,560,500 110.00 9,574.86 110.00 9,568.33 110.00 9,561.79 110.00 9,555.26 110.00 9,548.73 110.00 9,542.19 110.00 9,535.66 $2,560,500 $2,561,000 110.00 9,576.73 110.00 9,570.20 110.00 9,563.67 110.00 9,557.13 110.00 9,550.60 110.00 9,544.07 110.00 9,537.53 $2,561,000 $2,561,500 110.00 9,578.61 110.00 9,572.08 110.00 9,565.54 110.00 9,559.01 110.00 9,552.48 110.00 9,545.94 110.00 9,539.41 $2,561,500 $2,562,000 110.00 9,580.48 110.00 9,573.95 110.00 9,567.42 110.00 9,560.88 110.00 9,554.35 110.00 9,547.82 110.00 9,541.28 $2,562,000 $2,562,500 110.00 9,582.36 110.00 9,575.83 110.00 9,569.29 110.00 9,562.76 110.00 9,556.23 110.00 9,549.69 110.00 9,543.16 $2,562,500 $2,563,000 110.00 9,584.23 110.00 9,577.70 110.00 9,571.17 110.00 9,564.63 110.00 9,558.10 110.00 9,551.57 110.00 9,545.03 $2,563,000 $2,563,500 110.00 9,586.11 110.00 9,579.58 110.00 9,573.04 110.00 9,566.51 110.00 9,559.98 110.00 9,553.44 110.00 9,546.91 $2,563,500 $2,564,000 110.00 9,587.98 110.00 9,581.45 110.00 9,574.92 110.00 9,568.38 110.00 9,561.85 110.00 9,555.32 110.00 9,548.78 $2,564,000 $2,564,500 110.00 9,589.86 110.00 9,583.33 110.00 9,576.79 110.00 9,570.26 110.00 9,563.73 110.00 9,557.19 110.00 9,550.66 $2,564,500 $2,565,000 110.00 9,591.73 110.00 9,585.20 110.00 9,578.67 110.00 9,572.13 110.00 9,565.60 110.00 9,559.07 110.00 9,552.53 $2,565,000 $2,565,500 110.00 9,593.61 110.00 9,587.08 110.00 9,580.54 110.00 9,574.01 110.00 9,567.48 110.00 9,560.94 110.00 9,554.41 $2,565,500 $2,566,000 110.00 9,595.48 110.00 9,588.95 110.00 9,582.42 110.00 9,575.88 110.00 9,569.35 110.00 9,562.82 110.00 9,556.28 $2,566,000 $2,566,500 110.00 9,597.36 110.00 9,590.83 110.00 9,584.29 110.00 9,577.76 110.00 9,571.23 110.00 9,564.69 110.00 9,558.16 $2,566,500 $2,567,000 110.00 9,599.23 110.00 9,592.70 110.00 9,586.17 110.00 9,579.63 110.00 9,573.10 110.00 9,566.57 110.00 9,560.03 $2,567,000 $2,567,500 110.00 9,601.11 110.00 9,594.58 110.00 9,588.04 110.00 9,581.51 110.00 9,574.98 110.00 9,568.44 110.00 9,561.91 $2,567,500 $2,568,000 110.00 9,602.98 110.00 9,596.45 110.00 9,589.92 110.00 9,583.38 110.00 9,576.85 110.00 9,570.32 110.00 9,563.78 $2,568,000 $2,568,500 110.00 9,604.86 110.00 9,598.33 110.00 9,591.79 110.00 9,585.26 110.00 9,578.73 110.00 9,572.19 110.00 9,565.66 $2,568,500 $2,569,000 110.00 9,606.73 110.00 9,600.20 110.00 9,593.67 110.00 9,587.13 110.00 9,580.60 110.00 9,574.07 110.00 9,567.53 $2,569,000 $2,569,500 110.00 9,608.61 110.00 9,602.08 110.00 9,595.54 110.00 9,589.01 110.00 9,582.48 110.00 9,575.94 110.00 9,569.41 $2,569,500 $2,570,000 110.00 9,610.48 110.00 9,603.95 110.00 9,597.42 110.00 9,590.88 110.00 9,584.35 110.00 9,577.82 110.00 9,571.28 $2,570,000 $2,570,500 110.00 9,612.36 110.00 9,605.83 110.00 9,599.29 110.00 9,592.76 110.00 9,586.23 110.00 9,579.69 110.00 9,573.16 $2,570,500 $2,571,000 110.00 9,614.23 110.00 9,607.70 110.00 9,601.17 110.00 9,594.63 110.00 9,588.10 110.00 9,581.57 110.00 9,575.03 $2,571,000 $2,571,500 110.00 9,616.11 110.00 9,609.58 110.00 9,603.04 110.00 9,596.51 110.00 9,589.98 110.00 9,583.44 110.00 9,576.91 $2,571,500 $2,572,000 110.00 9,617.98 110.00 9,611.45 110.00 9,604.92 110.00 9,598.38 110.00 9,591.85 110.00 9,585.32 110.00 9,578.78 $2,572,000 $2,572,500 110.00 9,619.86 110.00 9,613.33 110.00 9,606.79 110.00 9,600.26 110.00 9,593.73 110.00 9,587.19 110.00 9,580.66 $2,572,500 $2,573,000 110.00 9,621.73 110.00 9,615.20 110.00 9,608.67 110.00 9,602.13 110.00 9,595.60 110.00 9,589.07 110.00 9,582.53 $2,573,000 $2,573,500 110.00 9,623.61 110.00 9,617.08 110.00 9,610.54 110.00 9,604.01 110.00 9,597.48 110.00 9,590.94 110.00 9,584.41 $2,573,500 $2,574,000 110.00 9,625.48 110.00 9,618.95 110.00 9,612.42 110.00 9,605.88 110.00 9,599.35 110.00 9,592.82 110.00 9,586.28 $2,574,000 $2,574,500 110.00 9,627.36 110.00 9,620.83 110.00 9,614.29 110.00 9,607.76 110.00 9,601.23 110.00 9,594.69 110.00 9,588.16 $2,574,500 $2,575,000 110.00 9,629.23 110.00 9,622.70 110.00 9,616.17 110.00 9,609.63 110.00 9,603.10 110.00 9,596.57 110.00 9,590.03 $2,575,000 $2,575,500 110.00 9,631.11 110.00 9,624.58 110.00 9,618.04 110.00 9,611.51 110.00 9,604.98 110.00 9,598.44 110.00 9,591.91 $2,575,500 $2,576,000 110.00 9,632.98 110.00 9,626.45 110.00 9,619.92 110.00 9,613.38 110.00 9,606.85 110.00 9,600.32 110.00 9,593.78 $2,576,000 $2,576,500 110.00 9,634.86 110.00 9,628.33 110.00 9,621.79 110.00 9,615.26 110.00 9,608.73 110.00 9,602.19 110.00 9,595.66 $2,576,500 $2,577,000 110.00 9,636.73 110.00 9,630.20 110.00 9,623.67 110.00 9,617.13 110.00 9,610.60 110.00 9,604.07 110.00 9,597.53 $2,577,000 $2,577,500 110.00 9,638.61 110.00 9,632.08 110.00 9,625.54 110.00 9,619.01 110.00 9,612.48 110.00 9,605.94 110.00 9,599.41 $2,577,500 $2,578,000 110.00 9,640.48 110.00 9,633.95 110.00 9,627.42 110.00 9,620.88 110.00 9,614.35 110.00 9,607.82 110.00 9,601.28 $2,578,000 $2,578,500 110.00 9,642.36 110.00 9,635.83 110.00 9,629.29 110.00 9,622.76 110.00 9,616.23 110.00 9,609.69 110.00 9,603.16 $2,578,500 $2,579,000 110.00 9,644.23 110.00 9,637.70 110.00 9,631.17 110.00 9,624.63 110.00 9,618.10 110.00 9,611.57 110.00 9,605.03 $2,579,000 $2,579,500 110.00 9,646.11 110.00 9,639.58 110.00 9,633.04 110.00 9,626.51 110.00 9,619.98 110.00 9,613.44 110.00 9,606.91 $2,579,500 $2,580,000 110.00 9,647.98 110.00 9,641.45 110.00 9,634.92 110.00 9,628.38 110.00 9,621.85 110.00 9,615.32 110.00 9,608.78 $2,580,000 $2,580,500 110.00 9,649.86 110.00 9,643.33 110.00 9,636.79 110.00 9,630.26 110.00 9,623.73 110.00 9,617.19 110.00 9,610.66 $2,580,500 $2,581,000 110.00 9,651.73 110.00 9,645.20 110.00 9,638.67 110.00 9,632.13 110.00 9,625.60 110.00 9,619.07 110.00 9,612.53 $2,581,000 $2,581,500 110.00 9,653.61 110.00 9,647.08 110.00 9,640.54 110.00 9,634.01 110.00 9,627.48 110.00 9,620.94 110.00 9,614.41 $2,581,500 $2,582,000 110.00 9,655.48 110.00 9,648.95 110.00 9,642.42 110.00 9,635.88 110.00 9,629.35 110.00 9,622.82 110.00 9,616.28 $2,582,000 $2,582,500 110.00 9,657.36 110.00 9,650.83 110.00 9,644.29 110.00 9,637.76 110.00 9,631.23 110.00 9,624.69 110.00 9,618.16 $2,582,500 $2,583,000 110.00 9,659.23 110.00 9,652.70 110.00 9,646.17 110.00 9,639.63 110.00 9,633.10 110.00 9,626.57 110.00 9,620.03 $2,583,000 $2,583,500 110.00 9,661.11 110.00 9,654.58 110.00 9,648.04 110.00 9,641.51 110.00 9,634.98 110.00 9,628.44 110.00 9,621.91 $2,583,500 $2,584,000 110.00 9,662.98 110.00 9,656.45 110.00 9,649.92 110.00 9,643.38 110.00 9,636.85 110.00 9,630.32 110.00 9,623.78 $2,584,000 $2,584,500 110.00 9,664.86 110.00 9,658.33 110.00 9,651.79 110.00 9,645.26 110.00 9,638.73 110.00 9,632.19 110.00 9,625.66 $2,584,500 $2,585,000 110.00 9,666.73 110.00 9,660.20 110.00 9,653.67 110.00 9,647.13 110.00 9,640.60 110.00 9,634.07 110.00 9,627.53 $2,585,000 $2,585,500 110.00 9,668.61 110.00 9,662.08 110.00 9,655.54 110.00 9,649.01 110.00 9,642.48 110.00 9,635.94 110.00 9,629.41 $2,585,500 $2,586,000 110.00 9,670.48 110.00 9,663.95 110.00 9,657.42 110.00 9,650.88 110.00 9,644.35 110.00 9,637.82 110.00 9,631.28 $2,586,000 $2,586,500 110.00 9,672.36 110.00 9,665.83 110.00 9,659.29 110.00 9,652.76 110.00 9,646.23 110.00 9,639.69 110.00 9,633.16 $2,586,500 $2,587,000 110.00 9,674.23 110.00 9,667.70 110.00 9,661.17 110.00 9,654.63 110.00 9,648.10 110.00 9,641.57 110.00 9,635.03 $2,587,000 $2,587,500 110.00 9,676.11 110.00 9,669.58 110.00 9,663.04 110.00 9,656.51 110.00 9,649.98 110.00 9,643.44 110.00 9,636.91 $2,587,500 $2,588,000 110.00 9,677.98 110.00 9,671.45 110.00 9,664.92 110.00 9,658.38 110.00 9,651.85 110.00 9,645.32 110.00 9,638.78 $2,588,000 $2,588,500 110.00 9,679.86 110.00 9,673.33 110.00 9,666.79 110.00 9,660.26 110.00 9,653.73 110.00 9,647.19 110.00 9,640.66 $2,588,500 $2,589,000 110.00 9,681.73 110.00 9,675.20 110.00 9,668.67 110.00 9,662.13 110.00 9,655.60 110.00 9,649.07 110.00 9,642.53 $2,589,000 $2,589,500 110.00 9,683.61 110.00 9,677.08 110.00 9,670.54 110.00 9,664.01 110.00 9,657.48 110.00 9,650.94 110.00 9,644.41 $2,589,500 $2,590,000 110.00 9,685.48 110.00 9,678.95 110.00 9,672.42 110.00 9,665.88 110.00 9,659.35 110.00 9,652.82 110.00 9,646.28 $2,590,000 $2,590,500 110.00 9,687.36 110.00 9,680.83 110.00 9,674.29 110.00 9,667.76 110.00 9,661.23 110.00 9,654.69 110.00 9,648.16 $2,590,500 $2,591,000 110.00 9,689.23 110.00 9,682.70 110.00 9,676.17 110.00 9,669.63 110.00 9,663.10 110.00 9,656.57 110.00 9,650.03 $2,591,000 $2,591,500 110.00 9,691.11 110.00 9,684.58 110.00 9,678.04 110.00 9,671.51 110.00 9,664.98 110.00 9,658.44 110.00 9,651.91 $2,591,500 $2,592,000 110.00 9,692.98 110.00 9,686.45 110.00 9,679.92 110.00 9,673.38 110.00 9,666.85 110.00 9,660.32 110.00 9,653.78 $2,592,000 $2,592,500 110.00 9,694.86 110.00 9,688.33 110.00 9,681.79 110.00 9,675.26 110.00 9,668.73 110.00 9,662.19 110.00 9,655.66 $2,592,500 $2,593,000 110.00 9,696.73 110.00 9,690.20 110.00 9,683.67 110.00 9,677.13 110.00 9,670.60 110.00 9,664.07 110.00 9,657.53 $2,593,000 $2,593,500 110.00 9,698.61 110.00 9,692.08 110.00 9,685.54 110.00 9,679.01 110.00 9,672.48 110.00 9,665.94 110.00 9,659.41 $2,593,500 $2,594,000 110.00 9,700.48 110.00 9,693.95 110.00 9,687.42 110.00 9,680.88 110.00 9,674.35 110.00 9,667.82 110.00 9,661.28 $2,594,000 $2,594,500 110.00 9,702.36 110.00 9,695.83 110.00 9,689.29 110.00 9,682.76 110.00 9,676.23 110.00 9,669.69 110.00 9,663.16 $2,594,500 $2,595,000 110.00 9,704.23 110.00 9,697.70 110.00 9,691.17 110.00 9,684.63 110.00 9,678.10 110.00 9,671.57 110.00 9,665.03 $2,595,000 $2,595,500 110.00 9,706.11 110.00 9,699.58 110.00 9,693.04 110.00 9,686.51 110.00 9,679.98 110.00 9,673.44 110.00 9,666.91 $2,595,500 $2,596,000 110.00 9,707.98 110.00 9,701.45 110.00 9,694.92 110.00 9,688.38 110.00 9,681.85 110.00 9,675.32 110.00 9,668.78 $2,596,000 $2,596,500 110.00 9,709.86 110.00 9,703.33 110.00 9,696.79 110.00 9,690.26 110.00 9,683.73 110.00 9,677.19 110.00 9,670.66 $2,596,500 $2,597,000 110.00 9,711.73 110.00 9,705.20 110.00 9,698.67 110.00 9,692.13 110.00 9,685.60 110.00 9,679.07 110.00 9,672.53 $2,597,000 $2,597,500 110.00 9,713.61 110.00 9,707.08 110.00 9,700.54 110.00 9,694.01 110.00 9,687.48 110.00 9,680.94 110.00 9,674.41 $2,597,500 $2,598,000 110.00 9,715.48 110.00 9,708.95 110.00 9,702.42 110.00 9,695.88 110.00 9,689.35 110.00 9,682.82 110.00 9,676.28 $2,598,000 $2,598,500 110.00 9,717.36 110.00 9,710.83 110.00 9,704.29 110.00 9,697.76 110.00 9,691.23 110.00 9,684.69 110.00 9,678.16 $2,598,500 $2,599,000 110.00 9,719.23 110.00 9,712.70 110.00 9,706.17 110.00 9,699.63 110.00 9,693.10 110.00 9,686.57 110.00 9,680.03 $2,599,000 $2,599,500 110.00 9,721.11 110.00 9,714.58 110.00 9,708.04 110.00 9,701.51 110.00 9,694.98 110.00 9,688.44 110.00 9,681.91 $2,599,500 $2,600,000 110.00 9,722.98 110.00 9,716.45 110.00 9,709.92 110.00 9,703.38 110.00 9,696.85 110.00 9,690.32 110.00 9,683.78 $2,600,000 $2,600,500 110.00 9,724.86 110.00 9,718.33 110.00 9,711.79 110.00 9,705.26 110.00 9,698.73 110.00 9,692.19 110.00 9,685.66 $2,600,500 $2,601,000 110.00 9,726.73 110.00 9,720.20 110.00 9,713.67 110.00 9,707.13 110.00 9,700.60 110.00 9,694.07 110.00 9,687.53

NJEIS Family Cost Participation Table Page 54 of 12 Effective July 1, 2015

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

$2,601,000 $2,601,500 110.00 9,728.61 110.00 9,722.08 110.00 9,715.54 110.00 9,709.01 110.00 9,702.48 110.00 9,695.94 110.00 9,689.41 $2,601,500 $2,602,000 110.00 9,730.48 110.00 9,723.95 110.00 9,717.42 110.00 9,710.88 110.00 9,704.35 110.00 9,697.82 110.00 9,691.28 $2,602,000 $2,602,500 110.00 9,732.36 110.00 9,725.83 110.00 9,719.29 110.00 9,712.76 110.00 9,706.23 110.00 9,699.69 110.00 9,693.16 $2,602,500 $2,603,000 110.00 9,734.23 110.00 9,727.70 110.00 9,721.17 110.00 9,714.63 110.00 9,708.10 110.00 9,701.57 110.00 9,695.03 $2,603,000 $2,603,500 110.00 9,736.11 110.00 9,729.58 110.00 9,723.04 110.00 9,716.51 110.00 9,709.98 110.00 9,703.44 110.00 9,696.91 $2,603,500 $2,604,000 110.00 9,737.98 110.00 9,731.45 110.00 9,724.92 110.00 9,718.38 110.00 9,711.85 110.00 9,705.32 110.00 9,698.78 $2,604,000 $2,604,500 110.00 9,739.86 110.00 9,733.33 110.00 9,726.79 110.00 9,720.26 110.00 9,713.73 110.00 9,707.19 110.00 9,700.66 $2,604,500 $2,605,000 110.00 9,741.73 110.00 9,735.20 110.00 9,728.67 110.00 9,722.13 110.00 9,715.60 110.00 9,709.07 110.00 9,702.53 $2,605,000 $2,605,500 110.00 9,743.61 110.00 9,737.08 110.00 9,730.54 110.00 9,724.01 110.00 9,717.48 110.00 9,710.94 110.00 9,704.41 $2,605,500 $2,606,000 110.00 9,745.48 110.00 9,738.95 110.00 9,732.42 110.00 9,725.88 110.00 9,719.35 110.00 9,712.82 110.00 9,706.28 $2,606,000 $2,606,500 110.00 9,747.36 110.00 9,740.83 110.00 9,734.29 110.00 9,727.76 110.00 9,721.23 110.00 9,714.69 110.00 9,708.16 $2,606,500 $2,607,000 110.00 9,749.23 110.00 9,742.70 110.00 9,736.17 110.00 9,729.63 110.00 9,723.10 110.00 9,716.57 110.00 9,710.03 $2,607,000 $2,607,500 110.00 9,751.11 110.00 9,744.58 110.00 9,738.04 110.00 9,731.51 110.00 9,724.98 110.00 9,718.44 110.00 9,711.91 $2,607,500 $2,608,000 110.00 9,752.98 110.00 9,746.45 110.00 9,739.92 110.00 9,733.38 110.00 9,726.85 110.00 9,720.32 110.00 9,713.78 $2,608,000 $2,608,500 110.00 9,754.86 110.00 9,748.33 110.00 9,741.79 110.00 9,735.26 110.00 9,728.73 110.00 9,722.19 110.00 9,715.66 $2,608,500 $2,609,000 110.00 9,756.73 110.00 9,750.20 110.00 9,743.67 110.00 9,737.13 110.00 9,730.60 110.00 9,724.07 110.00 9,717.53 $2,609,000 $2,609,500 110.00 9,758.61 110.00 9,752.08 110.00 9,745.54 110.00 9,739.01 110.00 9,732.48 110.00 9,725.94 110.00 9,719.41 $2,609,500 $2,610,000 110.00 9,760.48 110.00 9,753.95 110.00 9,747.42 110.00 9,740.88 110.00 9,734.35 110.00 9,727.82 110.00 9,721.28 $2,610,000 $2,610,500 110.00 9,762.36 110.00 9,755.83 110.00 9,749.29 110.00 9,742.76 110.00 9,736.23 110.00 9,729.69 110.00 9,723.16 $2,610,500 $2,611,000 110.00 9,764.23 110.00 9,757.70 110.00 9,751.17 110.00 9,744.63 110.00 9,738.10 110.00 9,731.57 110.00 9,725.03 $2,611,000 $2,611,500 110.00 9,766.11 110.00 9,759.58 110.00 9,753.04 110.00 9,746.51 110.00 9,739.98 110.00 9,733.44 110.00 9,726.91 $2,611,500 $2,612,000 110.00 9,767.98 110.00 9,761.45 110.00 9,754.92 110.00 9,748.38 110.00 9,741.85 110.00 9,735.32 110.00 9,728.78 $2,612,000 $2,612,500 110.00 9,769.86 110.00 9,763.33 110.00 9,756.79 110.00 9,750.26 110.00 9,743.73 110.00 9,737.19 110.00 9,730.66 $2,612,500 $2,613,000 110.00 9,771.73 110.00 9,765.20 110.00 9,758.67 110.00 9,752.13 110.00 9,745.60 110.00 9,739.07 110.00 9,732.53 $2,613,000 $2,613,500 110.00 9,773.61 110.00 9,767.08 110.00 9,760.54 110.00 9,754.01 110.00 9,747.48 110.00 9,740.94 110.00 9,734.41 $2,613,500 $2,614,000 110.00 9,775.48 110.00 9,768.95 110.00 9,762.42 110.00 9,755.88 110.00 9,749.35 110.00 9,742.82 110.00 9,736.28 $2,614,000 $2,614,500 110.00 9,777.36 110.00 9,770.83 110.00 9,764.29 110.00 9,757.76 110.00 9,751.23 110.00 9,744.69 110.00 9,738.16 $2,614,500 $2,615,000 110.00 9,779.23 110.00 9,772.70 110.00 9,766.17 110.00 9,759.63 110.00 9,753.10 110.00 9,746.57 110.00 9,740.03 $2,615,000 $2,615,500 110.00 9,781.11 110.00 9,774.58 110.00 9,768.04 110.00 9,761.51 110.00 9,754.98 110.00 9,748.44 110.00 9,741.91 $2,615,500 $2,616,000 110.00 9,782.98 110.00 9,776.45 110.00 9,769.92 110.00 9,763.38 110.00 9,756.85 110.00 9,750.32 110.00 9,743.78 $2,616,000 $2,616,500 110.00 9,784.86 110.00 9,778.33 110.00 9,771.79 110.00 9,765.26 110.00 9,758.73 110.00 9,752.19 110.00 9,745.66 $2,616,500 $2,617,000 110.00 9,786.73 110.00 9,780.20 110.00 9,773.67 110.00 9,767.13 110.00 9,760.60 110.00 9,754.07 110.00 9,747.53 $2,617,000 $2,617,500 110.00 9,788.61 110.00 9,782.08 110.00 9,775.54 110.00 9,769.01 110.00 9,762.48 110.00 9,755.94 110.00 9,749.41 $2,617,500 $2,618,000 110.00 9,790.48 110.00 9,783.95 110.00 9,777.42 110.00 9,770.88 110.00 9,764.35 110.00 9,757.82 110.00 9,751.28 $2,618,000 $2,618,500 110.00 9,792.36 110.00 9,785.83 110.00 9,779.29 110.00 9,772.76 110.00 9,766.23 110.00 9,759.69 110.00 9,753.16 $2,618,500 $2,619,000 110.00 9,794.23 110.00 9,787.70 110.00 9,781.17 110.00 9,774.63 110.00 9,768.10 110.00 9,761.57 110.00 9,755.03 $2,619,000 $2,619,500 110.00 9,796.11 110.00 9,789.58 110.00 9,783.04 110.00 9,776.51 110.00 9,769.98 110.00 9,763.44 110.00 9,756.91 $2,619,500 $2,620,000 110.00 9,797.98 110.00 9,791.45 110.00 9,784.92 110.00 9,778.38 110.00 9,771.85 110.00 9,765.32 110.00 9,758.78 $2,620,000 $2,620,500 110.00 9,799.86 110.00 9,793.33 110.00 9,786.79 110.00 9,780.26 110.00 9,773.73 110.00 9,767.19 110.00 9,760.66 $2,620,500 $2,621,000 110.00 9,801.73 110.00 9,795.20 110.00 9,788.67 110.00 9,782.13 110.00 9,775.60 110.00 9,769.07 110.00 9,762.53 $2,621,000 $2,621,500 110.00 9,803.61 110.00 9,797.08 110.00 9,790.54 110.00 9,784.01 110.00 9,777.48 110.00 9,770.94 110.00 9,764.41 $2,621,500 $2,622,000 110.00 9,805.48 110.00 9,798.95 110.00 9,792.42 110.00 9,785.88 110.00 9,779.35 110.00 9,772.82 110.00 9,766.28 $2,622,000 $2,622,500 110.00 9,807.36 110.00 9,800.83 110.00 9,794.29 110.00 9,787.76 110.00 9,781.23 110.00 9,774.69 110.00 9,768.16 $2,622,500 $2,623,000 110.00 9,809.23 110.00 9,802.70 110.00 9,796.17 110.00 9,789.63 110.00 9,783.10 110.00 9,776.57 110.00 9,770.03 $2,623,000 $2,623,500 110.00 9,811.11 110.00 9,804.58 110.00 9,798.04 110.00 9,791.51 110.00 9,784.98 110.00 9,778.44 110.00 9,771.91 $2,623,500 $2,624,000 110.00 9,812.98 110.00 9,806.45 110.00 9,799.92 110.00 9,793.38 110.00 9,786.85 110.00 9,780.32 110.00 9,773.78 $2,624,000 $2,624,500 110.00 9,814.86 110.00 9,808.33 110.00 9,801.79 110.00 9,795.26 110.00 9,788.73 110.00 9,782.19 110.00 9,775.66 $2,624,500 $2,625,000 110.00 9,816.73 110.00 9,810.20 110.00 9,803.67 110.00 9,797.13 110.00 9,790.60 110.00 9,784.07 110.00 9,777.53 $2,625,000 $2,625,500 110.00 9,818.61 110.00 9,812.08 110.00 9,805.54 110.00 9,799.01 110.00 9,792.48 110.00 9,785.94 110.00 9,779.41 $2,625,500 $2,626,000 110.00 9,820.48 110.00 9,813.95 110.00 9,807.42 110.00 9,800.88 110.00 9,794.35 110.00 9,787.82 110.00 9,781.28 $2,626,000 $2,626,500 110.00 9,822.36 110.00 9,815.83 110.00 9,809.29 110.00 9,802.76 110.00 9,796.23 110.00 9,789.69 110.00 9,783.16 $2,626,500 $2,627,000 110.00 9,824.23 110.00 9,817.70 110.00 9,811.17 110.00 9,804.63 110.00 9,798.10 110.00 9,791.57 110.00 9,785.03 $2,627,000 $2,627,500 110.00 9,826.11 110.00 9,819.58 110.00 9,813.04 110.00 9,806.51 110.00 9,799.98 110.00 9,793.44 110.00 9,786.91 $2,627,500 $2,628,000 110.00 9,827.98 110.00 9,821.45 110.00 9,814.92 110.00 9,808.38 110.00 9,801.85 110.00 9,795.32 110.00 9,788.78 $2,628,000 $2,628,500 110.00 9,829.86 110.00 9,823.33 110.00 9,816.79 110.00 9,810.26 110.00 9,803.73 110.00 9,797.19 110.00 9,790.66 $2,628,500 $2,629,000 110.00 9,831.73 110.00 9,825.20 110.00 9,818.67 110.00 9,812.13 110.00 9,805.60 110.00 9,799.07 110.00 9,792.53 $2,629,000 $2,629,500 110.00 9,833.61 110.00 9,827.08 110.00 9,820.54 110.00 9,814.01 110.00 9,807.48 110.00 9,800.94 110.00 9,794.41 $2,629,500 $2,630,000 110.00 9,835.48 110.00 9,828.95 110.00 9,822.42 110.00 9,815.88 110.00 9,809.35 110.00 9,802.82 110.00 9,796.28 $2,630,000 $2,630,500 110.00 9,837.36 110.00 9,830.83 110.00 9,824.29 110.00 9,817.76 110.00 9,811.23 110.00 9,804.69 110.00 9,798.16 $2,630,500 $2,631,000 110.00 9,839.23 110.00 9,832.70 110.00 9,826.17 110.00 9,819.63 110.00 9,813.10 110.00 9,806.57 110.00 9,800.03 $2,631,000 $2,631,500 110.00 9,841.11 110.00 9,834.58 110.00 9,828.04 110.00 9,821.51 110.00 9,814.98 110.00 9,808.44 110.00 9,801.91 $2,631,500 $2,632,000 110.00 9,842.98 110.00 9,836.45 110.00 9,829.92 110.00 9,823.38 110.00 9,816.85 110.00 9,810.32 110.00 9,803.78 $2,632,000 $2,632,500 110.00 9,844.86 110.00 9,838.33 110.00 9,831.79 110.00 9,825.26 110.00 9,818.73 110.00 9,812.19 110.00 9,805.66 $2,632,500 $2,633,000 110.00 9,846.73 110.00 9,840.20 110.00 9,833.67 110.00 9,827.13 110.00 9,820.60 110.00 9,814.07 110.00 9,807.53 $2,633,000 $2,633,500 110.00 9,848.61 110.00 9,842.08 110.00 9,835.54 110.00 9,829.01 110.00 9,822.48 110.00 9,815.94 110.00 9,809.41 $2,633,500 $2,634,000 110.00 9,850.48 110.00 9,843.95 110.00 9,837.42 110.00 9,830.88 110.00 9,824.35 110.00 9,817.82 110.00 9,811.28 $2,634,000 $2,634,500 110.00 9,852.36 110.00 9,845.83 110.00 9,839.29 110.00 9,832.76 110.00 9,826.23 110.00 9,819.69 110.00 9,813.16 $2,634,500 $2,635,000 110.00 9,854.23 110.00 9,847.70 110.00 9,841.17 110.00 9,834.63 110.00 9,828.10 110.00 9,821.57 110.00 9,815.03 $2,635,000 $2,635,500 110.00 9,856.11 110.00 9,849.58 110.00 9,843.04 110.00 9,836.51 110.00 9,829.98 110.00 9,823.44 110.00 9,816.91 $2,635,500 $2,636,000 110.00 9,857.98 110.00 9,851.45 110.00 9,844.92 110.00 9,838.38 110.00 9,831.85 110.00 9,825.32 110.00 9,818.78 $2,636,000 $2,636,500 110.00 9,859.86 110.00 9,853.33 110.00 9,846.79 110.00 9,840.26 110.00 9,833.73 110.00 9,827.19 110.00 9,820.66 $2,636,500 $2,637,000 110.00 9,861.73 110.00 9,855.20 110.00 9,848.67 110.00 9,842.13 110.00 9,835.60 110.00 9,829.07 110.00 9,822.53 $2,637,000 $2,637,500 110.00 9,863.61 110.00 9,857.08 110.00 9,850.54 110.00 9,844.01 110.00 9,837.48 110.00 9,830.94 110.00 9,824.41 $2,637,500 $2,638,000 110.00 9,865.48 110.00 9,858.95 110.00 9,852.42 110.00 9,845.88 110.00 9,839.35 110.00 9,832.82 110.00 9,826.28 $2,638,000 $2,638,500 110.00 9,867.36 110.00 9,860.83 110.00 9,854.29 110.00 9,847.76 110.00 9,841.23 110.00 9,834.69 110.00 9,828.16 $2,638,500 $2,639,000 110.00 9,869.23 110.00 9,862.70 110.00 9,856.17 110.00 9,849.63 110.00 9,843.10 110.00 9,836.57 110.00 9,830.03 $2,639,000 $2,639,500 110.00 9,871.11 110.00 9,864.58 110.00 9,858.04 110.00 9,851.51 110.00 9,844.98 110.00 9,838.44 110.00 9,831.91 $2,639,500 $2,640,000 110.00 9,872.98 110.00 9,866.45 110.00 9,859.92 110.00 9,853.38 110.00 9,846.85 110.00 9,840.32 110.00 9,833.78 $2,640,000 $2,640,500 110.00 9,874.86 110.00 9,868.33 110.00 9,861.79 110.00 9,855.26 110.00 9,848.73 110.00 9,842.19 110.00 9,835.66 $2,640,500 $2,641,000 110.00 9,876.73 110.00 9,870.20 110.00 9,863.67 110.00 9,857.13 110.00 9,850.60 110.00 9,844.07 110.00 9,837.53 $2,641,000 $2,641,500 110.00 9,878.61 110.00 9,872.08 110.00 9,865.54 110.00 9,859.01 110.00 9,852.48 110.00 9,845.94 110.00 9,839.41 $2,641,500 $2,642,000 110.00 9,880.48 110.00 9,873.95 110.00 9,867.42 110.00 9,860.88 110.00 9,854.35 110.00 9,847.82 110.00 9,841.28 $2,642,000 $2,642,500 110.00 9,882.36 110.00 9,875.83 110.00 9,869.29 110.00 9,862.76 110.00 9,856.23 110.00 9,849.69 110.00 9,843.16 $2,642,500 $2,643,000 110.00 9,884.23 110.00 9,877.70 110.00 9,871.17 110.00 9,864.63 110.00 9,858.10 110.00 9,851.57 110.00 9,845.03 $2,643,000 $2,643,500 110.00 9,886.11 110.00 9,879.58 110.00 9,873.04 110.00 9,866.51 110.00 9,859.98 110.00 9,853.44 110.00 9,846.91 $2,643,500 $2,644,000 110.00 9,887.98 110.00 9,881.45 110.00 9,874.92 110.00 9,868.38 110.00 9,861.85 110.00 9,855.32 110.00 9,848.78 $2,644,000 $2,644,500 110.00 9,889.86 110.00 9,883.33 110.00 9,876.79 110.00 9,870.26 110.00 9,863.73 110.00 9,857.19 110.00 9,850.66 $2,644,500 $2,645,000 110.00 9,891.73 110.00 9,885.20 110.00 9,878.67 110.00 9,872.13 110.00 9,865.60 110.00 9,859.07 110.00 9,852.53 $2,645,000 $2,645,500 110.00 9,893.61 110.00 9,887.08 110.00 9,880.54 110.00 9,874.01 110.00 9,867.48 110.00 9,860.94 110.00 9,854.41 $2,645,500 $2,646,000 110.00 9,895.48 110.00 9,888.95 110.00 9,882.42 110.00 9,875.88 110.00 9,869.35 110.00 9,862.82 110.00 9,856.28 $2,646,000 $2,646,500 110.00 9,897.36 110.00 9,890.83 110.00 9,884.29 110.00 9,877.76 110.00 9,871.23 110.00 9,864.69 110.00 9,858.16 $2,646,500 $2,647,000 110.00 9,899.23 110.00 9,892.70 110.00 9,886.17 110.00 9,879.63 110.00 9,873.10 110.00 9,866.57 110.00 9,860.03 $2,647,000 $2,647,500 110.00 9,901.11 110.00 9,894.58 110.00 9,888.04 110.00 9,881.51 110.00 9,874.98 110.00 9,868.44 110.00 9,861.91 $2,647,500 $2,648,000 110.00 9,902.98 110.00 9,896.45 110.00 9,889.92 110.00 9,883.38 110.00 9,876.85 110.00 9,870.32 110.00 9,863.78 $2,648,000 $2,648,500 110.00 9,904.86 110.00 9,898.33 110.00 9,891.79 110.00 9,885.26 110.00 9,878.73 110.00 9,872.19 110.00 9,865.66 $2,648,500 $2,649,000 110.00 9,906.73 110.00 9,900.20 110.00 9,893.67 110.00 9,887.13 110.00 9,880.60 110.00 9,874.07 110.00 9,867.53 $2,649,000 $2,649,500 110.00 9,908.61 110.00 9,902.08 110.00 9,895.54 110.00 9,889.01 110.00 9,882.48 110.00 9,875.94 110.00 9,869.41 $2,649,500 $2,650,000 110.00 9,910.48 110.00 9,903.95 110.00 9,897.42 110.00 9,890.88 110.00 9,884.35 110.00 9,877.82 110.00 9,871.28 $2,650,000 $2,650,500 110.00 9,912.36 110.00 9,905.83 110.00 9,899.29 110.00 9,892.76 110.00 9,886.23 110.00 9,879.69 110.00 9,873.16 $2,650,500 $2,651,000 110.00 9,914.23 110.00 9,907.70 110.00 9,901.17 110.00 9,894.63 110.00 9,888.10 110.00 9,881.57 110.00 9,875.03 $2,651,000 $2,651,500 110.00 9,916.11 110.00 9,909.58 110.00 9,903.04 110.00 9,896.51 110.00 9,889.98 110.00 9,883.44 110.00 9,876.91 $2,651,500 $2,652,000 110.00 9,917.98 110.00 9,911.45 110.00 9,904.92 110.00 9,898.38 110.00 9,891.85 110.00 9,885.32 110.00 9,878.78

NJEIS Family Cost Participation Table Page 55 of 12 Effective July 1, 2015

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

$2,652,000 $2,652,500 110.00 9,919.86 110.00 9,913.33 110.00 9,906.79 110.00 9,900.26 110.00 9,893.73 110.00 9,887.19 110.00 9,880.66 $2,652,500 $2,653,000 110.00 9,921.73 110.00 9,915.20 110.00 9,908.67 110.00 9,902.13 110.00 9,895.60 110.00 9,889.07 110.00 9,882.53 $2,653,000 $2,653,500 110.00 9,923.61 110.00 9,917.08 110.00 9,910.54 110.00 9,904.01 110.00 9,897.48 110.00 9,890.94 110.00 9,884.41 $2,653,500 $2,654,000 110.00 9,925.48 110.00 9,918.95 110.00 9,912.42 110.00 9,905.88 110.00 9,899.35 110.00 9,892.82 110.00 9,886.28 $2,654,000 $2,654,500 110.00 9,927.36 110.00 9,920.83 110.00 9,914.29 110.00 9,907.76 110.00 9,901.23 110.00 9,894.69 110.00 9,888.16 $2,654,500 $2,655,000 110.00 9,929.23 110.00 9,922.70 110.00 9,916.17 110.00 9,909.63 110.00 9,903.10 110.00 9,896.57 110.00 9,890.03 $2,655,000 $2,655,500 110.00 9,931.11 110.00 9,924.58 110.00 9,918.04 110.00 9,911.51 110.00 9,904.98 110.00 9,898.44 110.00 9,891.91 $2,655,500 $2,656,000 110.00 9,932.98 110.00 9,926.45 110.00 9,919.92 110.00 9,913.38 110.00 9,906.85 110.00 9,900.32 110.00 9,893.78 $2,656,000 $2,656,500 110.00 9,934.86 110.00 9,928.33 110.00 9,921.79 110.00 9,915.26 110.00 9,908.73 110.00 9,902.19 110.00 9,895.66 $2,656,500 $2,657,000 110.00 9,936.73 110.00 9,930.20 110.00 9,923.67 110.00 9,917.13 110.00 9,910.60 110.00 9,904.07 110.00 9,897.53 $2,657,000 $2,657,500 110.00 9,938.61 110.00 9,932.08 110.00 9,925.54 110.00 9,919.01 110.00 9,912.48 110.00 9,905.94 110.00 9,899.41 $2,657,500 $2,658,000 110.00 9,940.48 110.00 9,933.95 110.00 9,927.42 110.00 9,920.88 110.00 9,914.35 110.00 9,907.82 110.00 9,901.28 $2,658,000 $2,658,500 110.00 9,942.36 110.00 9,935.83 110.00 9,929.29 110.00 9,922.76 110.00 9,916.23 110.00 9,909.69 110.00 9,903.16 $2,658,500 $2,659,000 110.00 9,944.23 110.00 9,937.70 110.00 9,931.17 110.00 9,924.63 110.00 9,918.10 110.00 9,911.57 110.00 9,905.03 $2,659,000 $2,659,500 110.00 9,946.11 110.00 9,939.58 110.00 9,933.04 110.00 9,926.51 110.00 9,919.98 110.00 9,913.44 110.00 9,906.91 $2,659,500 $2,660,000 110.00 9,947.98 110.00 9,941.45 110.00 9,934.92 110.00 9,928.38 110.00 9,921.85 110.00 9,915.32 110.00 9,908.78 $2,660,000 $2,660,500 110.00 9,949.86 110.00 9,943.33 110.00 9,936.79 110.00 9,930.26 110.00 9,923.73 110.00 9,917.19 110.00 9,910.66 $2,660,500 $2,661,000 110.00 9,951.73 110.00 9,945.20 110.00 9,938.67 110.00 9,932.13 110.00 9,925.60 110.00 9,919.07 110.00 9,912.53 $2,661,000 $2,661,500 110.00 9,953.61 110.00 9,947.08 110.00 9,940.54 110.00 9,934.01 110.00 9,927.48 110.00 9,920.94 110.00 9,914.41 $2,661,500 $2,662,000 110.00 9,955.48 110.00 9,948.95 110.00 9,942.42 110.00 9,935.88 110.00 9,929.35 110.00 9,922.82 110.00 9,916.28 $2,662,000 $2,662,500 110.00 9,957.36 110.00 9,950.83 110.00 9,944.29 110.00 9,937.76 110.00 9,931.23 110.00 9,924.69 110.00 9,918.16 $2,662,500 $2,663,000 110.00 9,959.23 110.00 9,952.70 110.00 9,946.17 110.00 9,939.63 110.00 9,933.10 110.00 9,926.57 110.00 9,920.03 $2,663,000 $2,663,500 110.00 9,961.11 110.00 9,954.58 110.00 9,948.04 110.00 9,941.51 110.00 9,934.98 110.00 9,928.44 110.00 9,921.91 $2,663,500 $2,664,000 110.00 9,962.98 110.00 9,956.45 110.00 9,949.92 110.00 9,943.38 110.00 9,936.85 110.00 9,930.32 110.00 9,923.78 $2,664,000 $2,664,500 110.00 9,964.86 110.00 9,958.33 110.00 9,951.79 110.00 9,945.26 110.00 9,938.73 110.00 9,932.19 110.00 9,925.66 $2,664,500 $2,665,000 110.00 9,966.73 110.00 9,960.20 110.00 9,953.67 110.00 9,947.13 110.00 9,940.60 110.00 9,934.07 110.00 9,927.53 $2,665,000 $2,665,500 110.00 9,968.61 110.00 9,962.08 110.00 9,955.54 110.00 9,949.01 110.00 9,942.48 110.00 9,935.94 110.00 9,929.41 $2,665,500 $2,666,000 110.00 9,970.48 110.00 9,963.95 110.00 9,957.42 110.00 9,950.88 110.00 9,944.35 110.00 9,937.82 110.00 9,931.28 $2,666,000 $2,666,500 110.00 9,972.36 110.00 9,965.83 110.00 9,959.29 110.00 9,952.76 110.00 9,946.23 110.00 9,939.69 110.00 9,933.16 $2,666,500 $2,667,000 110.00 9,974.23 110.00 9,967.70 110.00 9,961.17 110.00 9,954.63 110.00 9,948.10 110.00 9,941.57 110.00 9,935.03 $2,667,000 $2,667,500 110.00 9,976.11 110.00 9,969.58 110.00 9,963.04 110.00 9,956.51 110.00 9,949.98 110.00 9,943.44 110.00 9,936.91 $2,667,500 $2,668,000 110.00 9,977.98 110.00 9,971.45 110.00 9,964.92 110.00 9,958.38 110.00 9,951.85 110.00 9,945.32 110.00 9,938.78 $2,668,000 $2,668,500 110.00 9,979.86 110.00 9,973.33 110.00 9,966.79 110.00 9,960.26 110.00 9,953.73 110.00 9,947.19 110.00 9,940.66 $2,668,500 $2,669,000 110.00 9,981.73 110.00 9,975.20 110.00 9,968.67 110.00 9,962.13 110.00 9,955.60 110.00 9,949.07 110.00 9,942.53 $2,669,000 $2,669,500 110.00 9,983.61 110.00 9,977.08 110.00 9,970.54 110.00 9,964.01 110.00 9,957.48 110.00 9,950.94 110.00 9,944.41 $2,669,500 $2,670,000 110.00 9,985.48 110.00 9,978.95 110.00 9,972.42 110.00 9,965.88 110.00 9,959.35 110.00 9,952.82 110.00 9,946.28 $2,670,000 $2,670,500 110.00 9,987.36 110.00 9,980.83 110.00 9,974.29 110.00 9,967.76 110.00 9,961.23 110.00 9,954.69 110.00 9,948.16 $2,670,500 $2,671,000 110.00 9,989.23 110.00 9,982.70 110.00 9,976.17 110.00 9,969.63 110.00 9,963.10 110.00 9,956.57 110.00 9,950.03 $2,671,000 $2,671,500 110.00 9,991.11 110.00 9,984.58 110.00 9,978.04 110.00 9,971.51 110.00 9,964.98 110.00 9,958.44 110.00 9,951.91 $2,671,500 $2,672,000 110.00 9,992.98 110.00 9,986.45 110.00 9,979.92 110.00 9,973.38 110.00 9,966.85 110.00 9,960.32 110.00 9,953.78 $2,672,000 $2,672,500 110.00 9,994.86 110.00 9,988.33 110.00 9,981.79 110.00 9,975.26 110.00 9,968.73 110.00 9,962.19 110.00 9,955.66 $2,672,500 $2,673,000 110.00 9,996.73 110.00 9,990.20 110.00 9,983.67 110.00 9,977.13 110.00 9,970.60 110.00 9,964.07 110.00 9,957.53 $2,673,000 $2,673,500 110.00 9,998.61 110.00 9,992.08 110.00 9,985.54 110.00 9,979.01 110.00 9,972.48 110.00 9,965.94 110.00 9,959.41 $2,673,500 $2,674,000 110.00 10,000.48 110.00 9,993.95 110.00 9,987.42 110.00 9,980.88 110.00 9,974.35 110.00 9,967.82 110.00 9,961.28 $2,674,000 $2,674,500 110.00 10,002.36 110.00 9,995.83 110.00 9,989.29 110.00 9,982.76 110.00 9,976.23 110.00 9,969.69 110.00 9,963.16 $2,674,500 $2,675,000 110.00 10,004.23 110.00 9,997.70 110.00 9,991.17 110.00 9,984.63 110.00 9,978.10 110.00 9,971.57 110.00 9,965.03 $2,675,000 $2,675,500 110.00 10,006.11 110.00 9,999.58 110.00 9,993.04 110.00 9,986.51 110.00 9,979.98 110.00 9,973.44 110.00 9,966.91 $2,675,500 $2,676,000 110.00 10,007.98 110.00 10,001.45 110.00 9,994.92 110.00 9,988.38 110.00 9,981.85 110.00 9,975.32 110.00 9,968.78 $2,676,000 $2,676,500 110.00 10,009.86 110.00 10,003.33 110.00 9,996.79 110.00 9,990.26 110.00 9,983.73 110.00 9,977.19 110.00 9,970.66 $2,676,500 $2,677,000 110.00 10,011.73 110.00 10,005.20 110.00 9,998.67 110.00 9,992.13 110.00 9,985.60 110.00 9,979.07 110.00 9,972.53 $2,677,000 $2,677,500 110.00 10,013.61 110.00 10,007.08 110.00 10,000.54 110.00 9,994.01 110.00 9,987.48 110.00 9,980.94 110.00 9,974.41 $2,677,500 $2,678,000 110.00 10,015.48 110.00 10,008.95 110.00 10,002.42 110.00 9,995.88 110.00 9,989.35 110.00 9,982.82 110.00 9,976.28 $2,678,000 $2,678,500 110.00 10,017.36 110.00 10,010.83 110.00 10,004.29 110.00 9,997.76 110.00 9,991.23 110.00 9,984.69 110.00 9,978.16 $2,678,500 $2,679,000 110.00 10,019.23 110.00 10,012.70 110.00 10,006.17 110.00 9,999.63 110.00 9,993.10 110.00 9,986.57 110.00 9,980.03 $2,679,000 $2,679,500 110.00 10,021.11 110.00 10,014.58 110.00 10,008.04 110.00 10,001.51 110.00 9,994.98 110.00 9,988.44 110.00 9,981.91 $2,679,500 $2,680,000 110.00 10,022.98 110.00 10,016.45 110.00 10,009.92 110.00 10,003.38 110.00 9,996.85 110.00 9,990.32 110.00 9,983.78 $2,680,000 $2,680,500 110.00 10,024.86 110.00 10,018.33 110.00 10,011.79 110.00 10,005.26 110.00 9,998.73 110.00 9,992.19 110.00 9,985.66 $2,680,500 $2,681,000 110.00 10,026.73 110.00 10,020.20 110.00 10,013.67 110.00 10,007.13 110.00 10,000.60 110.00 9,994.07 110.00 9,987.53 $2,681,000 $2,681,500 110.00 10,028.61 110.00 10,022.08 110.00 10,015.54 110.00 10,009.01 110.00 10,002.48 110.00 9,995.94 110.00 9,989.41 $2,681,500 $2,682,000 110.00 10,030.48 110.00 10,023.95 110.00 10,017.42 110.00 10,010.88 110.00 10,004.35 110.00 9,997.82 110.00 9,991.28 $2,682,000 $2,682,500 110.00 10,032.36 110.00 10,025.83 110.00 10,019.29 110.00 10,012.76 110.00 10,006.23 110.00 9,999.69 110.00 9,993.16 $2,682,500 $2,683,000 110.00 10,034.23 110.00 10,027.70 110.00 10,021.17 110.00 10,014.63 110.00 10,008.10 110.00 10,001.57 110.00 9,995.03 $2,683,000 $2,683,500 110.00 10,036.11 110.00 10,029.58 110.00 10,023.04 110.00 10,016.51 110.00 10,009.98 110.00 10,003.44 110.00 9,996.91 $2,683,500 $2,684,000 110.00 10,037.98 110.00 10,031.45 110.00 10,024.92 110.00 10,018.38 110.00 10,011.85 110.00 10,005.32 110.00 9,998.78 $2,684,000 $2,684,500 110.00 10,039.86 110.00 10,033.33 110.00 10,026.79 110.00 10,020.26 110.00 10,013.73 110.00 10,007.19 110.00 10,000.66 $2,684,500 $2,685,000 110.00 10,041.73 110.00 10,035.20 110.00 10,028.67 110.00 10,022.13 110.00 10,015.60 110.00 10,009.07 110.00 10,002.53 $2,685,000 $2,685,500 110.00 10,043.61 110.00 10,037.08 110.00 10,030.54 110.00 10,024.01 110.00 10,017.48 110.00 10,010.94 110.00 10,004.41 $2,685,500 $2,686,000 110.00 10,045.48 110.00 10,038.95 110.00 10,032.42 110.00 10,025.88 110.00 10,019.35 110.00 10,012.82 110.00 10,006.28 $2,686,000 $2,686,500 110.00 10,047.36 110.00 10,040.83 110.00 10,034.29 110.00 10,027.76 110.00 10,021.23 110.00 10,014.69 110.00 10,008.16 $2,686,500 $2,687,000 110.00 10,049.23 110.00 10,042.70 110.00 10,036.17 110.00 10,029.63 110.00 10,023.10 110.00 10,016.57 110.00 10,010.03 $2,687,000 $2,687,500 110.00 10,051.11 110.00 10,044.58 110.00 10,038.04 110.00 10,031.51 110.00 10,024.98 110.00 10,018.44 110.00 10,011.91 $2,687,500 $2,688,000 110.00 10,052.98 110.00 10,046.45 110.00 10,039.92 110.00 10,033.38 110.00 10,026.85 110.00 10,020.32 110.00 10,013.78 $2,688,000 $2,688,500 110.00 10,054.86 110.00 10,048.33 110.00 10,041.79 110.00 10,035.26 110.00 10,028.73 110.00 10,022.19 110.00 10,015.66 $2,688,500 $2,689,000 110.00 10,056.73 110.00 10,050.20 110.00 10,043.67 110.00 10,037.13 110.00 10,030.60 110.00 10,024.07 110.00 10,017.53 $2,689,000 $2,689,500 110.00 10,058.61 110.00 10,052.08 110.00 10,045.54 110.00 10,039.01 110.00 10,032.48 110.00 10,025.94 110.00 10,019.41 $2,689,500 $2,690,000 110.00 10,060.48 110.00 10,053.95 110.00 10,047.42 110.00 10,040.88 110.00 10,034.35 110.00 10,027.82 110.00 10,021.28 $2,690,000 $2,690,500 110.00 10,062.36 110.00 10,055.83 110.00 10,049.29 110.00 10,042.76 110.00 10,036.23 110.00 10,029.69 110.00 10,023.16 $2,690,500 $2,691,000 110.00 10,064.23 110.00 10,057.70 110.00 10,051.17 110.00 10,044.63 110.00 10,038.10 110.00 10,031.57 110.00 10,025.03 $2,691,000 $2,691,500 110.00 10,066.11 110.00 10,059.58 110.00 10,053.04 110.00 10,046.51 110.00 10,039.98 110.00 10,033.44 110.00 10,026.91 $2,691,500 $2,692,000 110.00 10,067.98 110.00 10,061.45 110.00 10,054.92 110.00 10,048.38 110.00 10,041.85 110.00 10,035.32 110.00 10,028.78 $2,692,000 $2,692,500 110.00 10,069.86 110.00 10,063.33 110.00 10,056.79 110.00 10,050.26 110.00 10,043.73 110.00 10,037.19 110.00 10,030.66 $2,692,500 $2,693,000 110.00 10,071.73 110.00 10,065.20 110.00 10,058.67 110.00 10,052.13 110.00 10,045.60 110.00 10,039.07 110.00 10,032.53 $2,693,000 $2,693,500 110.00 10,073.61 110.00 10,067.08 110.00 10,060.54 110.00 10,054.01 110.00 10,047.48 110.00 10,040.94 110.00 10,034.41 $2,693,500 $2,694,000 110.00 10,075.48 110.00 10,068.95 110.00 10,062.42 110.00 10,055.88 110.00 10,049.35 110.00 10,042.82 110.00 10,036.28 $2,694,000 $2,694,500 110.00 10,077.36 110.00 10,070.83 110.00 10,064.29 110.00 10,057.76 110.00 10,051.23 110.00 10,044.69 110.00 10,038.16 $2,694,500 $2,695,000 110.00 10,079.23 110.00 10,072.70 110.00 10,066.17 110.00 10,059.63 110.00 10,053.10 110.00 10,046.57 110.00 10,040.03 $2,695,000 $2,695,500 110.00 10,081.11 110.00 10,074.58 110.00 10,068.04 110.00 10,061.51 110.00 10,054.98 110.00 10,048.44 110.00 10,041.91 $2,695,500 $2,696,000 110.00 10,082.98 110.00 10,076.45 110.00 10,069.92 110.00 10,063.38 110.00 10,056.85 110.00 10,050.32 110.00 10,043.78 $2,696,000 $2,696,500 110.00 10,084.86 110.00 10,078.33 110.00 10,071.79 110.00 10,065.26 110.00 10,058.73 110.00 10,052.19 110.00 10,045.66 $2,696,500 $2,697,000 110.00 10,086.73 110.00 10,080.20 110.00 10,073.67 110.00 10,067.13 110.00 10,060.60 110.00 10,054.07 110.00 10,047.53 $2,697,000 $2,697,500 110.00 10,088.61 110.00 10,082.08 110.00 10,075.54 110.00 10,069.01 110.00 10,062.48 110.00 10,055.94 110.00 10,049.41 $2,697,500 $2,698,000 110.00 10,090.48 110.00 10,083.95 110.00 10,077.42 110.00 10,070.88 110.00 10,064.35 110.00 10,057.82 110.00 10,051.28 $2,698,000 $2,698,500 110.00 10,092.36 110.00 10,085.83 110.00 10,079.29 110.00 10,072.76 110.00 10,066.23 110.00 10,059.69 110.00 10,053.16 $2,698,500 $2,699,000 110.00 10,094.23 110.00 10,087.70 110.00 10,081.17 110.00 10,074.63 110.00 10,068.10 110.00 10,061.57 110.00 10,055.03 $2,699,000 $2,699,500 110.00 10,096.11 110.00 10,089.58 110.00 10,083.04 110.00 10,076.51 110.00 10,069.98 110.00 10,063.44 110.00 10,056.91 $2,699,500 $2,700,000 110.00 10,097.98 110.00 10,091.45 110.00 10,084.92 110.00 10,078.38 110.00 10,071.85 110.00 10,065.32 110.00 10,058.78 $2,700,000 $2,700,500 110.00 10,099.86 110.00 10,093.33 110.00 10,086.79 110.00 10,080.26 110.00 10,073.73 110.00 10,067.19 110.00 10,060.66 $2,700,500 $2,701,000 110.00 10,101.73 110.00 10,095.20 110.00 10,088.67 110.00 10,082.13 110.00 10,075.60 110.00 10,069.07 110.00 10,062.53 $2,701,000 $2,701,500 110.00 10,103.61 110.00 10,097.08 110.00 10,090.54 110.00 10,084.01 110.00 10,077.48 110.00 10,070.94 110.00 10,064.41 $2,701,500 $2,702,000 110.00 10,105.48 110.00 10,098.95 110.00 10,092.42 110.00 10,085.88 110.00 10,079.35 110.00 10,072.82 110.00 10,066.28 $2,702,000 $2,702,500 110.00 10,107.36 110.00 10,100.83 110.00 10,094.29 110.00 10,087.76 110.00 10,081.23 110.00 10,074.69 110.00 10,068.16 $2,702,500 $2,703,000 110.00 10,109.23 110.00 10,102.70 110.00 10,096.17 110.00 10,089.63 110.00 10,083.10 110.00 10,076.57 110.00 10,070.03

NJEIS Family Cost Participation Table Page 56 of 12 Effective July 1, 2015

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

$2,703,000 $2,703,500 110.00 10,111.11 110.00 10,104.58 110.00 10,098.04 110.00 10,091.51 110.00 10,084.98 110.00 10,078.44 110.00 10,071.91 $2,703,500 $2,704,000 110.00 10,112.98 110.00 10,106.45 110.00 10,099.92 110.00 10,093.38 110.00 10,086.85 110.00 10,080.32 110.00 10,073.78 $2,704,000 $2,704,500 110.00 10,114.86 110.00 10,108.33 110.00 10,101.79 110.00 10,095.26 110.00 10,088.73 110.00 10,082.19 110.00 10,075.66 $2,704,500 $2,705,000 110.00 10,116.73 110.00 10,110.20 110.00 10,103.67 110.00 10,097.13 110.00 10,090.60 110.00 10,084.07 110.00 10,077.53 $2,705,000 $2,705,500 110.00 10,118.61 110.00 10,112.08 110.00 10,105.54 110.00 10,099.01 110.00 10,092.48 110.00 10,085.94 110.00 10,079.41 $2,705,500 $2,706,000 110.00 10,120.48 110.00 10,113.95 110.00 10,107.42 110.00 10,100.88 110.00 10,094.35 110.00 10,087.82 110.00 10,081.28 $2,706,000 $2,706,500 110.00 10,122.36 110.00 10,115.83 110.00 10,109.29 110.00 10,102.76 110.00 10,096.23 110.00 10,089.69 110.00 10,083.16 $2,706,500 $2,707,000 110.00 10,124.23 110.00 10,117.70 110.00 10,111.17 110.00 10,104.63 110.00 10,098.10 110.00 10,091.57 110.00 10,085.03 $2,707,000 $2,707,500 110.00 10,126.11 110.00 10,119.58 110.00 10,113.04 110.00 10,106.51 110.00 10,099.98 110.00 10,093.44 110.00 10,086.91 $2,707,500 $2,708,000 110.00 10,127.98 110.00 10,121.45 110.00 10,114.92 110.00 10,108.38 110.00 10,101.85 110.00 10,095.32 110.00 10,088.78 $2,708,000 $2,708,500 110.00 10,129.86 110.00 10,123.33 110.00 10,116.79 110.00 10,110.26 110.00 10,103.73 110.00 10,097.19 110.00 10,090.66 $2,708,500 $2,709,000 110.00 10,131.73 110.00 10,125.20 110.00 10,118.67 110.00 10,112.13 110.00 10,105.60 110.00 10,099.07 110.00 10,092.53 $2,709,000 $2,709,500 110.00 10,133.61 110.00 10,127.08 110.00 10,120.54 110.00 10,114.01 110.00 10,107.48 110.00 10,100.94 110.00 10,094.41 $2,709,500 $2,710,000 110.00 10,135.48 110.00 10,128.95 110.00 10,122.42 110.00 10,115.88 110.00 10,109.35 110.00 10,102.82 110.00 10,096.28 $2,710,000 $2,710,500 110.00 10,137.36 110.00 10,130.83 110.00 10,124.29 110.00 10,117.76 110.00 10,111.23 110.00 10,104.69 110.00 10,098.16 $2,710,500 $2,711,000 110.00 10,139.23 110.00 10,132.70 110.00 10,126.17 110.00 10,119.63 110.00 10,113.10 110.00 10,106.57 110.00 10,100.03 $2,711,000 $2,711,500 110.00 10,141.11 110.00 10,134.58 110.00 10,128.04 110.00 10,121.51 110.00 10,114.98 110.00 10,108.44 110.00 10,101.91 $2,711,500 $2,712,000 110.00 10,142.98 110.00 10,136.45 110.00 10,129.92 110.00 10,123.38 110.00 10,116.85 110.00 10,110.32 110.00 10,103.78 $2,712,000 $2,712,500 110.00 10,144.86 110.00 10,138.33 110.00 10,131.79 110.00 10,125.26 110.00 10,118.73 110.00 10,112.19 110.00 10,105.66 $2,712,500 $2,713,000 110.00 10,146.73 110.00 10,140.20 110.00 10,133.67 110.00 10,127.13 110.00 10,120.60 110.00 10,114.07 110.00 10,107.53 $2,713,000 $2,713,500 110.00 10,148.61 110.00 10,142.08 110.00 10,135.54 110.00 10,129.01 110.00 10,122.48 110.00 10,115.94 110.00 10,109.41 $2,713,500 $2,714,000 110.00 10,150.48 110.00 10,143.95 110.00 10,137.42 110.00 10,130.88 110.00 10,124.35 110.00 10,117.82 110.00 10,111.28 $2,714,000 $2,714,500 110.00 10,152.36 110.00 10,145.83 110.00 10,139.29 110.00 10,132.76 110.00 10,126.23 110.00 10,119.69 110.00 10,113.16 $2,714,500 $2,715,000 110.00 10,154.23 110.00 10,147.70 110.00 10,141.17 110.00 10,134.63 110.00 10,128.10 110.00 10,121.57 110.00 10,115.03 $2,715,000 $2,715,500 110.00 10,156.11 110.00 10,149.58 110.00 10,143.04 110.00 10,136.51 110.00 10,129.98 110.00 10,123.44 110.00 10,116.91 $2,715,500 $2,716,000 110.00 10,157.98 110.00 10,151.45 110.00 10,144.92 110.00 10,138.38 110.00 10,131.85 110.00 10,125.32 110.00 10,118.78 $2,716,000 $2,716,500 110.00 10,159.86 110.00 10,153.33 110.00 10,146.79 110.00 10,140.26 110.00 10,133.73 110.00 10,127.19 110.00 10,120.66 $2,716,500 $2,717,000 110.00 10,161.73 110.00 10,155.20 110.00 10,148.67 110.00 10,142.13 110.00 10,135.60 110.00 10,129.07 110.00 10,122.53 $2,717,000 $2,717,500 110.00 10,163.61 110.00 10,157.08 110.00 10,150.54 110.00 10,144.01 110.00 10,137.48 110.00 10,130.94 110.00 10,124.41 $2,717,500 $2,718,000 110.00 10,165.48 110.00 10,158.95 110.00 10,152.42 110.00 10,145.88 110.00 10,139.35 110.00 10,132.82 110.00 10,126.28 $2,718,000 $2,718,500 110.00 10,167.36 110.00 10,160.83 110.00 10,154.29 110.00 10,147.76 110.00 10,141.23 110.00 10,134.69 110.00 10,128.16 $2,718,500 $2,719,000 110.00 10,169.23 110.00 10,162.70 110.00 10,156.17 110.00 10,149.63 110.00 10,143.10 110.00 10,136.57 110.00 10,130.03 $2,719,000 $2,719,500 110.00 10,171.11 110.00 10,164.58 110.00 10,158.04 110.00 10,151.51 110.00 10,144.98 110.00 10,138.44 110.00 10,131.91 $2,719,500 $2,720,000 110.00 10,172.98 110.00 10,166.45 110.00 10,159.92 110.00 10,153.38 110.00 10,146.85 110.00 10,140.32 110.00 10,133.78 $2,720,000 $2,720,500 110.00 10,174.86 110.00 10,168.33 110.00 10,161.79 110.00 10,155.26 110.00 10,148.73 110.00 10,142.19 110.00 10,135.66 $2,720,500 $2,721,000 110.00 10,176.73 110.00 10,170.20 110.00 10,163.67 110.00 10,157.13 110.00 10,150.60 110.00 10,144.07 110.00 10,137.53 $2,721,000 $2,721,500 110.00 10,178.61 110.00 10,172.08 110.00 10,165.54 110.00 10,159.01 110.00 10,152.48 110.00 10,145.94 110.00 10,139.41 $2,721,500 $2,722,000 110.00 10,180.48 110.00 10,173.95 110.00 10,167.42 110.00 10,160.88 110.00 10,154.35 110.00 10,147.82 110.00 10,141.28 $2,722,000 $2,722,500 110.00 10,182.36 110.00 10,175.83 110.00 10,169.29 110.00 10,162.76 110.00 10,156.23 110.00 10,149.69 110.00 10,143.16 $2,722,500 $2,723,000 110.00 10,184.23 110.00 10,177.70 110.00 10,171.17 110.00 10,164.63 110.00 10,158.10 110.00 10,151.57 110.00 10,145.03 $2,723,000 $2,723,500 110.00 10,186.11 110.00 10,179.58 110.00 10,173.04 110.00 10,166.51 110.00 10,159.98 110.00 10,153.44 110.00 10,146.91 $2,723,500 $2,724,000 110.00 10,187.98 110.00 10,181.45 110.00 10,174.92 110.00 10,168.38 110.00 10,161.85 110.00 10,155.32 110.00 10,148.78 $2,724,000 $2,724,500 110.00 10,189.86 110.00 10,183.33 110.00 10,176.79 110.00 10,170.26 110.00 10,163.73 110.00 10,157.19 110.00 10,150.66 $2,724,500 $2,725,000 110.00 10,191.73 110.00 10,185.20 110.00 10,178.67 110.00 10,172.13 110.00 10,165.60 110.00 10,159.07 110.00 10,152.53 $2,725,000 $2,725,500 110.00 10,193.61 110.00 10,187.08 110.00 10,180.54 110.00 10,174.01 110.00 10,167.48 110.00 10,160.94 110.00 10,154.41 $2,725,500 $2,726,000 110.00 10,195.48 110.00 10,188.95 110.00 10,182.42 110.00 10,175.88 110.00 10,169.35 110.00 10,162.82 110.00 10,156.28 $2,726,000 $2,726,500 110.00 10,197.36 110.00 10,190.83 110.00 10,184.29 110.00 10,177.76 110.00 10,171.23 110.00 10,164.69 110.00 10,158.16 $2,726,500 $2,727,000 110.00 10,199.23 110.00 10,192.70 110.00 10,186.17 110.00 10,179.63 110.00 10,173.10 110.00 10,166.57 110.00 10,160.03 $2,727,000 $2,727,500 110.00 10,201.11 110.00 10,194.58 110.00 10,188.04 110.00 10,181.51 110.00 10,174.98 110.00 10,168.44 110.00 10,161.91 $2,727,500 $2,728,000 110.00 10,202.98 110.00 10,196.45 110.00 10,189.92 110.00 10,183.38 110.00 10,176.85 110.00 10,170.32 110.00 10,163.78 $2,728,000 $2,728,500 110.00 10,204.86 110.00 10,198.33 110.00 10,191.79 110.00 10,185.26 110.00 10,178.73 110.00 10,172.19 110.00 10,165.66 $2,728,500 $2,729,000 110.00 10,206.73 110.00 10,200.20 110.00 10,193.67 110.00 10,187.13 110.00 10,180.60 110.00 10,174.07 110.00 10,167.53 $2,729,000 $2,729,500 110.00 10,208.61 110.00 10,202.08 110.00 10,195.54 110.00 10,189.01 110.00 10,182.48 110.00 10,175.94 110.00 10,169.41 $2,729,500 $2,730,000 110.00 10,210.48 110.00 10,203.95 110.00 10,197.42 110.00 10,190.88 110.00 10,184.35 110.00 10,177.82 110.00 10,171.28 $2,730,000 $2,730,500 110.00 10,212.36 110.00 10,205.83 110.00 10,199.29 110.00 10,192.76 110.00 10,186.23 110.00 10,179.69 110.00 10,173.16 $2,730,500 $2,731,000 110.00 10,214.23 110.00 10,207.70 110.00 10,201.17 110.00 10,194.63 110.00 10,188.10 110.00 10,181.57 110.00 10,175.03 $2,731,000 $2,731,500 110.00 10,216.11 110.00 10,209.58 110.00 10,203.04 110.00 10,196.51 110.00 10,189.98 110.00 10,183.44 110.00 10,176.91 $2,731,500 $2,732,000 110.00 10,217.98 110.00 10,211.45 110.00 10,204.92 110.00 10,198.38 110.00 10,191.85 110.00 10,185.32 110.00 10,178.78 $2,732,000 $2,732,500 110.00 10,219.86 110.00 10,213.33 110.00 10,206.79 110.00 10,200.26 110.00 10,193.73 110.00 10,187.19 110.00 10,180.66 $2,732,500 $2,733,000 110.00 10,221.73 110.00 10,215.20 110.00 10,208.67 110.00 10,202.13 110.00 10,195.60 110.00 10,189.07 110.00 10,182.53 $2,733,000 $2,733,500 110.00 10,223.61 110.00 10,217.08 110.00 10,210.54 110.00 10,204.01 110.00 10,197.48 110.00 10,190.94 110.00 10,184.41 $2,733,500 $2,734,000 110.00 10,225.48 110.00 10,218.95 110.00 10,212.42 110.00 10,205.88 110.00 10,199.35 110.00 10,192.82 110.00 10,186.28 $2,734,000 $2,734,500 110.00 10,227.36 110.00 10,220.83 110.00 10,214.29 110.00 10,207.76 110.00 10,201.23 110.00 10,194.69 110.00 10,188.16 $2,734,500 $2,735,000 110.00 10,229.23 110.00 10,222.70 110.00 10,216.17 110.00 10,209.63 110.00 10,203.10 110.00 10,196.57 110.00 10,190.03 $2,735,000 $2,735,500 110.00 10,231.11 110.00 10,224.58 110.00 10,218.04 110.00 10,211.51 110.00 10,204.98 110.00 10,198.44 110.00 10,191.91 $2,735,500 $2,736,000 110.00 10,232.98 110.00 10,226.45 110.00 10,219.92 110.00 10,213.38 110.00 10,206.85 110.00 10,200.32 110.00 10,193.78 $2,736,000 $2,736,500 110.00 10,234.86 110.00 10,228.33 110.00 10,221.79 110.00 10,215.26 110.00 10,208.73 110.00 10,202.19 110.00 10,195.66 $2,736,500 $2,737,000 110.00 10,236.73 110.00 10,230.20 110.00 10,223.67 110.00 10,217.13 110.00 10,210.60 110.00 10,204.07 110.00 10,197.53 $2,737,000 $2,737,500 110.00 10,238.61 110.00 10,232.08 110.00 10,225.54 110.00 10,219.01 110.00 10,212.48 110.00 10,205.94 110.00 10,199.41 $2,737,500 $2,738,000 110.00 10,240.48 110.00 10,233.95 110.00 10,227.42 110.00 10,220.88 110.00 10,214.35 110.00 10,207.82 110.00 10,201.28 $2,738,000 $2,738,500 110.00 10,242.36 110.00 10,235.83 110.00 10,229.29 110.00 10,222.76 110.00 10,216.23 110.00 10,209.69 110.00 10,203.16 $2,738,500 $2,739,000 110.00 10,244.23 110.00 10,237.70 110.00 10,231.17 110.00 10,224.63 110.00 10,218.10 110.00 10,211.57 110.00 10,205.03 $2,739,000 $2,739,500 110.00 10,246.11 110.00 10,239.58 110.00 10,233.04 110.00 10,226.51 110.00 10,219.98 110.00 10,213.44 110.00 10,206.91 $2,739,500 $2,740,000 110.00 10,247.98 110.00 10,241.45 110.00 10,234.92 110.00 10,228.38 110.00 10,221.85 110.00 10,215.32 110.00 10,208.78 $2,740,000 $2,740,500 110.00 10,249.86 110.00 10,243.33 110.00 10,236.79 110.00 10,230.26 110.00 10,223.73 110.00 10,217.19 110.00 10,210.66 $2,740,500 $2,741,000 110.00 10,251.73 110.00 10,245.20 110.00 10,238.67 110.00 10,232.13 110.00 10,225.60 110.00 10,219.07 110.00 10,212.53 $2,741,000 $2,741,500 110.00 10,253.61 110.00 10,247.08 110.00 10,240.54 110.00 10,234.01 110.00 10,227.48 110.00 10,220.94 110.00 10,214.41 $2,741,500 $2,742,000 110.00 10,255.48 110.00 10,248.95 110.00 10,242.42 110.00 10,235.88 110.00 10,229.35 110.00 10,222.82 110.00 10,216.28 $2,742,000 $2,742,500 110.00 10,257.36 110.00 10,250.83 110.00 10,244.29 110.00 10,237.76 110.00 10,231.23 110.00 10,224.69 110.00 10,218.16 $2,742,500 $2,743,000 110.00 10,259.23 110.00 10,252.70 110.00 10,246.17 110.00 10,239.63 110.00 10,233.10 110.00 10,226.57 110.00 10,220.03 $2,743,000 $2,743,500 110.00 10,261.11 110.00 10,254.58 110.00 10,248.04 110.00 10,241.51 110.00 10,234.98 110.00 10,228.44 110.00 10,221.91 $2,743,500 $2,744,000 110.00 10,262.98 110.00 10,256.45 110.00 10,249.92 110.00 10,243.38 110.00 10,236.85 110.00 10,230.32 110.00 10,223.78 $2,744,000 $2,744,500 110.00 10,264.86 110.00 10,258.33 110.00 10,251.79 110.00 10,245.26 110.00 10,238.73 110.00 10,232.19 110.00 10,225.66 $2,744,500 $2,745,000 110.00 10,266.73 110.00 10,260.20 110.00 10,253.67 110.00 10,247.13 110.00 10,240.60 110.00 10,234.07 110.00 10,227.53 $2,745,000 $2,745,500 110.00 10,268.61 110.00 10,262.08 110.00 10,255.54 110.00 10,249.01 110.00 10,242.48 110.00 10,235.94 110.00 10,229.41 $2,745,500 $2,746,000 110.00 10,270.48 110.00 10,263.95 110.00 10,257.42 110.00 10,250.88 110.00 10,244.35 110.00 10,237.82 110.00 10,231.28 $2,746,000 $2,746,500 110.00 10,272.36 110.00 10,265.83 110.00 10,259.29 110.00 10,252.76 110.00 10,246.23 110.00 10,239.69 110.00 10,233.16 $2,746,500 $2,747,000 110.00 10,274.23 110.00 10,267.70 110.00 10,261.17 110.00 10,254.63 110.00 10,248.10 110.00 10,241.57 110.00 10,235.03 $2,747,000 $2,747,500 110.00 10,276.11 110.00 10,269.58 110.00 10,263.04 110.00 10,256.51 110.00 10,249.98 110.00 10,243.44 110.00 10,236.91 $2,747,500 $2,748,000 110.00 10,277.98 110.00 10,271.45 110.00 10,264.92 110.00 10,258.38 110.00 10,251.85 110.00 10,245.32 110.00 10,238.78 $2,748,000 $2,748,500 110.00 10,279.86 110.00 10,273.33 110.00 10,266.79 110.00 10,260.26 110.00 10,253.73 110.00 10,247.19 110.00 10,240.66 $2,748,500 $2,749,000 110.00 10,281.73 110.00 10,275.20 110.00 10,268.67 110.00 10,262.13 110.00 10,255.60 110.00 10,249.07 110.00 10,242.53 $2,749,000 $2,749,500 110.00 10,283.61 110.00 10,277.08 110.00 10,270.54 110.00 10,264.01 110.00 10,257.48 110.00 10,250.94 110.00 10,244.41 $2,749,500 $2,750,000 110.00 10,285.48 110.00 10,278.95 110.00 10,272.42 110.00 10,265.88 110.00 10,259.35 110.00 10,252.82 110.00 10,246.28 $2,750,000 $2,750,500 110.00 10,287.36 110.00 10,280.83 110.00 10,274.29 110.00 10,267.76 110.00 10,261.23 110.00 10,254.69 110.00 10,248.16 $2,750,500 $2,751,000 110.00 10,289.23 110.00 10,282.70 110.00 10,276.17 110.00 10,269.63 110.00 10,263.10 110.00 10,256.57 110.00 10,250.03 $2,751,000 $2,751,500 110.00 10,291.11 110.00 10,284.58 110.00 10,278.04 110.00 10,271.51 110.00 10,264.98 110.00 10,258.44 110.00 10,251.91 $2,751,500 $2,752,000 110.00 10,292.98 110.00 10,286.45 110.00 10,279.92 110.00 10,273.38 110.00 10,266.85 110.00 10,260.32 110.00 10,253.78 $2,752,000 $2,752,500 110.00 10,294.86 110.00 10,288.33 110.00 10,281.79 110.00 10,275.26 110.00 10,268.73 110.00 10,262.19 110.00 10,255.66 $2,752,500 $2,753,000 110.00 10,296.73 110.00 10,290.20 110.00 10,283.67 110.00 10,277.13 110.00 10,270.60 110.00 10,264.07 110.00 10,257.53 $2,753,000 $2,753,500 110.00 10,298.61 110.00 10,292.08 110.00 10,285.54 110.00 10,279.01 110.00 10,272.48 110.00 10,265.94 110.00 10,259.41 $2,753,500 $2,754,000 110.00 10,300.48 110.00 10,293.95 110.00 10,287.42 110.00 10,280.88 110.00 10,274.35 110.00 10,267.82 110.00 10,261.28

NJEIS Family Cost Participation Table Page 57 of 12 Effective July 1, 2015

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

$2,754,000 $2,754,500 110.00 10,302.36 110.00 10,295.83 110.00 10,289.29 110.00 10,282.76 110.00 10,276.23 110.00 10,269.69 110.00 10,263.16 $2,754,500 $2,755,000 110.00 10,304.23 110.00 10,297.70 110.00 10,291.17 110.00 10,284.63 110.00 10,278.10 110.00 10,271.57 110.00 10,265.03 $2,755,000 $2,755,500 110.00 10,306.11 110.00 10,299.58 110.00 10,293.04 110.00 10,286.51 110.00 10,279.98 110.00 10,273.44 110.00 10,266.91 $2,755,500 $2,756,000 110.00 10,307.98 110.00 10,301.45 110.00 10,294.92 110.00 10,288.38 110.00 10,281.85 110.00 10,275.32 110.00 10,268.78 $2,756,000 $2,756,500 110.00 10,309.86 110.00 10,303.33 110.00 10,296.79 110.00 10,290.26 110.00 10,283.73 110.00 10,277.19 110.00 10,270.66 $2,756,500 $2,757,000 110.00 10,311.73 110.00 10,305.20 110.00 10,298.67 110.00 10,292.13 110.00 10,285.60 110.00 10,279.07 110.00 10,272.53 $2,757,000 $2,757,500 110.00 10,313.61 110.00 10,307.08 110.00 10,300.54 110.00 10,294.01 110.00 10,287.48 110.00 10,280.94 110.00 10,274.41 $2,757,500 $2,758,000 110.00 10,315.48 110.00 10,308.95 110.00 10,302.42 110.00 10,295.88 110.00 10,289.35 110.00 10,282.82 110.00 10,276.28 $2,758,000 $2,758,500 110.00 10,317.36 110.00 10,310.83 110.00 10,304.29 110.00 10,297.76 110.00 10,291.23 110.00 10,284.69 110.00 10,278.16 $2,758,500 $2,759,000 110.00 10,319.23 110.00 10,312.70 110.00 10,306.17 110.00 10,299.63 110.00 10,293.10 110.00 10,286.57 110.00 10,280.03 $2,759,000 $2,759,500 110.00 10,321.11 110.00 10,314.58 110.00 10,308.04 110.00 10,301.51 110.00 10,294.98 110.00 10,288.44 110.00 10,281.91 $2,759,500 $2,760,000 110.00 10,322.98 110.00 10,316.45 110.00 10,309.92 110.00 10,303.38 110.00 10,296.85 110.00 10,290.32 110.00 10,283.78 $2,760,000 $2,760,500 110.00 10,324.86 110.00 10,318.33 110.00 10,311.79 110.00 10,305.26 110.00 10,298.73 110.00 10,292.19 110.00 10,285.66 $2,760,500 $2,761,000 110.00 10,326.73 110.00 10,320.20 110.00 10,313.67 110.00 10,307.13 110.00 10,300.60 110.00 10,294.07 110.00 10,287.53 $2,761,000 $2,761,500 110.00 10,328.61 110.00 10,322.08 110.00 10,315.54 110.00 10,309.01 110.00 10,302.48 110.00 10,295.94 110.00 10,289.41 $2,761,500 $2,762,000 110.00 10,330.48 110.00 10,323.95 110.00 10,317.42 110.00 10,310.88 110.00 10,304.35 110.00 10,297.82 110.00 10,291.28 $2,762,000 $2,762,500 110.00 10,332.36 110.00 10,325.83 110.00 10,319.29 110.00 10,312.76 110.00 10,306.23 110.00 10,299.69 110.00 10,293.16 $2,762,500 $2,763,000 110.00 10,334.23 110.00 10,327.70 110.00 10,321.17 110.00 10,314.63 110.00 10,308.10 110.00 10,301.57 110.00 10,295.03 $2,763,000 $2,763,500 110.00 10,336.11 110.00 10,329.58 110.00 10,323.04 110.00 10,316.51 110.00 10,309.98 110.00 10,303.44 110.00 10,296.91 $2,763,500 $2,764,000 110.00 10,337.98 110.00 10,331.45 110.00 10,324.92 110.00 10,318.38 110.00 10,311.85 110.00 10,305.32 110.00 10,298.78 $2,764,000 $2,764,500 110.00 10,339.86 110.00 10,333.33 110.00 10,326.79 110.00 10,320.26 110.00 10,313.73 110.00 10,307.19 110.00 10,300.66 $2,764,500 $2,765,000 110.00 10,341.73 110.00 10,335.20 110.00 10,328.67 110.00 10,322.13 110.00 10,315.60 110.00 10,309.07 110.00 10,302.53 $2,765,000 $2,765,500 110.00 10,343.61 110.00 10,337.08 110.00 10,330.54 110.00 10,324.01 110.00 10,317.48 110.00 10,310.94 110.00 10,304.41 $2,765,500 $2,766,000 110.00 10,345.48 110.00 10,338.95 110.00 10,332.42 110.00 10,325.88 110.00 10,319.35 110.00 10,312.82 110.00 10,306.28 $2,766,000 $2,766,500 110.00 10,347.36 110.00 10,340.83 110.00 10,334.29 110.00 10,327.76 110.00 10,321.23 110.00 10,314.69 110.00 10,308.16 $2,766,500 $2,767,000 110.00 10,349.23 110.00 10,342.70 110.00 10,336.17 110.00 10,329.63 110.00 10,323.10 110.00 10,316.57 110.00 10,310.03 $2,767,000 $2,767,500 110.00 10,351.11 110.00 10,344.58 110.00 10,338.04 110.00 10,331.51 110.00 10,324.98 110.00 10,318.44 110.00 10,311.91 $2,767,500 $2,768,000 110.00 10,352.98 110.00 10,346.45 110.00 10,339.92 110.00 10,333.38 110.00 10,326.85 110.00 10,320.32 110.00 10,313.78 $2,768,000 $2,768,500 110.00 10,354.86 110.00 10,348.33 110.00 10,341.79 110.00 10,335.26 110.00 10,328.73 110.00 10,322.19 110.00 10,315.66 $2,768,500 $2,769,000 110.00 10,356.73 110.00 10,350.20 110.00 10,343.67 110.00 10,337.13 110.00 10,330.60 110.00 10,324.07 110.00 10,317.53 $2,769,000 $2,769,500 110.00 10,358.61 110.00 10,352.08 110.00 10,345.54 110.00 10,339.01 110.00 10,332.48 110.00 10,325.94 110.00 10,319.41 $2,769,500 $2,770,000 110.00 10,360.48 110.00 10,353.95 110.00 10,347.42 110.00 10,340.88 110.00 10,334.35 110.00 10,327.82 110.00 10,321.28 $2,770,000 $2,770,500 110.00 10,362.36 110.00 10,355.83 110.00 10,349.29 110.00 10,342.76 110.00 10,336.23 110.00 10,329.69 110.00 10,323.16 $2,770,500 $2,771,000 110.00 10,364.23 110.00 10,357.70 110.00 10,351.17 110.00 10,344.63 110.00 10,338.10 110.00 10,331.57 110.00 10,325.03 $2,771,000 $2,771,500 110.00 10,366.11 110.00 10,359.58 110.00 10,353.04 110.00 10,346.51 110.00 10,339.98 110.00 10,333.44 110.00 10,326.91 $2,771,500 $2,772,000 110.00 10,367.98 110.00 10,361.45 110.00 10,354.92 110.00 10,348.38 110.00 10,341.85 110.00 10,335.32 110.00 10,328.78 $2,772,000 $2,772,500 110.00 10,369.86 110.00 10,363.33 110.00 10,356.79 110.00 10,350.26 110.00 10,343.73 110.00 10,337.19 110.00 10,330.66 $2,772,500 $2,773,000 110.00 10,371.73 110.00 10,365.20 110.00 10,358.67 110.00 10,352.13 110.00 10,345.60 110.00 10,339.07 110.00 10,332.53 $2,773,000 $2,773,500 110.00 10,373.61 110.00 10,367.08 110.00 10,360.54 110.00 10,354.01 110.00 10,347.48 110.00 10,340.94 110.00 10,334.41 $2,773,500 $2,774,000 110.00 10,375.48 110.00 10,368.95 110.00 10,362.42 110.00 10,355.88 110.00 10,349.35 110.00 10,342.82 110.00 10,336.28 $2,774,000 $2,774,500 110.00 10,377.36 110.00 10,370.83 110.00 10,364.29 110.00 10,357.76 110.00 10,351.23 110.00 10,344.69 110.00 10,338.16 $2,774,500 $2,775,000 110.00 10,379.23 110.00 10,372.70 110.00 10,366.17 110.00 10,359.63 110.00 10,353.10 110.00 10,346.57 110.00 10,340.03 $2,775,000 $2,775,500 110.00 10,381.11 110.00 10,374.58 110.00 10,368.04 110.00 10,361.51 110.00 10,354.98 110.00 10,348.44 110.00 10,341.91 $2,775,500 $2,776,000 110.00 10,382.98 110.00 10,376.45 110.00 10,369.92 110.00 10,363.38 110.00 10,356.85 110.00 10,350.32 110.00 10,343.78 $2,776,000 $2,776,500 110.00 10,384.86 110.00 10,378.33 110.00 10,371.79 110.00 10,365.26 110.00 10,358.73 110.00 10,352.19 110.00 10,345.66 $2,776,500 $2,777,000 110.00 10,386.73 110.00 10,380.20 110.00 10,373.67 110.00 10,367.13 110.00 10,360.60 110.00 10,354.07 110.00 10,347.53 $2,777,000 $2,777,500 110.00 10,388.61 110.00 10,382.08 110.00 10,375.54 110.00 10,369.01 110.00 10,362.48 110.00 10,355.94 110.00 10,349.41 $2,777,500 $2,778,000 110.00 10,390.48 110.00 10,383.95 110.00 10,377.42 110.00 10,370.88 110.00 10,364.35 110.00 10,357.82 110.00 10,351.28 $2,778,000 $2,778,500 110.00 10,392.36 110.00 10,385.83 110.00 10,379.29 110.00 10,372.76 110.00 10,366.23 110.00 10,359.69 110.00 10,353.16 $2,778,500 $2,779,000 110.00 10,394.23 110.00 10,387.70 110.00 10,381.17 110.00 10,374.63 110.00 10,368.10 110.00 10,361.57 110.00 10,355.03 $2,779,000 $2,779,500 110.00 10,396.11 110.00 10,389.58 110.00 10,383.04 110.00 10,376.51 110.00 10,369.98 110.00 10,363.44 110.00 10,356.91 $2,779,500 $2,780,000 110.00 10,397.98 110.00 10,391.45 110.00 10,384.92 110.00 10,378.38 110.00 10,371.85 110.00 10,365.32 110.00 10,358.78 $2,780,000 $2,780,500 110.00 10,399.86 110.00 10,393.33 110.00 10,386.79 110.00 10,380.26 110.00 10,373.73 110.00 10,367.19 110.00 10,360.66 $2,780,500 $2,781,000 110.00 10,401.73 110.00 10,395.20 110.00 10,388.67 110.00 10,382.13 110.00 10,375.60 110.00 10,369.07 110.00 10,362.53 $2,781,000 $2,781,500 110.00 10,403.61 110.00 10,397.08 110.00 10,390.54 110.00 10,384.01 110.00 10,377.48 110.00 10,370.94 110.00 10,364.41 $2,781,500 $2,782,000 110.00 10,405.48 110.00 10,398.95 110.00 10,392.42 110.00 10,385.88 110.00 10,379.35 110.00 10,372.82 110.00 10,366.28 $2,782,000 $2,782,500 110.00 10,407.36 110.00 10,400.83 110.00 10,394.29 110.00 10,387.76 110.00 10,381.23 110.00 10,374.69 110.00 10,368.16 $2,782,500 $2,783,000 110.00 10,409.23 110.00 10,402.70 110.00 10,396.17 110.00 10,389.63 110.00 10,383.10 110.00 10,376.57 110.00 10,370.03 $2,783,000 $2,783,500 110.00 10,411.11 110.00 10,404.58 110.00 10,398.04 110.00 10,391.51 110.00 10,384.98 110.00 10,378.44 110.00 10,371.91 $2,783,500 $2,784,000 110.00 10,412.98 110.00 10,406.45 110.00 10,399.92 110.00 10,393.38 110.00 10,386.85 110.00 10,380.32 110.00 10,373.78 $2,784,000 $2,784,500 110.00 10,414.86 110.00 10,408.33 110.00 10,401.79 110.00 10,395.26 110.00 10,388.73 110.00 10,382.19 110.00 10,375.66 $2,784,500 $2,785,000 110.00 10,416.73 110.00 10,410.20 110.00 10,403.67 110.00 10,397.13 110.00 10,390.60 110.00 10,384.07 110.00 10,377.53 $2,785,000 $2,785,500 110.00 10,418.61 110.00 10,412.08 110.00 10,405.54 110.00 10,399.01 110.00 10,392.48 110.00 10,385.94 110.00 10,379.41 $2,785,500 $2,786,000 110.00 10,420.48 110.00 10,413.95 110.00 10,407.42 110.00 10,400.88 110.00 10,394.35 110.00 10,387.82 110.00 10,381.28 $2,786,000 $2,786,500 110.00 10,422.36 110.00 10,415.83 110.00 10,409.29 110.00 10,402.76 110.00 10,396.23 110.00 10,389.69 110.00 10,383.16 $2,786,500 $2,787,000 110.00 10,424.23 110.00 10,417.70 110.00 10,411.17 110.00 10,404.63 110.00 10,398.10 110.00 10,391.57 110.00 10,385.03 $2,787,000 $2,787,500 110.00 10,426.11 110.00 10,419.58 110.00 10,413.04 110.00 10,406.51 110.00 10,399.98 110.00 10,393.44 110.00 10,386.91 $2,787,500 $2,788,000 110.00 10,427.98 110.00 10,421.45 110.00 10,414.92 110.00 10,408.38 110.00 10,401.85 110.00 10,395.32 110.00 10,388.78 $2,788,000 $2,788,500 110.00 10,429.86 110.00 10,423.33 110.00 10,416.79 110.00 10,410.26 110.00 10,403.73 110.00 10,397.19 110.00 10,390.66 $2,788,500 $2,789,000 110.00 10,431.73 110.00 10,425.20 110.00 10,418.67 110.00 10,412.13 110.00 10,405.60 110.00 10,399.07 110.00 10,392.53 $2,789,000 $2,789,500 110.00 10,433.61 110.00 10,427.08 110.00 10,420.54 110.00 10,414.01 110.00 10,407.48 110.00 10,400.94 110.00 10,394.41 $2,789,500 $2,790,000 110.00 10,435.48 110.00 10,428.95 110.00 10,422.42 110.00 10,415.88 110.00 10,409.35 110.00 10,402.82 110.00 10,396.28 $2,790,000 $2,790,500 110.00 10,437.36 110.00 10,430.83 110.00 10,424.29 110.00 10,417.76 110.00 10,411.23 110.00 10,404.69 110.00 10,398.16 $2,790,500 $2,791,000 110.00 10,439.23 110.00 10,432.70 110.00 10,426.17 110.00 10,419.63 110.00 10,413.10 110.00 10,406.57 110.00 10,400.03 $2,791,000 $2,791,500 110.00 10,441.11 110.00 10,434.58 110.00 10,428.04 110.00 10,421.51 110.00 10,414.98 110.00 10,408.44 110.00 10,401.91 $2,791,500 $2,792,000 110.00 10,442.98 110.00 10,436.45 110.00 10,429.92 110.00 10,423.38 110.00 10,416.85 110.00 10,410.32 110.00 10,403.78 $2,792,000 $2,792,500 110.00 10,444.86 110.00 10,438.33 110.00 10,431.79 110.00 10,425.26 110.00 10,418.73 110.00 10,412.19 110.00 10,405.66 $2,792,500 $2,793,000 110.00 10,446.73 110.00 10,440.20 110.00 10,433.67 110.00 10,427.13 110.00 10,420.60 110.00 10,414.07 110.00 10,407.53 $2,793,000 $2,793,500 110.00 10,448.61 110.00 10,442.08 110.00 10,435.54 110.00 10,429.01 110.00 10,422.48 110.00 10,415.94 110.00 10,409.41 $2,793,500 $2,794,000 110.00 10,450.48 110.00 10,443.95 110.00 10,437.42 110.00 10,430.88 110.00 10,424.35 110.00 10,417.82 110.00 10,411.28 $2,794,000 $2,794,500 110.00 10,452.36 110.00 10,445.83 110.00 10,439.29 110.00 10,432.76 110.00 10,426.23 110.00 10,419.69 110.00 10,413.16 $2,794,500 $2,795,000 110.00 10,454.23 110.00 10,447.70 110.00 10,441.17 110.00 10,434.63 110.00 10,428.10 110.00 10,421.57 110.00 10,415.03 $2,795,000 $2,795,500 110.00 10,456.11 110.00 10,449.58 110.00 10,443.04 110.00 10,436.51 110.00 10,429.98 110.00 10,423.44 110.00 10,416.91 $2,795,500 $2,796,000 110.00 10,457.98 110.00 10,451.45 110.00 10,444.92 110.00 10,438.38 110.00 10,431.85 110.00 10,425.32 110.00 10,418.78 $2,796,000 $2,796,500 110.00 10,459.86 110.00 10,453.33 110.00 10,446.79 110.00 10,440.26 110.00 10,433.73 110.00 10,427.19 110.00 10,420.66 $2,796,500 $2,797,000 110.00 10,461.73 110.00 10,455.20 110.00 10,448.67 110.00 10,442.13 110.00 10,435.60 110.00 10,429.07 110.00 10,422.53 $2,797,000 $2,797,500 110.00 10,463.61 110.00 10,457.08 110.00 10,450.54 110.00 10,444.01 110.00 10,437.48 110.00 10,430.94 110.00 10,424.41 $2,797,500 $2,798,000 110.00 10,465.48 110.00 10,458.95 110.00 10,452.42 110.00 10,445.88 110.00 10,439.35 110.00 10,432.82 110.00 10,426.28 $2,798,000 $2,798,500 110.00 10,467.36 110.00 10,460.83 110.00 10,454.29 110.00 10,447.76 110.00 10,441.23 110.00 10,434.69 110.00 10,428.16 $2,798,500 $2,799,000 110.00 10,469.23 110.00 10,462.70 110.00 10,456.17 110.00 10,449.63 110.00 10,443.10 110.00 10,436.57 110.00 10,430.03 $2,799,000 $2,799,500 110.00 10,471.11 110.00 10,464.58 110.00 10,458.04 110.00 10,451.51 110.00 10,444.98 110.00 10,438.44 110.00 10,431.91 $2,799,500 $2,800,000 110.00 10,472.98 110.00 10,466.45 110.00 10,459.92 110.00 10,453.38 110.00 10,446.85 110.00 10,440.32 110.00 10,433.78 $2,800,000 $2,800,500 110.00 10,474.86 110.00 10,468.33 110.00 10,461.79 110.00 10,455.26 110.00 10,448.73 110.00 10,442.19 110.00 10,435.66 $2,800,500 $2,801,000 110.00 10,476.73 110.00 10,470.20 110.00 10,463.67 110.00 10,457.13 110.00 10,450.60 110.00 10,444.07 110.00 10,437.53 $2,801,000 $2,801,500 110.00 10,478.61 110.00 10,472.08 110.00 10,465.54 110.00 10,459.01 110.00 10,452.48 110.00 10,445.94 110.00 10,439.41 $2,801,500 $2,802,000 110.00 10,480.48 110.00 10,473.95 110.00 10,467.42 110.00 10,460.88 110.00 10,454.35 110.00 10,447.82 110.00 10,441.28 $2,802,000 $2,802,500 110.00 10,482.36 110.00 10,475.83 110.00 10,469.29 110.00 10,462.76 110.00 10,456.23 110.00 10,449.69 110.00 10,443.16 $2,802,500 $2,803,000 110.00 10,484.23 110.00 10,477.70 110.00 10,471.17 110.00 10,464.63 110.00 10,458.10 110.00 10,451.57 110.00 10,445.03 $2,803,000 $2,803,500 110.00 10,486.11 110.00 10,479.58 110.00 10,473.04 110.00 10,466.51 110.00 10,459.98 110.00 10,453.44 110.00 10,446.91 $2,803,500 $2,804,000 110.00 10,487.98 110.00 10,481.45 110.00 10,474.92 110.00 10,468.38 110.00 10,461.85 110.00 10,455.32 110.00 10,448.78 $2,804,000 $2,804,500 110.00 10,489.86 110.00 10,483.33 110.00 10,476.79 110.00 10,470.26 110.00 10,463.73 110.00 10,457.19 110.00 10,450.66 $2,804,500 $2,805,000 110.00 10,491.73 110.00 10,485.20 110.00 10,478.67 110.00 10,472.13 110.00 10,465.60 110.00 10,459.07 110.00 10,452.53

NJEIS Family Cost Participation Table Page 58 of 12 Effective July 1, 2015

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

$2,805,000 $2,805,500 110.00 10,493.61 110.00 10,487.08 110.00 10,480.54 110.00 10,474.01 110.00 10,467.48 110.00 10,460.94 110.00 10,454.41 $2,805,500 $2,806,000 110.00 10,495.48 110.00 10,488.95 110.00 10,482.42 110.00 10,475.88 110.00 10,469.35 110.00 10,462.82 110.00 10,456.28 $2,806,000 $2,806,500 110.00 10,497.36 110.00 10,490.83 110.00 10,484.29 110.00 10,477.76 110.00 10,471.23 110.00 10,464.69 110.00 10,458.16 $2,806,500 $2,807,000 110.00 10,499.23 110.00 10,492.70 110.00 10,486.17 110.00 10,479.63 110.00 10,473.10 110.00 10,466.57 110.00 10,460.03 $2,807,000 $2,807,500 110.00 10,501.11 110.00 10,494.58 110.00 10,488.04 110.00 10,481.51 110.00 10,474.98 110.00 10,468.44 110.00 10,461.91 $2,807,500 $2,808,000 110.00 10,502.98 110.00 10,496.45 110.00 10,489.92 110.00 10,483.38 110.00 10,476.85 110.00 10,470.32 110.00 10,463.78 $2,808,000 $2,808,500 110.00 10,504.86 110.00 10,498.33 110.00 10,491.79 110.00 10,485.26 110.00 10,478.73 110.00 10,472.19 110.00 10,465.66 $2,808,500 $2,809,000 110.00 10,506.73 110.00 10,500.20 110.00 10,493.67 110.00 10,487.13 110.00 10,480.60 110.00 10,474.07 110.00 10,467.53 $2,809,000 $2,809,500 110.00 10,508.61 110.00 10,502.08 110.00 10,495.54 110.00 10,489.01 110.00 10,482.48 110.00 10,475.94 110.00 10,469.41 $2,809,500 $2,810,000 110.00 10,510.48 110.00 10,503.95 110.00 10,497.42 110.00 10,490.88 110.00 10,484.35 110.00 10,477.82 110.00 10,471.28 $2,810,000 $2,810,500 110.00 10,512.36 110.00 10,505.83 110.00 10,499.29 110.00 10,492.76 110.00 10,486.23 110.00 10,479.69 110.00 10,473.16 $2,810,500 $2,811,000 110.00 10,514.23 110.00 10,507.70 110.00 10,501.17 110.00 10,494.63 110.00 10,488.10 110.00 10,481.57 110.00 10,475.03 $2,811,000 $2,811,500 110.00 10,516.11 110.00 10,509.58 110.00 10,503.04 110.00 10,496.51 110.00 10,489.98 110.00 10,483.44 110.00 10,476.91 $2,811,500 $2,812,000 110.00 10,517.98 110.00 10,511.45 110.00 10,504.92 110.00 10,498.38 110.00 10,491.85 110.00 10,485.32 110.00 10,478.78 $2,812,000 $2,812,500 110.00 10,519.86 110.00 10,513.33 110.00 10,506.79 110.00 10,500.26 110.00 10,493.73 110.00 10,487.19 110.00 10,480.66 $2,812,500 $2,813,000 110.00 10,521.73 110.00 10,515.20 110.00 10,508.67 110.00 10,502.13 110.00 10,495.60 110.00 10,489.07 110.00 10,482.53 $2,813,000 $2,813,500 110.00 10,523.61 110.00 10,517.08 110.00 10,510.54 110.00 10,504.01 110.00 10,497.48 110.00 10,490.94 110.00 10,484.41 $2,813,500 $2,814,000 110.00 10,525.48 110.00 10,518.95 110.00 10,512.42 110.00 10,505.88 110.00 10,499.35 110.00 10,492.82 110.00 10,486.28 $2,814,000 $2,814,500 110.00 10,527.36 110.00 10,520.83 110.00 10,514.29 110.00 10,507.76 110.00 10,501.23 110.00 10,494.69 110.00 10,488.16 $2,814,500 $2,815,000 110.00 10,529.23 110.00 10,522.70 110.00 10,516.17 110.00 10,509.63 110.00 10,503.10 110.00 10,496.57 110.00 10,490.03 $2,815,000 $2,815,500 110.00 10,531.11 110.00 10,524.58 110.00 10,518.04 110.00 10,511.51 110.00 10,504.98 110.00 10,498.44 110.00 10,491.91 $2,815,500 $2,816,000 110.00 10,532.98 110.00 10,526.45 110.00 10,519.92 110.00 10,513.38 110.00 10,506.85 110.00 10,500.32 110.00 10,493.78 $2,816,000 $2,816,500 110.00 10,534.86 110.00 10,528.33 110.00 10,521.79 110.00 10,515.26 110.00 10,508.73 110.00 10,502.19 110.00 10,495.66 $2,816,500 $2,817,000 110.00 10,536.73 110.00 10,530.20 110.00 10,523.67 110.00 10,517.13 110.00 10,510.60 110.00 10,504.07 110.00 10,497.53 $2,817,000 $2,817,500 110.00 10,538.61 110.00 10,532.08 110.00 10,525.54 110.00 10,519.01 110.00 10,512.48 110.00 10,505.94 110.00 10,499.41 $2,817,500 $2,818,000 110.00 10,540.48 110.00 10,533.95 110.00 10,527.42 110.00 10,520.88 110.00 10,514.35 110.00 10,507.82 110.00 10,501.28 $2,818,000 $2,818,500 110.00 10,542.36 110.00 10,535.83 110.00 10,529.29 110.00 10,522.76 110.00 10,516.23 110.00 10,509.69 110.00 10,503.16 $2,818,500 $2,819,000 110.00 10,544.23 110.00 10,537.70 110.00 10,531.17 110.00 10,524.63 110.00 10,518.10 110.00 10,511.57 110.00 10,505.03 $2,819,000 $2,819,500 110.00 10,546.11 110.00 10,539.58 110.00 10,533.04 110.00 10,526.51 110.00 10,519.98 110.00 10,513.44 110.00 10,506.91 $2,819,500 $2,820,000 110.00 10,547.98 110.00 10,541.45 110.00 10,534.92 110.00 10,528.38 110.00 10,521.85 110.00 10,515.32 110.00 10,508.78 $2,820,000 $2,820,500 110.00 10,549.86 110.00 10,543.33 110.00 10,536.79 110.00 10,530.26 110.00 10,523.73 110.00 10,517.19 110.00 10,510.66 $2,820,500 $2,821,000 110.00 10,551.73 110.00 10,545.20 110.00 10,538.67 110.00 10,532.13 110.00 10,525.60 110.00 10,519.07 110.00 10,512.53 $2,821,000 $2,821,500 110.00 10,553.61 110.00 10,547.08 110.00 10,540.54 110.00 10,534.01 110.00 10,527.48 110.00 10,520.94 110.00 10,514.41 $2,821,500 $2,822,000 110.00 10,555.48 110.00 10,548.95 110.00 10,542.42 110.00 10,535.88 110.00 10,529.35 110.00 10,522.82 110.00 10,516.28 $2,822,000 $2,822,500 110.00 10,557.36 110.00 10,550.83 110.00 10,544.29 110.00 10,537.76 110.00 10,531.23 110.00 10,524.69 110.00 10,518.16 $2,822,500 $2,823,000 110.00 10,559.23 110.00 10,552.70 110.00 10,546.17 110.00 10,539.63 110.00 10,533.10 110.00 10,526.57 110.00 10,520.03 $2,823,000 $2,823,500 110.00 10,561.11 110.00 10,554.58 110.00 10,548.04 110.00 10,541.51 110.00 10,534.98 110.00 10,528.44 110.00 10,521.91 $2,823,500 $2,824,000 110.00 10,562.98 110.00 10,556.45 110.00 10,549.92 110.00 10,543.38 110.00 10,536.85 110.00 10,530.32 110.00 10,523.78 $2,824,000 $2,824,500 110.00 10,564.86 110.00 10,558.33 110.00 10,551.79 110.00 10,545.26 110.00 10,538.73 110.00 10,532.19 110.00 10,525.66 $2,824,500 $2,825,000 110.00 10,566.73 110.00 10,560.20 110.00 10,553.67 110.00 10,547.13 110.00 10,540.60 110.00 10,534.07 110.00 10,527.53 $2,825,000 $2,825,500 110.00 10,568.61 110.00 10,562.08 110.00 10,555.54 110.00 10,549.01 110.00 10,542.48 110.00 10,535.94 110.00 10,529.41 $2,825,500 $2,826,000 110.00 10,570.48 110.00 10,563.95 110.00 10,557.42 110.00 10,550.88 110.00 10,544.35 110.00 10,537.82 110.00 10,531.28 $2,826,000 $2,826,500 110.00 10,572.36 110.00 10,565.83 110.00 10,559.29 110.00 10,552.76 110.00 10,546.23 110.00 10,539.69 110.00 10,533.16 $2,826,500 $2,827,000 110.00 10,574.23 110.00 10,567.70 110.00 10,561.17 110.00 10,554.63 110.00 10,548.10 110.00 10,541.57 110.00 10,535.03 $2,827,000 $2,827,500 110.00 10,576.11 110.00 10,569.58 110.00 10,563.04 110.00 10,556.51 110.00 10,549.98 110.00 10,543.44 110.00 10,536.91 $2,827,500 $2,828,000 110.00 10,577.98 110.00 10,571.45 110.00 10,564.92 110.00 10,558.38 110.00 10,551.85 110.00 10,545.32 110.00 10,538.78 $2,828,000 $2,828,500 110.00 10,579.86 110.00 10,573.33 110.00 10,566.79 110.00 10,560.26 110.00 10,553.73 110.00 10,547.19 110.00 10,540.66 $2,828,500 $2,829,000 110.00 10,581.73 110.00 10,575.20 110.00 10,568.67 110.00 10,562.13 110.00 10,555.60 110.00 10,549.07 110.00 10,542.53 $2,829,000 $2,829,500 110.00 10,583.61 110.00 10,577.08 110.00 10,570.54 110.00 10,564.01 110.00 10,557.48 110.00 10,550.94 110.00 10,544.41 $2,829,500 $2,830,000 110.00 10,585.48 110.00 10,578.95 110.00 10,572.42 110.00 10,565.88 110.00 10,559.35 110.00 10,552.82 110.00 10,546.28 $2,830,000 $2,830,500 110.00 10,587.36 110.00 10,580.83 110.00 10,574.29 110.00 10,567.76 110.00 10,561.23 110.00 10,554.69 110.00 10,548.16 $2,830,500 $2,831,000 110.00 10,589.23 110.00 10,582.70 110.00 10,576.17 110.00 10,569.63 110.00 10,563.10 110.00 10,556.57 110.00 10,550.03 $2,831,000 $2,831,500 110.00 10,591.11 110.00 10,584.58 110.00 10,578.04 110.00 10,571.51 110.00 10,564.98 110.00 10,558.44 110.00 10,551.91 $2,831,500 $2,832,000 110.00 10,592.98 110.00 10,586.45 110.00 10,579.92 110.00 10,573.38 110.00 10,566.85 110.00 10,560.32 110.00 10,553.78 $2,832,000 $2,832,500 110.00 10,594.86 110.00 10,588.33 110.00 10,581.79 110.00 10,575.26 110.00 10,568.73 110.00 10,562.19 110.00 10,555.66 $2,832,500 $2,833,000 110.00 10,596.73 110.00 10,590.20 110.00 10,583.67 110.00 10,577.13 110.00 10,570.60 110.00 10,564.07 110.00 10,557.53 $2,833,000 $2,833,500 110.00 10,598.61 110.00 10,592.08 110.00 10,585.54 110.00 10,579.01 110.00 10,572.48 110.00 10,565.94 110.00 10,559.41 $2,833,500 $2,834,000 110.00 10,600.48 110.00 10,593.95 110.00 10,587.42 110.00 10,580.88 110.00 10,574.35 110.00 10,567.82 110.00 10,561.28 $2,834,000 $2,834,500 110.00 10,602.36 110.00 10,595.83 110.00 10,589.29 110.00 10,582.76 110.00 10,576.23 110.00 10,569.69 110.00 10,563.16 $2,834,500 $2,835,000 110.00 10,604.23 110.00 10,597.70 110.00 10,591.17 110.00 10,584.63 110.00 10,578.10 110.00 10,571.57 110.00 10,565.03 $2,835,000 $2,835,500 110.00 10,606.11 110.00 10,599.58 110.00 10,593.04 110.00 10,586.51 110.00 10,579.98 110.00 10,573.44 110.00 10,566.91 $2,835,500 $2,836,000 110.00 10,607.98 110.00 10,601.45 110.00 10,594.92 110.00 10,588.38 110.00 10,581.85 110.00 10,575.32 110.00 10,568.78 $2,836,000 $2,836,500 110.00 10,609.86 110.00 10,603.33 110.00 10,596.79 110.00 10,590.26 110.00 10,583.73 110.00 10,577.19 110.00 10,570.66 $2,836,500 $2,837,000 110.00 10,611.73 110.00 10,605.20 110.00 10,598.67 110.00 10,592.13 110.00 10,585.60 110.00 10,579.07 110.00 10,572.53 $2,837,000 $2,837,500 110.00 10,613.61 110.00 10,607.08 110.00 10,600.54 110.00 10,594.01 110.00 10,587.48 110.00 10,580.94 110.00 10,574.41 $2,837,500 $2,838,000 110.00 10,615.48 110.00 10,608.95 110.00 10,602.42 110.00 10,595.88 110.00 10,589.35 110.00 10,582.82 110.00 10,576.28 $2,838,000 $2,838,500 110.00 10,617.36 110.00 10,610.83 110.00 10,604.29 110.00 10,597.76 110.00 10,591.23 110.00 10,584.69 110.00 10,578.16 $2,838,500 $2,839,000 110.00 10,619.23 110.00 10,612.70 110.00 10,606.17 110.00 10,599.63 110.00 10,593.10 110.00 10,586.57 110.00 10,580.03 $2,839,000 $2,839,500 110.00 10,621.11 110.00 10,614.58 110.00 10,608.04 110.00 10,601.51 110.00 10,594.98 110.00 10,588.44 110.00 10,581.91 $2,839,500 $2,840,000 110.00 10,622.98 110.00 10,616.45 110.00 10,609.92 110.00 10,603.38 110.00 10,596.85 110.00 10,590.32 110.00 10,583.78 $2,840,000 $2,840,500 110.00 10,624.86 110.00 10,618.33 110.00 10,611.79 110.00 10,605.26 110.00 10,598.73 110.00 10,592.19 110.00 10,585.66 $2,840,500 $2,841,000 110.00 10,626.73 110.00 10,620.20 110.00 10,613.67 110.00 10,607.13 110.00 10,600.60 110.00 10,594.07 110.00 10,587.53 $2,841,000 $2,841,500 110.00 10,628.61 110.00 10,622.08 110.00 10,615.54 110.00 10,609.01 110.00 10,602.48 110.00 10,595.94 110.00 10,589.41 $2,841,500 $2,842,000 110.00 10,630.48 110.00 10,623.95 110.00 10,617.42 110.00 10,610.88 110.00 10,604.35 110.00 10,597.82 110.00 10,591.28 $2,842,000 $2,842,500 110.00 10,632.36 110.00 10,625.83 110.00 10,619.29 110.00 10,612.76 110.00 10,606.23 110.00 10,599.69 110.00 10,593.16 $2,842,500 $2,843,000 110.00 10,634.23 110.00 10,627.70 110.00 10,621.17 110.00 10,614.63 110.00 10,608.10 110.00 10,601.57 110.00 10,595.03 $2,843,000 $2,843,500 110.00 10,636.11 110.00 10,629.58 110.00 10,623.04 110.00 10,616.51 110.00 10,609.98 110.00 10,603.44 110.00 10,596.91 $2,843,500 $2,844,000 110.00 10,637.98 110.00 10,631.45 110.00 10,624.92 110.00 10,618.38 110.00 10,611.85 110.00 10,605.32 110.00 10,598.78 $2,844,000 $2,844,500 110.00 10,639.86 110.00 10,633.33 110.00 10,626.79 110.00 10,620.26 110.00 10,613.73 110.00 10,607.19 110.00 10,600.66 $2,844,500 $2,845,000 110.00 10,641.73 110.00 10,635.20 110.00 10,628.67 110.00 10,622.13 110.00 10,615.60 110.00 10,609.07 110.00 10,602.53 $2,845,000 $2,845,500 110.00 10,643.61 110.00 10,637.08 110.00 10,630.54 110.00 10,624.01 110.00 10,617.48 110.00 10,610.94 110.00 10,604.41 $2,845,500 $2,846,000 110.00 10,645.48 110.00 10,638.95 110.00 10,632.42 110.00 10,625.88 110.00 10,619.35 110.00 10,612.82 110.00 10,606.28 $2,846,000 $2,846,500 110.00 10,647.36 110.00 10,640.83 110.00 10,634.29 110.00 10,627.76 110.00 10,621.23 110.00 10,614.69 110.00 10,608.16 $2,846,500 $2,847,000 110.00 10,649.23 110.00 10,642.70 110.00 10,636.17 110.00 10,629.63 110.00 10,623.10 110.00 10,616.57 110.00 10,610.03 $2,847,000 $2,847,500 110.00 10,651.11 110.00 10,644.58 110.00 10,638.04 110.00 10,631.51 110.00 10,624.98 110.00 10,618.44 110.00 10,611.91 $2,847,500 $2,848,000 110.00 10,652.98 110.00 10,646.45 110.00 10,639.92 110.00 10,633.38 110.00 10,626.85 110.00 10,620.32 110.00 10,613.78 $2,848,000 $2,848,500 110.00 10,654.86 110.00 10,648.33 110.00 10,641.79 110.00 10,635.26 110.00 10,628.73 110.00 10,622.19 110.00 10,615.66 $2,848,500 $2,849,000 110.00 10,656.73 110.00 10,650.20 110.00 10,643.67 110.00 10,637.13 110.00 10,630.60 110.00 10,624.07 110.00 10,617.53 $2,849,000 $2,849,500 110.00 10,658.61 110.00 10,652.08 110.00 10,645.54 110.00 10,639.01 110.00 10,632.48 110.00 10,625.94 110.00 10,619.41 $2,849,500 $2,850,000 110.00 10,660.48 110.00 10,653.95 110.00 10,647.42 110.00 10,640.88 110.00 10,634.35 110.00 10,627.82 110.00 10,621.28 $2,850,000 $2,850,500 110.00 10,662.36 110.00 10,655.83 110.00 10,649.29 110.00 10,642.76 110.00 10,636.23 110.00 10,629.69 110.00 10,623.16 $2,850,500 $2,851,000 110.00 10,664.23 110.00 10,657.70 110.00 10,651.17 110.00 10,644.63 110.00 10,638.10 110.00 10,631.57 110.00 10,625.03 $2,851,000 $2,851,500 110.00 10,666.11 110.00 10,659.58 110.00 10,653.04 110.00 10,646.51 110.00 10,639.98 110.00 10,633.44 110.00 10,626.91 $2,851,500 $2,852,000 110.00 10,667.98 110.00 10,661.45 110.00 10,654.92 110.00 10,648.38 110.00 10,641.85 110.00 10,635.32 110.00 10,628.78 $2,852,000 $2,852,500 110.00 10,669.86 110.00 10,663.33 110.00 10,656.79 110.00 10,650.26 110.00 10,643.73 110.00 10,637.19 110.00 10,630.66 $2,852,500 $2,853,000 110.00 10,671.73 110.00 10,665.20 110.00 10,658.67 110.00 10,652.13 110.00 10,645.60 110.00 10,639.07 110.00 10,632.53 $2,853,000 $2,853,500 110.00 10,673.61 110.00 10,667.08 110.00 10,660.54 110.00 10,654.01 110.00 10,647.48 110.00 10,640.94 110.00 10,634.41 $2,853,500 $2,854,000 110.00 10,675.48 110.00 10,668.95 110.00 10,662.42 110.00 10,655.88 110.00 10,649.35 110.00 10,642.82 110.00 10,636.28 $2,854,000 $2,854,500 110.00 10,677.36 110.00 10,670.83 110.00 10,664.29 110.00 10,657.76 110.00 10,651.23 110.00 10,644.69 110.00 10,638.16 $2,854,500 $2,855,000 110.00 10,679.23 110.00 10,672.70 110.00 10,666.17 110.00 10,659.63 110.00 10,653.10 110.00 10,646.57 110.00 10,640.03 $2,855,000 $2,855,500 110.00 10,681.11 110.00 10,674.58 110.00 10,668.04 110.00 10,661.51 110.00 10,654.98 110.00 10,648.44 110.00 10,641.91 $2,855,500 $2,856,000 110.00 10,682.98 110.00 10,676.45 110.00 10,669.92 110.00 10,663.38 110.00 10,656.85 110.00 10,650.32 110.00 10,643.78

NJEIS Family Cost Participation Table Page 59 of 12 Effective July 1, 2015

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

$2,856,000 $2,856,500 110.00 10,684.86 110.00 10,678.33 110.00 10,671.79 110.00 10,665.26 110.00 10,658.73 110.00 10,652.19 110.00 10,645.66 $2,856,500 $2,857,000 110.00 10,686.73 110.00 10,680.20 110.00 10,673.67 110.00 10,667.13 110.00 10,660.60 110.00 10,654.07 110.00 10,647.53 $2,857,000 $2,857,500 110.00 10,688.61 110.00 10,682.08 110.00 10,675.54 110.00 10,669.01 110.00 10,662.48 110.00 10,655.94 110.00 10,649.41 $2,857,500 $2,858,000 110.00 10,690.48 110.00 10,683.95 110.00 10,677.42 110.00 10,670.88 110.00 10,664.35 110.00 10,657.82 110.00 10,651.28 $2,858,000 $2,858,500 110.00 10,692.36 110.00 10,685.83 110.00 10,679.29 110.00 10,672.76 110.00 10,666.23 110.00 10,659.69 110.00 10,653.16 $2,858,500 $2,859,000 110.00 10,694.23 110.00 10,687.70 110.00 10,681.17 110.00 10,674.63 110.00 10,668.10 110.00 10,661.57 110.00 10,655.03 $2,859,000 $2,859,500 110.00 10,696.11 110.00 10,689.58 110.00 10,683.04 110.00 10,676.51 110.00 10,669.98 110.00 10,663.44 110.00 10,656.91 $2,859,500 $2,860,000 110.00 10,697.98 110.00 10,691.45 110.00 10,684.92 110.00 10,678.38 110.00 10,671.85 110.00 10,665.32 110.00 10,658.78 $2,860,000 $2,860,500 110.00 10,699.86 110.00 10,693.33 110.00 10,686.79 110.00 10,680.26 110.00 10,673.73 110.00 10,667.19 110.00 10,660.66 $2,860,500 $2,861,000 110.00 10,701.73 110.00 10,695.20 110.00 10,688.67 110.00 10,682.13 110.00 10,675.60 110.00 10,669.07 110.00 10,662.53 $2,861,000 $2,861,500 110.00 10,703.61 110.00 10,697.08 110.00 10,690.54 110.00 10,684.01 110.00 10,677.48 110.00 10,670.94 110.00 10,664.41 $2,861,500 $2,862,000 110.00 10,705.48 110.00 10,698.95 110.00 10,692.42 110.00 10,685.88 110.00 10,679.35 110.00 10,672.82 110.00 10,666.28 $2,862,000 $2,862,500 110.00 10,707.36 110.00 10,700.83 110.00 10,694.29 110.00 10,687.76 110.00 10,681.23 110.00 10,674.69 110.00 10,668.16 $2,862,500 $2,863,000 110.00 10,709.23 110.00 10,702.70 110.00 10,696.17 110.00 10,689.63 110.00 10,683.10 110.00 10,676.57 110.00 10,670.03 $2,863,000 $2,863,500 110.00 10,711.11 110.00 10,704.58 110.00 10,698.04 110.00 10,691.51 110.00 10,684.98 110.00 10,678.44 110.00 10,671.91 $2,863,500 $2,864,000 110.00 10,712.98 110.00 10,706.45 110.00 10,699.92 110.00 10,693.38 110.00 10,686.85 110.00 10,680.32 110.00 10,673.78 $2,864,000 $2,864,500 110.00 10,714.86 110.00 10,708.33 110.00 10,701.79 110.00 10,695.26 110.00 10,688.73 110.00 10,682.19 110.00 10,675.66 $2,864,500 $2,865,000 110.00 10,716.73 110.00 10,710.20 110.00 10,703.67 110.00 10,697.13 110.00 10,690.60 110.00 10,684.07 110.00 10,677.53 $2,865,000 $2,865,500 110.00 10,718.61 110.00 10,712.08 110.00 10,705.54 110.00 10,699.01 110.00 10,692.48 110.00 10,685.94 110.00 10,679.41 $2,865,500 $2,866,000 110.00 10,720.48 110.00 10,713.95 110.00 10,707.42 110.00 10,700.88 110.00 10,694.35 110.00 10,687.82 110.00 10,681.28 $2,866,000 $2,866,500 110.00 10,722.36 110.00 10,715.83 110.00 10,709.29 110.00 10,702.76 110.00 10,696.23 110.00 10,689.69 110.00 10,683.16 $2,866,500 $2,867,000 110.00 10,724.23 110.00 10,717.70 110.00 10,711.17 110.00 10,704.63 110.00 10,698.10 110.00 10,691.57 110.00 10,685.03 $2,867,000 $2,867,500 110.00 10,726.11 110.00 10,719.58 110.00 10,713.04 110.00 10,706.51 110.00 10,699.98 110.00 10,693.44 110.00 10,686.91 $2,867,500 $2,868,000 110.00 10,727.98 110.00 10,721.45 110.00 10,714.92 110.00 10,708.38 110.00 10,701.85 110.00 10,695.32 110.00 10,688.78 $2,868,000 $2,868,500 110.00 10,729.86 110.00 10,723.33 110.00 10,716.79 110.00 10,710.26 110.00 10,703.73 110.00 10,697.19 110.00 10,690.66 $2,868,500 $2,869,000 110.00 10,731.73 110.00 10,725.20 110.00 10,718.67 110.00 10,712.13 110.00 10,705.60 110.00 10,699.07 110.00 10,692.53 $2,869,000 $2,869,500 110.00 10,733.61 110.00 10,727.08 110.00 10,720.54 110.00 10,714.01 110.00 10,707.48 110.00 10,700.94 110.00 10,694.41 $2,869,500 $2,870,000 110.00 10,735.48 110.00 10,728.95 110.00 10,722.42 110.00 10,715.88 110.00 10,709.35 110.00 10,702.82 110.00 10,696.28 $2,870,000 $2,870,500 110.00 10,737.36 110.00 10,730.83 110.00 10,724.29 110.00 10,717.76 110.00 10,711.23 110.00 10,704.69 110.00 10,698.16 $2,870,500 $2,871,000 110.00 10,739.23 110.00 10,732.70 110.00 10,726.17 110.00 10,719.63 110.00 10,713.10 110.00 10,706.57 110.00 10,700.03 $2,871,000 $2,871,500 110.00 10,741.11 110.00 10,734.58 110.00 10,728.04 110.00 10,721.51 110.00 10,714.98 110.00 10,708.44 110.00 10,701.91 $2,871,500 $2,872,000 110.00 10,742.98 110.00 10,736.45 110.00 10,729.92 110.00 10,723.38 110.00 10,716.85 110.00 10,710.32 110.00 10,703.78 $2,872,000 $2,872,500 110.00 10,744.86 110.00 10,738.33 110.00 10,731.79 110.00 10,725.26 110.00 10,718.73 110.00 10,712.19 110.00 10,705.66 $2,872,500 $2,873,000 110.00 10,746.73 110.00 10,740.20 110.00 10,733.67 110.00 10,727.13 110.00 10,720.60 110.00 10,714.07 110.00 10,707.53 $2,873,000 $2,873,500 110.00 10,748.61 110.00 10,742.08 110.00 10,735.54 110.00 10,729.01 110.00 10,722.48 110.00 10,715.94 110.00 10,709.41 $2,873,500 $2,874,000 110.00 10,750.48 110.00 10,743.95 110.00 10,737.42 110.00 10,730.88 110.00 10,724.35 110.00 10,717.82 110.00 10,711.28 $2,874,000 $2,874,500 110.00 10,752.36 110.00 10,745.83 110.00 10,739.29 110.00 10,732.76 110.00 10,726.23 110.00 10,719.69 110.00 10,713.16 $2,874,500 $2,875,000 110.00 10,754.23 110.00 10,747.70 110.00 10,741.17 110.00 10,734.63 110.00 10,728.10 110.00 10,721.57 110.00 10,715.03 $2,875,000 $2,875,500 110.00 10,756.11 110.00 10,749.58 110.00 10,743.04 110.00 10,736.51 110.00 10,729.98 110.00 10,723.44 110.00 10,716.91 $2,875,500 $2,876,000 110.00 10,757.98 110.00 10,751.45 110.00 10,744.92 110.00 10,738.38 110.00 10,731.85 110.00 10,725.32 110.00 10,718.78 $2,876,000 $2,876,500 110.00 10,759.86 110.00 10,753.33 110.00 10,746.79 110.00 10,740.26 110.00 10,733.73 110.00 10,727.19 110.00 10,720.66 $2,876,500 $2,877,000 110.00 10,761.73 110.00 10,755.20 110.00 10,748.67 110.00 10,742.13 110.00 10,735.60 110.00 10,729.07 110.00 10,722.53 $2,877,000 $2,877,500 110.00 10,763.61 110.00 10,757.08 110.00 10,750.54 110.00 10,744.01 110.00 10,737.48 110.00 10,730.94 110.00 10,724.41 $2,877,500 $2,878,000 110.00 10,765.48 110.00 10,758.95 110.00 10,752.42 110.00 10,745.88 110.00 10,739.35 110.00 10,732.82 110.00 10,726.28 $2,878,000 $2,878,500 110.00 10,767.36 110.00 10,760.83 110.00 10,754.29 110.00 10,747.76 110.00 10,741.23 110.00 10,734.69 110.00 10,728.16 $2,878,500 $2,879,000 110.00 10,769.23 110.00 10,762.70 110.00 10,756.17 110.00 10,749.63 110.00 10,743.10 110.00 10,736.57 110.00 10,730.03 $2,879,000 $2,879,500 110.00 10,771.11 110.00 10,764.58 110.00 10,758.04 110.00 10,751.51 110.00 10,744.98 110.00 10,738.44 110.00 10,731.91 $2,879,500 $2,880,000 110.00 10,772.98 110.00 10,766.45 110.00 10,759.92 110.00 10,753.38 110.00 10,746.85 110.00 10,740.32 110.00 10,733.78 $2,880,000 $2,880,500 110.00 10,774.86 110.00 10,768.33 110.00 10,761.79 110.00 10,755.26 110.00 10,748.73 110.00 10,742.19 110.00 10,735.66 $2,880,500 $2,881,000 110.00 10,776.73 110.00 10,770.20 110.00 10,763.67 110.00 10,757.13 110.00 10,750.60 110.00 10,744.07 110.00 10,737.53 $2,881,000 $2,881,500 110.00 10,778.61 110.00 10,772.08 110.00 10,765.54 110.00 10,759.01 110.00 10,752.48 110.00 10,745.94 110.00 10,739.41 $2,881,500 $2,882,000 110.00 10,780.48 110.00 10,773.95 110.00 10,767.42 110.00 10,760.88 110.00 10,754.35 110.00 10,747.82 110.00 10,741.28 $2,882,000 $2,882,500 110.00 10,782.36 110.00 10,775.83 110.00 10,769.29 110.00 10,762.76 110.00 10,756.23 110.00 10,749.69 110.00 10,743.16 $2,882,500 $2,883,000 110.00 10,784.23 110.00 10,777.70 110.00 10,771.17 110.00 10,764.63 110.00 10,758.10 110.00 10,751.57 110.00 10,745.03 $2,883,000 $2,883,500 110.00 10,786.11 110.00 10,779.58 110.00 10,773.04 110.00 10,766.51 110.00 10,759.98 110.00 10,753.44 110.00 10,746.91 $2,883,500 $2,884,000 110.00 10,787.98 110.00 10,781.45 110.00 10,774.92 110.00 10,768.38 110.00 10,761.85 110.00 10,755.32 110.00 10,748.78 $2,884,000 $2,884,500 110.00 10,789.86 110.00 10,783.33 110.00 10,776.79 110.00 10,770.26 110.00 10,763.73 110.00 10,757.19 110.00 10,750.66 $2,884,500 $2,885,000 110.00 10,791.73 110.00 10,785.20 110.00 10,778.67 110.00 10,772.13 110.00 10,765.60 110.00 10,759.07 110.00 10,752.53 $2,885,000 $2,885,500 110.00 10,793.61 110.00 10,787.08 110.00 10,780.54 110.00 10,774.01 110.00 10,767.48 110.00 10,760.94 110.00 10,754.41 $2,885,500 $2,886,000 110.00 10,795.48 110.00 10,788.95 110.00 10,782.42 110.00 10,775.88 110.00 10,769.35 110.00 10,762.82 110.00 10,756.28 $2,886,000 $2,886,500 110.00 10,797.36 110.00 10,790.83 110.00 10,784.29 110.00 10,777.76 110.00 10,771.23 110.00 10,764.69 110.00 10,758.16 $2,886,500 $2,887,000 110.00 10,799.23 110.00 10,792.70 110.00 10,786.17 110.00 10,779.63 110.00 10,773.10 110.00 10,766.57 110.00 10,760.03 $2,887,000 $2,887,500 110.00 10,801.11 110.00 10,794.58 110.00 10,788.04 110.00 10,781.51 110.00 10,774.98 110.00 10,768.44 110.00 10,761.91 $2,887,500 $2,888,000 110.00 10,802.98 110.00 10,796.45 110.00 10,789.92 110.00 10,783.38 110.00 10,776.85 110.00 10,770.32 110.00 10,763.78 $2,888,000 $2,888,500 110.00 10,804.86 110.00 10,798.33 110.00 10,791.79 110.00 10,785.26 110.00 10,778.73 110.00 10,772.19 110.00 10,765.66 $2,888,500 $2,889,000 110.00 10,806.73 110.00 10,800.20 110.00 10,793.67 110.00 10,787.13 110.00 10,780.60 110.00 10,774.07 110.00 10,767.53 $2,889,000 $2,889,500 110.00 10,808.61 110.00 10,802.08 110.00 10,795.54 110.00 10,789.01 110.00 10,782.48 110.00 10,775.94 110.00 10,769.41 $2,889,500 $2,890,000 110.00 10,810.48 110.00 10,803.95 110.00 10,797.42 110.00 10,790.88 110.00 10,784.35 110.00 10,777.82 110.00 10,771.28 $2,890,000 $2,890,500 110.00 10,812.36 110.00 10,805.83 110.00 10,799.29 110.00 10,792.76 110.00 10,786.23 110.00 10,779.69 110.00 10,773.16 $2,890,500 $2,891,000 110.00 10,814.23 110.00 10,807.70 110.00 10,801.17 110.00 10,794.63 110.00 10,788.10 110.00 10,781.57 110.00 10,775.03 $2,891,000 $2,891,500 110.00 10,816.11 110.00 10,809.58 110.00 10,803.04 110.00 10,796.51 110.00 10,789.98 110.00 10,783.44 110.00 10,776.91 $2,891,500 $2,892,000 110.00 10,817.98 110.00 10,811.45 110.00 10,804.92 110.00 10,798.38 110.00 10,791.85 110.00 10,785.32 110.00 10,778.78 $2,892,000 $2,892,500 110.00 10,819.86 110.00 10,813.33 110.00 10,806.79 110.00 10,800.26 110.00 10,793.73 110.00 10,787.19 110.00 10,780.66 $2,892,500 $2,893,000 110.00 10,821.73 110.00 10,815.20 110.00 10,808.67 110.00 10,802.13 110.00 10,795.60 110.00 10,789.07 110.00 10,782.53 $2,893,000 $2,893,500 110.00 10,823.61 110.00 10,817.08 110.00 10,810.54 110.00 10,804.01 110.00 10,797.48 110.00 10,790.94 110.00 10,784.41 $2,893,500 $2,894,000 110.00 10,825.48 110.00 10,818.95 110.00 10,812.42 110.00 10,805.88 110.00 10,799.35 110.00 10,792.82 110.00 10,786.28 $2,894,000 $2,894,500 110.00 10,827.36 110.00 10,820.83 110.00 10,814.29 110.00 10,807.76 110.00 10,801.23 110.00 10,794.69 110.00 10,788.16 $2,894,500 $2,895,000 110.00 10,829.23 110.00 10,822.70 110.00 10,816.17 110.00 10,809.63 110.00 10,803.10 110.00 10,796.57 110.00 10,790.03 $2,895,000 $2,895,500 110.00 10,831.11 110.00 10,824.58 110.00 10,818.04 110.00 10,811.51 110.00 10,804.98 110.00 10,798.44 110.00 10,791.91 $2,895,500 $2,896,000 110.00 10,832.98 110.00 10,826.45 110.00 10,819.92 110.00 10,813.38 110.00 10,806.85 110.00 10,800.32 110.00 10,793.78 $2,896,000 $2,896,500 110.00 10,834.86 110.00 10,828.33 110.00 10,821.79 110.00 10,815.26 110.00 10,808.73 110.00 10,802.19 110.00 10,795.66 $2,896,500 $2,897,000 110.00 10,836.73 110.00 10,830.20 110.00 10,823.67 110.00 10,817.13 110.00 10,810.60 110.00 10,804.07 110.00 10,797.53 $2,897,000 $2,897,500 110.00 10,838.61 110.00 10,832.08 110.00 10,825.54 110.00 10,819.01 110.00 10,812.48 110.00 10,805.94 110.00 10,799.41 $2,897,500 $2,898,000 110.00 10,840.48 110.00 10,833.95 110.00 10,827.42 110.00 10,820.88 110.00 10,814.35 110.00 10,807.82 110.00 10,801.28 $2,898,000 $2,898,500 110.00 10,842.36 110.00 10,835.83 110.00 10,829.29 110.00 10,822.76 110.00 10,816.23 110.00 10,809.69 110.00 10,803.16 $2,898,500 $2,899,000 110.00 10,844.23 110.00 10,837.70 110.00 10,831.17 110.00 10,824.63 110.00 10,818.10 110.00 10,811.57 110.00 10,805.03 $2,899,000 $2,899,500 110.00 10,846.11 110.00 10,839.58 110.00 10,833.04 110.00 10,826.51 110.00 10,819.98 110.00 10,813.44 110.00 10,806.91 $2,899,500 $2,900,000 110.00 10,847.98 110.00 10,841.45 110.00 10,834.92 110.00 10,828.38 110.00 10,821.85 110.00 10,815.32 110.00 10,808.78 $2,900,000 $2,900,500 110.00 10,849.86 110.00 10,843.33 110.00 10,836.79 110.00 10,830.26 110.00 10,823.73 110.00 10,817.19 110.00 10,810.66 $2,900,500 $2,901,000 110.00 10,851.73 110.00 10,845.20 110.00 10,838.67 110.00 10,832.13 110.00 10,825.60 110.00 10,819.07 110.00 10,812.53 $2,901,000 $2,901,500 110.00 10,853.61 110.00 10,847.08 110.00 10,840.54 110.00 10,834.01 110.00 10,827.48 110.00 10,820.94 110.00 10,814.41 $2,901,500 $2,902,000 110.00 10,855.48 110.00 10,848.95 110.00 10,842.42 110.00 10,835.88 110.00 10,829.35 110.00 10,822.82 110.00 10,816.28 $2,902,000 $2,902,500 110.00 10,857.36 110.00 10,850.83 110.00 10,844.29 110.00 10,837.76 110.00 10,831.23 110.00 10,824.69 110.00 10,818.16 $2,902,500 $2,903,000 110.00 10,859.23 110.00 10,852.70 110.00 10,846.17 110.00 10,839.63 110.00 10,833.10 110.00 10,826.57 110.00 10,820.03 $2,903,000 $2,903,500 110.00 10,861.11 110.00 10,854.58 110.00 10,848.04 110.00 10,841.51 110.00 10,834.98 110.00 10,828.44 110.00 10,821.91 $2,903,500 $2,904,000 110.00 10,862.98 110.00 10,856.45 110.00 10,849.92 110.00 10,843.38 110.00 10,836.85 110.00 10,830.32 110.00 10,823.78 $2,904,000 $2,904,500 110.00 10,864.86 110.00 10,858.33 110.00 10,851.79 110.00 10,845.26 110.00 10,838.73 110.00 10,832.19 110.00 10,825.66 $2,904,500 $2,905,000 110.00 10,866.73 110.00 10,860.20 110.00 10,853.67 110.00 10,847.13 110.00 10,840.60 110.00 10,834.07 110.00 10,827.53 $2,905,000 $2,905,500 110.00 10,868.61 110.00 10,862.08 110.00 10,855.54 110.00 10,849.01 110.00 10,842.48 110.00 10,835.94 110.00 10,829.41 $2,905,500 $2,906,000 110.00 10,870.48 110.00 10,863.95 110.00 10,857.42 110.00 10,850.88 110.00 10,844.35 110.00 10,837.82 110.00 10,831.28 $2,906,000 $2,906,500 110.00 10,872.36 110.00 10,865.83 110.00 10,859.29 110.00 10,852.76 110.00 10,846.23 110.00 10,839.69 110.00 10,833.16 $2,906,500 $2,907,000 110.00 10,874.23 110.00 10,867.70 110.00 10,861.17 110.00 10,854.63 110.00 10,848.10 110.00 10,841.57 110.00 10,835.03

NJEIS Family Cost Participation Table Page 60 of 12 Effective July 1, 2015

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

$2,907,000 $2,907,500 110.00 10,876.11 110.00 10,869.58 110.00 10,863.04 110.00 10,856.51 110.00 10,849.98 110.00 10,843.44 110.00 10,836.91 $2,907,500 $2,908,000 110.00 10,877.98 110.00 10,871.45 110.00 10,864.92 110.00 10,858.38 110.00 10,851.85 110.00 10,845.32 110.00 10,838.78 $2,908,000 $2,908,500 110.00 10,879.86 110.00 10,873.33 110.00 10,866.79 110.00 10,860.26 110.00 10,853.73 110.00 10,847.19 110.00 10,840.66 $2,908,500 $2,909,000 110.00 10,881.73 110.00 10,875.20 110.00 10,868.67 110.00 10,862.13 110.00 10,855.60 110.00 10,849.07 110.00 10,842.53 $2,909,000 $2,909,500 110.00 10,883.61 110.00 10,877.08 110.00 10,870.54 110.00 10,864.01 110.00 10,857.48 110.00 10,850.94 110.00 10,844.41 $2,909,500 $2,910,000 110.00 10,885.48 110.00 10,878.95 110.00 10,872.42 110.00 10,865.88 110.00 10,859.35 110.00 10,852.82 110.00 10,846.28 $2,910,000 $2,910,500 110.00 10,887.36 110.00 10,880.83 110.00 10,874.29 110.00 10,867.76 110.00 10,861.23 110.00 10,854.69 110.00 10,848.16 $2,910,500 $2,911,000 110.00 10,889.23 110.00 10,882.70 110.00 10,876.17 110.00 10,869.63 110.00 10,863.10 110.00 10,856.57 110.00 10,850.03 $2,911,000 $2,911,500 110.00 10,891.11 110.00 10,884.58 110.00 10,878.04 110.00 10,871.51 110.00 10,864.98 110.00 10,858.44 110.00 10,851.91 $2,911,500 $2,912,000 110.00 10,892.98 110.00 10,886.45 110.00 10,879.92 110.00 10,873.38 110.00 10,866.85 110.00 10,860.32 110.00 10,853.78 $2,912,000 $2,912,500 110.00 10,894.86 110.00 10,888.33 110.00 10,881.79 110.00 10,875.26 110.00 10,868.73 110.00 10,862.19 110.00 10,855.66 $2,912,500 $2,913,000 110.00 10,896.73 110.00 10,890.20 110.00 10,883.67 110.00 10,877.13 110.00 10,870.60 110.00 10,864.07 110.00 10,857.53 $2,913,000 $2,913,500 110.00 10,898.61 110.00 10,892.08 110.00 10,885.54 110.00 10,879.01 110.00 10,872.48 110.00 10,865.94 110.00 10,859.41 $2,913,500 $2,914,000 110.00 10,900.48 110.00 10,893.95 110.00 10,887.42 110.00 10,880.88 110.00 10,874.35 110.00 10,867.82 110.00 10,861.28 $2,914,000 $2,914,500 110.00 10,902.36 110.00 10,895.83 110.00 10,889.29 110.00 10,882.76 110.00 10,876.23 110.00 10,869.69 110.00 10,863.16 $2,914,500 $2,915,000 110.00 10,904.23 110.00 10,897.70 110.00 10,891.17 110.00 10,884.63 110.00 10,878.10 110.00 10,871.57 110.00 10,865.03 $2,915,000 $2,915,500 110.00 10,906.11 110.00 10,899.58 110.00 10,893.04 110.00 10,886.51 110.00 10,879.98 110.00 10,873.44 110.00 10,866.91 $2,915,500 $2,916,000 110.00 10,907.98 110.00 10,901.45 110.00 10,894.92 110.00 10,888.38 110.00 10,881.85 110.00 10,875.32 110.00 10,868.78 $2,916,000 $2,916,500 110.00 10,909.86 110.00 10,903.33 110.00 10,896.79 110.00 10,890.26 110.00 10,883.73 110.00 10,877.19 110.00 10,870.66 $2,916,500 $2,917,000 110.00 10,911.73 110.00 10,905.20 110.00 10,898.67 110.00 10,892.13 110.00 10,885.60 110.00 10,879.07 110.00 10,872.53 $2,917,000 $2,917,500 110.00 10,913.61 110.00 10,907.08 110.00 10,900.54 110.00 10,894.01 110.00 10,887.48 110.00 10,880.94 110.00 10,874.41 $2,917,500 $2,918,000 110.00 10,915.48 110.00 10,908.95 110.00 10,902.42 110.00 10,895.88 110.00 10,889.35 110.00 10,882.82 110.00 10,876.28 $2,918,000 $2,918,500 110.00 10,917.36 110.00 10,910.83 110.00 10,904.29 110.00 10,897.76 110.00 10,891.23 110.00 10,884.69 110.00 10,878.16 $2,918,500 $2,919,000 110.00 10,919.23 110.00 10,912.70 110.00 10,906.17 110.00 10,899.63 110.00 10,893.10 110.00 10,886.57 110.00 10,880.03 $2,919,000 $2,919,500 110.00 10,921.11 110.00 10,914.58 110.00 10,908.04 110.00 10,901.51 110.00 10,894.98 110.00 10,888.44 110.00 10,881.91 $2,919,500 $2,920,000 110.00 10,922.98 110.00 10,916.45 110.00 10,909.92 110.00 10,903.38 110.00 10,896.85 110.00 10,890.32 110.00 10,883.78 $2,920,000 $2,920,500 110.00 10,924.86 110.00 10,918.33 110.00 10,911.79 110.00 10,905.26 110.00 10,898.73 110.00 10,892.19 110.00 10,885.66 $2,920,500 $2,921,000 110.00 10,926.73 110.00 10,920.20 110.00 10,913.67 110.00 10,907.13 110.00 10,900.60 110.00 10,894.07 110.00 10,887.53 $2,921,000 $2,921,500 110.00 10,928.61 110.00 10,922.08 110.00 10,915.54 110.00 10,909.01 110.00 10,902.48 110.00 10,895.94 110.00 10,889.41 $2,921,500 $2,922,000 110.00 10,930.48 110.00 10,923.95 110.00 10,917.42 110.00 10,910.88 110.00 10,904.35 110.00 10,897.82 110.00 10,891.28 $2,922,000 $2,922,500 110.00 10,932.36 110.00 10,925.83 110.00 10,919.29 110.00 10,912.76 110.00 10,906.23 110.00 10,899.69 110.00 10,893.16 $2,922,500 $2,923,000 110.00 10,934.23 110.00 10,927.70 110.00 10,921.17 110.00 10,914.63 110.00 10,908.10 110.00 10,901.57 110.00 10,895.03 $2,923,000 $2,923,500 110.00 10,936.11 110.00 10,929.58 110.00 10,923.04 110.00 10,916.51 110.00 10,909.98 110.00 10,903.44 110.00 10,896.91 $2,923,500 $2,924,000 110.00 10,937.98 110.00 10,931.45 110.00 10,924.92 110.00 10,918.38 110.00 10,911.85 110.00 10,905.32 110.00 10,898.78 $2,924,000 $2,924,500 110.00 10,939.86 110.00 10,933.33 110.00 10,926.79 110.00 10,920.26 110.00 10,913.73 110.00 10,907.19 110.00 10,900.66 $2,924,500 $2,925,000 110.00 10,941.73 110.00 10,935.20 110.00 10,928.67 110.00 10,922.13 110.00 10,915.60 110.00 10,909.07 110.00 10,902.53 $2,925,000 $2,925,500 110.00 10,943.61 110.00 10,937.08 110.00 10,930.54 110.00 10,924.01 110.00 10,917.48 110.00 10,910.94 110.00 10,904.41 $2,925,500 $2,926,000 110.00 10,945.48 110.00 10,938.95 110.00 10,932.42 110.00 10,925.88 110.00 10,919.35 110.00 10,912.82 110.00 10,906.28 $2,926,000 $2,926,500 110.00 10,947.36 110.00 10,940.83 110.00 10,934.29 110.00 10,927.76 110.00 10,921.23 110.00 10,914.69 110.00 10,908.16 $2,926,500 $2,927,000 110.00 10,949.23 110.00 10,942.70 110.00 10,936.17 110.00 10,929.63 110.00 10,923.10 110.00 10,916.57 110.00 10,910.03 $2,927,000 $2,927,500 110.00 10,951.11 110.00 10,944.58 110.00 10,938.04 110.00 10,931.51 110.00 10,924.98 110.00 10,918.44 110.00 10,911.91 $2,927,500 $2,928,000 110.00 10,952.98 110.00 10,946.45 110.00 10,939.92 110.00 10,933.38 110.00 10,926.85 110.00 10,920.32 110.00 10,913.78 $2,928,000 $2,928,500 110.00 10,954.86 110.00 10,948.33 110.00 10,941.79 110.00 10,935.26 110.00 10,928.73 110.00 10,922.19 110.00 10,915.66 $2,928,500 $2,929,000 110.00 10,956.73 110.00 10,950.20 110.00 10,943.67 110.00 10,937.13 110.00 10,930.60 110.00 10,924.07 110.00 10,917.53 $2,929,000 $2,929,500 110.00 10,958.61 110.00 10,952.08 110.00 10,945.54 110.00 10,939.01 110.00 10,932.48 110.00 10,925.94 110.00 10,919.41 $2,929,500 $2,930,000 110.00 10,960.48 110.00 10,953.95 110.00 10,947.42 110.00 10,940.88 110.00 10,934.35 110.00 10,927.82 110.00 10,921.28 $2,930,000 $2,930,500 110.00 10,962.36 110.00 10,955.83 110.00 10,949.29 110.00 10,942.76 110.00 10,936.23 110.00 10,929.69 110.00 10,923.16 $2,930,500 $2,931,000 110.00 10,964.23 110.00 10,957.70 110.00 10,951.17 110.00 10,944.63 110.00 10,938.10 110.00 10,931.57 110.00 10,925.03 $2,931,000 $2,931,500 110.00 10,966.11 110.00 10,959.58 110.00 10,953.04 110.00 10,946.51 110.00 10,939.98 110.00 10,933.44 110.00 10,926.91 $2,931,500 $2,932,000 110.00 10,967.98 110.00 10,961.45 110.00 10,954.92 110.00 10,948.38 110.00 10,941.85 110.00 10,935.32 110.00 10,928.78 $2,932,000 $2,932,500 110.00 10,969.86 110.00 10,963.33 110.00 10,956.79 110.00 10,950.26 110.00 10,943.73 110.00 10,937.19 110.00 10,930.66 $2,932,500 $2,933,000 110.00 10,971.73 110.00 10,965.20 110.00 10,958.67 110.00 10,952.13 110.00 10,945.60 110.00 10,939.07 110.00 10,932.53 $2,933,000 $2,933,500 110.00 10,973.61 110.00 10,967.08 110.00 10,960.54 110.00 10,954.01 110.00 10,947.48 110.00 10,940.94 110.00 10,934.41 $2,933,500 $2,934,000 110.00 10,975.48 110.00 10,968.95 110.00 10,962.42 110.00 10,955.88 110.00 10,949.35 110.00 10,942.82 110.00 10,936.28 $2,934,000 $2,934,500 110.00 10,977.36 110.00 10,970.83 110.00 10,964.29 110.00 10,957.76 110.00 10,951.23 110.00 10,944.69 110.00 10,938.16 $2,934,500 $2,935,000 110.00 10,979.23 110.00 10,972.70 110.00 10,966.17 110.00 10,959.63 110.00 10,953.10 110.00 10,946.57 110.00 10,940.03 $2,935,000 $2,935,500 110.00 10,981.11 110.00 10,974.58 110.00 10,968.04 110.00 10,961.51 110.00 10,954.98 110.00 10,948.44 110.00 10,941.91 $2,935,500 $2,936,000 110.00 10,982.98 110.00 10,976.45 110.00 10,969.92 110.00 10,963.38 110.00 10,956.85 110.00 10,950.32 110.00 10,943.78 $2,936,000 $2,936,500 110.00 10,984.86 110.00 10,978.33 110.00 10,971.79 110.00 10,965.26 110.00 10,958.73 110.00 10,952.19 110.00 10,945.66 $2,936,500 $2,937,000 110.00 10,986.73 110.00 10,980.20 110.00 10,973.67 110.00 10,967.13 110.00 10,960.60 110.00 10,954.07 110.00 10,947.53 $2,937,000 $2,937,500 110.00 10,988.61 110.00 10,982.08 110.00 10,975.54 110.00 10,969.01 110.00 10,962.48 110.00 10,955.94 110.00 10,949.41 $2,937,500 $2,938,000 110.00 10,990.48 110.00 10,983.95 110.00 10,977.42 110.00 10,970.88 110.00 10,964.35 110.00 10,957.82 110.00 10,951.28 $2,938,000 $2,938,500 110.00 10,992.36 110.00 10,985.83 110.00 10,979.29 110.00 10,972.76 110.00 10,966.23 110.00 10,959.69 110.00 10,953.16 $2,938,500 $2,939,000 110.00 10,994.23 110.00 10,987.70 110.00 10,981.17 110.00 10,974.63 110.00 10,968.10 110.00 10,961.57 110.00 10,955.03 $2,939,000 $2,939,500 110.00 10,996.11 110.00 10,989.58 110.00 10,983.04 110.00 10,976.51 110.00 10,969.98 110.00 10,963.44 110.00 10,956.91 $2,939,500 $2,940,000 110.00 10,997.98 110.00 10,991.45 110.00 10,984.92 110.00 10,978.38 110.00 10,971.85 110.00 10,965.32 110.00 10,958.78 $2,940,000 $2,940,500 110.00 10,999.86 110.00 10,993.33 110.00 10,986.79 110.00 10,980.26 110.00 10,973.73 110.00 10,967.19 110.00 10,960.66 $2,940,500 $2,941,000 110.00 11,001.73 110.00 10,995.20 110.00 10,988.67 110.00 10,982.13 110.00 10,975.60 110.00 10,969.07 110.00 10,962.53 $2,941,000 $2,941,500 110.00 11,003.61 110.00 10,997.08 110.00 10,990.54 110.00 10,984.01 110.00 10,977.48 110.00 10,970.94 110.00 10,964.41 $2,941,500 $2,942,000 110.00 11,005.48 110.00 10,998.95 110.00 10,992.42 110.00 10,985.88 110.00 10,979.35 110.00 10,972.82 110.00 10,966.28 $2,942,000 $2,942,500 110.00 11,007.36 110.00 11,000.83 110.00 10,994.29 110.00 10,987.76 110.00 10,981.23 110.00 10,974.69 110.00 10,968.16 $2,942,500 $2,943,000 110.00 11,009.23 110.00 11,002.70 110.00 10,996.17 110.00 10,989.63 110.00 10,983.10 110.00 10,976.57 110.00 10,970.03 $2,943,000 $2,943,500 110.00 11,011.11 110.00 11,004.58 110.00 10,998.04 110.00 10,991.51 110.00 10,984.98 110.00 10,978.44 110.00 10,971.91 $2,943,500 $2,944,000 110.00 11,012.98 110.00 11,006.45 110.00 10,999.92 110.00 10,993.38 110.00 10,986.85 110.00 10,980.32 110.00 10,973.78 $2,944,000 $2,944,500 110.00 11,014.86 110.00 11,008.33 110.00 11,001.79 110.00 10,995.26 110.00 10,988.73 110.00 10,982.19 110.00 10,975.66 $2,944,500 $2,945,000 110.00 11,016.73 110.00 11,010.20 110.00 11,003.67 110.00 10,997.13 110.00 10,990.60 110.00 10,984.07 110.00 10,977.53 $2,945,000 $2,945,500 110.00 11,018.61 110.00 11,012.08 110.00 11,005.54 110.00 10,999.01 110.00 10,992.48 110.00 10,985.94 110.00 10,979.41 $2,945,500 $2,946,000 110.00 11,020.48 110.00 11,013.95 110.00 11,007.42 110.00 11,000.88 110.00 10,994.35 110.00 10,987.82 110.00 10,981.28 $2,946,000 $2,946,500 110.00 11,022.36 110.00 11,015.83 110.00 11,009.29 110.00 11,002.76 110.00 10,996.23 110.00 10,989.69 110.00 10,983.16 $2,946,500 $2,947,000 110.00 11,024.23 110.00 11,017.70 110.00 11,011.17 110.00 11,004.63 110.00 10,998.10 110.00 10,991.57 110.00 10,985.03 $2,947,000 $2,947,500 110.00 11,026.11 110.00 11,019.58 110.00 11,013.04 110.00 11,006.51 110.00 10,999.98 110.00 10,993.44 110.00 10,986.91 $2,947,500 $2,948,000 110.00 11,027.98 110.00 11,021.45 110.00 11,014.92 110.00 11,008.38 110.00 11,001.85 110.00 10,995.32 110.00 10,988.78 $2,948,000 $2,948,500 110.00 11,029.86 110.00 11,023.33 110.00 11,016.79 110.00 11,010.26 110.00 11,003.73 110.00 10,997.19 110.00 10,990.66 $2,948,500 $2,949,000 110.00 11,031.73 110.00 11,025.20 110.00 11,018.67 110.00 11,012.13 110.00 11,005.60 110.00 10,999.07 110.00 10,992.53 $2,949,000 $2,949,500 110.00 11,033.61 110.00 11,027.08 110.00 11,020.54 110.00 11,014.01 110.00 11,007.48 110.00 11,000.94 110.00 10,994.41 $2,949,500 $2,950,000 110.00 11,035.48 110.00 11,028.95 110.00 11,022.42 110.00 11,015.88 110.00 11,009.35 110.00 11,002.82 110.00 10,996.28 $2,950,000 $2,950,500 110.00 11,037.36 110.00 11,030.83 110.00 11,024.29 110.00 11,017.76 110.00 11,011.23 110.00 11,004.69 110.00 10,998.16 $2,950,500 $2,951,000 110.00 11,039.23 110.00 11,032.70 110.00 11,026.17 110.00 11,019.63 110.00 11,013.10 110.00 11,006.57 110.00 11,000.03 $2,951,000 $2,951,500 110.00 11,041.11 110.00 11,034.58 110.00 11,028.04 110.00 11,021.51 110.00 11,014.98 110.00 11,008.44 110.00 11,001.91 $2,951,500 $2,952,000 110.00 11,042.98 110.00 11,036.45 110.00 11,029.92 110.00 11,023.38 110.00 11,016.85 110.00 11,010.32 110.00 11,003.78 $2,952,000 $2,952,500 110.00 11,044.86 110.00 11,038.33 110.00 11,031.79 110.00 11,025.26 110.00 11,018.73 110.00 11,012.19 110.00 11,005.66 $2,952,500 $2,953,000 110.00 11,046.73 110.00 11,040.20 110.00 11,033.67 110.00 11,027.13 110.00 11,020.60 110.00 11,014.07 110.00 11,007.53 $2,953,000 $2,953,500 110.00 11,048.61 110.00 11,042.08 110.00 11,035.54 110.00 11,029.01 110.00 11,022.48 110.00 11,015.94 110.00 11,009.41 $2,953,500 $2,954,000 110.00 11,050.48 110.00 11,043.95 110.00 11,037.42 110.00 11,030.88 110.00 11,024.35 110.00 11,017.82 110.00 11,011.28 $2,954,000 $2,954,500 110.00 11,052.36 110.00 11,045.83 110.00 11,039.29 110.00 11,032.76 110.00 11,026.23 110.00 11,019.69 110.00 11,013.16 $2,954,500 $2,955,000 110.00 11,054.23 110.00 11,047.70 110.00 11,041.17 110.00 11,034.63 110.00 11,028.10 110.00 11,021.57 110.00 11,015.03 $2,955,000 $2,955,500 110.00 11,056.11 110.00 11,049.58 110.00 11,043.04 110.00 11,036.51 110.00 11,029.98 110.00 11,023.44 110.00 11,016.91 $2,955,500 $2,956,000 110.00 11,057.98 110.00 11,051.45 110.00 11,044.92 110.00 11,038.38 110.00 11,031.85 110.00 11,025.32 110.00 11,018.78 $2,956,000 $2,956,500 110.00 11,059.86 110.00 11,053.33 110.00 11,046.79 110.00 11,040.26 110.00 11,033.73 110.00 11,027.19 110.00 11,020.66 $2,956,500 $2,957,000 110.00 11,061.73 110.00 11,055.20 110.00 11,048.67 110.00 11,042.13 110.00 11,035.60 110.00 11,029.07 110.00 11,022.53 $2,957,000 $2,957,500 110.00 11,063.61 110.00 11,057.08 110.00 11,050.54 110.00 11,044.01 110.00 11,037.48 110.00 11,030.94 110.00 11,024.41 $2,957,500 $2,958,000 110.00 11,065.48 110.00 11,058.95 110.00 11,052.42 110.00 11,045.88 110.00 11,039.35 110.00 11,032.82 110.00 11,026.28

NJEIS Family Cost Participation Table Page 61 of 12 Effective July 1, 2015

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

$2,958,000 $2,958,500 110.00 11,067.36 110.00 11,060.83 110.00 11,054.29 110.00 11,047.76 110.00 11,041.23 110.00 11,034.69 110.00 11,028.16 $2,958,500 $2,959,000 110.00 11,069.23 110.00 11,062.70 110.00 11,056.17 110.00 11,049.63 110.00 11,043.10 110.00 11,036.57 110.00 11,030.03 $2,959,000 $2,959,500 110.00 11,071.11 110.00 11,064.58 110.00 11,058.04 110.00 11,051.51 110.00 11,044.98 110.00 11,038.44 110.00 11,031.91 $2,959,500 $2,960,000 110.00 11,072.98 110.00 11,066.45 110.00 11,059.92 110.00 11,053.38 110.00 11,046.85 110.00 11,040.32 110.00 11,033.78 $2,960,000 $2,960,500 110.00 11,074.86 110.00 11,068.33 110.00 11,061.79 110.00 11,055.26 110.00 11,048.73 110.00 11,042.19 110.00 11,035.66 $2,960,500 $2,961,000 110.00 11,076.73 110.00 11,070.20 110.00 11,063.67 110.00 11,057.13 110.00 11,050.60 110.00 11,044.07 110.00 11,037.53 $2,961,000 $2,961,500 110.00 11,078.61 110.00 11,072.08 110.00 11,065.54 110.00 11,059.01 110.00 11,052.48 110.00 11,045.94 110.00 11,039.41 $2,961,500 $2,962,000 110.00 11,080.48 110.00 11,073.95 110.00 11,067.42 110.00 11,060.88 110.00 11,054.35 110.00 11,047.82 110.00 11,041.28 $2,962,000 $2,962,500 110.00 11,082.36 110.00 11,075.83 110.00 11,069.29 110.00 11,062.76 110.00 11,056.23 110.00 11,049.69 110.00 11,043.16 $2,962,500 $2,963,000 110.00 11,084.23 110.00 11,077.70 110.00 11,071.17 110.00 11,064.63 110.00 11,058.10 110.00 11,051.57 110.00 11,045.03 $2,963,000 $2,963,500 110.00 11,086.11 110.00 11,079.58 110.00 11,073.04 110.00 11,066.51 110.00 11,059.98 110.00 11,053.44 110.00 11,046.91 $2,963,500 $2,964,000 110.00 11,087.98 110.00 11,081.45 110.00 11,074.92 110.00 11,068.38 110.00 11,061.85 110.00 11,055.32 110.00 11,048.78 $2,964,000 $2,964,500 110.00 11,089.86 110.00 11,083.33 110.00 11,076.79 110.00 11,070.26 110.00 11,063.73 110.00 11,057.19 110.00 11,050.66 $2,964,500 $2,965,000 110.00 11,091.73 110.00 11,085.20 110.00 11,078.67 110.00 11,072.13 110.00 11,065.60 110.00 11,059.07 110.00 11,052.53 $2,965,000 $2,965,500 110.00 11,093.61 110.00 11,087.08 110.00 11,080.54 110.00 11,074.01 110.00 11,067.48 110.00 11,060.94 110.00 11,054.41 $2,965,500 $2,966,000 110.00 11,095.48 110.00 11,088.95 110.00 11,082.42 110.00 11,075.88 110.00 11,069.35 110.00 11,062.82 110.00 11,056.28 $2,966,000 $2,966,500 110.00 11,097.36 110.00 11,090.83 110.00 11,084.29 110.00 11,077.76 110.00 11,071.23 110.00 11,064.69 110.00 11,058.16 $2,966,500 $2,967,000 110.00 11,099.23 110.00 11,092.70 110.00 11,086.17 110.00 11,079.63 110.00 11,073.10 110.00 11,066.57 110.00 11,060.03 $2,967,000 $2,967,500 110.00 11,101.11 110.00 11,094.58 110.00 11,088.04 110.00 11,081.51 110.00 11,074.98 110.00 11,068.44 110.00 11,061.91 $2,967,500 $2,968,000 110.00 11,102.98 110.00 11,096.45 110.00 11,089.92 110.00 11,083.38 110.00 11,076.85 110.00 11,070.32 110.00 11,063.78 $2,968,000 $2,968,500 110.00 11,104.86 110.00 11,098.33 110.00 11,091.79 110.00 11,085.26 110.00 11,078.73 110.00 11,072.19 110.00 11,065.66 $2,968,500 $2,969,000 110.00 11,106.73 110.00 11,100.20 110.00 11,093.67 110.00 11,087.13 110.00 11,080.60 110.00 11,074.07 110.00 11,067.53 $2,969,000 $2,969,500 110.00 11,108.61 110.00 11,102.08 110.00 11,095.54 110.00 11,089.01 110.00 11,082.48 110.00 11,075.94 110.00 11,069.41 $2,969,500 $2,970,000 110.00 11,110.48 110.00 11,103.95 110.00 11,097.42 110.00 11,090.88 110.00 11,084.35 110.00 11,077.82 110.00 11,071.28 $2,970,000 $2,970,500 110.00 11,112.36 110.00 11,105.83 110.00 11,099.29 110.00 11,092.76 110.00 11,086.23 110.00 11,079.69 110.00 11,073.16 $2,970,500 $2,971,000 110.00 11,114.23 110.00 11,107.70 110.00 11,101.17 110.00 11,094.63 110.00 11,088.10 110.00 11,081.57 110.00 11,075.03 $2,971,000 $2,971,500 110.00 11,116.11 110.00 11,109.58 110.00 11,103.04 110.00 11,096.51 110.00 11,089.98 110.00 11,083.44 110.00 11,076.91 $2,971,500 $2,972,000 110.00 11,117.98 110.00 11,111.45 110.00 11,104.92 110.00 11,098.38 110.00 11,091.85 110.00 11,085.32 110.00 11,078.78 $2,972,000 $2,972,500 110.00 11,119.86 110.00 11,113.33 110.00 11,106.79 110.00 11,100.26 110.00 11,093.73 110.00 11,087.19 110.00 11,080.66 $2,972,500 $2,973,000 110.00 11,121.73 110.00 11,115.20 110.00 11,108.67 110.00 11,102.13 110.00 11,095.60 110.00 11,089.07 110.00 11,082.53 $2,973,000 $2,973,500 110.00 11,123.61 110.00 11,117.08 110.00 11,110.54 110.00 11,104.01 110.00 11,097.48 110.00 11,090.94 110.00 11,084.41 $2,973,500 $2,974,000 110.00 11,125.48 110.00 11,118.95 110.00 11,112.42 110.00 11,105.88 110.00 11,099.35 110.00 11,092.82 110.00 11,086.28 $2,974,000 $2,974,500 110.00 11,127.36 110.00 11,120.83 110.00 11,114.29 110.00 11,107.76 110.00 11,101.23 110.00 11,094.69 110.00 11,088.16 $2,974,500 $2,975,000 110.00 11,129.23 110.00 11,122.70 110.00 11,116.17 110.00 11,109.63 110.00 11,103.10 110.00 11,096.57 110.00 11,090.03 $2,975,000 $2,975,500 110.00 11,131.11 110.00 11,124.58 110.00 11,118.04 110.00 11,111.51 110.00 11,104.98 110.00 11,098.44 110.00 11,091.91 $2,975,500 $2,976,000 110.00 11,132.98 110.00 11,126.45 110.00 11,119.92 110.00 11,113.38 110.00 11,106.85 110.00 11,100.32 110.00 11,093.78 $2,976,000 $2,976,500 110.00 11,134.86 110.00 11,128.33 110.00 11,121.79 110.00 11,115.26 110.00 11,108.73 110.00 11,102.19 110.00 11,095.66 $2,976,500 $2,977,000 110.00 11,136.73 110.00 11,130.20 110.00 11,123.67 110.00 11,117.13 110.00 11,110.60 110.00 11,104.07 110.00 11,097.53 $2,977,000 $2,977,500 110.00 11,138.61 110.00 11,132.08 110.00 11,125.54 110.00 11,119.01 110.00 11,112.48 110.00 11,105.94 110.00 11,099.41 $2,977,500 $2,978,000 110.00 11,140.48 110.00 11,133.95 110.00 11,127.42 110.00 11,120.88 110.00 11,114.35 110.00 11,107.82 110.00 11,101.28 $2,978,000 $2,978,500 110.00 11,142.36 110.00 11,135.83 110.00 11,129.29 110.00 11,122.76 110.00 11,116.23 110.00 11,109.69 110.00 11,103.16 $2,978,500 $2,979,000 110.00 11,144.23 110.00 11,137.70 110.00 11,131.17 110.00 11,124.63 110.00 11,118.10 110.00 11,111.57 110.00 11,105.03 $2,979,000 $2,979,500 110.00 11,146.11 110.00 11,139.58 110.00 11,133.04 110.00 11,126.51 110.00 11,119.98 110.00 11,113.44 110.00 11,106.91 $2,979,500 $2,980,000 110.00 11,147.98 110.00 11,141.45 110.00 11,134.92 110.00 11,128.38 110.00 11,121.85 110.00 11,115.32 110.00 11,108.78 $2,980,000 $2,980,500 110.00 11,149.86 110.00 11,143.33 110.00 11,136.79 110.00 11,130.26 110.00 11,123.73 110.00 11,117.19 110.00 11,110.66 $2,980,500 $2,981,000 110.00 11,151.73 110.00 11,145.20 110.00 11,138.67 110.00 11,132.13 110.00 11,125.60 110.00 11,119.07 110.00 11,112.53 $2,981,000 $2,981,500 110.00 11,153.61 110.00 11,147.08 110.00 11,140.54 110.00 11,134.01 110.00 11,127.48 110.00 11,120.94 110.00 11,114.41 $2,981,500 $2,982,000 110.00 11,155.48 110.00 11,148.95 110.00 11,142.42 110.00 11,135.88 110.00 11,129.35 110.00 11,122.82 110.00 11,116.28 $2,982,000 $2,982,500 110.00 11,157.36 110.00 11,150.83 110.00 11,144.29 110.00 11,137.76 110.00 11,131.23 110.00 11,124.69 110.00 11,118.16 $2,982,500 $2,983,000 110.00 11,159.23 110.00 11,152.70 110.00 11,146.17 110.00 11,139.63 110.00 11,133.10 110.00 11,126.57 110.00 11,120.03 $2,983,000 $2,983,500 110.00 11,161.11 110.00 11,154.58 110.00 11,148.04 110.00 11,141.51 110.00 11,134.98 110.00 11,128.44 110.00 11,121.91 $2,983,500 $2,984,000 110.00 11,162.98 110.00 11,156.45 110.00 11,149.92 110.00 11,143.38 110.00 11,136.85 110.00 11,130.32 110.00 11,123.78 $2,984,000 $2,984,500 110.00 11,164.86 110.00 11,158.33 110.00 11,151.79 110.00 11,145.26 110.00 11,138.73 110.00 11,132.19 110.00 11,125.66 $2,984,500 $2,985,000 110.00 11,166.73 110.00 11,160.20 110.00 11,153.67 110.00 11,147.13 110.00 11,140.60 110.00 11,134.07 110.00 11,127.53 $2,985,000 $2,985,500 110.00 11,168.61 110.00 11,162.08 110.00 11,155.54 110.00 11,149.01 110.00 11,142.48 110.00 11,135.94 110.00 11,129.41 $2,985,500 $2,986,000 110.00 11,170.48 110.00 11,163.95 110.00 11,157.42 110.00 11,150.88 110.00 11,144.35 110.00 11,137.82 110.00 11,131.28 $2,986,000 $2,986,500 110.00 11,172.36 110.00 11,165.83 110.00 11,159.29 110.00 11,152.76 110.00 11,146.23 110.00 11,139.69 110.00 11,133.16 $2,986,500 $2,987,000 110.00 11,174.23 110.00 11,167.70 110.00 11,161.17 110.00 11,154.63 110.00 11,148.10 110.00 11,141.57 110.00 11,135.03 $2,987,000 $2,987,500 110.00 11,176.11 110.00 11,169.58 110.00 11,163.04 110.00 11,156.51 110.00 11,149.98 110.00 11,143.44 110.00 11,136.91 $2,987,500 $2,988,000 110.00 11,177.98 110.00 11,171.45 110.00 11,164.92 110.00 11,158.38 110.00 11,151.85 110.00 11,145.32 110.00 11,138.78 $2,988,000 $2,988,500 110.00 11,179.86 110.00 11,173.33 110.00 11,166.79 110.00 11,160.26 110.00 11,153.73 110.00 11,147.19 110.00 11,140.66 $2,988,500 $2,989,000 110.00 11,181.73 110.00 11,175.20 110.00 11,168.67 110.00 11,162.13 110.00 11,155.60 110.00 11,149.07 110.00 11,142.53 $2,989,000 $2,989,500 110.00 11,183.61 110.00 11,177.08 110.00 11,170.54 110.00 11,164.01 110.00 11,157.48 110.00 11,150.94 110.00 11,144.41 $2,989,500 $2,990,000 110.00 11,185.48 110.00 11,178.95 110.00 11,172.42 110.00 11,165.88 110.00 11,159.35 110.00 11,152.82 110.00 11,146.28 $2,990,000 $2,990,500 110.00 11,187.36 110.00 11,180.83 110.00 11,174.29 110.00 11,167.76 110.00 11,161.23 110.00 11,154.69 110.00 11,148.16 $2,990,500 $2,991,000 110.00 11,189.23 110.00 11,182.70 110.00 11,176.17 110.00 11,169.63 110.00 11,163.10 110.00 11,156.57 110.00 11,150.03 $2,991,000 $2,991,500 110.00 11,191.11 110.00 11,184.58 110.00 11,178.04 110.00 11,171.51 110.00 11,164.98 110.00 11,158.44 110.00 11,151.91 $2,991,500 $2,992,000 110.00 11,192.98 110.00 11,186.45 110.00 11,179.92 110.00 11,173.38 110.00 11,166.85 110.00 11,160.32 110.00 11,153.78 $2,992,000 $2,992,500 110.00 11,194.86 110.00 11,188.33 110.00 11,181.79 110.00 11,175.26 110.00 11,168.73 110.00 11,162.19 110.00 11,155.66 $2,992,500 $2,993,000 110.00 11,196.73 110.00 11,190.20 110.00 11,183.67 110.00 11,177.13 110.00 11,170.60 110.00 11,164.07 110.00 11,157.53 $2,993,000 $2,993,500 110.00 11,198.61 110.00 11,192.08 110.00 11,185.54 110.00 11,179.01 110.00 11,172.48 110.00 11,165.94 110.00 11,159.41 $2,993,500 $2,994,000 110.00 11,200.48 110.00 11,193.95 110.00 11,187.42 110.00 11,180.88 110.00 11,174.35 110.00 11,167.82 110.00 11,161.28 $2,994,000 $2,994,500 110.00 11,202.36 110.00 11,195.83 110.00 11,189.29 110.00 11,182.76 110.00 11,176.23 110.00 11,169.69 110.00 11,163.16 $2,994,500 $2,995,000 110.00 11,204.23 110.00 11,197.70 110.00 11,191.17 110.00 11,184.63 110.00 11,178.10 110.00 11,171.57 110.00 11,165.03 $2,995,000 $2,995,500 110.00 11,206.11 110.00 11,199.58 110.00 11,193.04 110.00 11,186.51 110.00 11,179.98 110.00 11,173.44 110.00 11,166.91 $2,995,500 $2,996,000 110.00 11,207.98 110.00 11,201.45 110.00 11,194.92 110.00 11,188.38 110.00 11,181.85 110.00 11,175.32 110.00 11,168.78 $2,996,000 $2,996,500 110.00 11,209.86 110.00 11,203.33 110.00 11,196.79 110.00 11,190.26 110.00 11,183.73 110.00 11,177.19 110.00 11,170.66 $2,996,500 $2,997,000 110.00 11,211.73 110.00 11,205.20 110.00 11,198.67 110.00 11,192.13 110.00 11,185.60 110.00 11,179.07 110.00 11,172.53 $2,997,000 $2,997,500 110.00 11,213.61 110.00 11,207.08 110.00 11,200.54 110.00 11,194.01 110.00 11,187.48 110.00 11,180.94 110.00 11,174.41 $2,997,500 $2,998,000 110.00 11,215.48 110.00 11,208.95 110.00 11,202.42 110.00 11,195.88 110.00 11,189.35 110.00 11,182.82 110.00 11,176.28 $2,998,000 $2,998,500 110.00 11,217.36 110.00 11,210.83 110.00 11,204.29 110.00 11,197.76 110.00 11,191.23 110.00 11,184.69 110.00 11,178.16 $2,998,500 $2,999,000 110.00 11,219.23 110.00 11,212.70 110.00 11,206.17 110.00 11,199.63 110.00 11,193.10 110.00 11,186.57 110.00 11,180.03 $2,999,000 $2,999,500 110.00 11,221.11 110.00 11,214.58 110.00 11,208.04 110.00 11,201.51 110.00 11,194.98 110.00 11,188.44 110.00 11,181.91 $2,999,500 $3,000,000 110.00 11,222.98 110.00 11,216.45 110.00 11,209.92 110.00 11,203.38 110.00 11,196.85 110.00 11,190.32 110.00 11,183.78 $3,000,000 $3,000,500 110.00 11,224.86 110.00 11,218.33 110.00 11,211.79 110.00 11,205.26 110.00 11,198.73 110.00 11,192.19 110.00 11,185.66 $3,000,500 $3,001,000 110.00 11,226.73 110.00 11,220.20 110.00 11,213.67 110.00 11,207.13 110.00 11,200.60 110.00 11,194.07 110.00 11,187.53 $3,001,000 $3,001,500 110.00 11,228.61 110.00 11,222.08 110.00 11,215.54 110.00 11,209.01 110.00 11,202.48 110.00 11,195.94 110.00 11,189.41 $3,001,500 $3,002,000 110.00 11,230.48 110.00 11,223.95 110.00 11,217.42 110.00 11,210.88 110.00 11,204.35 110.00 11,197.82 110.00 11,191.28 $3,002,000 $3,002,500 110.00 11,232.36 110.00 11,225.83 110.00 11,219.29 110.00 11,212.76 110.00 11,206.23 110.00 11,199.69 110.00 11,193.16 $3,002,500 $3,003,000 110.00 11,234.23 110.00 11,227.70 110.00 11,221.17 110.00 11,214.63 110.00 11,208.10 110.00 11,201.57 110.00 11,195.03 $3,003,000 $3,003,500 110.00 11,236.11 110.00 11,229.58 110.00 11,223.04 110.00 11,216.51 110.00 11,209.98 110.00 11,203.44 110.00 11,196.91 $3,003,500 $3,004,000 110.00 11,237.98 110.00 11,231.45 110.00 11,224.92 110.00 11,218.38 110.00 11,211.85 110.00 11,205.32 110.00 11,198.78 $3,004,000 $3,004,500 110.00 11,239.86 110.00 11,233.33 110.00 11,226.79 110.00 11,220.26 110.00 11,213.73 110.00 11,207.19 110.00 11,200.66 $3,004,500 $3,005,000 110.00 11,241.73 110.00 11,235.20 110.00 11,228.67 110.00 11,222.13 110.00 11,215.60 110.00 11,209.07 110.00 11,202.53 $3,005,000 $3,005,500 110.00 11,243.61 110.00 11,237.08 110.00 11,230.54 110.00 11,224.01 110.00 11,217.48 110.00 11,210.94 110.00 11,204.41 $3,005,500 $3,006,000 110.00 11,245.48 110.00 11,238.95 110.00 11,232.42 110.00 11,225.88 110.00 11,219.35 110.00 11,212.82 110.00 11,206.28 $3,006,000 $3,006,500 110.00 11,247.36 110.00 11,240.83 110.00 11,234.29 110.00 11,227.76 110.00 11,221.23 110.00 11,214.69 110.00 11,208.16 $3,006,500 $3,007,000 110.00 11,249.23 110.00 11,242.70 110.00 11,236.17 110.00 11,229.63 110.00 11,223.10 110.00 11,216.57 110.00 11,210.03 $3,007,000 $3,007,500 110.00 11,251.11 110.00 11,244.58 110.00 11,238.04 110.00 11,231.51 110.00 11,224.98 110.00 11,218.44 110.00 11,211.91 $3,007,500 $3,008,000 110.00 11,252.98 110.00 11,246.45 110.00 11,239.92 110.00 11,233.38 110.00 11,226.85 110.00 11,220.32 110.00 11,213.78 $3,008,000 $3,008,500 110.00 11,254.86 110.00 11,248.33 110.00 11,241.79 110.00 11,235.26 110.00 11,228.73 110.00 11,222.19 110.00 11,215.66 $3,008,500 $3,009,000 110.00 11,256.73 110.00 11,250.20 110.00 11,243.67 110.00 11,237.13 110.00 11,230.60 110.00 11,224.07 110.00 11,217.53

NJEIS Family Cost Participation Table Page 62 of 12 Effective July 1, 2015

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

$3,009,000 $3,009,500 110.00 11,258.61 110.00 11,252.08 110.00 11,245.54 110.00 11,239.01 110.00 11,232.48 110.00 11,225.94 110.00 11,219.41 $3,009,500 $3,010,000 110.00 11,260.48 110.00 11,253.95 110.00 11,247.42 110.00 11,240.88 110.00 11,234.35 110.00 11,227.82 110.00 11,221.28 $3,010,000 $3,010,500 110.00 11,262.36 110.00 11,255.83 110.00 11,249.29 110.00 11,242.76 110.00 11,236.23 110.00 11,229.69 110.00 11,223.16 $3,010,500 $3,011,000 110.00 11,264.23 110.00 11,257.70 110.00 11,251.17 110.00 11,244.63 110.00 11,238.10 110.00 11,231.57 110.00 11,225.03 $3,011,000 $3,011,500 110.00 11,266.11 110.00 11,259.58 110.00 11,253.04 110.00 11,246.51 110.00 11,239.98 110.00 11,233.44 110.00 11,226.91 $3,011,500 $3,012,000 110.00 11,267.98 110.00 11,261.45 110.00 11,254.92 110.00 11,248.38 110.00 11,241.85 110.00 11,235.32 110.00 11,228.78 $3,012,000 $3,012,500 110.00 11,269.86 110.00 11,263.33 110.00 11,256.79 110.00 11,250.26 110.00 11,243.73 110.00 11,237.19 110.00 11,230.66 $3,012,500 $3,013,000 110.00 11,271.73 110.00 11,265.20 110.00 11,258.67 110.00 11,252.13 110.00 11,245.60 110.00 11,239.07 110.00 11,232.53 $3,013,000 $3,013,500 110.00 11,273.61 110.00 11,267.08 110.00 11,260.54 110.00 11,254.01 110.00 11,247.48 110.00 11,240.94 110.00 11,234.41 $3,013,500 $3,014,000 110.00 11,275.48 110.00 11,268.95 110.00 11,262.42 110.00 11,255.88 110.00 11,249.35 110.00 11,242.82 110.00 11,236.28 $3,014,000 $3,014,500 110.00 11,277.36 110.00 11,270.83 110.00 11,264.29 110.00 11,257.76 110.00 11,251.23 110.00 11,244.69 110.00 11,238.16 $3,014,500 $3,015,000 110.00 11,279.23 110.00 11,272.70 110.00 11,266.17 110.00 11,259.63 110.00 11,253.10 110.00 11,246.57 110.00 11,240.03 $3,015,000 $3,015,500 110.00 11,281.11 110.00 11,274.58 110.00 11,268.04 110.00 11,261.51 110.00 11,254.98 110.00 11,248.44 110.00 11,241.91 $3,015,500 $3,016,000 110.00 11,282.98 110.00 11,276.45 110.00 11,269.92 110.00 11,263.38 110.00 11,256.85 110.00 11,250.32 110.00 11,243.78 $3,016,000 $3,016,500 110.00 11,284.86 110.00 11,278.33 110.00 11,271.79 110.00 11,265.26 110.00 11,258.73 110.00 11,252.19 110.00 11,245.66 $3,016,500 $3,017,000 110.00 11,286.73 110.00 11,280.20 110.00 11,273.67 110.00 11,267.13 110.00 11,260.60 110.00 11,254.07 110.00 11,247.53 $3,017,000 $3,017,500 110.00 11,288.61 110.00 11,282.08 110.00 11,275.54 110.00 11,269.01 110.00 11,262.48 110.00 11,255.94 110.00 11,249.41 $3,017,500 $3,018,000 110.00 11,290.48 110.00 11,283.95 110.00 11,277.42 110.00 11,270.88 110.00 11,264.35 110.00 11,257.82 110.00 11,251.28 $3,018,000 $3,018,500 110.00 11,292.36 110.00 11,285.83 110.00 11,279.29 110.00 11,272.76 110.00 11,266.23 110.00 11,259.69 110.00 11,253.16 $3,018,500 $3,019,000 110.00 11,294.23 110.00 11,287.70 110.00 11,281.17 110.00 11,274.63 110.00 11,268.10 110.00 11,261.57 110.00 11,255.03 $3,019,000 $3,019,500 110.00 11,296.11 110.00 11,289.58 110.00 11,283.04 110.00 11,276.51 110.00 11,269.98 110.00 11,263.44 110.00 11,256.91 $3,019,500 $3,020,000 110.00 11,297.98 110.00 11,291.45 110.00 11,284.92 110.00 11,278.38 110.00 11,271.85 110.00 11,265.32 110.00 11,258.78 $3,020,000 $3,020,500 110.00 11,299.86 110.00 11,293.33 110.00 11,286.79 110.00 11,280.26 110.00 11,273.73 110.00 11,267.19 110.00 11,260.66 $3,020,500 $3,021,000 110.00 11,301.73 110.00 11,295.20 110.00 11,288.67 110.00 11,282.13 110.00 11,275.60 110.00 11,269.07 110.00 11,262.53 $3,021,000 $3,021,500 110.00 11,303.61 110.00 11,297.08 110.00 11,290.54 110.00 11,284.01 110.00 11,277.48 110.00 11,270.94 110.00 11,264.41 $3,021,500 $3,022,000 110.00 11,305.48 110.00 11,298.95 110.00 11,292.42 110.00 11,285.88 110.00 11,279.35 110.00 11,272.82 110.00 11,266.28 $3,022,000 $3,022,500 110.00 11,307.36 110.00 11,300.83 110.00 11,294.29 110.00 11,287.76 110.00 11,281.23 110.00 11,274.69 110.00 11,268.16 $3,022,500 $3,023,000 110.00 11,309.23 110.00 11,302.70 110.00 11,296.17 110.00 11,289.63 110.00 11,283.10 110.00 11,276.57 110.00 11,270.03 $3,023,000 $3,023,500 110.00 11,311.11 110.00 11,304.58 110.00 11,298.04 110.00 11,291.51 110.00 11,284.98 110.00 11,278.44 110.00 11,271.91 $3,023,500 $3,024,000 110.00 11,312.98 110.00 11,306.45 110.00 11,299.92 110.00 11,293.38 110.00 11,286.85 110.00 11,280.32 110.00 11,273.78 $3,024,000 $3,024,500 110.00 11,314.86 110.00 11,308.33 110.00 11,301.79 110.00 11,295.26 110.00 11,288.73 110.00 11,282.19 110.00 11,275.66 $3,024,500 $3,025,000 110.00 11,316.73 110.00 11,310.20 110.00 11,303.67 110.00 11,297.13 110.00 11,290.60 110.00 11,284.07 110.00 11,277.53 $3,025,000 $3,025,500 110.00 11,318.61 110.00 11,312.08 110.00 11,305.54 110.00 11,299.01 110.00 11,292.48 110.00 11,285.94 110.00 11,279.41 $3,025,500 $3,026,000 110.00 11,320.48 110.00 11,313.95 110.00 11,307.42 110.00 11,300.88 110.00 11,294.35 110.00 11,287.82 110.00 11,281.28 $3,026,000 $3,026,500 110.00 11,322.36 110.00 11,315.83 110.00 11,309.29 110.00 11,302.76 110.00 11,296.23 110.00 11,289.69 110.00 11,283.16 $3,026,500 $3,027,000 110.00 11,324.23 110.00 11,317.70 110.00 11,311.17 110.00 11,304.63 110.00 11,298.10 110.00 11,291.57 110.00 11,285.03 $3,027,000 $3,027,500 110.00 11,326.11 110.00 11,319.58 110.00 11,313.04 110.00 11,306.51 110.00 11,299.98 110.00 11,293.44 110.00 11,286.91 $3,027,500 $3,028,000 110.00 11,327.98 110.00 11,321.45 110.00 11,314.92 110.00 11,308.38 110.00 11,301.85 110.00 11,295.32 110.00 11,288.78 $3,028,000 $3,028,500 110.00 11,329.86 110.00 11,323.33 110.00 11,316.79 110.00 11,310.26 110.00 11,303.73 110.00 11,297.19 110.00 11,290.66 $3,028,500 $3,029,000 110.00 11,331.73 110.00 11,325.20 110.00 11,318.67 110.00 11,312.13 110.00 11,305.60 110.00 11,299.07 110.00 11,292.53 $3,029,000 $3,029,500 110.00 11,333.61 110.00 11,327.08 110.00 11,320.54 110.00 11,314.01 110.00 11,307.48 110.00 11,300.94 110.00 11,294.41 $3,029,500 $3,030,000 110.00 11,335.48 110.00 11,328.95 110.00 11,322.42 110.00 11,315.88 110.00 11,309.35 110.00 11,302.82 110.00 11,296.28 $3,030,000 $3,030,500 110.00 11,337.36 110.00 11,330.83 110.00 11,324.29 110.00 11,317.76 110.00 11,311.23 110.00 11,304.69 110.00 11,298.16 $3,030,500 $3,031,000 110.00 11,339.23 110.00 11,332.70 110.00 11,326.17 110.00 11,319.63 110.00 11,313.10 110.00 11,306.57 110.00 11,300.03 $3,031,000 $3,031,500 110.00 11,341.11 110.00 11,334.58 110.00 11,328.04 110.00 11,321.51 110.00 11,314.98 110.00 11,308.44 110.00 11,301.91 $3,031,500 $3,032,000 110.00 11,342.98 110.00 11,336.45 110.00 11,329.92 110.00 11,323.38 110.00 11,316.85 110.00 11,310.32 110.00 11,303.78 $3,032,000 $3,032,500 110.00 11,344.86 110.00 11,338.33 110.00 11,331.79 110.00 11,325.26 110.00 11,318.73 110.00 11,312.19 110.00 11,305.66 $3,032,500 $3,033,000 110.00 11,346.73 110.00 11,340.20 110.00 11,333.67 110.00 11,327.13 110.00 11,320.60 110.00 11,314.07 110.00 11,307.53 $3,033,000 $3,033,500 110.00 11,348.61 110.00 11,342.08 110.00 11,335.54 110.00 11,329.01 110.00 11,322.48 110.00 11,315.94 110.00 11,309.41 $3,033,500 $3,034,000 110.00 11,350.48 110.00 11,343.95 110.00 11,337.42 110.00 11,330.88 110.00 11,324.35 110.00 11,317.82 110.00 11,311.28 $3,034,000 $3,034,500 110.00 11,352.36 110.00 11,345.83 110.00 11,339.29 110.00 11,332.76 110.00 11,326.23 110.00 11,319.69 110.00 11,313.16 $3,034,500 $3,035,000 110.00 11,354.23 110.00 11,347.70 110.00 11,341.17 110.00 11,334.63 110.00 11,328.10 110.00 11,321.57 110.00 11,315.03 $3,035,000 $3,035,500 110.00 11,356.11 110.00 11,349.58 110.00 11,343.04 110.00 11,336.51 110.00 11,329.98 110.00 11,323.44 110.00 11,316.91 $3,035,500 $3,036,000 110.00 11,357.98 110.00 11,351.45 110.00 11,344.92 110.00 11,338.38 110.00 11,331.85 110.00 11,325.32 110.00 11,318.78 $3,036,000 $3,036,500 110.00 11,359.86 110.00 11,353.33 110.00 11,346.79 110.00 11,340.26 110.00 11,333.73 110.00 11,327.19 110.00 11,320.66 $3,036,500 $3,037,000 110.00 11,361.73 110.00 11,355.20 110.00 11,348.67 110.00 11,342.13 110.00 11,335.60 110.00 11,329.07 110.00 11,322.53 $3,037,000 $3,037,500 110.00 11,363.61 110.00 11,357.08 110.00 11,350.54 110.00 11,344.01 110.00 11,337.48 110.00 11,330.94 110.00 11,324.41 $3,037,500 $3,038,000 110.00 11,365.48 110.00 11,358.95 110.00 11,352.42 110.00 11,345.88 110.00 11,339.35 110.00 11,332.82 110.00 11,326.28 $3,038,000 $3,038,500 110.00 11,367.36 110.00 11,360.83 110.00 11,354.29 110.00 11,347.76 110.00 11,341.23 110.00 11,334.69 110.00 11,328.16 $3,038,500 $3,039,000 110.00 11,369.23 110.00 11,362.70 110.00 11,356.17 110.00 11,349.63 110.00 11,343.10 110.00 11,336.57 110.00 11,330.03 $3,039,000 $3,039,500 110.00 11,371.11 110.00 11,364.58 110.00 11,358.04 110.00 11,351.51 110.00 11,344.98 110.00 11,338.44 110.00 11,331.91 $3,039,500 $3,040,000 110.00 11,372.98 110.00 11,366.45 110.00 11,359.92 110.00 11,353.38 110.00 11,346.85 110.00 11,340.32 110.00 11,333.78 $3,040,000 $3,040,500 110.00 11,374.86 110.00 11,368.33 110.00 11,361.79 110.00 11,355.26 110.00 11,348.73 110.00 11,342.19 110.00 11,335.66 $3,040,500 $3,041,000 110.00 11,376.73 110.00 11,370.20 110.00 11,363.67 110.00 11,357.13 110.00 11,350.60 110.00 11,344.07 110.00 11,337.53 $3,041,000 $3,041,500 110.00 11,378.61 110.00 11,372.08 110.00 11,365.54 110.00 11,359.01 110.00 11,352.48 110.00 11,345.94 110.00 11,339.41 $3,041,500 $3,042,000 110.00 11,380.48 110.00 11,373.95 110.00 11,367.42 110.00 11,360.88 110.00 11,354.35 110.00 11,347.82 110.00 11,341.28 $3,042,000 $3,042,500 110.00 11,382.36 110.00 11,375.83 110.00 11,369.29 110.00 11,362.76 110.00 11,356.23 110.00 11,349.69 110.00 11,343.16 $3,042,500 $3,043,000 110.00 11,384.23 110.00 11,377.70 110.00 11,371.17 110.00 11,364.63 110.00 11,358.10 110.00 11,351.57 110.00 11,345.03 $3,043,000 $3,043,500 110.00 11,386.11 110.00 11,379.58 110.00 11,373.04 110.00 11,366.51 110.00 11,359.98 110.00 11,353.44 110.00 11,346.91 $3,043,500 $3,044,000 110.00 11,387.98 110.00 11,381.45 110.00 11,374.92 110.00 11,368.38 110.00 11,361.85 110.00 11,355.32 110.00 11,348.78 $3,044,000 $3,044,500 110.00 11,389.86 110.00 11,383.33 110.00 11,376.79 110.00 11,370.26 110.00 11,363.73 110.00 11,357.19 110.00 11,350.66 $3,044,500 $3,045,000 110.00 11,391.73 110.00 11,385.20 110.00 11,378.67 110.00 11,372.13 110.00 11,365.60 110.00 11,359.07 110.00 11,352.53 $3,045,000 $3,045,500 110.00 11,393.61 110.00 11,387.08 110.00 11,380.54 110.00 11,374.01 110.00 11,367.48 110.00 11,360.94 110.00 11,354.41 $3,045,500 $3,046,000 110.00 11,395.48 110.00 11,388.95 110.00 11,382.42 110.00 11,375.88 110.00 11,369.35 110.00 11,362.82 110.00 11,356.28 $3,046,000 $3,046,500 110.00 11,397.36 110.00 11,390.83 110.00 11,384.29 110.00 11,377.76 110.00 11,371.23 110.00 11,364.69 110.00 11,358.16 $3,046,500 $3,047,000 110.00 11,399.23 110.00 11,392.70 110.00 11,386.17 110.00 11,379.63 110.00 11,373.10 110.00 11,366.57 110.00 11,360.03 $3,047,000 $3,047,500 110.00 11,401.11 110.00 11,394.58 110.00 11,388.04 110.00 11,381.51 110.00 11,374.98 110.00 11,368.44 110.00 11,361.91 $3,047,500 $3,048,000 110.00 11,402.98 110.00 11,396.45 110.00 11,389.92 110.00 11,383.38 110.00 11,376.85 110.00 11,370.32 110.00 11,363.78 $3,048,000 $3,048,500 110.00 11,404.86 110.00 11,398.33 110.00 11,391.79 110.00 11,385.26 110.00 11,378.73 110.00 11,372.19 110.00 11,365.66 $3,048,500 $3,049,000 110.00 11,406.73 110.00 11,400.20 110.00 11,393.67 110.00 11,387.13 110.00 11,380.60 110.00 11,374.07 110.00 11,367.53 $3,049,000 $3,049,500 110.00 11,408.61 110.00 11,402.08 110.00 11,395.54 110.00 11,389.01 110.00 11,382.48 110.00 11,375.94 110.00 11,369.41 $3,049,500 $3,050,000 110.00 11,410.48 110.00 11,403.95 110.00 11,397.42 110.00 11,390.88 110.00 11,384.35 110.00 11,377.82 110.00 11,371.28 $3,050,000 $3,050,500 110.00 11,412.36 110.00 11,405.83 110.00 11,399.29 110.00 11,392.76 110.00 11,386.23 110.00 11,379.69 110.00 11,373.16 $3,050,500 $3,051,000 110.00 11,414.23 110.00 11,407.70 110.00 11,401.17 110.00 11,394.63 110.00 11,388.10 110.00 11,381.57 110.00 11,375.03 $3,051,000 $3,051,500 110.00 11,416.11 110.00 11,409.58 110.00 11,403.04 110.00 11,396.51 110.00 11,389.98 110.00 11,383.44 110.00 11,376.91 $3,051,500 $3,052,000 110.00 11,417.98 110.00 11,411.45 110.00 11,404.92 110.00 11,398.38 110.00 11,391.85 110.00 11,385.32 110.00 11,378.78 $3,052,000 $3,052,500 110.00 11,419.86 110.00 11,413.33 110.00 11,406.79 110.00 11,400.26 110.00 11,393.73 110.00 11,387.19 110.00 11,380.66 $3,052,500 $3,053,000 110.00 11,421.73 110.00 11,415.20 110.00 11,408.67 110.00 11,402.13 110.00 11,395.60 110.00 11,389.07 110.00 11,382.53 $3,053,000 $3,053,500 110.00 11,423.61 110.00 11,417.08 110.00 11,410.54 110.00 11,404.01 110.00 11,397.48 110.00 11,390.94 110.00 11,384.41 $3,053,500 $3,054,000 110.00 11,425.48 110.00 11,418.95 110.00 11,412.42 110.00 11,405.88 110.00 11,399.35 110.00 11,392.82 110.00 11,386.28 $3,054,000 $3,054,500 110.00 11,427.36 110.00 11,420.83 110.00 11,414.29 110.00 11,407.76 110.00 11,401.23 110.00 11,394.69 110.00 11,388.16 $3,054,500 $3,055,000 110.00 11,429.23 110.00 11,422.70 110.00 11,416.17 110.00 11,409.63 110.00 11,403.10 110.00 11,396.57 110.00 11,390.03 $3,055,000 $3,055,500 110.00 11,431.11 110.00 11,424.58 110.00 11,418.04 110.00 11,411.51 110.00 11,404.98 110.00 11,398.44 110.00 11,391.91 $3,055,500 $3,056,000 110.00 11,432.98 110.00 11,426.45 110.00 11,419.92 110.00 11,413.38 110.00 11,406.85 110.00 11,400.32 110.00 11,393.78 $3,056,000 $3,056,500 110.00 11,434.86 110.00 11,428.33 110.00 11,421.79 110.00 11,415.26 110.00 11,408.73 110.00 11,402.19 110.00 11,395.66 $3,056,500 $3,057,000 110.00 11,436.73 110.00 11,430.20 110.00 11,423.67 110.00 11,417.13 110.00 11,410.60 110.00 11,404.07 110.00 11,397.53 $3,057,000 $3,057,500 110.00 11,438.61 110.00 11,432.08 110.00 11,425.54 110.00 11,419.01 110.00 11,412.48 110.00 11,405.94 110.00 11,399.41 $3,057,500 $3,058,000 110.00 11,440.48 110.00 11,433.95 110.00 11,427.42 110.00 11,420.88 110.00 11,414.35 110.00 11,407.82 110.00 11,401.28 $3,058,000 $3,058,500 110.00 11,442.36 110.00 11,435.83 110.00 11,429.29 110.00 11,422.76 110.00 11,416.23 110.00 11,409.69 110.00 11,403.16 $3,058,500 $3,059,000 110.00 11,444.23 110.00 11,437.70 110.00 11,431.17 110.00 11,424.63 110.00 11,418.10 110.00 11,411.57 110.00 11,405.03 $3,059,000 $3,059,500 110.00 11,446.11 110.00 11,439.58 110.00 11,433.04 110.00 11,426.51 110.00 11,419.98 110.00 11,413.44 110.00 11,406.91 $3,059,500 $3,060,000 110.00 11,447.98 110.00 11,441.45 110.00 11,434.92 110.00 11,428.38 110.00 11,421.85 110.00 11,415.32 110.00 11,408.78

NJEIS Family Cost Participation Table Page 63 of 12 Effective July 1, 2015

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

$3,060,000 $3,060,500 110.00 11,449.86 110.00 11,443.33 110.00 11,436.79 110.00 11,430.26 110.00 11,423.73 110.00 11,417.19 110.00 11,410.66 $3,060,500 $3,061,000 110.00 11,451.73 110.00 11,445.20 110.00 11,438.67 110.00 11,432.13 110.00 11,425.60 110.00 11,419.07 110.00 11,412.53 $3,061,000 $3,061,500 110.00 11,453.61 110.00 11,447.08 110.00 11,440.54 110.00 11,434.01 110.00 11,427.48 110.00 11,420.94 110.00 11,414.41 $3,061,500 $3,062,000 110.00 11,455.48 110.00 11,448.95 110.00 11,442.42 110.00 11,435.88 110.00 11,429.35 110.00 11,422.82 110.00 11,416.28 $3,062,000 $3,062,500 110.00 11,457.36 110.00 11,450.83 110.00 11,444.29 110.00 11,437.76 110.00 11,431.23 110.00 11,424.69 110.00 11,418.16 $3,062,500 $3,063,000 110.00 11,459.23 110.00 11,452.70 110.00 11,446.17 110.00 11,439.63 110.00 11,433.10 110.00 11,426.57 110.00 11,420.03 $3,063,000 $3,063,500 110.00 11,461.11 110.00 11,454.58 110.00 11,448.04 110.00 11,441.51 110.00 11,434.98 110.00 11,428.44 110.00 11,421.91 $3,063,500 $3,064,000 110.00 11,462.98 110.00 11,456.45 110.00 11,449.92 110.00 11,443.38 110.00 11,436.85 110.00 11,430.32 110.00 11,423.78 $3,064,000 $3,064,500 110.00 11,464.86 110.00 11,458.33 110.00 11,451.79 110.00 11,445.26 110.00 11,438.73 110.00 11,432.19 110.00 11,425.66 $3,064,500 $3,065,000 110.00 11,466.73 110.00 11,460.20 110.00 11,453.67 110.00 11,447.13 110.00 11,440.60 110.00 11,434.07 110.00 11,427.53 $3,065,000 $3,065,500 110.00 11,468.61 110.00 11,462.08 110.00 11,455.54 110.00 11,449.01 110.00 11,442.48 110.00 11,435.94 110.00 11,429.41 $3,065,500 $3,066,000 110.00 11,470.48 110.00 11,463.95 110.00 11,457.42 110.00 11,450.88 110.00 11,444.35 110.00 11,437.82 110.00 11,431.28 $3,066,000 $3,066,500 110.00 11,472.36 110.00 11,465.83 110.00 11,459.29 110.00 11,452.76 110.00 11,446.23 110.00 11,439.69 110.00 11,433.16 $3,066,500 $3,067,000 110.00 11,474.23 110.00 11,467.70 110.00 11,461.17 110.00 11,454.63 110.00 11,448.10 110.00 11,441.57 110.00 11,435.03 $3,067,000 $3,067,500 110.00 11,476.11 110.00 11,469.58 110.00 11,463.04 110.00 11,456.51 110.00 11,449.98 110.00 11,443.44 110.00 11,436.91 $3,067,500 $3,068,000 110.00 11,477.98 110.00 11,471.45 110.00 11,464.92 110.00 11,458.38 110.00 11,451.85 110.00 11,445.32 110.00 11,438.78 $3,068,000 $3,068,500 110.00 11,479.86 110.00 11,473.33 110.00 11,466.79 110.00 11,460.26 110.00 11,453.73 110.00 11,447.19 110.00 11,440.66 $3,068,500 $3,069,000 110.00 11,481.73 110.00 11,475.20 110.00 11,468.67 110.00 11,462.13 110.00 11,455.60 110.00 11,449.07 110.00 11,442.53 $3,069,000 $3,069,500 110.00 11,483.61 110.00 11,477.08 110.00 11,470.54 110.00 11,464.01 110.00 11,457.48 110.00 11,450.94 110.00 11,444.41 $3,069,500 $3,070,000 110.00 11,485.48 110.00 11,478.95 110.00 11,472.42 110.00 11,465.88 110.00 11,459.35 110.00 11,452.82 110.00 11,446.28 $3,070,000 $3,070,500 110.00 11,487.36 110.00 11,480.83 110.00 11,474.29 110.00 11,467.76 110.00 11,461.23 110.00 11,454.69 110.00 11,448.16 $3,070,500 $3,071,000 110.00 11,489.23 110.00 11,482.70 110.00 11,476.17 110.00 11,469.63 110.00 11,463.10 110.00 11,456.57 110.00 11,450.03 $3,071,000 $3,071,500 110.00 11,491.11 110.00 11,484.58 110.00 11,478.04 110.00 11,471.51 110.00 11,464.98 110.00 11,458.44 110.00 11,451.91 $3,071,500 $3,072,000 110.00 11,492.98 110.00 11,486.45 110.00 11,479.92 110.00 11,473.38 110.00 11,466.85 110.00 11,460.32 110.00 11,453.78 $3,072,000 $3,072,500 110.00 11,494.86 110.00 11,488.33 110.00 11,481.79 110.00 11,475.26 110.00 11,468.73 110.00 11,462.19 110.00 11,455.66 $3,072,500 $3,073,000 110.00 11,496.73 110.00 11,490.20 110.00 11,483.67 110.00 11,477.13 110.00 11,470.60 110.00 11,464.07 110.00 11,457.53 $3,073,000 $3,073,500 110.00 11,498.61 110.00 11,492.08 110.00 11,485.54 110.00 11,479.01 110.00 11,472.48 110.00 11,465.94 110.00 11,459.41 $3,073,500 $3,074,000 110.00 11,500.48 110.00 11,493.95 110.00 11,487.42 110.00 11,480.88 110.00 11,474.35 110.00 11,467.82 110.00 11,461.28 $3,074,000 $3,074,500 110.00 11,502.36 110.00 11,495.83 110.00 11,489.29 110.00 11,482.76 110.00 11,476.23 110.00 11,469.69 110.00 11,463.16 $3,074,500 $3,075,000 110.00 11,504.23 110.00 11,497.70 110.00 11,491.17 110.00 11,484.63 110.00 11,478.10 110.00 11,471.57 110.00 11,465.03 $3,075,000 $3,075,500 110.00 11,506.11 110.00 11,499.58 110.00 11,493.04 110.00 11,486.51 110.00 11,479.98 110.00 11,473.44 110.00 11,466.91 $3,075,500 $3,076,000 110.00 11,507.98 110.00 11,501.45 110.00 11,494.92 110.00 11,488.38 110.00 11,481.85 110.00 11,475.32 110.00 11,468.78 $3,076,000 $3,076,500 110.00 11,509.86 110.00 11,503.33 110.00 11,496.79 110.00 11,490.26 110.00 11,483.73 110.00 11,477.19 110.00 11,470.66 $3,076,500 $3,077,000 110.00 11,511.73 110.00 11,505.20 110.00 11,498.67 110.00 11,492.13 110.00 11,485.60 110.00 11,479.07 110.00 11,472.53 $3,077,000 $3,077,500 110.00 11,513.61 110.00 11,507.08 110.00 11,500.54 110.00 11,494.01 110.00 11,487.48 110.00 11,480.94 110.00 11,474.41 $3,077,500 $3,078,000 110.00 11,515.48 110.00 11,508.95 110.00 11,502.42 110.00 11,495.88 110.00 11,489.35 110.00 11,482.82 110.00 11,476.28 $3,078,000 $3,078,500 110.00 11,517.36 110.00 11,510.83 110.00 11,504.29 110.00 11,497.76 110.00 11,491.23 110.00 11,484.69 110.00 11,478.16 $3,078,500 $3,079,000 110.00 11,519.23 110.00 11,512.70 110.00 11,506.17 110.00 11,499.63 110.00 11,493.10 110.00 11,486.57 110.00 11,480.03 $3,079,000 $3,079,500 110.00 11,521.11 110.00 11,514.58 110.00 11,508.04 110.00 11,501.51 110.00 11,494.98 110.00 11,488.44 110.00 11,481.91 $3,079,500 $3,080,000 110.00 11,522.98 110.00 11,516.45 110.00 11,509.92 110.00 11,503.38 110.00 11,496.85 110.00 11,490.32 110.00 11,483.78 $3,080,000 $3,080,500 110.00 11,524.86 110.00 11,518.33 110.00 11,511.79 110.00 11,505.26 110.00 11,498.73 110.00 11,492.19 110.00 11,485.66 $3,080,500 $3,081,000 110.00 11,526.73 110.00 11,520.20 110.00 11,513.67 110.00 11,507.13 110.00 11,500.60 110.00 11,494.07 110.00 11,487.53 $3,081,000 $3,081,500 110.00 11,528.61 110.00 11,522.08 110.00 11,515.54 110.00 11,509.01 110.00 11,502.48 110.00 11,495.94 110.00 11,489.41 $3,081,500 $3,082,000 110.00 11,530.48 110.00 11,523.95 110.00 11,517.42 110.00 11,510.88 110.00 11,504.35 110.00 11,497.82 110.00 11,491.28 $3,082,000 $3,082,500 110.00 11,532.36 110.00 11,525.83 110.00 11,519.29 110.00 11,512.76 110.00 11,506.23 110.00 11,499.69 110.00 11,493.16 $3,082,500 $3,083,000 110.00 11,534.23 110.00 11,527.70 110.00 11,521.17 110.00 11,514.63 110.00 11,508.10 110.00 11,501.57 110.00 11,495.03 $3,083,000 $3,083,500 110.00 11,536.11 110.00 11,529.58 110.00 11,523.04 110.00 11,516.51 110.00 11,509.98 110.00 11,503.44 110.00 11,496.91 $3,083,500 $3,084,000 110.00 11,537.98 110.00 11,531.45 110.00 11,524.92 110.00 11,518.38 110.00 11,511.85 110.00 11,505.32 110.00 11,498.78 $3,084,000 $3,084,500 110.00 11,539.86 110.00 11,533.33 110.00 11,526.79 110.00 11,520.26 110.00 11,513.73 110.00 11,507.19 110.00 11,500.66 $3,084,500 $3,085,000 110.00 11,541.73 110.00 11,535.20 110.00 11,528.67 110.00 11,522.13 110.00 11,515.60 110.00 11,509.07 110.00 11,502.53 $3,085,000 $3,085,500 110.00 11,543.61 110.00 11,537.08 110.00 11,530.54 110.00 11,524.01 110.00 11,517.48 110.00 11,510.94 110.00 11,504.41 $3,085,500 $3,086,000 110.00 11,545.48 110.00 11,538.95 110.00 11,532.42 110.00 11,525.88 110.00 11,519.35 110.00 11,512.82 110.00 11,506.28 $3,086,000 $3,086,500 110.00 11,547.36 110.00 11,540.83 110.00 11,534.29 110.00 11,527.76 110.00 11,521.23 110.00 11,514.69 110.00 11,508.16 $3,086,500 $3,087,000 110.00 11,549.23 110.00 11,542.70 110.00 11,536.17 110.00 11,529.63 110.00 11,523.10 110.00 11,516.57 110.00 11,510.03 $3,087,000 $3,087,500 110.00 11,551.11 110.00 11,544.58 110.00 11,538.04 110.00 11,531.51 110.00 11,524.98 110.00 11,518.44 110.00 11,511.91 $3,087,500 $3,088,000 110.00 11,552.98 110.00 11,546.45 110.00 11,539.92 110.00 11,533.38 110.00 11,526.85 110.00 11,520.32 110.00 11,513.78 $3,088,000 $3,088,500 110.00 11,554.86 110.00 11,548.33 110.00 11,541.79 110.00 11,535.26 110.00 11,528.73 110.00 11,522.19 110.00 11,515.66 $3,088,500 $3,089,000 110.00 11,556.73 110.00 11,550.20 110.00 11,543.67 110.00 11,537.13 110.00 11,530.60 110.00 11,524.07 110.00 11,517.53 $3,089,000 $3,089,500 110.00 11,558.61 110.00 11,552.08 110.00 11,545.54 110.00 11,539.01 110.00 11,532.48 110.00 11,525.94 110.00 11,519.41 $3,089,500 $3,090,000 110.00 11,560.48 110.00 11,553.95 110.00 11,547.42 110.00 11,540.88 110.00 11,534.35 110.00 11,527.82 110.00 11,521.28 $3,090,000 $3,090,500 110.00 11,562.36 110.00 11,555.83 110.00 11,549.29 110.00 11,542.76 110.00 11,536.23 110.00 11,529.69 110.00 11,523.16 $3,090,500 $3,091,000 110.00 11,564.23 110.00 11,557.70 110.00 11,551.17 110.00 11,544.63 110.00 11,538.10 110.00 11,531.57 110.00 11,525.03 $3,091,000 $3,091,500 110.00 11,566.11 110.00 11,559.58 110.00 11,553.04 110.00 11,546.51 110.00 11,539.98 110.00 11,533.44 110.00 11,526.91 $3,091,500 $3,092,000 110.00 11,567.98 110.00 11,561.45 110.00 11,554.92 110.00 11,548.38 110.00 11,541.85 110.00 11,535.32 110.00 11,528.78 $3,092,000 $3,092,500 110.00 11,569.86 110.00 11,563.33 110.00 11,556.79 110.00 11,550.26 110.00 11,543.73 110.00 11,537.19 110.00 11,530.66 $3,092,500 $3,093,000 110.00 11,571.73 110.00 11,565.20 110.00 11,558.67 110.00 11,552.13 110.00 11,545.60 110.00 11,539.07 110.00 11,532.53 $3,093,000 $3,093,500 110.00 11,573.61 110.00 11,567.08 110.00 11,560.54 110.00 11,554.01 110.00 11,547.48 110.00 11,540.94 110.00 11,534.41 $3,093,500 $3,094,000 110.00 11,575.48 110.00 11,568.95 110.00 11,562.42 110.00 11,555.88 110.00 11,549.35 110.00 11,542.82 110.00 11,536.28 $3,094,000 $3,094,500 110.00 11,577.36 110.00 11,570.83 110.00 11,564.29 110.00 11,557.76 110.00 11,551.23 110.00 11,544.69 110.00 11,538.16 $3,094,500 $3,095,000 110.00 11,579.23 110.00 11,572.70 110.00 11,566.17 110.00 11,559.63 110.00 11,553.10 110.00 11,546.57 110.00 11,540.03 $3,095,000 $3,095,500 110.00 11,581.11 110.00 11,574.58 110.00 11,568.04 110.00 11,561.51 110.00 11,554.98 110.00 11,548.44 110.00 11,541.91 $3,095,500 $3,096,000 110.00 11,582.98 110.00 11,576.45 110.00 11,569.92 110.00 11,563.38 110.00 11,556.85 110.00 11,550.32 110.00 11,543.78 $3,096,000 $3,096,500 110.00 11,584.86 110.00 11,578.33 110.00 11,571.79 110.00 11,565.26 110.00 11,558.73 110.00 11,552.19 110.00 11,545.66 $3,096,500 $3,097,000 110.00 11,586.73 110.00 11,580.20 110.00 11,573.67 110.00 11,567.13 110.00 11,560.60 110.00 11,554.07 110.00 11,547.53 $3,097,000 $3,097,500 110.00 11,588.61 110.00 11,582.08 110.00 11,575.54 110.00 11,569.01 110.00 11,562.48 110.00 11,555.94 110.00 11,549.41 $3,097,500 $3,098,000 110.00 11,590.48 110.00 11,583.95 110.00 11,577.42 110.00 11,570.88 110.00 11,564.35 110.00 11,557.82 110.00 11,551.28 $3,098,000 $3,098,500 110.00 11,592.36 110.00 11,585.83 110.00 11,579.29 110.00 11,572.76 110.00 11,566.23 110.00 11,559.69 110.00 11,553.16 $3,098,500 $3,099,000 110.00 11,594.23 110.00 11,587.70 110.00 11,581.17 110.00 11,574.63 110.00 11,568.10 110.00 11,561.57 110.00 11,555.03 $3,099,000 $3,099,500 110.00 11,596.11 110.00 11,589.58 110.00 11,583.04 110.00 11,576.51 110.00 11,569.98 110.00 11,563.44 110.00 11,556.91 $3,099,500 $3,100,000 110.00 11,597.98 110.00 11,591.45 110.00 11,584.92 110.00 11,578.38 110.00 11,571.85 110.00 11,565.32 110.00 11,558.78 $3,100,000 $3,100,500 110.00 11,599.86 110.00 11,593.33 110.00 11,586.79 110.00 11,580.26 110.00 11,573.73 110.00 11,567.19 110.00 11,560.66 $3,100,500 $3,101,000 110.00 11,601.73 110.00 11,595.20 110.00 11,588.67 110.00 11,582.13 110.00 11,575.60 110.00 11,569.07 110.00 11,562.53 $3,101,000 $3,101,500 110.00 11,603.61 110.00 11,597.08 110.00 11,590.54 110.00 11,584.01 110.00 11,577.48 110.00 11,570.94 110.00 11,564.41 $3,101,500 $3,102,000 110.00 11,605.48 110.00 11,598.95 110.00 11,592.42 110.00 11,585.88 110.00 11,579.35 110.00 11,572.82 110.00 11,566.28 $3,102,000 $3,102,500 110.00 11,607.36 110.00 11,600.83 110.00 11,594.29 110.00 11,587.76 110.00 11,581.23 110.00 11,574.69 110.00 11,568.16 $3,102,500 $3,103,000 110.00 11,609.23 110.00 11,602.70 110.00 11,596.17 110.00 11,589.63 110.00 11,583.10 110.00 11,576.57 110.00 11,570.03 $3,103,000 $3,103,500 110.00 11,611.11 110.00 11,604.58 110.00 11,598.04 110.00 11,591.51 110.00 11,584.98 110.00 11,578.44 110.00 11,571.91 $3,103,500 $3,104,000 110.00 11,612.98 110.00 11,606.45 110.00 11,599.92 110.00 11,593.38 110.00 11,586.85 110.00 11,580.32 110.00 11,573.78 $3,104,000 $3,104,500 110.00 11,614.86 110.00 11,608.33 110.00 11,601.79 110.00 11,595.26 110.00 11,588.73 110.00 11,582.19 110.00 11,575.66 $3,104,500 $3,105,000 110.00 11,616.73 110.00 11,610.20 110.00 11,603.67 110.00 11,597.13 110.00 11,590.60 110.00 11,584.07 110.00 11,577.53 $3,105,000 $3,105,500 110.00 11,618.61 110.00 11,612.08 110.00 11,605.54 110.00 11,599.01 110.00 11,592.48 110.00 11,585.94 110.00 11,579.41 $3,105,500 $3,106,000 110.00 11,620.48 110.00 11,613.95 110.00 11,607.42 110.00 11,600.88 110.00 11,594.35 110.00 11,587.82 110.00 11,581.28 $3,106,000 $3,106,500 110.00 11,622.36 110.00 11,615.83 110.00 11,609.29 110.00 11,602.76 110.00 11,596.23 110.00 11,589.69 110.00 11,583.16 $3,106,500 $3,107,000 110.00 11,624.23 110.00 11,617.70 110.00 11,611.17 110.00 11,604.63 110.00 11,598.10 110.00 11,591.57 110.00 11,585.03 $3,107,000 $3,107,500 110.00 11,626.11 110.00 11,619.58 110.00 11,613.04 110.00 11,606.51 110.00 11,599.98 110.00 11,593.44 110.00 11,586.91 $3,107,500 $3,108,000 110.00 11,627.98 110.00 11,621.45 110.00 11,614.92 110.00 11,608.38 110.00 11,601.85 110.00 11,595.32 110.00 11,588.78 $3,108,000 $3,108,500 110.00 11,629.86 110.00 11,623.33 110.00 11,616.79 110.00 11,610.26 110.00 11,603.73 110.00 11,597.19 110.00 11,590.66 $3,108,500 $3,109,000 110.00 11,631.73 110.00 11,625.20 110.00 11,618.67 110.00 11,612.13 110.00 11,605.60 110.00 11,599.07 110.00 11,592.53 $3,109,000 $3,109,500 110.00 11,633.61 110.00 11,627.08 110.00 11,620.54 110.00 11,614.01 110.00 11,607.48 110.00 11,600.94 110.00 11,594.41 $3,109,500 $3,110,000 110.00 11,635.48 110.00 11,628.95 110.00 11,622.42 110.00 11,615.88 110.00 11,609.35 110.00 11,602.82 110.00 11,596.28 $3,110,000 $3,110,500 110.00 11,637.36 110.00 11,630.83 110.00 11,624.29 110.00 11,617.76 110.00 11,611.23 110.00 11,604.69 110.00 11,598.16 $3,110,500 $3,111,000 110.00 11,639.23 110.00 11,632.70 110.00 11,626.17 110.00 11,619.63 110.00 11,613.10 110.00 11,606.57 110.00 11,600.03

NJEIS Family Cost Participation Table Page 64 of 12 Effective July 1, 2015

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

$3,111,000 $3,111,500 110.00 11,641.11 110.00 11,634.58 110.00 11,628.04 110.00 11,621.51 110.00 11,614.98 110.00 11,608.44 110.00 11,601.91 $3,111,500 $3,112,000 110.00 11,642.98 110.00 11,636.45 110.00 11,629.92 110.00 11,623.38 110.00 11,616.85 110.00 11,610.32 110.00 11,603.78 $3,112,000 $3,112,500 110.00 11,644.86 110.00 11,638.33 110.00 11,631.79 110.00 11,625.26 110.00 11,618.73 110.00 11,612.19 110.00 11,605.66 $3,112,500 $3,113,000 110.00 11,646.73 110.00 11,640.20 110.00 11,633.67 110.00 11,627.13 110.00 11,620.60 110.00 11,614.07 110.00 11,607.53 $3,113,000 $3,113,500 110.00 11,648.61 110.00 11,642.08 110.00 11,635.54 110.00 11,629.01 110.00 11,622.48 110.00 11,615.94 110.00 11,609.41 $3,113,500 $3,114,000 110.00 11,650.48 110.00 11,643.95 110.00 11,637.42 110.00 11,630.88 110.00 11,624.35 110.00 11,617.82 110.00 11,611.28 $3,114,000 $3,114,500 110.00 11,652.36 110.00 11,645.83 110.00 11,639.29 110.00 11,632.76 110.00 11,626.23 110.00 11,619.69 110.00 11,613.16 $3,114,500 $3,115,000 110.00 11,654.23 110.00 11,647.70 110.00 11,641.17 110.00 11,634.63 110.00 11,628.10 110.00 11,621.57 110.00 11,615.03 $3,115,000 $3,115,500 110.00 11,656.11 110.00 11,649.58 110.00 11,643.04 110.00 11,636.51 110.00 11,629.98 110.00 11,623.44 110.00 11,616.91 $3,115,500 $3,116,000 110.00 11,657.98 110.00 11,651.45 110.00 11,644.92 110.00 11,638.38 110.00 11,631.85 110.00 11,625.32 110.00 11,618.78 $3,116,000 $3,116,500 110.00 11,659.86 110.00 11,653.33 110.00 11,646.79 110.00 11,640.26 110.00 11,633.73 110.00 11,627.19 110.00 11,620.66 $3,116,500 $3,117,000 110.00 11,661.73 110.00 11,655.20 110.00 11,648.67 110.00 11,642.13 110.00 11,635.60 110.00 11,629.07 110.00 11,622.53 $3,117,000 $3,117,500 110.00 11,663.61 110.00 11,657.08 110.00 11,650.54 110.00 11,644.01 110.00 11,637.48 110.00 11,630.94 110.00 11,624.41 $3,117,500 $3,118,000 110.00 11,665.48 110.00 11,658.95 110.00 11,652.42 110.00 11,645.88 110.00 11,639.35 110.00 11,632.82 110.00 11,626.28 $3,118,000 $3,118,500 110.00 11,667.36 110.00 11,660.83 110.00 11,654.29 110.00 11,647.76 110.00 11,641.23 110.00 11,634.69 110.00 11,628.16 $3,118,500 $3,119,000 110.00 11,669.23 110.00 11,662.70 110.00 11,656.17 110.00 11,649.63 110.00 11,643.10 110.00 11,636.57 110.00 11,630.03 $3,119,000 $3,119,500 110.00 11,671.11 110.00 11,664.58 110.00 11,658.04 110.00 11,651.51 110.00 11,644.98 110.00 11,638.44 110.00 11,631.91 $3,119,500 $3,120,000 110.00 11,672.98 110.00 11,666.45 110.00 11,659.92 110.00 11,653.38 110.00 11,646.85 110.00 11,640.32 110.00 11,633.78 $3,120,000 $3,120,500 110.00 11,674.86 110.00 11,668.33 110.00 11,661.79 110.00 11,655.26 110.00 11,648.73 110.00 11,642.19 110.00 11,635.66 $3,120,500 $3,121,000 110.00 11,676.73 110.00 11,670.20 110.00 11,663.67 110.00 11,657.13 110.00 11,650.60 110.00 11,644.07 110.00 11,637.53 $3,121,000 $3,121,500 110.00 11,678.61 110.00 11,672.08 110.00 11,665.54 110.00 11,659.01 110.00 11,652.48 110.00 11,645.94 110.00 11,639.41 $3,121,500 $3,122,000 110.00 11,680.48 110.00 11,673.95 110.00 11,667.42 110.00 11,660.88 110.00 11,654.35 110.00 11,647.82 110.00 11,641.28 $3,122,000 $3,122,500 110.00 11,682.36 110.00 11,675.83 110.00 11,669.29 110.00 11,662.76 110.00 11,656.23 110.00 11,649.69 110.00 11,643.16 $3,122,500 $3,123,000 110.00 11,684.23 110.00 11,677.70 110.00 11,671.17 110.00 11,664.63 110.00 11,658.10 110.00 11,651.57 110.00 11,645.03 $3,123,000 $3,123,500 110.00 11,686.11 110.00 11,679.58 110.00 11,673.04 110.00 11,666.51 110.00 11,659.98 110.00 11,653.44 110.00 11,646.91 $3,123,500 $3,124,000 110.00 11,687.98 110.00 11,681.45 110.00 11,674.92 110.00 11,668.38 110.00 11,661.85 110.00 11,655.32 110.00 11,648.78 $3,124,000 $3,124,500 110.00 11,689.86 110.00 11,683.33 110.00 11,676.79 110.00 11,670.26 110.00 11,663.73 110.00 11,657.19 110.00 11,650.66 $3,124,500 $3,125,000 110.00 11,691.73 110.00 11,685.20 110.00 11,678.67 110.00 11,672.13 110.00 11,665.60 110.00 11,659.07 110.00 11,652.53 $3,125,000 $3,125,500 110.00 11,693.61 110.00 11,687.08 110.00 11,680.54 110.00 11,674.01 110.00 11,667.48 110.00 11,660.94 110.00 11,654.41 $3,125,500 $3,126,000 110.00 11,695.48 110.00 11,688.95 110.00 11,682.42 110.00 11,675.88 110.00 11,669.35 110.00 11,662.82 110.00 11,656.28 $3,126,000 $3,126,500 110.00 11,697.36 110.00 11,690.83 110.00 11,684.29 110.00 11,677.76 110.00 11,671.23 110.00 11,664.69 110.00 11,658.16 $3,126,500 $3,127,000 110.00 11,699.23 110.00 11,692.70 110.00 11,686.17 110.00 11,679.63 110.00 11,673.10 110.00 11,666.57 110.00 11,660.03 $3,127,000 $3,127,500 110.00 11,701.11 110.00 11,694.58 110.00 11,688.04 110.00 11,681.51 110.00 11,674.98 110.00 11,668.44 110.00 11,661.91 $3,127,500 $3,128,000 110.00 11,702.98 110.00 11,696.45 110.00 11,689.92 110.00 11,683.38 110.00 11,676.85 110.00 11,670.32 110.00 11,663.78 $3,128,000 $3,128,500 110.00 11,704.86 110.00 11,698.33 110.00 11,691.79 110.00 11,685.26 110.00 11,678.73 110.00 11,672.19 110.00 11,665.66 $3,128,500 $3,129,000 110.00 11,706.73 110.00 11,700.20 110.00 11,693.67 110.00 11,687.13 110.00 11,680.60 110.00 11,674.07 110.00 11,667.53 $3,129,000 $3,129,500 110.00 11,708.61 110.00 11,702.08 110.00 11,695.54 110.00 11,689.01 110.00 11,682.48 110.00 11,675.94 110.00 11,669.41 $3,129,500 $3,130,000 110.00 11,710.48 110.00 11,703.95 110.00 11,697.42 110.00 11,690.88 110.00 11,684.35 110.00 11,677.82 110.00 11,671.28 $3,130,000 $3,130,500 110.00 11,712.36 110.00 11,705.83 110.00 11,699.29 110.00 11,692.76 110.00 11,686.23 110.00 11,679.69 110.00 11,673.16 $3,130,500 $3,131,000 110.00 11,714.23 110.00 11,707.70 110.00 11,701.17 110.00 11,694.63 110.00 11,688.10 110.00 11,681.57 110.00 11,675.03 $3,131,000 $3,131,500 110.00 11,716.11 110.00 11,709.58 110.00 11,703.04 110.00 11,696.51 110.00 11,689.98 110.00 11,683.44 110.00 11,676.91 $3,131,500 $3,132,000 110.00 11,717.98 110.00 11,711.45 110.00 11,704.92 110.00 11,698.38 110.00 11,691.85 110.00 11,685.32 110.00 11,678.78 $3,132,000 $3,132,500 110.00 11,719.86 110.00 11,713.33 110.00 11,706.79 110.00 11,700.26 110.00 11,693.73 110.00 11,687.19 110.00 11,680.66 $3,132,500 $3,133,000 110.00 11,721.73 110.00 11,715.20 110.00 11,708.67 110.00 11,702.13 110.00 11,695.60 110.00 11,689.07 110.00 11,682.53 $3,133,000 $3,133,500 110.00 11,723.61 110.00 11,717.08 110.00 11,710.54 110.00 11,704.01 110.00 11,697.48 110.00 11,690.94 110.00 11,684.41 $3,133,500 $3,134,000 110.00 11,725.48 110.00 11,718.95 110.00 11,712.42 110.00 11,705.88 110.00 11,699.35 110.00 11,692.82 110.00 11,686.28 $3,134,000 $3,134,500 110.00 11,727.36 110.00 11,720.83 110.00 11,714.29 110.00 11,707.76 110.00 11,701.23 110.00 11,694.69 110.00 11,688.16 $3,134,500 $3,135,000 110.00 11,729.23 110.00 11,722.70 110.00 11,716.17 110.00 11,709.63 110.00 11,703.10 110.00 11,696.57 110.00 11,690.03 $3,135,000 $3,135,500 110.00 11,731.11 110.00 11,724.58 110.00 11,718.04 110.00 11,711.51 110.00 11,704.98 110.00 11,698.44 110.00 11,691.91 $3,135,500 $3,136,000 110.00 11,732.98 110.00 11,726.45 110.00 11,719.92 110.00 11,713.38 110.00 11,706.85 110.00 11,700.32 110.00 11,693.78 $3,136,000 $3,136,500 110.00 11,734.86 110.00 11,728.33 110.00 11,721.79 110.00 11,715.26 110.00 11,708.73 110.00 11,702.19 110.00 11,695.66 $3,136,500 $3,137,000 110.00 11,736.73 110.00 11,730.20 110.00 11,723.67 110.00 11,717.13 110.00 11,710.60 110.00 11,704.07 110.00 11,697.53 $3,137,000 $3,137,500 110.00 11,738.61 110.00 11,732.08 110.00 11,725.54 110.00 11,719.01 110.00 11,712.48 110.00 11,705.94 110.00 11,699.41 $3,137,500 $3,138,000 110.00 11,740.48 110.00 11,733.95 110.00 11,727.42 110.00 11,720.88 110.00 11,714.35 110.00 11,707.82 110.00 11,701.28 $3,138,000 $3,138,500 110.00 11,742.36 110.00 11,735.83 110.00 11,729.29 110.00 11,722.76 110.00 11,716.23 110.00 11,709.69 110.00 11,703.16 $3,138,500 $3,139,000 110.00 11,744.23 110.00 11,737.70 110.00 11,731.17 110.00 11,724.63 110.00 11,718.10 110.00 11,711.57 110.00 11,705.03 $3,139,000 $3,139,500 110.00 11,746.11 110.00 11,739.58 110.00 11,733.04 110.00 11,726.51 110.00 11,719.98 110.00 11,713.44 110.00 11,706.91 $3,139,500 $3,140,000 110.00 11,747.98 110.00 11,741.45 110.00 11,734.92 110.00 11,728.38 110.00 11,721.85 110.00 11,715.32 110.00 11,708.78 $3,140,000 $3,140,500 110.00 11,749.86 110.00 11,743.33 110.00 11,736.79 110.00 11,730.26 110.00 11,723.73 110.00 11,717.19 110.00 11,710.66 $3,140,500 $3,141,000 110.00 11,751.73 110.00 11,745.20 110.00 11,738.67 110.00 11,732.13 110.00 11,725.60 110.00 11,719.07 110.00 11,712.53 $3,141,000 $3,141,500 110.00 11,753.61 110.00 11,747.08 110.00 11,740.54 110.00 11,734.01 110.00 11,727.48 110.00 11,720.94 110.00 11,714.41 $3,141,500 $3,142,000 110.00 11,755.48 110.00 11,748.95 110.00 11,742.42 110.00 11,735.88 110.00 11,729.35 110.00 11,722.82 110.00 11,716.28 $3,142,000 $3,142,500 110.00 11,757.36 110.00 11,750.83 110.00 11,744.29 110.00 11,737.76 110.00 11,731.23 110.00 11,724.69 110.00 11,718.16 $3,142,500 $3,143,000 110.00 11,759.23 110.00 11,752.70 110.00 11,746.17 110.00 11,739.63 110.00 11,733.10 110.00 11,726.57 110.00 11,720.03 $3,143,000 $3,143,500 110.00 11,761.11 110.00 11,754.58 110.00 11,748.04 110.00 11,741.51 110.00 11,734.98 110.00 11,728.44 110.00 11,721.91 $3,143,500 $3,144,000 110.00 11,762.98 110.00 11,756.45 110.00 11,749.92 110.00 11,743.38 110.00 11,736.85 110.00 11,730.32 110.00 11,723.78 $3,144,000 $3,144,500 110.00 11,764.86 110.00 11,758.33 110.00 11,751.79 110.00 11,745.26 110.00 11,738.73 110.00 11,732.19 110.00 11,725.66 $3,144,500 $3,145,000 110.00 11,766.73 110.00 11,760.20 110.00 11,753.67 110.00 11,747.13 110.00 11,740.60 110.00 11,734.07 110.00 11,727.53 $3,145,000 $3,145,500 110.00 11,768.61 110.00 11,762.08 110.00 11,755.54 110.00 11,749.01 110.00 11,742.48 110.00 11,735.94 110.00 11,729.41 $3,145,500 $3,146,000 110.00 11,770.48 110.00 11,763.95 110.00 11,757.42 110.00 11,750.88 110.00 11,744.35 110.00 11,737.82 110.00 11,731.28 $3,146,000 $3,146,500 110.00 11,772.36 110.00 11,765.83 110.00 11,759.29 110.00 11,752.76 110.00 11,746.23 110.00 11,739.69 110.00 11,733.16 $3,146,500 $3,147,000 110.00 11,774.23 110.00 11,767.70 110.00 11,761.17 110.00 11,754.63 110.00 11,748.10 110.00 11,741.57 110.00 11,735.03 $3,147,000 $3,147,500 110.00 11,776.11 110.00 11,769.58 110.00 11,763.04 110.00 11,756.51 110.00 11,749.98 110.00 11,743.44 110.00 11,736.91 $3,147,500 $3,148,000 110.00 11,777.98 110.00 11,771.45 110.00 11,764.92 110.00 11,758.38 110.00 11,751.85 110.00 11,745.32 110.00 11,738.78 $3,148,000 $3,148,500 110.00 11,779.86 110.00 11,773.33 110.00 11,766.79 110.00 11,760.26 110.00 11,753.73 110.00 11,747.19 110.00 11,740.66 $3,148,500 $3,149,000 110.00 11,781.73 110.00 11,775.20 110.00 11,768.67 110.00 11,762.13 110.00 11,755.60 110.00 11,749.07 110.00 11,742.53 $3,149,000 $3,149,500 110.00 11,783.61 110.00 11,777.08 110.00 11,770.54 110.00 11,764.01 110.00 11,757.48 110.00 11,750.94 110.00 11,744.41 $3,149,500 $3,150,000 110.00 11,785.48 110.00 11,778.95 110.00 11,772.42 110.00 11,765.88 110.00 11,759.35 110.00 11,752.82 110.00 11,746.28 $3,150,000 $3,150,500 110.00 11,787.36 110.00 11,780.83 110.00 11,774.29 110.00 11,767.76 110.00 11,761.23 110.00 11,754.69 110.00 11,748.16 $3,150,500 $3,151,000 110.00 11,789.23 110.00 11,782.70 110.00 11,776.17 110.00 11,769.63 110.00 11,763.10 110.00 11,756.57 110.00 11,750.03 $3,151,000 $3,151,500 110.00 11,791.11 110.00 11,784.58 110.00 11,778.04 110.00 11,771.51 110.00 11,764.98 110.00 11,758.44 110.00 11,751.91 $3,151,500 $3,152,000 110.00 11,792.98 110.00 11,786.45 110.00 11,779.92 110.00 11,773.38 110.00 11,766.85 110.00 11,760.32 110.00 11,753.78 $3,152,000 $3,152,500 110.00 11,794.86 110.00 11,788.33 110.00 11,781.79 110.00 11,775.26 110.00 11,768.73 110.00 11,762.19 110.00 11,755.66 $3,152,500 $3,153,000 110.00 11,796.73 110.00 11,790.20 110.00 11,783.67 110.00 11,777.13 110.00 11,770.60 110.00 11,764.07 110.00 11,757.53 $3,153,000 $3,153,500 110.00 11,798.61 110.00 11,792.08 110.00 11,785.54 110.00 11,779.01 110.00 11,772.48 110.00 11,765.94 110.00 11,759.41 $3,153,500 $3,154,000 110.00 11,800.48 110.00 11,793.95 110.00 11,787.42 110.00 11,780.88 110.00 11,774.35 110.00 11,767.82 110.00 11,761.28 $3,154,000 $3,154,500 110.00 11,802.36 110.00 11,795.83 110.00 11,789.29 110.00 11,782.76 110.00 11,776.23 110.00 11,769.69 110.00 11,763.16 $3,154,500 $3,155,000 110.00 11,804.23 110.00 11,797.70 110.00 11,791.17 110.00 11,784.63 110.00 11,778.10 110.00 11,771.57 110.00 11,765.03 $3,155,000 $3,155,500 110.00 11,806.11 110.00 11,799.58 110.00 11,793.04 110.00 11,786.51 110.00 11,779.98 110.00 11,773.44 110.00 11,766.91 $3,155,500 $3,156,000 110.00 11,807.98 110.00 11,801.45 110.00 11,794.92 110.00 11,788.38 110.00 11,781.85 110.00 11,775.32 110.00 11,768.78 $3,156,000 $3,156,500 110.00 11,809.86 110.00 11,803.33 110.00 11,796.79 110.00 11,790.26 110.00 11,783.73 110.00 11,777.19 110.00 11,770.66 $3,156,500 $3,157,000 110.00 11,811.73 110.00 11,805.20 110.00 11,798.67 110.00 11,792.13 110.00 11,785.60 110.00 11,779.07 110.00 11,772.53 $3,157,000 $3,157,500 110.00 11,813.61 110.00 11,807.08 110.00 11,800.54 110.00 11,794.01 110.00 11,787.48 110.00 11,780.94 110.00 11,774.41 $3,157,500 $3,158,000 110.00 11,815.48 110.00 11,808.95 110.00 11,802.42 110.00 11,795.88 110.00 11,789.35 110.00 11,782.82 110.00 11,776.28 $3,158,000 $3,158,500 110.00 11,817.36 110.00 11,810.83 110.00 11,804.29 110.00 11,797.76 110.00 11,791.23 110.00 11,784.69 110.00 11,778.16 $3,158,500 $3,159,000 110.00 11,819.23 110.00 11,812.70 110.00 11,806.17 110.00 11,799.63 110.00 11,793.10 110.00 11,786.57 110.00 11,780.03 $3,159,000 $3,159,500 110.00 11,821.11 110.00 11,814.58 110.00 11,808.04 110.00 11,801.51 110.00 11,794.98 110.00 11,788.44 110.00 11,781.91 $3,159,500 $3,160,000 110.00 11,822.98 110.00 11,816.45 110.00 11,809.92 110.00 11,803.38 110.00 11,796.85 110.00 11,790.32 110.00 11,783.78 $3,160,000 $3,160,500 110.00 11,824.86 110.00 11,818.33 110.00 11,811.79 110.00 11,805.26 110.00 11,798.73 110.00 11,792.19 110.00 11,785.66 $3,160,500 $3,161,000 110.00 11,826.73 110.00 11,820.20 110.00 11,813.67 110.00 11,807.13 110.00 11,800.60 110.00 11,794.07 110.00 11,787.53 $3,161,000 $3,161,500 110.00 11,828.61 110.00 11,822.08 110.00 11,815.54 110.00 11,809.01 110.00 11,802.48 110.00 11,795.94 110.00 11,789.41 $3,161,500 $3,162,000 110.00 11,830.48 110.00 11,823.95 110.00 11,817.42 110.00 11,810.88 110.00 11,804.35 110.00 11,797.82 110.00 11,791.28

NJEIS Family Cost Participation Table Page 65 of 12 Effective July 1, 2015

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

$3,162,000 $3,162,500 110.00 11,832.36 110.00 11,825.83 110.00 11,819.29 110.00 11,812.76 110.00 11,806.23 110.00 11,799.69 110.00 11,793.16 $3,162,500 $3,163,000 110.00 11,834.23 110.00 11,827.70 110.00 11,821.17 110.00 11,814.63 110.00 11,808.10 110.00 11,801.57 110.00 11,795.03 $3,163,000 $3,163,500 110.00 11,836.11 110.00 11,829.58 110.00 11,823.04 110.00 11,816.51 110.00 11,809.98 110.00 11,803.44 110.00 11,796.91 $3,163,500 $3,164,000 110.00 11,837.98 110.00 11,831.45 110.00 11,824.92 110.00 11,818.38 110.00 11,811.85 110.00 11,805.32 110.00 11,798.78 $3,164,000 $3,164,500 110.00 11,839.86 110.00 11,833.33 110.00 11,826.79 110.00 11,820.26 110.00 11,813.73 110.00 11,807.19 110.00 11,800.66 $3,164,500 $3,165,000 110.00 11,841.73 110.00 11,835.20 110.00 11,828.67 110.00 11,822.13 110.00 11,815.60 110.00 11,809.07 110.00 11,802.53 $3,165,000 $3,165,500 110.00 11,843.61 110.00 11,837.08 110.00 11,830.54 110.00 11,824.01 110.00 11,817.48 110.00 11,810.94 110.00 11,804.41 $3,165,500 $3,166,000 110.00 11,845.48 110.00 11,838.95 110.00 11,832.42 110.00 11,825.88 110.00 11,819.35 110.00 11,812.82 110.00 11,806.28 $3,166,000 $3,166,500 110.00 11,847.36 110.00 11,840.83 110.00 11,834.29 110.00 11,827.76 110.00 11,821.23 110.00 11,814.69 110.00 11,808.16 $3,166,500 $3,167,000 110.00 11,849.23 110.00 11,842.70 110.00 11,836.17 110.00 11,829.63 110.00 11,823.10 110.00 11,816.57 110.00 11,810.03 $3,167,000 $3,167,500 110.00 11,851.11 110.00 11,844.58 110.00 11,838.04 110.00 11,831.51 110.00 11,824.98 110.00 11,818.44 110.00 11,811.91 $3,167,500 $3,168,000 110.00 11,852.98 110.00 11,846.45 110.00 11,839.92 110.00 11,833.38 110.00 11,826.85 110.00 11,820.32 110.00 11,813.78 $3,168,000 $3,168,500 110.00 11,854.86 110.00 11,848.33 110.00 11,841.79 110.00 11,835.26 110.00 11,828.73 110.00 11,822.19 110.00 11,815.66 $3,168,500 $3,169,000 110.00 11,856.73 110.00 11,850.20 110.00 11,843.67 110.00 11,837.13 110.00 11,830.60 110.00 11,824.07 110.00 11,817.53 $3,169,000 $3,169,500 110.00 11,858.61 110.00 11,852.08 110.00 11,845.54 110.00 11,839.01 110.00 11,832.48 110.00 11,825.94 110.00 11,819.41 $3,169,500 $3,170,000 110.00 11,860.48 110.00 11,853.95 110.00 11,847.42 110.00 11,840.88 110.00 11,834.35 110.00 11,827.82 110.00 11,821.28 $3,170,000 $3,170,500 110.00 11,862.36 110.00 11,855.83 110.00 11,849.29 110.00 11,842.76 110.00 11,836.23 110.00 11,829.69 110.00 11,823.16 $3,170,500 $3,171,000 110.00 11,864.23 110.00 11,857.70 110.00 11,851.17 110.00 11,844.63 110.00 11,838.10 110.00 11,831.57 110.00 11,825.03 $3,171,000 $3,171,500 110.00 11,866.11 110.00 11,859.58 110.00 11,853.04 110.00 11,846.51 110.00 11,839.98 110.00 11,833.44 110.00 11,826.91 $3,171,500 $3,172,000 110.00 11,867.98 110.00 11,861.45 110.00 11,854.92 110.00 11,848.38 110.00 11,841.85 110.00 11,835.32 110.00 11,828.78 $3,172,000 $3,172,500 110.00 11,869.86 110.00 11,863.33 110.00 11,856.79 110.00 11,850.26 110.00 11,843.73 110.00 11,837.19 110.00 11,830.66 $3,172,500 $3,173,000 110.00 11,871.73 110.00 11,865.20 110.00 11,858.67 110.00 11,852.13 110.00 11,845.60 110.00 11,839.07 110.00 11,832.53 $3,173,000 $3,173,500 110.00 11,873.61 110.00 11,867.08 110.00 11,860.54 110.00 11,854.01 110.00 11,847.48 110.00 11,840.94 110.00 11,834.41 $3,173,500 $3,174,000 110.00 11,875.48 110.00 11,868.95 110.00 11,862.42 110.00 11,855.88 110.00 11,849.35 110.00 11,842.82 110.00 11,836.28 $3,174,000 $3,174,500 110.00 11,877.36 110.00 11,870.83 110.00 11,864.29 110.00 11,857.76 110.00 11,851.23 110.00 11,844.69 110.00 11,838.16 $3,174,500 $3,175,000 110.00 11,879.23 110.00 11,872.70 110.00 11,866.17 110.00 11,859.63 110.00 11,853.10 110.00 11,846.57 110.00 11,840.03 $3,175,000 $3,175,500 110.00 11,881.11 110.00 11,874.58 110.00 11,868.04 110.00 11,861.51 110.00 11,854.98 110.00 11,848.44 110.00 11,841.91 $3,175,500 $3,176,000 110.00 11,882.98 110.00 11,876.45 110.00 11,869.92 110.00 11,863.38 110.00 11,856.85 110.00 11,850.32 110.00 11,843.78 $3,176,000 $3,176,500 110.00 11,884.86 110.00 11,878.33 110.00 11,871.79 110.00 11,865.26 110.00 11,858.73 110.00 11,852.19 110.00 11,845.66 $3,176,500 $3,177,000 110.00 11,886.73 110.00 11,880.20 110.00 11,873.67 110.00 11,867.13 110.00 11,860.60 110.00 11,854.07 110.00 11,847.53 $3,177,000 $3,177,500 110.00 11,888.61 110.00 11,882.08 110.00 11,875.54 110.00 11,869.01 110.00 11,862.48 110.00 11,855.94 110.00 11,849.41 $3,177,500 $3,178,000 110.00 11,890.48 110.00 11,883.95 110.00 11,877.42 110.00 11,870.88 110.00 11,864.35 110.00 11,857.82 110.00 11,851.28 $3,178,000 $3,178,500 110.00 11,892.36 110.00 11,885.83 110.00 11,879.29 110.00 11,872.76 110.00 11,866.23 110.00 11,859.69 110.00 11,853.16 $3,178,500 $3,179,000 110.00 11,894.23 110.00 11,887.70 110.00 11,881.17 110.00 11,874.63 110.00 11,868.10 110.00 11,861.57 110.00 11,855.03 $3,179,000 $3,179,500 110.00 11,896.11 110.00 11,889.58 110.00 11,883.04 110.00 11,876.51 110.00 11,869.98 110.00 11,863.44 110.00 11,856.91 $3,179,500 $3,180,000 110.00 11,897.98 110.00 11,891.45 110.00 11,884.92 110.00 11,878.38 110.00 11,871.85 110.00 11,865.32 110.00 11,858.78 $3,180,000 $3,180,500 110.00 11,899.86 110.00 11,893.33 110.00 11,886.79 110.00 11,880.26 110.00 11,873.73 110.00 11,867.19 110.00 11,860.66 $3,180,500 $3,181,000 110.00 11,901.73 110.00 11,895.20 110.00 11,888.67 110.00 11,882.13 110.00 11,875.60 110.00 11,869.07 110.00 11,862.53 $3,181,000 $3,181,500 110.00 11,903.61 110.00 11,897.08 110.00 11,890.54 110.00 11,884.01 110.00 11,877.48 110.00 11,870.94 110.00 11,864.41 $3,181,500 $3,182,000 110.00 11,905.48 110.00 11,898.95 110.00 11,892.42 110.00 11,885.88 110.00 11,879.35 110.00 11,872.82 110.00 11,866.28 $3,182,000 $3,182,500 110.00 11,907.36 110.00 11,900.83 110.00 11,894.29 110.00 11,887.76 110.00 11,881.23 110.00 11,874.69 110.00 11,868.16 $3,182,500 $3,183,000 110.00 11,909.23 110.00 11,902.70 110.00 11,896.17 110.00 11,889.63 110.00 11,883.10 110.00 11,876.57 110.00 11,870.03 $3,183,000 $3,183,500 110.00 11,911.11 110.00 11,904.58 110.00 11,898.04 110.00 11,891.51 110.00 11,884.98 110.00 11,878.44 110.00 11,871.91 $3,183,500 $3,184,000 110.00 11,912.98 110.00 11,906.45 110.00 11,899.92 110.00 11,893.38 110.00 11,886.85 110.00 11,880.32 110.00 11,873.78 $3,184,000 $3,184,500 110.00 11,914.86 110.00 11,908.33 110.00 11,901.79 110.00 11,895.26 110.00 11,888.73 110.00 11,882.19 110.00 11,875.66 $3,184,500 $3,185,000 110.00 11,916.73 110.00 11,910.20 110.00 11,903.67 110.00 11,897.13 110.00 11,890.60 110.00 11,884.07 110.00 11,877.53 $3,185,000 $3,185,500 110.00 11,918.61 110.00 11,912.08 110.00 11,905.54 110.00 11,899.01 110.00 11,892.48 110.00 11,885.94 110.00 11,879.41 $3,185,500 $3,186,000 110.00 11,920.48 110.00 11,913.95 110.00 11,907.42 110.00 11,900.88 110.00 11,894.35 110.00 11,887.82 110.00 11,881.28 $3,186,000 $3,186,500 110.00 11,922.36 110.00 11,915.83 110.00 11,909.29 110.00 11,902.76 110.00 11,896.23 110.00 11,889.69 110.00 11,883.16 $3,186,500 $3,187,000 110.00 11,924.23 110.00 11,917.70 110.00 11,911.17 110.00 11,904.63 110.00 11,898.10 110.00 11,891.57 110.00 11,885.03 $3,187,000 $3,187,500 110.00 11,926.11 110.00 11,919.58 110.00 11,913.04 110.00 11,906.51 110.00 11,899.98 110.00 11,893.44 110.00 11,886.91 $3,187,500 $3,188,000 110.00 11,927.98 110.00 11,921.45 110.00 11,914.92 110.00 11,908.38 110.00 11,901.85 110.00 11,895.32 110.00 11,888.78 $3,188,000 $3,188,500 110.00 11,929.86 110.00 11,923.33 110.00 11,916.79 110.00 11,910.26 110.00 11,903.73 110.00 11,897.19 110.00 11,890.66 $3,188,500 $3,189,000 110.00 11,931.73 110.00 11,925.20 110.00 11,918.67 110.00 11,912.13 110.00 11,905.60 110.00 11,899.07 110.00 11,892.53 $3,189,000 $3,189,500 110.00 11,933.61 110.00 11,927.08 110.00 11,920.54 110.00 11,914.01 110.00 11,907.48 110.00 11,900.94 110.00 11,894.41 $3,189,500 $3,190,000 110.00 11,935.48 110.00 11,928.95 110.00 11,922.42 110.00 11,915.88 110.00 11,909.35 110.00 11,902.82 110.00 11,896.28 $3,190,000 $3,190,500 110.00 11,937.36 110.00 11,930.83 110.00 11,924.29 110.00 11,917.76 110.00 11,911.23 110.00 11,904.69 110.00 11,898.16 $3,190,500 $3,191,000 110.00 11,939.23 110.00 11,932.70 110.00 11,926.17 110.00 11,919.63 110.00 11,913.10 110.00 11,906.57 110.00 11,900.03 $3,191,000 $3,191,500 110.00 11,941.11 110.00 11,934.58 110.00 11,928.04 110.00 11,921.51 110.00 11,914.98 110.00 11,908.44 110.00 11,901.91 $3,191,500 $3,192,000 110.00 11,942.98 110.00 11,936.45 110.00 11,929.92 110.00 11,923.38 110.00 11,916.85 110.00 11,910.32 110.00 11,903.78 $3,192,000 $3,192,500 110.00 11,944.86 110.00 11,938.33 110.00 11,931.79 110.00 11,925.26 110.00 11,918.73 110.00 11,912.19 110.00 11,905.66 $3,192,500 $3,193,000 110.00 11,946.73 110.00 11,940.20 110.00 11,933.67 110.00 11,927.13 110.00 11,920.60 110.00 11,914.07 110.00 11,907.53 $3,193,000 $3,193,500 110.00 11,948.61 110.00 11,942.08 110.00 11,935.54 110.00 11,929.01 110.00 11,922.48 110.00 11,915.94 110.00 11,909.41 $3,193,500 $3,194,000 110.00 11,950.48 110.00 11,943.95 110.00 11,937.42 110.00 11,930.88 110.00 11,924.35 110.00 11,917.82 110.00 11,911.28 $3,194,000 $3,194,500 110.00 11,952.36 110.00 11,945.83 110.00 11,939.29 110.00 11,932.76 110.00 11,926.23 110.00 11,919.69 110.00 11,913.16 $3,194,500 $3,195,000 110.00 11,954.23 110.00 11,947.70 110.00 11,941.17 110.00 11,934.63 110.00 11,928.10 110.00 11,921.57 110.00 11,915.03 $3,195,000 $3,195,500 110.00 11,956.11 110.00 11,949.58 110.00 11,943.04 110.00 11,936.51 110.00 11,929.98 110.00 11,923.44 110.00 11,916.91 $3,195,500 $3,196,000 110.00 11,957.98 110.00 11,951.45 110.00 11,944.92 110.00 11,938.38 110.00 11,931.85 110.00 11,925.32 110.00 11,918.78 $3,196,000 $3,196,500 110.00 11,959.86 110.00 11,953.33 110.00 11,946.79 110.00 11,940.26 110.00 11,933.73 110.00 11,927.19 110.00 11,920.66 $3,196,500 $3,197,000 110.00 11,961.73 110.00 11,955.20 110.00 11,948.67 110.00 11,942.13 110.00 11,935.60 110.00 11,929.07 110.00 11,922.53 $3,197,000 $3,197,500 110.00 11,963.61 110.00 11,957.08 110.00 11,950.54 110.00 11,944.01 110.00 11,937.48 110.00 11,930.94 110.00 11,924.41 $3,197,500 $3,198,000 110.00 11,965.48 110.00 11,958.95 110.00 11,952.42 110.00 11,945.88 110.00 11,939.35 110.00 11,932.82 110.00 11,926.28 $3,198,000 $3,198,500 110.00 11,967.36 110.00 11,960.83 110.00 11,954.29 110.00 11,947.76 110.00 11,941.23 110.00 11,934.69 110.00 11,928.16 $3,198,500 $3,199,000 110.00 11,969.23 110.00 11,962.70 110.00 11,956.17 110.00 11,949.63 110.00 11,943.10 110.00 11,936.57 110.00 11,930.03 $3,199,000 $3,199,500 110.00 11,971.11 110.00 11,964.58 110.00 11,958.04 110.00 11,951.51 110.00 11,944.98 110.00 11,938.44 110.00 11,931.91 $3,199,500 $3,200,000 110.00 11,972.98 110.00 11,966.45 110.00 11,959.92 110.00 11,953.38 110.00 11,946.85 110.00 11,940.32 110.00 11,933.78 $3,200,000 $3,200,500 110.00 11,974.86 110.00 11,968.33 110.00 11,961.79 110.00 11,955.26 110.00 11,948.73 110.00 11,942.19 110.00 11,935.66 $3,200,500 $3,201,000 110.00 11,976.73 110.00 11,970.20 110.00 11,963.67 110.00 11,957.13 110.00 11,950.60 110.00 11,944.07 110.00 11,937.53 $3,201,000 $3,201,500 110.00 11,978.61 110.00 11,972.08 110.00 11,965.54 110.00 11,959.01 110.00 11,952.48 110.00 11,945.94 110.00 11,939.41 $3,201,500 $3,202,000 110.00 11,980.48 110.00 11,973.95 110.00 11,967.42 110.00 11,960.88 110.00 11,954.35 110.00 11,947.82 110.00 11,941.28 $3,202,000 $3,202,500 110.00 11,982.36 110.00 11,975.83 110.00 11,969.29 110.00 11,962.76 110.00 11,956.23 110.00 11,949.69 110.00 11,943.16 $3,202,500 $3,203,000 110.00 11,984.23 110.00 11,977.70 110.00 11,971.17 110.00 11,964.63 110.00 11,958.10 110.00 11,951.57 110.00 11,945.03 $3,203,000 $3,203,500 110.00 11,986.11 110.00 11,979.58 110.00 11,973.04 110.00 11,966.51 110.00 11,959.98 110.00 11,953.44 110.00 11,946.91 $3,203,500 $3,204,000 110.00 11,987.98 110.00 11,981.45 110.00 11,974.92 110.00 11,968.38 110.00 11,961.85 110.00 11,955.32 110.00 11,948.78 $3,204,000 $3,204,500 110.00 11,989.86 110.00 11,983.33 110.00 11,976.79 110.00 11,970.26 110.00 11,963.73 110.00 11,957.19 110.00 11,950.66 $3,204,500 $3,205,000 110.00 11,991.73 110.00 11,985.20 110.00 11,978.67 110.00 11,972.13 110.00 11,965.60 110.00 11,959.07 110.00 11,952.53 $3,205,000 $3,205,500 110.00 11,993.61 110.00 11,987.08 110.00 11,980.54 110.00 11,974.01 110.00 11,967.48 110.00 11,960.94 110.00 11,954.41 $3,205,500 $3,206,000 110.00 11,995.48 110.00 11,988.95 110.00 11,982.42 110.00 11,975.88 110.00 11,969.35 110.00 11,962.82 110.00 11,956.28 $3,206,000 $3,206,500 110.00 11,997.36 110.00 11,990.83 110.00 11,984.29 110.00 11,977.76 110.00 11,971.23 110.00 11,964.69 110.00 11,958.16 $3,206,500 $3,207,000 110.00 11,999.23 110.00 11,992.70 110.00 11,986.17 110.00 11,979.63 110.00 11,973.10 110.00 11,966.57 110.00 11,960.03 $3,207,000 $3,207,500 110.00 12,001.11 110.00 11,994.58 110.00 11,988.04 110.00 11,981.51 110.00 11,974.98 110.00 11,968.44 110.00 11,961.91 $3,207,500 $3,208,000 110.00 12,002.98 110.00 11,996.45 110.00 11,989.92 110.00 11,983.38 110.00 11,976.85 110.00 11,970.32 110.00 11,963.78 $3,208,000 $3,208,500 110.00 12,004.86 110.00 11,998.33 110.00 11,991.79 110.00 11,985.26 110.00 11,978.73 110.00 11,972.19 110.00 11,965.66 $3,208,500 $3,209,000 110.00 12,006.73 110.00 12,000.20 110.00 11,993.67 110.00 11,987.13 110.00 11,980.60 110.00 11,974.07 110.00 11,967.53 $3,209,000 $3,209,500 110.00 12,008.61 110.00 12,002.08 110.00 11,995.54 110.00 11,989.01 110.00 11,982.48 110.00 11,975.94 110.00 11,969.41 $3,209,500 $3,210,000 110.00 12,010.48 110.00 12,003.95 110.00 11,997.42 110.00 11,990.88 110.00 11,984.35 110.00 11,977.82 110.00 11,971.28 $3,210,000 $3,210,500 110.00 12,012.36 110.00 12,005.83 110.00 11,999.29 110.00 11,992.76 110.00 11,986.23 110.00 11,979.69 110.00 11,973.16 $3,210,500 $3,211,000 110.00 12,014.23 110.00 12,007.70 110.00 12,001.17 110.00 11,994.63 110.00 11,988.10 110.00 11,981.57 110.00 11,975.03 $3,211,000 $3,211,500 110.00 12,016.11 110.00 12,009.58 110.00 12,003.04 110.00 11,996.51 110.00 11,989.98 110.00 11,983.44 110.00 11,976.91 $3,211,500 $3,212,000 110.00 12,017.98 110.00 12,011.45 110.00 12,004.92 110.00 11,998.38 110.00 11,991.85 110.00 11,985.32 110.00 11,978.78 $3,212,000 $3,212,500 110.00 12,019.86 110.00 12,013.33 110.00 12,006.79 110.00 12,000.26 110.00 11,993.73 110.00 11,987.19 110.00 11,980.66 $3,212,500 $3,213,000 110.00 12,021.73 110.00 12,015.20 110.00 12,008.67 110.00 12,002.13 110.00 11,995.60 110.00 11,989.07 110.00 11,982.53

NJEIS Family Cost Participation Table Page 66 of 12 Effective July 1, 2015

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

$3,213,000 $3,213,500 110.00 12,023.61 110.00 12,017.08 110.00 12,010.54 110.00 12,004.01 110.00 11,997.48 110.00 11,990.94 110.00 11,984.41 $3,213,500 $3,214,000 110.00 12,025.48 110.00 12,018.95 110.00 12,012.42 110.00 12,005.88 110.00 11,999.35 110.00 11,992.82 110.00 11,986.28 $3,214,000 $3,214,500 110.00 12,027.36 110.00 12,020.83 110.00 12,014.29 110.00 12,007.76 110.00 12,001.23 110.00 11,994.69 110.00 11,988.16 $3,214,500 $3,215,000 110.00 12,029.23 110.00 12,022.70 110.00 12,016.17 110.00 12,009.63 110.00 12,003.10 110.00 11,996.57 110.00 11,990.03 $3,215,000 $3,215,500 110.00 12,031.11 110.00 12,024.58 110.00 12,018.04 110.00 12,011.51 110.00 12,004.98 110.00 11,998.44 110.00 11,991.91 $3,215,500 $3,216,000 110.00 12,032.98 110.00 12,026.45 110.00 12,019.92 110.00 12,013.38 110.00 12,006.85 110.00 12,000.32 110.00 11,993.78 $3,216,000 $3,216,500 110.00 12,034.86 110.00 12,028.33 110.00 12,021.79 110.00 12,015.26 110.00 12,008.73 110.00 12,002.19 110.00 11,995.66 $3,216,500 $3,217,000 110.00 12,036.73 110.00 12,030.20 110.00 12,023.67 110.00 12,017.13 110.00 12,010.60 110.00 12,004.07 110.00 11,997.53 $3,217,000 $3,217,500 110.00 12,038.61 110.00 12,032.08 110.00 12,025.54 110.00 12,019.01 110.00 12,012.48 110.00 12,005.94 110.00 11,999.41 $3,217,500 $3,218,000 110.00 12,040.48 110.00 12,033.95 110.00 12,027.42 110.00 12,020.88 110.00 12,014.35 110.00 12,007.82 110.00 12,001.28 $3,218,000 $3,218,500 110.00 12,042.36 110.00 12,035.83 110.00 12,029.29 110.00 12,022.76 110.00 12,016.23 110.00 12,009.69 110.00 12,003.16 $3,218,500 $3,219,000 110.00 12,044.23 110.00 12,037.70 110.00 12,031.17 110.00 12,024.63 110.00 12,018.10 110.00 12,011.57 110.00 12,005.03 $3,219,000 $3,219,500 110.00 12,046.11 110.00 12,039.58 110.00 12,033.04 110.00 12,026.51 110.00 12,019.98 110.00 12,013.44 110.00 12,006.91 $3,219,500 $3,220,000 110.00 12,047.98 110.00 12,041.45 110.00 12,034.92 110.00 12,028.38 110.00 12,021.85 110.00 12,015.32 110.00 12,008.78 $3,220,000 $3,220,500 110.00 12,049.86 110.00 12,043.33 110.00 12,036.79 110.00 12,030.26 110.00 12,023.73 110.00 12,017.19 110.00 12,010.66 $3,220,500 $3,221,000 110.00 12,051.73 110.00 12,045.20 110.00 12,038.67 110.00 12,032.13 110.00 12,025.60 110.00 12,019.07 110.00 12,012.53 $3,221,000 $3,221,500 110.00 12,053.61 110.00 12,047.08 110.00 12,040.54 110.00 12,034.01 110.00 12,027.48 110.00 12,020.94 110.00 12,014.41 $3,221,500 $3,222,000 110.00 12,055.48 110.00 12,048.95 110.00 12,042.42 110.00 12,035.88 110.00 12,029.35 110.00 12,022.82 110.00 12,016.28 $3,222,000 $3,222,500 110.00 12,057.36 110.00 12,050.83 110.00 12,044.29 110.00 12,037.76 110.00 12,031.23 110.00 12,024.69 110.00 12,018.16 $3,222,500 $3,223,000 110.00 12,059.23 110.00 12,052.70 110.00 12,046.17 110.00 12,039.63 110.00 12,033.10 110.00 12,026.57 110.00 12,020.03 $3,223,000 $3,223,500 110.00 12,061.11 110.00 12,054.58 110.00 12,048.04 110.00 12,041.51 110.00 12,034.98 110.00 12,028.44 110.00 12,021.91 $3,223,500 $3,224,000 110.00 12,062.98 110.00 12,056.45 110.00 12,049.92 110.00 12,043.38 110.00 12,036.85 110.00 12,030.32 110.00 12,023.78 $3,224,000 $3,224,500 110.00 12,064.86 110.00 12,058.33 110.00 12,051.79 110.00 12,045.26 110.00 12,038.73 110.00 12,032.19 110.00 12,025.66 $3,224,500 $3,225,000 110.00 12,066.73 110.00 12,060.20 110.00 12,053.67 110.00 12,047.13 110.00 12,040.60 110.00 12,034.07 110.00 12,027.53 $3,225,000 $3,225,500 110.00 12,068.61 110.00 12,062.08 110.00 12,055.54 110.00 12,049.01 110.00 12,042.48 110.00 12,035.94 110.00 12,029.41 $3,225,500 $3,226,000 110.00 12,070.48 110.00 12,063.95 110.00 12,057.42 110.00 12,050.88 110.00 12,044.35 110.00 12,037.82 110.00 12,031.28 $3,226,000 $3,226,500 110.00 12,072.36 110.00 12,065.83 110.00 12,059.29 110.00 12,052.76 110.00 12,046.23 110.00 12,039.69 110.00 12,033.16 $3,226,500 $3,227,000 110.00 12,074.23 110.00 12,067.70 110.00 12,061.17 110.00 12,054.63 110.00 12,048.10 110.00 12,041.57 110.00 12,035.03 $3,227,000 $3,227,500 110.00 12,076.11 110.00 12,069.58 110.00 12,063.04 110.00 12,056.51 110.00 12,049.98 110.00 12,043.44 110.00 12,036.91 $3,227,500 $3,228,000 110.00 12,077.98 110.00 12,071.45 110.00 12,064.92 110.00 12,058.38 110.00 12,051.85 110.00 12,045.32 110.00 12,038.78 $3,228,000 $3,228,500 110.00 12,079.86 110.00 12,073.33 110.00 12,066.79 110.00 12,060.26 110.00 12,053.73 110.00 12,047.19 110.00 12,040.66 $3,228,500 $3,229,000 110.00 12,081.73 110.00 12,075.20 110.00 12,068.67 110.00 12,062.13 110.00 12,055.60 110.00 12,049.07 110.00 12,042.53 $3,229,000 $3,229,500 110.00 12,083.61 110.00 12,077.08 110.00 12,070.54 110.00 12,064.01 110.00 12,057.48 110.00 12,050.94 110.00 12,044.41 $3,229,500 $3,230,000 110.00 12,085.48 110.00 12,078.95 110.00 12,072.42 110.00 12,065.88 110.00 12,059.35 110.00 12,052.82 110.00 12,046.28 $3,230,000 $3,230,500 110.00 12,087.36 110.00 12,080.83 110.00 12,074.29 110.00 12,067.76 110.00 12,061.23 110.00 12,054.69 110.00 12,048.16 $3,230,500 $3,231,000 110.00 12,089.23 110.00 12,082.70 110.00 12,076.17 110.00 12,069.63 110.00 12,063.10 110.00 12,056.57 110.00 12,050.03 $3,231,000 $3,231,500 110.00 12,091.11 110.00 12,084.58 110.00 12,078.04 110.00 12,071.51 110.00 12,064.98 110.00 12,058.44 110.00 12,051.91 $3,231,500 $3,232,000 110.00 12,092.98 110.00 12,086.45 110.00 12,079.92 110.00 12,073.38 110.00 12,066.85 110.00 12,060.32 110.00 12,053.78 $3,232,000 $3,232,500 110.00 12,094.86 110.00 12,088.33 110.00 12,081.79 110.00 12,075.26 110.00 12,068.73 110.00 12,062.19 110.00 12,055.66 $3,232,500 $3,233,000 110.00 12,096.73 110.00 12,090.20 110.00 12,083.67 110.00 12,077.13 110.00 12,070.60 110.00 12,064.07 110.00 12,057.53 $3,233,000 $3,233,500 110.00 12,098.61 110.00 12,092.08 110.00 12,085.54 110.00 12,079.01 110.00 12,072.48 110.00 12,065.94 110.00 12,059.41 $3,233,500 $3,234,000 110.00 12,100.48 110.00 12,093.95 110.00 12,087.42 110.00 12,080.88 110.00 12,074.35 110.00 12,067.82 110.00 12,061.28 $3,234,000 $3,234,500 110.00 12,102.36 110.00 12,095.83 110.00 12,089.29 110.00 12,082.76 110.00 12,076.23 110.00 12,069.69 110.00 12,063.16 $3,234,500 $3,235,000 110.00 12,104.23 110.00 12,097.70 110.00 12,091.17 110.00 12,084.63 110.00 12,078.10 110.00 12,071.57 110.00 12,065.03 $3,235,000 $3,235,500 110.00 12,106.11 110.00 12,099.58 110.00 12,093.04 110.00 12,086.51 110.00 12,079.98 110.00 12,073.44 110.00 12,066.91 $3,235,500 $3,236,000 110.00 12,107.98 110.00 12,101.45 110.00 12,094.92 110.00 12,088.38 110.00 12,081.85 110.00 12,075.32 110.00 12,068.78 $3,236,000 $3,236,500 110.00 12,109.86 110.00 12,103.33 110.00 12,096.79 110.00 12,090.26 110.00 12,083.73 110.00 12,077.19 110.00 12,070.66 $3,236,500 $3,237,000 110.00 12,111.73 110.00 12,105.20 110.00 12,098.67 110.00 12,092.13 110.00 12,085.60 110.00 12,079.07 110.00 12,072.53 $3,237,000 $3,237,500 110.00 12,113.61 110.00 12,107.08 110.00 12,100.54 110.00 12,094.01 110.00 12,087.48 110.00 12,080.94 110.00 12,074.41 $3,237,500 $3,238,000 110.00 12,115.48 110.00 12,108.95 110.00 12,102.42 110.00 12,095.88 110.00 12,089.35 110.00 12,082.82 110.00 12,076.28 $3,238,000 $3,238,500 110.00 12,117.36 110.00 12,110.83 110.00 12,104.29 110.00 12,097.76 110.00 12,091.23 110.00 12,084.69 110.00 12,078.16 $3,238,500 $3,239,000 110.00 12,119.23 110.00 12,112.70 110.00 12,106.17 110.00 12,099.63 110.00 12,093.10 110.00 12,086.57 110.00 12,080.03 $3,239,000 $3,239,500 110.00 12,121.11 110.00 12,114.58 110.00 12,108.04 110.00 12,101.51 110.00 12,094.98 110.00 12,088.44 110.00 12,081.91 $3,239,500 $3,240,000 110.00 12,122.98 110.00 12,116.45 110.00 12,109.92 110.00 12,103.38 110.00 12,096.85 110.00 12,090.32 110.00 12,083.78 $3,240,000 $3,240,500 110.00 12,124.86 110.00 12,118.33 110.00 12,111.79 110.00 12,105.26 110.00 12,098.73 110.00 12,092.19 110.00 12,085.66 $3,240,500 $3,241,000 110.00 12,126.73 110.00 12,120.20 110.00 12,113.67 110.00 12,107.13 110.00 12,100.60 110.00 12,094.07 110.00 12,087.53 $3,241,000 $3,241,500 110.00 12,128.61 110.00 12,122.08 110.00 12,115.54 110.00 12,109.01 110.00 12,102.48 110.00 12,095.94 110.00 12,089.41 $3,241,500 $3,242,000 110.00 12,130.48 110.00 12,123.95 110.00 12,117.42 110.00 12,110.88 110.00 12,104.35 110.00 12,097.82 110.00 12,091.28 $3,242,000 $3,242,500 110.00 12,132.36 110.00 12,125.83 110.00 12,119.29 110.00 12,112.76 110.00 12,106.23 110.00 12,099.69 110.00 12,093.16 $3,242,500 $3,243,000 110.00 12,134.23 110.00 12,127.70 110.00 12,121.17 110.00 12,114.63 110.00 12,108.10 110.00 12,101.57 110.00 12,095.03 $3,243,000 $3,243,500 110.00 12,136.11 110.00 12,129.58 110.00 12,123.04 110.00 12,116.51 110.00 12,109.98 110.00 12,103.44 110.00 12,096.91 $3,243,500 $3,244,000 110.00 12,137.98 110.00 12,131.45 110.00 12,124.92 110.00 12,118.38 110.00 12,111.85 110.00 12,105.32 110.00 12,098.78 $3,244,000 $3,244,500 110.00 12,139.86 110.00 12,133.33 110.00 12,126.79 110.00 12,120.26 110.00 12,113.73 110.00 12,107.19 110.00 12,100.66 $3,244,500 $3,245,000 110.00 12,141.73 110.00 12,135.20 110.00 12,128.67 110.00 12,122.13 110.00 12,115.60 110.00 12,109.07 110.00 12,102.53 $3,245,000 $3,245,500 110.00 12,143.61 110.00 12,137.08 110.00 12,130.54 110.00 12,124.01 110.00 12,117.48 110.00 12,110.94 110.00 12,104.41 $3,245,500 $3,246,000 110.00 12,145.48 110.00 12,138.95 110.00 12,132.42 110.00 12,125.88 110.00 12,119.35 110.00 12,112.82 110.00 12,106.28 $3,246,000 $3,246,500 110.00 12,147.36 110.00 12,140.83 110.00 12,134.29 110.00 12,127.76 110.00 12,121.23 110.00 12,114.69 110.00 12,108.16 $3,246,500 $3,247,000 110.00 12,149.23 110.00 12,142.70 110.00 12,136.17 110.00 12,129.63 110.00 12,123.10 110.00 12,116.57 110.00 12,110.03 $3,247,000 $3,247,500 110.00 12,151.11 110.00 12,144.58 110.00 12,138.04 110.00 12,131.51 110.00 12,124.98 110.00 12,118.44 110.00 12,111.91 $3,247,500 $3,248,000 110.00 12,152.98 110.00 12,146.45 110.00 12,139.92 110.00 12,133.38 110.00 12,126.85 110.00 12,120.32 110.00 12,113.78 $3,248,000 $3,248,500 110.00 12,154.86 110.00 12,148.33 110.00 12,141.79 110.00 12,135.26 110.00 12,128.73 110.00 12,122.19 110.00 12,115.66 $3,248,500 $3,249,000 110.00 12,156.73 110.00 12,150.20 110.00 12,143.67 110.00 12,137.13 110.00 12,130.60 110.00 12,124.07 110.00 12,117.53 $3,249,000 $3,249,500 110.00 12,158.61 110.00 12,152.08 110.00 12,145.54 110.00 12,139.01 110.00 12,132.48 110.00 12,125.94 110.00 12,119.41 $3,249,500 $3,250,000 110.00 12,160.48 110.00 12,153.95 110.00 12,147.42 110.00 12,140.88 110.00 12,134.35 110.00 12,127.82 110.00 12,121.28 $3,250,000 $3,250,500 110.00 12,162.36 110.00 12,155.83 110.00 12,149.29 110.00 12,142.76 110.00 12,136.23 110.00 12,129.69 110.00 12,123.16 $3,250,500 $3,251,000 110.00 12,164.23 110.00 12,157.70 110.00 12,151.17 110.00 12,144.63 110.00 12,138.10 110.00 12,131.57 110.00 12,125.03 $3,251,000 $3,251,500 110.00 12,166.11 110.00 12,159.58 110.00 12,153.04 110.00 12,146.51 110.00 12,139.98 110.00 12,133.44 110.00 12,126.91 $3,251,500 $3,252,000 110.00 12,167.98 110.00 12,161.45 110.00 12,154.92 110.00 12,148.38 110.00 12,141.85 110.00 12,135.32 110.00 12,128.78 $3,252,000 $3,252,500 110.00 12,169.86 110.00 12,163.33 110.00 12,156.79 110.00 12,150.26 110.00 12,143.73 110.00 12,137.19 110.00 12,130.66 $3,252,500 $3,253,000 110.00 12,171.73 110.00 12,165.20 110.00 12,158.67 110.00 12,152.13 110.00 12,145.60 110.00 12,139.07 110.00 12,132.53 $3,253,000 $3,253,500 110.00 12,173.61 110.00 12,167.08 110.00 12,160.54 110.00 12,154.01 110.00 12,147.48 110.00 12,140.94 110.00 12,134.41 $3,253,500 $3,254,000 110.00 12,175.48 110.00 12,168.95 110.00 12,162.42 110.00 12,155.88 110.00 12,149.35 110.00 12,142.82 110.00 12,136.28 $3,254,000 $3,254,500 110.00 12,177.36 110.00 12,170.83 110.00 12,164.29 110.00 12,157.76 110.00 12,151.23 110.00 12,144.69 110.00 12,138.16 $3,254,500 $3,255,000 110.00 12,179.23 110.00 12,172.70 110.00 12,166.17 110.00 12,159.63 110.00 12,153.10 110.00 12,146.57 110.00 12,140.03 $3,255,000 $3,255,500 110.00 12,181.11 110.00 12,174.58 110.00 12,168.04 110.00 12,161.51 110.00 12,154.98 110.00 12,148.44 110.00 12,141.91 $3,255,500 $3,256,000 110.00 12,182.98 110.00 12,176.45 110.00 12,169.92 110.00 12,163.38 110.00 12,156.85 110.00 12,150.32 110.00 12,143.78 $3,256,000 $3,256,500 110.00 12,184.86 110.00 12,178.33 110.00 12,171.79 110.00 12,165.26 110.00 12,158.73 110.00 12,152.19 110.00 12,145.66 $3,256,500 $3,257,000 110.00 12,186.73 110.00 12,180.20 110.00 12,173.67 110.00 12,167.13 110.00 12,160.60 110.00 12,154.07 110.00 12,147.53 $3,257,000 $3,257,500 110.00 12,188.61 110.00 12,182.08 110.00 12,175.54 110.00 12,169.01 110.00 12,162.48 110.00 12,155.94 110.00 12,149.41 $3,257,500 $3,258,000 110.00 12,190.48 110.00 12,183.95 110.00 12,177.42 110.00 12,170.88 110.00 12,164.35 110.00 12,157.82 110.00 12,151.28 $3,258,000 $3,258,500 110.00 12,192.36 110.00 12,185.83 110.00 12,179.29 110.00 12,172.76 110.00 12,166.23 110.00 12,159.69 110.00 12,153.16 $3,258,500 $3,259,000 110.00 12,194.23 110.00 12,187.70 110.00 12,181.17 110.00 12,174.63 110.00 12,168.10 110.00 12,161.57 110.00 12,155.03 $3,259,000 $3,259,500 110.00 12,196.11 110.00 12,189.58 110.00 12,183.04 110.00 12,176.51 110.00 12,169.98 110.00 12,163.44 110.00 12,156.91 $3,259,500 $3,260,000 110.00 12,197.98 110.00 12,191.45 110.00 12,184.92 110.00 12,178.38 110.00 12,171.85 110.00 12,165.32 110.00 12,158.78 $3,260,000 $3,260,500 110.00 12,199.86 110.00 12,193.33 110.00 12,186.79 110.00 12,180.26 110.00 12,173.73 110.00 12,167.19 110.00 12,160.66 $3,260,500 $3,261,000 110.00 12,201.73 110.00 12,195.20 110.00 12,188.67 110.00 12,182.13 110.00 12,175.60 110.00 12,169.07 110.00 12,162.53 $3,261,000 $3,261,500 110.00 12,203.61 110.00 12,197.08 110.00 12,190.54 110.00 12,184.01 110.00 12,177.48 110.00 12,170.94 110.00 12,164.41 $3,261,500 $3,262,000 110.00 12,205.48 110.00 12,198.95 110.00 12,192.42 110.00 12,185.88 110.00 12,179.35 110.00 12,172.82 110.00 12,166.28 $3,262,000 $3,262,500 110.00 12,207.36 110.00 12,200.83 110.00 12,194.29 110.00 12,187.76 110.00 12,181.23 110.00 12,174.69 110.00 12,168.16 $3,262,500 $3,263,000 110.00 12,209.23 110.00 12,202.70 110.00 12,196.17 110.00 12,189.63 110.00 12,183.10 110.00 12,176.57 110.00 12,170.03 $3,263,000 $3,263,500 110.00 12,211.11 110.00 12,204.58 110.00 12,198.04 110.00 12,191.51 110.00 12,184.98 110.00 12,178.44 110.00 12,171.91 $3,263,500 $3,264,000 110.00 12,212.98 110.00 12,206.45 110.00 12,199.92 110.00 12,193.38 110.00 12,186.85 110.00 12,180.32 110.00 12,173.78

NJEIS Family Cost Participation Table Page 67 of 12 Effective July 1, 2015

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

$3,264,000 $3,264,500 110.00 12,214.86 110.00 12,208.33 110.00 12,201.79 110.00 12,195.26 110.00 12,188.73 110.00 12,182.19 110.00 12,175.66 $3,264,500 $3,265,000 110.00 12,216.73 110.00 12,210.20 110.00 12,203.67 110.00 12,197.13 110.00 12,190.60 110.00 12,184.07 110.00 12,177.53 $3,265,000 $3,265,500 110.00 12,218.61 110.00 12,212.08 110.00 12,205.54 110.00 12,199.01 110.00 12,192.48 110.00 12,185.94 110.00 12,179.41 $3,265,500 $3,266,000 110.00 12,220.48 110.00 12,213.95 110.00 12,207.42 110.00 12,200.88 110.00 12,194.35 110.00 12,187.82 110.00 12,181.28 $3,266,000 $3,266,500 110.00 12,222.36 110.00 12,215.83 110.00 12,209.29 110.00 12,202.76 110.00 12,196.23 110.00 12,189.69 110.00 12,183.16 $3,266,500 $3,267,000 110.00 12,224.23 110.00 12,217.70 110.00 12,211.17 110.00 12,204.63 110.00 12,198.10 110.00 12,191.57 110.00 12,185.03 $3,267,000 $3,267,500 110.00 12,226.11 110.00 12,219.58 110.00 12,213.04 110.00 12,206.51 110.00 12,199.98 110.00 12,193.44 110.00 12,186.91 $3,267,500 $3,268,000 110.00 12,227.98 110.00 12,221.45 110.00 12,214.92 110.00 12,208.38 110.00 12,201.85 110.00 12,195.32 110.00 12,188.78 $3,268,000 $3,268,500 110.00 12,229.86 110.00 12,223.33 110.00 12,216.79 110.00 12,210.26 110.00 12,203.73 110.00 12,197.19 110.00 12,190.66 $3,268,500 $3,269,000 110.00 12,231.73 110.00 12,225.20 110.00 12,218.67 110.00 12,212.13 110.00 12,205.60 110.00 12,199.07 110.00 12,192.53 $3,269,000 $3,269,500 110.00 12,233.61 110.00 12,227.08 110.00 12,220.54 110.00 12,214.01 110.00 12,207.48 110.00 12,200.94 110.00 12,194.41 $3,269,500 $3,270,000 110.00 12,235.48 110.00 12,228.95 110.00 12,222.42 110.00 12,215.88 110.00 12,209.35 110.00 12,202.82 110.00 12,196.28 $3,270,000 $3,270,500 110.00 12,237.36 110.00 12,230.83 110.00 12,224.29 110.00 12,217.76 110.00 12,211.23 110.00 12,204.69 110.00 12,198.16 $3,270,500 $3,271,000 110.00 12,239.23 110.00 12,232.70 110.00 12,226.17 110.00 12,219.63 110.00 12,213.10 110.00 12,206.57 110.00 12,200.03 $3,271,000 $3,271,500 110.00 12,241.11 110.00 12,234.58 110.00 12,228.04 110.00 12,221.51 110.00 12,214.98 110.00 12,208.44 110.00 12,201.91 $3,271,500 $3,272,000 110.00 12,242.98 110.00 12,236.45 110.00 12,229.92 110.00 12,223.38 110.00 12,216.85 110.00 12,210.32 110.00 12,203.78 $3,272,000 $3,272,500 110.00 12,244.86 110.00 12,238.33 110.00 12,231.79 110.00 12,225.26 110.00 12,218.73 110.00 12,212.19 110.00 12,205.66 $3,272,500 $3,273,000 110.00 12,246.73 110.00 12,240.20 110.00 12,233.67 110.00 12,227.13 110.00 12,220.60 110.00 12,214.07 110.00 12,207.53 $3,273,000 $3,273,500 110.00 12,248.61 110.00 12,242.08 110.00 12,235.54 110.00 12,229.01 110.00 12,222.48 110.00 12,215.94 110.00 12,209.41 $3,273,500 $3,274,000 110.00 12,250.48 110.00 12,243.95 110.00 12,237.42 110.00 12,230.88 110.00 12,224.35 110.00 12,217.82 110.00 12,211.28 $3,274,000 $3,274,500 110.00 12,252.36 110.00 12,245.83 110.00 12,239.29 110.00 12,232.76 110.00 12,226.23 110.00 12,219.69 110.00 12,213.16 $3,274,500 $3,275,000 110.00 12,254.23 110.00 12,247.70 110.00 12,241.17 110.00 12,234.63 110.00 12,228.10 110.00 12,221.57 110.00 12,215.03 $3,275,000 $3,275,500 110.00 12,256.11 110.00 12,249.58 110.00 12,243.04 110.00 12,236.51 110.00 12,229.98 110.00 12,223.44 110.00 12,216.91 $3,275,500 $3,276,000 110.00 12,257.98 110.00 12,251.45 110.00 12,244.92 110.00 12,238.38 110.00 12,231.85 110.00 12,225.32 110.00 12,218.78 $3,276,000 $3,276,500 110.00 12,259.86 110.00 12,253.33 110.00 12,246.79 110.00 12,240.26 110.00 12,233.73 110.00 12,227.19 110.00 12,220.66 $3,276,500 $3,277,000 110.00 12,261.73 110.00 12,255.20 110.00 12,248.67 110.00 12,242.13 110.00 12,235.60 110.00 12,229.07 110.00 12,222.53 $3,277,000 $3,277,500 110.00 12,263.61 110.00 12,257.08 110.00 12,250.54 110.00 12,244.01 110.00 12,237.48 110.00 12,230.94 110.00 12,224.41 $3,277,500 $3,278,000 110.00 12,265.48 110.00 12,258.95 110.00 12,252.42 110.00 12,245.88 110.00 12,239.35 110.00 12,232.82 110.00 12,226.28 $3,278,000 $3,278,500 110.00 12,267.36 110.00 12,260.83 110.00 12,254.29 110.00 12,247.76 110.00 12,241.23 110.00 12,234.69 110.00 12,228.16 $3,278,500 $3,279,000 110.00 12,269.23 110.00 12,262.70 110.00 12,256.17 110.00 12,249.63 110.00 12,243.10 110.00 12,236.57 110.00 12,230.03 $3,279,000 $3,279,500 110.00 12,271.11 110.00 12,264.58 110.00 12,258.04 110.00 12,251.51 110.00 12,244.98 110.00 12,238.44 110.00 12,231.91 $3,279,500 $3,280,000 110.00 12,272.98 110.00 12,266.45 110.00 12,259.92 110.00 12,253.38 110.00 12,246.85 110.00 12,240.32 110.00 12,233.78 $3,280,000 $3,280,500 110.00 12,274.86 110.00 12,268.33 110.00 12,261.79 110.00 12,255.26 110.00 12,248.73 110.00 12,242.19 110.00 12,235.66 $3,280,500 $3,281,000 110.00 12,276.73 110.00 12,270.20 110.00 12,263.67 110.00 12,257.13 110.00 12,250.60 110.00 12,244.07 110.00 12,237.53 $3,281,000 $3,281,500 110.00 12,278.61 110.00 12,272.08 110.00 12,265.54 110.00 12,259.01 110.00 12,252.48 110.00 12,245.94 110.00 12,239.41 $3,281,500 $3,282,000 110.00 12,280.48 110.00 12,273.95 110.00 12,267.42 110.00 12,260.88 110.00 12,254.35 110.00 12,247.82 110.00 12,241.28 $3,282,000 $3,282,500 110.00 12,282.36 110.00 12,275.83 110.00 12,269.29 110.00 12,262.76 110.00 12,256.23 110.00 12,249.69 110.00 12,243.16 $3,282,500 $3,283,000 110.00 12,284.23 110.00 12,277.70 110.00 12,271.17 110.00 12,264.63 110.00 12,258.10 110.00 12,251.57 110.00 12,245.03 $3,283,000 $3,283,500 110.00 12,286.11 110.00 12,279.58 110.00 12,273.04 110.00 12,266.51 110.00 12,259.98 110.00 12,253.44 110.00 12,246.91 $3,283,500 $3,284,000 110.00 12,287.98 110.00 12,281.45 110.00 12,274.92 110.00 12,268.38 110.00 12,261.85 110.00 12,255.32 110.00 12,248.78 $3,284,000 $3,284,500 110.00 12,289.86 110.00 12,283.33 110.00 12,276.79 110.00 12,270.26 110.00 12,263.73 110.00 12,257.19 110.00 12,250.66 $3,284,500 $3,285,000 110.00 12,291.73 110.00 12,285.20 110.00 12,278.67 110.00 12,272.13 110.00 12,265.60 110.00 12,259.07 110.00 12,252.53 $3,285,000 $3,285,500 110.00 12,293.61 110.00 12,287.08 110.00 12,280.54 110.00 12,274.01 110.00 12,267.48 110.00 12,260.94 110.00 12,254.41 $3,285,500 $3,286,000 110.00 12,295.48 110.00 12,288.95 110.00 12,282.42 110.00 12,275.88 110.00 12,269.35 110.00 12,262.82 110.00 12,256.28 $3,286,000 $3,286,500 110.00 12,297.36 110.00 12,290.83 110.00 12,284.29 110.00 12,277.76 110.00 12,271.23 110.00 12,264.69 110.00 12,258.16 $3,286,500 $3,287,000 110.00 12,299.23 110.00 12,292.70 110.00 12,286.17 110.00 12,279.63 110.00 12,273.10 110.00 12,266.57 110.00 12,260.03 $3,287,000 $3,287,500 110.00 12,301.11 110.00 12,294.58 110.00 12,288.04 110.00 12,281.51 110.00 12,274.98 110.00 12,268.44 110.00 12,261.91 $3,287,500 $3,288,000 110.00 12,302.98 110.00 12,296.45 110.00 12,289.92 110.00 12,283.38 110.00 12,276.85 110.00 12,270.32 110.00 12,263.78 $3,288,000 $3,288,500 110.00 12,304.86 110.00 12,298.33 110.00 12,291.79 110.00 12,285.26 110.00 12,278.73 110.00 12,272.19 110.00 12,265.66 $3,288,500 $3,289,000 110.00 12,306.73 110.00 12,300.20 110.00 12,293.67 110.00 12,287.13 110.00 12,280.60 110.00 12,274.07 110.00 12,267.53 $3,289,000 $3,289,500 110.00 12,308.61 110.00 12,302.08 110.00 12,295.54 110.00 12,289.01 110.00 12,282.48 110.00 12,275.94 110.00 12,269.41 $3,289,500 $3,290,000 110.00 12,310.48 110.00 12,303.95 110.00 12,297.42 110.00 12,290.88 110.00 12,284.35 110.00 12,277.82 110.00 12,271.28 $3,290,000 $3,290,500 110.00 12,312.36 110.00 12,305.83 110.00 12,299.29 110.00 12,292.76 110.00 12,286.23 110.00 12,279.69 110.00 12,273.16 $3,290,500 $3,291,000 110.00 12,314.23 110.00 12,307.70 110.00 12,301.17 110.00 12,294.63 110.00 12,288.10 110.00 12,281.57 110.00 12,275.03 $3,291,000 $3,291,500 110.00 12,316.11 110.00 12,309.58 110.00 12,303.04 110.00 12,296.51 110.00 12,289.98 110.00 12,283.44 110.00 12,276.91 $3,291,500 $3,292,000 110.00 12,317.98 110.00 12,311.45 110.00 12,304.92 110.00 12,298.38 110.00 12,291.85 110.00 12,285.32 110.00 12,278.78 $3,292,000 $3,292,500 110.00 12,319.86 110.00 12,313.33 110.00 12,306.79 110.00 12,300.26 110.00 12,293.73 110.00 12,287.19 110.00 12,280.66 $3,292,500 $3,293,000 110.00 12,321.73 110.00 12,315.20 110.00 12,308.67 110.00 12,302.13 110.00 12,295.60 110.00 12,289.07 110.00 12,282.53 $3,293,000 $3,293,500 110.00 12,323.61 110.00 12,317.08 110.00 12,310.54 110.00 12,304.01 110.00 12,297.48 110.00 12,290.94 110.00 12,284.41 $3,293,500 $3,294,000 110.00 12,325.48 110.00 12,318.95 110.00 12,312.42 110.00 12,305.88 110.00 12,299.35 110.00 12,292.82 110.00 12,286.28 $3,294,000 $3,294,500 110.00 12,327.36 110.00 12,320.83 110.00 12,314.29 110.00 12,307.76 110.00 12,301.23 110.00 12,294.69 110.00 12,288.16 $3,294,500 $3,295,000 110.00 12,329.23 110.00 12,322.70 110.00 12,316.17 110.00 12,309.63 110.00 12,303.10 110.00 12,296.57 110.00 12,290.03 $3,295,000 $3,295,500 110.00 12,331.11 110.00 12,324.58 110.00 12,318.04 110.00 12,311.51 110.00 12,304.98 110.00 12,298.44 110.00 12,291.91 $3,295,500 $3,296,000 110.00 12,332.98 110.00 12,326.45 110.00 12,319.92 110.00 12,313.38 110.00 12,306.85 110.00 12,300.32 110.00 12,293.78 $3,296,000 $3,296,500 110.00 12,334.86 110.00 12,328.33 110.00 12,321.79 110.00 12,315.26 110.00 12,308.73 110.00 12,302.19 110.00 12,295.66 $3,296,500 $3,297,000 110.00 12,336.73 110.00 12,330.20 110.00 12,323.67 110.00 12,317.13 110.00 12,310.60 110.00 12,304.07 110.00 12,297.53 $3,297,000 $3,297,500 110.00 12,338.61 110.00 12,332.08 110.00 12,325.54 110.00 12,319.01 110.00 12,312.48 110.00 12,305.94 110.00 12,299.41 $3,297,500 $3,298,000 110.00 12,340.48 110.00 12,333.95 110.00 12,327.42 110.00 12,320.88 110.00 12,314.35 110.00 12,307.82 110.00 12,301.28 $3,298,000 $3,298,500 110.00 12,342.36 110.00 12,335.83 110.00 12,329.29 110.00 12,322.76 110.00 12,316.23 110.00 12,309.69 110.00 12,303.16 $3,298,500 $3,299,000 110.00 12,344.23 110.00 12,337.70 110.00 12,331.17 110.00 12,324.63 110.00 12,318.10 110.00 12,311.57 110.00 12,305.03 $3,299,000 $3,299,500 110.00 12,346.11 110.00 12,339.58 110.00 12,333.04 110.00 12,326.51 110.00 12,319.98 110.00 12,313.44 110.00 12,306.91 $3,299,500 $3,300,000 110.00 12,347.98 110.00 12,341.45 110.00 12,334.92 110.00 12,328.38 110.00 12,321.85 110.00 12,315.32 110.00 12,308.78 $3,300,000 $3,300,500 110.00 12,349.86 110.00 12,343.33 110.00 12,336.79 110.00 12,330.26 110.00 12,323.73 110.00 12,317.19 110.00 12,310.66 $3,300,500 $3,301,000 110.00 12,351.73 110.00 12,345.20 110.00 12,338.67 110.00 12,332.13 110.00 12,325.60 110.00 12,319.07 110.00 12,312.53 $3,301,000 $3,301,500 110.00 12,353.61 110.00 12,347.08 110.00 12,340.54 110.00 12,334.01 110.00 12,327.48 110.00 12,320.94 110.00 12,314.41 $3,301,500 $3,302,000 110.00 12,355.48 110.00 12,348.95 110.00 12,342.42 110.00 12,335.88 110.00 12,329.35 110.00 12,322.82 110.00 12,316.28 $3,302,000 $3,302,500 110.00 12,357.36 110.00 12,350.83 110.00 12,344.29 110.00 12,337.76 110.00 12,331.23 110.00 12,324.69 110.00 12,318.16 $3,302,500 $3,303,000 110.00 12,359.23 110.00 12,352.70 110.00 12,346.17 110.00 12,339.63 110.00 12,333.10 110.00 12,326.57 110.00 12,320.03 $3,303,000 $3,303,500 110.00 12,361.11 110.00 12,354.58 110.00 12,348.04 110.00 12,341.51 110.00 12,334.98 110.00 12,328.44 110.00 12,321.91 $3,303,500 $3,304,000 110.00 12,362.98 110.00 12,356.45 110.00 12,349.92 110.00 12,343.38 110.00 12,336.85 110.00 12,330.32 110.00 12,323.78 $3,304,000 $3,304,500 110.00 12,364.86 110.00 12,358.33 110.00 12,351.79 110.00 12,345.26 110.00 12,338.73 110.00 12,332.19 110.00 12,325.66 $3,304,500 $3,305,000 110.00 12,366.73 110.00 12,360.20 110.00 12,353.67 110.00 12,347.13 110.00 12,340.60 110.00 12,334.07 110.00 12,327.53 $3,305,000 $3,305,500 110.00 12,368.61 110.00 12,362.08 110.00 12,355.54 110.00 12,349.01 110.00 12,342.48 110.00 12,335.94 110.00 12,329.41 $3,305,500 $3,306,000 110.00 12,370.48 110.00 12,363.95 110.00 12,357.42 110.00 12,350.88 110.00 12,344.35 110.00 12,337.82 110.00 12,331.28 $3,306,000 $3,306,500 110.00 12,372.36 110.00 12,365.83 110.00 12,359.29 110.00 12,352.76 110.00 12,346.23 110.00 12,339.69 110.00 12,333.16 $3,306,500 $3,307,000 110.00 12,374.23 110.00 12,367.70 110.00 12,361.17 110.00 12,354.63 110.00 12,348.10 110.00 12,341.57 110.00 12,335.03 $3,307,000 $3,307,500 110.00 12,376.11 110.00 12,369.58 110.00 12,363.04 110.00 12,356.51 110.00 12,349.98 110.00 12,343.44 110.00 12,336.91 $3,307,500 $3,308,000 110.00 12,377.98 110.00 12,371.45 110.00 12,364.92 110.00 12,358.38 110.00 12,351.85 110.00 12,345.32 110.00 12,338.78 $3,308,000 $3,308,500 110.00 12,379.86 110.00 12,373.33 110.00 12,366.79 110.00 12,360.26 110.00 12,353.73 110.00 12,347.19 110.00 12,340.66 $3,308,500 $3,309,000 110.00 12,381.73 110.00 12,375.20 110.00 12,368.67 110.00 12,362.13 110.00 12,355.60 110.00 12,349.07 110.00 12,342.53 $3,309,000 $3,309,500 110.00 12,383.61 110.00 12,377.08 110.00 12,370.54 110.00 12,364.01 110.00 12,357.48 110.00 12,350.94 110.00 12,344.41 $3,309,500 $3,310,000 110.00 12,385.48 110.00 12,378.95 110.00 12,372.42 110.00 12,365.88 110.00 12,359.35 110.00 12,352.82 110.00 12,346.28 $3,310,000 $3,310,500 110.00 12,387.36 110.00 12,380.83 110.00 12,374.29 110.00 12,367.76 110.00 12,361.23 110.00 12,354.69 110.00 12,348.16 $3,310,500 $3,311,000 110.00 12,389.23 110.00 12,382.70 110.00 12,376.17 110.00 12,369.63 110.00 12,363.10 110.00 12,356.57 110.00 12,350.03 $3,311,000 $3,311,500 110.00 12,391.11 110.00 12,384.58 110.00 12,378.04 110.00 12,371.51 110.00 12,364.98 110.00 12,358.44 110.00 12,351.91 $3,311,500 $3,312,000 110.00 12,392.98 110.00 12,386.45 110.00 12,379.92 110.00 12,373.38 110.00 12,366.85 110.00 12,360.32 110.00 12,353.78 $3,312,000 $3,312,500 110.00 12,394.86 110.00 12,388.33 110.00 12,381.79 110.00 12,375.26 110.00 12,368.73 110.00 12,362.19 110.00 12,355.66 $3,312,500 $3,313,000 110.00 12,396.73 110.00 12,390.20 110.00 12,383.67 110.00 12,377.13 110.00 12,370.60 110.00 12,364.07 110.00 12,357.53 $3,313,000 $3,313,500 110.00 12,398.61 110.00 12,392.08 110.00 12,385.54 110.00 12,379.01 110.00 12,372.48 110.00 12,365.94 110.00 12,359.41 $3,313,500 $3,314,000 110.00 12,400.48 110.00 12,393.95 110.00 12,387.42 110.00 12,380.88 110.00 12,374.35 110.00 12,367.82 110.00 12,361.28 $3,314,000 $3,314,500 110.00 12,402.36 110.00 12,395.83 110.00 12,389.29 110.00 12,382.76 110.00 12,376.23 110.00 12,369.69 110.00 12,363.16 $3,314,500 $3,315,000 110.00 12,404.23 110.00 12,397.70 110.00 12,391.17 110.00 12,384.63 110.00 12,378.10 110.00 12,371.57 110.00 12,365.03

NJEIS Family Cost Participation Table Page 68 of 12 Effective July 1, 2015

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

$3,315,000 $3,315,500 110.00 12,406.11 110.00 12,399.58 110.00 12,393.04 110.00 12,386.51 110.00 12,379.98 110.00 12,373.44 110.00 12,366.91 $3,315,500 $3,316,000 110.00 12,407.98 110.00 12,401.45 110.00 12,394.92 110.00 12,388.38 110.00 12,381.85 110.00 12,375.32 110.00 12,368.78 $3,316,000 $3,316,500 110.00 12,409.86 110.00 12,403.33 110.00 12,396.79 110.00 12,390.26 110.00 12,383.73 110.00 12,377.19 110.00 12,370.66 $3,316,500 $3,317,000 110.00 12,411.73 110.00 12,405.20 110.00 12,398.67 110.00 12,392.13 110.00 12,385.60 110.00 12,379.07 110.00 12,372.53 $3,317,000 $3,317,500 110.00 12,413.61 110.00 12,407.08 110.00 12,400.54 110.00 12,394.01 110.00 12,387.48 110.00 12,380.94 110.00 12,374.41 $3,317,500 $3,318,000 110.00 12,415.48 110.00 12,408.95 110.00 12,402.42 110.00 12,395.88 110.00 12,389.35 110.00 12,382.82 110.00 12,376.28 $3,318,000 $3,318,500 110.00 12,417.36 110.00 12,410.83 110.00 12,404.29 110.00 12,397.76 110.00 12,391.23 110.00 12,384.69 110.00 12,378.16 $3,318,500 $3,319,000 110.00 12,419.23 110.00 12,412.70 110.00 12,406.17 110.00 12,399.63 110.00 12,393.10 110.00 12,386.57 110.00 12,380.03 $3,319,000 $3,319,500 110.00 12,421.11 110.00 12,414.58 110.00 12,408.04 110.00 12,401.51 110.00 12,394.98 110.00 12,388.44 110.00 12,381.91 $3,319,500 $3,320,000 110.00 12,422.98 110.00 12,416.45 110.00 12,409.92 110.00 12,403.38 110.00 12,396.85 110.00 12,390.32 110.00 12,383.78 $3,320,000 $3,320,500 110.00 12,424.86 110.00 12,418.33 110.00 12,411.79 110.00 12,405.26 110.00 12,398.73 110.00 12,392.19 110.00 12,385.66 $3,320,500 $3,321,000 110.00 12,426.73 110.00 12,420.20 110.00 12,413.67 110.00 12,407.13 110.00 12,400.60 110.00 12,394.07 110.00 12,387.53 $3,321,000 $3,321,500 110.00 12,428.61 110.00 12,422.08 110.00 12,415.54 110.00 12,409.01 110.00 12,402.48 110.00 12,395.94 110.00 12,389.41 $3,321,500 $3,322,000 110.00 12,430.48 110.00 12,423.95 110.00 12,417.42 110.00 12,410.88 110.00 12,404.35 110.00 12,397.82 110.00 12,391.28 $3,322,000 $3,322,500 110.00 12,432.36 110.00 12,425.83 110.00 12,419.29 110.00 12,412.76 110.00 12,406.23 110.00 12,399.69 110.00 12,393.16 $3,322,500 $3,323,000 110.00 12,434.23 110.00 12,427.70 110.00 12,421.17 110.00 12,414.63 110.00 12,408.10 110.00 12,401.57 110.00 12,395.03 $3,323,000 $3,323,500 110.00 12,436.11 110.00 12,429.58 110.00 12,423.04 110.00 12,416.51 110.00 12,409.98 110.00 12,403.44 110.00 12,396.91 $3,323,500 $3,324,000 110.00 12,437.98 110.00 12,431.45 110.00 12,424.92 110.00 12,418.38 110.00 12,411.85 110.00 12,405.32 110.00 12,398.78 $3,324,000 $3,324,500 110.00 12,439.86 110.00 12,433.33 110.00 12,426.79 110.00 12,420.26 110.00 12,413.73 110.00 12,407.19 110.00 12,400.66 $3,324,500 $3,325,000 110.00 12,441.73 110.00 12,435.20 110.00 12,428.67 110.00 12,422.13 110.00 12,415.60 110.00 12,409.07 110.00 12,402.53 $3,325,000 $3,325,500 110.00 12,443.61 110.00 12,437.08 110.00 12,430.54 110.00 12,424.01 110.00 12,417.48 110.00 12,410.94 110.00 12,404.41 $3,325,500 $3,326,000 110.00 12,445.48 110.00 12,438.95 110.00 12,432.42 110.00 12,425.88 110.00 12,419.35 110.00 12,412.82 110.00 12,406.28 $3,326,000 $3,326,500 110.00 12,447.36 110.00 12,440.83 110.00 12,434.29 110.00 12,427.76 110.00 12,421.23 110.00 12,414.69 110.00 12,408.16 $3,326,500 $3,327,000 110.00 12,449.23 110.00 12,442.70 110.00 12,436.17 110.00 12,429.63 110.00 12,423.10 110.00 12,416.57 110.00 12,410.03 $3,327,000 $3,327,500 110.00 12,451.11 110.00 12,444.58 110.00 12,438.04 110.00 12,431.51 110.00 12,424.98 110.00 12,418.44 110.00 12,411.91 $3,327,500 $3,328,000 110.00 12,452.98 110.00 12,446.45 110.00 12,439.92 110.00 12,433.38 110.00 12,426.85 110.00 12,420.32 110.00 12,413.78 $3,328,000 $3,328,500 110.00 12,454.86 110.00 12,448.33 110.00 12,441.79 110.00 12,435.26 110.00 12,428.73 110.00 12,422.19 110.00 12,415.66 $3,328,500 $3,329,000 110.00 12,456.73 110.00 12,450.20 110.00 12,443.67 110.00 12,437.13 110.00 12,430.60 110.00 12,424.07 110.00 12,417.53 $3,329,000 $3,329,500 110.00 12,458.61 110.00 12,452.08 110.00 12,445.54 110.00 12,439.01 110.00 12,432.48 110.00 12,425.94 110.00 12,419.41 $3,329,500 $3,330,000 110.00 12,460.48 110.00 12,453.95 110.00 12,447.42 110.00 12,440.88 110.00 12,434.35 110.00 12,427.82 110.00 12,421.28 $3,330,000 $3,330,500 110.00 12,462.36 110.00 12,455.83 110.00 12,449.29 110.00 12,442.76 110.00 12,436.23 110.00 12,429.69 110.00 12,423.16 $3,330,500 $3,331,000 110.00 12,464.23 110.00 12,457.70 110.00 12,451.17 110.00 12,444.63 110.00 12,438.10 110.00 12,431.57 110.00 12,425.03 $3,331,000 $3,331,500 110.00 12,466.11 110.00 12,459.58 110.00 12,453.04 110.00 12,446.51 110.00 12,439.98 110.00 12,433.44 110.00 12,426.91 $3,331,500 $3,332,000 110.00 12,467.98 110.00 12,461.45 110.00 12,454.92 110.00 12,448.38 110.00 12,441.85 110.00 12,435.32 110.00 12,428.78 $3,332,000 $3,332,500 110.00 12,469.86 110.00 12,463.33 110.00 12,456.79 110.00 12,450.26 110.00 12,443.73 110.00 12,437.19 110.00 12,430.66 $3,332,500 $3,333,000 110.00 12,471.73 110.00 12,465.20 110.00 12,458.67 110.00 12,452.13 110.00 12,445.60 110.00 12,439.07 110.00 12,432.53 $3,333,000 $3,333,500 110.00 12,473.61 110.00 12,467.08 110.00 12,460.54 110.00 12,454.01 110.00 12,447.48 110.00 12,440.94 110.00 12,434.41 $3,333,500 $3,334,000 110.00 12,475.48 110.00 12,468.95 110.00 12,462.42 110.00 12,455.88 110.00 12,449.35 110.00 12,442.82 110.00 12,436.28 $3,334,000 $3,334,500 110.00 12,477.36 110.00 12,470.83 110.00 12,464.29 110.00 12,457.76 110.00 12,451.23 110.00 12,444.69 110.00 12,438.16 $3,334,500 $3,335,000 110.00 12,479.23 110.00 12,472.70 110.00 12,466.17 110.00 12,459.63 110.00 12,453.10 110.00 12,446.57 110.00 12,440.03 $3,335,000 $3,335,500 110.00 12,481.11 110.00 12,474.58 110.00 12,468.04 110.00 12,461.51 110.00 12,454.98 110.00 12,448.44 110.00 12,441.91 $3,335,500 $3,336,000 110.00 12,482.98 110.00 12,476.45 110.00 12,469.92 110.00 12,463.38 110.00 12,456.85 110.00 12,450.32 110.00 12,443.78 $3,336,000 $3,336,500 110.00 12,484.86 110.00 12,478.33 110.00 12,471.79 110.00 12,465.26 110.00 12,458.73 110.00 12,452.19 110.00 12,445.66 $3,336,500 $3,337,000 110.00 12,486.73 110.00 12,480.20 110.00 12,473.67 110.00 12,467.13 110.00 12,460.60 110.00 12,454.07 110.00 12,447.53 $3,337,000 $3,337,500 110.00 12,488.61 110.00 12,482.08 110.00 12,475.54 110.00 12,469.01 110.00 12,462.48 110.00 12,455.94 110.00 12,449.41 $3,337,500 $3,338,000 110.00 12,490.48 110.00 12,483.95 110.00 12,477.42 110.00 12,470.88 110.00 12,464.35 110.00 12,457.82 110.00 12,451.28 $3,338,000 $3,338,500 110.00 12,492.36 110.00 12,485.83 110.00 12,479.29 110.00 12,472.76 110.00 12,466.23 110.00 12,459.69 110.00 12,453.16 $3,338,500 $3,339,000 110.00 12,494.23 110.00 12,487.70 110.00 12,481.17 110.00 12,474.63 110.00 12,468.10 110.00 12,461.57 110.00 12,455.03 $3,339,000 $3,339,500 110.00 12,496.11 110.00 12,489.58 110.00 12,483.04 110.00 12,476.51 110.00 12,469.98 110.00 12,463.44 110.00 12,456.91 $3,339,500 $3,340,000 110.00 12,497.98 110.00 12,491.45 110.00 12,484.92 110.00 12,478.38 110.00 12,471.85 110.00 12,465.32 110.00 12,458.78 $3,340,000 $3,340,500 110.00 12,499.86 110.00 12,493.33 110.00 12,486.79 110.00 12,480.26 110.00 12,473.73 110.00 12,467.19 110.00 12,460.66 $3,340,500 $3,341,000 110.00 12,501.73 110.00 12,495.20 110.00 12,488.67 110.00 12,482.13 110.00 12,475.60 110.00 12,469.07 110.00 12,462.53 $3,341,000 $3,341,500 110.00 12,503.61 110.00 12,497.08 110.00 12,490.54 110.00 12,484.01 110.00 12,477.48 110.00 12,470.94 110.00 12,464.41 $3,341,500 $3,342,000 110.00 12,505.48 110.00 12,498.95 110.00 12,492.42 110.00 12,485.88 110.00 12,479.35 110.00 12,472.82 110.00 12,466.28 $3,342,000 $3,342,500 110.00 12,507.36 110.00 12,500.83 110.00 12,494.29 110.00 12,487.76 110.00 12,481.23 110.00 12,474.69 110.00 12,468.16 $3,342,500 $3,343,000 110.00 12,509.23 110.00 12,502.70 110.00 12,496.17 110.00 12,489.63 110.00 12,483.10 110.00 12,476.57 110.00 12,470.03 $3,343,000 $3,343,500 110.00 12,511.11 110.00 12,504.58 110.00 12,498.04 110.00 12,491.51 110.00 12,484.98 110.00 12,478.44 110.00 12,471.91 $3,343,500 $3,344,000 110.00 12,512.98 110.00 12,506.45 110.00 12,499.92 110.00 12,493.38 110.00 12,486.85 110.00 12,480.32 110.00 12,473.78 $3,344,000 $3,344,500 110.00 12,514.86 110.00 12,508.33 110.00 12,501.79 110.00 12,495.26 110.00 12,488.73 110.00 12,482.19 110.00 12,475.66 $3,344,500 $3,345,000 110.00 12,516.73 110.00 12,510.20 110.00 12,503.67 110.00 12,497.13 110.00 12,490.60 110.00 12,484.07 110.00 12,477.53 $3,345,000 $3,345,500 110.00 12,518.61 110.00 12,512.08 110.00 12,505.54 110.00 12,499.01 110.00 12,492.48 110.00 12,485.94 110.00 12,479.41 $3,345,500 $3,346,000 110.00 12,520.48 110.00 12,513.95 110.00 12,507.42 110.00 12,500.88 110.00 12,494.35 110.00 12,487.82 110.00 12,481.28 $3,346,000 $3,346,500 110.00 12,522.36 110.00 12,515.83 110.00 12,509.29 110.00 12,502.76 110.00 12,496.23 110.00 12,489.69 110.00 12,483.16 $3,346,500 $3,347,000 110.00 12,524.23 110.00 12,517.70 110.00 12,511.17 110.00 12,504.63 110.00 12,498.10 110.00 12,491.57 110.00 12,485.03 $3,347,000 $3,347,500 110.00 12,526.11 110.00 12,519.58 110.00 12,513.04 110.00 12,506.51 110.00 12,499.98 110.00 12,493.44 110.00 12,486.91 $3,347,500 $3,348,000 110.00 12,527.98 110.00 12,521.45 110.00 12,514.92 110.00 12,508.38 110.00 12,501.85 110.00 12,495.32 110.00 12,488.78 $3,348,000 $3,348,500 110.00 12,529.86 110.00 12,523.33 110.00 12,516.79 110.00 12,510.26 110.00 12,503.73 110.00 12,497.19 110.00 12,490.66 $3,348,500 $3,349,000 110.00 12,531.73 110.00 12,525.20 110.00 12,518.67 110.00 12,512.13 110.00 12,505.60 110.00 12,499.07 110.00 12,492.53 $3,349,000 $3,349,500 110.00 12,533.61 110.00 12,527.08 110.00 12,520.54 110.00 12,514.01 110.00 12,507.48 110.00 12,500.94 110.00 12,494.41 $3,349,500 $3,350,000 110.00 12,535.48 110.00 12,528.95 110.00 12,522.42 110.00 12,515.88 110.00 12,509.35 110.00 12,502.82 110.00 12,496.28 $3,350,000 $3,350,500 110.00 12,537.36 110.00 12,530.83 110.00 12,524.29 110.00 12,517.76 110.00 12,511.23 110.00 12,504.69 110.00 12,498.16 $3,350,500 $3,351,000 110.00 12,539.23 110.00 12,532.70 110.00 12,526.17 110.00 12,519.63 110.00 12,513.10 110.00 12,506.57 110.00 12,500.03 $3,351,000 $3,351,500 110.00 12,541.11 110.00 12,534.58 110.00 12,528.04 110.00 12,521.51 110.00 12,514.98 110.00 12,508.44 110.00 12,501.91 $3,351,500 $3,352,000 110.00 12,542.98 110.00 12,536.45 110.00 12,529.92 110.00 12,523.38 110.00 12,516.85 110.00 12,510.32 110.00 12,503.78 $3,352,000 $3,352,500 110.00 12,544.86 110.00 12,538.33 110.00 12,531.79 110.00 12,525.26 110.00 12,518.73 110.00 12,512.19 110.00 12,505.66 $3,352,500 $3,353,000 110.00 12,546.73 110.00 12,540.20 110.00 12,533.67 110.00 12,527.13 110.00 12,520.60 110.00 12,514.07 110.00 12,507.53 $3,353,000 $3,353,500 110.00 12,548.61 110.00 12,542.08 110.00 12,535.54 110.00 12,529.01 110.00 12,522.48 110.00 12,515.94 110.00 12,509.41 $3,353,500 $3,354,000 110.00 12,550.48 110.00 12,543.95 110.00 12,537.42 110.00 12,530.88 110.00 12,524.35 110.00 12,517.82 110.00 12,511.28 $3,354,000 $3,354,500 110.00 12,552.36 110.00 12,545.83 110.00 12,539.29 110.00 12,532.76 110.00 12,526.23 110.00 12,519.69 110.00 12,513.16 $3,354,500 $3,355,000 110.00 12,554.23 110.00 12,547.70 110.00 12,541.17 110.00 12,534.63 110.00 12,528.10 110.00 12,521.57 110.00 12,515.03 $3,355,000 $3,355,500 110.00 12,556.11 110.00 12,549.58 110.00 12,543.04 110.00 12,536.51 110.00 12,529.98 110.00 12,523.44 110.00 12,516.91 $3,355,500 $3,356,000 110.00 12,557.98 110.00 12,551.45 110.00 12,544.92 110.00 12,538.38 110.00 12,531.85 110.00 12,525.32 110.00 12,518.78 $3,356,000 $3,356,500 110.00 12,559.86 110.00 12,553.33 110.00 12,546.79 110.00 12,540.26 110.00 12,533.73 110.00 12,527.19 110.00 12,520.66 $3,356,500 $3,357,000 110.00 12,561.73 110.00 12,555.20 110.00 12,548.67 110.00 12,542.13 110.00 12,535.60 110.00 12,529.07 110.00 12,522.53 $3,357,000 $3,357,500 110.00 12,563.61 110.00 12,557.08 110.00 12,550.54 110.00 12,544.01 110.00 12,537.48 110.00 12,530.94 110.00 12,524.41 $3,357,500 $3,358,000 110.00 12,565.48 110.00 12,558.95 110.00 12,552.42 110.00 12,545.88 110.00 12,539.35 110.00 12,532.82 110.00 12,526.28 $3,358,000 $3,358,500 110.00 12,567.36 110.00 12,560.83 110.00 12,554.29 110.00 12,547.76 110.00 12,541.23 110.00 12,534.69 110.00 12,528.16 $3,358,500 $3,359,000 110.00 12,569.23 110.00 12,562.70 110.00 12,556.17 110.00 12,549.63 110.00 12,543.10 110.00 12,536.57 110.00 12,530.03 $3,359,000 $3,359,500 110.00 12,571.11 110.00 12,564.58 110.00 12,558.04 110.00 12,551.51 110.00 12,544.98 110.00 12,538.44 110.00 12,531.91 $3,359,500 $3,360,000 110.00 12,572.98 110.00 12,566.45 110.00 12,559.92 110.00 12,553.38 110.00 12,546.85 110.00 12,540.32 110.00 12,533.78 $3,360,000 $3,360,500 110.00 12,574.86 110.00 12,568.33 110.00 12,561.79 110.00 12,555.26 110.00 12,548.73 110.00 12,542.19 110.00 12,535.66 $3,360,500 $3,361,000 110.00 12,576.73 110.00 12,570.20 110.00 12,563.67 110.00 12,557.13 110.00 12,550.60 110.00 12,544.07 110.00 12,537.53 $3,361,000 $3,361,500 110.00 12,578.61 110.00 12,572.08 110.00 12,565.54 110.00 12,559.01 110.00 12,552.48 110.00 12,545.94 110.00 12,539.41 $3,361,500 $3,362,000 110.00 12,580.48 110.00 12,573.95 110.00 12,567.42 110.00 12,560.88 110.00 12,554.35 110.00 12,547.82 110.00 12,541.28 $3,362,000 $3,362,500 110.00 12,582.36 110.00 12,575.83 110.00 12,569.29 110.00 12,562.76 110.00 12,556.23 110.00 12,549.69 110.00 12,543.16 $3,362,500 $3,363,000 110.00 12,584.23 110.00 12,577.70 110.00 12,571.17 110.00 12,564.63 110.00 12,558.10 110.00 12,551.57 110.00 12,545.03 $3,363,000 $3,363,500 110.00 12,586.11 110.00 12,579.58 110.00 12,573.04 110.00 12,566.51 110.00 12,559.98 110.00 12,553.44 110.00 12,546.91 $3,363,500 $3,364,000 110.00 12,587.98 110.00 12,581.45 110.00 12,574.92 110.00 12,568.38 110.00 12,561.85 110.00 12,555.32 110.00 12,548.78 $3,364,000 $3,364,500 110.00 12,589.86 110.00 12,583.33 110.00 12,576.79 110.00 12,570.26 110.00 12,563.73 110.00 12,557.19 110.00 12,550.66 $3,364,500 $3,365,000 110.00 12,591.73 110.00 12,585.20 110.00 12,578.67 110.00 12,572.13 110.00 12,565.60 110.00 12,559.07 110.00 12,552.53 $3,365,000 $3,365,500 110.00 12,593.61 110.00 12,587.08 110.00 12,580.54 110.00 12,574.01 110.00 12,567.48 110.00 12,560.94 110.00 12,554.41 $3,365,500 $3,366,000 110.00 12,595.48 110.00 12,588.95 110.00 12,582.42 110.00 12,575.88 110.00 12,569.35 110.00 12,562.82 110.00 12,556.28

NJEIS Family Cost Participation Table Page 69 of 12 Effective July 1, 2015

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

$3,366,000 $3,366,500 110.00 12,597.36 110.00 12,590.83 110.00 12,584.29 110.00 12,577.76 110.00 12,571.23 110.00 12,564.69 110.00 12,558.16 $3,366,500 $3,367,000 110.00 12,599.23 110.00 12,592.70 110.00 12,586.17 110.00 12,579.63 110.00 12,573.10 110.00 12,566.57 110.00 12,560.03 $3,367,000 $3,367,500 110.00 12,601.11 110.00 12,594.58 110.00 12,588.04 110.00 12,581.51 110.00 12,574.98 110.00 12,568.44 110.00 12,561.91 $3,367,500 $3,368,000 110.00 12,602.98 110.00 12,596.45 110.00 12,589.92 110.00 12,583.38 110.00 12,576.85 110.00 12,570.32 110.00 12,563.78 $3,368,000 $3,368,500 110.00 12,604.86 110.00 12,598.33 110.00 12,591.79 110.00 12,585.26 110.00 12,578.73 110.00 12,572.19 110.00 12,565.66 $3,368,500 $3,369,000 110.00 12,606.73 110.00 12,600.20 110.00 12,593.67 110.00 12,587.13 110.00 12,580.60 110.00 12,574.07 110.00 12,567.53 $3,369,000 $3,369,500 110.00 12,608.61 110.00 12,602.08 110.00 12,595.54 110.00 12,589.01 110.00 12,582.48 110.00 12,575.94 110.00 12,569.41 $3,369,500 $3,370,000 110.00 12,610.48 110.00 12,603.95 110.00 12,597.42 110.00 12,590.88 110.00 12,584.35 110.00 12,577.82 110.00 12,571.28 $3,370,000 $3,370,500 110.00 12,612.36 110.00 12,605.83 110.00 12,599.29 110.00 12,592.76 110.00 12,586.23 110.00 12,579.69 110.00 12,573.16 $3,370,500 $3,371,000 110.00 12,614.23 110.00 12,607.70 110.00 12,601.17 110.00 12,594.63 110.00 12,588.10 110.00 12,581.57 110.00 12,575.03 $3,371,000 $3,371,500 110.00 12,616.11 110.00 12,609.58 110.00 12,603.04 110.00 12,596.51 110.00 12,589.98 110.00 12,583.44 110.00 12,576.91 $3,371,500 $3,372,000 110.00 12,617.98 110.00 12,611.45 110.00 12,604.92 110.00 12,598.38 110.00 12,591.85 110.00 12,585.32 110.00 12,578.78 $3,372,000 $3,372,500 110.00 12,619.86 110.00 12,613.33 110.00 12,606.79 110.00 12,600.26 110.00 12,593.73 110.00 12,587.19 110.00 12,580.66 $3,372,500 $3,373,000 110.00 12,621.73 110.00 12,615.20 110.00 12,608.67 110.00 12,602.13 110.00 12,595.60 110.00 12,589.07 110.00 12,582.53 $3,373,000 $3,373,500 110.00 12,623.61 110.00 12,617.08 110.00 12,610.54 110.00 12,604.01 110.00 12,597.48 110.00 12,590.94 110.00 12,584.41 $3,373,500 $3,374,000 110.00 12,625.48 110.00 12,618.95 110.00 12,612.42 110.00 12,605.88 110.00 12,599.35 110.00 12,592.82 110.00 12,586.28 $3,374,000 $3,374,500 110.00 12,627.36 110.00 12,620.83 110.00 12,614.29 110.00 12,607.76 110.00 12,601.23 110.00 12,594.69 110.00 12,588.16 $3,374,500 $3,375,000 110.00 12,629.23 110.00 12,622.70 110.00 12,616.17 110.00 12,609.63 110.00 12,603.10 110.00 12,596.57 110.00 12,590.03 $3,375,000 $3,375,500 110.00 12,631.11 110.00 12,624.58 110.00 12,618.04 110.00 12,611.51 110.00 12,604.98 110.00 12,598.44 110.00 12,591.91 $3,375,500 $3,376,000 110.00 12,632.98 110.00 12,626.45 110.00 12,619.92 110.00 12,613.38 110.00 12,606.85 110.00 12,600.32 110.00 12,593.78 $3,376,000 $3,376,500 110.00 12,634.86 110.00 12,628.33 110.00 12,621.79 110.00 12,615.26 110.00 12,608.73 110.00 12,602.19 110.00 12,595.66 $3,376,500 $3,377,000 110.00 12,636.73 110.00 12,630.20 110.00 12,623.67 110.00 12,617.13 110.00 12,610.60 110.00 12,604.07 110.00 12,597.53 $3,377,000 $3,377,500 110.00 12,638.61 110.00 12,632.08 110.00 12,625.54 110.00 12,619.01 110.00 12,612.48 110.00 12,605.94 110.00 12,599.41 $3,377,500 $3,378,000 110.00 12,640.48 110.00 12,633.95 110.00 12,627.42 110.00 12,620.88 110.00 12,614.35 110.00 12,607.82 110.00 12,601.28 $3,378,000 $3,378,500 110.00 12,642.36 110.00 12,635.83 110.00 12,629.29 110.00 12,622.76 110.00 12,616.23 110.00 12,609.69 110.00 12,603.16 $3,378,500 $3,379,000 110.00 12,644.23 110.00 12,637.70 110.00 12,631.17 110.00 12,624.63 110.00 12,618.10 110.00 12,611.57 110.00 12,605.03 $3,379,000 $3,379,500 110.00 12,646.11 110.00 12,639.58 110.00 12,633.04 110.00 12,626.51 110.00 12,619.98 110.00 12,613.44 110.00 12,606.91 $3,379,500 $3,380,000 110.00 12,647.98 110.00 12,641.45 110.00 12,634.92 110.00 12,628.38 110.00 12,621.85 110.00 12,615.32 110.00 12,608.78 $3,380,000 $3,380,500 110.00 12,649.86 110.00 12,643.33 110.00 12,636.79 110.00 12,630.26 110.00 12,623.73 110.00 12,617.19 110.00 12,610.66 $3,380,500 $3,381,000 110.00 12,651.73 110.00 12,645.20 110.00 12,638.67 110.00 12,632.13 110.00 12,625.60 110.00 12,619.07 110.00 12,612.53 $3,381,000 $3,381,500 110.00 12,653.61 110.00 12,647.08 110.00 12,640.54 110.00 12,634.01 110.00 12,627.48 110.00 12,620.94 110.00 12,614.41 $3,381,500 $3,382,000 110.00 12,655.48 110.00 12,648.95 110.00 12,642.42 110.00 12,635.88 110.00 12,629.35 110.00 12,622.82 110.00 12,616.28 $3,382,000 $3,382,500 110.00 12,657.36 110.00 12,650.83 110.00 12,644.29 110.00 12,637.76 110.00 12,631.23 110.00 12,624.69 110.00 12,618.16 $3,382,500 $3,383,000 110.00 12,659.23 110.00 12,652.70 110.00 12,646.17 110.00 12,639.63 110.00 12,633.10 110.00 12,626.57 110.00 12,620.03 $3,383,000 $3,383,500 110.00 12,661.11 110.00 12,654.58 110.00 12,648.04 110.00 12,641.51 110.00 12,634.98 110.00 12,628.44 110.00 12,621.91 $3,383,500 $3,384,000 110.00 12,662.98 110.00 12,656.45 110.00 12,649.92 110.00 12,643.38 110.00 12,636.85 110.00 12,630.32 110.00 12,623.78 $3,384,000 $3,384,500 110.00 12,664.86 110.00 12,658.33 110.00 12,651.79 110.00 12,645.26 110.00 12,638.73 110.00 12,632.19 110.00 12,625.66 $3,384,500 $3,385,000 110.00 12,666.73 110.00 12,660.20 110.00 12,653.67 110.00 12,647.13 110.00 12,640.60 110.00 12,634.07 110.00 12,627.53 $3,385,000 $3,385,500 110.00 12,668.61 110.00 12,662.08 110.00 12,655.54 110.00 12,649.01 110.00 12,642.48 110.00 12,635.94 110.00 12,629.41 $3,385,500 $3,386,000 110.00 12,670.48 110.00 12,663.95 110.00 12,657.42 110.00 12,650.88 110.00 12,644.35 110.00 12,637.82 110.00 12,631.28 $3,386,000 $3,386,500 110.00 12,672.36 110.00 12,665.83 110.00 12,659.29 110.00 12,652.76 110.00 12,646.23 110.00 12,639.69 110.00 12,633.16 $3,386,500 $3,387,000 110.00 12,674.23 110.00 12,667.70 110.00 12,661.17 110.00 12,654.63 110.00 12,648.10 110.00 12,641.57 110.00 12,635.03 $3,387,000 $3,387,500 110.00 12,676.11 110.00 12,669.58 110.00 12,663.04 110.00 12,656.51 110.00 12,649.98 110.00 12,643.44 110.00 12,636.91 $3,387,500 $3,388,000 110.00 12,677.98 110.00 12,671.45 110.00 12,664.92 110.00 12,658.38 110.00 12,651.85 110.00 12,645.32 110.00 12,638.78 $3,388,000 $3,388,500 110.00 12,679.86 110.00 12,673.33 110.00 12,666.79 110.00 12,660.26 110.00 12,653.73 110.00 12,647.19 110.00 12,640.66 $3,388,500 $3,389,000 110.00 12,681.73 110.00 12,675.20 110.00 12,668.67 110.00 12,662.13 110.00 12,655.60 110.00 12,649.07 110.00 12,642.53 $3,389,000 $3,389,500 110.00 12,683.61 110.00 12,677.08 110.00 12,670.54 110.00 12,664.01 110.00 12,657.48 110.00 12,650.94 110.00 12,644.41 $3,389,500 $3,390,000 110.00 12,685.48 110.00 12,678.95 110.00 12,672.42 110.00 12,665.88 110.00 12,659.35 110.00 12,652.82 110.00 12,646.28 $3,390,000 $3,390,500 110.00 12,687.36 110.00 12,680.83 110.00 12,674.29 110.00 12,667.76 110.00 12,661.23 110.00 12,654.69 110.00 12,648.16 $3,390,500 $3,391,000 110.00 12,689.23 110.00 12,682.70 110.00 12,676.17 110.00 12,669.63 110.00 12,663.10 110.00 12,656.57 110.00 12,650.03 $3,391,000 $3,391,500 110.00 12,691.11 110.00 12,684.58 110.00 12,678.04 110.00 12,671.51 110.00 12,664.98 110.00 12,658.44 110.00 12,651.91 $3,391,500 $3,392,000 110.00 12,692.98 110.00 12,686.45 110.00 12,679.92 110.00 12,673.38 110.00 12,666.85 110.00 12,660.32 110.00 12,653.78 $3,392,000 $3,392,500 110.00 12,694.86 110.00 12,688.33 110.00 12,681.79 110.00 12,675.26 110.00 12,668.73 110.00 12,662.19 110.00 12,655.66 $3,392,500 $3,393,000 110.00 12,696.73 110.00 12,690.20 110.00 12,683.67 110.00 12,677.13 110.00 12,670.60 110.00 12,664.07 110.00 12,657.53 $3,393,000 $3,393,500 110.00 12,698.61 110.00 12,692.08 110.00 12,685.54 110.00 12,679.01 110.00 12,672.48 110.00 12,665.94 110.00 12,659.41 $3,393,500 $3,394,000 110.00 12,700.48 110.00 12,693.95 110.00 12,687.42 110.00 12,680.88 110.00 12,674.35 110.00 12,667.82 110.00 12,661.28 $3,394,000 $3,394,500 110.00 12,702.36 110.00 12,695.83 110.00 12,689.29 110.00 12,682.76 110.00 12,676.23 110.00 12,669.69 110.00 12,663.16 $3,394,500 $3,395,000 110.00 12,704.23 110.00 12,697.70 110.00 12,691.17 110.00 12,684.63 110.00 12,678.10 110.00 12,671.57 110.00 12,665.03 $3,395,000 $3,395,500 110.00 12,706.11 110.00 12,699.58 110.00 12,693.04 110.00 12,686.51 110.00 12,679.98 110.00 12,673.44 110.00 12,666.91 $3,395,500 $3,396,000 110.00 12,707.98 110.00 12,701.45 110.00 12,694.92 110.00 12,688.38 110.00 12,681.85 110.00 12,675.32 110.00 12,668.78 $3,396,000 $3,396,500 110.00 12,709.86 110.00 12,703.33 110.00 12,696.79 110.00 12,690.26 110.00 12,683.73 110.00 12,677.19 110.00 12,670.66 $3,396,500 $3,397,000 110.00 12,711.73 110.00 12,705.20 110.00 12,698.67 110.00 12,692.13 110.00 12,685.60 110.00 12,679.07 110.00 12,672.53 $3,397,000 $3,397,500 110.00 12,713.61 110.00 12,707.08 110.00 12,700.54 110.00 12,694.01 110.00 12,687.48 110.00 12,680.94 110.00 12,674.41 $3,397,500 $3,398,000 110.00 12,715.48 110.00 12,708.95 110.00 12,702.42 110.00 12,695.88 110.00 12,689.35 110.00 12,682.82 110.00 12,676.28 $3,398,000 $3,398,500 110.00 12,717.36 110.00 12,710.83 110.00 12,704.29 110.00 12,697.76 110.00 12,691.23 110.00 12,684.69 110.00 12,678.16 $3,398,500 $3,399,000 110.00 12,719.23 110.00 12,712.70 110.00 12,706.17 110.00 12,699.63 110.00 12,693.10 110.00 12,686.57 110.00 12,680.03 $3,399,000 $3,399,500 110.00 12,721.11 110.00 12,714.58 110.00 12,708.04 110.00 12,701.51 110.00 12,694.98 110.00 12,688.44 110.00 12,681.91 $3,399,500 $3,400,000 110.00 12,722.98 110.00 12,716.45 110.00 12,709.92 110.00 12,703.38 110.00 12,696.85 110.00 12,690.32 110.00 12,683.78 $3,400,000 $3,400,500 110.00 12,724.86 110.00 12,718.33 110.00 12,711.79 110.00 12,705.26 110.00 12,698.73 110.00 12,692.19 110.00 12,685.66 $3,400,500 $3,401,000 110.00 12,726.73 110.00 12,720.20 110.00 12,713.67 110.00 12,707.13 110.00 12,700.60 110.00 12,694.07 110.00 12,687.53 $3,401,000 $3,401,500 110.00 12,728.61 110.00 12,722.08 110.00 12,715.54 110.00 12,709.01 110.00 12,702.48 110.00 12,695.94 110.00 12,689.41 $3,401,500 $3,402,000 110.00 12,730.48 110.00 12,723.95 110.00 12,717.42 110.00 12,710.88 110.00 12,704.35 110.00 12,697.82 110.00 12,691.28 $3,402,000 $3,402,500 110.00 12,732.36 110.00 12,725.83 110.00 12,719.29 110.00 12,712.76 110.00 12,706.23 110.00 12,699.69 110.00 12,693.16 $3,402,500 $3,403,000 110.00 12,734.23 110.00 12,727.70 110.00 12,721.17 110.00 12,714.63 110.00 12,708.10 110.00 12,701.57 110.00 12,695.03 $3,403,000 $3,403,500 110.00 12,736.11 110.00 12,729.58 110.00 12,723.04 110.00 12,716.51 110.00 12,709.98 110.00 12,703.44 110.00 12,696.91 $3,403,500 $3,404,000 110.00 12,737.98 110.00 12,731.45 110.00 12,724.92 110.00 12,718.38 110.00 12,711.85 110.00 12,705.32 110.00 12,698.78 $3,404,000 $3,404,500 110.00 12,739.86 110.00 12,733.33 110.00 12,726.79 110.00 12,720.26 110.00 12,713.73 110.00 12,707.19 110.00 12,700.66 $3,404,500 $3,405,000 110.00 12,741.73 110.00 12,735.20 110.00 12,728.67 110.00 12,722.13 110.00 12,715.60 110.00 12,709.07 110.00 12,702.53 $3,405,000 $3,405,500 110.00 12,743.61 110.00 12,737.08 110.00 12,730.54 110.00 12,724.01 110.00 12,717.48 110.00 12,710.94 110.00 12,704.41 $3,405,500 $3,406,000 110.00 12,745.48 110.00 12,738.95 110.00 12,732.42 110.00 12,725.88 110.00 12,719.35 110.00 12,712.82 110.00 12,706.28 $3,406,000 $3,406,500 110.00 12,747.36 110.00 12,740.83 110.00 12,734.29 110.00 12,727.76 110.00 12,721.23 110.00 12,714.69 110.00 12,708.16 $3,406,500 $3,407,000 110.00 12,749.23 110.00 12,742.70 110.00 12,736.17 110.00 12,729.63 110.00 12,723.10 110.00 12,716.57 110.00 12,710.03 $3,407,000 $3,407,500 110.00 12,751.11 110.00 12,744.58 110.00 12,738.04 110.00 12,731.51 110.00 12,724.98 110.00 12,718.44 110.00 12,711.91 $3,407,500 $3,408,000 110.00 12,752.98 110.00 12,746.45 110.00 12,739.92 110.00 12,733.38 110.00 12,726.85 110.00 12,720.32 110.00 12,713.78 $3,408,000 $3,408,500 110.00 12,754.86 110.00 12,748.33 110.00 12,741.79 110.00 12,735.26 110.00 12,728.73 110.00 12,722.19 110.00 12,715.66 $3,408,500 $3,409,000 110.00 12,756.73 110.00 12,750.20 110.00 12,743.67 110.00 12,737.13 110.00 12,730.60 110.00 12,724.07 110.00 12,717.53 $3,409,000 $3,409,500 110.00 12,758.61 110.00 12,752.08 110.00 12,745.54 110.00 12,739.01 110.00 12,732.48 110.00 12,725.94 110.00 12,719.41 $3,409,500 $3,410,000 110.00 12,760.48 110.00 12,753.95 110.00 12,747.42 110.00 12,740.88 110.00 12,734.35 110.00 12,727.82 110.00 12,721.28 $3,410,000 $3,410,500 110.00 12,762.36 110.00 12,755.83 110.00 12,749.29 110.00 12,742.76 110.00 12,736.23 110.00 12,729.69 110.00 12,723.16 $3,410,500 $3,411,000 110.00 12,764.23 110.00 12,757.70 110.00 12,751.17 110.00 12,744.63 110.00 12,738.10 110.00 12,731.57 110.00 12,725.03 $3,411,000 $3,411,500 110.00 12,766.11 110.00 12,759.58 110.00 12,753.04 110.00 12,746.51 110.00 12,739.98 110.00 12,733.44 110.00 12,726.91 $3,411,500 $3,412,000 110.00 12,767.98 110.00 12,761.45 110.00 12,754.92 110.00 12,748.38 110.00 12,741.85 110.00 12,735.32 110.00 12,728.78 $3,412,000 $3,412,500 110.00 12,769.86 110.00 12,763.33 110.00 12,756.79 110.00 12,750.26 110.00 12,743.73 110.00 12,737.19 110.00 12,730.66 $3,412,500 $3,413,000 110.00 12,771.73 110.00 12,765.20 110.00 12,758.67 110.00 12,752.13 110.00 12,745.60 110.00 12,739.07 110.00 12,732.53 $3,413,000 $3,413,500 110.00 12,773.61 110.00 12,767.08 110.00 12,760.54 110.00 12,754.01 110.00 12,747.48 110.00 12,740.94 110.00 12,734.41 $3,413,500 $3,414,000 110.00 12,775.48 110.00 12,768.95 110.00 12,762.42 110.00 12,755.88 110.00 12,749.35 110.00 12,742.82 110.00 12,736.28 $3,414,000 $3,414,500 110.00 12,777.36 110.00 12,770.83 110.00 12,764.29 110.00 12,757.76 110.00 12,751.23 110.00 12,744.69 110.00 12,738.16 $3,414,500 $3,415,000 110.00 12,779.23 110.00 12,772.70 110.00 12,766.17 110.00 12,759.63 110.00 12,753.10 110.00 12,746.57 110.00 12,740.03 $3,415,000 $3,415,500 110.00 12,781.11 110.00 12,774.58 110.00 12,768.04 110.00 12,761.51 110.00 12,754.98 110.00 12,748.44 110.00 12,741.91 $3,415,500 $3,416,000 110.00 12,782.98 110.00 12,776.45 110.00 12,769.92 110.00 12,763.38 110.00 12,756.85 110.00 12,750.32 110.00 12,743.78 $3,416,000 $3,416,500 110.00 12,784.86 110.00 12,778.33 110.00 12,771.79 110.00 12,765.26 110.00 12,758.73 110.00 12,752.19 110.00 12,745.66 $3,416,500 $3,417,000 110.00 12,786.73 110.00 12,780.20 110.00 12,773.67 110.00 12,767.13 110.00 12,760.60 110.00 12,754.07 110.00 12,747.53

NJEIS Family Cost Participation Table Page 70 of 12 Effective July 1, 2015

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

$3,417,000 $3,417,500 110.00 12,788.61 110.00 12,782.08 110.00 12,775.54 110.00 12,769.01 110.00 12,762.48 110.00 12,755.94 110.00 12,749.41 $3,417,500 $3,418,000 110.00 12,790.48 110.00 12,783.95 110.00 12,777.42 110.00 12,770.88 110.00 12,764.35 110.00 12,757.82 110.00 12,751.28 $3,418,000 $3,418,500 110.00 12,792.36 110.00 12,785.83 110.00 12,779.29 110.00 12,772.76 110.00 12,766.23 110.00 12,759.69 110.00 12,753.16 $3,418,500 $3,419,000 110.00 12,794.23 110.00 12,787.70 110.00 12,781.17 110.00 12,774.63 110.00 12,768.10 110.00 12,761.57 110.00 12,755.03 $3,419,000 $3,419,500 110.00 12,796.11 110.00 12,789.58 110.00 12,783.04 110.00 12,776.51 110.00 12,769.98 110.00 12,763.44 110.00 12,756.91 $3,419,500 $3,420,000 110.00 12,797.98 110.00 12,791.45 110.00 12,784.92 110.00 12,778.38 110.00 12,771.85 110.00 12,765.32 110.00 12,758.78 $3,420,000 $3,420,500 110.00 12,799.86 110.00 12,793.33 110.00 12,786.79 110.00 12,780.26 110.00 12,773.73 110.00 12,767.19 110.00 12,760.66 $3,420,500 $3,421,000 110.00 12,801.73 110.00 12,795.20 110.00 12,788.67 110.00 12,782.13 110.00 12,775.60 110.00 12,769.07 110.00 12,762.53 $3,421,000 $3,421,500 110.00 12,803.61 110.00 12,797.08 110.00 12,790.54 110.00 12,784.01 110.00 12,777.48 110.00 12,770.94 110.00 12,764.41 $3,421,500 $3,422,000 110.00 12,805.48 110.00 12,798.95 110.00 12,792.42 110.00 12,785.88 110.00 12,779.35 110.00 12,772.82 110.00 12,766.28 $3,422,000 $3,422,500 110.00 12,807.36 110.00 12,800.83 110.00 12,794.29 110.00 12,787.76 110.00 12,781.23 110.00 12,774.69 110.00 12,768.16 $3,422,500 $3,423,000 110.00 12,809.23 110.00 12,802.70 110.00 12,796.17 110.00 12,789.63 110.00 12,783.10 110.00 12,776.57 110.00 12,770.03 $3,423,000 $3,423,500 110.00 12,811.11 110.00 12,804.58 110.00 12,798.04 110.00 12,791.51 110.00 12,784.98 110.00 12,778.44 110.00 12,771.91 $3,423,500 $3,424,000 110.00 12,812.98 110.00 12,806.45 110.00 12,799.92 110.00 12,793.38 110.00 12,786.85 110.00 12,780.32 110.00 12,773.78 $3,424,000 $3,424,500 110.00 12,814.86 110.00 12,808.33 110.00 12,801.79 110.00 12,795.26 110.00 12,788.73 110.00 12,782.19 110.00 12,775.66 $3,424,500 $3,425,000 110.00 12,816.73 110.00 12,810.20 110.00 12,803.67 110.00 12,797.13 110.00 12,790.60 110.00 12,784.07 110.00 12,777.53 $3,425,000 $3,425,500 110.00 12,818.61 110.00 12,812.08 110.00 12,805.54 110.00 12,799.01 110.00 12,792.48 110.00 12,785.94 110.00 12,779.41 $3,425,500 $3,426,000 110.00 12,820.48 110.00 12,813.95 110.00 12,807.42 110.00 12,800.88 110.00 12,794.35 110.00 12,787.82 110.00 12,781.28 $3,426,000 $3,426,500 110.00 12,822.36 110.00 12,815.83 110.00 12,809.29 110.00 12,802.76 110.00 12,796.23 110.00 12,789.69 110.00 12,783.16 $3,426,500 $3,427,000 110.00 12,824.23 110.00 12,817.70 110.00 12,811.17 110.00 12,804.63 110.00 12,798.10 110.00 12,791.57 110.00 12,785.03 $3,427,000 $3,427,500 110.00 12,826.11 110.00 12,819.58 110.00 12,813.04 110.00 12,806.51 110.00 12,799.98 110.00 12,793.44 110.00 12,786.91 $3,427,500 $3,428,000 110.00 12,827.98 110.00 12,821.45 110.00 12,814.92 110.00 12,808.38 110.00 12,801.85 110.00 12,795.32 110.00 12,788.78 $3,428,000 $3,428,500 110.00 12,829.86 110.00 12,823.33 110.00 12,816.79 110.00 12,810.26 110.00 12,803.73 110.00 12,797.19 110.00 12,790.66 $3,428,500 $3,429,000 110.00 12,831.73 110.00 12,825.20 110.00 12,818.67 110.00 12,812.13 110.00 12,805.60 110.00 12,799.07 110.00 12,792.53 $3,429,000 $3,429,500 110.00 12,833.61 110.00 12,827.08 110.00 12,820.54 110.00 12,814.01 110.00 12,807.48 110.00 12,800.94 110.00 12,794.41 $3,429,500 $3,430,000 110.00 12,835.48 110.00 12,828.95 110.00 12,822.42 110.00 12,815.88 110.00 12,809.35 110.00 12,802.82 110.00 12,796.28 $3,430,000 $3,430,500 110.00 12,837.36 110.00 12,830.83 110.00 12,824.29 110.00 12,817.76 110.00 12,811.23 110.00 12,804.69 110.00 12,798.16 $3,430,500 $3,431,000 110.00 12,839.23 110.00 12,832.70 110.00 12,826.17 110.00 12,819.63 110.00 12,813.10 110.00 12,806.57 110.00 12,800.03 $3,431,000 $3,431,500 110.00 12,841.11 110.00 12,834.58 110.00 12,828.04 110.00 12,821.51 110.00 12,814.98 110.00 12,808.44 110.00 12,801.91 $3,431,500 $3,432,000 110.00 12,842.98 110.00 12,836.45 110.00 12,829.92 110.00 12,823.38 110.00 12,816.85 110.00 12,810.32 110.00 12,803.78 $3,432,000 $3,432,500 110.00 12,844.86 110.00 12,838.33 110.00 12,831.79 110.00 12,825.26 110.00 12,818.73 110.00 12,812.19 110.00 12,805.66 $3,432,500 $3,433,000 110.00 12,846.73 110.00 12,840.20 110.00 12,833.67 110.00 12,827.13 110.00 12,820.60 110.00 12,814.07 110.00 12,807.53 $3,433,000 $3,433,500 110.00 12,848.61 110.00 12,842.08 110.00 12,835.54 110.00 12,829.01 110.00 12,822.48 110.00 12,815.94 110.00 12,809.41 $3,433,500 $3,434,000 110.00 12,850.48 110.00 12,843.95 110.00 12,837.42 110.00 12,830.88 110.00 12,824.35 110.00 12,817.82 110.00 12,811.28 $3,434,000 $3,434,500 110.00 12,852.36 110.00 12,845.83 110.00 12,839.29 110.00 12,832.76 110.00 12,826.23 110.00 12,819.69 110.00 12,813.16 $3,434,500 $3,435,000 110.00 12,854.23 110.00 12,847.70 110.00 12,841.17 110.00 12,834.63 110.00 12,828.10 110.00 12,821.57 110.00 12,815.03 $3,435,000 $3,435,500 110.00 12,856.11 110.00 12,849.58 110.00 12,843.04 110.00 12,836.51 110.00 12,829.98 110.00 12,823.44 110.00 12,816.91 $3,435,500 $3,436,000 110.00 12,857.98 110.00 12,851.45 110.00 12,844.92 110.00 12,838.38 110.00 12,831.85 110.00 12,825.32 110.00 12,818.78 $3,436,000 $3,436,500 110.00 12,859.86 110.00 12,853.33 110.00 12,846.79 110.00 12,840.26 110.00 12,833.73 110.00 12,827.19 110.00 12,820.66 $3,436,500 $3,437,000 110.00 12,861.73 110.00 12,855.20 110.00 12,848.67 110.00 12,842.13 110.00 12,835.60 110.00 12,829.07 110.00 12,822.53 $3,437,000 $3,437,500 110.00 12,863.61 110.00 12,857.08 110.00 12,850.54 110.00 12,844.01 110.00 12,837.48 110.00 12,830.94 110.00 12,824.41 $3,437,500 $3,438,000 110.00 12,865.48 110.00 12,858.95 110.00 12,852.42 110.00 12,845.88 110.00 12,839.35 110.00 12,832.82 110.00 12,826.28 $3,438,000 $3,438,500 110.00 12,867.36 110.00 12,860.83 110.00 12,854.29 110.00 12,847.76 110.00 12,841.23 110.00 12,834.69 110.00 12,828.16 $3,438,500 $3,439,000 110.00 12,869.23 110.00 12,862.70 110.00 12,856.17 110.00 12,849.63 110.00 12,843.10 110.00 12,836.57 110.00 12,830.03 $3,439,000 $3,439,500 110.00 12,871.11 110.00 12,864.58 110.00 12,858.04 110.00 12,851.51 110.00 12,844.98 110.00 12,838.44 110.00 12,831.91 $3,439,500 $3,440,000 110.00 12,872.98 110.00 12,866.45 110.00 12,859.92 110.00 12,853.38 110.00 12,846.85 110.00 12,840.32 110.00 12,833.78 $3,440,000 $3,440,500 110.00 12,874.86 110.00 12,868.33 110.00 12,861.79 110.00 12,855.26 110.00 12,848.73 110.00 12,842.19 110.00 12,835.66 $3,440,500 $3,441,000 110.00 12,876.73 110.00 12,870.20 110.00 12,863.67 110.00 12,857.13 110.00 12,850.60 110.00 12,844.07 110.00 12,837.53 $3,441,000 $3,441,500 110.00 12,878.61 110.00 12,872.08 110.00 12,865.54 110.00 12,859.01 110.00 12,852.48 110.00 12,845.94 110.00 12,839.41 $3,441,500 $3,442,000 110.00 12,880.48 110.00 12,873.95 110.00 12,867.42 110.00 12,860.88 110.00 12,854.35 110.00 12,847.82 110.00 12,841.28 $3,442,000 $3,442,500 110.00 12,882.36 110.00 12,875.83 110.00 12,869.29 110.00 12,862.76 110.00 12,856.23 110.00 12,849.69 110.00 12,843.16 $3,442,500 $3,443,000 110.00 12,884.23 110.00 12,877.70 110.00 12,871.17 110.00 12,864.63 110.00 12,858.10 110.00 12,851.57 110.00 12,845.03 $3,443,000 $3,443,500 110.00 12,886.11 110.00 12,879.58 110.00 12,873.04 110.00 12,866.51 110.00 12,859.98 110.00 12,853.44 110.00 12,846.91 $3,443,500 $3,444,000 110.00 12,887.98 110.00 12,881.45 110.00 12,874.92 110.00 12,868.38 110.00 12,861.85 110.00 12,855.32 110.00 12,848.78 $3,444,000 $3,444,500 110.00 12,889.86 110.00 12,883.33 110.00 12,876.79 110.00 12,870.26 110.00 12,863.73 110.00 12,857.19 110.00 12,850.66 $3,444,500 $3,445,000 110.00 12,891.73 110.00 12,885.20 110.00 12,878.67 110.00 12,872.13 110.00 12,865.60 110.00 12,859.07 110.00 12,852.53 $3,445,000 $3,445,500 110.00 12,893.61 110.00 12,887.08 110.00 12,880.54 110.00 12,874.01 110.00 12,867.48 110.00 12,860.94 110.00 12,854.41 $3,445,500 $3,446,000 110.00 12,895.48 110.00 12,888.95 110.00 12,882.42 110.00 12,875.88 110.00 12,869.35 110.00 12,862.82 110.00 12,856.28 $3,446,000 $3,446,500 110.00 12,897.36 110.00 12,890.83 110.00 12,884.29 110.00 12,877.76 110.00 12,871.23 110.00 12,864.69 110.00 12,858.16 $3,446,500 $3,447,000 110.00 12,899.23 110.00 12,892.70 110.00 12,886.17 110.00 12,879.63 110.00 12,873.10 110.00 12,866.57 110.00 12,860.03 $3,447,000 $3,447,500 110.00 12,901.11 110.00 12,894.58 110.00 12,888.04 110.00 12,881.51 110.00 12,874.98 110.00 12,868.44 110.00 12,861.91 $3,447,500 $3,448,000 110.00 12,902.98 110.00 12,896.45 110.00 12,889.92 110.00 12,883.38 110.00 12,876.85 110.00 12,870.32 110.00 12,863.78 $3,448,000 $3,448,500 110.00 12,904.86 110.00 12,898.33 110.00 12,891.79 110.00 12,885.26 110.00 12,878.73 110.00 12,872.19 110.00 12,865.66 $3,448,500 $3,449,000 110.00 12,906.73 110.00 12,900.20 110.00 12,893.67 110.00 12,887.13 110.00 12,880.60 110.00 12,874.07 110.00 12,867.53 $3,449,000 $3,449,500 110.00 12,908.61 110.00 12,902.08 110.00 12,895.54 110.00 12,889.01 110.00 12,882.48 110.00 12,875.94 110.00 12,869.41 $3,449,500 $3,450,000 110.00 12,910.48 110.00 12,903.95 110.00 12,897.42 110.00 12,890.88 110.00 12,884.35 110.00 12,877.82 110.00 12,871.28 $3,450,000 $3,450,500 110.00 12,912.36 110.00 12,905.83 110.00 12,899.29 110.00 12,892.76 110.00 12,886.23 110.00 12,879.69 110.00 12,873.16 $3,450,500 $3,451,000 110.00 12,914.23 110.00 12,907.70 110.00 12,901.17 110.00 12,894.63 110.00 12,888.10 110.00 12,881.57 110.00 12,875.03 $3,451,000 $3,451,500 110.00 12,916.11 110.00 12,909.58 110.00 12,903.04 110.00 12,896.51 110.00 12,889.98 110.00 12,883.44 110.00 12,876.91 $3,451,500 $3,452,000 110.00 12,917.98 110.00 12,911.45 110.00 12,904.92 110.00 12,898.38 110.00 12,891.85 110.00 12,885.32 110.00 12,878.78 $3,452,000 $3,452,500 110.00 12,919.86 110.00 12,913.33 110.00 12,906.79 110.00 12,900.26 110.00 12,893.73 110.00 12,887.19 110.00 12,880.66 $3,452,500 $3,453,000 110.00 12,921.73 110.00 12,915.20 110.00 12,908.67 110.00 12,902.13 110.00 12,895.60 110.00 12,889.07 110.00 12,882.53 $3,453,000 $3,453,500 110.00 12,923.61 110.00 12,917.08 110.00 12,910.54 110.00 12,904.01 110.00 12,897.48 110.00 12,890.94 110.00 12,884.41 $3,453,500 $3,454,000 110.00 12,925.48 110.00 12,918.95 110.00 12,912.42 110.00 12,905.88 110.00 12,899.35 110.00 12,892.82 110.00 12,886.28 $3,454,000 $3,454,500 110.00 12,927.36 110.00 12,920.83 110.00 12,914.29 110.00 12,907.76 110.00 12,901.23 110.00 12,894.69 110.00 12,888.16 $3,454,500 $3,455,000 110.00 12,929.23 110.00 12,922.70 110.00 12,916.17 110.00 12,909.63 110.00 12,903.10 110.00 12,896.57 110.00 12,890.03 $3,455,000 $3,455,500 110.00 12,931.11 110.00 12,924.58 110.00 12,918.04 110.00 12,911.51 110.00 12,904.98 110.00 12,898.44 110.00 12,891.91 $3,455,500 $3,456,000 110.00 12,932.98 110.00 12,926.45 110.00 12,919.92 110.00 12,913.38 110.00 12,906.85 110.00 12,900.32 110.00 12,893.78 $3,456,000 $3,456,500 110.00 12,934.86 110.00 12,928.33 110.00 12,921.79 110.00 12,915.26 110.00 12,908.73 110.00 12,902.19 110.00 12,895.66 $3,456,500 $3,457,000 110.00 12,936.73 110.00 12,930.20 110.00 12,923.67 110.00 12,917.13 110.00 12,910.60 110.00 12,904.07 110.00 12,897.53 $3,457,000 $3,457,500 110.00 12,938.61 110.00 12,932.08 110.00 12,925.54 110.00 12,919.01 110.00 12,912.48 110.00 12,905.94 110.00 12,899.41 $3,457,500 $3,458,000 110.00 12,940.48 110.00 12,933.95 110.00 12,927.42 110.00 12,920.88 110.00 12,914.35 110.00 12,907.82 110.00 12,901.28 $3,458,000 $3,458,500 110.00 12,942.36 110.00 12,935.83 110.00 12,929.29 110.00 12,922.76 110.00 12,916.23 110.00 12,909.69 110.00 12,903.16 $3,458,500 $3,459,000 110.00 12,944.23 110.00 12,937.70 110.00 12,931.17 110.00 12,924.63 110.00 12,918.10 110.00 12,911.57 110.00 12,905.03 $3,459,000 $3,459,500 110.00 12,946.11 110.00 12,939.58 110.00 12,933.04 110.00 12,926.51 110.00 12,919.98 110.00 12,913.44 110.00 12,906.91 $3,459,500 $3,460,000 110.00 12,947.98 110.00 12,941.45 110.00 12,934.92 110.00 12,928.38 110.00 12,921.85 110.00 12,915.32 110.00 12,908.78 $3,460,000 $3,460,500 110.00 12,949.86 110.00 12,943.33 110.00 12,936.79 110.00 12,930.26 110.00 12,923.73 110.00 12,917.19 110.00 12,910.66 $3,460,500 $3,461,000 110.00 12,951.73 110.00 12,945.20 110.00 12,938.67 110.00 12,932.13 110.00 12,925.60 110.00 12,919.07 110.00 12,912.53 $3,461,000 $3,461,500 110.00 12,953.61 110.00 12,947.08 110.00 12,940.54 110.00 12,934.01 110.00 12,927.48 110.00 12,920.94 110.00 12,914.41 $3,461,500 $3,462,000 110.00 12,955.48 110.00 12,948.95 110.00 12,942.42 110.00 12,935.88 110.00 12,929.35 110.00 12,922.82 110.00 12,916.28 $3,462,000 $3,462,500 110.00 12,957.36 110.00 12,950.83 110.00 12,944.29 110.00 12,937.76 110.00 12,931.23 110.00 12,924.69 110.00 12,918.16 $3,462,500 $3,463,000 110.00 12,959.23 110.00 12,952.70 110.00 12,946.17 110.00 12,939.63 110.00 12,933.10 110.00 12,926.57 110.00 12,920.03 $3,463,000 $3,463,500 110.00 12,961.11 110.00 12,954.58 110.00 12,948.04 110.00 12,941.51 110.00 12,934.98 110.00 12,928.44 110.00 12,921.91 $3,463,500 $3,464,000 110.00 12,962.98 110.00 12,956.45 110.00 12,949.92 110.00 12,943.38 110.00 12,936.85 110.00 12,930.32 110.00 12,923.78 $3,464,000 $3,464,500 110.00 12,964.86 110.00 12,958.33 110.00 12,951.79 110.00 12,945.26 110.00 12,938.73 110.00 12,932.19 110.00 12,925.66 $3,464,500 $3,465,000 110.00 12,966.73 110.00 12,960.20 110.00 12,953.67 110.00 12,947.13 110.00 12,940.60 110.00 12,934.07 110.00 12,927.53 $3,465,000 $3,465,500 110.00 12,968.61 110.00 12,962.08 110.00 12,955.54 110.00 12,949.01 110.00 12,942.48 110.00 12,935.94 110.00 12,929.41 $3,465,500 $3,466,000 110.00 12,970.48 110.00 12,963.95 110.00 12,957.42 110.00 12,950.88 110.00 12,944.35 110.00 12,937.82 110.00 12,931.28 $3,466,000 $3,466,500 110.00 12,972.36 110.00 12,965.83 110.00 12,959.29 110.00 12,952.76 110.00 12,946.23 110.00 12,939.69 110.00 12,933.16 $3,466,500 $3,467,000 110.00 12,974.23 110.00 12,967.70 110.00 12,961.17 110.00 12,954.63 110.00 12,948.10 110.00 12,941.57 110.00 12,935.03 $3,467,000 $3,467,500 110.00 12,976.11 110.00 12,969.58 110.00 12,963.04 110.00 12,956.51 110.00 12,949.98 110.00 12,943.44 110.00 12,936.91 $3,467,500 $3,468,000 110.00 12,977.98 110.00 12,971.45 110.00 12,964.92 110.00 12,958.38 110.00 12,951.85 110.00 12,945.32 110.00 12,938.78

NJEIS Family Cost Participation Table Page 71 of 12 Effective July 1, 2015

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

$3,468,000 $3,468,500 110.00 12,979.86 110.00 12,973.33 110.00 12,966.79 110.00 12,960.26 110.00 12,953.73 110.00 12,947.19 110.00 12,940.66 $3,468,500 $3,469,000 110.00 12,981.73 110.00 12,975.20 110.00 12,968.67 110.00 12,962.13 110.00 12,955.60 110.00 12,949.07 110.00 12,942.53 $3,469,000 $3,469,500 110.00 12,983.61 110.00 12,977.08 110.00 12,970.54 110.00 12,964.01 110.00 12,957.48 110.00 12,950.94 110.00 12,944.41 $3,469,500 $3,470,000 110.00 12,985.48 110.00 12,978.95 110.00 12,972.42 110.00 12,965.88 110.00 12,959.35 110.00 12,952.82 110.00 12,946.28 $3,470,000 $3,470,500 110.00 12,987.36 110.00 12,980.83 110.00 12,974.29 110.00 12,967.76 110.00 12,961.23 110.00 12,954.69 110.00 12,948.16 $3,470,500 $3,471,000 110.00 12,989.23 110.00 12,982.70 110.00 12,976.17 110.00 12,969.63 110.00 12,963.10 110.00 12,956.57 110.00 12,950.03 $3,471,000 $3,471,500 110.00 12,991.11 110.00 12,984.58 110.00 12,978.04 110.00 12,971.51 110.00 12,964.98 110.00 12,958.44 110.00 12,951.91 $3,471,500 $3,472,000 110.00 12,992.98 110.00 12,986.45 110.00 12,979.92 110.00 12,973.38 110.00 12,966.85 110.00 12,960.32 110.00 12,953.78 $3,472,000 $3,472,500 110.00 12,994.86 110.00 12,988.33 110.00 12,981.79 110.00 12,975.26 110.00 12,968.73 110.00 12,962.19 110.00 12,955.66 $3,472,500 $3,473,000 110.00 12,996.73 110.00 12,990.20 110.00 12,983.67 110.00 12,977.13 110.00 12,970.60 110.00 12,964.07 110.00 12,957.53 $3,473,000 $3,473,500 110.00 12,998.61 110.00 12,992.08 110.00 12,985.54 110.00 12,979.01 110.00 12,972.48 110.00 12,965.94 110.00 12,959.41 $3,473,500 $3,474,000 110.00 13,000.48 110.00 12,993.95 110.00 12,987.42 110.00 12,980.88 110.00 12,974.35 110.00 12,967.82 110.00 12,961.28 $3,474,000 $3,474,500 110.00 13,002.36 110.00 12,995.83 110.00 12,989.29 110.00 12,982.76 110.00 12,976.23 110.00 12,969.69 110.00 12,963.16 $3,474,500 $3,475,000 110.00 13,004.23 110.00 12,997.70 110.00 12,991.17 110.00 12,984.63 110.00 12,978.10 110.00 12,971.57 110.00 12,965.03 $3,475,000 $3,475,500 110.00 13,006.11 110.00 12,999.58 110.00 12,993.04 110.00 12,986.51 110.00 12,979.98 110.00 12,973.44 110.00 12,966.91 $3,475,500 $3,476,000 110.00 13,007.98 110.00 13,001.45 110.00 12,994.92 110.00 12,988.38 110.00 12,981.85 110.00 12,975.32 110.00 12,968.78 $3,476,000 $3,476,500 110.00 13,009.86 110.00 13,003.33 110.00 12,996.79 110.00 12,990.26 110.00 12,983.73 110.00 12,977.19 110.00 12,970.66 $3,476,500 $3,477,000 110.00 13,011.73 110.00 13,005.20 110.00 12,998.67 110.00 12,992.13 110.00 12,985.60 110.00 12,979.07 110.00 12,972.53 $3,477,000 $3,477,500 110.00 13,013.61 110.00 13,007.08 110.00 13,000.54 110.00 12,994.01 110.00 12,987.48 110.00 12,980.94 110.00 12,974.41 $3,477,500 $3,478,000 110.00 13,015.48 110.00 13,008.95 110.00 13,002.42 110.00 12,995.88 110.00 12,989.35 110.00 12,982.82 110.00 12,976.28 $3,478,000 $3,478,500 110.00 13,017.36 110.00 13,010.83 110.00 13,004.29 110.00 12,997.76 110.00 12,991.23 110.00 12,984.69 110.00 12,978.16 $3,478,500 $3,479,000 110.00 13,019.23 110.00 13,012.70 110.00 13,006.17 110.00 12,999.63 110.00 12,993.10 110.00 12,986.57 110.00 12,980.03 $3,479,000 $3,479,500 110.00 13,021.11 110.00 13,014.58 110.00 13,008.04 110.00 13,001.51 110.00 12,994.98 110.00 12,988.44 110.00 12,981.91 $3,479,500 $3,480,000 110.00 13,022.98 110.00 13,016.45 110.00 13,009.92 110.00 13,003.38 110.00 12,996.85 110.00 12,990.32 110.00 12,983.78 $3,480,000 $3,480,500 110.00 13,024.86 110.00 13,018.33 110.00 13,011.79 110.00 13,005.26 110.00 12,998.73 110.00 12,992.19 110.00 12,985.66 $3,480,500 $3,481,000 110.00 13,026.73 110.00 13,020.20 110.00 13,013.67 110.00 13,007.13 110.00 13,000.60 110.00 12,994.07 110.00 12,987.53 $3,481,000 $3,481,500 110.00 13,028.61 110.00 13,022.08 110.00 13,015.54 110.00 13,009.01 110.00 13,002.48 110.00 12,995.94 110.00 12,989.41 $3,481,500 $3,482,000 110.00 13,030.48 110.00 13,023.95 110.00 13,017.42 110.00 13,010.88 110.00 13,004.35 110.00 12,997.82 110.00 12,991.28 $3,482,000 $3,482,500 110.00 13,032.36 110.00 13,025.83 110.00 13,019.29 110.00 13,012.76 110.00 13,006.23 110.00 12,999.69 110.00 12,993.16 $3,482,500 $3,483,000 110.00 13,034.23 110.00 13,027.70 110.00 13,021.17 110.00 13,014.63 110.00 13,008.10 110.00 13,001.57 110.00 12,995.03 $3,483,000 $3,483,500 110.00 13,036.11 110.00 13,029.58 110.00 13,023.04 110.00 13,016.51 110.00 13,009.98 110.00 13,003.44 110.00 12,996.91 $3,483,500 $3,484,000 110.00 13,037.98 110.00 13,031.45 110.00 13,024.92 110.00 13,018.38 110.00 13,011.85 110.00 13,005.32 110.00 12,998.78 $3,484,000 $3,484,500 110.00 13,039.86 110.00 13,033.33 110.00 13,026.79 110.00 13,020.26 110.00 13,013.73 110.00 13,007.19 110.00 13,000.66 $3,484,500 $3,485,000 110.00 13,041.73 110.00 13,035.20 110.00 13,028.67 110.00 13,022.13 110.00 13,015.60 110.00 13,009.07 110.00 13,002.53 $3,485,000 $3,485,500 110.00 13,043.61 110.00 13,037.08 110.00 13,030.54 110.00 13,024.01 110.00 13,017.48 110.00 13,010.94 110.00 13,004.41 $3,485,500 $3,486,000 110.00 13,045.48 110.00 13,038.95 110.00 13,032.42 110.00 13,025.88 110.00 13,019.35 110.00 13,012.82 110.00 13,006.28 $3,486,000 $3,486,500 110.00 13,047.36 110.00 13,040.83 110.00 13,034.29 110.00 13,027.76 110.00 13,021.23 110.00 13,014.69 110.00 13,008.16 $3,486,500 $3,487,000 110.00 13,049.23 110.00 13,042.70 110.00 13,036.17 110.00 13,029.63 110.00 13,023.10 110.00 13,016.57 110.00 13,010.03 $3,487,000 $3,487,500 110.00 13,051.11 110.00 13,044.58 110.00 13,038.04 110.00 13,031.51 110.00 13,024.98 110.00 13,018.44 110.00 13,011.91 $3,487,500 $3,488,000 110.00 13,052.98 110.00 13,046.45 110.00 13,039.92 110.00 13,033.38 110.00 13,026.85 110.00 13,020.32 110.00 13,013.78 $3,488,000 $3,488,500 110.00 13,054.86 110.00 13,048.33 110.00 13,041.79 110.00 13,035.26 110.00 13,028.73 110.00 13,022.19 110.00 13,015.66 $3,488,500 $3,489,000 110.00 13,056.73 110.00 13,050.20 110.00 13,043.67 110.00 13,037.13 110.00 13,030.60 110.00 13,024.07 110.00 13,017.53 $3,489,000 $3,489,500 110.00 13,058.61 110.00 13,052.08 110.00 13,045.54 110.00 13,039.01 110.00 13,032.48 110.00 13,025.94 110.00 13,019.41 $3,489,500 $3,490,000 110.00 13,060.48 110.00 13,053.95 110.00 13,047.42 110.00 13,040.88 110.00 13,034.35 110.00 13,027.82 110.00 13,021.28 $3,490,000 $3,490,500 110.00 13,062.36 110.00 13,055.83 110.00 13,049.29 110.00 13,042.76 110.00 13,036.23 110.00 13,029.69 110.00 13,023.16 $3,490,500 $3,491,000 110.00 13,064.23 110.00 13,057.70 110.00 13,051.17 110.00 13,044.63 110.00 13,038.10 110.00 13,031.57 110.00 13,025.03 $3,491,000 $3,491,500 110.00 13,066.11 110.00 13,059.58 110.00 13,053.04 110.00 13,046.51 110.00 13,039.98 110.00 13,033.44 110.00 13,026.91 $3,491,500 $3,492,000 110.00 13,067.98 110.00 13,061.45 110.00 13,054.92 110.00 13,048.38 110.00 13,041.85 110.00 13,035.32 110.00 13,028.78 $3,492,000 $3,492,500 110.00 13,069.86 110.00 13,063.33 110.00 13,056.79 110.00 13,050.26 110.00 13,043.73 110.00 13,037.19 110.00 13,030.66 $3,492,500 $3,493,000 110.00 13,071.73 110.00 13,065.20 110.00 13,058.67 110.00 13,052.13 110.00 13,045.60 110.00 13,039.07 110.00 13,032.53 $3,493,000 $3,493,500 110.00 13,073.61 110.00 13,067.08 110.00 13,060.54 110.00 13,054.01 110.00 13,047.48 110.00 13,040.94 110.00 13,034.41 $3,493,500 $3,494,000 110.00 13,075.48 110.00 13,068.95 110.00 13,062.42 110.00 13,055.88 110.00 13,049.35 110.00 13,042.82 110.00 13,036.28 $3,494,000 $3,494,500 110.00 13,077.36 110.00 13,070.83 110.00 13,064.29 110.00 13,057.76 110.00 13,051.23 110.00 13,044.69 110.00 13,038.16 $3,494,500 $3,495,000 110.00 13,079.23 110.00 13,072.70 110.00 13,066.17 110.00 13,059.63 110.00 13,053.10 110.00 13,046.57 110.00 13,040.03 $3,495,000 $3,495,500 110.00 13,081.11 110.00 13,074.58 110.00 13,068.04 110.00 13,061.51 110.00 13,054.98 110.00 13,048.44 110.00 13,041.91 $3,495,500 $3,496,000 110.00 13,082.98 110.00 13,076.45 110.00 13,069.92 110.00 13,063.38 110.00 13,056.85 110.00 13,050.32 110.00 13,043.78 $3,496,000 $3,496,500 110.00 13,084.86 110.00 13,078.33 110.00 13,071.79 110.00 13,065.26 110.00 13,058.73 110.00 13,052.19 110.00 13,045.66 $3,496,500 $3,497,000 110.00 13,086.73 110.00 13,080.20 110.00 13,073.67 110.00 13,067.13 110.00 13,060.60 110.00 13,054.07 110.00 13,047.53 $3,497,000 $3,497,500 110.00 13,088.61 110.00 13,082.08 110.00 13,075.54 110.00 13,069.01 110.00 13,062.48 110.00 13,055.94 110.00 13,049.41 $3,497,500 $3,498,000 110.00 13,090.48 110.00 13,083.95 110.00 13,077.42 110.00 13,070.88 110.00 13,064.35 110.00 13,057.82 110.00 13,051.28 $3,498,000 $3,498,500 110.00 13,092.36 110.00 13,085.83 110.00 13,079.29 110.00 13,072.76 110.00 13,066.23 110.00 13,059.69 110.00 13,053.16 $3,498,500 $3,499,000 110.00 13,094.23 110.00 13,087.70 110.00 13,081.17 110.00 13,074.63 110.00 13,068.10 110.00 13,061.57 110.00 13,055.03 $3,499,000 $3,499,500 110.00 13,096.11 110.00 13,089.58 110.00 13,083.04 110.00 13,076.51 110.00 13,069.98 110.00 13,063.44 110.00 13,056.91 $3,499,500 $3,500,000 110.00 13,097.98 110.00 13,091.45 110.00 13,084.92 110.00 13,078.38 110.00 13,071.85 110.00 13,065.32 110.00 13,058.78 $3,500,000 $3,500,500 110.00 13,099.86 110.00 13,093.33 110.00 13,086.79 110.00 13,080.26 110.00 13,073.73 110.00 13,067.19 110.00 13,060.66 $3,500,500 $3,501,000 110.00 13,101.73 110.00 13,095.20 110.00 13,088.67 110.00 13,082.13 110.00 13,075.60 110.00 13,069.07 110.00 13,062.53 $3,501,000 $3,501,500 110.00 13,103.61 110.00 13,097.08 110.00 13,090.54 110.00 13,084.01 110.00 13,077.48 110.00 13,070.94 110.00 13,064.41 $3,501,500 $3,502,000 110.00 13,105.48 110.00 13,098.95 110.00 13,092.42 110.00 13,085.88 110.00 13,079.35 110.00 13,072.82 110.00 13,066.28 $3,502,000 $3,502,500 110.00 13,107.36 110.00 13,100.83 110.00 13,094.29 110.00 13,087.76 110.00 13,081.23 110.00 13,074.69 110.00 13,068.16 $3,502,500 $3,503,000 110.00 13,109.23 110.00 13,102.70 110.00 13,096.17 110.00 13,089.63 110.00 13,083.10 110.00 13,076.57 110.00 13,070.03 $3,503,000 $3,503,500 110.00 13,111.11 110.00 13,104.58 110.00 13,098.04 110.00 13,091.51 110.00 13,084.98 110.00 13,078.44 110.00 13,071.91 $3,503,500 $3,504,000 110.00 13,112.98 110.00 13,106.45 110.00 13,099.92 110.00 13,093.38 110.00 13,086.85 110.00 13,080.32 110.00 13,073.78 $3,504,000 $3,504,500 110.00 13,114.86 110.00 13,108.33 110.00 13,101.79 110.00 13,095.26 110.00 13,088.73 110.00 13,082.19 110.00 13,075.66 $3,504,500 $3,505,000 110.00 13,116.73 110.00 13,110.20 110.00 13,103.67 110.00 13,097.13 110.00 13,090.60 110.00 13,084.07 110.00 13,077.53 $3,505,000 $3,505,500 110.00 13,118.61 110.00 13,112.08 110.00 13,105.54 110.00 13,099.01 110.00 13,092.48 110.00 13,085.94 110.00 13,079.41 $3,505,500 $3,506,000 110.00 13,120.48 110.00 13,113.95 110.00 13,107.42 110.00 13,100.88 110.00 13,094.35 110.00 13,087.82 110.00 13,081.28 $3,506,000 $3,506,500 110.00 13,122.36 110.00 13,115.83 110.00 13,109.29 110.00 13,102.76 110.00 13,096.23 110.00 13,089.69 110.00 13,083.16 $3,506,500 $3,507,000 110.00 13,124.23 110.00 13,117.70 110.00 13,111.17 110.00 13,104.63 110.00 13,098.10 110.00 13,091.57 110.00 13,085.03 $3,507,000 $3,507,500 110.00 13,126.11 110.00 13,119.58 110.00 13,113.04 110.00 13,106.51 110.00 13,099.98 110.00 13,093.44 110.00 13,086.91 $3,507,500 $3,508,000 110.00 13,127.98 110.00 13,121.45 110.00 13,114.92 110.00 13,108.38 110.00 13,101.85 110.00 13,095.32 110.00 13,088.78 $3,508,000 $3,508,500 110.00 13,129.86 110.00 13,123.33 110.00 13,116.79 110.00 13,110.26 110.00 13,103.73 110.00 13,097.19 110.00 13,090.66 $3,508,500 $3,509,000 110.00 13,131.73 110.00 13,125.20 110.00 13,118.67 110.00 13,112.13 110.00 13,105.60 110.00 13,099.07 110.00 13,092.53 $3,509,000 $3,509,500 110.00 13,133.61 110.00 13,127.08 110.00 13,120.54 110.00 13,114.01 110.00 13,107.48 110.00 13,100.94 110.00 13,094.41 $3,509,500 $3,510,000 110.00 13,135.48 110.00 13,128.95 110.00 13,122.42 110.00 13,115.88 110.00 13,109.35 110.00 13,102.82 110.00 13,096.28 $3,510,000 $3,510,500 110.00 13,137.36 110.00 13,130.83 110.00 13,124.29 110.00 13,117.76 110.00 13,111.23 110.00 13,104.69 110.00 13,098.16 $3,510,500 $3,511,000 110.00 13,139.23 110.00 13,132.70 110.00 13,126.17 110.00 13,119.63 110.00 13,113.10 110.00 13,106.57 110.00 13,100.03 $3,511,000 $3,511,500 110.00 13,141.11 110.00 13,134.58 110.00 13,128.04 110.00 13,121.51 110.00 13,114.98 110.00 13,108.44 110.00 13,101.91 $3,511,500 $3,512,000 110.00 13,142.98 110.00 13,136.45 110.00 13,129.92 110.00 13,123.38 110.00 13,116.85 110.00 13,110.32 110.00 13,103.78 $3,512,000 $3,512,500 110.00 13,144.86 110.00 13,138.33 110.00 13,131.79 110.00 13,125.26 110.00 13,118.73 110.00 13,112.19 110.00 13,105.66 $3,512,500 $3,513,000 110.00 13,146.73 110.00 13,140.20 110.00 13,133.67 110.00 13,127.13 110.00 13,120.60 110.00 13,114.07 110.00 13,107.53 $3,513,000 $3,513,500 110.00 13,148.61 110.00 13,142.08 110.00 13,135.54 110.00 13,129.01 110.00 13,122.48 110.00 13,115.94 110.00 13,109.41 $3,513,500 $3,514,000 110.00 13,150.48 110.00 13,143.95 110.00 13,137.42 110.00 13,130.88 110.00 13,124.35 110.00 13,117.82 110.00 13,111.28 $3,514,000 $3,514,500 110.00 13,152.36 110.00 13,145.83 110.00 13,139.29 110.00 13,132.76 110.00 13,126.23 110.00 13,119.69 110.00 13,113.16 $3,514,500 $3,515,000 110.00 13,154.23 110.00 13,147.70 110.00 13,141.17 110.00 13,134.63 110.00 13,128.10 110.00 13,121.57 110.00 13,115.03 $3,515,000 $3,515,500 110.00 13,156.11 110.00 13,149.58 110.00 13,143.04 110.00 13,136.51 110.00 13,129.98 110.00 13,123.44 110.00 13,116.91 $3,515,500 $3,516,000 110.00 13,157.98 110.00 13,151.45 110.00 13,144.92 110.00 13,138.38 110.00 13,131.85 110.00 13,125.32 110.00 13,118.78 $3,516,000 $3,516,500 110.00 13,159.86 110.00 13,153.33 110.00 13,146.79 110.00 13,140.26 110.00 13,133.73 110.00 13,127.19 110.00 13,120.66 $3,516,500 $3,517,000 110.00 13,161.73 110.00 13,155.20 110.00 13,148.67 110.00 13,142.13 110.00 13,135.60 110.00 13,129.07 110.00 13,122.53 $3,517,000 $3,517,500 110.00 13,163.61 110.00 13,157.08 110.00 13,150.54 110.00 13,144.01 110.00 13,137.48 110.00 13,130.94 110.00 13,124.41 $3,517,500 $3,518,000 110.00 13,165.48 110.00 13,158.95 110.00 13,152.42 110.00 13,145.88 110.00 13,139.35 110.00 13,132.82 110.00 13,126.28 $3,518,000 $3,518,500 110.00 13,167.36 110.00 13,160.83 110.00 13,154.29 110.00 13,147.76 110.00 13,141.23 110.00 13,134.69 110.00 13,128.16 $3,518,500 $3,519,000 110.00 13,169.23 110.00 13,162.70 110.00 13,156.17 110.00 13,149.63 110.00 13,143.10 110.00 13,136.57 110.00 13,130.03

NJEIS Family Cost Participation Table Page 72 of 12 Effective July 1, 2015

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

$3,519,000 $3,519,500 110.00 13,171.11 110.00 13,164.58 110.00 13,158.04 110.00 13,151.51 110.00 13,144.98 110.00 13,138.44 110.00 13,131.91 $3,519,500 $3,520,000 110.00 13,172.98 110.00 13,166.45 110.00 13,159.92 110.00 13,153.38 110.00 13,146.85 110.00 13,140.32 110.00 13,133.78 $3,520,000 $3,520,500 110.00 13,174.86 110.00 13,168.33 110.00 13,161.79 110.00 13,155.26 110.00 13,148.73 110.00 13,142.19 110.00 13,135.66 $3,520,500 $3,521,000 110.00 13,176.73 110.00 13,170.20 110.00 13,163.67 110.00 13,157.13 110.00 13,150.60 110.00 13,144.07 110.00 13,137.53 $3,521,000 $3,521,500 110.00 13,178.61 110.00 13,172.08 110.00 13,165.54 110.00 13,159.01 110.00 13,152.48 110.00 13,145.94 110.00 13,139.41 $3,521,500 $3,522,000 110.00 13,180.48 110.00 13,173.95 110.00 13,167.42 110.00 13,160.88 110.00 13,154.35 110.00 13,147.82 110.00 13,141.28 $3,522,000 $3,522,500 110.00 13,182.36 110.00 13,175.83 110.00 13,169.29 110.00 13,162.76 110.00 13,156.23 110.00 13,149.69 110.00 13,143.16 $3,522,500 $3,523,000 110.00 13,184.23 110.00 13,177.70 110.00 13,171.17 110.00 13,164.63 110.00 13,158.10 110.00 13,151.57 110.00 13,145.03 $3,523,000 $3,523,500 110.00 13,186.11 110.00 13,179.58 110.00 13,173.04 110.00 13,166.51 110.00 13,159.98 110.00 13,153.44 110.00 13,146.91 $3,523,500 $3,524,000 110.00 13,187.98 110.00 13,181.45 110.00 13,174.92 110.00 13,168.38 110.00 13,161.85 110.00 13,155.32 110.00 13,148.78 $3,524,000 $3,524,500 110.00 13,189.86 110.00 13,183.33 110.00 13,176.79 110.00 13,170.26 110.00 13,163.73 110.00 13,157.19 110.00 13,150.66 $3,524,500 $3,525,000 110.00 13,191.73 110.00 13,185.20 110.00 13,178.67 110.00 13,172.13 110.00 13,165.60 110.00 13,159.07 110.00 13,152.53 $3,525,000 $3,525,500 110.00 13,193.61 110.00 13,187.08 110.00 13,180.54 110.00 13,174.01 110.00 13,167.48 110.00 13,160.94 110.00 13,154.41 $3,525,500 $3,526,000 110.00 13,195.48 110.00 13,188.95 110.00 13,182.42 110.00 13,175.88 110.00 13,169.35 110.00 13,162.82 110.00 13,156.28 $3,526,000 $3,526,500 110.00 13,197.36 110.00 13,190.83 110.00 13,184.29 110.00 13,177.76 110.00 13,171.23 110.00 13,164.69 110.00 13,158.16 $3,526,500 $3,527,000 110.00 13,199.23 110.00 13,192.70 110.00 13,186.17 110.00 13,179.63 110.00 13,173.10 110.00 13,166.57 110.00 13,160.03 $3,527,000 $3,527,500 110.00 13,201.11 110.00 13,194.58 110.00 13,188.04 110.00 13,181.51 110.00 13,174.98 110.00 13,168.44 110.00 13,161.91 $3,527,500 $3,528,000 110.00 13,202.98 110.00 13,196.45 110.00 13,189.92 110.00 13,183.38 110.00 13,176.85 110.00 13,170.32 110.00 13,163.78 $3,528,000 $3,528,500 110.00 13,204.86 110.00 13,198.33 110.00 13,191.79 110.00 13,185.26 110.00 13,178.73 110.00 13,172.19 110.00 13,165.66 $3,528,500 $3,529,000 110.00 13,206.73 110.00 13,200.20 110.00 13,193.67 110.00 13,187.13 110.00 13,180.60 110.00 13,174.07 110.00 13,167.53 $3,529,000 $3,529,500 110.00 13,208.61 110.00 13,202.08 110.00 13,195.54 110.00 13,189.01 110.00 13,182.48 110.00 13,175.94 110.00 13,169.41 $3,529,500 $3,530,000 110.00 13,210.48 110.00 13,203.95 110.00 13,197.42 110.00 13,190.88 110.00 13,184.35 110.00 13,177.82 110.00 13,171.28 $3,530,000 $3,530,500 110.00 13,212.36 110.00 13,205.83 110.00 13,199.29 110.00 13,192.76 110.00 13,186.23 110.00 13,179.69 110.00 13,173.16 $3,530,500 $3,531,000 110.00 13,214.23 110.00 13,207.70 110.00 13,201.17 110.00 13,194.63 110.00 13,188.10 110.00 13,181.57 110.00 13,175.03 $3,531,000 $3,531,500 110.00 13,216.11 110.00 13,209.58 110.00 13,203.04 110.00 13,196.51 110.00 13,189.98 110.00 13,183.44 110.00 13,176.91 $3,531,500 $3,532,000 110.00 13,217.98 110.00 13,211.45 110.00 13,204.92 110.00 13,198.38 110.00 13,191.85 110.00 13,185.32 110.00 13,178.78 $3,532,000 $3,532,500 110.00 13,219.86 110.00 13,213.33 110.00 13,206.79 110.00 13,200.26 110.00 13,193.73 110.00 13,187.19 110.00 13,180.66 $3,532,500 $3,533,000 110.00 13,221.73 110.00 13,215.20 110.00 13,208.67 110.00 13,202.13 110.00 13,195.60 110.00 13,189.07 110.00 13,182.53 $3,533,000 $3,533,500 110.00 13,223.61 110.00 13,217.08 110.00 13,210.54 110.00 13,204.01 110.00 13,197.48 110.00 13,190.94 110.00 13,184.41 $3,533,500 $3,534,000 110.00 13,225.48 110.00 13,218.95 110.00 13,212.42 110.00 13,205.88 110.00 13,199.35 110.00 13,192.82 110.00 13,186.28 $3,534,000 $3,534,500 110.00 13,227.36 110.00 13,220.83 110.00 13,214.29 110.00 13,207.76 110.00 13,201.23 110.00 13,194.69 110.00 13,188.16 $3,534,500 $3,535,000 110.00 13,229.23 110.00 13,222.70 110.00 13,216.17 110.00 13,209.63 110.00 13,203.10 110.00 13,196.57 110.00 13,190.03 $3,535,000 $3,535,500 110.00 13,231.11 110.00 13,224.58 110.00 13,218.04 110.00 13,211.51 110.00 13,204.98 110.00 13,198.44 110.00 13,191.91 $3,535,500 $3,536,000 110.00 13,232.98 110.00 13,226.45 110.00 13,219.92 110.00 13,213.38 110.00 13,206.85 110.00 13,200.32 110.00 13,193.78 $3,536,000 $3,536,500 110.00 13,234.86 110.00 13,228.33 110.00 13,221.79 110.00 13,215.26 110.00 13,208.73 110.00 13,202.19 110.00 13,195.66 $3,536,500 $3,537,000 110.00 13,236.73 110.00 13,230.20 110.00 13,223.67 110.00 13,217.13 110.00 13,210.60 110.00 13,204.07 110.00 13,197.53 $3,537,000 $3,537,500 110.00 13,238.61 110.00 13,232.08 110.00 13,225.54 110.00 13,219.01 110.00 13,212.48 110.00 13,205.94 110.00 13,199.41 $3,537,500 $3,538,000 110.00 13,240.48 110.00 13,233.95 110.00 13,227.42 110.00 13,220.88 110.00 13,214.35 110.00 13,207.82 110.00 13,201.28 $3,538,000 $3,538,500 110.00 13,242.36 110.00 13,235.83 110.00 13,229.29 110.00 13,222.76 110.00 13,216.23 110.00 13,209.69 110.00 13,203.16 $3,538,500 $3,539,000 110.00 13,244.23 110.00 13,237.70 110.00 13,231.17 110.00 13,224.63 110.00 13,218.10 110.00 13,211.57 110.00 13,205.03 $3,539,000 $3,539,500 110.00 13,246.11 110.00 13,239.58 110.00 13,233.04 110.00 13,226.51 110.00 13,219.98 110.00 13,213.44 110.00 13,206.91 $3,539,500 $3,540,000 110.00 13,247.98 110.00 13,241.45 110.00 13,234.92 110.00 13,228.38 110.00 13,221.85 110.00 13,215.32 110.00 13,208.78 $3,540,000 $3,540,500 110.00 13,249.86 110.00 13,243.33 110.00 13,236.79 110.00 13,230.26 110.00 13,223.73 110.00 13,217.19 110.00 13,210.66 $3,540,500 $3,541,000 110.00 13,251.73 110.00 13,245.20 110.00 13,238.67 110.00 13,232.13 110.00 13,225.60 110.00 13,219.07 110.00 13,212.53 $3,541,000 $3,541,500 110.00 13,253.61 110.00 13,247.08 110.00 13,240.54 110.00 13,234.01 110.00 13,227.48 110.00 13,220.94 110.00 13,214.41 $3,541,500 $3,542,000 110.00 13,255.48 110.00 13,248.95 110.00 13,242.42 110.00 13,235.88 110.00 13,229.35 110.00 13,222.82 110.00 13,216.28 $3,542,000 $3,542,500 110.00 13,257.36 110.00 13,250.83 110.00 13,244.29 110.00 13,237.76 110.00 13,231.23 110.00 13,224.69 110.00 13,218.16 $3,542,500 $3,543,000 110.00 13,259.23 110.00 13,252.70 110.00 13,246.17 110.00 13,239.63 110.00 13,233.10 110.00 13,226.57 110.00 13,220.03 $3,543,000 $3,543,500 110.00 13,261.11 110.00 13,254.58 110.00 13,248.04 110.00 13,241.51 110.00 13,234.98 110.00 13,228.44 110.00 13,221.91 $3,543,500 $3,544,000 110.00 13,262.98 110.00 13,256.45 110.00 13,249.92 110.00 13,243.38 110.00 13,236.85 110.00 13,230.32 110.00 13,223.78 $3,544,000 $3,544,500 110.00 13,264.86 110.00 13,258.33 110.00 13,251.79 110.00 13,245.26 110.00 13,238.73 110.00 13,232.19 110.00 13,225.66 $3,544,500 $3,545,000 110.00 13,266.73 110.00 13,260.20 110.00 13,253.67 110.00 13,247.13 110.00 13,240.60 110.00 13,234.07 110.00 13,227.53 $3,545,000 $3,545,500 110.00 13,268.61 110.00 13,262.08 110.00 13,255.54 110.00 13,249.01 110.00 13,242.48 110.00 13,235.94 110.00 13,229.41 $3,545,500 $3,546,000 110.00 13,270.48 110.00 13,263.95 110.00 13,257.42 110.00 13,250.88 110.00 13,244.35 110.00 13,237.82 110.00 13,231.28 $3,546,000 $3,546,500 110.00 13,272.36 110.00 13,265.83 110.00 13,259.29 110.00 13,252.76 110.00 13,246.23 110.00 13,239.69 110.00 13,233.16 $3,546,500 $3,547,000 110.00 13,274.23 110.00 13,267.70 110.00 13,261.17 110.00 13,254.63 110.00 13,248.10 110.00 13,241.57 110.00 13,235.03 $3,547,000 $3,547,500 110.00 13,276.11 110.00 13,269.58 110.00 13,263.04 110.00 13,256.51 110.00 13,249.98 110.00 13,243.44 110.00 13,236.91 $3,547,500 $3,548,000 110.00 13,277.98 110.00 13,271.45 110.00 13,264.92 110.00 13,258.38 110.00 13,251.85 110.00 13,245.32 110.00 13,238.78 $3,548,000 $3,548,500 110.00 13,279.86 110.00 13,273.33 110.00 13,266.79 110.00 13,260.26 110.00 13,253.73 110.00 13,247.19 110.00 13,240.66 $3,548,500 $3,549,000 110.00 13,281.73 110.00 13,275.20 110.00 13,268.67 110.00 13,262.13 110.00 13,255.60 110.00 13,249.07 110.00 13,242.53 $3,549,000 $3,549,500 110.00 13,283.61 110.00 13,277.08 110.00 13,270.54 110.00 13,264.01 110.00 13,257.48 110.00 13,250.94 110.00 13,244.41 $3,549,500 $3,550,000 110.00 13,285.48 110.00 13,278.95 110.00 13,272.42 110.00 13,265.88 110.00 13,259.35 110.00 13,252.82 110.00 13,246.28 $3,550,000 $3,550,500 110.00 13,287.36 110.00 13,280.83 110.00 13,274.29 110.00 13,267.76 110.00 13,261.23 110.00 13,254.69 110.00 13,248.16 $3,550,500 $3,551,000 110.00 13,289.23 110.00 13,282.70 110.00 13,276.17 110.00 13,269.63 110.00 13,263.10 110.00 13,256.57 110.00 13,250.03 $3,551,000 $3,551,500 110.00 13,291.11 110.00 13,284.58 110.00 13,278.04 110.00 13,271.51 110.00 13,264.98 110.00 13,258.44 110.00 13,251.91 $3,551,500 $3,552,000 110.00 13,292.98 110.00 13,286.45 110.00 13,279.92 110.00 13,273.38 110.00 13,266.85 110.00 13,260.32 110.00 13,253.78 $3,552,000 $3,552,500 110.00 13,294.86 110.00 13,288.33 110.00 13,281.79 110.00 13,275.26 110.00 13,268.73 110.00 13,262.19 110.00 13,255.66 $3,552,500 $3,553,000 110.00 13,296.73 110.00 13,290.20 110.00 13,283.67 110.00 13,277.13 110.00 13,270.60 110.00 13,264.07 110.00 13,257.53 $3,553,000 $3,553,500 110.00 13,298.61 110.00 13,292.08 110.00 13,285.54 110.00 13,279.01 110.00 13,272.48 110.00 13,265.94 110.00 13,259.41 $3,553,500 $3,554,000 110.00 13,300.48 110.00 13,293.95 110.00 13,287.42 110.00 13,280.88 110.00 13,274.35 110.00 13,267.82 110.00 13,261.28 $3,554,000 $3,554,500 110.00 13,302.36 110.00 13,295.83 110.00 13,289.29 110.00 13,282.76 110.00 13,276.23 110.00 13,269.69 110.00 13,263.16 $3,554,500 $3,555,000 110.00 13,304.23 110.00 13,297.70 110.00 13,291.17 110.00 13,284.63 110.00 13,278.10 110.00 13,271.57 110.00 13,265.03 $3,555,000 $3,555,500 110.00 13,306.11 110.00 13,299.58 110.00 13,293.04 110.00 13,286.51 110.00 13,279.98 110.00 13,273.44 110.00 13,266.91 $3,555,500 $3,556,000 110.00 13,307.98 110.00 13,301.45 110.00 13,294.92 110.00 13,288.38 110.00 13,281.85 110.00 13,275.32 110.00 13,268.78 $3,556,000 $3,556,500 110.00 13,309.86 110.00 13,303.33 110.00 13,296.79 110.00 13,290.26 110.00 13,283.73 110.00 13,277.19 110.00 13,270.66 $3,556,500 $3,557,000 110.00 13,311.73 110.00 13,305.20 110.00 13,298.67 110.00 13,292.13 110.00 13,285.60 110.00 13,279.07 110.00 13,272.53 $3,557,000 $3,557,500 110.00 13,313.61 110.00 13,307.08 110.00 13,300.54 110.00 13,294.01 110.00 13,287.48 110.00 13,280.94 110.00 13,274.41 $3,557,500 $3,558,000 110.00 13,315.48 110.00 13,308.95 110.00 13,302.42 110.00 13,295.88 110.00 13,289.35 110.00 13,282.82 110.00 13,276.28 $3,558,000 $3,558,500 110.00 13,317.36 110.00 13,310.83 110.00 13,304.29 110.00 13,297.76 110.00 13,291.23 110.00 13,284.69 110.00 13,278.16 $3,558,500 $3,559,000 110.00 13,319.23 110.00 13,312.70 110.00 13,306.17 110.00 13,299.63 110.00 13,293.10 110.00 13,286.57 110.00 13,280.03 $3,559,000 $3,559,500 110.00 13,321.11 110.00 13,314.58 110.00 13,308.04 110.00 13,301.51 110.00 13,294.98 110.00 13,288.44 110.00 13,281.91 $3,559,500 $3,560,000 110.00 13,322.98 110.00 13,316.45 110.00 13,309.92 110.00 13,303.38 110.00 13,296.85 110.00 13,290.32 110.00 13,283.78 $3,560,000 $3,560,500 110.00 13,324.86 110.00 13,318.33 110.00 13,311.79 110.00 13,305.26 110.00 13,298.73 110.00 13,292.19 110.00 13,285.66 $3,560,500 $3,561,000 110.00 13,326.73 110.00 13,320.20 110.00 13,313.67 110.00 13,307.13 110.00 13,300.60 110.00 13,294.07 110.00 13,287.53 $3,561,000 $3,561,500 110.00 13,328.61 110.00 13,322.08 110.00 13,315.54 110.00 13,309.01 110.00 13,302.48 110.00 13,295.94 110.00 13,289.41 $3,561,500 $3,562,000 110.00 13,330.48 110.00 13,323.95 110.00 13,317.42 110.00 13,310.88 110.00 13,304.35 110.00 13,297.82 110.00 13,291.28 $3,562,000 $3,562,500 110.00 13,332.36 110.00 13,325.83 110.00 13,319.29 110.00 13,312.76 110.00 13,306.23 110.00 13,299.69 110.00 13,293.16 $3,562,500 $3,563,000 110.00 13,334.23 110.00 13,327.70 110.00 13,321.17 110.00 13,314.63 110.00 13,308.10 110.00 13,301.57 110.00 13,295.03 $3,563,000 $3,563,500 110.00 13,336.11 110.00 13,329.58 110.00 13,323.04 110.00 13,316.51 110.00 13,309.98 110.00 13,303.44 110.00 13,296.91 $3,563,500 $3,564,000 110.00 13,337.98 110.00 13,331.45 110.00 13,324.92 110.00 13,318.38 110.00 13,311.85 110.00 13,305.32 110.00 13,298.78 $3,564,000 $3,564,500 110.00 13,339.86 110.00 13,333.33 110.00 13,326.79 110.00 13,320.26 110.00 13,313.73 110.00 13,307.19 110.00 13,300.66 $3,564,500 $3,565,000 110.00 13,341.73 110.00 13,335.20 110.00 13,328.67 110.00 13,322.13 110.00 13,315.60 110.00 13,309.07 110.00 13,302.53 $3,565,000 $3,565,500 110.00 13,343.61 110.00 13,337.08 110.00 13,330.54 110.00 13,324.01 110.00 13,317.48 110.00 13,310.94 110.00 13,304.41 $3,565,500 $3,566,000 110.00 13,345.48 110.00 13,338.95 110.00 13,332.42 110.00 13,325.88 110.00 13,319.35 110.00 13,312.82 110.00 13,306.28 $3,566,000 $3,566,500 110.00 13,347.36 110.00 13,340.83 110.00 13,334.29 110.00 13,327.76 110.00 13,321.23 110.00 13,314.69 110.00 13,308.16 $3,566,500 $3,567,000 110.00 13,349.23 110.00 13,342.70 110.00 13,336.17 110.00 13,329.63 110.00 13,323.10 110.00 13,316.57 110.00 13,310.03 $3,567,000 $3,567,500 110.00 13,351.11 110.00 13,344.58 110.00 13,338.04 110.00 13,331.51 110.00 13,324.98 110.00 13,318.44 110.00 13,311.91 $3,567,500 $3,568,000 110.00 13,352.98 110.00 13,346.45 110.00 13,339.92 110.00 13,333.38 110.00 13,326.85 110.00 13,320.32 110.00 13,313.78 $3,568,000 $3,568,500 110.00 13,354.86 110.00 13,348.33 110.00 13,341.79 110.00 13,335.26 110.00 13,328.73 110.00 13,322.19 110.00 13,315.66 $3,568,500 $3,569,000 110.00 13,356.73 110.00 13,350.20 110.00 13,343.67 110.00 13,337.13 110.00 13,330.60 110.00 13,324.07 110.00 13,317.53 $3,569,000 $3,569,500 110.00 13,358.61 110.00 13,352.08 110.00 13,345.54 110.00 13,339.01 110.00 13,332.48 110.00 13,325.94 110.00 13,319.41 $3,569,500 $3,570,000 110.00 13,360.48 110.00 13,353.95 110.00 13,347.42 110.00 13,340.88 110.00 13,334.35 110.00 13,327.82 110.00 13,321.28

NJEIS Family Cost Participation Table Page 73 of 12 Effective July 1, 2015

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

$3,570,000 $3,570,500 110.00 13,362.36 110.00 13,355.83 110.00 13,349.29 110.00 13,342.76 110.00 13,336.23 110.00 13,329.69 110.00 13,323.16 $3,570,500 $3,571,000 110.00 13,364.23 110.00 13,357.70 110.00 13,351.17 110.00 13,344.63 110.00 13,338.10 110.00 13,331.57 110.00 13,325.03 $3,571,000 $3,571,500 110.00 13,366.11 110.00 13,359.58 110.00 13,353.04 110.00 13,346.51 110.00 13,339.98 110.00 13,333.44 110.00 13,326.91 $3,571,500 $3,572,000 110.00 13,367.98 110.00 13,361.45 110.00 13,354.92 110.00 13,348.38 110.00 13,341.85 110.00 13,335.32 110.00 13,328.78 $3,572,000 $3,572,500 110.00 13,369.86 110.00 13,363.33 110.00 13,356.79 110.00 13,350.26 110.00 13,343.73 110.00 13,337.19 110.00 13,330.66 $3,572,500 $3,573,000 110.00 13,371.73 110.00 13,365.20 110.00 13,358.67 110.00 13,352.13 110.00 13,345.60 110.00 13,339.07 110.00 13,332.53 $3,573,000 $3,573,500 110.00 13,373.61 110.00 13,367.08 110.00 13,360.54 110.00 13,354.01 110.00 13,347.48 110.00 13,340.94 110.00 13,334.41 $3,573,500 $3,574,000 110.00 13,375.48 110.00 13,368.95 110.00 13,362.42 110.00 13,355.88 110.00 13,349.35 110.00 13,342.82 110.00 13,336.28 $3,574,000 $3,574,500 110.00 13,377.36 110.00 13,370.83 110.00 13,364.29 110.00 13,357.76 110.00 13,351.23 110.00 13,344.69 110.00 13,338.16 $3,574,500 $3,575,000 110.00 13,379.23 110.00 13,372.70 110.00 13,366.17 110.00 13,359.63 110.00 13,353.10 110.00 13,346.57 110.00 13,340.03 $3,575,000 $3,575,500 110.00 13,381.11 110.00 13,374.58 110.00 13,368.04 110.00 13,361.51 110.00 13,354.98 110.00 13,348.44 110.00 13,341.91 $3,575,500 $3,576,000 110.00 13,382.98 110.00 13,376.45 110.00 13,369.92 110.00 13,363.38 110.00 13,356.85 110.00 13,350.32 110.00 13,343.78 $3,576,000 $3,576,500 110.00 13,384.86 110.00 13,378.33 110.00 13,371.79 110.00 13,365.26 110.00 13,358.73 110.00 13,352.19 110.00 13,345.66 $3,576,500 $3,577,000 110.00 13,386.73 110.00 13,380.20 110.00 13,373.67 110.00 13,367.13 110.00 13,360.60 110.00 13,354.07 110.00 13,347.53 $3,577,000 $3,577,500 110.00 13,388.61 110.00 13,382.08 110.00 13,375.54 110.00 13,369.01 110.00 13,362.48 110.00 13,355.94 110.00 13,349.41 $3,577,500 $3,578,000 110.00 13,390.48 110.00 13,383.95 110.00 13,377.42 110.00 13,370.88 110.00 13,364.35 110.00 13,357.82 110.00 13,351.28 $3,578,000 $3,578,500 110.00 13,392.36 110.00 13,385.83 110.00 13,379.29 110.00 13,372.76 110.00 13,366.23 110.00 13,359.69 110.00 13,353.16 $3,578,500 $3,579,000 110.00 13,394.23 110.00 13,387.70 110.00 13,381.17 110.00 13,374.63 110.00 13,368.10 110.00 13,361.57 110.00 13,355.03 $3,579,000 $3,579,500 110.00 13,396.11 110.00 13,389.58 110.00 13,383.04 110.00 13,376.51 110.00 13,369.98 110.00 13,363.44 110.00 13,356.91 $3,579,500 $3,580,000 110.00 13,397.98 110.00 13,391.45 110.00 13,384.92 110.00 13,378.38 110.00 13,371.85 110.00 13,365.32 110.00 13,358.78 $3,580,000 $3,580,500 110.00 13,399.86 110.00 13,393.33 110.00 13,386.79 110.00 13,380.26 110.00 13,373.73 110.00 13,367.19 110.00 13,360.66 $3,580,500 $3,581,000 110.00 13,401.73 110.00 13,395.20 110.00 13,388.67 110.00 13,382.13 110.00 13,375.60 110.00 13,369.07 110.00 13,362.53 $3,581,000 $3,581,500 110.00 13,403.61 110.00 13,397.08 110.00 13,390.54 110.00 13,384.01 110.00 13,377.48 110.00 13,370.94 110.00 13,364.41 $3,581,500 $3,582,000 110.00 13,405.48 110.00 13,398.95 110.00 13,392.42 110.00 13,385.88 110.00 13,379.35 110.00 13,372.82 110.00 13,366.28 $3,582,000 $3,582,500 110.00 13,407.36 110.00 13,400.83 110.00 13,394.29 110.00 13,387.76 110.00 13,381.23 110.00 13,374.69 110.00 13,368.16 $3,582,500 $3,583,000 110.00 13,409.23 110.00 13,402.70 110.00 13,396.17 110.00 13,389.63 110.00 13,383.10 110.00 13,376.57 110.00 13,370.03 $3,583,000 $3,583,500 110.00 13,411.11 110.00 13,404.58 110.00 13,398.04 110.00 13,391.51 110.00 13,384.98 110.00 13,378.44 110.00 13,371.91 $3,583,500 $3,584,000 110.00 13,412.98 110.00 13,406.45 110.00 13,399.92 110.00 13,393.38 110.00 13,386.85 110.00 13,380.32 110.00 13,373.78 $3,584,000 $3,584,500 110.00 13,414.86 110.00 13,408.33 110.00 13,401.79 110.00 13,395.26 110.00 13,388.73 110.00 13,382.19 110.00 13,375.66 $3,584,500 $3,585,000 110.00 13,416.73 110.00 13,410.20 110.00 13,403.67 110.00 13,397.13 110.00 13,390.60 110.00 13,384.07 110.00 13,377.53 $3,585,000 $3,585,500 110.00 13,418.61 110.00 13,412.08 110.00 13,405.54 110.00 13,399.01 110.00 13,392.48 110.00 13,385.94 110.00 13,379.41 $3,585,500 $3,586,000 110.00 13,420.48 110.00 13,413.95 110.00 13,407.42 110.00 13,400.88 110.00 13,394.35 110.00 13,387.82 110.00 13,381.28 $3,586,000 $3,586,500 110.00 13,422.36 110.00 13,415.83 110.00 13,409.29 110.00 13,402.76 110.00 13,396.23 110.00 13,389.69 110.00 13,383.16 $3,586,500 $3,587,000 110.00 13,424.23 110.00 13,417.70 110.00 13,411.17 110.00 13,404.63 110.00 13,398.10 110.00 13,391.57 110.00 13,385.03 $3,587,000 $3,587,500 110.00 13,426.11 110.00 13,419.58 110.00 13,413.04 110.00 13,406.51 110.00 13,399.98 110.00 13,393.44 110.00 13,386.91 $3,587,500 $3,588,000 110.00 13,427.98 110.00 13,421.45 110.00 13,414.92 110.00 13,408.38 110.00 13,401.85 110.00 13,395.32 110.00 13,388.78 $3,588,000 $3,588,500 110.00 13,429.86 110.00 13,423.33 110.00 13,416.79 110.00 13,410.26 110.00 13,403.73 110.00 13,397.19 110.00 13,390.66 $3,588,500 $3,589,000 110.00 13,431.73 110.00 13,425.20 110.00 13,418.67 110.00 13,412.13 110.00 13,405.60 110.00 13,399.07 110.00 13,392.53 $3,589,000 $3,589,500 110.00 13,433.61 110.00 13,427.08 110.00 13,420.54 110.00 13,414.01 110.00 13,407.48 110.00 13,400.94 110.00 13,394.41 $3,589,500 $3,590,000 110.00 13,435.48 110.00 13,428.95 110.00 13,422.42 110.00 13,415.88 110.00 13,409.35 110.00 13,402.82 110.00 13,396.28 $3,590,000 $3,590,500 110.00 13,437.36 110.00 13,430.83 110.00 13,424.29 110.00 13,417.76 110.00 13,411.23 110.00 13,404.69 110.00 13,398.16 $3,590,500 $3,591,000 110.00 13,439.23 110.00 13,432.70 110.00 13,426.17 110.00 13,419.63 110.00 13,413.10 110.00 13,406.57 110.00 13,400.03 $3,591,000 $3,591,500 110.00 13,441.11 110.00 13,434.58 110.00 13,428.04 110.00 13,421.51 110.00 13,414.98 110.00 13,408.44 110.00 13,401.91 $3,591,500 $3,592,000 110.00 13,442.98 110.00 13,436.45 110.00 13,429.92 110.00 13,423.38 110.00 13,416.85 110.00 13,410.32 110.00 13,403.78 $3,592,000 $3,592,500 110.00 13,444.86 110.00 13,438.33 110.00 13,431.79 110.00 13,425.26 110.00 13,418.73 110.00 13,412.19 110.00 13,405.66 $3,592,500 $3,593,000 110.00 13,446.73 110.00 13,440.20 110.00 13,433.67 110.00 13,427.13 110.00 13,420.60 110.00 13,414.07 110.00 13,407.53 $3,593,000 $3,593,500 110.00 13,448.61 110.00 13,442.08 110.00 13,435.54 110.00 13,429.01 110.00 13,422.48 110.00 13,415.94 110.00 13,409.41 $3,593,500 $3,594,000 110.00 13,450.48 110.00 13,443.95 110.00 13,437.42 110.00 13,430.88 110.00 13,424.35 110.00 13,417.82 110.00 13,411.28 $3,594,000 $3,594,500 110.00 13,452.36 110.00 13,445.83 110.00 13,439.29 110.00 13,432.76 110.00 13,426.23 110.00 13,419.69 110.00 13,413.16 $3,594,500 $3,595,000 110.00 13,454.23 110.00 13,447.70 110.00 13,441.17 110.00 13,434.63 110.00 13,428.10 110.00 13,421.57 110.00 13,415.03 $3,595,000 $3,595,500 110.00 13,456.11 110.00 13,449.58 110.00 13,443.04 110.00 13,436.51 110.00 13,429.98 110.00 13,423.44 110.00 13,416.91 $3,595,500 $3,596,000 110.00 13,457.98 110.00 13,451.45 110.00 13,444.92 110.00 13,438.38 110.00 13,431.85 110.00 13,425.32 110.00 13,418.78 $3,596,000 $3,596,500 110.00 13,459.86 110.00 13,453.33 110.00 13,446.79 110.00 13,440.26 110.00 13,433.73 110.00 13,427.19 110.00 13,420.66 $3,596,500 $3,597,000 110.00 13,461.73 110.00 13,455.20 110.00 13,448.67 110.00 13,442.13 110.00 13,435.60 110.00 13,429.07 110.00 13,422.53 $3,597,000 $3,597,500 110.00 13,463.61 110.00 13,457.08 110.00 13,450.54 110.00 13,444.01 110.00 13,437.48 110.00 13,430.94 110.00 13,424.41 $3,597,500 $3,598,000 110.00 13,465.48 110.00 13,458.95 110.00 13,452.42 110.00 13,445.88 110.00 13,439.35 110.00 13,432.82 110.00 13,426.28 $3,598,000 $3,598,500 110.00 13,467.36 110.00 13,460.83 110.00 13,454.29 110.00 13,447.76 110.00 13,441.23 110.00 13,434.69 110.00 13,428.16 $3,598,500 $3,599,000 110.00 13,469.23 110.00 13,462.70 110.00 13,456.17 110.00 13,449.63 110.00 13,443.10 110.00 13,436.57 110.00 13,430.03 $3,599,000 $3,599,500 110.00 13,471.11 110.00 13,464.58 110.00 13,458.04 110.00 13,451.51 110.00 13,444.98 110.00 13,438.44 110.00 13,431.91 $3,599,500 $3,600,000 110.00 13,472.98 110.00 13,466.45 110.00 13,459.92 110.00 13,453.38 110.00 13,446.85 110.00 13,440.32 110.00 13,433.78 $3,600,000 $3,600,500 110.00 13,474.86 110.00 13,468.33 110.00 13,461.79 110.00 13,455.26 110.00 13,448.73 110.00 13,442.19 110.00 13,435.66 $3,600,500 $3,601,000 110.00 13,476.73 110.00 13,470.20 110.00 13,463.67 110.00 13,457.13 110.00 13,450.60 110.00 13,444.07 110.00 13,437.53 $3,601,000 $3,601,500 110.00 13,478.61 110.00 13,472.08 110.00 13,465.54 110.00 13,459.01 110.00 13,452.48 110.00 13,445.94 110.00 13,439.41 $3,601,500 $3,602,000 110.00 13,480.48 110.00 13,473.95 110.00 13,467.42 110.00 13,460.88 110.00 13,454.35 110.00 13,447.82 110.00 13,441.28 $3,602,000 $3,602,500 110.00 13,482.36 110.00 13,475.83 110.00 13,469.29 110.00 13,462.76 110.00 13,456.23 110.00 13,449.69 110.00 13,443.16 $3,602,500 $3,603,000 110.00 13,484.23 110.00 13,477.70 110.00 13,471.17 110.00 13,464.63 110.00 13,458.10 110.00 13,451.57 110.00 13,445.03 $3,603,000 $3,603,500 110.00 13,486.11 110.00 13,479.58 110.00 13,473.04 110.00 13,466.51 110.00 13,459.98 110.00 13,453.44 110.00 13,446.91 $3,603,500 $3,604,000 110.00 13,487.98 110.00 13,481.45 110.00 13,474.92 110.00 13,468.38 110.00 13,461.85 110.00 13,455.32 110.00 13,448.78 $3,604,000 $3,604,500 110.00 13,489.86 110.00 13,483.33 110.00 13,476.79 110.00 13,470.26 110.00 13,463.73 110.00 13,457.19 110.00 13,450.66 $3,604,500 $3,605,000 110.00 13,491.73 110.00 13,485.20 110.00 13,478.67 110.00 13,472.13 110.00 13,465.60 110.00 13,459.07 110.00 13,452.53 $3,605,000 $3,605,500 110.00 13,493.61 110.00 13,487.08 110.00 13,480.54 110.00 13,474.01 110.00 13,467.48 110.00 13,460.94 110.00 13,454.41 $3,605,500 $3,606,000 110.00 13,495.48 110.00 13,488.95 110.00 13,482.42 110.00 13,475.88 110.00 13,469.35 110.00 13,462.82 110.00 13,456.28 $3,606,000 $3,606,500 110.00 13,497.36 110.00 13,490.83 110.00 13,484.29 110.00 13,477.76 110.00 13,471.23 110.00 13,464.69 110.00 13,458.16 $3,606,500 $3,607,000 110.00 13,499.23 110.00 13,492.70 110.00 13,486.17 110.00 13,479.63 110.00 13,473.10 110.00 13,466.57 110.00 13,460.03 $3,607,000 $3,607,500 110.00 13,501.11 110.00 13,494.58 110.00 13,488.04 110.00 13,481.51 110.00 13,474.98 110.00 13,468.44 110.00 13,461.91 $3,607,500 $3,608,000 110.00 13,502.98 110.00 13,496.45 110.00 13,489.92 110.00 13,483.38 110.00 13,476.85 110.00 13,470.32 110.00 13,463.78 $3,608,000 $3,608,500 110.00 13,504.86 110.00 13,498.33 110.00 13,491.79 110.00 13,485.26 110.00 13,478.73 110.00 13,472.19 110.00 13,465.66 $3,608,500 $3,609,000 110.00 13,506.73 110.00 13,500.20 110.00 13,493.67 110.00 13,487.13 110.00 13,480.60 110.00 13,474.07 110.00 13,467.53 $3,609,000 $3,609,500 110.00 13,508.61 110.00 13,502.08 110.00 13,495.54 110.00 13,489.01 110.00 13,482.48 110.00 13,475.94 110.00 13,469.41 $3,609,500 $3,610,000 110.00 13,510.48 110.00 13,503.95 110.00 13,497.42 110.00 13,490.88 110.00 13,484.35 110.00 13,477.82 110.00 13,471.28 $3,610,000 $3,610,500 110.00 13,512.36 110.00 13,505.83 110.00 13,499.29 110.00 13,492.76 110.00 13,486.23 110.00 13,479.69 110.00 13,473.16 $3,610,500 $3,611,000 110.00 13,514.23 110.00 13,507.70 110.00 13,501.17 110.00 13,494.63 110.00 13,488.10 110.00 13,481.57 110.00 13,475.03 $3,611,000 $3,611,500 110.00 13,516.11 110.00 13,509.58 110.00 13,503.04 110.00 13,496.51 110.00 13,489.98 110.00 13,483.44 110.00 13,476.91 $3,611,500 $3,612,000 110.00 13,517.98 110.00 13,511.45 110.00 13,504.92 110.00 13,498.38 110.00 13,491.85 110.00 13,485.32 110.00 13,478.78 $3,612,000 $3,612,500 110.00 13,519.86 110.00 13,513.33 110.00 13,506.79 110.00 13,500.26 110.00 13,493.73 110.00 13,487.19 110.00 13,480.66 $3,612,500 $3,613,000 110.00 13,521.73 110.00 13,515.20 110.00 13,508.67 110.00 13,502.13 110.00 13,495.60 110.00 13,489.07 110.00 13,482.53 $3,613,000 $3,613,500 110.00 13,523.61 110.00 13,517.08 110.00 13,510.54 110.00 13,504.01 110.00 13,497.48 110.00 13,490.94 110.00 13,484.41 $3,613,500 $3,614,000 110.00 13,525.48 110.00 13,518.95 110.00 13,512.42 110.00 13,505.88 110.00 13,499.35 110.00 13,492.82 110.00 13,486.28 $3,614,000 $3,614,500 110.00 13,527.36 110.00 13,520.83 110.00 13,514.29 110.00 13,507.76 110.00 13,501.23 110.00 13,494.69 110.00 13,488.16 $3,614,500 $3,615,000 110.00 13,529.23 110.00 13,522.70 110.00 13,516.17 110.00 13,509.63 110.00 13,503.10 110.00 13,496.57 110.00 13,490.03 $3,615,000 $3,615,500 110.00 13,531.11 110.00 13,524.58 110.00 13,518.04 110.00 13,511.51 110.00 13,504.98 110.00 13,498.44 110.00 13,491.91 $3,615,500 $3,616,000 110.00 13,532.98 110.00 13,526.45 110.00 13,519.92 110.00 13,513.38 110.00 13,506.85 110.00 13,500.32 110.00 13,493.78 $3,616,000 $3,616,500 110.00 13,534.86 110.00 13,528.33 110.00 13,521.79 110.00 13,515.26 110.00 13,508.73 110.00 13,502.19 110.00 13,495.66 $3,616,500 $3,617,000 110.00 13,536.73 110.00 13,530.20 110.00 13,523.67 110.00 13,517.13 110.00 13,510.60 110.00 13,504.07 110.00 13,497.53 $3,617,000 $3,617,500 110.00 13,538.61 110.00 13,532.08 110.00 13,525.54 110.00 13,519.01 110.00 13,512.48 110.00 13,505.94 110.00 13,499.41 $3,617,500 $3,618,000 110.00 13,540.48 110.00 13,533.95 110.00 13,527.42 110.00 13,520.88 110.00 13,514.35 110.00 13,507.82 110.00 13,501.28 $3,618,000 $3,618,500 110.00 13,542.36 110.00 13,535.83 110.00 13,529.29 110.00 13,522.76 110.00 13,516.23 110.00 13,509.69 110.00 13,503.16 $3,618,500 $3,619,000 110.00 13,544.23 110.00 13,537.70 110.00 13,531.17 110.00 13,524.63 110.00 13,518.10 110.00 13,511.57 110.00 13,505.03 $3,619,000 $3,619,500 110.00 13,546.11 110.00 13,539.58 110.00 13,533.04 110.00 13,526.51 110.00 13,519.98 110.00 13,513.44 110.00 13,506.91 $3,619,500 $3,620,000 110.00 13,547.98 110.00 13,541.45 110.00 13,534.92 110.00 13,528.38 110.00 13,521.85 110.00 13,515.32 110.00 13,508.78 $3,620,000 $3,620,500 110.00 13,549.86 110.00 13,543.33 110.00 13,536.79 110.00 13,530.26 110.00 13,523.73 110.00 13,517.19 110.00 13,510.66 $3,620,500 $3,621,000 110.00 13,551.73 110.00 13,545.20 110.00 13,538.67 110.00 13,532.13 110.00 13,525.60 110.00 13,519.07 110.00 13,512.53

NJEIS Family Cost Participation Table Page 74 of 12 Effective July 1, 2015

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

$3,621,000 $3,621,500 110.00 13,553.61 110.00 13,547.08 110.00 13,540.54 110.00 13,534.01 110.00 13,527.48 110.00 13,520.94 110.00 13,514.41 $3,621,500 $3,622,000 110.00 13,555.48 110.00 13,548.95 110.00 13,542.42 110.00 13,535.88 110.00 13,529.35 110.00 13,522.82 110.00 13,516.28 $3,622,000 $3,622,500 110.00 13,557.36 110.00 13,550.83 110.00 13,544.29 110.00 13,537.76 110.00 13,531.23 110.00 13,524.69 110.00 13,518.16 $3,622,500 $3,623,000 110.00 13,559.23 110.00 13,552.70 110.00 13,546.17 110.00 13,539.63 110.00 13,533.10 110.00 13,526.57 110.00 13,520.03 $3,623,000 $3,623,500 110.00 13,561.11 110.00 13,554.58 110.00 13,548.04 110.00 13,541.51 110.00 13,534.98 110.00 13,528.44 110.00 13,521.91 $3,623,500 $3,624,000 110.00 13,562.98 110.00 13,556.45 110.00 13,549.92 110.00 13,543.38 110.00 13,536.85 110.00 13,530.32 110.00 13,523.78 $3,624,000 $3,624,500 110.00 13,564.86 110.00 13,558.33 110.00 13,551.79 110.00 13,545.26 110.00 13,538.73 110.00 13,532.19 110.00 13,525.66 $3,624,500 $3,625,000 110.00 13,566.73 110.00 13,560.20 110.00 13,553.67 110.00 13,547.13 110.00 13,540.60 110.00 13,534.07 110.00 13,527.53 $3,625,000 $3,625,500 110.00 13,568.61 110.00 13,562.08 110.00 13,555.54 110.00 13,549.01 110.00 13,542.48 110.00 13,535.94 110.00 13,529.41 $3,625,500 $3,626,000 110.00 13,570.48 110.00 13,563.95 110.00 13,557.42 110.00 13,550.88 110.00 13,544.35 110.00 13,537.82 110.00 13,531.28 $3,626,000 $3,626,500 110.00 13,572.36 110.00 13,565.83 110.00 13,559.29 110.00 13,552.76 110.00 13,546.23 110.00 13,539.69 110.00 13,533.16 $3,626,500 $3,627,000 110.00 13,574.23 110.00 13,567.70 110.00 13,561.17 110.00 13,554.63 110.00 13,548.10 110.00 13,541.57 110.00 13,535.03 $3,627,000 $3,627,500 110.00 13,576.11 110.00 13,569.58 110.00 13,563.04 110.00 13,556.51 110.00 13,549.98 110.00 13,543.44 110.00 13,536.91 $3,627,500 $3,628,000 110.00 13,577.98 110.00 13,571.45 110.00 13,564.92 110.00 13,558.38 110.00 13,551.85 110.00 13,545.32 110.00 13,538.78 $3,628,000 $3,628,500 110.00 13,579.86 110.00 13,573.33 110.00 13,566.79 110.00 13,560.26 110.00 13,553.73 110.00 13,547.19 110.00 13,540.66 $3,628,500 $3,629,000 110.00 13,581.73 110.00 13,575.20 110.00 13,568.67 110.00 13,562.13 110.00 13,555.60 110.00 13,549.07 110.00 13,542.53 $3,629,000 $3,629,500 110.00 13,583.61 110.00 13,577.08 110.00 13,570.54 110.00 13,564.01 110.00 13,557.48 110.00 13,550.94 110.00 13,544.41 $3,629,500 $3,630,000 110.00 13,585.48 110.00 13,578.95 110.00 13,572.42 110.00 13,565.88 110.00 13,559.35 110.00 13,552.82 110.00 13,546.28 $3,630,000 $3,630,500 110.00 13,587.36 110.00 13,580.83 110.00 13,574.29 110.00 13,567.76 110.00 13,561.23 110.00 13,554.69 110.00 13,548.16 $3,630,500 $3,631,000 110.00 13,589.23 110.00 13,582.70 110.00 13,576.17 110.00 13,569.63 110.00 13,563.10 110.00 13,556.57 110.00 13,550.03 $3,631,000 $3,631,500 110.00 13,591.11 110.00 13,584.58 110.00 13,578.04 110.00 13,571.51 110.00 13,564.98 110.00 13,558.44 110.00 13,551.91 $3,631,500 $3,632,000 110.00 13,592.98 110.00 13,586.45 110.00 13,579.92 110.00 13,573.38 110.00 13,566.85 110.00 13,560.32 110.00 13,553.78 $3,632,000 $3,632,500 110.00 13,594.86 110.00 13,588.33 110.00 13,581.79 110.00 13,575.26 110.00 13,568.73 110.00 13,562.19 110.00 13,555.66 $3,632,500 $3,633,000 110.00 13,596.73 110.00 13,590.20 110.00 13,583.67 110.00 13,577.13 110.00 13,570.60 110.00 13,564.07 110.00 13,557.53 $3,633,000 $3,633,500 110.00 13,598.61 110.00 13,592.08 110.00 13,585.54 110.00 13,579.01 110.00 13,572.48 110.00 13,565.94 110.00 13,559.41 $3,633,500 $3,634,000 110.00 13,600.48 110.00 13,593.95 110.00 13,587.42 110.00 13,580.88 110.00 13,574.35 110.00 13,567.82 110.00 13,561.28 $3,634,000 $3,634,500 110.00 13,602.36 110.00 13,595.83 110.00 13,589.29 110.00 13,582.76 110.00 13,576.23 110.00 13,569.69 110.00 13,563.16 $3,634,500 $3,635,000 110.00 13,604.23 110.00 13,597.70 110.00 13,591.17 110.00 13,584.63 110.00 13,578.10 110.00 13,571.57 110.00 13,565.03 $3,635,000 $3,635,500 110.00 13,606.11 110.00 13,599.58 110.00 13,593.04 110.00 13,586.51 110.00 13,579.98 110.00 13,573.44 110.00 13,566.91 $3,635,500 $3,636,000 110.00 13,607.98 110.00 13,601.45 110.00 13,594.92 110.00 13,588.38 110.00 13,581.85 110.00 13,575.32 110.00 13,568.78 $3,636,000 $3,636,500 110.00 13,609.86 110.00 13,603.33 110.00 13,596.79 110.00 13,590.26 110.00 13,583.73 110.00 13,577.19 110.00 13,570.66 $3,636,500 $3,637,000 110.00 13,611.73 110.00 13,605.20 110.00 13,598.67 110.00 13,592.13 110.00 13,585.60 110.00 13,579.07 110.00 13,572.53 $3,637,000 $3,637,500 110.00 13,613.61 110.00 13,607.08 110.00 13,600.54 110.00 13,594.01 110.00 13,587.48 110.00 13,580.94 110.00 13,574.41 $3,637,500 $3,638,000 110.00 13,615.48 110.00 13,608.95 110.00 13,602.42 110.00 13,595.88 110.00 13,589.35 110.00 13,582.82 110.00 13,576.28 $3,638,000 $3,638,500 110.00 13,617.36 110.00 13,610.83 110.00 13,604.29 110.00 13,597.76 110.00 13,591.23 110.00 13,584.69 110.00 13,578.16 $3,638,500 $3,639,000 110.00 13,619.23 110.00 13,612.70 110.00 13,606.17 110.00 13,599.63 110.00 13,593.10 110.00 13,586.57 110.00 13,580.03 $3,639,000 $3,639,500 110.00 13,621.11 110.00 13,614.58 110.00 13,608.04 110.00 13,601.51 110.00 13,594.98 110.00 13,588.44 110.00 13,581.91 $3,639,500 $3,640,000 110.00 13,622.98 110.00 13,616.45 110.00 13,609.92 110.00 13,603.38 110.00 13,596.85 110.00 13,590.32 110.00 13,583.78 $3,640,000 $3,640,500 110.00 13,624.86 110.00 13,618.33 110.00 13,611.79 110.00 13,605.26 110.00 13,598.73 110.00 13,592.19 110.00 13,585.66 $3,640,500 $3,641,000 110.00 13,626.73 110.00 13,620.20 110.00 13,613.67 110.00 13,607.13 110.00 13,600.60 110.00 13,594.07 110.00 13,587.53 $3,641,000 $3,641,500 110.00 13,628.61 110.00 13,622.08 110.00 13,615.54 110.00 13,609.01 110.00 13,602.48 110.00 13,595.94 110.00 13,589.41 $3,641,500 $3,642,000 110.00 13,630.48 110.00 13,623.95 110.00 13,617.42 110.00 13,610.88 110.00 13,604.35 110.00 13,597.82 110.00 13,591.28 $3,642,000 $3,642,500 110.00 13,632.36 110.00 13,625.83 110.00 13,619.29 110.00 13,612.76 110.00 13,606.23 110.00 13,599.69 110.00 13,593.16 $3,642,500 $3,643,000 110.00 13,634.23 110.00 13,627.70 110.00 13,621.17 110.00 13,614.63 110.00 13,608.10 110.00 13,601.57 110.00 13,595.03 $3,643,000 $3,643,500 110.00 13,636.11 110.00 13,629.58 110.00 13,623.04 110.00 13,616.51 110.00 13,609.98 110.00 13,603.44 110.00 13,596.91 $3,643,500 $3,644,000 110.00 13,637.98 110.00 13,631.45 110.00 13,624.92 110.00 13,618.38 110.00 13,611.85 110.00 13,605.32 110.00 13,598.78 $3,644,000 $3,644,500 110.00 13,639.86 110.00 13,633.33 110.00 13,626.79 110.00 13,620.26 110.00 13,613.73 110.00 13,607.19 110.00 13,600.66 $3,644,500 $3,645,000 110.00 13,641.73 110.00 13,635.20 110.00 13,628.67 110.00 13,622.13 110.00 13,615.60 110.00 13,609.07 110.00 13,602.53 $3,645,000 $3,645,500 110.00 13,643.61 110.00 13,637.08 110.00 13,630.54 110.00 13,624.01 110.00 13,617.48 110.00 13,610.94 110.00 13,604.41 $3,645,500 $3,646,000 110.00 13,645.48 110.00 13,638.95 110.00 13,632.42 110.00 13,625.88 110.00 13,619.35 110.00 13,612.82 110.00 13,606.28 $3,646,000 $3,646,500 110.00 13,647.36 110.00 13,640.83 110.00 13,634.29 110.00 13,627.76 110.00 13,621.23 110.00 13,614.69 110.00 13,608.16 $3,646,500 $3,647,000 110.00 13,649.23 110.00 13,642.70 110.00 13,636.17 110.00 13,629.63 110.00 13,623.10 110.00 13,616.57 110.00 13,610.03 $3,647,000 $3,647,500 110.00 13,651.11 110.00 13,644.58 110.00 13,638.04 110.00 13,631.51 110.00 13,624.98 110.00 13,618.44 110.00 13,611.91 $3,647,500 $3,648,000 110.00 13,652.98 110.00 13,646.45 110.00 13,639.92 110.00 13,633.38 110.00 13,626.85 110.00 13,620.32 110.00 13,613.78 $3,648,000 $3,648,500 110.00 13,654.86 110.00 13,648.33 110.00 13,641.79 110.00 13,635.26 110.00 13,628.73 110.00 13,622.19 110.00 13,615.66 $3,648,500 $3,649,000 110.00 13,656.73 110.00 13,650.20 110.00 13,643.67 110.00 13,637.13 110.00 13,630.60 110.00 13,624.07 110.00 13,617.53 $3,649,000 $3,649,500 110.00 13,658.61 110.00 13,652.08 110.00 13,645.54 110.00 13,639.01 110.00 13,632.48 110.00 13,625.94 110.00 13,619.41 $3,649,500 $3,650,000 110.00 13,660.48 110.00 13,653.95 110.00 13,647.42 110.00 13,640.88 110.00 13,634.35 110.00 13,627.82 110.00 13,621.28 $3,650,000 $3,650,500 110.00 13,662.36 110.00 13,655.83 110.00 13,649.29 110.00 13,642.76 110.00 13,636.23 110.00 13,629.69 110.00 13,623.16 $3,650,500 $3,651,000 110.00 13,664.23 110.00 13,657.70 110.00 13,651.17 110.00 13,644.63 110.00 13,638.10 110.00 13,631.57 110.00 13,625.03 $3,651,000 $3,651,500 110.00 13,666.11 110.00 13,659.58 110.00 13,653.04 110.00 13,646.51 110.00 13,639.98 110.00 13,633.44 110.00 13,626.91 $3,651,500 $3,652,000 110.00 13,667.98 110.00 13,661.45 110.00 13,654.92 110.00 13,648.38 110.00 13,641.85 110.00 13,635.32 110.00 13,628.78 $3,652,000 $3,652,500 110.00 13,669.86 110.00 13,663.33 110.00 13,656.79 110.00 13,650.26 110.00 13,643.73 110.00 13,637.19 110.00 13,630.66 $3,652,500 $3,653,000 110.00 13,671.73 110.00 13,665.20 110.00 13,658.67 110.00 13,652.13 110.00 13,645.60 110.00 13,639.07 110.00 13,632.53 $3,653,000 $3,653,500 110.00 13,673.61 110.00 13,667.08 110.00 13,660.54 110.00 13,654.01 110.00 13,647.48 110.00 13,640.94 110.00 13,634.41 $3,653,500 $3,654,000 110.00 13,675.48 110.00 13,668.95 110.00 13,662.42 110.00 13,655.88 110.00 13,649.35 110.00 13,642.82 110.00 13,636.28 $3,654,000 $3,654,500 110.00 13,677.36 110.00 13,670.83 110.00 13,664.29 110.00 13,657.76 110.00 13,651.23 110.00 13,644.69 110.00 13,638.16 $3,654,500 $3,655,000 110.00 13,679.23 110.00 13,672.70 110.00 13,666.17 110.00 13,659.63 110.00 13,653.10 110.00 13,646.57 110.00 13,640.03 $3,655,000 $3,655,500 110.00 13,681.11 110.00 13,674.58 110.00 13,668.04 110.00 13,661.51 110.00 13,654.98 110.00 13,648.44 110.00 13,641.91 $3,655,500 $3,656,000 110.00 13,682.98 110.00 13,676.45 110.00 13,669.92 110.00 13,663.38 110.00 13,656.85 110.00 13,650.32 110.00 13,643.78 $3,656,000 $3,656,500 110.00 13,684.86 110.00 13,678.33 110.00 13,671.79 110.00 13,665.26 110.00 13,658.73 110.00 13,652.19 110.00 13,645.66 $3,656,500 $3,657,000 110.00 13,686.73 110.00 13,680.20 110.00 13,673.67 110.00 13,667.13 110.00 13,660.60 110.00 13,654.07 110.00 13,647.53 $3,657,000 $3,657,500 110.00 13,688.61 110.00 13,682.08 110.00 13,675.54 110.00 13,669.01 110.00 13,662.48 110.00 13,655.94 110.00 13,649.41 $3,657,500 $3,658,000 110.00 13,690.48 110.00 13,683.95 110.00 13,677.42 110.00 13,670.88 110.00 13,664.35 110.00 13,657.82 110.00 13,651.28 $3,658,000 $3,658,500 110.00 13,692.36 110.00 13,685.83 110.00 13,679.29 110.00 13,672.76 110.00 13,666.23 110.00 13,659.69 110.00 13,653.16 $3,658,500 $3,659,000 110.00 13,694.23 110.00 13,687.70 110.00 13,681.17 110.00 13,674.63 110.00 13,668.10 110.00 13,661.57 110.00 13,655.03 $3,659,000 $3,659,500 110.00 13,696.11 110.00 13,689.58 110.00 13,683.04 110.00 13,676.51 110.00 13,669.98 110.00 13,663.44 110.00 13,656.91 $3,659,500 $3,660,000 110.00 13,697.98 110.00 13,691.45 110.00 13,684.92 110.00 13,678.38 110.00 13,671.85 110.00 13,665.32 110.00 13,658.78 $3,660,000 $3,660,500 110.00 13,699.86 110.00 13,693.33 110.00 13,686.79 110.00 13,680.26 110.00 13,673.73 110.00 13,667.19 110.00 13,660.66 $3,660,500 $3,661,000 110.00 13,701.73 110.00 13,695.20 110.00 13,688.67 110.00 13,682.13 110.00 13,675.60 110.00 13,669.07 110.00 13,662.53 $3,661,000 $3,661,500 110.00 13,703.61 110.00 13,697.08 110.00 13,690.54 110.00 13,684.01 110.00 13,677.48 110.00 13,670.94 110.00 13,664.41 $3,661,500 $3,662,000 110.00 13,705.48 110.00 13,698.95 110.00 13,692.42 110.00 13,685.88 110.00 13,679.35 110.00 13,672.82 110.00 13,666.28 $3,662,000 $3,662,500 110.00 13,707.36 110.00 13,700.83 110.00 13,694.29 110.00 13,687.76 110.00 13,681.23 110.00 13,674.69 110.00 13,668.16 $3,662,500 $3,663,000 110.00 13,709.23 110.00 13,702.70 110.00 13,696.17 110.00 13,689.63 110.00 13,683.10 110.00 13,676.57 110.00 13,670.03 $3,663,000 $3,663,500 110.00 13,711.11 110.00 13,704.58 110.00 13,698.04 110.00 13,691.51 110.00 13,684.98 110.00 13,678.44 110.00 13,671.91 $3,663,500 $3,664,000 110.00 13,712.98 110.00 13,706.45 110.00 13,699.92 110.00 13,693.38 110.00 13,686.85 110.00 13,680.32 110.00 13,673.78 $3,664,000 $3,664,500 110.00 13,714.86 110.00 13,708.33 110.00 13,701.79 110.00 13,695.26 110.00 13,688.73 110.00 13,682.19 110.00 13,675.66 $3,664,500 $3,665,000 110.00 13,716.73 110.00 13,710.20 110.00 13,703.67 110.00 13,697.13 110.00 13,690.60 110.00 13,684.07 110.00 13,677.53 $3,665,000 $3,665,500 110.00 13,718.61 110.00 13,712.08 110.00 13,705.54 110.00 13,699.01 110.00 13,692.48 110.00 13,685.94 110.00 13,679.41 $3,665,500 $3,666,000 110.00 13,720.48 110.00 13,713.95 110.00 13,707.42 110.00 13,700.88 110.00 13,694.35 110.00 13,687.82 110.00 13,681.28 $3,666,000 $3,666,500 110.00 13,722.36 110.00 13,715.83 110.00 13,709.29 110.00 13,702.76 110.00 13,696.23 110.00 13,689.69 110.00 13,683.16 $3,666,500 $3,667,000 110.00 13,724.23 110.00 13,717.70 110.00 13,711.17 110.00 13,704.63 110.00 13,698.10 110.00 13,691.57 110.00 13,685.03 $3,667,000 $3,667,500 110.00 13,726.11 110.00 13,719.58 110.00 13,713.04 110.00 13,706.51 110.00 13,699.98 110.00 13,693.44 110.00 13,686.91 $3,667,500 $3,668,000 110.00 13,727.98 110.00 13,721.45 110.00 13,714.92 110.00 13,708.38 110.00 13,701.85 110.00 13,695.32 110.00 13,688.78 $3,668,000 $3,668,500 110.00 13,729.86 110.00 13,723.33 110.00 13,716.79 110.00 13,710.26 110.00 13,703.73 110.00 13,697.19 110.00 13,690.66 $3,668,500 $3,669,000 110.00 13,731.73 110.00 13,725.20 110.00 13,718.67 110.00 13,712.13 110.00 13,705.60 110.00 13,699.07 110.00 13,692.53 $3,669,000 $3,669,500 110.00 13,733.61 110.00 13,727.08 110.00 13,720.54 110.00 13,714.01 110.00 13,707.48 110.00 13,700.94 110.00 13,694.41 $3,669,500 $3,670,000 110.00 13,735.48 110.00 13,728.95 110.00 13,722.42 110.00 13,715.88 110.00 13,709.35 110.00 13,702.82 110.00 13,696.28 $3,670,000 $3,670,500 110.00 13,737.36 110.00 13,730.83 110.00 13,724.29 110.00 13,717.76 110.00 13,711.23 110.00 13,704.69 110.00 13,698.16 $3,670,500 $3,671,000 110.00 13,739.23 110.00 13,732.70 110.00 13,726.17 110.00 13,719.63 110.00 13,713.10 110.00 13,706.57 110.00 13,700.03 $3,671,000 $3,671,500 110.00 13,741.11 110.00 13,734.58 110.00 13,728.04 110.00 13,721.51 110.00 13,714.98 110.00 13,708.44 110.00 13,701.91 $3,671,500 $3,672,000 110.00 13,742.98 110.00 13,736.45 110.00 13,729.92 110.00 13,723.38 110.00 13,716.85 110.00 13,710.32 110.00 13,703.78

NJEIS Family Cost Participation Table Page 75 of 12 Effective July 1, 2015

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

$3,672,000 $3,672,500 110.00 13,744.86 110.00 13,738.33 110.00 13,731.79 110.00 13,725.26 110.00 13,718.73 110.00 13,712.19 110.00 13,705.66 $3,672,500 $3,673,000 110.00 13,746.73 110.00 13,740.20 110.00 13,733.67 110.00 13,727.13 110.00 13,720.60 110.00 13,714.07 110.00 13,707.53 $3,673,000 $3,673,500 110.00 13,748.61 110.00 13,742.08 110.00 13,735.54 110.00 13,729.01 110.00 13,722.48 110.00 13,715.94 110.00 13,709.41 $3,673,500 $3,674,000 110.00 13,750.48 110.00 13,743.95 110.00 13,737.42 110.00 13,730.88 110.00 13,724.35 110.00 13,717.82 110.00 13,711.28 $3,674,000 $3,674,500 110.00 13,752.36 110.00 13,745.83 110.00 13,739.29 110.00 13,732.76 110.00 13,726.23 110.00 13,719.69 110.00 13,713.16 $3,674,500 $3,675,000 110.00 13,754.23 110.00 13,747.70 110.00 13,741.17 110.00 13,734.63 110.00 13,728.10 110.00 13,721.57 110.00 13,715.03 $3,675,000 $3,675,500 110.00 13,756.11 110.00 13,749.58 110.00 13,743.04 110.00 13,736.51 110.00 13,729.98 110.00 13,723.44 110.00 13,716.91 $3,675,500 $3,676,000 110.00 13,757.98 110.00 13,751.45 110.00 13,744.92 110.00 13,738.38 110.00 13,731.85 110.00 13,725.32 110.00 13,718.78 $3,676,000 $3,676,500 110.00 13,759.86 110.00 13,753.33 110.00 13,746.79 110.00 13,740.26 110.00 13,733.73 110.00 13,727.19 110.00 13,720.66 $3,676,500 $3,677,000 110.00 13,761.73 110.00 13,755.20 110.00 13,748.67 110.00 13,742.13 110.00 13,735.60 110.00 13,729.07 110.00 13,722.53 $3,677,000 $3,677,500 110.00 13,763.61 110.00 13,757.08 110.00 13,750.54 110.00 13,744.01 110.00 13,737.48 110.00 13,730.94 110.00 13,724.41 $3,677,500 $3,678,000 110.00 13,765.48 110.00 13,758.95 110.00 13,752.42 110.00 13,745.88 110.00 13,739.35 110.00 13,732.82 110.00 13,726.28 $3,678,000 $3,678,500 110.00 13,767.36 110.00 13,760.83 110.00 13,754.29 110.00 13,747.76 110.00 13,741.23 110.00 13,734.69 110.00 13,728.16 $3,678,500 $3,679,000 110.00 13,769.23 110.00 13,762.70 110.00 13,756.17 110.00 13,749.63 110.00 13,743.10 110.00 13,736.57 110.00 13,730.03 $3,679,000 $3,679,500 110.00 13,771.11 110.00 13,764.58 110.00 13,758.04 110.00 13,751.51 110.00 13,744.98 110.00 13,738.44 110.00 13,731.91 $3,679,500 $3,680,000 110.00 13,772.98 110.00 13,766.45 110.00 13,759.92 110.00 13,753.38 110.00 13,746.85 110.00 13,740.32 110.00 13,733.78 $3,680,000 $3,680,500 110.00 13,774.86 110.00 13,768.33 110.00 13,761.79 110.00 13,755.26 110.00 13,748.73 110.00 13,742.19 110.00 13,735.66 $3,680,500 $3,681,000 110.00 13,776.73 110.00 13,770.20 110.00 13,763.67 110.00 13,757.13 110.00 13,750.60 110.00 13,744.07 110.00 13,737.53 $3,681,000 $3,681,500 110.00 13,778.61 110.00 13,772.08 110.00 13,765.54 110.00 13,759.01 110.00 13,752.48 110.00 13,745.94 110.00 13,739.41 $3,681,500 $3,682,000 110.00 13,780.48 110.00 13,773.95 110.00 13,767.42 110.00 13,760.88 110.00 13,754.35 110.00 13,747.82 110.00 13,741.28 $3,682,000 $3,682,500 110.00 13,782.36 110.00 13,775.83 110.00 13,769.29 110.00 13,762.76 110.00 13,756.23 110.00 13,749.69 110.00 13,743.16 $3,682,500 $3,683,000 110.00 13,784.23 110.00 13,777.70 110.00 13,771.17 110.00 13,764.63 110.00 13,758.10 110.00 13,751.57 110.00 13,745.03 $3,683,000 $3,683,500 110.00 13,786.11 110.00 13,779.58 110.00 13,773.04 110.00 13,766.51 110.00 13,759.98 110.00 13,753.44 110.00 13,746.91 $3,683,500 $3,684,000 110.00 13,787.98 110.00 13,781.45 110.00 13,774.92 110.00 13,768.38 110.00 13,761.85 110.00 13,755.32 110.00 13,748.78 $3,684,000 $3,684,500 110.00 13,789.86 110.00 13,783.33 110.00 13,776.79 110.00 13,770.26 110.00 13,763.73 110.00 13,757.19 110.00 13,750.66 $3,684,500 $3,685,000 110.00 13,791.73 110.00 13,785.20 110.00 13,778.67 110.00 13,772.13 110.00 13,765.60 110.00 13,759.07 110.00 13,752.53 $3,685,000 $3,685,500 110.00 13,793.61 110.00 13,787.08 110.00 13,780.54 110.00 13,774.01 110.00 13,767.48 110.00 13,760.94 110.00 13,754.41 $3,685,500 $3,686,000 110.00 13,795.48 110.00 13,788.95 110.00 13,782.42 110.00 13,775.88 110.00 13,769.35 110.00 13,762.82 110.00 13,756.28 $3,686,000 $3,686,500 110.00 13,797.36 110.00 13,790.83 110.00 13,784.29 110.00 13,777.76 110.00 13,771.23 110.00 13,764.69 110.00 13,758.16 $3,686,500 $3,687,000 110.00 13,799.23 110.00 13,792.70 110.00 13,786.17 110.00 13,779.63 110.00 13,773.10 110.00 13,766.57 110.00 13,760.03 $3,687,000 $3,687,500 110.00 13,801.11 110.00 13,794.58 110.00 13,788.04 110.00 13,781.51 110.00 13,774.98 110.00 13,768.44 110.00 13,761.91 $3,687,500 $3,688,000 110.00 13,802.98 110.00 13,796.45 110.00 13,789.92 110.00 13,783.38 110.00 13,776.85 110.00 13,770.32 110.00 13,763.78 $3,688,000 $3,688,500 110.00 13,804.86 110.00 13,798.33 110.00 13,791.79 110.00 13,785.26 110.00 13,778.73 110.00 13,772.19 110.00 13,765.66 $3,688,500 $3,689,000 110.00 13,806.73 110.00 13,800.20 110.00 13,793.67 110.00 13,787.13 110.00 13,780.60 110.00 13,774.07 110.00 13,767.53 $3,689,000 $3,689,500 110.00 13,808.61 110.00 13,802.08 110.00 13,795.54 110.00 13,789.01 110.00 13,782.48 110.00 13,775.94 110.00 13,769.41 $3,689,500 $3,690,000 110.00 13,810.48 110.00 13,803.95 110.00 13,797.42 110.00 13,790.88 110.00 13,784.35 110.00 13,777.82 110.00 13,771.28 $3,690,000 $3,690,500 110.00 13,812.36 110.00 13,805.83 110.00 13,799.29 110.00 13,792.76 110.00 13,786.23 110.00 13,779.69 110.00 13,773.16 $3,690,500 $3,691,000 110.00 13,814.23 110.00 13,807.70 110.00 13,801.17 110.00 13,794.63 110.00 13,788.10 110.00 13,781.57 110.00 13,775.03 $3,691,000 $3,691,500 110.00 13,816.11 110.00 13,809.58 110.00 13,803.04 110.00 13,796.51 110.00 13,789.98 110.00 13,783.44 110.00 13,776.91 $3,691,500 $3,692,000 110.00 13,817.98 110.00 13,811.45 110.00 13,804.92 110.00 13,798.38 110.00 13,791.85 110.00 13,785.32 110.00 13,778.78 $3,692,000 $3,692,500 110.00 13,819.86 110.00 13,813.33 110.00 13,806.79 110.00 13,800.26 110.00 13,793.73 110.00 13,787.19 110.00 13,780.66 $3,692,500 $3,693,000 110.00 13,821.73 110.00 13,815.20 110.00 13,808.67 110.00 13,802.13 110.00 13,795.60 110.00 13,789.07 110.00 13,782.53 $3,693,000 $3,693,500 110.00 13,823.61 110.00 13,817.08 110.00 13,810.54 110.00 13,804.01 110.00 13,797.48 110.00 13,790.94 110.00 13,784.41 $3,693,500 $3,694,000 110.00 13,825.48 110.00 13,818.95 110.00 13,812.42 110.00 13,805.88 110.00 13,799.35 110.00 13,792.82 110.00 13,786.28 $3,694,000 $3,694,500 110.00 13,827.36 110.00 13,820.83 110.00 13,814.29 110.00 13,807.76 110.00 13,801.23 110.00 13,794.69 110.00 13,788.16 $3,694,500 $3,695,000 110.00 13,829.23 110.00 13,822.70 110.00 13,816.17 110.00 13,809.63 110.00 13,803.10 110.00 13,796.57 110.00 13,790.03 $3,695,000 $3,695,500 110.00 13,831.11 110.00 13,824.58 110.00 13,818.04 110.00 13,811.51 110.00 13,804.98 110.00 13,798.44 110.00 13,791.91 $3,695,500 $3,696,000 110.00 13,832.98 110.00 13,826.45 110.00 13,819.92 110.00 13,813.38 110.00 13,806.85 110.00 13,800.32 110.00 13,793.78 $3,696,000 $3,696,500 110.00 13,834.86 110.00 13,828.33 110.00 13,821.79 110.00 13,815.26 110.00 13,808.73 110.00 13,802.19 110.00 13,795.66 $3,696,500 $3,697,000 110.00 13,836.73 110.00 13,830.20 110.00 13,823.67 110.00 13,817.13 110.00 13,810.60 110.00 13,804.07 110.00 13,797.53 $3,697,000 $3,697,500 110.00 13,838.61 110.00 13,832.08 110.00 13,825.54 110.00 13,819.01 110.00 13,812.48 110.00 13,805.94 110.00 13,799.41 $3,697,500 $3,698,000 110.00 13,840.48 110.00 13,833.95 110.00 13,827.42 110.00 13,820.88 110.00 13,814.35 110.00 13,807.82 110.00 13,801.28 $3,698,000 $3,698,500 110.00 13,842.36 110.00 13,835.83 110.00 13,829.29 110.00 13,822.76 110.00 13,816.23 110.00 13,809.69 110.00 13,803.16 $3,698,500 $3,699,000 110.00 13,844.23 110.00 13,837.70 110.00 13,831.17 110.00 13,824.63 110.00 13,818.10 110.00 13,811.57 110.00 13,805.03 $3,699,000 $3,699,500 110.00 13,846.11 110.00 13,839.58 110.00 13,833.04 110.00 13,826.51 110.00 13,819.98 110.00 13,813.44 110.00 13,806.91 $3,699,500 $3,700,000 110.00 13,847.98 110.00 13,841.45 110.00 13,834.92 110.00 13,828.38 110.00 13,821.85 110.00 13,815.32 110.00 13,808.78 $3,700,000 $3,700,500 110.00 13,849.86 110.00 13,843.33 110.00 13,836.79 110.00 13,830.26 110.00 13,823.73 110.00 13,817.19 110.00 13,810.66 $3,700,500 $3,701,000 110.00 13,851.73 110.00 13,845.20 110.00 13,838.67 110.00 13,832.13 110.00 13,825.60 110.00 13,819.07 110.00 13,812.53 $3,701,000 $3,701,500 110.00 13,853.61 110.00 13,847.08 110.00 13,840.54 110.00 13,834.01 110.00 13,827.48 110.00 13,820.94 110.00 13,814.41 $3,701,500 $3,702,000 110.00 13,855.48 110.00 13,848.95 110.00 13,842.42 110.00 13,835.88 110.00 13,829.35 110.00 13,822.82 110.00 13,816.28 $3,702,000 $3,702,500 110.00 13,857.36 110.00 13,850.83 110.00 13,844.29 110.00 13,837.76 110.00 13,831.23 110.00 13,824.69 110.00 13,818.16 $3,702,500 $3,703,000 110.00 13,859.23 110.00 13,852.70 110.00 13,846.17 110.00 13,839.63 110.00 13,833.10 110.00 13,826.57 110.00 13,820.03 $3,703,000 $3,703,500 110.00 13,861.11 110.00 13,854.58 110.00 13,848.04 110.00 13,841.51 110.00 13,834.98 110.00 13,828.44 110.00 13,821.91 $3,703,500 $3,704,000 110.00 13,862.98 110.00 13,856.45 110.00 13,849.92 110.00 13,843.38 110.00 13,836.85 110.00 13,830.32 110.00 13,823.78 $3,704,000 $3,704,500 110.00 13,864.86 110.00 13,858.33 110.00 13,851.79 110.00 13,845.26 110.00 13,838.73 110.00 13,832.19 110.00 13,825.66 $3,704,500 $3,705,000 110.00 13,866.73 110.00 13,860.20 110.00 13,853.67 110.00 13,847.13 110.00 13,840.60 110.00 13,834.07 110.00 13,827.53 $3,705,000 $3,705,500 110.00 13,868.61 110.00 13,862.08 110.00 13,855.54 110.00 13,849.01 110.00 13,842.48 110.00 13,835.94 110.00 13,829.41 $3,705,500 $3,706,000 110.00 13,870.48 110.00 13,863.95 110.00 13,857.42 110.00 13,850.88 110.00 13,844.35 110.00 13,837.82 110.00 13,831.28 $3,706,000 $3,706,500 110.00 13,872.36 110.00 13,865.83 110.00 13,859.29 110.00 13,852.76 110.00 13,846.23 110.00 13,839.69 110.00 13,833.16 $3,706,500 $3,707,000 110.00 13,874.23 110.00 13,867.70 110.00 13,861.17 110.00 13,854.63 110.00 13,848.10 110.00 13,841.57 110.00 13,835.03 $3,707,000 $3,707,500 110.00 13,876.11 110.00 13,869.58 110.00 13,863.04 110.00 13,856.51 110.00 13,849.98 110.00 13,843.44 110.00 13,836.91 $3,707,500 $3,708,000 110.00 13,877.98 110.00 13,871.45 110.00 13,864.92 110.00 13,858.38 110.00 13,851.85 110.00 13,845.32 110.00 13,838.78 $3,708,000 $3,708,500 110.00 13,879.86 110.00 13,873.33 110.00 13,866.79 110.00 13,860.26 110.00 13,853.73 110.00 13,847.19 110.00 13,840.66 $3,708,500 $3,709,000 110.00 13,881.73 110.00 13,875.20 110.00 13,868.67 110.00 13,862.13 110.00 13,855.60 110.00 13,849.07 110.00 13,842.53 $3,709,000 $3,709,500 110.00 13,883.61 110.00 13,877.08 110.00 13,870.54 110.00 13,864.01 110.00 13,857.48 110.00 13,850.94 110.00 13,844.41 $3,709,500 $3,710,000 110.00 13,885.48 110.00 13,878.95 110.00 13,872.42 110.00 13,865.88 110.00 13,859.35 110.00 13,852.82 110.00 13,846.28 $3,710,000 $3,710,500 110.00 13,887.36 110.00 13,880.83 110.00 13,874.29 110.00 13,867.76 110.00 13,861.23 110.00 13,854.69 110.00 13,848.16 $3,710,500 $3,711,000 110.00 13,889.23 110.00 13,882.70 110.00 13,876.17 110.00 13,869.63 110.00 13,863.10 110.00 13,856.57 110.00 13,850.03 $3,711,000 $3,711,500 110.00 13,891.11 110.00 13,884.58 110.00 13,878.04 110.00 13,871.51 110.00 13,864.98 110.00 13,858.44 110.00 13,851.91 $3,711,500 $3,712,000 110.00 13,892.98 110.00 13,886.45 110.00 13,879.92 110.00 13,873.38 110.00 13,866.85 110.00 13,860.32 110.00 13,853.78 $3,712,000 $3,712,500 110.00 13,894.86 110.00 13,888.33 110.00 13,881.79 110.00 13,875.26 110.00 13,868.73 110.00 13,862.19 110.00 13,855.66 $3,712,500 $3,713,000 110.00 13,896.73 110.00 13,890.20 110.00 13,883.67 110.00 13,877.13 110.00 13,870.60 110.00 13,864.07 110.00 13,857.53 $3,713,000 $3,713,500 110.00 13,898.61 110.00 13,892.08 110.00 13,885.54 110.00 13,879.01 110.00 13,872.48 110.00 13,865.94 110.00 13,859.41 $3,713,500 $3,714,000 110.00 13,900.48 110.00 13,893.95 110.00 13,887.42 110.00 13,880.88 110.00 13,874.35 110.00 13,867.82 110.00 13,861.28 $3,714,000 $3,714,500 110.00 13,902.36 110.00 13,895.83 110.00 13,889.29 110.00 13,882.76 110.00 13,876.23 110.00 13,869.69 110.00 13,863.16 $3,714,500 $3,715,000 110.00 13,904.23 110.00 13,897.70 110.00 13,891.17 110.00 13,884.63 110.00 13,878.10 110.00 13,871.57 110.00 13,865.03 $3,715,000 $3,715,500 110.00 13,906.11 110.00 13,899.58 110.00 13,893.04 110.00 13,886.51 110.00 13,879.98 110.00 13,873.44 110.00 13,866.91 $3,715,500 $3,716,000 110.00 13,907.98 110.00 13,901.45 110.00 13,894.92 110.00 13,888.38 110.00 13,881.85 110.00 13,875.32 110.00 13,868.78 $3,716,000 $3,716,500 110.00 13,909.86 110.00 13,903.33 110.00 13,896.79 110.00 13,890.26 110.00 13,883.73 110.00 13,877.19 110.00 13,870.66 $3,716,500 $3,717,000 110.00 13,911.73 110.00 13,905.20 110.00 13,898.67 110.00 13,892.13 110.00 13,885.60 110.00 13,879.07 110.00 13,872.53 $3,717,000 $3,717,500 110.00 13,913.61 110.00 13,907.08 110.00 13,900.54 110.00 13,894.01 110.00 13,887.48 110.00 13,880.94 110.00 13,874.41 $3,717,500 $3,718,000 110.00 13,915.48 110.00 13,908.95 110.00 13,902.42 110.00 13,895.88 110.00 13,889.35 110.00 13,882.82 110.00 13,876.28 $3,718,000 $3,718,500 110.00 13,917.36 110.00 13,910.83 110.00 13,904.29 110.00 13,897.76 110.00 13,891.23 110.00 13,884.69 110.00 13,878.16 $3,718,500 $3,719,000 110.00 13,919.23 110.00 13,912.70 110.00 13,906.17 110.00 13,899.63 110.00 13,893.10 110.00 13,886.57 110.00 13,880.03 $3,719,000 $3,719,500 110.00 13,921.11 110.00 13,914.58 110.00 13,908.04 110.00 13,901.51 110.00 13,894.98 110.00 13,888.44 110.00 13,881.91 $3,719,500 $3,720,000 110.00 13,922.98 110.00 13,916.45 110.00 13,909.92 110.00 13,903.38 110.00 13,896.85 110.00 13,890.32 110.00 13,883.78 $3,720,000 $3,720,500 110.00 13,924.86 110.00 13,918.33 110.00 13,911.79 110.00 13,905.26 110.00 13,898.73 110.00 13,892.19 110.00 13,885.66 $3,720,500 $3,721,000 110.00 13,926.73 110.00 13,920.20 110.00 13,913.67 110.00 13,907.13 110.00 13,900.60 110.00 13,894.07 110.00 13,887.53 $3,721,000 $3,721,500 110.00 13,928.61 110.00 13,922.08 110.00 13,915.54 110.00 13,909.01 110.00 13,902.48 110.00 13,895.94 110.00 13,889.41 $3,721,500 $3,722,000 110.00 13,930.48 110.00 13,923.95 110.00 13,917.42 110.00 13,910.88 110.00 13,904.35 110.00 13,897.82 110.00 13,891.28 $3,722,000 $3,722,500 110.00 13,932.36 110.00 13,925.83 110.00 13,919.29 110.00 13,912.76 110.00 13,906.23 110.00 13,899.69 110.00 13,893.16 $3,722,500 $3,723,000 110.00 13,934.23 110.00 13,927.70 110.00 13,921.17 110.00 13,914.63 110.00 13,908.10 110.00 13,901.57 110.00 13,895.03

NJEIS Family Cost Participation Table Page 76 of 12 Effective July 1, 2015

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

$3,723,000 $3,723,500 110.00 13,936.11 110.00 13,929.58 110.00 13,923.04 110.00 13,916.51 110.00 13,909.98 110.00 13,903.44 110.00 13,896.91 $3,723,500 $3,724,000 110.00 13,937.98 110.00 13,931.45 110.00 13,924.92 110.00 13,918.38 110.00 13,911.85 110.00 13,905.32 110.00 13,898.78 $3,724,000 $3,724,500 110.00 13,939.86 110.00 13,933.33 110.00 13,926.79 110.00 13,920.26 110.00 13,913.73 110.00 13,907.19 110.00 13,900.66 $3,724,500 $3,725,000 110.00 13,941.73 110.00 13,935.20 110.00 13,928.67 110.00 13,922.13 110.00 13,915.60 110.00 13,909.07 110.00 13,902.53 $3,725,000 $3,725,500 110.00 13,943.61 110.00 13,937.08 110.00 13,930.54 110.00 13,924.01 110.00 13,917.48 110.00 13,910.94 110.00 13,904.41 $3,725,500 $3,726,000 110.00 13,945.48 110.00 13,938.95 110.00 13,932.42 110.00 13,925.88 110.00 13,919.35 110.00 13,912.82 110.00 13,906.28 $3,726,000 $3,726,500 110.00 13,947.36 110.00 13,940.83 110.00 13,934.29 110.00 13,927.76 110.00 13,921.23 110.00 13,914.69 110.00 13,908.16 $3,726,500 $3,727,000 110.00 13,949.23 110.00 13,942.70 110.00 13,936.17 110.00 13,929.63 110.00 13,923.10 110.00 13,916.57 110.00 13,910.03 $3,727,000 $3,727,500 110.00 13,951.11 110.00 13,944.58 110.00 13,938.04 110.00 13,931.51 110.00 13,924.98 110.00 13,918.44 110.00 13,911.91 $3,727,500 $3,728,000 110.00 13,952.98 110.00 13,946.45 110.00 13,939.92 110.00 13,933.38 110.00 13,926.85 110.00 13,920.32 110.00 13,913.78 $3,728,000 $3,728,500 110.00 13,954.86 110.00 13,948.33 110.00 13,941.79 110.00 13,935.26 110.00 13,928.73 110.00 13,922.19 110.00 13,915.66 $3,728,500 $3,729,000 110.00 13,956.73 110.00 13,950.20 110.00 13,943.67 110.00 13,937.13 110.00 13,930.60 110.00 13,924.07 110.00 13,917.53 $3,729,000 $3,729,500 110.00 13,958.61 110.00 13,952.08 110.00 13,945.54 110.00 13,939.01 110.00 13,932.48 110.00 13,925.94 110.00 13,919.41 $3,729,500 $3,730,000 110.00 13,960.48 110.00 13,953.95 110.00 13,947.42 110.00 13,940.88 110.00 13,934.35 110.00 13,927.82 110.00 13,921.28 $3,730,000 $3,730,500 110.00 13,962.36 110.00 13,955.83 110.00 13,949.29 110.00 13,942.76 110.00 13,936.23 110.00 13,929.69 110.00 13,923.16 $3,730,500 $3,731,000 110.00 13,964.23 110.00 13,957.70 110.00 13,951.17 110.00 13,944.63 110.00 13,938.10 110.00 13,931.57 110.00 13,925.03 $3,731,000 $3,731,500 110.00 13,966.11 110.00 13,959.58 110.00 13,953.04 110.00 13,946.51 110.00 13,939.98 110.00 13,933.44 110.00 13,926.91 $3,731,500 $3,732,000 110.00 13,967.98 110.00 13,961.45 110.00 13,954.92 110.00 13,948.38 110.00 13,941.85 110.00 13,935.32 110.00 13,928.78 $3,732,000 $3,732,500 110.00 13,969.86 110.00 13,963.33 110.00 13,956.79 110.00 13,950.26 110.00 13,943.73 110.00 13,937.19 110.00 13,930.66 $3,732,500 $3,733,000 110.00 13,971.73 110.00 13,965.20 110.00 13,958.67 110.00 13,952.13 110.00 13,945.60 110.00 13,939.07 110.00 13,932.53 $3,733,000 $3,733,500 110.00 13,973.61 110.00 13,967.08 110.00 13,960.54 110.00 13,954.01 110.00 13,947.48 110.00 13,940.94 110.00 13,934.41 $3,733,500 $3,734,000 110.00 13,975.48 110.00 13,968.95 110.00 13,962.42 110.00 13,955.88 110.00 13,949.35 110.00 13,942.82 110.00 13,936.28 $3,734,000 $3,734,500 110.00 13,977.36 110.00 13,970.83 110.00 13,964.29 110.00 13,957.76 110.00 13,951.23 110.00 13,944.69 110.00 13,938.16 $3,734,500 $3,735,000 110.00 13,979.23 110.00 13,972.70 110.00 13,966.17 110.00 13,959.63 110.00 13,953.10 110.00 13,946.57 110.00 13,940.03 $3,735,000 $3,735,500 110.00 13,981.11 110.00 13,974.58 110.00 13,968.04 110.00 13,961.51 110.00 13,954.98 110.00 13,948.44 110.00 13,941.91 $3,735,500 $3,736,000 110.00 13,982.98 110.00 13,976.45 110.00 13,969.92 110.00 13,963.38 110.00 13,956.85 110.00 13,950.32 110.00 13,943.78 $3,736,000 $3,736,500 110.00 13,984.86 110.00 13,978.33 110.00 13,971.79 110.00 13,965.26 110.00 13,958.73 110.00 13,952.19 110.00 13,945.66 $3,736,500 $3,737,000 110.00 13,986.73 110.00 13,980.20 110.00 13,973.67 110.00 13,967.13 110.00 13,960.60 110.00 13,954.07 110.00 13,947.53 $3,737,000 $3,737,500 110.00 13,988.61 110.00 13,982.08 110.00 13,975.54 110.00 13,969.01 110.00 13,962.48 110.00 13,955.94 110.00 13,949.41 $3,737,500 $3,738,000 110.00 13,990.48 110.00 13,983.95 110.00 13,977.42 110.00 13,970.88 110.00 13,964.35 110.00 13,957.82 110.00 13,951.28 $3,738,000 $3,738,500 110.00 13,992.36 110.00 13,985.83 110.00 13,979.29 110.00 13,972.76 110.00 13,966.23 110.00 13,959.69 110.00 13,953.16 $3,738,500 $3,739,000 110.00 13,994.23 110.00 13,987.70 110.00 13,981.17 110.00 13,974.63 110.00 13,968.10 110.00 13,961.57 110.00 13,955.03 $3,739,000 $3,739,500 110.00 13,996.11 110.00 13,989.58 110.00 13,983.04 110.00 13,976.51 110.00 13,969.98 110.00 13,963.44 110.00 13,956.91 $3,739,500 $3,740,000 110.00 13,997.98 110.00 13,991.45 110.00 13,984.92 110.00 13,978.38 110.00 13,971.85 110.00 13,965.32 110.00 13,958.78 $3,740,000 $3,740,500 110.00 13,999.86 110.00 13,993.33 110.00 13,986.79 110.00 13,980.26 110.00 13,973.73 110.00 13,967.19 110.00 13,960.66 $3,740,500 $3,741,000 110.00 14,001.73 110.00 13,995.20 110.00 13,988.67 110.00 13,982.13 110.00 13,975.60 110.00 13,969.07 110.00 13,962.53 $3,741,000 $3,741,500 110.00 14,003.61 110.00 13,997.08 110.00 13,990.54 110.00 13,984.01 110.00 13,977.48 110.00 13,970.94 110.00 13,964.41 $3,741,500 $3,742,000 110.00 14,005.48 110.00 13,998.95 110.00 13,992.42 110.00 13,985.88 110.00 13,979.35 110.00 13,972.82 110.00 13,966.28 $3,742,000 $3,742,500 110.00 14,007.36 110.00 14,000.83 110.00 13,994.29 110.00 13,987.76 110.00 13,981.23 110.00 13,974.69 110.00 13,968.16 $3,742,500 $3,743,000 110.00 14,009.23 110.00 14,002.70 110.00 13,996.17 110.00 13,989.63 110.00 13,983.10 110.00 13,976.57 110.00 13,970.03 $3,743,000 $3,743,500 110.00 14,011.11 110.00 14,004.58 110.00 13,998.04 110.00 13,991.51 110.00 13,984.98 110.00 13,978.44 110.00 13,971.91 $3,743,500 $3,744,000 110.00 14,012.98 110.00 14,006.45 110.00 13,999.92 110.00 13,993.38 110.00 13,986.85 110.00 13,980.32 110.00 13,973.78 $3,744,000 $3,744,500 110.00 14,014.86 110.00 14,008.33 110.00 14,001.79 110.00 13,995.26 110.00 13,988.73 110.00 13,982.19 110.00 13,975.66 $3,744,500 $3,745,000 110.00 14,016.73 110.00 14,010.20 110.00 14,003.67 110.00 13,997.13 110.00 13,990.60 110.00 13,984.07 110.00 13,977.53 $3,745,000 $3,745,500 110.00 14,018.61 110.00 14,012.08 110.00 14,005.54 110.00 13,999.01 110.00 13,992.48 110.00 13,985.94 110.00 13,979.41 $3,745,500 $3,746,000 110.00 14,020.48 110.00 14,013.95 110.00 14,007.42 110.00 14,000.88 110.00 13,994.35 110.00 13,987.82 110.00 13,981.28 $3,746,000 $3,746,500 110.00 14,022.36 110.00 14,015.83 110.00 14,009.29 110.00 14,002.76 110.00 13,996.23 110.00 13,989.69 110.00 13,983.16 $3,746,500 $3,747,000 110.00 14,024.23 110.00 14,017.70 110.00 14,011.17 110.00 14,004.63 110.00 13,998.10 110.00 13,991.57 110.00 13,985.03 $3,747,000 $3,747,500 110.00 14,026.11 110.00 14,019.58 110.00 14,013.04 110.00 14,006.51 110.00 13,999.98 110.00 13,993.44 110.00 13,986.91 $3,747,500 $3,748,000 110.00 14,027.98 110.00 14,021.45 110.00 14,014.92 110.00 14,008.38 110.00 14,001.85 110.00 13,995.32 110.00 13,988.78 $3,748,000 $3,748,500 110.00 14,029.86 110.00 14,023.33 110.00 14,016.79 110.00 14,010.26 110.00 14,003.73 110.00 13,997.19 110.00 13,990.66 $3,748,500 $3,749,000 110.00 14,031.73 110.00 14,025.20 110.00 14,018.67 110.00 14,012.13 110.00 14,005.60 110.00 13,999.07 110.00 13,992.53 $3,749,000 $3,749,500 110.00 14,033.61 110.00 14,027.08 110.00 14,020.54 110.00 14,014.01 110.00 14,007.48 110.00 14,000.94 110.00 13,994.41 $3,749,500 $3,750,000 110.00 14,035.48 110.00 14,028.95 110.00 14,022.42 110.00 14,015.88 110.00 14,009.35 110.00 14,002.82 110.00 13,996.28 $3,750,000 $3,750,500 110.00 14,037.36 110.00 14,030.83 110.00 14,024.29 110.00 14,017.76 110.00 14,011.23 110.00 14,004.69 110.00 13,998.16 $3,750,500 $3,751,000 110.00 14,039.23 110.00 14,032.70 110.00 14,026.17 110.00 14,019.63 110.00 14,013.10 110.00 14,006.57 110.00 14,000.03 $3,751,000 $3,751,500 110.00 14,041.11 110.00 14,034.58 110.00 14,028.04 110.00 14,021.51 110.00 14,014.98 110.00 14,008.44 110.00 14,001.91 $3,751,500 $3,752,000 110.00 14,042.98 110.00 14,036.45 110.00 14,029.92 110.00 14,023.38 110.00 14,016.85 110.00 14,010.32 110.00 14,003.78 $3,752,000 $3,752,500 110.00 14,044.86 110.00 14,038.33 110.00 14,031.79 110.00 14,025.26 110.00 14,018.73 110.00 14,012.19 110.00 14,005.66 $3,752,500 $3,753,000 110.00 14,046.73 110.00 14,040.20 110.00 14,033.67 110.00 14,027.13 110.00 14,020.60 110.00 14,014.07 110.00 14,007.53 $3,753,000 $3,753,500 110.00 14,048.61 110.00 14,042.08 110.00 14,035.54 110.00 14,029.01 110.00 14,022.48 110.00 14,015.94 110.00 14,009.41 $3,753,500 $3,754,000 110.00 14,050.48 110.00 14,043.95 110.00 14,037.42 110.00 14,030.88 110.00 14,024.35 110.00 14,017.82 110.00 14,011.28 $3,754,000 $3,754,500 110.00 14,052.36 110.00 14,045.83 110.00 14,039.29 110.00 14,032.76 110.00 14,026.23 110.00 14,019.69 110.00 14,013.16 $3,754,500 $3,755,000 110.00 14,054.23 110.00 14,047.70 110.00 14,041.17 110.00 14,034.63 110.00 14,028.10 110.00 14,021.57 110.00 14,015.03 $3,755,000 $3,755,500 110.00 14,056.11 110.00 14,049.58 110.00 14,043.04 110.00 14,036.51 110.00 14,029.98 110.00 14,023.44 110.00 14,016.91 $3,755,500 $3,756,000 110.00 14,057.98 110.00 14,051.45 110.00 14,044.92 110.00 14,038.38 110.00 14,031.85 110.00 14,025.32 110.00 14,018.78 $3,756,000 $3,756,500 110.00 14,059.86 110.00 14,053.33 110.00 14,046.79 110.00 14,040.26 110.00 14,033.73 110.00 14,027.19 110.00 14,020.66 $3,756,500 $3,757,000 110.00 14,061.73 110.00 14,055.20 110.00 14,048.67 110.00 14,042.13 110.00 14,035.60 110.00 14,029.07 110.00 14,022.53 $3,757,000 $3,757,500 110.00 14,063.61 110.00 14,057.08 110.00 14,050.54 110.00 14,044.01 110.00 14,037.48 110.00 14,030.94 110.00 14,024.41 $3,757,500 $3,758,000 110.00 14,065.48 110.00 14,058.95 110.00 14,052.42 110.00 14,045.88 110.00 14,039.35 110.00 14,032.82 110.00 14,026.28 $3,758,000 $3,758,500 110.00 14,067.36 110.00 14,060.83 110.00 14,054.29 110.00 14,047.76 110.00 14,041.23 110.00 14,034.69 110.00 14,028.16 $3,758,500 $3,759,000 110.00 14,069.23 110.00 14,062.70 110.00 14,056.17 110.00 14,049.63 110.00 14,043.10 110.00 14,036.57 110.00 14,030.03 $3,759,000 $3,759,500 110.00 14,071.11 110.00 14,064.58 110.00 14,058.04 110.00 14,051.51 110.00 14,044.98 110.00 14,038.44 110.00 14,031.91 $3,759,500 $3,760,000 110.00 14,072.98 110.00 14,066.45 110.00 14,059.92 110.00 14,053.38 110.00 14,046.85 110.00 14,040.32 110.00 14,033.78 $3,760,000 $3,760,500 110.00 14,074.86 110.00 14,068.33 110.00 14,061.79 110.00 14,055.26 110.00 14,048.73 110.00 14,042.19 110.00 14,035.66 $3,760,500 $3,761,000 110.00 14,076.73 110.00 14,070.20 110.00 14,063.67 110.00 14,057.13 110.00 14,050.60 110.00 14,044.07 110.00 14,037.53 $3,761,000 $3,761,500 110.00 14,078.61 110.00 14,072.08 110.00 14,065.54 110.00 14,059.01 110.00 14,052.48 110.00 14,045.94 110.00 14,039.41 $3,761,500 $3,762,000 110.00 14,080.48 110.00 14,073.95 110.00 14,067.42 110.00 14,060.88 110.00 14,054.35 110.00 14,047.82 110.00 14,041.28 $3,762,000 $3,762,500 110.00 14,082.36 110.00 14,075.83 110.00 14,069.29 110.00 14,062.76 110.00 14,056.23 110.00 14,049.69 110.00 14,043.16 $3,762,500 $3,763,000 110.00 14,084.23 110.00 14,077.70 110.00 14,071.17 110.00 14,064.63 110.00 14,058.10 110.00 14,051.57 110.00 14,045.03 $3,763,000 $3,763,500 110.00 14,086.11 110.00 14,079.58 110.00 14,073.04 110.00 14,066.51 110.00 14,059.98 110.00 14,053.44 110.00 14,046.91 $3,763,500 $3,764,000 110.00 14,087.98 110.00 14,081.45 110.00 14,074.92 110.00 14,068.38 110.00 14,061.85 110.00 14,055.32 110.00 14,048.78 $3,764,000 $3,764,500 110.00 14,089.86 110.00 14,083.33 110.00 14,076.79 110.00 14,070.26 110.00 14,063.73 110.00 14,057.19 110.00 14,050.66 $3,764,500 $3,765,000 110.00 14,091.73 110.00 14,085.20 110.00 14,078.67 110.00 14,072.13 110.00 14,065.60 110.00 14,059.07 110.00 14,052.53 $3,765,000 $3,765,500 110.00 14,093.61 110.00 14,087.08 110.00 14,080.54 110.00 14,074.01 110.00 14,067.48 110.00 14,060.94 110.00 14,054.41 $3,765,500 $3,766,000 110.00 14,095.48 110.00 14,088.95 110.00 14,082.42 110.00 14,075.88 110.00 14,069.35 110.00 14,062.82 110.00 14,056.28 $3,766,000 $3,766,500 110.00 14,097.36 110.00 14,090.83 110.00 14,084.29 110.00 14,077.76 110.00 14,071.23 110.00 14,064.69 110.00 14,058.16 $3,766,500 $3,767,000 110.00 14,099.23 110.00 14,092.70 110.00 14,086.17 110.00 14,079.63 110.00 14,073.10 110.00 14,066.57 110.00 14,060.03 $3,767,000 $3,767,500 110.00 14,101.11 110.00 14,094.58 110.00 14,088.04 110.00 14,081.51 110.00 14,074.98 110.00 14,068.44 110.00 14,061.91 $3,767,500 $3,768,000 110.00 14,102.98 110.00 14,096.45 110.00 14,089.92 110.00 14,083.38 110.00 14,076.85 110.00 14,070.32 110.00 14,063.78 $3,768,000 $3,768,500 110.00 14,104.86 110.00 14,098.33 110.00 14,091.79 110.00 14,085.26 110.00 14,078.73 110.00 14,072.19 110.00 14,065.66 $3,768,500 $3,769,000 110.00 14,106.73 110.00 14,100.20 110.00 14,093.67 110.00 14,087.13 110.00 14,080.60 110.00 14,074.07 110.00 14,067.53 $3,769,000 $3,769,500 110.00 14,108.61 110.00 14,102.08 110.00 14,095.54 110.00 14,089.01 110.00 14,082.48 110.00 14,075.94 110.00 14,069.41 $3,769,500 $3,770,000 110.00 14,110.48 110.00 14,103.95 110.00 14,097.42 110.00 14,090.88 110.00 14,084.35 110.00 14,077.82 110.00 14,071.28 $3,770,000 $3,770,500 110.00 14,112.36 110.00 14,105.83 110.00 14,099.29 110.00 14,092.76 110.00 14,086.23 110.00 14,079.69 110.00 14,073.16 $3,770,500 $3,771,000 110.00 14,114.23 110.00 14,107.70 110.00 14,101.17 110.00 14,094.63 110.00 14,088.10 110.00 14,081.57 110.00 14,075.03 $3,771,000 $3,771,500 110.00 14,116.11 110.00 14,109.58 110.00 14,103.04 110.00 14,096.51 110.00 14,089.98 110.00 14,083.44 110.00 14,076.91 $3,771,500 $3,772,000 110.00 14,117.98 110.00 14,111.45 110.00 14,104.92 110.00 14,098.38 110.00 14,091.85 110.00 14,085.32 110.00 14,078.78 $3,772,000 $3,772,500 110.00 14,119.86 110.00 14,113.33 110.00 14,106.79 110.00 14,100.26 110.00 14,093.73 110.00 14,087.19 110.00 14,080.66 $3,772,500 $3,773,000 110.00 14,121.73 110.00 14,115.20 110.00 14,108.67 110.00 14,102.13 110.00 14,095.60 110.00 14,089.07 110.00 14,082.53 $3,773,000 $3,773,500 110.00 14,123.61 110.00 14,117.08 110.00 14,110.54 110.00 14,104.01 110.00 14,097.48 110.00 14,090.94 110.00 14,084.41 $3,773,500 $3,774,000 110.00 14,125.48 110.00 14,118.95 110.00 14,112.42 110.00 14,105.88 110.00 14,099.35 110.00 14,092.82 110.00 14,086.28

NJEIS Family Cost Participation Table Page 77 of 12 Effective July 1, 2015

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

$3,774,000 $3,774,500 110.00 14,127.36 110.00 14,120.83 110.00 14,114.29 110.00 14,107.76 110.00 14,101.23 110.00 14,094.69 110.00 14,088.16 $3,774,500 $3,775,000 110.00 14,129.23 110.00 14,122.70 110.00 14,116.17 110.00 14,109.63 110.00 14,103.10 110.00 14,096.57 110.00 14,090.03 $3,775,000 $3,775,500 110.00 14,131.11 110.00 14,124.58 110.00 14,118.04 110.00 14,111.51 110.00 14,104.98 110.00 14,098.44 110.00 14,091.91 $3,775,500 $3,776,000 110.00 14,132.98 110.00 14,126.45 110.00 14,119.92 110.00 14,113.38 110.00 14,106.85 110.00 14,100.32 110.00 14,093.78 $3,776,000 $3,776,500 110.00 14,134.86 110.00 14,128.33 110.00 14,121.79 110.00 14,115.26 110.00 14,108.73 110.00 14,102.19 110.00 14,095.66 $3,776,500 $3,777,000 110.00 14,136.73 110.00 14,130.20 110.00 14,123.67 110.00 14,117.13 110.00 14,110.60 110.00 14,104.07 110.00 14,097.53 $3,777,000 $3,777,500 110.00 14,138.61 110.00 14,132.08 110.00 14,125.54 110.00 14,119.01 110.00 14,112.48 110.00 14,105.94 110.00 14,099.41 $3,777,500 $3,778,000 110.00 14,140.48 110.00 14,133.95 110.00 14,127.42 110.00 14,120.88 110.00 14,114.35 110.00 14,107.82 110.00 14,101.28 $3,778,000 $3,778,500 110.00 14,142.36 110.00 14,135.83 110.00 14,129.29 110.00 14,122.76 110.00 14,116.23 110.00 14,109.69 110.00 14,103.16 $3,778,500 $3,779,000 110.00 14,144.23 110.00 14,137.70 110.00 14,131.17 110.00 14,124.63 110.00 14,118.10 110.00 14,111.57 110.00 14,105.03 $3,779,000 $3,779,500 110.00 14,146.11 110.00 14,139.58 110.00 14,133.04 110.00 14,126.51 110.00 14,119.98 110.00 14,113.44 110.00 14,106.91 $3,779,500 $3,780,000 110.00 14,147.98 110.00 14,141.45 110.00 14,134.92 110.00 14,128.38 110.00 14,121.85 110.00 14,115.32 110.00 14,108.78 $3,780,000 $3,780,500 110.00 14,149.86 110.00 14,143.33 110.00 14,136.79 110.00 14,130.26 110.00 14,123.73 110.00 14,117.19 110.00 14,110.66 $3,780,500 $3,781,000 110.00 14,151.73 110.00 14,145.20 110.00 14,138.67 110.00 14,132.13 110.00 14,125.60 110.00 14,119.07 110.00 14,112.53 $3,781,000 $3,781,500 110.00 14,153.61 110.00 14,147.08 110.00 14,140.54 110.00 14,134.01 110.00 14,127.48 110.00 14,120.94 110.00 14,114.41 $3,781,500 $3,782,000 110.00 14,155.48 110.00 14,148.95 110.00 14,142.42 110.00 14,135.88 110.00 14,129.35 110.00 14,122.82 110.00 14,116.28 $3,782,000 $3,782,500 110.00 14,157.36 110.00 14,150.83 110.00 14,144.29 110.00 14,137.76 110.00 14,131.23 110.00 14,124.69 110.00 14,118.16 $3,782,500 $3,783,000 110.00 14,159.23 110.00 14,152.70 110.00 14,146.17 110.00 14,139.63 110.00 14,133.10 110.00 14,126.57 110.00 14,120.03 $3,783,000 $3,783,500 110.00 14,161.11 110.00 14,154.58 110.00 14,148.04 110.00 14,141.51 110.00 14,134.98 110.00 14,128.44 110.00 14,121.91 $3,783,500 $3,784,000 110.00 14,162.98 110.00 14,156.45 110.00 14,149.92 110.00 14,143.38 110.00 14,136.85 110.00 14,130.32 110.00 14,123.78 $3,784,000 $3,784,500 110.00 14,164.86 110.00 14,158.33 110.00 14,151.79 110.00 14,145.26 110.00 14,138.73 110.00 14,132.19 110.00 14,125.66 $3,784,500 $3,785,000 110.00 14,166.73 110.00 14,160.20 110.00 14,153.67 110.00 14,147.13 110.00 14,140.60 110.00 14,134.07 110.00 14,127.53 $3,785,000 $3,785,500 110.00 14,168.61 110.00 14,162.08 110.00 14,155.54 110.00 14,149.01 110.00 14,142.48 110.00 14,135.94 110.00 14,129.41 $3,785,500 $3,786,000 110.00 14,170.48 110.00 14,163.95 110.00 14,157.42 110.00 14,150.88 110.00 14,144.35 110.00 14,137.82 110.00 14,131.28 $3,786,000 $3,786,500 110.00 14,172.36 110.00 14,165.83 110.00 14,159.29 110.00 14,152.76 110.00 14,146.23 110.00 14,139.69 110.00 14,133.16 $3,786,500 $3,787,000 110.00 14,174.23 110.00 14,167.70 110.00 14,161.17 110.00 14,154.63 110.00 14,148.10 110.00 14,141.57 110.00 14,135.03 $3,787,000 $3,787,500 110.00 14,176.11 110.00 14,169.58 110.00 14,163.04 110.00 14,156.51 110.00 14,149.98 110.00 14,143.44 110.00 14,136.91 $3,787,500 $3,788,000 110.00 14,177.98 110.00 14,171.45 110.00 14,164.92 110.00 14,158.38 110.00 14,151.85 110.00 14,145.32 110.00 14,138.78 $3,788,000 $3,788,500 110.00 14,179.86 110.00 14,173.33 110.00 14,166.79 110.00 14,160.26 110.00 14,153.73 110.00 14,147.19 110.00 14,140.66 $3,788,500 $3,789,000 110.00 14,181.73 110.00 14,175.20 110.00 14,168.67 110.00 14,162.13 110.00 14,155.60 110.00 14,149.07 110.00 14,142.53 $3,789,000 $3,789,500 110.00 14,183.61 110.00 14,177.08 110.00 14,170.54 110.00 14,164.01 110.00 14,157.48 110.00 14,150.94 110.00 14,144.41 $3,789,500 $3,790,000 110.00 14,185.48 110.00 14,178.95 110.00 14,172.42 110.00 14,165.88 110.00 14,159.35 110.00 14,152.82 110.00 14,146.28 $3,790,000 $3,790,500 110.00 14,187.36 110.00 14,180.83 110.00 14,174.29 110.00 14,167.76 110.00 14,161.23 110.00 14,154.69 110.00 14,148.16 $3,790,500 $3,791,000 110.00 14,189.23 110.00 14,182.70 110.00 14,176.17 110.00 14,169.63 110.00 14,163.10 110.00 14,156.57 110.00 14,150.03 $3,791,000 $3,791,500 110.00 14,191.11 110.00 14,184.58 110.00 14,178.04 110.00 14,171.51 110.00 14,164.98 110.00 14,158.44 110.00 14,151.91 $3,791,500 $3,792,000 110.00 14,192.98 110.00 14,186.45 110.00 14,179.92 110.00 14,173.38 110.00 14,166.85 110.00 14,160.32 110.00 14,153.78 $3,792,000 $3,792,500 110.00 14,194.86 110.00 14,188.33 110.00 14,181.79 110.00 14,175.26 110.00 14,168.73 110.00 14,162.19 110.00 14,155.66 $3,792,500 $3,793,000 110.00 14,196.73 110.00 14,190.20 110.00 14,183.67 110.00 14,177.13 110.00 14,170.60 110.00 14,164.07 110.00 14,157.53 $3,793,000 $3,793,500 110.00 14,198.61 110.00 14,192.08 110.00 14,185.54 110.00 14,179.01 110.00 14,172.48 110.00 14,165.94 110.00 14,159.41 $3,793,500 $3,794,000 110.00 14,200.48 110.00 14,193.95 110.00 14,187.42 110.00 14,180.88 110.00 14,174.35 110.00 14,167.82 110.00 14,161.28 $3,794,000 $3,794,500 110.00 14,202.36 110.00 14,195.83 110.00 14,189.29 110.00 14,182.76 110.00 14,176.23 110.00 14,169.69 110.00 14,163.16 $3,794,500 $3,795,000 110.00 14,204.23 110.00 14,197.70 110.00 14,191.17 110.00 14,184.63 110.00 14,178.10 110.00 14,171.57 110.00 14,165.03 $3,795,000 $3,795,500 110.00 14,206.11 110.00 14,199.58 110.00 14,193.04 110.00 14,186.51 110.00 14,179.98 110.00 14,173.44 110.00 14,166.91 $3,795,500 $3,796,000 110.00 14,207.98 110.00 14,201.45 110.00 14,194.92 110.00 14,188.38 110.00 14,181.85 110.00 14,175.32 110.00 14,168.78 $3,796,000 $3,796,500 110.00 14,209.86 110.00 14,203.33 110.00 14,196.79 110.00 14,190.26 110.00 14,183.73 110.00 14,177.19 110.00 14,170.66 $3,796,500 $3,797,000 110.00 14,211.73 110.00 14,205.20 110.00 14,198.67 110.00 14,192.13 110.00 14,185.60 110.00 14,179.07 110.00 14,172.53 $3,797,000 $3,797,500 110.00 14,213.61 110.00 14,207.08 110.00 14,200.54 110.00 14,194.01 110.00 14,187.48 110.00 14,180.94 110.00 14,174.41 $3,797,500 $3,798,000 110.00 14,215.48 110.00 14,208.95 110.00 14,202.42 110.00 14,195.88 110.00 14,189.35 110.00 14,182.82 110.00 14,176.28 $3,798,000 $3,798,500 110.00 14,217.36 110.00 14,210.83 110.00 14,204.29 110.00 14,197.76 110.00 14,191.23 110.00 14,184.69 110.00 14,178.16 $3,798,500 $3,799,000 110.00 14,219.23 110.00 14,212.70 110.00 14,206.17 110.00 14,199.63 110.00 14,193.10 110.00 14,186.57 110.00 14,180.03 $3,799,000 $3,799,500 110.00 14,221.11 110.00 14,214.58 110.00 14,208.04 110.00 14,201.51 110.00 14,194.98 110.00 14,188.44 110.00 14,181.91 $3,799,500 $3,800,000 110.00 14,222.98 110.00 14,216.45 110.00 14,209.92 110.00 14,203.38 110.00 14,196.85 110.00 14,190.32 110.00 14,183.78 $3,800,000 $3,800,500 110.00 14,224.86 110.00 14,218.33 110.00 14,211.79 110.00 14,205.26 110.00 14,198.73 110.00 14,192.19 110.00 14,185.66 $3,800,500 $3,801,000 110.00 14,226.73 110.00 14,220.20 110.00 14,213.67 110.00 14,207.13 110.00 14,200.60 110.00 14,194.07 110.00 14,187.53 $3,801,000 $3,801,500 110.00 14,228.61 110.00 14,222.08 110.00 14,215.54 110.00 14,209.01 110.00 14,202.48 110.00 14,195.94 110.00 14,189.41 $3,801,500 $3,802,000 110.00 14,230.48 110.00 14,223.95 110.00 14,217.42 110.00 14,210.88 110.00 14,204.35 110.00 14,197.82 110.00 14,191.28 $3,802,000 $3,802,500 110.00 14,232.36 110.00 14,225.83 110.00 14,219.29 110.00 14,212.76 110.00 14,206.23 110.00 14,199.69 110.00 14,193.16 $3,802,500 $3,803,000 110.00 14,234.23 110.00 14,227.70 110.00 14,221.17 110.00 14,214.63 110.00 14,208.10 110.00 14,201.57 110.00 14,195.03 $3,803,000 $3,803,500 110.00 14,236.11 110.00 14,229.58 110.00 14,223.04 110.00 14,216.51 110.00 14,209.98 110.00 14,203.44 110.00 14,196.91 $3,803,500 $3,804,000 110.00 14,237.98 110.00 14,231.45 110.00 14,224.92 110.00 14,218.38 110.00 14,211.85 110.00 14,205.32 110.00 14,198.78 $3,804,000 $3,804,500 110.00 14,239.86 110.00 14,233.33 110.00 14,226.79 110.00 14,220.26 110.00 14,213.73 110.00 14,207.19 110.00 14,200.66 $3,804,500 $3,805,000 110.00 14,241.73 110.00 14,235.20 110.00 14,228.67 110.00 14,222.13 110.00 14,215.60 110.00 14,209.07 110.00 14,202.53 $3,805,000 $3,805,500 110.00 14,243.61 110.00 14,237.08 110.00 14,230.54 110.00 14,224.01 110.00 14,217.48 110.00 14,210.94 110.00 14,204.41 $3,805,500 $3,806,000 110.00 14,245.48 110.00 14,238.95 110.00 14,232.42 110.00 14,225.88 110.00 14,219.35 110.00 14,212.82 110.00 14,206.28 $3,806,000 $3,806,500 110.00 14,247.36 110.00 14,240.83 110.00 14,234.29 110.00 14,227.76 110.00 14,221.23 110.00 14,214.69 110.00 14,208.16 $3,806,500 $3,807,000 110.00 14,249.23 110.00 14,242.70 110.00 14,236.17 110.00 14,229.63 110.00 14,223.10 110.00 14,216.57 110.00 14,210.03 $3,807,000 $3,807,500 110.00 14,251.11 110.00 14,244.58 110.00 14,238.04 110.00 14,231.51 110.00 14,224.98 110.00 14,218.44 110.00 14,211.91 $3,807,500 $3,808,000 110.00 14,252.98 110.00 14,246.45 110.00 14,239.92 110.00 14,233.38 110.00 14,226.85 110.00 14,220.32 110.00 14,213.78 $3,808,000 $3,808,500 110.00 14,254.86 110.00 14,248.33 110.00 14,241.79 110.00 14,235.26 110.00 14,228.73 110.00 14,222.19 110.00 14,215.66 $3,808,500 $3,809,000 110.00 14,256.73 110.00 14,250.20 110.00 14,243.67 110.00 14,237.13 110.00 14,230.60 110.00 14,224.07 110.00 14,217.53 $3,809,000 $3,809,500 110.00 14,258.61 110.00 14,252.08 110.00 14,245.54 110.00 14,239.01 110.00 14,232.48 110.00 14,225.94 110.00 14,219.41 $3,809,500 $3,810,000 110.00 14,260.48 110.00 14,253.95 110.00 14,247.42 110.00 14,240.88 110.00 14,234.35 110.00 14,227.82 110.00 14,221.28 $3,810,000 $3,810,500 110.00 14,262.36 110.00 14,255.83 110.00 14,249.29 110.00 14,242.76 110.00 14,236.23 110.00 14,229.69 110.00 14,223.16 $3,810,500 $3,811,000 110.00 14,264.23 110.00 14,257.70 110.00 14,251.17 110.00 14,244.63 110.00 14,238.10 110.00 14,231.57 110.00 14,225.03 $3,811,000 $3,811,500 110.00 14,266.11 110.00 14,259.58 110.00 14,253.04 110.00 14,246.51 110.00 14,239.98 110.00 14,233.44 110.00 14,226.91 $3,811,500 $3,812,000 110.00 14,267.98 110.00 14,261.45 110.00 14,254.92 110.00 14,248.38 110.00 14,241.85 110.00 14,235.32 110.00 14,228.78 $3,812,000 $3,812,500 110.00 14,269.86 110.00 14,263.33 110.00 14,256.79 110.00 14,250.26 110.00 14,243.73 110.00 14,237.19 110.00 14,230.66 $3,812,500 $3,813,000 110.00 14,271.73 110.00 14,265.20 110.00 14,258.67 110.00 14,252.13 110.00 14,245.60 110.00 14,239.07 110.00 14,232.53 $3,813,000 $3,813,500 110.00 14,273.61 110.00 14,267.08 110.00 14,260.54 110.00 14,254.01 110.00 14,247.48 110.00 14,240.94 110.00 14,234.41 $3,813,500 $3,814,000 110.00 14,275.48 110.00 14,268.95 110.00 14,262.42 110.00 14,255.88 110.00 14,249.35 110.00 14,242.82 110.00 14,236.28 $3,814,000 $3,814,500 110.00 14,277.36 110.00 14,270.83 110.00 14,264.29 110.00 14,257.76 110.00 14,251.23 110.00 14,244.69 110.00 14,238.16 $3,814,500 $3,815,000 110.00 14,279.23 110.00 14,272.70 110.00 14,266.17 110.00 14,259.63 110.00 14,253.10 110.00 14,246.57 110.00 14,240.03 $3,815,000 $3,815,500 110.00 14,281.11 110.00 14,274.58 110.00 14,268.04 110.00 14,261.51 110.00 14,254.98 110.00 14,248.44 110.00 14,241.91 $3,815,500 $3,816,000 110.00 14,282.98 110.00 14,276.45 110.00 14,269.92 110.00 14,263.38 110.00 14,256.85 110.00 14,250.32 110.00 14,243.78 $3,816,000 $3,816,500 110.00 14,284.86 110.00 14,278.33 110.00 14,271.79 110.00 14,265.26 110.00 14,258.73 110.00 14,252.19 110.00 14,245.66 $3,816,500 $3,817,000 110.00 14,286.73 110.00 14,280.20 110.00 14,273.67 110.00 14,267.13 110.00 14,260.60 110.00 14,254.07 110.00 14,247.53 $3,817,000 $3,817,500 110.00 14,288.61 110.00 14,282.08 110.00 14,275.54 110.00 14,269.01 110.00 14,262.48 110.00 14,255.94 110.00 14,249.41 $3,817,500 $3,818,000 110.00 14,290.48 110.00 14,283.95 110.00 14,277.42 110.00 14,270.88 110.00 14,264.35 110.00 14,257.82 110.00 14,251.28 $3,818,000 $3,818,500 110.00 14,292.36 110.00 14,285.83 110.00 14,279.29 110.00 14,272.76 110.00 14,266.23 110.00 14,259.69 110.00 14,253.16 $3,818,500 $3,819,000 110.00 14,294.23 110.00 14,287.70 110.00 14,281.17 110.00 14,274.63 110.00 14,268.10 110.00 14,261.57 110.00 14,255.03 $3,819,000 $3,819,500 110.00 14,296.11 110.00 14,289.58 110.00 14,283.04 110.00 14,276.51 110.00 14,269.98 110.00 14,263.44 110.00 14,256.91 $3,819,500 $3,820,000 110.00 14,297.98 110.00 14,291.45 110.00 14,284.92 110.00 14,278.38 110.00 14,271.85 110.00 14,265.32 110.00 14,258.78 $3,820,000 $3,820,500 110.00 14,299.86 110.00 14,293.33 110.00 14,286.79 110.00 14,280.26 110.00 14,273.73 110.00 14,267.19 110.00 14,260.66 $3,820,500 $3,821,000 110.00 14,301.73 110.00 14,295.20 110.00 14,288.67 110.00 14,282.13 110.00 14,275.60 110.00 14,269.07 110.00 14,262.53 $3,821,000 $3,821,500 110.00 14,303.61 110.00 14,297.08 110.00 14,290.54 110.00 14,284.01 110.00 14,277.48 110.00 14,270.94 110.00 14,264.41 $3,821,500 $3,822,000 110.00 14,305.48 110.00 14,298.95 110.00 14,292.42 110.00 14,285.88 110.00 14,279.35 110.00 14,272.82 110.00 14,266.28 $3,822,000 $3,822,500 110.00 14,307.36 110.00 14,300.83 110.00 14,294.29 110.00 14,287.76 110.00 14,281.23 110.00 14,274.69 110.00 14,268.16 $3,822,500 $3,823,000 110.00 14,309.23 110.00 14,302.70 110.00 14,296.17 110.00 14,289.63 110.00 14,283.10 110.00 14,276.57 110.00 14,270.03 $3,823,000 $3,823,500 110.00 14,311.11 110.00 14,304.58 110.00 14,298.04 110.00 14,291.51 110.00 14,284.98 110.00 14,278.44 110.00 14,271.91 $3,823,500 $3,824,000 110.00 14,312.98 110.00 14,306.45 110.00 14,299.92 110.00 14,293.38 110.00 14,286.85 110.00 14,280.32 110.00 14,273.78 $3,824,000 $3,824,500 110.00 14,314.86 110.00 14,308.33 110.00 14,301.79 110.00 14,295.26 110.00 14,288.73 110.00 14,282.19 110.00 14,275.66 $3,824,500 $3,825,000 110.00 14,316.73 110.00 14,310.20 110.00 14,303.67 110.00 14,297.13 110.00 14,290.60 110.00 14,284.07 110.00 14,277.53

NJEIS Family Cost Participation Table Page 78 of 12 Effective July 1, 2015

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

$3,825,000 $3,825,500 110.00 14,318.61 110.00 14,312.08 110.00 14,305.54 110.00 14,299.01 110.00 14,292.48 110.00 14,285.94 110.00 14,279.41 $3,825,500 $3,826,000 110.00 14,320.48 110.00 14,313.95 110.00 14,307.42 110.00 14,300.88 110.00 14,294.35 110.00 14,287.82 110.00 14,281.28 $3,826,000 $3,826,500 110.00 14,322.36 110.00 14,315.83 110.00 14,309.29 110.00 14,302.76 110.00 14,296.23 110.00 14,289.69 110.00 14,283.16 $3,826,500 $3,827,000 110.00 14,324.23 110.00 14,317.70 110.00 14,311.17 110.00 14,304.63 110.00 14,298.10 110.00 14,291.57 110.00 14,285.03 $3,827,000 $3,827,500 110.00 14,326.11 110.00 14,319.58 110.00 14,313.04 110.00 14,306.51 110.00 14,299.98 110.00 14,293.44 110.00 14,286.91 $3,827,500 $3,828,000 110.00 14,327.98 110.00 14,321.45 110.00 14,314.92 110.00 14,308.38 110.00 14,301.85 110.00 14,295.32 110.00 14,288.78 $3,828,000 $3,828,500 110.00 14,329.86 110.00 14,323.33 110.00 14,316.79 110.00 14,310.26 110.00 14,303.73 110.00 14,297.19 110.00 14,290.66 $3,828,500 $3,829,000 110.00 14,331.73 110.00 14,325.20 110.00 14,318.67 110.00 14,312.13 110.00 14,305.60 110.00 14,299.07 110.00 14,292.53 $3,829,000 $3,829,500 110.00 14,333.61 110.00 14,327.08 110.00 14,320.54 110.00 14,314.01 110.00 14,307.48 110.00 14,300.94 110.00 14,294.41 $3,829,500 $3,830,000 110.00 14,335.48 110.00 14,328.95 110.00 14,322.42 110.00 14,315.88 110.00 14,309.35 110.00 14,302.82 110.00 14,296.28 $3,830,000 $3,830,500 110.00 14,337.36 110.00 14,330.83 110.00 14,324.29 110.00 14,317.76 110.00 14,311.23 110.00 14,304.69 110.00 14,298.16 $3,830,500 $3,831,000 110.00 14,339.23 110.00 14,332.70 110.00 14,326.17 110.00 14,319.63 110.00 14,313.10 110.00 14,306.57 110.00 14,300.03 $3,831,000 $3,831,500 110.00 14,341.11 110.00 14,334.58 110.00 14,328.04 110.00 14,321.51 110.00 14,314.98 110.00 14,308.44 110.00 14,301.91 $3,831,500 $3,832,000 110.00 14,342.98 110.00 14,336.45 110.00 14,329.92 110.00 14,323.38 110.00 14,316.85 110.00 14,310.32 110.00 14,303.78 $3,832,000 $3,832,500 110.00 14,344.86 110.00 14,338.33 110.00 14,331.79 110.00 14,325.26 110.00 14,318.73 110.00 14,312.19 110.00 14,305.66 $3,832,500 $3,833,000 110.00 14,346.73 110.00 14,340.20 110.00 14,333.67 110.00 14,327.13 110.00 14,320.60 110.00 14,314.07 110.00 14,307.53 $3,833,000 $3,833,500 110.00 14,348.61 110.00 14,342.08 110.00 14,335.54 110.00 14,329.01 110.00 14,322.48 110.00 14,315.94 110.00 14,309.41 $3,833,500 $3,834,000 110.00 14,350.48 110.00 14,343.95 110.00 14,337.42 110.00 14,330.88 110.00 14,324.35 110.00 14,317.82 110.00 14,311.28 $3,834,000 $3,834,500 110.00 14,352.36 110.00 14,345.83 110.00 14,339.29 110.00 14,332.76 110.00 14,326.23 110.00 14,319.69 110.00 14,313.16 $3,834,500 $3,835,000 110.00 14,354.23 110.00 14,347.70 110.00 14,341.17 110.00 14,334.63 110.00 14,328.10 110.00 14,321.57 110.00 14,315.03 $3,835,000 $3,835,500 110.00 14,356.11 110.00 14,349.58 110.00 14,343.04 110.00 14,336.51 110.00 14,329.98 110.00 14,323.44 110.00 14,316.91 $3,835,500 $3,836,000 110.00 14,357.98 110.00 14,351.45 110.00 14,344.92 110.00 14,338.38 110.00 14,331.85 110.00 14,325.32 110.00 14,318.78 $3,836,000 $3,836,500 110.00 14,359.86 110.00 14,353.33 110.00 14,346.79 110.00 14,340.26 110.00 14,333.73 110.00 14,327.19 110.00 14,320.66 $3,836,500 $3,837,000 110.00 14,361.73 110.00 14,355.20 110.00 14,348.67 110.00 14,342.13 110.00 14,335.60 110.00 14,329.07 110.00 14,322.53 $3,837,000 $3,837,500 110.00 14,363.61 110.00 14,357.08 110.00 14,350.54 110.00 14,344.01 110.00 14,337.48 110.00 14,330.94 110.00 14,324.41 $3,837,500 $3,838,000 110.00 14,365.48 110.00 14,358.95 110.00 14,352.42 110.00 14,345.88 110.00 14,339.35 110.00 14,332.82 110.00 14,326.28 $3,838,000 $3,838,500 110.00 14,367.36 110.00 14,360.83 110.00 14,354.29 110.00 14,347.76 110.00 14,341.23 110.00 14,334.69 110.00 14,328.16 $3,838,500 $3,839,000 110.00 14,369.23 110.00 14,362.70 110.00 14,356.17 110.00 14,349.63 110.00 14,343.10 110.00 14,336.57 110.00 14,330.03 $3,839,000 $3,839,500 110.00 14,371.11 110.00 14,364.58 110.00 14,358.04 110.00 14,351.51 110.00 14,344.98 110.00 14,338.44 110.00 14,331.91 $3,839,500 $3,840,000 110.00 14,372.98 110.00 14,366.45 110.00 14,359.92 110.00 14,353.38 110.00 14,346.85 110.00 14,340.32 110.00 14,333.78 $3,840,000 $3,840,500 110.00 14,374.86 110.00 14,368.33 110.00 14,361.79 110.00 14,355.26 110.00 14,348.73 110.00 14,342.19 110.00 14,335.66 $3,840,500 $3,841,000 110.00 14,376.73 110.00 14,370.20 110.00 14,363.67 110.00 14,357.13 110.00 14,350.60 110.00 14,344.07 110.00 14,337.53 $3,841,000 $3,841,500 110.00 14,378.61 110.00 14,372.08 110.00 14,365.54 110.00 14,359.01 110.00 14,352.48 110.00 14,345.94 110.00 14,339.41 $3,841,500 $3,842,000 110.00 14,380.48 110.00 14,373.95 110.00 14,367.42 110.00 14,360.88 110.00 14,354.35 110.00 14,347.82 110.00 14,341.28 $3,842,000 $3,842,500 110.00 14,382.36 110.00 14,375.83 110.00 14,369.29 110.00 14,362.76 110.00 14,356.23 110.00 14,349.69 110.00 14,343.16 $3,842,500 $3,843,000 110.00 14,384.23 110.00 14,377.70 110.00 14,371.17 110.00 14,364.63 110.00 14,358.10 110.00 14,351.57 110.00 14,345.03 $3,843,000 $3,843,500 110.00 14,386.11 110.00 14,379.58 110.00 14,373.04 110.00 14,366.51 110.00 14,359.98 110.00 14,353.44 110.00 14,346.91 $3,843,500 $3,844,000 110.00 14,387.98 110.00 14,381.45 110.00 14,374.92 110.00 14,368.38 110.00 14,361.85 110.00 14,355.32 110.00 14,348.78 $3,844,000 $3,844,500 110.00 14,389.86 110.00 14,383.33 110.00 14,376.79 110.00 14,370.26 110.00 14,363.73 110.00 14,357.19 110.00 14,350.66 $3,844,500 $3,845,000 110.00 14,391.73 110.00 14,385.20 110.00 14,378.67 110.00 14,372.13 110.00 14,365.60 110.00 14,359.07 110.00 14,352.53 $3,845,000 $3,845,500 110.00 14,393.61 110.00 14,387.08 110.00 14,380.54 110.00 14,374.01 110.00 14,367.48 110.00 14,360.94 110.00 14,354.41 $3,845,500 $3,846,000 110.00 14,395.48 110.00 14,388.95 110.00 14,382.42 110.00 14,375.88 110.00 14,369.35 110.00 14,362.82 110.00 14,356.28 $3,846,000 $3,846,500 110.00 14,397.36 110.00 14,390.83 110.00 14,384.29 110.00 14,377.76 110.00 14,371.23 110.00 14,364.69 110.00 14,358.16 $3,846,500 $3,847,000 110.00 14,399.23 110.00 14,392.70 110.00 14,386.17 110.00 14,379.63 110.00 14,373.10 110.00 14,366.57 110.00 14,360.03 $3,847,000 $3,847,500 110.00 14,401.11 110.00 14,394.58 110.00 14,388.04 110.00 14,381.51 110.00 14,374.98 110.00 14,368.44 110.00 14,361.91 $3,847,500 $3,848,000 110.00 14,402.98 110.00 14,396.45 110.00 14,389.92 110.00 14,383.38 110.00 14,376.85 110.00 14,370.32 110.00 14,363.78 $3,848,000 $3,848,500 110.00 14,404.86 110.00 14,398.33 110.00 14,391.79 110.00 14,385.26 110.00 14,378.73 110.00 14,372.19 110.00 14,365.66 $3,848,500 $3,849,000 110.00 14,406.73 110.00 14,400.20 110.00 14,393.67 110.00 14,387.13 110.00 14,380.60 110.00 14,374.07 110.00 14,367.53 $3,849,000 $3,849,500 110.00 14,408.61 110.00 14,402.08 110.00 14,395.54 110.00 14,389.01 110.00 14,382.48 110.00 14,375.94 110.00 14,369.41 $3,849,500 $3,850,000 110.00 14,410.48 110.00 14,403.95 110.00 14,397.42 110.00 14,390.88 110.00 14,384.35 110.00 14,377.82 110.00 14,371.28 $3,850,000 $3,850,500 110.00 14,412.36 110.00 14,405.83 110.00 14,399.29 110.00 14,392.76 110.00 14,386.23 110.00 14,379.69 110.00 14,373.16 $3,850,500 $3,851,000 110.00 14,414.23 110.00 14,407.70 110.00 14,401.17 110.00 14,394.63 110.00 14,388.10 110.00 14,381.57 110.00 14,375.03 $3,851,000 $3,851,500 110.00 14,416.11 110.00 14,409.58 110.00 14,403.04 110.00 14,396.51 110.00 14,389.98 110.00 14,383.44 110.00 14,376.91 $3,851,500 $3,852,000 110.00 14,417.98 110.00 14,411.45 110.00 14,404.92 110.00 14,398.38 110.00 14,391.85 110.00 14,385.32 110.00 14,378.78 $3,852,000 $3,852,500 110.00 14,419.86 110.00 14,413.33 110.00 14,406.79 110.00 14,400.26 110.00 14,393.73 110.00 14,387.19 110.00 14,380.66 $3,852,500 $3,853,000 110.00 14,421.73 110.00 14,415.20 110.00 14,408.67 110.00 14,402.13 110.00 14,395.60 110.00 14,389.07 110.00 14,382.53 $3,853,000 $3,853,500 110.00 14,423.61 110.00 14,417.08 110.00 14,410.54 110.00 14,404.01 110.00 14,397.48 110.00 14,390.94 110.00 14,384.41 $3,853,500 $3,854,000 110.00 14,425.48 110.00 14,418.95 110.00 14,412.42 110.00 14,405.88 110.00 14,399.35 110.00 14,392.82 110.00 14,386.28 $3,854,000 $3,854,500 110.00 14,427.36 110.00 14,420.83 110.00 14,414.29 110.00 14,407.76 110.00 14,401.23 110.00 14,394.69 110.00 14,388.16 $3,854,500 $3,855,000 110.00 14,429.23 110.00 14,422.70 110.00 14,416.17 110.00 14,409.63 110.00 14,403.10 110.00 14,396.57 110.00 14,390.03 $3,855,000 $3,855,500 110.00 14,431.11 110.00 14,424.58 110.00 14,418.04 110.00 14,411.51 110.00 14,404.98 110.00 14,398.44 110.00 14,391.91 $3,855,500 $3,856,000 110.00 14,432.98 110.00 14,426.45 110.00 14,419.92 110.00 14,413.38 110.00 14,406.85 110.00 14,400.32 110.00 14,393.78 $3,856,000 $3,856,500 110.00 14,434.86 110.00 14,428.33 110.00 14,421.79 110.00 14,415.26 110.00 14,408.73 110.00 14,402.19 110.00 14,395.66 $3,856,500 $3,857,000 110.00 14,436.73 110.00 14,430.20 110.00 14,423.67 110.00 14,417.13 110.00 14,410.60 110.00 14,404.07 110.00 14,397.53 $3,857,000 $3,857,500 110.00 14,438.61 110.00 14,432.08 110.00 14,425.54 110.00 14,419.01 110.00 14,412.48 110.00 14,405.94 110.00 14,399.41 $3,857,500 $3,858,000 110.00 14,440.48 110.00 14,433.95 110.00 14,427.42 110.00 14,420.88 110.00 14,414.35 110.00 14,407.82 110.00 14,401.28 $3,858,000 $3,858,500 110.00 14,442.36 110.00 14,435.83 110.00 14,429.29 110.00 14,422.76 110.00 14,416.23 110.00 14,409.69 110.00 14,403.16 $3,858,500 $3,859,000 110.00 14,444.23 110.00 14,437.70 110.00 14,431.17 110.00 14,424.63 110.00 14,418.10 110.00 14,411.57 110.00 14,405.03 $3,859,000 $3,859,500 110.00 14,446.11 110.00 14,439.58 110.00 14,433.04 110.00 14,426.51 110.00 14,419.98 110.00 14,413.44 110.00 14,406.91 $3,859,500 $3,860,000 110.00 14,447.98 110.00 14,441.45 110.00 14,434.92 110.00 14,428.38 110.00 14,421.85 110.00 14,415.32 110.00 14,408.78 $3,860,000 $3,860,500 110.00 14,449.86 110.00 14,443.33 110.00 14,436.79 110.00 14,430.26 110.00 14,423.73 110.00 14,417.19 110.00 14,410.66 $3,860,500 $3,861,000 110.00 14,451.73 110.00 14,445.20 110.00 14,438.67 110.00 14,432.13 110.00 14,425.60 110.00 14,419.07 110.00 14,412.53 $3,861,000 $3,861,500 110.00 14,453.61 110.00 14,447.08 110.00 14,440.54 110.00 14,434.01 110.00 14,427.48 110.00 14,420.94 110.00 14,414.41 $3,861,500 $3,862,000 110.00 14,455.48 110.00 14,448.95 110.00 14,442.42 110.00 14,435.88 110.00 14,429.35 110.00 14,422.82 110.00 14,416.28 $3,862,000 $3,862,500 110.00 14,457.36 110.00 14,450.83 110.00 14,444.29 110.00 14,437.76 110.00 14,431.23 110.00 14,424.69 110.00 14,418.16 $3,862,500 $3,863,000 110.00 14,459.23 110.00 14,452.70 110.00 14,446.17 110.00 14,439.63 110.00 14,433.10 110.00 14,426.57 110.00 14,420.03 $3,863,000 $3,863,500 110.00 14,461.11 110.00 14,454.58 110.00 14,448.04 110.00 14,441.51 110.00 14,434.98 110.00 14,428.44 110.00 14,421.91 $3,863,500 $3,864,000 110.00 14,462.98 110.00 14,456.45 110.00 14,449.92 110.00 14,443.38 110.00 14,436.85 110.00 14,430.32 110.00 14,423.78 $3,864,000 $3,864,500 110.00 14,464.86 110.00 14,458.33 110.00 14,451.79 110.00 14,445.26 110.00 14,438.73 110.00 14,432.19 110.00 14,425.66 $3,864,500 $3,865,000 110.00 14,466.73 110.00 14,460.20 110.00 14,453.67 110.00 14,447.13 110.00 14,440.60 110.00 14,434.07 110.00 14,427.53 $3,865,000 $3,865,500 110.00 14,468.61 110.00 14,462.08 110.00 14,455.54 110.00 14,449.01 110.00 14,442.48 110.00 14,435.94 110.00 14,429.41 $3,865,500 $3,866,000 110.00 14,470.48 110.00 14,463.95 110.00 14,457.42 110.00 14,450.88 110.00 14,444.35 110.00 14,437.82 110.00 14,431.28 $3,866,000 $3,866,500 110.00 14,472.36 110.00 14,465.83 110.00 14,459.29 110.00 14,452.76 110.00 14,446.23 110.00 14,439.69 110.00 14,433.16 $3,866,500 $3,867,000 110.00 14,474.23 110.00 14,467.70 110.00 14,461.17 110.00 14,454.63 110.00 14,448.10 110.00 14,441.57 110.00 14,435.03 $3,867,000 $3,867,500 110.00 14,476.11 110.00 14,469.58 110.00 14,463.04 110.00 14,456.51 110.00 14,449.98 110.00 14,443.44 110.00 14,436.91 $3,867,500 $3,868,000 110.00 14,477.98 110.00 14,471.45 110.00 14,464.92 110.00 14,458.38 110.00 14,451.85 110.00 14,445.32 110.00 14,438.78 $3,868,000 $3,868,500 110.00 14,479.86 110.00 14,473.33 110.00 14,466.79 110.00 14,460.26 110.00 14,453.73 110.00 14,447.19 110.00 14,440.66 $3,868,500 $3,869,000 110.00 14,481.73 110.00 14,475.20 110.00 14,468.67 110.00 14,462.13 110.00 14,455.60 110.00 14,449.07 110.00 14,442.53 $3,869,000 $3,869,500 110.00 14,483.61 110.00 14,477.08 110.00 14,470.54 110.00 14,464.01 110.00 14,457.48 110.00 14,450.94 110.00 14,444.41 $3,869,500 $3,870,000 110.00 14,485.48 110.00 14,478.95 110.00 14,472.42 110.00 14,465.88 110.00 14,459.35 110.00 14,452.82 110.00 14,446.28 $3,870,000 $3,870,500 110.00 14,487.36 110.00 14,480.83 110.00 14,474.29 110.00 14,467.76 110.00 14,461.23 110.00 14,454.69 110.00 14,448.16 $3,870,500 $3,871,000 110.00 14,489.23 110.00 14,482.70 110.00 14,476.17 110.00 14,469.63 110.00 14,463.10 110.00 14,456.57 110.00 14,450.03 $3,871,000 $3,871,500 110.00 14,491.11 110.00 14,484.58 110.00 14,478.04 110.00 14,471.51 110.00 14,464.98 110.00 14,458.44 110.00 14,451.91 $3,871,500 $3,872,000 110.00 14,492.98 110.00 14,486.45 110.00 14,479.92 110.00 14,473.38 110.00 14,466.85 110.00 14,460.32 110.00 14,453.78 $3,872,000 $3,872,500 110.00 14,494.86 110.00 14,488.33 110.00 14,481.79 110.00 14,475.26 110.00 14,468.73 110.00 14,462.19 110.00 14,455.66 $3,872,500 $3,873,000 110.00 14,496.73 110.00 14,490.20 110.00 14,483.67 110.00 14,477.13 110.00 14,470.60 110.00 14,464.07 110.00 14,457.53 $3,873,000 $3,873,500 110.00 14,498.61 110.00 14,492.08 110.00 14,485.54 110.00 14,479.01 110.00 14,472.48 110.00 14,465.94 110.00 14,459.41 $3,873,500 $3,874,000 110.00 14,500.48 110.00 14,493.95 110.00 14,487.42 110.00 14,480.88 110.00 14,474.35 110.00 14,467.82 110.00 14,461.28 $3,874,000 $3,874,500 110.00 14,502.36 110.00 14,495.83 110.00 14,489.29 110.00 14,482.76 110.00 14,476.23 110.00 14,469.69 110.00 14,463.16 $3,874,500 $3,875,000 110.00 14,504.23 110.00 14,497.70 110.00 14,491.17 110.00 14,484.63 110.00 14,478.10 110.00 14,471.57 110.00 14,465.03 $3,875,000 $3,875,500 110.00 14,506.11 110.00 14,499.58 110.00 14,493.04 110.00 14,486.51 110.00 14,479.98 110.00 14,473.44 110.00 14,466.91 $3,875,500 $3,876,000 110.00 14,507.98 110.00 14,501.45 110.00 14,494.92 110.00 14,488.38 110.00 14,481.85 110.00 14,475.32 110.00 14,468.78

NJEIS Family Cost Participation Table Page 79 of 12 Effective July 1, 2015

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

$3,876,000 $3,876,500 110.00 14,509.86 110.00 14,503.33 110.00 14,496.79 110.00 14,490.26 110.00 14,483.73 110.00 14,477.19 110.00 14,470.66 $3,876,500 $3,877,000 110.00 14,511.73 110.00 14,505.20 110.00 14,498.67 110.00 14,492.13 110.00 14,485.60 110.00 14,479.07 110.00 14,472.53 $3,877,000 $3,877,500 110.00 14,513.61 110.00 14,507.08 110.00 14,500.54 110.00 14,494.01 110.00 14,487.48 110.00 14,480.94 110.00 14,474.41 $3,877,500 $3,878,000 110.00 14,515.48 110.00 14,508.95 110.00 14,502.42 110.00 14,495.88 110.00 14,489.35 110.00 14,482.82 110.00 14,476.28 $3,878,000 $3,878,500 110.00 14,517.36 110.00 14,510.83 110.00 14,504.29 110.00 14,497.76 110.00 14,491.23 110.00 14,484.69 110.00 14,478.16 $3,878,500 $3,879,000 110.00 14,519.23 110.00 14,512.70 110.00 14,506.17 110.00 14,499.63 110.00 14,493.10 110.00 14,486.57 110.00 14,480.03 $3,879,000 $3,879,500 110.00 14,521.11 110.00 14,514.58 110.00 14,508.04 110.00 14,501.51 110.00 14,494.98 110.00 14,488.44 110.00 14,481.91 $3,879,500 $3,880,000 110.00 14,522.98 110.00 14,516.45 110.00 14,509.92 110.00 14,503.38 110.00 14,496.85 110.00 14,490.32 110.00 14,483.78 $3,880,000 $3,880,500 110.00 14,524.86 110.00 14,518.33 110.00 14,511.79 110.00 14,505.26 110.00 14,498.73 110.00 14,492.19 110.00 14,485.66 $3,880,500 $3,881,000 110.00 14,526.73 110.00 14,520.20 110.00 14,513.67 110.00 14,507.13 110.00 14,500.60 110.00 14,494.07 110.00 14,487.53 $3,881,000 $3,881,500 110.00 14,528.61 110.00 14,522.08 110.00 14,515.54 110.00 14,509.01 110.00 14,502.48 110.00 14,495.94 110.00 14,489.41 $3,881,500 $3,882,000 110.00 14,530.48 110.00 14,523.95 110.00 14,517.42 110.00 14,510.88 110.00 14,504.35 110.00 14,497.82 110.00 14,491.28 $3,882,000 $3,882,500 110.00 14,532.36 110.00 14,525.83 110.00 14,519.29 110.00 14,512.76 110.00 14,506.23 110.00 14,499.69 110.00 14,493.16 $3,882,500 $3,883,000 110.00 14,534.23 110.00 14,527.70 110.00 14,521.17 110.00 14,514.63 110.00 14,508.10 110.00 14,501.57 110.00 14,495.03 $3,883,000 $3,883,500 110.00 14,536.11 110.00 14,529.58 110.00 14,523.04 110.00 14,516.51 110.00 14,509.98 110.00 14,503.44 110.00 14,496.91 $3,883,500 $3,884,000 110.00 14,537.98 110.00 14,531.45 110.00 14,524.92 110.00 14,518.38 110.00 14,511.85 110.00 14,505.32 110.00 14,498.78 $3,884,000 $3,884,500 110.00 14,539.86 110.00 14,533.33 110.00 14,526.79 110.00 14,520.26 110.00 14,513.73 110.00 14,507.19 110.00 14,500.66 $3,884,500 $3,885,000 110.00 14,541.73 110.00 14,535.20 110.00 14,528.67 110.00 14,522.13 110.00 14,515.60 110.00 14,509.07 110.00 14,502.53 $3,885,000 $3,885,500 110.00 14,543.61 110.00 14,537.08 110.00 14,530.54 110.00 14,524.01 110.00 14,517.48 110.00 14,510.94 110.00 14,504.41 $3,885,500 $3,886,000 110.00 14,545.48 110.00 14,538.95 110.00 14,532.42 110.00 14,525.88 110.00 14,519.35 110.00 14,512.82 110.00 14,506.28 $3,886,000 $3,886,500 110.00 14,547.36 110.00 14,540.83 110.00 14,534.29 110.00 14,527.76 110.00 14,521.23 110.00 14,514.69 110.00 14,508.16 $3,886,500 $3,887,000 110.00 14,549.23 110.00 14,542.70 110.00 14,536.17 110.00 14,529.63 110.00 14,523.10 110.00 14,516.57 110.00 14,510.03 $3,887,000 $3,887,500 110.00 14,551.11 110.00 14,544.58 110.00 14,538.04 110.00 14,531.51 110.00 14,524.98 110.00 14,518.44 110.00 14,511.91 $3,887,500 $3,888,000 110.00 14,552.98 110.00 14,546.45 110.00 14,539.92 110.00 14,533.38 110.00 14,526.85 110.00 14,520.32 110.00 14,513.78 $3,888,000 $3,888,500 110.00 14,554.86 110.00 14,548.33 110.00 14,541.79 110.00 14,535.26 110.00 14,528.73 110.00 14,522.19 110.00 14,515.66 $3,888,500 $3,889,000 110.00 14,556.73 110.00 14,550.20 110.00 14,543.67 110.00 14,537.13 110.00 14,530.60 110.00 14,524.07 110.00 14,517.53 $3,889,000 $3,889,500 110.00 14,558.61 110.00 14,552.08 110.00 14,545.54 110.00 14,539.01 110.00 14,532.48 110.00 14,525.94 110.00 14,519.41 $3,889,500 $3,890,000 110.00 14,560.48 110.00 14,553.95 110.00 14,547.42 110.00 14,540.88 110.00 14,534.35 110.00 14,527.82 110.00 14,521.28 $3,890,000 $3,890,500 110.00 14,562.36 110.00 14,555.83 110.00 14,549.29 110.00 14,542.76 110.00 14,536.23 110.00 14,529.69 110.00 14,523.16 $3,890,500 $3,891,000 110.00 14,564.23 110.00 14,557.70 110.00 14,551.17 110.00 14,544.63 110.00 14,538.10 110.00 14,531.57 110.00 14,525.03 $3,891,000 $3,891,500 110.00 14,566.11 110.00 14,559.58 110.00 14,553.04 110.00 14,546.51 110.00 14,539.98 110.00 14,533.44 110.00 14,526.91 $3,891,500 $3,892,000 110.00 14,567.98 110.00 14,561.45 110.00 14,554.92 110.00 14,548.38 110.00 14,541.85 110.00 14,535.32 110.00 14,528.78 $3,892,000 $3,892,500 110.00 14,569.86 110.00 14,563.33 110.00 14,556.79 110.00 14,550.26 110.00 14,543.73 110.00 14,537.19 110.00 14,530.66 $3,892,500 $3,893,000 110.00 14,571.73 110.00 14,565.20 110.00 14,558.67 110.00 14,552.13 110.00 14,545.60 110.00 14,539.07 110.00 14,532.53 $3,893,000 $3,893,500 110.00 14,573.61 110.00 14,567.08 110.00 14,560.54 110.00 14,554.01 110.00 14,547.48 110.00 14,540.94 110.00 14,534.41 $3,893,500 $3,894,000 110.00 14,575.48 110.00 14,568.95 110.00 14,562.42 110.00 14,555.88 110.00 14,549.35 110.00 14,542.82 110.00 14,536.28 $3,894,000 $3,894,500 110.00 14,577.36 110.00 14,570.83 110.00 14,564.29 110.00 14,557.76 110.00 14,551.23 110.00 14,544.69 110.00 14,538.16 $3,894,500 $3,895,000 110.00 14,579.23 110.00 14,572.70 110.00 14,566.17 110.00 14,559.63 110.00 14,553.10 110.00 14,546.57 110.00 14,540.03 $3,895,000 $3,895,500 110.00 14,581.11 110.00 14,574.58 110.00 14,568.04 110.00 14,561.51 110.00 14,554.98 110.00 14,548.44 110.00 14,541.91 $3,895,500 $3,896,000 110.00 14,582.98 110.00 14,576.45 110.00 14,569.92 110.00 14,563.38 110.00 14,556.85 110.00 14,550.32 110.00 14,543.78 $3,896,000 $3,896,500 110.00 14,584.86 110.00 14,578.33 110.00 14,571.79 110.00 14,565.26 110.00 14,558.73 110.00 14,552.19 110.00 14,545.66 $3,896,500 $3,897,000 110.00 14,586.73 110.00 14,580.20 110.00 14,573.67 110.00 14,567.13 110.00 14,560.60 110.00 14,554.07 110.00 14,547.53 $3,897,000 $3,897,500 110.00 14,588.61 110.00 14,582.08 110.00 14,575.54 110.00 14,569.01 110.00 14,562.48 110.00 14,555.94 110.00 14,549.41 $3,897,500 $3,898,000 110.00 14,590.48 110.00 14,583.95 110.00 14,577.42 110.00 14,570.88 110.00 14,564.35 110.00 14,557.82 110.00 14,551.28 $3,898,000 $3,898,500 110.00 14,592.36 110.00 14,585.83 110.00 14,579.29 110.00 14,572.76 110.00 14,566.23 110.00 14,559.69 110.00 14,553.16 $3,898,500 $3,899,000 110.00 14,594.23 110.00 14,587.70 110.00 14,581.17 110.00 14,574.63 110.00 14,568.10 110.00 14,561.57 110.00 14,555.03 $3,899,000 $3,899,500 110.00 14,596.11 110.00 14,589.58 110.00 14,583.04 110.00 14,576.51 110.00 14,569.98 110.00 14,563.44 110.00 14,556.91 $3,899,500 $3,900,000 110.00 14,597.98 110.00 14,591.45 110.00 14,584.92 110.00 14,578.38 110.00 14,571.85 110.00 14,565.32 110.00 14,558.78 $3,900,000 $3,900,500 110.00 14,599.86 110.00 14,593.33 110.00 14,586.79 110.00 14,580.26 110.00 14,573.73 110.00 14,567.19 110.00 14,560.66 $3,900,500 $3,901,000 110.00 14,601.73 110.00 14,595.20 110.00 14,588.67 110.00 14,582.13 110.00 14,575.60 110.00 14,569.07 110.00 14,562.53 $3,901,000 $3,901,500 110.00 14,603.61 110.00 14,597.08 110.00 14,590.54 110.00 14,584.01 110.00 14,577.48 110.00 14,570.94 110.00 14,564.41 $3,901,500 $3,902,000 110.00 14,605.48 110.00 14,598.95 110.00 14,592.42 110.00 14,585.88 110.00 14,579.35 110.00 14,572.82 110.00 14,566.28 $3,902,000 $3,902,500 110.00 14,607.36 110.00 14,600.83 110.00 14,594.29 110.00 14,587.76 110.00 14,581.23 110.00 14,574.69 110.00 14,568.16 $3,902,500 $3,903,000 110.00 14,609.23 110.00 14,602.70 110.00 14,596.17 110.00 14,589.63 110.00 14,583.10 110.00 14,576.57 110.00 14,570.03 $3,903,000 $3,903,500 110.00 14,611.11 110.00 14,604.58 110.00 14,598.04 110.00 14,591.51 110.00 14,584.98 110.00 14,578.44 110.00 14,571.91 $3,903,500 $3,904,000 110.00 14,612.98 110.00 14,606.45 110.00 14,599.92 110.00 14,593.38 110.00 14,586.85 110.00 14,580.32 110.00 14,573.78 $3,904,000 $3,904,500 110.00 14,614.86 110.00 14,608.33 110.00 14,601.79 110.00 14,595.26 110.00 14,588.73 110.00 14,582.19 110.00 14,575.66 $3,904,500 $3,905,000 110.00 14,616.73 110.00 14,610.20 110.00 14,603.67 110.00 14,597.13 110.00 14,590.60 110.00 14,584.07 110.00 14,577.53 $3,905,000 $3,905,500 110.00 14,618.61 110.00 14,612.08 110.00 14,605.54 110.00 14,599.01 110.00 14,592.48 110.00 14,585.94 110.00 14,579.41 $3,905,500 $3,906,000 110.00 14,620.48 110.00 14,613.95 110.00 14,607.42 110.00 14,600.88 110.00 14,594.35 110.00 14,587.82 110.00 14,581.28 $3,906,000 $3,906,500 110.00 14,622.36 110.00 14,615.83 110.00 14,609.29 110.00 14,602.76 110.00 14,596.23 110.00 14,589.69 110.00 14,583.16 $3,906,500 $3,907,000 110.00 14,624.23 110.00 14,617.70 110.00 14,611.17 110.00 14,604.63 110.00 14,598.10 110.00 14,591.57 110.00 14,585.03 $3,907,000 $3,907,500 110.00 14,626.11 110.00 14,619.58 110.00 14,613.04 110.00 14,606.51 110.00 14,599.98 110.00 14,593.44 110.00 14,586.91 $3,907,500 $3,908,000 110.00 14,627.98 110.00 14,621.45 110.00 14,614.92 110.00 14,608.38 110.00 14,601.85 110.00 14,595.32 110.00 14,588.78 $3,908,000 $3,908,500 110.00 14,629.86 110.00 14,623.33 110.00 14,616.79 110.00 14,610.26 110.00 14,603.73 110.00 14,597.19 110.00 14,590.66 $3,908,500 $3,909,000 110.00 14,631.73 110.00 14,625.20 110.00 14,618.67 110.00 14,612.13 110.00 14,605.60 110.00 14,599.07 110.00 14,592.53 $3,909,000 $3,909,500 110.00 14,633.61 110.00 14,627.08 110.00 14,620.54 110.00 14,614.01 110.00 14,607.48 110.00 14,600.94 110.00 14,594.41 $3,909,500 $3,910,000 110.00 14,635.48 110.00 14,628.95 110.00 14,622.42 110.00 14,615.88 110.00 14,609.35 110.00 14,602.82 110.00 14,596.28 $3,910,000 $3,910,500 110.00 14,637.36 110.00 14,630.83 110.00 14,624.29 110.00 14,617.76 110.00 14,611.23 110.00 14,604.69 110.00 14,598.16 $3,910,500 $3,911,000 110.00 14,639.23 110.00 14,632.70 110.00 14,626.17 110.00 14,619.63 110.00 14,613.10 110.00 14,606.57 110.00 14,600.03 $3,911,000 $3,911,500 110.00 14,641.11 110.00 14,634.58 110.00 14,628.04 110.00 14,621.51 110.00 14,614.98 110.00 14,608.44 110.00 14,601.91 $3,911,500 $3,912,000 110.00 14,642.98 110.00 14,636.45 110.00 14,629.92 110.00 14,623.38 110.00 14,616.85 110.00 14,610.32 110.00 14,603.78 $3,912,000 $3,912,500 110.00 14,644.86 110.00 14,638.33 110.00 14,631.79 110.00 14,625.26 110.00 14,618.73 110.00 14,612.19 110.00 14,605.66 $3,912,500 $3,913,000 110.00 14,646.73 110.00 14,640.20 110.00 14,633.67 110.00 14,627.13 110.00 14,620.60 110.00 14,614.07 110.00 14,607.53 $3,913,000 $3,913,500 110.00 14,648.61 110.00 14,642.08 110.00 14,635.54 110.00 14,629.01 110.00 14,622.48 110.00 14,615.94 110.00 14,609.41 $3,913,500 $3,914,000 110.00 14,650.48 110.00 14,643.95 110.00 14,637.42 110.00 14,630.88 110.00 14,624.35 110.00 14,617.82 110.00 14,611.28 $3,914,000 $3,914,500 110.00 14,652.36 110.00 14,645.83 110.00 14,639.29 110.00 14,632.76 110.00 14,626.23 110.00 14,619.69 110.00 14,613.16 $3,914,500 $3,915,000 110.00 14,654.23 110.00 14,647.70 110.00 14,641.17 110.00 14,634.63 110.00 14,628.10 110.00 14,621.57 110.00 14,615.03 $3,915,000 $3,915,500 110.00 14,656.11 110.00 14,649.58 110.00 14,643.04 110.00 14,636.51 110.00 14,629.98 110.00 14,623.44 110.00 14,616.91 $3,915,500 $3,916,000 110.00 14,657.98 110.00 14,651.45 110.00 14,644.92 110.00 14,638.38 110.00 14,631.85 110.00 14,625.32 110.00 14,618.78 $3,916,000 $3,916,500 110.00 14,659.86 110.00 14,653.33 110.00 14,646.79 110.00 14,640.26 110.00 14,633.73 110.00 14,627.19 110.00 14,620.66 $3,916,500 $3,917,000 110.00 14,661.73 110.00 14,655.20 110.00 14,648.67 110.00 14,642.13 110.00 14,635.60 110.00 14,629.07 110.00 14,622.53 $3,917,000 $3,917,500 110.00 14,663.61 110.00 14,657.08 110.00 14,650.54 110.00 14,644.01 110.00 14,637.48 110.00 14,630.94 110.00 14,624.41 $3,917,500 $3,918,000 110.00 14,665.48 110.00 14,658.95 110.00 14,652.42 110.00 14,645.88 110.00 14,639.35 110.00 14,632.82 110.00 14,626.28 $3,918,000 $3,918,500 110.00 14,667.36 110.00 14,660.83 110.00 14,654.29 110.00 14,647.76 110.00 14,641.23 110.00 14,634.69 110.00 14,628.16 $3,918,500 $3,919,000 110.00 14,669.23 110.00 14,662.70 110.00 14,656.17 110.00 14,649.63 110.00 14,643.10 110.00 14,636.57 110.00 14,630.03 $3,919,000 $3,919,500 110.00 14,671.11 110.00 14,664.58 110.00 14,658.04 110.00 14,651.51 110.00 14,644.98 110.00 14,638.44 110.00 14,631.91 $3,919,500 $3,920,000 110.00 14,672.98 110.00 14,666.45 110.00 14,659.92 110.00 14,653.38 110.00 14,646.85 110.00 14,640.32 110.00 14,633.78 $3,920,000 $3,920,500 110.00 14,674.86 110.00 14,668.33 110.00 14,661.79 110.00 14,655.26 110.00 14,648.73 110.00 14,642.19 110.00 14,635.66 $3,920,500 $3,921,000 110.00 14,676.73 110.00 14,670.20 110.00 14,663.67 110.00 14,657.13 110.00 14,650.60 110.00 14,644.07 110.00 14,637.53 $3,921,000 $3,921,500 110.00 14,678.61 110.00 14,672.08 110.00 14,665.54 110.00 14,659.01 110.00 14,652.48 110.00 14,645.94 110.00 14,639.41 $3,921,500 $3,922,000 110.00 14,680.48 110.00 14,673.95 110.00 14,667.42 110.00 14,660.88 110.00 14,654.35 110.00 14,647.82 110.00 14,641.28 $3,922,000 $3,922,500 110.00 14,682.36 110.00 14,675.83 110.00 14,669.29 110.00 14,662.76 110.00 14,656.23 110.00 14,649.69 110.00 14,643.16 $3,922,500 $3,923,000 110.00 14,684.23 110.00 14,677.70 110.00 14,671.17 110.00 14,664.63 110.00 14,658.10 110.00 14,651.57 110.00 14,645.03 $3,923,000 $3,923,500 110.00 14,686.11 110.00 14,679.58 110.00 14,673.04 110.00 14,666.51 110.00 14,659.98 110.00 14,653.44 110.00 14,646.91 $3,923,500 $3,924,000 110.00 14,687.98 110.00 14,681.45 110.00 14,674.92 110.00 14,668.38 110.00 14,661.85 110.00 14,655.32 110.00 14,648.78 $3,924,000 $3,924,500 110.00 14,689.86 110.00 14,683.33 110.00 14,676.79 110.00 14,670.26 110.00 14,663.73 110.00 14,657.19 110.00 14,650.66 $3,924,500 $3,925,000 110.00 14,691.73 110.00 14,685.20 110.00 14,678.67 110.00 14,672.13 110.00 14,665.60 110.00 14,659.07 110.00 14,652.53 $3,925,000 $3,925,500 110.00 14,693.61 110.00 14,687.08 110.00 14,680.54 110.00 14,674.01 110.00 14,667.48 110.00 14,660.94 110.00 14,654.41 $3,925,500 $3,926,000 110.00 14,695.48 110.00 14,688.95 110.00 14,682.42 110.00 14,675.88 110.00 14,669.35 110.00 14,662.82 110.00 14,656.28 $3,926,000 $3,926,500 110.00 14,697.36 110.00 14,690.83 110.00 14,684.29 110.00 14,677.76 110.00 14,671.23 110.00 14,664.69 110.00 14,658.16 $3,926,500 $3,927,000 110.00 14,699.23 110.00 14,692.70 110.00 14,686.17 110.00 14,679.63 110.00 14,673.10 110.00 14,666.57 110.00 14,660.03

NJEIS Family Cost Participation Table Page 80 of 12 Effective July 1, 2015

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

$3,927,000 $3,927,500 110.00 14,701.11 110.00 14,694.58 110.00 14,688.04 110.00 14,681.51 110.00 14,674.98 110.00 14,668.44 110.00 14,661.91 $3,927,500 $3,928,000 110.00 14,702.98 110.00 14,696.45 110.00 14,689.92 110.00 14,683.38 110.00 14,676.85 110.00 14,670.32 110.00 14,663.78 $3,928,000 $3,928,500 110.00 14,704.86 110.00 14,698.33 110.00 14,691.79 110.00 14,685.26 110.00 14,678.73 110.00 14,672.19 110.00 14,665.66 $3,928,500 $3,929,000 110.00 14,706.73 110.00 14,700.20 110.00 14,693.67 110.00 14,687.13 110.00 14,680.60 110.00 14,674.07 110.00 14,667.53 $3,929,000 $3,929,500 110.00 14,708.61 110.00 14,702.08 110.00 14,695.54 110.00 14,689.01 110.00 14,682.48 110.00 14,675.94 110.00 14,669.41 $3,929,500 $3,930,000 110.00 14,710.48 110.00 14,703.95 110.00 14,697.42 110.00 14,690.88 110.00 14,684.35 110.00 14,677.82 110.00 14,671.28 $3,930,000 $3,930,500 110.00 14,712.36 110.00 14,705.83 110.00 14,699.29 110.00 14,692.76 110.00 14,686.23 110.00 14,679.69 110.00 14,673.16 $3,930,500 $3,931,000 110.00 14,714.23 110.00 14,707.70 110.00 14,701.17 110.00 14,694.63 110.00 14,688.10 110.00 14,681.57 110.00 14,675.03 $3,931,000 $3,931,500 110.00 14,716.11 110.00 14,709.58 110.00 14,703.04 110.00 14,696.51 110.00 14,689.98 110.00 14,683.44 110.00 14,676.91 $3,931,500 $3,932,000 110.00 14,717.98 110.00 14,711.45 110.00 14,704.92 110.00 14,698.38 110.00 14,691.85 110.00 14,685.32 110.00 14,678.78 $3,932,000 $3,932,500 110.00 14,719.86 110.00 14,713.33 110.00 14,706.79 110.00 14,700.26 110.00 14,693.73 110.00 14,687.19 110.00 14,680.66 $3,932,500 $3,933,000 110.00 14,721.73 110.00 14,715.20 110.00 14,708.67 110.00 14,702.13 110.00 14,695.60 110.00 14,689.07 110.00 14,682.53 $3,933,000 $3,933,500 110.00 14,723.61 110.00 14,717.08 110.00 14,710.54 110.00 14,704.01 110.00 14,697.48 110.00 14,690.94 110.00 14,684.41 $3,933,500 $3,934,000 110.00 14,725.48 110.00 14,718.95 110.00 14,712.42 110.00 14,705.88 110.00 14,699.35 110.00 14,692.82 110.00 14,686.28 $3,934,000 $3,934,500 110.00 14,727.36 110.00 14,720.83 110.00 14,714.29 110.00 14,707.76 110.00 14,701.23 110.00 14,694.69 110.00 14,688.16 $3,934,500 $3,935,000 110.00 14,729.23 110.00 14,722.70 110.00 14,716.17 110.00 14,709.63 110.00 14,703.10 110.00 14,696.57 110.00 14,690.03 $3,935,000 $3,935,500 110.00 14,731.11 110.00 14,724.58 110.00 14,718.04 110.00 14,711.51 110.00 14,704.98 110.00 14,698.44 110.00 14,691.91 $3,935,500 $3,936,000 110.00 14,732.98 110.00 14,726.45 110.00 14,719.92 110.00 14,713.38 110.00 14,706.85 110.00 14,700.32 110.00 14,693.78 $3,936,000 $3,936,500 110.00 14,734.86 110.00 14,728.33 110.00 14,721.79 110.00 14,715.26 110.00 14,708.73 110.00 14,702.19 110.00 14,695.66 $3,936,500 $3,937,000 110.00 14,736.73 110.00 14,730.20 110.00 14,723.67 110.00 14,717.13 110.00 14,710.60 110.00 14,704.07 110.00 14,697.53 $3,937,000 $3,937,500 110.00 14,738.61 110.00 14,732.08 110.00 14,725.54 110.00 14,719.01 110.00 14,712.48 110.00 14,705.94 110.00 14,699.41 $3,937,500 $3,938,000 110.00 14,740.48 110.00 14,733.95 110.00 14,727.42 110.00 14,720.88 110.00 14,714.35 110.00 14,707.82 110.00 14,701.28 $3,938,000 $3,938,500 110.00 14,742.36 110.00 14,735.83 110.00 14,729.29 110.00 14,722.76 110.00 14,716.23 110.00 14,709.69 110.00 14,703.16 $3,938,500 $3,939,000 110.00 14,744.23 110.00 14,737.70 110.00 14,731.17 110.00 14,724.63 110.00 14,718.10 110.00 14,711.57 110.00 14,705.03 $3,939,000 $3,939,500 110.00 14,746.11 110.00 14,739.58 110.00 14,733.04 110.00 14,726.51 110.00 14,719.98 110.00 14,713.44 110.00 14,706.91 $3,939,500 $3,940,000 110.00 14,747.98 110.00 14,741.45 110.00 14,734.92 110.00 14,728.38 110.00 14,721.85 110.00 14,715.32 110.00 14,708.78 $3,940,000 $3,940,500 110.00 14,749.86 110.00 14,743.33 110.00 14,736.79 110.00 14,730.26 110.00 14,723.73 110.00 14,717.19 110.00 14,710.66 $3,940,500 $3,941,000 110.00 14,751.73 110.00 14,745.20 110.00 14,738.67 110.00 14,732.13 110.00 14,725.60 110.00 14,719.07 110.00 14,712.53 $3,941,000 $3,941,500 110.00 14,753.61 110.00 14,747.08 110.00 14,740.54 110.00 14,734.01 110.00 14,727.48 110.00 14,720.94 110.00 14,714.41 $3,941,500 $3,942,000 110.00 14,755.48 110.00 14,748.95 110.00 14,742.42 110.00 14,735.88 110.00 14,729.35 110.00 14,722.82 110.00 14,716.28 $3,942,000 $3,942,500 110.00 14,757.36 110.00 14,750.83 110.00 14,744.29 110.00 14,737.76 110.00 14,731.23 110.00 14,724.69 110.00 14,718.16 $3,942,500 $3,943,000 110.00 14,759.23 110.00 14,752.70 110.00 14,746.17 110.00 14,739.63 110.00 14,733.10 110.00 14,726.57 110.00 14,720.03 $3,943,000 $3,943,500 110.00 14,761.11 110.00 14,754.58 110.00 14,748.04 110.00 14,741.51 110.00 14,734.98 110.00 14,728.44 110.00 14,721.91 $3,943,500 $3,944,000 110.00 14,762.98 110.00 14,756.45 110.00 14,749.92 110.00 14,743.38 110.00 14,736.85 110.00 14,730.32 110.00 14,723.78 $3,944,000 $3,944,500 110.00 14,764.86 110.00 14,758.33 110.00 14,751.79 110.00 14,745.26 110.00 14,738.73 110.00 14,732.19 110.00 14,725.66 $3,944,500 $3,945,000 110.00 14,766.73 110.00 14,760.20 110.00 14,753.67 110.00 14,747.13 110.00 14,740.60 110.00 14,734.07 110.00 14,727.53 $3,945,000 $3,945,500 110.00 14,768.61 110.00 14,762.08 110.00 14,755.54 110.00 14,749.01 110.00 14,742.48 110.00 14,735.94 110.00 14,729.41 $3,945,500 $3,946,000 110.00 14,770.48 110.00 14,763.95 110.00 14,757.42 110.00 14,750.88 110.00 14,744.35 110.00 14,737.82 110.00 14,731.28 $3,946,000 $3,946,500 110.00 14,772.36 110.00 14,765.83 110.00 14,759.29 110.00 14,752.76 110.00 14,746.23 110.00 14,739.69 110.00 14,733.16 $3,946,500 $3,947,000 110.00 14,774.23 110.00 14,767.70 110.00 14,761.17 110.00 14,754.63 110.00 14,748.10 110.00 14,741.57 110.00 14,735.03 $3,947,000 $3,947,500 110.00 14,776.11 110.00 14,769.58 110.00 14,763.04 110.00 14,756.51 110.00 14,749.98 110.00 14,743.44 110.00 14,736.91 $3,947,500 $3,948,000 110.00 14,777.98 110.00 14,771.45 110.00 14,764.92 110.00 14,758.38 110.00 14,751.85 110.00 14,745.32 110.00 14,738.78 $3,948,000 $3,948,500 110.00 14,779.86 110.00 14,773.33 110.00 14,766.79 110.00 14,760.26 110.00 14,753.73 110.00 14,747.19 110.00 14,740.66 $3,948,500 $3,949,000 110.00 14,781.73 110.00 14,775.20 110.00 14,768.67 110.00 14,762.13 110.00 14,755.60 110.00 14,749.07 110.00 14,742.53 $3,949,000 $3,949,500 110.00 14,783.61 110.00 14,777.08 110.00 14,770.54 110.00 14,764.01 110.00 14,757.48 110.00 14,750.94 110.00 14,744.41 $3,949,500 $3,950,000 110.00 14,785.48 110.00 14,778.95 110.00 14,772.42 110.00 14,765.88 110.00 14,759.35 110.00 14,752.82 110.00 14,746.28 $3,950,000 $3,950,500 110.00 14,787.36 110.00 14,780.83 110.00 14,774.29 110.00 14,767.76 110.00 14,761.23 110.00 14,754.69 110.00 14,748.16 $3,950,500 $3,951,000 110.00 14,789.23 110.00 14,782.70 110.00 14,776.17 110.00 14,769.63 110.00 14,763.10 110.00 14,756.57 110.00 14,750.03 $3,951,000 $3,951,500 110.00 14,791.11 110.00 14,784.58 110.00 14,778.04 110.00 14,771.51 110.00 14,764.98 110.00 14,758.44 110.00 14,751.91 $3,951,500 $3,952,000 110.00 14,792.98 110.00 14,786.45 110.00 14,779.92 110.00 14,773.38 110.00 14,766.85 110.00 14,760.32 110.00 14,753.78 $3,952,000 $3,952,500 110.00 14,794.86 110.00 14,788.33 110.00 14,781.79 110.00 14,775.26 110.00 14,768.73 110.00 14,762.19 110.00 14,755.66 $3,952,500 $3,953,000 110.00 14,796.73 110.00 14,790.20 110.00 14,783.67 110.00 14,777.13 110.00 14,770.60 110.00 14,764.07 110.00 14,757.53 $3,953,000 $3,953,500 110.00 14,798.61 110.00 14,792.08 110.00 14,785.54 110.00 14,779.01 110.00 14,772.48 110.00 14,765.94 110.00 14,759.41 $3,953,500 $3,954,000 110.00 14,800.48 110.00 14,793.95 110.00 14,787.42 110.00 14,780.88 110.00 14,774.35 110.00 14,767.82 110.00 14,761.28 $3,954,000 $3,954,500 110.00 14,802.36 110.00 14,795.83 110.00 14,789.29 110.00 14,782.76 110.00 14,776.23 110.00 14,769.69 110.00 14,763.16 $3,954,500 $3,955,000 110.00 14,804.23 110.00 14,797.70 110.00 14,791.17 110.00 14,784.63 110.00 14,778.10 110.00 14,771.57 110.00 14,765.03 $3,955,000 $3,955,500 110.00 14,806.11 110.00 14,799.58 110.00 14,793.04 110.00 14,786.51 110.00 14,779.98 110.00 14,773.44 110.00 14,766.91 $3,955,500 $3,956,000 110.00 14,807.98 110.00 14,801.45 110.00 14,794.92 110.00 14,788.38 110.00 14,781.85 110.00 14,775.32 110.00 14,768.78 $3,956,000 $3,956,500 110.00 14,809.86 110.00 14,803.33 110.00 14,796.79 110.00 14,790.26 110.00 14,783.73 110.00 14,777.19 110.00 14,770.66 $3,956,500 $3,957,000 110.00 14,811.73 110.00 14,805.20 110.00 14,798.67 110.00 14,792.13 110.00 14,785.60 110.00 14,779.07 110.00 14,772.53 $3,957,000 $3,957,500 110.00 14,813.61 110.00 14,807.08 110.00 14,800.54 110.00 14,794.01 110.00 14,787.48 110.00 14,780.94 110.00 14,774.41 $3,957,500 $3,958,000 110.00 14,815.48 110.00 14,808.95 110.00 14,802.42 110.00 14,795.88 110.00 14,789.35 110.00 14,782.82 110.00 14,776.28 $3,958,000 $3,958,500 110.00 14,817.36 110.00 14,810.83 110.00 14,804.29 110.00 14,797.76 110.00 14,791.23 110.00 14,784.69 110.00 14,778.16 $3,958,500 $3,959,000 110.00 14,819.23 110.00 14,812.70 110.00 14,806.17 110.00 14,799.63 110.00 14,793.10 110.00 14,786.57 110.00 14,780.03 $3,959,000 $3,959,500 110.00 14,821.11 110.00 14,814.58 110.00 14,808.04 110.00 14,801.51 110.00 14,794.98 110.00 14,788.44 110.00 14,781.91 $3,959,500 $3,960,000 110.00 14,822.98 110.00 14,816.45 110.00 14,809.92 110.00 14,803.38 110.00 14,796.85 110.00 14,790.32 110.00 14,783.78 $3,960,000 $3,960,500 110.00 14,824.86 110.00 14,818.33 110.00 14,811.79 110.00 14,805.26 110.00 14,798.73 110.00 14,792.19 110.00 14,785.66 $3,960,500 $3,961,000 110.00 14,826.73 110.00 14,820.20 110.00 14,813.67 110.00 14,807.13 110.00 14,800.60 110.00 14,794.07 110.00 14,787.53 $3,961,000 $3,961,500 110.00 14,828.61 110.00 14,822.08 110.00 14,815.54 110.00 14,809.01 110.00 14,802.48 110.00 14,795.94 110.00 14,789.41 $3,961,500 $3,962,000 110.00 14,830.48 110.00 14,823.95 110.00 14,817.42 110.00 14,810.88 110.00 14,804.35 110.00 14,797.82 110.00 14,791.28 $3,962,000 $3,962,500 110.00 14,832.36 110.00 14,825.83 110.00 14,819.29 110.00 14,812.76 110.00 14,806.23 110.00 14,799.69 110.00 14,793.16 $3,962,500 $3,963,000 110.00 14,834.23 110.00 14,827.70 110.00 14,821.17 110.00 14,814.63 110.00 14,808.10 110.00 14,801.57 110.00 14,795.03 $3,963,000 $3,963,500 110.00 14,836.11 110.00 14,829.58 110.00 14,823.04 110.00 14,816.51 110.00 14,809.98 110.00 14,803.44 110.00 14,796.91 $3,963,500 $3,964,000 110.00 14,837.98 110.00 14,831.45 110.00 14,824.92 110.00 14,818.38 110.00 14,811.85 110.00 14,805.32 110.00 14,798.78 $3,964,000 $3,964,500 110.00 14,839.86 110.00 14,833.33 110.00 14,826.79 110.00 14,820.26 110.00 14,813.73 110.00 14,807.19 110.00 14,800.66 $3,964,500 $3,965,000 110.00 14,841.73 110.00 14,835.20 110.00 14,828.67 110.00 14,822.13 110.00 14,815.60 110.00 14,809.07 110.00 14,802.53 $3,965,000 $3,965,500 110.00 14,843.61 110.00 14,837.08 110.00 14,830.54 110.00 14,824.01 110.00 14,817.48 110.00 14,810.94 110.00 14,804.41 $3,965,500 $3,966,000 110.00 14,845.48 110.00 14,838.95 110.00 14,832.42 110.00 14,825.88 110.00 14,819.35 110.00 14,812.82 110.00 14,806.28 $3,966,000 $3,966,500 110.00 14,847.36 110.00 14,840.83 110.00 14,834.29 110.00 14,827.76 110.00 14,821.23 110.00 14,814.69 110.00 14,808.16 $3,966,500 $3,967,000 110.00 14,849.23 110.00 14,842.70 110.00 14,836.17 110.00 14,829.63 110.00 14,823.10 110.00 14,816.57 110.00 14,810.03 $3,967,000 $3,967,500 110.00 14,851.11 110.00 14,844.58 110.00 14,838.04 110.00 14,831.51 110.00 14,824.98 110.00 14,818.44 110.00 14,811.91 $3,967,500 $3,968,000 110.00 14,852.98 110.00 14,846.45 110.00 14,839.92 110.00 14,833.38 110.00 14,826.85 110.00 14,820.32 110.00 14,813.78 $3,968,000 $3,968,500 110.00 14,854.86 110.00 14,848.33 110.00 14,841.79 110.00 14,835.26 110.00 14,828.73 110.00 14,822.19 110.00 14,815.66 $3,968,500 $3,969,000 110.00 14,856.73 110.00 14,850.20 110.00 14,843.67 110.00 14,837.13 110.00 14,830.60 110.00 14,824.07 110.00 14,817.53 $3,969,000 $3,969,500 110.00 14,858.61 110.00 14,852.08 110.00 14,845.54 110.00 14,839.01 110.00 14,832.48 110.00 14,825.94 110.00 14,819.41 $3,969,500 $3,970,000 110.00 14,860.48 110.00 14,853.95 110.00 14,847.42 110.00 14,840.88 110.00 14,834.35 110.00 14,827.82 110.00 14,821.28 $3,970,000 $3,970,500 110.00 14,862.36 110.00 14,855.83 110.00 14,849.29 110.00 14,842.76 110.00 14,836.23 110.00 14,829.69 110.00 14,823.16 $3,970,500 $3,971,000 110.00 14,864.23 110.00 14,857.70 110.00 14,851.17 110.00 14,844.63 110.00 14,838.10 110.00 14,831.57 110.00 14,825.03 $3,971,000 $3,971,500 110.00 14,866.11 110.00 14,859.58 110.00 14,853.04 110.00 14,846.51 110.00 14,839.98 110.00 14,833.44 110.00 14,826.91 $3,971,500 $3,972,000 110.00 14,867.98 110.00 14,861.45 110.00 14,854.92 110.00 14,848.38 110.00 14,841.85 110.00 14,835.32 110.00 14,828.78 $3,972,000 $3,972,500 110.00 14,869.86 110.00 14,863.33 110.00 14,856.79 110.00 14,850.26 110.00 14,843.73 110.00 14,837.19 110.00 14,830.66 $3,972,500 $3,973,000 110.00 14,871.73 110.00 14,865.20 110.00 14,858.67 110.00 14,852.13 110.00 14,845.60 110.00 14,839.07 110.00 14,832.53 $3,973,000 $3,973,500 110.00 14,873.61 110.00 14,867.08 110.00 14,860.54 110.00 14,854.01 110.00 14,847.48 110.00 14,840.94 110.00 14,834.41 $3,973,500 $3,974,000 110.00 14,875.48 110.00 14,868.95 110.00 14,862.42 110.00 14,855.88 110.00 14,849.35 110.00 14,842.82 110.00 14,836.28 $3,974,000 $3,974,500 110.00 14,877.36 110.00 14,870.83 110.00 14,864.29 110.00 14,857.76 110.00 14,851.23 110.00 14,844.69 110.00 14,838.16 $3,974,500 $3,975,000 110.00 14,879.23 110.00 14,872.70 110.00 14,866.17 110.00 14,859.63 110.00 14,853.10 110.00 14,846.57 110.00 14,840.03 $3,975,000 $3,975,500 110.00 14,881.11 110.00 14,874.58 110.00 14,868.04 110.00 14,861.51 110.00 14,854.98 110.00 14,848.44 110.00 14,841.91 $3,975,500 $3,976,000 110.00 14,882.98 110.00 14,876.45 110.00 14,869.92 110.00 14,863.38 110.00 14,856.85 110.00 14,850.32 110.00 14,843.78 $3,976,000 $3,976,500 110.00 14,884.86 110.00 14,878.33 110.00 14,871.79 110.00 14,865.26 110.00 14,858.73 110.00 14,852.19 110.00 14,845.66 $3,976,500 $3,977,000 110.00 14,886.73 110.00 14,880.20 110.00 14,873.67 110.00 14,867.13 110.00 14,860.60 110.00 14,854.07 110.00 14,847.53 $3,977,000 $3,977,500 110.00 14,888.61 110.00 14,882.08 110.00 14,875.54 110.00 14,869.01 110.00 14,862.48 110.00 14,855.94 110.00 14,849.41 $3,977,500 $3,978,000 110.00 14,890.48 110.00 14,883.95 110.00 14,877.42 110.00 14,870.88 110.00 14,864.35 110.00 14,857.82 110.00 14,851.28

NJEIS Family Cost Participation Table Page 81 of 12 Effective July 1, 2015

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

$3,978,000 $3,978,500 110.00 14,892.36 110.00 14,885.83 110.00 14,879.29 110.00 14,872.76 110.00 14,866.23 110.00 14,859.69 110.00 14,853.16 $3,978,500 $3,979,000 110.00 14,894.23 110.00 14,887.70 110.00 14,881.17 110.00 14,874.63 110.00 14,868.10 110.00 14,861.57 110.00 14,855.03 $3,979,000 $3,979,500 110.00 14,896.11 110.00 14,889.58 110.00 14,883.04 110.00 14,876.51 110.00 14,869.98 110.00 14,863.44 110.00 14,856.91 $3,979,500 $3,980,000 110.00 14,897.98 110.00 14,891.45 110.00 14,884.92 110.00 14,878.38 110.00 14,871.85 110.00 14,865.32 110.00 14,858.78 $3,980,000 $3,980,500 110.00 14,899.86 110.00 14,893.33 110.00 14,886.79 110.00 14,880.26 110.00 14,873.73 110.00 14,867.19 110.00 14,860.66 $3,980,500 $3,981,000 110.00 14,901.73 110.00 14,895.20 110.00 14,888.67 110.00 14,882.13 110.00 14,875.60 110.00 14,869.07 110.00 14,862.53 $3,981,000 $3,981,500 110.00 14,903.61 110.00 14,897.08 110.00 14,890.54 110.00 14,884.01 110.00 14,877.48 110.00 14,870.94 110.00 14,864.41 $3,981,500 $3,982,000 110.00 14,905.48 110.00 14,898.95 110.00 14,892.42 110.00 14,885.88 110.00 14,879.35 110.00 14,872.82 110.00 14,866.28 $3,982,000 $3,982,500 110.00 14,907.36 110.00 14,900.83 110.00 14,894.29 110.00 14,887.76 110.00 14,881.23 110.00 14,874.69 110.00 14,868.16 $3,982,500 $3,983,000 110.00 14,909.23 110.00 14,902.70 110.00 14,896.17 110.00 14,889.63 110.00 14,883.10 110.00 14,876.57 110.00 14,870.03 $3,983,000 $3,983,500 110.00 14,911.11 110.00 14,904.58 110.00 14,898.04 110.00 14,891.51 110.00 14,884.98 110.00 14,878.44 110.00 14,871.91 $3,983,500 $3,984,000 110.00 14,912.98 110.00 14,906.45 110.00 14,899.92 110.00 14,893.38 110.00 14,886.85 110.00 14,880.32 110.00 14,873.78 $3,984,000 $3,984,500 110.00 14,914.86 110.00 14,908.33 110.00 14,901.79 110.00 14,895.26 110.00 14,888.73 110.00 14,882.19 110.00 14,875.66 $3,984,500 $3,985,000 110.00 14,916.73 110.00 14,910.20 110.00 14,903.67 110.00 14,897.13 110.00 14,890.60 110.00 14,884.07 110.00 14,877.53 $3,985,000 $3,985,500 110.00 14,918.61 110.00 14,912.08 110.00 14,905.54 110.00 14,899.01 110.00 14,892.48 110.00 14,885.94 110.00 14,879.41 $3,985,500 $3,986,000 110.00 14,920.48 110.00 14,913.95 110.00 14,907.42 110.00 14,900.88 110.00 14,894.35 110.00 14,887.82 110.00 14,881.28 $3,986,000 $3,986,500 110.00 14,922.36 110.00 14,915.83 110.00 14,909.29 110.00 14,902.76 110.00 14,896.23 110.00 14,889.69 110.00 14,883.16 $3,986,500 $3,987,000 110.00 14,924.23 110.00 14,917.70 110.00 14,911.17 110.00 14,904.63 110.00 14,898.10 110.00 14,891.57 110.00 14,885.03 $3,987,000 $3,987,500 110.00 14,926.11 110.00 14,919.58 110.00 14,913.04 110.00 14,906.51 110.00 14,899.98 110.00 14,893.44 110.00 14,886.91 $3,987,500 $3,988,000 110.00 14,927.98 110.00 14,921.45 110.00 14,914.92 110.00 14,908.38 110.00 14,901.85 110.00 14,895.32 110.00 14,888.78 $3,988,000 $3,988,500 110.00 14,929.86 110.00 14,923.33 110.00 14,916.79 110.00 14,910.26 110.00 14,903.73 110.00 14,897.19 110.00 14,890.66 $3,988,500 $3,989,000 110.00 14,931.73 110.00 14,925.20 110.00 14,918.67 110.00 14,912.13 110.00 14,905.60 110.00 14,899.07 110.00 14,892.53 $3,989,000 $3,989,500 110.00 14,933.61 110.00 14,927.08 110.00 14,920.54 110.00 14,914.01 110.00 14,907.48 110.00 14,900.94 110.00 14,894.41 $3,989,500 $3,990,000 110.00 14,935.48 110.00 14,928.95 110.00 14,922.42 110.00 14,915.88 110.00 14,909.35 110.00 14,902.82 110.00 14,896.28 $3,990,000 $3,990,500 110.00 14,937.36 110.00 14,930.83 110.00 14,924.29 110.00 14,917.76 110.00 14,911.23 110.00 14,904.69 110.00 14,898.16 $3,990,500 $3,991,000 110.00 14,939.23 110.00 14,932.70 110.00 14,926.17 110.00 14,919.63 110.00 14,913.10 110.00 14,906.57 110.00 14,900.03 $3,991,000 $3,991,500 110.00 14,941.11 110.00 14,934.58 110.00 14,928.04 110.00 14,921.51 110.00 14,914.98 110.00 14,908.44 110.00 14,901.91 $3,991,500 $3,992,000 110.00 14,942.98 110.00 14,936.45 110.00 14,929.92 110.00 14,923.38 110.00 14,916.85 110.00 14,910.32 110.00 14,903.78 $3,992,000 $3,992,500 110.00 14,944.86 110.00 14,938.33 110.00 14,931.79 110.00 14,925.26 110.00 14,918.73 110.00 14,912.19 110.00 14,905.66 $3,992,500 $3,993,000 110.00 14,946.73 110.00 14,940.20 110.00 14,933.67 110.00 14,927.13 110.00 14,920.60 110.00 14,914.07 110.00 14,907.53 $3,993,000 $3,993,500 110.00 14,948.61 110.00 14,942.08 110.00 14,935.54 110.00 14,929.01 110.00 14,922.48 110.00 14,915.94 110.00 14,909.41 $3,993,500 $3,994,000 110.00 14,950.48 110.00 14,943.95 110.00 14,937.42 110.00 14,930.88 110.00 14,924.35 110.00 14,917.82 110.00 14,911.28 $3,994,000 $3,994,500 110.00 14,952.36 110.00 14,945.83 110.00 14,939.29 110.00 14,932.76 110.00 14,926.23 110.00 14,919.69 110.00 14,913.16 $3,994,500 $3,995,000 110.00 14,954.23 110.00 14,947.70 110.00 14,941.17 110.00 14,934.63 110.00 14,928.10 110.00 14,921.57 110.00 14,915.03 $3,995,000 $3,995,500 110.00 14,956.11 110.00 14,949.58 110.00 14,943.04 110.00 14,936.51 110.00 14,929.98 110.00 14,923.44 110.00 14,916.91 $3,995,500 $3,996,000 110.00 14,957.98 110.00 14,951.45 110.00 14,944.92 110.00 14,938.38 110.00 14,931.85 110.00 14,925.32 110.00 14,918.78 $3,996,000 $3,996,500 110.00 14,959.86 110.00 14,953.33 110.00 14,946.79 110.00 14,940.26 110.00 14,933.73 110.00 14,927.19 110.00 14,920.66 $3,996,500 $3,997,000 110.00 14,961.73 110.00 14,955.20 110.00 14,948.67 110.00 14,942.13 110.00 14,935.60 110.00 14,929.07 110.00 14,922.53 $3,997,000 $3,997,500 110.00 14,963.61 110.00 14,957.08 110.00 14,950.54 110.00 14,944.01 110.00 14,937.48 110.00 14,930.94 110.00 14,924.41 $3,997,500 $3,998,000 110.00 14,965.48 110.00 14,958.95 110.00 14,952.42 110.00 14,945.88 110.00 14,939.35 110.00 14,932.82 110.00 14,926.28 $3,998,000 $3,998,500 110.00 14,967.36 110.00 14,960.83 110.00 14,954.29 110.00 14,947.76 110.00 14,941.23 110.00 14,934.69 110.00 14,928.16 $3,998,500 $3,999,000 110.00 14,969.23 110.00 14,962.70 110.00 14,956.17 110.00 14,949.63 110.00 14,943.10 110.00 14,936.57 110.00 14,930.03 $3,999,000 $3,999,500 110.00 14,971.11 110.00 14,964.58 110.00 14,958.04 110.00 14,951.51 110.00 14,944.98 110.00 14,938.44 110.00 14,931.91 $3,999,500 $4,000,000 110.00 14,972.98 110.00 14,966.45 110.00 14,959.92 110.00 14,953.38 110.00 14,946.85 110.00 14,940.32 110.00 14,933.78 $4,000,000 $4,000,500 110.00 14,974.86 110.00 14,968.33 110.00 14,961.79 110.00 14,955.26 110.00 14,948.73 110.00 14,942.19 110.00 14,935.66 $4,000,500 $4,001,000 110.00 14,976.73 110.00 14,970.20 110.00 14,963.67 110.00 14,957.13 110.00 14,950.60 110.00 14,944.07 110.00 14,937.53 $4,001,000 $4,001,500 110.00 14,978.61 110.00 14,972.08 110.00 14,965.54 110.00 14,959.01 110.00 14,952.48 110.00 14,945.94 110.00 14,939.41 $4,001,500 $4,002,000 110.00 14,980.48 110.00 14,973.95 110.00 14,967.42 110.00 14,960.88 110.00 14,954.35 110.00 14,947.82 110.00 14,941.28 $4,002,000 $4,002,500 110.00 14,982.36 110.00 14,975.83 110.00 14,969.29 110.00 14,962.76 110.00 14,956.23 110.00 14,949.69 110.00 14,943.16 $4,002,500 $4,003,000 110.00 14,984.23 110.00 14,977.70 110.00 14,971.17 110.00 14,964.63 110.00 14,958.10 110.00 14,951.57 110.00 14,945.03 $4,003,000 $4,003,500 110.00 14,986.11 110.00 14,979.58 110.00 14,973.04 110.00 14,966.51 110.00 14,959.98 110.00 14,953.44 110.00 14,946.91 $4,003,500 $4,004,000 110.00 14,987.98 110.00 14,981.45 110.00 14,974.92 110.00 14,968.38 110.00 14,961.85 110.00 14,955.32 110.00 14,948.78 $4,004,000 $4,004,500 110.00 14,989.86 110.00 14,983.33 110.00 14,976.79 110.00 14,970.26 110.00 14,963.73 110.00 14,957.19 110.00 14,950.66 $4,004,500 $4,005,000 110.00 14,991.73 110.00 14,985.20 110.00 14,978.67 110.00 14,972.13 110.00 14,965.60 110.00 14,959.07 110.00 14,952.53 $4,005,000 $4,005,500 110.00 14,993.61 110.00 14,987.08 110.00 14,980.54 110.00 14,974.01 110.00 14,967.48 110.00 14,960.94 110.00 14,954.41 $4,005,500 $4,006,000 110.00 14,995.48 110.00 14,988.95 110.00 14,982.42 110.00 14,975.88 110.00 14,969.35 110.00 14,962.82 110.00 14,956.28 $4,006,000 $4,006,500 110.00 14,997.36 110.00 14,990.83 110.00 14,984.29 110.00 14,977.76 110.00 14,971.23 110.00 14,964.69 110.00 14,958.16 $4,006,500 $4,007,000 110.00 14,999.23 110.00 14,992.70 110.00 14,986.17 110.00 14,979.63 110.00 14,973.10 110.00 14,966.57 110.00 14,960.03 $4,007,000 $4,007,500 110.00 15,001.11 110.00 14,994.58 110.00 14,988.04 110.00 14,981.51 110.00 14,974.98 110.00 14,968.44 110.00 14,961.91 $4,007,500 $4,008,000 110.00 15,002.98 110.00 14,996.45 110.00 14,989.92 110.00 14,983.38 110.00 14,976.85 110.00 14,970.32 110.00 14,963.78 $4,008,000 $4,008,500 110.00 15,004.86 110.00 14,998.33 110.00 14,991.79 110.00 14,985.26 110.00 14,978.73 110.00 14,972.19 110.00 14,965.66 $4,008,500 $4,009,000 110.00 15,006.73 110.00 15,000.20 110.00 14,993.67 110.00 14,987.13 110.00 14,980.60 110.00 14,974.07 110.00 14,967.53 $4,009,000 $4,009,500 110.00 15,008.61 110.00 15,002.08 110.00 14,995.54 110.00 14,989.01 110.00 14,982.48 110.00 14,975.94 110.00 14,969.41 $4,009,500 $4,010,000 110.00 15,010.48 110.00 15,003.95 110.00 14,997.42 110.00 14,990.88 110.00 14,984.35 110.00 14,977.82 110.00 14,971.28 $4,010,000 $4,010,500 110.00 15,012.36 110.00 15,005.83 110.00 14,999.29 110.00 14,992.76 110.00 14,986.23 110.00 14,979.69 110.00 14,973.16 $4,010,500 $4,011,000 110.00 15,014.23 110.00 15,007.70 110.00 15,001.17 110.00 14,994.63 110.00 14,988.10 110.00 14,981.57 110.00 14,975.03 $4,011,000 $4,011,500 110.00 15,016.11 110.00 15,009.58 110.00 15,003.04 110.00 14,996.51 110.00 14,989.98 110.00 14,983.44 110.00 14,976.91 $4,011,500 $4,012,000 110.00 15,017.98 110.00 15,011.45 110.00 15,004.92 110.00 14,998.38 110.00 14,991.85 110.00 14,985.32 110.00 14,978.78 $4,012,000 $4,012,500 110.00 15,019.86 110.00 15,013.33 110.00 15,006.79 110.00 15,000.26 110.00 14,993.73 110.00 14,987.19 110.00 14,980.66 $4,012,500 $4,013,000 110.00 15,021.73 110.00 15,015.20 110.00 15,008.67 110.00 15,002.13 110.00 14,995.60 110.00 14,989.07 110.00 14,982.53 $4,013,000 $4,013,500 110.00 15,023.61 110.00 15,017.08 110.00 15,010.54 110.00 15,004.01 110.00 14,997.48 110.00 14,990.94 110.00 14,984.41 $4,013,500 $4,014,000 110.00 15,025.48 110.00 15,018.95 110.00 15,012.42 110.00 15,005.88 110.00 14,999.35 110.00 14,992.82 110.00 14,986.28 $4,014,000 $4,014,500 110.00 15,027.36 110.00 15,020.83 110.00 15,014.29 110.00 15,007.76 110.00 15,001.23 110.00 14,994.69 110.00 14,988.16 $4,014,500 $4,015,000 110.00 15,029.23 110.00 15,022.70 110.00 15,016.17 110.00 15,009.63 110.00 15,003.10 110.00 14,996.57 110.00 14,990.03 $4,015,000 $4,015,500 110.00 15,031.11 110.00 15,024.58 110.00 15,018.04 110.00 15,011.51 110.00 15,004.98 110.00 14,998.44 110.00 14,991.91 $4,015,500 $4,016,000 110.00 15,032.98 110.00 15,026.45 110.00 15,019.92 110.00 15,013.38 110.00 15,006.85 110.00 15,000.32 110.00 14,993.78 $4,016,000 $4,016,500 110.00 15,034.86 110.00 15,028.33 110.00 15,021.79 110.00 15,015.26 110.00 15,008.73 110.00 15,002.19 110.00 14,995.66 $4,016,500 $4,017,000 110.00 15,036.73 110.00 15,030.20 110.00 15,023.67 110.00 15,017.13 110.00 15,010.60 110.00 15,004.07 110.00 14,997.53 $4,017,000 $4,017,500 110.00 15,038.61 110.00 15,032.08 110.00 15,025.54 110.00 15,019.01 110.00 15,012.48 110.00 15,005.94 110.00 14,999.41 $4,017,500 $4,018,000 110.00 15,040.48 110.00 15,033.95 110.00 15,027.42 110.00 15,020.88 110.00 15,014.35 110.00 15,007.82 110.00 15,001.28 $4,018,000 $4,018,500 110.00 15,042.36 110.00 15,035.83 110.00 15,029.29 110.00 15,022.76 110.00 15,016.23 110.00 15,009.69 110.00 15,003.16 $4,018,500 $4,019,000 110.00 15,044.23 110.00 15,037.70 110.00 15,031.17 110.00 15,024.63 110.00 15,018.10 110.00 15,011.57 110.00 15,005.03 $4,019,000 $4,019,500 110.00 15,046.11 110.00 15,039.58 110.00 15,033.04 110.00 15,026.51 110.00 15,019.98 110.00 15,013.44 110.00 15,006.91 $4,019,500 $4,020,000 110.00 15,047.98 110.00 15,041.45 110.00 15,034.92 110.00 15,028.38 110.00 15,021.85 110.00 15,015.32 110.00 15,008.78 $4,020,000 $4,020,500 110.00 15,049.86 110.00 15,043.33 110.00 15,036.79 110.00 15,030.26 110.00 15,023.73 110.00 15,017.19 110.00 15,010.66 $4,020,500 $4,021,000 110.00 15,051.73 110.00 15,045.20 110.00 15,038.67 110.00 15,032.13 110.00 15,025.60 110.00 15,019.07 110.00 15,012.53 $4,021,000 $4,021,500 110.00 15,053.61 110.00 15,047.08 110.00 15,040.54 110.00 15,034.01 110.00 15,027.48 110.00 15,020.94 110.00 15,014.41 $4,021,500 $4,022,000 110.00 15,055.48 110.00 15,048.95 110.00 15,042.42 110.00 15,035.88 110.00 15,029.35 110.00 15,022.82 110.00 15,016.28 $4,022,000 $4,022,500 110.00 15,057.36 110.00 15,050.83 110.00 15,044.29 110.00 15,037.76 110.00 15,031.23 110.00 15,024.69 110.00 15,018.16 $4,022,500 $4,023,000 110.00 15,059.23 110.00 15,052.70 110.00 15,046.17 110.00 15,039.63 110.00 15,033.10 110.00 15,026.57 110.00 15,020.03 $4,023,000 $4,023,500 110.00 15,061.11 110.00 15,054.58 110.00 15,048.04 110.00 15,041.51 110.00 15,034.98 110.00 15,028.44 110.00 15,021.91 $4,023,500 $4,024,000 110.00 15,062.98 110.00 15,056.45 110.00 15,049.92 110.00 15,043.38 110.00 15,036.85 110.00 15,030.32 110.00 15,023.78 $4,024,000 $4,024,500 110.00 15,064.86 110.00 15,058.33 110.00 15,051.79 110.00 15,045.26 110.00 15,038.73 110.00 15,032.19 110.00 15,025.66 $4,024,500 $4,025,000 110.00 15,066.73 110.00 15,060.20 110.00 15,053.67 110.00 15,047.13 110.00 15,040.60 110.00 15,034.07 110.00 15,027.53 $4,025,000 $4,025,500 110.00 15,068.61 110.00 15,062.08 110.00 15,055.54 110.00 15,049.01 110.00 15,042.48 110.00 15,035.94 110.00 15,029.41 $4,025,500 $4,026,000 110.00 15,070.48 110.00 15,063.95 110.00 15,057.42 110.00 15,050.88 110.00 15,044.35 110.00 15,037.82 110.00 15,031.28 $4,026,000 $4,026,500 110.00 15,072.36 110.00 15,065.83 110.00 15,059.29 110.00 15,052.76 110.00 15,046.23 110.00 15,039.69 110.00 15,033.16 $4,026,500 $4,027,000 110.00 15,074.23 110.00 15,067.70 110.00 15,061.17 110.00 15,054.63 110.00 15,048.10 110.00 15,041.57 110.00 15,035.03 $4,027,000 $4,027,500 110.00 15,076.11 110.00 15,069.58 110.00 15,063.04 110.00 15,056.51 110.00 15,049.98 110.00 15,043.44 110.00 15,036.91 $4,027,500 $4,028,000 110.00 15,077.98 110.00 15,071.45 110.00 15,064.92 110.00 15,058.38 110.00 15,051.85 110.00 15,045.32 110.00 15,038.78 $4,028,000 $4,028,500 110.00 15,079.86 110.00 15,073.33 110.00 15,066.79 110.00 15,060.26 110.00 15,053.73 110.00 15,047.19 110.00 15,040.66 $4,028,500 $4,029,000 110.00 15,081.73 110.00 15,075.20 110.00 15,068.67 110.00 15,062.13 110.00 15,055.60 110.00 15,049.07 110.00 15,042.53

NJEIS Family Cost Participation Table Page 82 of 12 Effective July 1, 2015

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

$4,029,000 $4,029,500 110.00 15,083.61 110.00 15,077.08 110.00 15,070.54 110.00 15,064.01 110.00 15,057.48 110.00 15,050.94 110.00 15,044.41 $4,029,500 $4,030,000 110.00 15,085.48 110.00 15,078.95 110.00 15,072.42 110.00 15,065.88 110.00 15,059.35 110.00 15,052.82 110.00 15,046.28 $4,030,000 $4,030,500 110.00 15,087.36 110.00 15,080.83 110.00 15,074.29 110.00 15,067.76 110.00 15,061.23 110.00 15,054.69 110.00 15,048.16 $4,030,500 $4,031,000 110.00 15,089.23 110.00 15,082.70 110.00 15,076.17 110.00 15,069.63 110.00 15,063.10 110.00 15,056.57 110.00 15,050.03 $4,031,000 $4,031,500 110.00 15,091.11 110.00 15,084.58 110.00 15,078.04 110.00 15,071.51 110.00 15,064.98 110.00 15,058.44 110.00 15,051.91 $4,031,500 $4,032,000 110.00 15,092.98 110.00 15,086.45 110.00 15,079.92 110.00 15,073.38 110.00 15,066.85 110.00 15,060.32 110.00 15,053.78 $4,032,000 $4,032,500 110.00 15,094.86 110.00 15,088.33 110.00 15,081.79 110.00 15,075.26 110.00 15,068.73 110.00 15,062.19 110.00 15,055.66 $4,032,500 $4,033,000 110.00 15,096.73 110.00 15,090.20 110.00 15,083.67 110.00 15,077.13 110.00 15,070.60 110.00 15,064.07 110.00 15,057.53 $4,033,000 $4,033,500 110.00 15,098.61 110.00 15,092.08 110.00 15,085.54 110.00 15,079.01 110.00 15,072.48 110.00 15,065.94 110.00 15,059.41 $4,033,500 $4,034,000 110.00 15,100.48 110.00 15,093.95 110.00 15,087.42 110.00 15,080.88 110.00 15,074.35 110.00 15,067.82 110.00 15,061.28 $4,034,000 $4,034,500 110.00 15,102.36 110.00 15,095.83 110.00 15,089.29 110.00 15,082.76 110.00 15,076.23 110.00 15,069.69 110.00 15,063.16 $4,034,500 $4,035,000 110.00 15,104.23 110.00 15,097.70 110.00 15,091.17 110.00 15,084.63 110.00 15,078.10 110.00 15,071.57 110.00 15,065.03 $4,035,000 $4,035,500 110.00 15,106.11 110.00 15,099.58 110.00 15,093.04 110.00 15,086.51 110.00 15,079.98 110.00 15,073.44 110.00 15,066.91 $4,035,500 $4,036,000 110.00 15,107.98 110.00 15,101.45 110.00 15,094.92 110.00 15,088.38 110.00 15,081.85 110.00 15,075.32 110.00 15,068.78 $4,036,000 $4,036,500 110.00 15,109.86 110.00 15,103.33 110.00 15,096.79 110.00 15,090.26 110.00 15,083.73 110.00 15,077.19 110.00 15,070.66 $4,036,500 $4,037,000 110.00 15,111.73 110.00 15,105.20 110.00 15,098.67 110.00 15,092.13 110.00 15,085.60 110.00 15,079.07 110.00 15,072.53 $4,037,000 $4,037,500 110.00 15,113.61 110.00 15,107.08 110.00 15,100.54 110.00 15,094.01 110.00 15,087.48 110.00 15,080.94 110.00 15,074.41 $4,037,500 $4,038,000 110.00 15,115.48 110.00 15,108.95 110.00 15,102.42 110.00 15,095.88 110.00 15,089.35 110.00 15,082.82 110.00 15,076.28 $4,038,000 $4,038,500 110.00 15,117.36 110.00 15,110.83 110.00 15,104.29 110.00 15,097.76 110.00 15,091.23 110.00 15,084.69 110.00 15,078.16 $4,038,500 $4,039,000 110.00 15,119.23 110.00 15,112.70 110.00 15,106.17 110.00 15,099.63 110.00 15,093.10 110.00 15,086.57 110.00 15,080.03 $4,039,000 $4,039,500 110.00 15,121.11 110.00 15,114.58 110.00 15,108.04 110.00 15,101.51 110.00 15,094.98 110.00 15,088.44 110.00 15,081.91 $4,039,500 $4,040,000 110.00 15,122.98 110.00 15,116.45 110.00 15,109.92 110.00 15,103.38 110.00 15,096.85 110.00 15,090.32 110.00 15,083.78 $4,040,000 $4,040,500 110.00 15,124.86 110.00 15,118.33 110.00 15,111.79 110.00 15,105.26 110.00 15,098.73 110.00 15,092.19 110.00 15,085.66 $4,040,500 $4,041,000 110.00 15,126.73 110.00 15,120.20 110.00 15,113.67 110.00 15,107.13 110.00 15,100.60 110.00 15,094.07 110.00 15,087.53 $4,041,000 $4,041,500 110.00 15,128.61 110.00 15,122.08 110.00 15,115.54 110.00 15,109.01 110.00 15,102.48 110.00 15,095.94 110.00 15,089.41 $4,041,500 $4,042,000 110.00 15,130.48 110.00 15,123.95 110.00 15,117.42 110.00 15,110.88 110.00 15,104.35 110.00 15,097.82 110.00 15,091.28 $4,042,000 $4,042,500 110.00 15,132.36 110.00 15,125.83 110.00 15,119.29 110.00 15,112.76 110.00 15,106.23 110.00 15,099.69 110.00 15,093.16 $4,042,500 $4,043,000 110.00 15,134.23 110.00 15,127.70 110.00 15,121.17 110.00 15,114.63 110.00 15,108.10 110.00 15,101.57 110.00 15,095.03 $4,043,000 $4,043,500 110.00 15,136.11 110.00 15,129.58 110.00 15,123.04 110.00 15,116.51 110.00 15,109.98 110.00 15,103.44 110.00 15,096.91 $4,043,500 $4,044,000 110.00 15,137.98 110.00 15,131.45 110.00 15,124.92 110.00 15,118.38 110.00 15,111.85 110.00 15,105.32 110.00 15,098.78 $4,044,000 $4,044,500 110.00 15,139.86 110.00 15,133.33 110.00 15,126.79 110.00 15,120.26 110.00 15,113.73 110.00 15,107.19 110.00 15,100.66 $4,044,500 $4,045,000 110.00 15,141.73 110.00 15,135.20 110.00 15,128.67 110.00 15,122.13 110.00 15,115.60 110.00 15,109.07 110.00 15,102.53 $4,045,000 $4,045,500 110.00 15,143.61 110.00 15,137.08 110.00 15,130.54 110.00 15,124.01 110.00 15,117.48 110.00 15,110.94 110.00 15,104.41 $4,045,500 $4,046,000 110.00 15,145.48 110.00 15,138.95 110.00 15,132.42 110.00 15,125.88 110.00 15,119.35 110.00 15,112.82 110.00 15,106.28 $4,046,000 $4,046,500 110.00 15,147.36 110.00 15,140.83 110.00 15,134.29 110.00 15,127.76 110.00 15,121.23 110.00 15,114.69 110.00 15,108.16 $4,046,500 $4,047,000 110.00 15,149.23 110.00 15,142.70 110.00 15,136.17 110.00 15,129.63 110.00 15,123.10 110.00 15,116.57 110.00 15,110.03 $4,047,000 $4,047,500 110.00 15,151.11 110.00 15,144.58 110.00 15,138.04 110.00 15,131.51 110.00 15,124.98 110.00 15,118.44 110.00 15,111.91 $4,047,500 $4,048,000 110.00 15,152.98 110.00 15,146.45 110.00 15,139.92 110.00 15,133.38 110.00 15,126.85 110.00 15,120.32 110.00 15,113.78 $4,048,000 $4,048,500 110.00 15,154.86 110.00 15,148.33 110.00 15,141.79 110.00 15,135.26 110.00 15,128.73 110.00 15,122.19 110.00 15,115.66 $4,048,500 $4,049,000 110.00 15,156.73 110.00 15,150.20 110.00 15,143.67 110.00 15,137.13 110.00 15,130.60 110.00 15,124.07 110.00 15,117.53 $4,049,000 $4,049,500 110.00 15,158.61 110.00 15,152.08 110.00 15,145.54 110.00 15,139.01 110.00 15,132.48 110.00 15,125.94 110.00 15,119.41 $4,049,500 $4,050,000 110.00 15,160.48 110.00 15,153.95 110.00 15,147.42 110.00 15,140.88 110.00 15,134.35 110.00 15,127.82 110.00 15,121.28 $4,050,000 $4,050,500 110.00 15,162.36 110.00 15,155.83 110.00 15,149.29 110.00 15,142.76 110.00 15,136.23 110.00 15,129.69 110.00 15,123.16 $4,050,500 $4,051,000 110.00 15,164.23 110.00 15,157.70 110.00 15,151.17 110.00 15,144.63 110.00 15,138.10 110.00 15,131.57 110.00 15,125.03 $4,051,000 $4,051,500 110.00 15,166.11 110.00 15,159.58 110.00 15,153.04 110.00 15,146.51 110.00 15,139.98 110.00 15,133.44 110.00 15,126.91 $4,051,500 $4,052,000 110.00 15,167.98 110.00 15,161.45 110.00 15,154.92 110.00 15,148.38 110.00 15,141.85 110.00 15,135.32 110.00 15,128.78 $4,052,000 $4,052,500 110.00 15,169.86 110.00 15,163.33 110.00 15,156.79 110.00 15,150.26 110.00 15,143.73 110.00 15,137.19 110.00 15,130.66 $4,052,500 $4,053,000 110.00 15,171.73 110.00 15,165.20 110.00 15,158.67 110.00 15,152.13 110.00 15,145.60 110.00 15,139.07 110.00 15,132.53 $4,053,000 $4,053,500 110.00 15,173.61 110.00 15,167.08 110.00 15,160.54 110.00 15,154.01 110.00 15,147.48 110.00 15,140.94 110.00 15,134.41 $4,053,500 $4,054,000 110.00 15,175.48 110.00 15,168.95 110.00 15,162.42 110.00 15,155.88 110.00 15,149.35 110.00 15,142.82 110.00 15,136.28 $4,054,000 $4,054,500 110.00 15,177.36 110.00 15,170.83 110.00 15,164.29 110.00 15,157.76 110.00 15,151.23 110.00 15,144.69 110.00 15,138.16 $4,054,500 $4,055,000 110.00 15,179.23 110.00 15,172.70 110.00 15,166.17 110.00 15,159.63 110.00 15,153.10 110.00 15,146.57 110.00 15,140.03 $4,055,000 $4,055,500 110.00 15,181.11 110.00 15,174.58 110.00 15,168.04 110.00 15,161.51 110.00 15,154.98 110.00 15,148.44 110.00 15,141.91 $4,055,500 $4,056,000 110.00 15,182.98 110.00 15,176.45 110.00 15,169.92 110.00 15,163.38 110.00 15,156.85 110.00 15,150.32 110.00 15,143.78 $4,056,000 $4,056,500 110.00 15,184.86 110.00 15,178.33 110.00 15,171.79 110.00 15,165.26 110.00 15,158.73 110.00 15,152.19 110.00 15,145.66 $4,056,500 $4,057,000 110.00 15,186.73 110.00 15,180.20 110.00 15,173.67 110.00 15,167.13 110.00 15,160.60 110.00 15,154.07 110.00 15,147.53 $4,057,000 $4,057,500 110.00 15,188.61 110.00 15,182.08 110.00 15,175.54 110.00 15,169.01 110.00 15,162.48 110.00 15,155.94 110.00 15,149.41 $4,057,500 $4,058,000 110.00 15,190.48 110.00 15,183.95 110.00 15,177.42 110.00 15,170.88 110.00 15,164.35 110.00 15,157.82 110.00 15,151.28 $4,058,000 $4,058,500 110.00 15,192.36 110.00 15,185.83 110.00 15,179.29 110.00 15,172.76 110.00 15,166.23 110.00 15,159.69 110.00 15,153.16 $4,058,500 $4,059,000 110.00 15,194.23 110.00 15,187.70 110.00 15,181.17 110.00 15,174.63 110.00 15,168.10 110.00 15,161.57 110.00 15,155.03 $4,059,000 $4,059,500 110.00 15,196.11 110.00 15,189.58 110.00 15,183.04 110.00 15,176.51 110.00 15,169.98 110.00 15,163.44 110.00 15,156.91 $4,059,500 $4,060,000 110.00 15,197.98 110.00 15,191.45 110.00 15,184.92 110.00 15,178.38 110.00 15,171.85 110.00 15,165.32 110.00 15,158.78 $4,060,000 $4,060,500 110.00 15,199.86 110.00 15,193.33 110.00 15,186.79 110.00 15,180.26 110.00 15,173.73 110.00 15,167.19 110.00 15,160.66 $4,060,500 $4,061,000 110.00 15,201.73 110.00 15,195.20 110.00 15,188.67 110.00 15,182.13 110.00 15,175.60 110.00 15,169.07 110.00 15,162.53 $4,061,000 $4,061,500 110.00 15,203.61 110.00 15,197.08 110.00 15,190.54 110.00 15,184.01 110.00 15,177.48 110.00 15,170.94 110.00 15,164.41 $4,061,500 $4,062,000 110.00 15,205.48 110.00 15,198.95 110.00 15,192.42 110.00 15,185.88 110.00 15,179.35 110.00 15,172.82 110.00 15,166.28 $4,062,000 $4,062,500 110.00 15,207.36 110.00 15,200.83 110.00 15,194.29 110.00 15,187.76 110.00 15,181.23 110.00 15,174.69 110.00 15,168.16 $4,062,500 $4,063,000 110.00 15,209.23 110.00 15,202.70 110.00 15,196.17 110.00 15,189.63 110.00 15,183.10 110.00 15,176.57 110.00 15,170.03 $4,063,000 $4,063,500 110.00 15,211.11 110.00 15,204.58 110.00 15,198.04 110.00 15,191.51 110.00 15,184.98 110.00 15,178.44 110.00 15,171.91 $4,063,500 $4,064,000 110.00 15,212.98 110.00 15,206.45 110.00 15,199.92 110.00 15,193.38 110.00 15,186.85 110.00 15,180.32 110.00 15,173.78 $4,064,000 $4,064,500 110.00 15,214.86 110.00 15,208.33 110.00 15,201.79 110.00 15,195.26 110.00 15,188.73 110.00 15,182.19 110.00 15,175.66 $4,064,500 $4,065,000 110.00 15,216.73 110.00 15,210.20 110.00 15,203.67 110.00 15,197.13 110.00 15,190.60 110.00 15,184.07 110.00 15,177.53 $4,065,000 $4,065,500 110.00 15,218.61 110.00 15,212.08 110.00 15,205.54 110.00 15,199.01 110.00 15,192.48 110.00 15,185.94 110.00 15,179.41 $4,065,500 $4,066,000 110.00 15,220.48 110.00 15,213.95 110.00 15,207.42 110.00 15,200.88 110.00 15,194.35 110.00 15,187.82 110.00 15,181.28 $4,066,000 $4,066,500 110.00 15,222.36 110.00 15,215.83 110.00 15,209.29 110.00 15,202.76 110.00 15,196.23 110.00 15,189.69 110.00 15,183.16 $4,066,500 $4,067,000 110.00 15,224.23 110.00 15,217.70 110.00 15,211.17 110.00 15,204.63 110.00 15,198.10 110.00 15,191.57 110.00 15,185.03 $4,067,000 $4,067,500 110.00 15,226.11 110.00 15,219.58 110.00 15,213.04 110.00 15,206.51 110.00 15,199.98 110.00 15,193.44 110.00 15,186.91 $4,067,500 $4,068,000 110.00 15,227.98 110.00 15,221.45 110.00 15,214.92 110.00 15,208.38 110.00 15,201.85 110.00 15,195.32 110.00 15,188.78 $4,068,000 $4,068,500 110.00 15,229.86 110.00 15,223.33 110.00 15,216.79 110.00 15,210.26 110.00 15,203.73 110.00 15,197.19 110.00 15,190.66 $4,068,500 $4,069,000 110.00 15,231.73 110.00 15,225.20 110.00 15,218.67 110.00 15,212.13 110.00 15,205.60 110.00 15,199.07 110.00 15,192.53 $4,069,000 $4,069,500 110.00 15,233.61 110.00 15,227.08 110.00 15,220.54 110.00 15,214.01 110.00 15,207.48 110.00 15,200.94 110.00 15,194.41 $4,069,500 $4,070,000 110.00 15,235.48 110.00 15,228.95 110.00 15,222.42 110.00 15,215.88 110.00 15,209.35 110.00 15,202.82 110.00 15,196.28 $4,070,000 $4,070,500 110.00 15,237.36 110.00 15,230.83 110.00 15,224.29 110.00 15,217.76 110.00 15,211.23 110.00 15,204.69 110.00 15,198.16 $4,070,500 $4,071,000 110.00 15,239.23 110.00 15,232.70 110.00 15,226.17 110.00 15,219.63 110.00 15,213.10 110.00 15,206.57 110.00 15,200.03 $4,071,000 $4,071,500 110.00 15,241.11 110.00 15,234.58 110.00 15,228.04 110.00 15,221.51 110.00 15,214.98 110.00 15,208.44 110.00 15,201.91 $4,071,500 $4,072,000 110.00 15,242.98 110.00 15,236.45 110.00 15,229.92 110.00 15,223.38 110.00 15,216.85 110.00 15,210.32 110.00 15,203.78 $4,072,000 $4,072,500 110.00 15,244.86 110.00 15,238.33 110.00 15,231.79 110.00 15,225.26 110.00 15,218.73 110.00 15,212.19 110.00 15,205.66 $4,072,500 $4,073,000 110.00 15,246.73 110.00 15,240.20 110.00 15,233.67 110.00 15,227.13 110.00 15,220.60 110.00 15,214.07 110.00 15,207.53 $4,073,000 $4,073,500 110.00 15,248.61 110.00 15,242.08 110.00 15,235.54 110.00 15,229.01 110.00 15,222.48 110.00 15,215.94 110.00 15,209.41 $4,073,500 $4,074,000 110.00 15,250.48 110.00 15,243.95 110.00 15,237.42 110.00 15,230.88 110.00 15,224.35 110.00 15,217.82 110.00 15,211.28 $4,074,000 $4,074,500 110.00 15,252.36 110.00 15,245.83 110.00 15,239.29 110.00 15,232.76 110.00 15,226.23 110.00 15,219.69 110.00 15,213.16 $4,074,500 $4,075,000 110.00 15,254.23 110.00 15,247.70 110.00 15,241.17 110.00 15,234.63 110.00 15,228.10 110.00 15,221.57 110.00 15,215.03 $4,075,000 $4,075,500 110.00 15,256.11 110.00 15,249.58 110.00 15,243.04 110.00 15,236.51 110.00 15,229.98 110.00 15,223.44 110.00 15,216.91 $4,075,500 $4,076,000 110.00 15,257.98 110.00 15,251.45 110.00 15,244.92 110.00 15,238.38 110.00 15,231.85 110.00 15,225.32 110.00 15,218.78 $4,076,000 $4,076,500 110.00 15,259.86 110.00 15,253.33 110.00 15,246.79 110.00 15,240.26 110.00 15,233.73 110.00 15,227.19 110.00 15,220.66 $4,076,500 $4,077,000 110.00 15,261.73 110.00 15,255.20 110.00 15,248.67 110.00 15,242.13 110.00 15,235.60 110.00 15,229.07 110.00 15,222.53 $4,077,000 $4,077,500 110.00 15,263.61 110.00 15,257.08 110.00 15,250.54 110.00 15,244.01 110.00 15,237.48 110.00 15,230.94 110.00 15,224.41 $4,077,500 $4,078,000 110.00 15,265.48 110.00 15,258.95 110.00 15,252.42 110.00 15,245.88 110.00 15,239.35 110.00 15,232.82 110.00 15,226.28 $4,078,000 $4,078,500 110.00 15,267.36 110.00 15,260.83 110.00 15,254.29 110.00 15,247.76 110.00 15,241.23 110.00 15,234.69 110.00 15,228.16 $4,078,500 $4,079,000 110.00 15,269.23 110.00 15,262.70 110.00 15,256.17 110.00 15,249.63 110.00 15,243.10 110.00 15,236.57 110.00 15,230.03 $4,079,000 $4,079,500 110.00 15,271.11 110.00 15,264.58 110.00 15,258.04 110.00 15,251.51 110.00 15,244.98 110.00 15,238.44 110.00 15,231.91 $4,079,500 $4,080,000 110.00 15,272.98 110.00 15,266.45 110.00 15,259.92 110.00 15,253.38 110.00 15,246.85 110.00 15,240.32 110.00 15,233.78

NJEIS Family Cost Participation Table Page 83 of 12 Effective July 1, 2015

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

$4,080,000 $4,080,500 110.00 15,274.86 110.00 15,268.33 110.00 15,261.79 110.00 15,255.26 110.00 15,248.73 110.00 15,242.19 110.00 15,235.66 $4,080,500 $4,081,000 110.00 15,276.73 110.00 15,270.20 110.00 15,263.67 110.00 15,257.13 110.00 15,250.60 110.00 15,244.07 110.00 15,237.53 $4,081,000 $4,081,500 110.00 15,278.61 110.00 15,272.08 110.00 15,265.54 110.00 15,259.01 110.00 15,252.48 110.00 15,245.94 110.00 15,239.41 $4,081,500 $4,082,000 110.00 15,280.48 110.00 15,273.95 110.00 15,267.42 110.00 15,260.88 110.00 15,254.35 110.00 15,247.82 110.00 15,241.28 $4,082,000 $4,082,500 110.00 15,282.36 110.00 15,275.83 110.00 15,269.29 110.00 15,262.76 110.00 15,256.23 110.00 15,249.69 110.00 15,243.16 $4,082,500 $4,083,000 110.00 15,284.23 110.00 15,277.70 110.00 15,271.17 110.00 15,264.63 110.00 15,258.10 110.00 15,251.57 110.00 15,245.03 $4,083,000 $4,083,500 110.00 15,286.11 110.00 15,279.58 110.00 15,273.04 110.00 15,266.51 110.00 15,259.98 110.00 15,253.44 110.00 15,246.91 $4,083,500 $4,084,000 110.00 15,287.98 110.00 15,281.45 110.00 15,274.92 110.00 15,268.38 110.00 15,261.85 110.00 15,255.32 110.00 15,248.78 $4,084,000 $4,084,500 110.00 15,289.86 110.00 15,283.33 110.00 15,276.79 110.00 15,270.26 110.00 15,263.73 110.00 15,257.19 110.00 15,250.66 $4,084,500 $4,085,000 110.00 15,291.73 110.00 15,285.20 110.00 15,278.67 110.00 15,272.13 110.00 15,265.60 110.00 15,259.07 110.00 15,252.53 $4,085,000 $4,085,500 110.00 15,293.61 110.00 15,287.08 110.00 15,280.54 110.00 15,274.01 110.00 15,267.48 110.00 15,260.94 110.00 15,254.41 $4,085,500 $4,086,000 110.00 15,295.48 110.00 15,288.95 110.00 15,282.42 110.00 15,275.88 110.00 15,269.35 110.00 15,262.82 110.00 15,256.28 $4,086,000 $4,086,500 110.00 15,297.36 110.00 15,290.83 110.00 15,284.29 110.00 15,277.76 110.00 15,271.23 110.00 15,264.69 110.00 15,258.16 $4,086,500 $4,087,000 110.00 15,299.23 110.00 15,292.70 110.00 15,286.17 110.00 15,279.63 110.00 15,273.10 110.00 15,266.57 110.00 15,260.03 $4,087,000 $4,087,500 110.00 15,301.11 110.00 15,294.58 110.00 15,288.04 110.00 15,281.51 110.00 15,274.98 110.00 15,268.44 110.00 15,261.91 $4,087,500 $4,088,000 110.00 15,302.98 110.00 15,296.45 110.00 15,289.92 110.00 15,283.38 110.00 15,276.85 110.00 15,270.32 110.00 15,263.78 $4,088,000 $4,088,500 110.00 15,304.86 110.00 15,298.33 110.00 15,291.79 110.00 15,285.26 110.00 15,278.73 110.00 15,272.19 110.00 15,265.66 $4,088,500 $4,089,000 110.00 15,306.73 110.00 15,300.20 110.00 15,293.67 110.00 15,287.13 110.00 15,280.60 110.00 15,274.07 110.00 15,267.53 $4,089,000 $4,089,500 110.00 15,308.61 110.00 15,302.08 110.00 15,295.54 110.00 15,289.01 110.00 15,282.48 110.00 15,275.94 110.00 15,269.41 $4,089,500 $4,090,000 110.00 15,310.48 110.00 15,303.95 110.00 15,297.42 110.00 15,290.88 110.00 15,284.35 110.00 15,277.82 110.00 15,271.28 $4,090,000 $4,090,500 110.00 15,312.36 110.00 15,305.83 110.00 15,299.29 110.00 15,292.76 110.00 15,286.23 110.00 15,279.69 110.00 15,273.16 $4,090,500 $4,091,000 110.00 15,314.23 110.00 15,307.70 110.00 15,301.17 110.00 15,294.63 110.00 15,288.10 110.00 15,281.57 110.00 15,275.03 $4,091,000 $4,091,500 110.00 15,316.11 110.00 15,309.58 110.00 15,303.04 110.00 15,296.51 110.00 15,289.98 110.00 15,283.44 110.00 15,276.91 $4,091,500 $4,092,000 110.00 15,317.98 110.00 15,311.45 110.00 15,304.92 110.00 15,298.38 110.00 15,291.85 110.00 15,285.32 110.00 15,278.78 $4,092,000 $4,092,500 110.00 15,319.86 110.00 15,313.33 110.00 15,306.79 110.00 15,300.26 110.00 15,293.73 110.00 15,287.19 110.00 15,280.66 $4,092,500 $4,093,000 110.00 15,321.73 110.00 15,315.20 110.00 15,308.67 110.00 15,302.13 110.00 15,295.60 110.00 15,289.07 110.00 15,282.53 $4,093,000 $4,093,500 110.00 15,323.61 110.00 15,317.08 110.00 15,310.54 110.00 15,304.01 110.00 15,297.48 110.00 15,290.94 110.00 15,284.41 $4,093,500 $4,094,000 110.00 15,325.48 110.00 15,318.95 110.00 15,312.42 110.00 15,305.88 110.00 15,299.35 110.00 15,292.82 110.00 15,286.28 $4,094,000 $4,094,500 110.00 15,327.36 110.00 15,320.83 110.00 15,314.29 110.00 15,307.76 110.00 15,301.23 110.00 15,294.69 110.00 15,288.16 $4,094,500 $4,095,000 110.00 15,329.23 110.00 15,322.70 110.00 15,316.17 110.00 15,309.63 110.00 15,303.10 110.00 15,296.57 110.00 15,290.03 $4,095,000 $4,095,500 110.00 15,331.11 110.00 15,324.58 110.00 15,318.04 110.00 15,311.51 110.00 15,304.98 110.00 15,298.44 110.00 15,291.91 $4,095,500 $4,096,000 110.00 15,332.98 110.00 15,326.45 110.00 15,319.92 110.00 15,313.38 110.00 15,306.85 110.00 15,300.32 110.00 15,293.78 $4,096,000 $4,096,500 110.00 15,334.86 110.00 15,328.33 110.00 15,321.79 110.00 15,315.26 110.00 15,308.73 110.00 15,302.19 110.00 15,295.66 $4,096,500 $4,097,000 110.00 15,336.73 110.00 15,330.20 110.00 15,323.67 110.00 15,317.13 110.00 15,310.60 110.00 15,304.07 110.00 15,297.53 $4,097,000 $4,097,500 110.00 15,338.61 110.00 15,332.08 110.00 15,325.54 110.00 15,319.01 110.00 15,312.48 110.00 15,305.94 110.00 15,299.41 $4,097,500 $4,098,000 110.00 15,340.48 110.00 15,333.95 110.00 15,327.42 110.00 15,320.88 110.00 15,314.35 110.00 15,307.82 110.00 15,301.28 $4,098,000 $4,098,500 110.00 15,342.36 110.00 15,335.83 110.00 15,329.29 110.00 15,322.76 110.00 15,316.23 110.00 15,309.69 110.00 15,303.16 $4,098,500 $4,099,000 110.00 15,344.23 110.00 15,337.70 110.00 15,331.17 110.00 15,324.63 110.00 15,318.10 110.00 15,311.57 110.00 15,305.03 $4,099,000 $4,099,500 110.00 15,346.11 110.00 15,339.58 110.00 15,333.04 110.00 15,326.51 110.00 15,319.98 110.00 15,313.44 110.00 15,306.91 $4,099,500 $4,100,000 110.00 15,347.98 110.00 15,341.45 110.00 15,334.92 110.00 15,328.38 110.00 15,321.85 110.00 15,315.32 110.00 15,308.78 $4,100,000 $4,100,500 110.00 15,349.86 110.00 15,343.33 110.00 15,336.79 110.00 15,330.26 110.00 15,323.73 110.00 15,317.19 110.00 15,310.66 $4,100,500 $4,101,000 110.00 15,351.73 110.00 15,345.20 110.00 15,338.67 110.00 15,332.13 110.00 15,325.60 110.00 15,319.07 110.00 15,312.53 $4,101,000 $4,101,500 110.00 15,353.61 110.00 15,347.08 110.00 15,340.54 110.00 15,334.01 110.00 15,327.48 110.00 15,320.94 110.00 15,314.41 $4,101,500 $4,102,000 110.00 15,355.48 110.00 15,348.95 110.00 15,342.42 110.00 15,335.88 110.00 15,329.35 110.00 15,322.82 110.00 15,316.28 $4,102,000 $4,102,500 110.00 15,357.36 110.00 15,350.83 110.00 15,344.29 110.00 15,337.76 110.00 15,331.23 110.00 15,324.69 110.00 15,318.16 $4,102,500 $4,103,000 110.00 15,359.23 110.00 15,352.70 110.00 15,346.17 110.00 15,339.63 110.00 15,333.10 110.00 15,326.57 110.00 15,320.03 $4,103,000 $4,103,500 110.00 15,361.11 110.00 15,354.58 110.00 15,348.04 110.00 15,341.51 110.00 15,334.98 110.00 15,328.44 110.00 15,321.91 $4,103,500 $4,104,000 110.00 15,362.98 110.00 15,356.45 110.00 15,349.92 110.00 15,343.38 110.00 15,336.85 110.00 15,330.32 110.00 15,323.78 $4,104,000 $4,104,500 110.00 15,364.86 110.00 15,358.33 110.00 15,351.79 110.00 15,345.26 110.00 15,338.73 110.00 15,332.19 110.00 15,325.66 $4,104,500 $4,105,000 110.00 15,366.73 110.00 15,360.20 110.00 15,353.67 110.00 15,347.13 110.00 15,340.60 110.00 15,334.07 110.00 15,327.53 $4,105,000 $4,105,500 110.00 15,368.61 110.00 15,362.08 110.00 15,355.54 110.00 15,349.01 110.00 15,342.48 110.00 15,335.94 110.00 15,329.41 $4,105,500 $4,106,000 110.00 15,370.48 110.00 15,363.95 110.00 15,357.42 110.00 15,350.88 110.00 15,344.35 110.00 15,337.82 110.00 15,331.28 $4,106,000 $4,106,500 110.00 15,372.36 110.00 15,365.83 110.00 15,359.29 110.00 15,352.76 110.00 15,346.23 110.00 15,339.69 110.00 15,333.16 $4,106,500 $4,107,000 110.00 15,374.23 110.00 15,367.70 110.00 15,361.17 110.00 15,354.63 110.00 15,348.10 110.00 15,341.57 110.00 15,335.03 $4,107,000 $4,107,500 110.00 15,376.11 110.00 15,369.58 110.00 15,363.04 110.00 15,356.51 110.00 15,349.98 110.00 15,343.44 110.00 15,336.91 $4,107,500 $4,108,000 110.00 15,377.98 110.00 15,371.45 110.00 15,364.92 110.00 15,358.38 110.00 15,351.85 110.00 15,345.32 110.00 15,338.78 $4,108,000 $4,108,500 110.00 15,379.86 110.00 15,373.33 110.00 15,366.79 110.00 15,360.26 110.00 15,353.73 110.00 15,347.19 110.00 15,340.66 $4,108,500 $4,109,000 110.00 15,381.73 110.00 15,375.20 110.00 15,368.67 110.00 15,362.13 110.00 15,355.60 110.00 15,349.07 110.00 15,342.53 $4,109,000 $4,109,500 110.00 15,383.61 110.00 15,377.08 110.00 15,370.54 110.00 15,364.01 110.00 15,357.48 110.00 15,350.94 110.00 15,344.41 $4,109,500 $4,110,000 110.00 15,385.48 110.00 15,378.95 110.00 15,372.42 110.00 15,365.88 110.00 15,359.35 110.00 15,352.82 110.00 15,346.28 $4,110,000 $4,110,500 110.00 15,387.36 110.00 15,380.83 110.00 15,374.29 110.00 15,367.76 110.00 15,361.23 110.00 15,354.69 110.00 15,348.16 $4,110,500 $4,111,000 110.00 15,389.23 110.00 15,382.70 110.00 15,376.17 110.00 15,369.63 110.00 15,363.10 110.00 15,356.57 110.00 15,350.03 $4,111,000 $4,111,500 110.00 15,391.11 110.00 15,384.58 110.00 15,378.04 110.00 15,371.51 110.00 15,364.98 110.00 15,358.44 110.00 15,351.91 $4,111,500 $4,112,000 110.00 15,392.98 110.00 15,386.45 110.00 15,379.92 110.00 15,373.38 110.00 15,366.85 110.00 15,360.32 110.00 15,353.78 $4,112,000 $4,112,500 110.00 15,394.86 110.00 15,388.33 110.00 15,381.79 110.00 15,375.26 110.00 15,368.73 110.00 15,362.19 110.00 15,355.66 $4,112,500 $4,113,000 110.00 15,396.73 110.00 15,390.20 110.00 15,383.67 110.00 15,377.13 110.00 15,370.60 110.00 15,364.07 110.00 15,357.53 $4,113,000 $4,113,500 110.00 15,398.61 110.00 15,392.08 110.00 15,385.54 110.00 15,379.01 110.00 15,372.48 110.00 15,365.94 110.00 15,359.41 $4,113,500 $4,114,000 110.00 15,400.48 110.00 15,393.95 110.00 15,387.42 110.00 15,380.88 110.00 15,374.35 110.00 15,367.82 110.00 15,361.28 $4,114,000 $4,114,500 110.00 15,402.36 110.00 15,395.83 110.00 15,389.29 110.00 15,382.76 110.00 15,376.23 110.00 15,369.69 110.00 15,363.16 $4,114,500 $4,115,000 110.00 15,404.23 110.00 15,397.70 110.00 15,391.17 110.00 15,384.63 110.00 15,378.10 110.00 15,371.57 110.00 15,365.03 $4,115,000 $4,115,500 110.00 15,406.11 110.00 15,399.58 110.00 15,393.04 110.00 15,386.51 110.00 15,379.98 110.00 15,373.44 110.00 15,366.91 $4,115,500 $4,116,000 110.00 15,407.98 110.00 15,401.45 110.00 15,394.92 110.00 15,388.38 110.00 15,381.85 110.00 15,375.32 110.00 15,368.78 $4,116,000 $4,116,500 110.00 15,409.86 110.00 15,403.33 110.00 15,396.79 110.00 15,390.26 110.00 15,383.73 110.00 15,377.19 110.00 15,370.66 $4,116,500 $4,117,000 110.00 15,411.73 110.00 15,405.20 110.00 15,398.67 110.00 15,392.13 110.00 15,385.60 110.00 15,379.07 110.00 15,372.53 $4,117,000 $4,117,500 110.00 15,413.61 110.00 15,407.08 110.00 15,400.54 110.00 15,394.01 110.00 15,387.48 110.00 15,380.94 110.00 15,374.41 $4,117,500 $4,118,000 110.00 15,415.48 110.00 15,408.95 110.00 15,402.42 110.00 15,395.88 110.00 15,389.35 110.00 15,382.82 110.00 15,376.28 $4,118,000 $4,118,500 110.00 15,417.36 110.00 15,410.83 110.00 15,404.29 110.00 15,397.76 110.00 15,391.23 110.00 15,384.69 110.00 15,378.16 $4,118,500 $4,119,000 110.00 15,419.23 110.00 15,412.70 110.00 15,406.17 110.00 15,399.63 110.00 15,393.10 110.00 15,386.57 110.00 15,380.03 $4,119,000 $4,119,500 110.00 15,421.11 110.00 15,414.58 110.00 15,408.04 110.00 15,401.51 110.00 15,394.98 110.00 15,388.44 110.00 15,381.91 $4,119,500 $4,120,000 110.00 15,422.98 110.00 15,416.45 110.00 15,409.92 110.00 15,403.38 110.00 15,396.85 110.00 15,390.32 110.00 15,383.78 $4,120,000 $4,120,500 110.00 15,424.86 110.00 15,418.33 110.00 15,411.79 110.00 15,405.26 110.00 15,398.73 110.00 15,392.19 110.00 15,385.66 $4,120,500 $4,121,000 110.00 15,426.73 110.00 15,420.20 110.00 15,413.67 110.00 15,407.13 110.00 15,400.60 110.00 15,394.07 110.00 15,387.53 $4,121,000 $4,121,500 110.00 15,428.61 110.00 15,422.08 110.00 15,415.54 110.00 15,409.01 110.00 15,402.48 110.00 15,395.94 110.00 15,389.41 $4,121,500 $4,122,000 110.00 15,430.48 110.00 15,423.95 110.00 15,417.42 110.00 15,410.88 110.00 15,404.35 110.00 15,397.82 110.00 15,391.28 $4,122,000 $4,122,500 110.00 15,432.36 110.00 15,425.83 110.00 15,419.29 110.00 15,412.76 110.00 15,406.23 110.00 15,399.69 110.00 15,393.16 $4,122,500 $4,123,000 110.00 15,434.23 110.00 15,427.70 110.00 15,421.17 110.00 15,414.63 110.00 15,408.10 110.00 15,401.57 110.00 15,395.03 $4,123,000 $4,123,500 110.00 15,436.11 110.00 15,429.58 110.00 15,423.04 110.00 15,416.51 110.00 15,409.98 110.00 15,403.44 110.00 15,396.91 $4,123,500 $4,124,000 110.00 15,437.98 110.00 15,431.45 110.00 15,424.92 110.00 15,418.38 110.00 15,411.85 110.00 15,405.32 110.00 15,398.78 $4,124,000 $4,124,500 110.00 15,439.86 110.00 15,433.33 110.00 15,426.79 110.00 15,420.26 110.00 15,413.73 110.00 15,407.19 110.00 15,400.66 $4,124,500 $4,125,000 110.00 15,441.73 110.00 15,435.20 110.00 15,428.67 110.00 15,422.13 110.00 15,415.60 110.00 15,409.07 110.00 15,402.53 $4,125,000 $4,125,500 110.00 15,443.61 110.00 15,437.08 110.00 15,430.54 110.00 15,424.01 110.00 15,417.48 110.00 15,410.94 110.00 15,404.41 $4,125,500 $4,126,000 110.00 15,445.48 110.00 15,438.95 110.00 15,432.42 110.00 15,425.88 110.00 15,419.35 110.00 15,412.82 110.00 15,406.28 $4,126,000 $4,126,500 110.00 15,447.36 110.00 15,440.83 110.00 15,434.29 110.00 15,427.76 110.00 15,421.23 110.00 15,414.69 110.00 15,408.16 $4,126,500 $4,127,000 110.00 15,449.23 110.00 15,442.70 110.00 15,436.17 110.00 15,429.63 110.00 15,423.10 110.00 15,416.57 110.00 15,410.03 $4,127,000 $4,127,500 110.00 15,451.11 110.00 15,444.58 110.00 15,438.04 110.00 15,431.51 110.00 15,424.98 110.00 15,418.44 110.00 15,411.91 $4,127,500 $4,128,000 110.00 15,452.98 110.00 15,446.45 110.00 15,439.92 110.00 15,433.38 110.00 15,426.85 110.00 15,420.32 110.00 15,413.78 $4,128,000 $4,128,500 110.00 15,454.86 110.00 15,448.33 110.00 15,441.79 110.00 15,435.26 110.00 15,428.73 110.00 15,422.19 110.00 15,415.66 $4,128,500 $4,129,000 110.00 15,456.73 110.00 15,450.20 110.00 15,443.67 110.00 15,437.13 110.00 15,430.60 110.00 15,424.07 110.00 15,417.53 $4,129,000 $4,129,500 110.00 15,458.61 110.00 15,452.08 110.00 15,445.54 110.00 15,439.01 110.00 15,432.48 110.00 15,425.94 110.00 15,419.41 $4,129,500 $4,130,000 110.00 15,460.48 110.00 15,453.95 110.00 15,447.42 110.00 15,440.88 110.00 15,434.35 110.00 15,427.82 110.00 15,421.28 $4,130,000 $4,130,500 110.00 15,462.36 110.00 15,455.83 110.00 15,449.29 110.00 15,442.76 110.00 15,436.23 110.00 15,429.69 110.00 15,423.16 $4,130,500 $4,131,000 110.00 15,464.23 110.00 15,457.70 110.00 15,451.17 110.00 15,444.63 110.00 15,438.10 110.00 15,431.57 110.00 15,425.03

NJEIS Family Cost Participation Table Page 84 of 12 Effective July 1, 2015

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

$4,131,000 $4,131,500 110.00 15,466.11 110.00 15,459.58 110.00 15,453.04 110.00 15,446.51 110.00 15,439.98 110.00 15,433.44 110.00 15,426.91 $4,131,500 $4,132,000 110.00 15,467.98 110.00 15,461.45 110.00 15,454.92 110.00 15,448.38 110.00 15,441.85 110.00 15,435.32 110.00 15,428.78 $4,132,000 $4,132,500 110.00 15,469.86 110.00 15,463.33 110.00 15,456.79 110.00 15,450.26 110.00 15,443.73 110.00 15,437.19 110.00 15,430.66 $4,132,500 $4,133,000 110.00 15,471.73 110.00 15,465.20 110.00 15,458.67 110.00 15,452.13 110.00 15,445.60 110.00 15,439.07 110.00 15,432.53 $4,133,000 $4,133,500 110.00 15,473.61 110.00 15,467.08 110.00 15,460.54 110.00 15,454.01 110.00 15,447.48 110.00 15,440.94 110.00 15,434.41 $4,133,500 $4,134,000 110.00 15,475.48 110.00 15,468.95 110.00 15,462.42 110.00 15,455.88 110.00 15,449.35 110.00 15,442.82 110.00 15,436.28 $4,134,000 $4,134,500 110.00 15,477.36 110.00 15,470.83 110.00 15,464.29 110.00 15,457.76 110.00 15,451.23 110.00 15,444.69 110.00 15,438.16 $4,134,500 $4,135,000 110.00 15,479.23 110.00 15,472.70 110.00 15,466.17 110.00 15,459.63 110.00 15,453.10 110.00 15,446.57 110.00 15,440.03 $4,135,000 $4,135,500 110.00 15,481.11 110.00 15,474.58 110.00 15,468.04 110.00 15,461.51 110.00 15,454.98 110.00 15,448.44 110.00 15,441.91 $4,135,500 $4,136,000 110.00 15,482.98 110.00 15,476.45 110.00 15,469.92 110.00 15,463.38 110.00 15,456.85 110.00 15,450.32 110.00 15,443.78 $4,136,000 $4,136,500 110.00 15,484.86 110.00 15,478.33 110.00 15,471.79 110.00 15,465.26 110.00 15,458.73 110.00 15,452.19 110.00 15,445.66 $4,136,500 $4,137,000 110.00 15,486.73 110.00 15,480.20 110.00 15,473.67 110.00 15,467.13 110.00 15,460.60 110.00 15,454.07 110.00 15,447.53 $4,137,000 $4,137,500 110.00 15,488.61 110.00 15,482.08 110.00 15,475.54 110.00 15,469.01 110.00 15,462.48 110.00 15,455.94 110.00 15,449.41 $4,137,500 $4,138,000 110.00 15,490.48 110.00 15,483.95 110.00 15,477.42 110.00 15,470.88 110.00 15,464.35 110.00 15,457.82 110.00 15,451.28 $4,138,000 $4,138,500 110.00 15,492.36 110.00 15,485.83 110.00 15,479.29 110.00 15,472.76 110.00 15,466.23 110.00 15,459.69 110.00 15,453.16 $4,138,500 $4,139,000 110.00 15,494.23 110.00 15,487.70 110.00 15,481.17 110.00 15,474.63 110.00 15,468.10 110.00 15,461.57 110.00 15,455.03 $4,139,000 $4,139,500 110.00 15,496.11 110.00 15,489.58 110.00 15,483.04 110.00 15,476.51 110.00 15,469.98 110.00 15,463.44 110.00 15,456.91 $4,139,500 $4,140,000 110.00 15,497.98 110.00 15,491.45 110.00 15,484.92 110.00 15,478.38 110.00 15,471.85 110.00 15,465.32 110.00 15,458.78 $4,140,000 $4,140,500 110.00 15,499.86 110.00 15,493.33 110.00 15,486.79 110.00 15,480.26 110.00 15,473.73 110.00 15,467.19 110.00 15,460.66 $4,140,500 $4,141,000 110.00 15,501.73 110.00 15,495.20 110.00 15,488.67 110.00 15,482.13 110.00 15,475.60 110.00 15,469.07 110.00 15,462.53 $4,141,000 $4,141,500 110.00 15,503.61 110.00 15,497.08 110.00 15,490.54 110.00 15,484.01 110.00 15,477.48 110.00 15,470.94 110.00 15,464.41 $4,141,500 $4,142,000 110.00 15,505.48 110.00 15,498.95 110.00 15,492.42 110.00 15,485.88 110.00 15,479.35 110.00 15,472.82 110.00 15,466.28 $4,142,000 $4,142,500 110.00 15,507.36 110.00 15,500.83 110.00 15,494.29 110.00 15,487.76 110.00 15,481.23 110.00 15,474.69 110.00 15,468.16 $4,142,500 $4,143,000 110.00 15,509.23 110.00 15,502.70 110.00 15,496.17 110.00 15,489.63 110.00 15,483.10 110.00 15,476.57 110.00 15,470.03 $4,143,000 $4,143,500 110.00 15,511.11 110.00 15,504.58 110.00 15,498.04 110.00 15,491.51 110.00 15,484.98 110.00 15,478.44 110.00 15,471.91 $4,143,500 $4,144,000 110.00 15,512.98 110.00 15,506.45 110.00 15,499.92 110.00 15,493.38 110.00 15,486.85 110.00 15,480.32 110.00 15,473.78 $4,144,000 $4,144,500 110.00 15,514.86 110.00 15,508.33 110.00 15,501.79 110.00 15,495.26 110.00 15,488.73 110.00 15,482.19 110.00 15,475.66 $4,144,500 $4,145,000 110.00 15,516.73 110.00 15,510.20 110.00 15,503.67 110.00 15,497.13 110.00 15,490.60 110.00 15,484.07 110.00 15,477.53 $4,145,000 $4,145,500 110.00 15,518.61 110.00 15,512.08 110.00 15,505.54 110.00 15,499.01 110.00 15,492.48 110.00 15,485.94 110.00 15,479.41 $4,145,500 $4,146,000 110.00 15,520.48 110.00 15,513.95 110.00 15,507.42 110.00 15,500.88 110.00 15,494.35 110.00 15,487.82 110.00 15,481.28 $4,146,000 $4,146,500 110.00 15,522.36 110.00 15,515.83 110.00 15,509.29 110.00 15,502.76 110.00 15,496.23 110.00 15,489.69 110.00 15,483.16 $4,146,500 $4,147,000 110.00 15,524.23 110.00 15,517.70 110.00 15,511.17 110.00 15,504.63 110.00 15,498.10 110.00 15,491.57 110.00 15,485.03 $4,147,000 $4,147,500 110.00 15,526.11 110.00 15,519.58 110.00 15,513.04 110.00 15,506.51 110.00 15,499.98 110.00 15,493.44 110.00 15,486.91 $4,147,500 $4,148,000 110.00 15,527.98 110.00 15,521.45 110.00 15,514.92 110.00 15,508.38 110.00 15,501.85 110.00 15,495.32 110.00 15,488.78 $4,148,000 $4,148,500 110.00 15,529.86 110.00 15,523.33 110.00 15,516.79 110.00 15,510.26 110.00 15,503.73 110.00 15,497.19 110.00 15,490.66 $4,148,500 $4,149,000 110.00 15,531.73 110.00 15,525.20 110.00 15,518.67 110.00 15,512.13 110.00 15,505.60 110.00 15,499.07 110.00 15,492.53 $4,149,000 $4,149,500 110.00 15,533.61 110.00 15,527.08 110.00 15,520.54 110.00 15,514.01 110.00 15,507.48 110.00 15,500.94 110.00 15,494.41 $4,149,500 $4,150,000 110.00 15,535.48 110.00 15,528.95 110.00 15,522.42 110.00 15,515.88 110.00 15,509.35 110.00 15,502.82 110.00 15,496.28 $4,150,000 $4,150,500 110.00 15,537.36 110.00 15,530.83 110.00 15,524.29 110.00 15,517.76 110.00 15,511.23 110.00 15,504.69 110.00 15,498.16 $4,150,500 $4,151,000 110.00 15,539.23 110.00 15,532.70 110.00 15,526.17 110.00 15,519.63 110.00 15,513.10 110.00 15,506.57 110.00 15,500.03 $4,151,000 $4,151,500 110.00 15,541.11 110.00 15,534.58 110.00 15,528.04 110.00 15,521.51 110.00 15,514.98 110.00 15,508.44 110.00 15,501.91 $4,151,500 $4,152,000 110.00 15,542.98 110.00 15,536.45 110.00 15,529.92 110.00 15,523.38 110.00 15,516.85 110.00 15,510.32 110.00 15,503.78 $4,152,000 $4,152,500 110.00 15,544.86 110.00 15,538.33 110.00 15,531.79 110.00 15,525.26 110.00 15,518.73 110.00 15,512.19 110.00 15,505.66 $4,152,500 $4,153,000 110.00 15,546.73 110.00 15,540.20 110.00 15,533.67 110.00 15,527.13 110.00 15,520.60 110.00 15,514.07 110.00 15,507.53 $4,153,000 $4,153,500 110.00 15,548.61 110.00 15,542.08 110.00 15,535.54 110.00 15,529.01 110.00 15,522.48 110.00 15,515.94 110.00 15,509.41 $4,153,500 $4,154,000 110.00 15,550.48 110.00 15,543.95 110.00 15,537.42 110.00 15,530.88 110.00 15,524.35 110.00 15,517.82 110.00 15,511.28 $4,154,000 $4,154,500 110.00 15,552.36 110.00 15,545.83 110.00 15,539.29 110.00 15,532.76 110.00 15,526.23 110.00 15,519.69 110.00 15,513.16 $4,154,500 $4,155,000 110.00 15,554.23 110.00 15,547.70 110.00 15,541.17 110.00 15,534.63 110.00 15,528.10 110.00 15,521.57 110.00 15,515.03 $4,155,000 $4,155,500 110.00 15,556.11 110.00 15,549.58 110.00 15,543.04 110.00 15,536.51 110.00 15,529.98 110.00 15,523.44 110.00 15,516.91 $4,155,500 $4,156,000 110.00 15,557.98 110.00 15,551.45 110.00 15,544.92 110.00 15,538.38 110.00 15,531.85 110.00 15,525.32 110.00 15,518.78 $4,156,000 $4,156,500 110.00 15,559.86 110.00 15,553.33 110.00 15,546.79 110.00 15,540.26 110.00 15,533.73 110.00 15,527.19 110.00 15,520.66 $4,156,500 $4,157,000 110.00 15,561.73 110.00 15,555.20 110.00 15,548.67 110.00 15,542.13 110.00 15,535.60 110.00 15,529.07 110.00 15,522.53 $4,157,000 $4,157,500 110.00 15,563.61 110.00 15,557.08 110.00 15,550.54 110.00 15,544.01 110.00 15,537.48 110.00 15,530.94 110.00 15,524.41 $4,157,500 $4,158,000 110.00 15,565.48 110.00 15,558.95 110.00 15,552.42 110.00 15,545.88 110.00 15,539.35 110.00 15,532.82 110.00 15,526.28 $4,158,000 $4,158,500 110.00 15,567.36 110.00 15,560.83 110.00 15,554.29 110.00 15,547.76 110.00 15,541.23 110.00 15,534.69 110.00 15,528.16 $4,158,500 $4,159,000 110.00 15,569.23 110.00 15,562.70 110.00 15,556.17 110.00 15,549.63 110.00 15,543.10 110.00 15,536.57 110.00 15,530.03 $4,159,000 $4,159,500 110.00 15,571.11 110.00 15,564.58 110.00 15,558.04 110.00 15,551.51 110.00 15,544.98 110.00 15,538.44 110.00 15,531.91 $4,159,500 $4,160,000 110.00 15,572.98 110.00 15,566.45 110.00 15,559.92 110.00 15,553.38 110.00 15,546.85 110.00 15,540.32 110.00 15,533.78 $4,160,000 $4,160,500 110.00 15,574.86 110.00 15,568.33 110.00 15,561.79 110.00 15,555.26 110.00 15,548.73 110.00 15,542.19 110.00 15,535.66 $4,160,500 $4,161,000 110.00 15,576.73 110.00 15,570.20 110.00 15,563.67 110.00 15,557.13 110.00 15,550.60 110.00 15,544.07 110.00 15,537.53 $4,161,000 $4,161,500 110.00 15,578.61 110.00 15,572.08 110.00 15,565.54 110.00 15,559.01 110.00 15,552.48 110.00 15,545.94 110.00 15,539.41 $4,161,500 $4,162,000 110.00 15,580.48 110.00 15,573.95 110.00 15,567.42 110.00 15,560.88 110.00 15,554.35 110.00 15,547.82 110.00 15,541.28 $4,162,000 $4,162,500 110.00 15,582.36 110.00 15,575.83 110.00 15,569.29 110.00 15,562.76 110.00 15,556.23 110.00 15,549.69 110.00 15,543.16 $4,162,500 $4,163,000 110.00 15,584.23 110.00 15,577.70 110.00 15,571.17 110.00 15,564.63 110.00 15,558.10 110.00 15,551.57 110.00 15,545.03 $4,163,000 $4,163,500 110.00 15,586.11 110.00 15,579.58 110.00 15,573.04 110.00 15,566.51 110.00 15,559.98 110.00 15,553.44 110.00 15,546.91 $4,163,500 $4,164,000 110.00 15,587.98 110.00 15,581.45 110.00 15,574.92 110.00 15,568.38 110.00 15,561.85 110.00 15,555.32 110.00 15,548.78 $4,164,000 $4,164,500 110.00 15,589.86 110.00 15,583.33 110.00 15,576.79 110.00 15,570.26 110.00 15,563.73 110.00 15,557.19 110.00 15,550.66 $4,164,500 $4,165,000 110.00 15,591.73 110.00 15,585.20 110.00 15,578.67 110.00 15,572.13 110.00 15,565.60 110.00 15,559.07 110.00 15,552.53 $4,165,000 $4,165,500 110.00 15,593.61 110.00 15,587.08 110.00 15,580.54 110.00 15,574.01 110.00 15,567.48 110.00 15,560.94 110.00 15,554.41 $4,165,500 $4,166,000 110.00 15,595.48 110.00 15,588.95 110.00 15,582.42 110.00 15,575.88 110.00 15,569.35 110.00 15,562.82 110.00 15,556.28 $4,166,000 $4,166,500 110.00 15,597.36 110.00 15,590.83 110.00 15,584.29 110.00 15,577.76 110.00 15,571.23 110.00 15,564.69 110.00 15,558.16 $4,166,500 $4,167,000 110.00 15,599.23 110.00 15,592.70 110.00 15,586.17 110.00 15,579.63 110.00 15,573.10 110.00 15,566.57 110.00 15,560.03 $4,167,000 $4,167,500 110.00 15,601.11 110.00 15,594.58 110.00 15,588.04 110.00 15,581.51 110.00 15,574.98 110.00 15,568.44 110.00 15,561.91 $4,167,500 $4,168,000 110.00 15,602.98 110.00 15,596.45 110.00 15,589.92 110.00 15,583.38 110.00 15,576.85 110.00 15,570.32 110.00 15,563.78 $4,168,000 $4,168,500 110.00 15,604.86 110.00 15,598.33 110.00 15,591.79 110.00 15,585.26 110.00 15,578.73 110.00 15,572.19 110.00 15,565.66 $4,168,500 $4,169,000 110.00 15,606.73 110.00 15,600.20 110.00 15,593.67 110.00 15,587.13 110.00 15,580.60 110.00 15,574.07 110.00 15,567.53 $4,169,000 $4,169,500 110.00 15,608.61 110.00 15,602.08 110.00 15,595.54 110.00 15,589.01 110.00 15,582.48 110.00 15,575.94 110.00 15,569.41 $4,169,500 $4,170,000 110.00 15,610.48 110.00 15,603.95 110.00 15,597.42 110.00 15,590.88 110.00 15,584.35 110.00 15,577.82 110.00 15,571.28 $4,170,000 $4,170,500 110.00 15,612.36 110.00 15,605.83 110.00 15,599.29 110.00 15,592.76 110.00 15,586.23 110.00 15,579.69 110.00 15,573.16 $4,170,500 $4,171,000 110.00 15,614.23 110.00 15,607.70 110.00 15,601.17 110.00 15,594.63 110.00 15,588.10 110.00 15,581.57 110.00 15,575.03 $4,171,000 $4,171,500 110.00 15,616.11 110.00 15,609.58 110.00 15,603.04 110.00 15,596.51 110.00 15,589.98 110.00 15,583.44 110.00 15,576.91 $4,171,500 $4,172,000 110.00 15,617.98 110.00 15,611.45 110.00 15,604.92 110.00 15,598.38 110.00 15,591.85 110.00 15,585.32 110.00 15,578.78 $4,172,000 $4,172,500 110.00 15,619.86 110.00 15,613.33 110.00 15,606.79 110.00 15,600.26 110.00 15,593.73 110.00 15,587.19 110.00 15,580.66 $4,172,500 $4,173,000 110.00 15,621.73 110.00 15,615.20 110.00 15,608.67 110.00 15,602.13 110.00 15,595.60 110.00 15,589.07 110.00 15,582.53 $4,173,000 $4,173,500 110.00 15,623.61 110.00 15,617.08 110.00 15,610.54 110.00 15,604.01 110.00 15,597.48 110.00 15,590.94 110.00 15,584.41 $4,173,500 $4,174,000 110.00 15,625.48 110.00 15,618.95 110.00 15,612.42 110.00 15,605.88 110.00 15,599.35 110.00 15,592.82 110.00 15,586.28 $4,174,000 $4,174,500 110.00 15,627.36 110.00 15,620.83 110.00 15,614.29 110.00 15,607.76 110.00 15,601.23 110.00 15,594.69 110.00 15,588.16 $4,174,500 $4,175,000 110.00 15,629.23 110.00 15,622.70 110.00 15,616.17 110.00 15,609.63 110.00 15,603.10 110.00 15,596.57 110.00 15,590.03 $4,175,000 $4,175,500 110.00 15,631.11 110.00 15,624.58 110.00 15,618.04 110.00 15,611.51 110.00 15,604.98 110.00 15,598.44 110.00 15,591.91 $4,175,500 $4,176,000 110.00 15,632.98 110.00 15,626.45 110.00 15,619.92 110.00 15,613.38 110.00 15,606.85 110.00 15,600.32 110.00 15,593.78 $4,176,000 $4,176,500 110.00 15,634.86 110.00 15,628.33 110.00 15,621.79 110.00 15,615.26 110.00 15,608.73 110.00 15,602.19 110.00 15,595.66 $4,176,500 $4,177,000 110.00 15,636.73 110.00 15,630.20 110.00 15,623.67 110.00 15,617.13 110.00 15,610.60 110.00 15,604.07 110.00 15,597.53 $4,177,000 $4,177,500 110.00 15,638.61 110.00 15,632.08 110.00 15,625.54 110.00 15,619.01 110.00 15,612.48 110.00 15,605.94 110.00 15,599.41 $4,177,500 $4,178,000 110.00 15,640.48 110.00 15,633.95 110.00 15,627.42 110.00 15,620.88 110.00 15,614.35 110.00 15,607.82 110.00 15,601.28 $4,178,000 $4,178,500 110.00 15,642.36 110.00 15,635.83 110.00 15,629.29 110.00 15,622.76 110.00 15,616.23 110.00 15,609.69 110.00 15,603.16 $4,178,500 $4,179,000 110.00 15,644.23 110.00 15,637.70 110.00 15,631.17 110.00 15,624.63 110.00 15,618.10 110.00 15,611.57 110.00 15,605.03 $4,179,000 $4,179,500 110.00 15,646.11 110.00 15,639.58 110.00 15,633.04 110.00 15,626.51 110.00 15,619.98 110.00 15,613.44 110.00 15,606.91 $4,179,500 $4,180,000 110.00 15,647.98 110.00 15,641.45 110.00 15,634.92 110.00 15,628.38 110.00 15,621.85 110.00 15,615.32 110.00 15,608.78 $4,180,000 $4,180,500 110.00 15,649.86 110.00 15,643.33 110.00 15,636.79 110.00 15,630.26 110.00 15,623.73 110.00 15,617.19 110.00 15,610.66 $4,180,500 $4,181,000 110.00 15,651.73 110.00 15,645.20 110.00 15,638.67 110.00 15,632.13 110.00 15,625.60 110.00 15,619.07 110.00 15,612.53 $4,181,000 $4,181,500 110.00 15,653.61 110.00 15,647.08 110.00 15,640.54 110.00 15,634.01 110.00 15,627.48 110.00 15,620.94 110.00 15,614.41 $4,181,500 $4,182,000 110.00 15,655.48 110.00 15,648.95 110.00 15,642.42 110.00 15,635.88 110.00 15,629.35 110.00 15,622.82 110.00 15,616.28

NJEIS Family Cost Participation Table Page 85 of 12 Effective July 1, 2015

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

$4,182,000 $4,182,500 110.00 15,657.36 110.00 15,650.83 110.00 15,644.29 110.00 15,637.76 110.00 15,631.23 110.00 15,624.69 110.00 15,618.16 $4,182,500 $4,183,000 110.00 15,659.23 110.00 15,652.70 110.00 15,646.17 110.00 15,639.63 110.00 15,633.10 110.00 15,626.57 110.00 15,620.03 $4,183,000 $4,183,500 110.00 15,661.11 110.00 15,654.58 110.00 15,648.04 110.00 15,641.51 110.00 15,634.98 110.00 15,628.44 110.00 15,621.91 $4,183,500 $4,184,000 110.00 15,662.98 110.00 15,656.45 110.00 15,649.92 110.00 15,643.38 110.00 15,636.85 110.00 15,630.32 110.00 15,623.78 $4,184,000 $4,184,500 110.00 15,664.86 110.00 15,658.33 110.00 15,651.79 110.00 15,645.26 110.00 15,638.73 110.00 15,632.19 110.00 15,625.66 $4,184,500 $4,185,000 110.00 15,666.73 110.00 15,660.20 110.00 15,653.67 110.00 15,647.13 110.00 15,640.60 110.00 15,634.07 110.00 15,627.53 $4,185,000 $4,185,500 110.00 15,668.61 110.00 15,662.08 110.00 15,655.54 110.00 15,649.01 110.00 15,642.48 110.00 15,635.94 110.00 15,629.41 $4,185,500 $4,186,000 110.00 15,670.48 110.00 15,663.95 110.00 15,657.42 110.00 15,650.88 110.00 15,644.35 110.00 15,637.82 110.00 15,631.28 $4,186,000 $4,186,500 110.00 15,672.36 110.00 15,665.83 110.00 15,659.29 110.00 15,652.76 110.00 15,646.23 110.00 15,639.69 110.00 15,633.16 $4,186,500 $4,187,000 110.00 15,674.23 110.00 15,667.70 110.00 15,661.17 110.00 15,654.63 110.00 15,648.10 110.00 15,641.57 110.00 15,635.03 $4,187,000 $4,187,500 110.00 15,676.11 110.00 15,669.58 110.00 15,663.04 110.00 15,656.51 110.00 15,649.98 110.00 15,643.44 110.00 15,636.91 $4,187,500 $4,188,000 110.00 15,677.98 110.00 15,671.45 110.00 15,664.92 110.00 15,658.38 110.00 15,651.85 110.00 15,645.32 110.00 15,638.78 $4,188,000 $4,188,500 110.00 15,679.86 110.00 15,673.33 110.00 15,666.79 110.00 15,660.26 110.00 15,653.73 110.00 15,647.19 110.00 15,640.66 $4,188,500 $4,189,000 110.00 15,681.73 110.00 15,675.20 110.00 15,668.67 110.00 15,662.13 110.00 15,655.60 110.00 15,649.07 110.00 15,642.53 $4,189,000 $4,189,500 110.00 15,683.61 110.00 15,677.08 110.00 15,670.54 110.00 15,664.01 110.00 15,657.48 110.00 15,650.94 110.00 15,644.41 $4,189,500 $4,190,000 110.00 15,685.48 110.00 15,678.95 110.00 15,672.42 110.00 15,665.88 110.00 15,659.35 110.00 15,652.82 110.00 15,646.28 $4,190,000 $4,190,500 110.00 15,687.36 110.00 15,680.83 110.00 15,674.29 110.00 15,667.76 110.00 15,661.23 110.00 15,654.69 110.00 15,648.16 $4,190,500 $4,191,000 110.00 15,689.23 110.00 15,682.70 110.00 15,676.17 110.00 15,669.63 110.00 15,663.10 110.00 15,656.57 110.00 15,650.03 $4,191,000 $4,191,500 110.00 15,691.11 110.00 15,684.58 110.00 15,678.04 110.00 15,671.51 110.00 15,664.98 110.00 15,658.44 110.00 15,651.91 $4,191,500 $4,192,000 110.00 15,692.98 110.00 15,686.45 110.00 15,679.92 110.00 15,673.38 110.00 15,666.85 110.00 15,660.32 110.00 15,653.78 $4,192,000 $4,192,500 110.00 15,694.86 110.00 15,688.33 110.00 15,681.79 110.00 15,675.26 110.00 15,668.73 110.00 15,662.19 110.00 15,655.66 $4,192,500 $4,193,000 110.00 15,696.73 110.00 15,690.20 110.00 15,683.67 110.00 15,677.13 110.00 15,670.60 110.00 15,664.07 110.00 15,657.53 $4,193,000 $4,193,500 110.00 15,698.61 110.00 15,692.08 110.00 15,685.54 110.00 15,679.01 110.00 15,672.48 110.00 15,665.94 110.00 15,659.41 $4,193,500 $4,194,000 110.00 15,700.48 110.00 15,693.95 110.00 15,687.42 110.00 15,680.88 110.00 15,674.35 110.00 15,667.82 110.00 15,661.28 $4,194,000 $4,194,500 110.00 15,702.36 110.00 15,695.83 110.00 15,689.29 110.00 15,682.76 110.00 15,676.23 110.00 15,669.69 110.00 15,663.16 $4,194,500 $4,195,000 110.00 15,704.23 110.00 15,697.70 110.00 15,691.17 110.00 15,684.63 110.00 15,678.10 110.00 15,671.57 110.00 15,665.03 $4,195,000 $4,195,500 110.00 15,706.11 110.00 15,699.58 110.00 15,693.04 110.00 15,686.51 110.00 15,679.98 110.00 15,673.44 110.00 15,666.91 $4,195,500 $4,196,000 110.00 15,707.98 110.00 15,701.45 110.00 15,694.92 110.00 15,688.38 110.00 15,681.85 110.00 15,675.32 110.00 15,668.78 $4,196,000 $4,196,500 110.00 15,709.86 110.00 15,703.33 110.00 15,696.79 110.00 15,690.26 110.00 15,683.73 110.00 15,677.19 110.00 15,670.66 $4,196,500 $4,197,000 110.00 15,711.73 110.00 15,705.20 110.00 15,698.67 110.00 15,692.13 110.00 15,685.60 110.00 15,679.07 110.00 15,672.53 $4,197,000 $4,197,500 110.00 15,713.61 110.00 15,707.08 110.00 15,700.54 110.00 15,694.01 110.00 15,687.48 110.00 15,680.94 110.00 15,674.41 $4,197,500 $4,198,000 110.00 15,715.48 110.00 15,708.95 110.00 15,702.42 110.00 15,695.88 110.00 15,689.35 110.00 15,682.82 110.00 15,676.28 $4,198,000 $4,198,500 110.00 15,717.36 110.00 15,710.83 110.00 15,704.29 110.00 15,697.76 110.00 15,691.23 110.00 15,684.69 110.00 15,678.16 $4,198,500 $4,199,000 110.00 15,719.23 110.00 15,712.70 110.00 15,706.17 110.00 15,699.63 110.00 15,693.10 110.00 15,686.57 110.00 15,680.03 $4,199,000 $4,199,500 110.00 15,721.11 110.00 15,714.58 110.00 15,708.04 110.00 15,701.51 110.00 15,694.98 110.00 15,688.44 110.00 15,681.91 $4,199,500 $4,200,000 110.00 15,722.98 110.00 15,716.45 110.00 15,709.92 110.00 15,703.38 110.00 15,696.85 110.00 15,690.32 110.00 15,683.78 $4,200,000 $4,200,500 110.00 15,724.86 110.00 15,718.33 110.00 15,711.79 110.00 15,705.26 110.00 15,698.73 110.00 15,692.19 110.00 15,685.66 $4,200,500 $4,201,000 110.00 15,726.73 110.00 15,720.20 110.00 15,713.67 110.00 15,707.13 110.00 15,700.60 110.00 15,694.07 110.00 15,687.53 $4,201,000 $4,201,500 110.00 15,728.61 110.00 15,722.08 110.00 15,715.54 110.00 15,709.01 110.00 15,702.48 110.00 15,695.94 110.00 15,689.41 $4,201,500 $4,202,000 110.00 15,730.48 110.00 15,723.95 110.00 15,717.42 110.00 15,710.88 110.00 15,704.35 110.00 15,697.82 110.00 15,691.28 $4,202,000 $4,202,500 110.00 15,732.36 110.00 15,725.83 110.00 15,719.29 110.00 15,712.76 110.00 15,706.23 110.00 15,699.69 110.00 15,693.16 $4,202,500 $4,203,000 110.00 15,734.23 110.00 15,727.70 110.00 15,721.17 110.00 15,714.63 110.00 15,708.10 110.00 15,701.57 110.00 15,695.03 $4,203,000 $4,203,500 110.00 15,736.11 110.00 15,729.58 110.00 15,723.04 110.00 15,716.51 110.00 15,709.98 110.00 15,703.44 110.00 15,696.91 $4,203,500 $4,204,000 110.00 15,737.98 110.00 15,731.45 110.00 15,724.92 110.00 15,718.38 110.00 15,711.85 110.00 15,705.32 110.00 15,698.78 $4,204,000 $4,204,500 110.00 15,739.86 110.00 15,733.33 110.00 15,726.79 110.00 15,720.26 110.00 15,713.73 110.00 15,707.19 110.00 15,700.66 $4,204,500 $4,205,000 110.00 15,741.73 110.00 15,735.20 110.00 15,728.67 110.00 15,722.13 110.00 15,715.60 110.00 15,709.07 110.00 15,702.53 $4,205,000 $4,205,500 110.00 15,743.61 110.00 15,737.08 110.00 15,730.54 110.00 15,724.01 110.00 15,717.48 110.00 15,710.94 110.00 15,704.41 $4,205,500 $4,206,000 110.00 15,745.48 110.00 15,738.95 110.00 15,732.42 110.00 15,725.88 110.00 15,719.35 110.00 15,712.82 110.00 15,706.28 $4,206,000 $4,206,500 110.00 15,747.36 110.00 15,740.83 110.00 15,734.29 110.00 15,727.76 110.00 15,721.23 110.00 15,714.69 110.00 15,708.16 $4,206,500 $4,207,000 110.00 15,749.23 110.00 15,742.70 110.00 15,736.17 110.00 15,729.63 110.00 15,723.10 110.00 15,716.57 110.00 15,710.03 $4,207,000 $4,207,500 110.00 15,751.11 110.00 15,744.58 110.00 15,738.04 110.00 15,731.51 110.00 15,724.98 110.00 15,718.44 110.00 15,711.91 $4,207,500 $4,208,000 110.00 15,752.98 110.00 15,746.45 110.00 15,739.92 110.00 15,733.38 110.00 15,726.85 110.00 15,720.32 110.00 15,713.78 $4,208,000 $4,208,500 110.00 15,754.86 110.00 15,748.33 110.00 15,741.79 110.00 15,735.26 110.00 15,728.73 110.00 15,722.19 110.00 15,715.66 $4,208,500 $4,209,000 110.00 15,756.73 110.00 15,750.20 110.00 15,743.67 110.00 15,737.13 110.00 15,730.60 110.00 15,724.07 110.00 15,717.53 $4,209,000 $4,209,500 110.00 15,758.61 110.00 15,752.08 110.00 15,745.54 110.00 15,739.01 110.00 15,732.48 110.00 15,725.94 110.00 15,719.41 $4,209,500 $4,210,000 110.00 15,760.48 110.00 15,753.95 110.00 15,747.42 110.00 15,740.88 110.00 15,734.35 110.00 15,727.82 110.00 15,721.28 $4,210,000 $4,210,500 110.00 15,762.36 110.00 15,755.83 110.00 15,749.29 110.00 15,742.76 110.00 15,736.23 110.00 15,729.69 110.00 15,723.16 $4,210,500 $4,211,000 110.00 15,764.23 110.00 15,757.70 110.00 15,751.17 110.00 15,744.63 110.00 15,738.10 110.00 15,731.57 110.00 15,725.03 $4,211,000 $4,211,500 110.00 15,766.11 110.00 15,759.58 110.00 15,753.04 110.00 15,746.51 110.00 15,739.98 110.00 15,733.44 110.00 15,726.91 $4,211,500 $4,212,000 110.00 15,767.98 110.00 15,761.45 110.00 15,754.92 110.00 15,748.38 110.00 15,741.85 110.00 15,735.32 110.00 15,728.78 $4,212,000 $4,212,500 110.00 15,769.86 110.00 15,763.33 110.00 15,756.79 110.00 15,750.26 110.00 15,743.73 110.00 15,737.19 110.00 15,730.66 $4,212,500 $4,213,000 110.00 15,771.73 110.00 15,765.20 110.00 15,758.67 110.00 15,752.13 110.00 15,745.60 110.00 15,739.07 110.00 15,732.53 $4,213,000 $4,213,500 110.00 15,773.61 110.00 15,767.08 110.00 15,760.54 110.00 15,754.01 110.00 15,747.48 110.00 15,740.94 110.00 15,734.41 $4,213,500 $4,214,000 110.00 15,775.48 110.00 15,768.95 110.00 15,762.42 110.00 15,755.88 110.00 15,749.35 110.00 15,742.82 110.00 15,736.28 $4,214,000 $4,214,500 110.00 15,777.36 110.00 15,770.83 110.00 15,764.29 110.00 15,757.76 110.00 15,751.23 110.00 15,744.69 110.00 15,738.16 $4,214,500 $4,215,000 110.00 15,779.23 110.00 15,772.70 110.00 15,766.17 110.00 15,759.63 110.00 15,753.10 110.00 15,746.57 110.00 15,740.03 $4,215,000 $4,215,500 110.00 15,781.11 110.00 15,774.58 110.00 15,768.04 110.00 15,761.51 110.00 15,754.98 110.00 15,748.44 110.00 15,741.91 $4,215,500 $4,216,000 110.00 15,782.98 110.00 15,776.45 110.00 15,769.92 110.00 15,763.38 110.00 15,756.85 110.00 15,750.32 110.00 15,743.78 $4,216,000 $4,216,500 110.00 15,784.86 110.00 15,778.33 110.00 15,771.79 110.00 15,765.26 110.00 15,758.73 110.00 15,752.19 110.00 15,745.66 $4,216,500 $4,217,000 110.00 15,786.73 110.00 15,780.20 110.00 15,773.67 110.00 15,767.13 110.00 15,760.60 110.00 15,754.07 110.00 15,747.53 $4,217,000 $4,217,500 110.00 15,788.61 110.00 15,782.08 110.00 15,775.54 110.00 15,769.01 110.00 15,762.48 110.00 15,755.94 110.00 15,749.41 $4,217,500 $4,218,000 110.00 15,790.48 110.00 15,783.95 110.00 15,777.42 110.00 15,770.88 110.00 15,764.35 110.00 15,757.82 110.00 15,751.28 $4,218,000 $4,218,500 110.00 15,792.36 110.00 15,785.83 110.00 15,779.29 110.00 15,772.76 110.00 15,766.23 110.00 15,759.69 110.00 15,753.16 $4,218,500 $4,219,000 110.00 15,794.23 110.00 15,787.70 110.00 15,781.17 110.00 15,774.63 110.00 15,768.10 110.00 15,761.57 110.00 15,755.03 $4,219,000 $4,219,500 110.00 15,796.11 110.00 15,789.58 110.00 15,783.04 110.00 15,776.51 110.00 15,769.98 110.00 15,763.44 110.00 15,756.91 $4,219,500 $4,220,000 110.00 15,797.98 110.00 15,791.45 110.00 15,784.92 110.00 15,778.38 110.00 15,771.85 110.00 15,765.32 110.00 15,758.78 $4,220,000 $4,220,500 110.00 15,799.86 110.00 15,793.33 110.00 15,786.79 110.00 15,780.26 110.00 15,773.73 110.00 15,767.19 110.00 15,760.66 $4,220,500 $4,221,000 110.00 15,801.73 110.00 15,795.20 110.00 15,788.67 110.00 15,782.13 110.00 15,775.60 110.00 15,769.07 110.00 15,762.53 $4,221,000 $4,221,500 110.00 15,803.61 110.00 15,797.08 110.00 15,790.54 110.00 15,784.01 110.00 15,777.48 110.00 15,770.94 110.00 15,764.41 $4,221,500 $4,222,000 110.00 15,805.48 110.00 15,798.95 110.00 15,792.42 110.00 15,785.88 110.00 15,779.35 110.00 15,772.82 110.00 15,766.28 $4,222,000 $4,222,500 110.00 15,807.36 110.00 15,800.83 110.00 15,794.29 110.00 15,787.76 110.00 15,781.23 110.00 15,774.69 110.00 15,768.16 $4,222,500 $4,223,000 110.00 15,809.23 110.00 15,802.70 110.00 15,796.17 110.00 15,789.63 110.00 15,783.10 110.00 15,776.57 110.00 15,770.03 $4,223,000 $4,223,500 110.00 15,811.11 110.00 15,804.58 110.00 15,798.04 110.00 15,791.51 110.00 15,784.98 110.00 15,778.44 110.00 15,771.91 $4,223,500 $4,224,000 110.00 15,812.98 110.00 15,806.45 110.00 15,799.92 110.00 15,793.38 110.00 15,786.85 110.00 15,780.32 110.00 15,773.78 $4,224,000 $4,224,500 110.00 15,814.86 110.00 15,808.33 110.00 15,801.79 110.00 15,795.26 110.00 15,788.73 110.00 15,782.19 110.00 15,775.66 $4,224,500 $4,225,000 110.00 15,816.73 110.00 15,810.20 110.00 15,803.67 110.00 15,797.13 110.00 15,790.60 110.00 15,784.07 110.00 15,777.53 $4,225,000 $4,225,500 110.00 15,818.61 110.00 15,812.08 110.00 15,805.54 110.00 15,799.01 110.00 15,792.48 110.00 15,785.94 110.00 15,779.41 $4,225,500 $4,226,000 110.00 15,820.48 110.00 15,813.95 110.00 15,807.42 110.00 15,800.88 110.00 15,794.35 110.00 15,787.82 110.00 15,781.28 $4,226,000 $4,226,500 110.00 15,822.36 110.00 15,815.83 110.00 15,809.29 110.00 15,802.76 110.00 15,796.23 110.00 15,789.69 110.00 15,783.16 $4,226,500 $4,227,000 110.00 15,824.23 110.00 15,817.70 110.00 15,811.17 110.00 15,804.63 110.00 15,798.10 110.00 15,791.57 110.00 15,785.03 $4,227,000 $4,227,500 110.00 15,826.11 110.00 15,819.58 110.00 15,813.04 110.00 15,806.51 110.00 15,799.98 110.00 15,793.44 110.00 15,786.91 $4,227,500 $4,228,000 110.00 15,827.98 110.00 15,821.45 110.00 15,814.92 110.00 15,808.38 110.00 15,801.85 110.00 15,795.32 110.00 15,788.78 $4,228,000 $4,228,500 110.00 15,829.86 110.00 15,823.33 110.00 15,816.79 110.00 15,810.26 110.00 15,803.73 110.00 15,797.19 110.00 15,790.66 $4,228,500 $4,229,000 110.00 15,831.73 110.00 15,825.20 110.00 15,818.67 110.00 15,812.13 110.00 15,805.60 110.00 15,799.07 110.00 15,792.53 $4,229,000 $4,229,500 110.00 15,833.61 110.00 15,827.08 110.00 15,820.54 110.00 15,814.01 110.00 15,807.48 110.00 15,800.94 110.00 15,794.41 $4,229,500 $4,230,000 110.00 15,835.48 110.00 15,828.95 110.00 15,822.42 110.00 15,815.88 110.00 15,809.35 110.00 15,802.82 110.00 15,796.28 $4,230,000 $4,230,500 110.00 15,837.36 110.00 15,830.83 110.00 15,824.29 110.00 15,817.76 110.00 15,811.23 110.00 15,804.69 110.00 15,798.16 $4,230,500 $4,231,000 110.00 15,839.23 110.00 15,832.70 110.00 15,826.17 110.00 15,819.63 110.00 15,813.10 110.00 15,806.57 110.00 15,800.03 $4,231,000 $4,231,500 110.00 15,841.11 110.00 15,834.58 110.00 15,828.04 110.00 15,821.51 110.00 15,814.98 110.00 15,808.44 110.00 15,801.91 $4,231,500 $4,232,000 110.00 15,842.98 110.00 15,836.45 110.00 15,829.92 110.00 15,823.38 110.00 15,816.85 110.00 15,810.32 110.00 15,803.78 $4,232,000 $4,232,500 110.00 15,844.86 110.00 15,838.33 110.00 15,831.79 110.00 15,825.26 110.00 15,818.73 110.00 15,812.19 110.00 15,805.66 $4,232,500 $4,233,000 110.00 15,846.73 110.00 15,840.20 110.00 15,833.67 110.00 15,827.13 110.00 15,820.60 110.00 15,814.07 110.00 15,807.53

NJEIS Family Cost Participation Table Page 86 of 12 Effective July 1, 2015

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

$4,233,000 $4,233,500 110.00 15,848.61 110.00 15,842.08 110.00 15,835.54 110.00 15,829.01 110.00 15,822.48 110.00 15,815.94 110.00 15,809.41 $4,233,500 $4,234,000 110.00 15,850.48 110.00 15,843.95 110.00 15,837.42 110.00 15,830.88 110.00 15,824.35 110.00 15,817.82 110.00 15,811.28 $4,234,000 $4,234,500 110.00 15,852.36 110.00 15,845.83 110.00 15,839.29 110.00 15,832.76 110.00 15,826.23 110.00 15,819.69 110.00 15,813.16 $4,234,500 $4,235,000 110.00 15,854.23 110.00 15,847.70 110.00 15,841.17 110.00 15,834.63 110.00 15,828.10 110.00 15,821.57 110.00 15,815.03 $4,235,000 $4,235,500 110.00 15,856.11 110.00 15,849.58 110.00 15,843.04 110.00 15,836.51 110.00 15,829.98 110.00 15,823.44 110.00 15,816.91 $4,235,500 $4,236,000 110.00 15,857.98 110.00 15,851.45 110.00 15,844.92 110.00 15,838.38 110.00 15,831.85 110.00 15,825.32 110.00 15,818.78 $4,236,000 $4,236,500 110.00 15,859.86 110.00 15,853.33 110.00 15,846.79 110.00 15,840.26 110.00 15,833.73 110.00 15,827.19 110.00 15,820.66 $4,236,500 $4,237,000 110.00 15,861.73 110.00 15,855.20 110.00 15,848.67 110.00 15,842.13 110.00 15,835.60 110.00 15,829.07 110.00 15,822.53 $4,237,000 $4,237,500 110.00 15,863.61 110.00 15,857.08 110.00 15,850.54 110.00 15,844.01 110.00 15,837.48 110.00 15,830.94 110.00 15,824.41 $4,237,500 $4,238,000 110.00 15,865.48 110.00 15,858.95 110.00 15,852.42 110.00 15,845.88 110.00 15,839.35 110.00 15,832.82 110.00 15,826.28 $4,238,000 $4,238,500 110.00 15,867.36 110.00 15,860.83 110.00 15,854.29 110.00 15,847.76 110.00 15,841.23 110.00 15,834.69 110.00 15,828.16 $4,238,500 $4,239,000 110.00 15,869.23 110.00 15,862.70 110.00 15,856.17 110.00 15,849.63 110.00 15,843.10 110.00 15,836.57 110.00 15,830.03 $4,239,000 $4,239,500 110.00 15,871.11 110.00 15,864.58 110.00 15,858.04 110.00 15,851.51 110.00 15,844.98 110.00 15,838.44 110.00 15,831.91 $4,239,500 $4,240,000 110.00 15,872.98 110.00 15,866.45 110.00 15,859.92 110.00 15,853.38 110.00 15,846.85 110.00 15,840.32 110.00 15,833.78 $4,240,000 $4,240,500 110.00 15,874.86 110.00 15,868.33 110.00 15,861.79 110.00 15,855.26 110.00 15,848.73 110.00 15,842.19 110.00 15,835.66 $4,240,500 $4,241,000 110.00 15,876.73 110.00 15,870.20 110.00 15,863.67 110.00 15,857.13 110.00 15,850.60 110.00 15,844.07 110.00 15,837.53 $4,241,000 $4,241,500 110.00 15,878.61 110.00 15,872.08 110.00 15,865.54 110.00 15,859.01 110.00 15,852.48 110.00 15,845.94 110.00 15,839.41 $4,241,500 $4,242,000 110.00 15,880.48 110.00 15,873.95 110.00 15,867.42 110.00 15,860.88 110.00 15,854.35 110.00 15,847.82 110.00 15,841.28 $4,242,000 $4,242,500 110.00 15,882.36 110.00 15,875.83 110.00 15,869.29 110.00 15,862.76 110.00 15,856.23 110.00 15,849.69 110.00 15,843.16 $4,242,500 $4,243,000 110.00 15,884.23 110.00 15,877.70 110.00 15,871.17 110.00 15,864.63 110.00 15,858.10 110.00 15,851.57 110.00 15,845.03 $4,243,000 $4,243,500 110.00 15,886.11 110.00 15,879.58 110.00 15,873.04 110.00 15,866.51 110.00 15,859.98 110.00 15,853.44 110.00 15,846.91 $4,243,500 $4,244,000 110.00 15,887.98 110.00 15,881.45 110.00 15,874.92 110.00 15,868.38 110.00 15,861.85 110.00 15,855.32 110.00 15,848.78 $4,244,000 $4,244,500 110.00 15,889.86 110.00 15,883.33 110.00 15,876.79 110.00 15,870.26 110.00 15,863.73 110.00 15,857.19 110.00 15,850.66 $4,244,500 $4,245,000 110.00 15,891.73 110.00 15,885.20 110.00 15,878.67 110.00 15,872.13 110.00 15,865.60 110.00 15,859.07 110.00 15,852.53 $4,245,000 $4,245,500 110.00 15,893.61 110.00 15,887.08 110.00 15,880.54 110.00 15,874.01 110.00 15,867.48 110.00 15,860.94 110.00 15,854.41 $4,245,500 $4,246,000 110.00 15,895.48 110.00 15,888.95 110.00 15,882.42 110.00 15,875.88 110.00 15,869.35 110.00 15,862.82 110.00 15,856.28 $4,246,000 $4,246,500 110.00 15,897.36 110.00 15,890.83 110.00 15,884.29 110.00 15,877.76 110.00 15,871.23 110.00 15,864.69 110.00 15,858.16 $4,246,500 $4,247,000 110.00 15,899.23 110.00 15,892.70 110.00 15,886.17 110.00 15,879.63 110.00 15,873.10 110.00 15,866.57 110.00 15,860.03 $4,247,000 $4,247,500 110.00 15,901.11 110.00 15,894.58 110.00 15,888.04 110.00 15,881.51 110.00 15,874.98 110.00 15,868.44 110.00 15,861.91 $4,247,500 $4,248,000 110.00 15,902.98 110.00 15,896.45 110.00 15,889.92 110.00 15,883.38 110.00 15,876.85 110.00 15,870.32 110.00 15,863.78 $4,248,000 $4,248,500 110.00 15,904.86 110.00 15,898.33 110.00 15,891.79 110.00 15,885.26 110.00 15,878.73 110.00 15,872.19 110.00 15,865.66 $4,248,500 $4,249,000 110.00 15,906.73 110.00 15,900.20 110.00 15,893.67 110.00 15,887.13 110.00 15,880.60 110.00 15,874.07 110.00 15,867.53 $4,249,000 $4,249,500 110.00 15,908.61 110.00 15,902.08 110.00 15,895.54 110.00 15,889.01 110.00 15,882.48 110.00 15,875.94 110.00 15,869.41 $4,249,500 $4,250,000 110.00 15,910.48 110.00 15,903.95 110.00 15,897.42 110.00 15,890.88 110.00 15,884.35 110.00 15,877.82 110.00 15,871.28 $4,250,000 $4,250,500 110.00 15,912.36 110.00 15,905.83 110.00 15,899.29 110.00 15,892.76 110.00 15,886.23 110.00 15,879.69 110.00 15,873.16 $4,250,500 $4,251,000 110.00 15,914.23 110.00 15,907.70 110.00 15,901.17 110.00 15,894.63 110.00 15,888.10 110.00 15,881.57 110.00 15,875.03 $4,251,000 $4,251,500 110.00 15,916.11 110.00 15,909.58 110.00 15,903.04 110.00 15,896.51 110.00 15,889.98 110.00 15,883.44 110.00 15,876.91 $4,251,500 $4,252,000 110.00 15,917.98 110.00 15,911.45 110.00 15,904.92 110.00 15,898.38 110.00 15,891.85 110.00 15,885.32 110.00 15,878.78 $4,252,000 $4,252,500 110.00 15,919.86 110.00 15,913.33 110.00 15,906.79 110.00 15,900.26 110.00 15,893.73 110.00 15,887.19 110.00 15,880.66 $4,252,500 $4,253,000 110.00 15,921.73 110.00 15,915.20 110.00 15,908.67 110.00 15,902.13 110.00 15,895.60 110.00 15,889.07 110.00 15,882.53 $4,253,000 $4,253,500 110.00 15,923.61 110.00 15,917.08 110.00 15,910.54 110.00 15,904.01 110.00 15,897.48 110.00 15,890.94 110.00 15,884.41 $4,253,500 $4,254,000 110.00 15,925.48 110.00 15,918.95 110.00 15,912.42 110.00 15,905.88 110.00 15,899.35 110.00 15,892.82 110.00 15,886.28 $4,254,000 $4,254,500 110.00 15,927.36 110.00 15,920.83 110.00 15,914.29 110.00 15,907.76 110.00 15,901.23 110.00 15,894.69 110.00 15,888.16 $4,254,500 $4,255,000 110.00 15,929.23 110.00 15,922.70 110.00 15,916.17 110.00 15,909.63 110.00 15,903.10 110.00 15,896.57 110.00 15,890.03 $4,255,000 $4,255,500 110.00 15,931.11 110.00 15,924.58 110.00 15,918.04 110.00 15,911.51 110.00 15,904.98 110.00 15,898.44 110.00 15,891.91 $4,255,500 $4,256,000 110.00 15,932.98 110.00 15,926.45 110.00 15,919.92 110.00 15,913.38 110.00 15,906.85 110.00 15,900.32 110.00 15,893.78 $4,256,000 $4,256,500 110.00 15,934.86 110.00 15,928.33 110.00 15,921.79 110.00 15,915.26 110.00 15,908.73 110.00 15,902.19 110.00 15,895.66 $4,256,500 $4,257,000 110.00 15,936.73 110.00 15,930.20 110.00 15,923.67 110.00 15,917.13 110.00 15,910.60 110.00 15,904.07 110.00 15,897.53 $4,257,000 $4,257,500 110.00 15,938.61 110.00 15,932.08 110.00 15,925.54 110.00 15,919.01 110.00 15,912.48 110.00 15,905.94 110.00 15,899.41 $4,257,500 $4,258,000 110.00 15,940.48 110.00 15,933.95 110.00 15,927.42 110.00 15,920.88 110.00 15,914.35 110.00 15,907.82 110.00 15,901.28 $4,258,000 $4,258,500 110.00 15,942.36 110.00 15,935.83 110.00 15,929.29 110.00 15,922.76 110.00 15,916.23 110.00 15,909.69 110.00 15,903.16 $4,258,500 $4,259,000 110.00 15,944.23 110.00 15,937.70 110.00 15,931.17 110.00 15,924.63 110.00 15,918.10 110.00 15,911.57 110.00 15,905.03 $4,259,000 $4,259,500 110.00 15,946.11 110.00 15,939.58 110.00 15,933.04 110.00 15,926.51 110.00 15,919.98 110.00 15,913.44 110.00 15,906.91 $4,259,500 $4,260,000 110.00 15,947.98 110.00 15,941.45 110.00 15,934.92 110.00 15,928.38 110.00 15,921.85 110.00 15,915.32 110.00 15,908.78 $4,260,000 $4,260,500 110.00 15,949.86 110.00 15,943.33 110.00 15,936.79 110.00 15,930.26 110.00 15,923.73 110.00 15,917.19 110.00 15,910.66 $4,260,500 $4,261,000 110.00 15,951.73 110.00 15,945.20 110.00 15,938.67 110.00 15,932.13 110.00 15,925.60 110.00 15,919.07 110.00 15,912.53 $4,261,000 $4,261,500 110.00 15,953.61 110.00 15,947.08 110.00 15,940.54 110.00 15,934.01 110.00 15,927.48 110.00 15,920.94 110.00 15,914.41 $4,261,500 $4,262,000 110.00 15,955.48 110.00 15,948.95 110.00 15,942.42 110.00 15,935.88 110.00 15,929.35 110.00 15,922.82 110.00 15,916.28 $4,262,000 $4,262,500 110.00 15,957.36 110.00 15,950.83 110.00 15,944.29 110.00 15,937.76 110.00 15,931.23 110.00 15,924.69 110.00 15,918.16 $4,262,500 $4,263,000 110.00 15,959.23 110.00 15,952.70 110.00 15,946.17 110.00 15,939.63 110.00 15,933.10 110.00 15,926.57 110.00 15,920.03 $4,263,000 $4,263,500 110.00 15,961.11 110.00 15,954.58 110.00 15,948.04 110.00 15,941.51 110.00 15,934.98 110.00 15,928.44 110.00 15,921.91 $4,263,500 $4,264,000 110.00 15,962.98 110.00 15,956.45 110.00 15,949.92 110.00 15,943.38 110.00 15,936.85 110.00 15,930.32 110.00 15,923.78 $4,264,000 $4,264,500 110.00 15,964.86 110.00 15,958.33 110.00 15,951.79 110.00 15,945.26 110.00 15,938.73 110.00 15,932.19 110.00 15,925.66 $4,264,500 $4,265,000 110.00 15,966.73 110.00 15,960.20 110.00 15,953.67 110.00 15,947.13 110.00 15,940.60 110.00 15,934.07 110.00 15,927.53 $4,265,000 $4,265,500 110.00 15,968.61 110.00 15,962.08 110.00 15,955.54 110.00 15,949.01 110.00 15,942.48 110.00 15,935.94 110.00 15,929.41 $4,265,500 $4,266,000 110.00 15,970.48 110.00 15,963.95 110.00 15,957.42 110.00 15,950.88 110.00 15,944.35 110.00 15,937.82 110.00 15,931.28 $4,266,000 $4,266,500 110.00 15,972.36 110.00 15,965.83 110.00 15,959.29 110.00 15,952.76 110.00 15,946.23 110.00 15,939.69 110.00 15,933.16 $4,266,500 $4,267,000 110.00 15,974.23 110.00 15,967.70 110.00 15,961.17 110.00 15,954.63 110.00 15,948.10 110.00 15,941.57 110.00 15,935.03 $4,267,000 $4,267,500 110.00 15,976.11 110.00 15,969.58 110.00 15,963.04 110.00 15,956.51 110.00 15,949.98 110.00 15,943.44 110.00 15,936.91 $4,267,500 $4,268,000 110.00 15,977.98 110.00 15,971.45 110.00 15,964.92 110.00 15,958.38 110.00 15,951.85 110.00 15,945.32 110.00 15,938.78 $4,268,000 $4,268,500 110.00 15,979.86 110.00 15,973.33 110.00 15,966.79 110.00 15,960.26 110.00 15,953.73 110.00 15,947.19 110.00 15,940.66 $4,268,500 $4,269,000 110.00 15,981.73 110.00 15,975.20 110.00 15,968.67 110.00 15,962.13 110.00 15,955.60 110.00 15,949.07 110.00 15,942.53 $4,269,000 $4,269,500 110.00 15,983.61 110.00 15,977.08 110.00 15,970.54 110.00 15,964.01 110.00 15,957.48 110.00 15,950.94 110.00 15,944.41 $4,269,500 $4,270,000 110.00 15,985.48 110.00 15,978.95 110.00 15,972.42 110.00 15,965.88 110.00 15,959.35 110.00 15,952.82 110.00 15,946.28 $4,270,000 $4,270,500 110.00 15,987.36 110.00 15,980.83 110.00 15,974.29 110.00 15,967.76 110.00 15,961.23 110.00 15,954.69 110.00 15,948.16 $4,270,500 $4,271,000 110.00 15,989.23 110.00 15,982.70 110.00 15,976.17 110.00 15,969.63 110.00 15,963.10 110.00 15,956.57 110.00 15,950.03 $4,271,000 $4,271,500 110.00 15,991.11 110.00 15,984.58 110.00 15,978.04 110.00 15,971.51 110.00 15,964.98 110.00 15,958.44 110.00 15,951.91 $4,271,500 $4,272,000 110.00 15,992.98 110.00 15,986.45 110.00 15,979.92 110.00 15,973.38 110.00 15,966.85 110.00 15,960.32 110.00 15,953.78 $4,272,000 $4,272,500 110.00 15,994.86 110.00 15,988.33 110.00 15,981.79 110.00 15,975.26 110.00 15,968.73 110.00 15,962.19 110.00 15,955.66 $4,272,500 $4,273,000 110.00 15,996.73 110.00 15,990.20 110.00 15,983.67 110.00 15,977.13 110.00 15,970.60 110.00 15,964.07 110.00 15,957.53 $4,273,000 $4,273,500 110.00 15,998.61 110.00 15,992.08 110.00 15,985.54 110.00 15,979.01 110.00 15,972.48 110.00 15,965.94 110.00 15,959.41 $4,273,500 $4,274,000 110.00 16,000.48 110.00 15,993.95 110.00 15,987.42 110.00 15,980.88 110.00 15,974.35 110.00 15,967.82 110.00 15,961.28 $4,274,000 $4,274,500 110.00 16,002.36 110.00 15,995.83 110.00 15,989.29 110.00 15,982.76 110.00 15,976.23 110.00 15,969.69 110.00 15,963.16 $4,274,500 $4,275,000 110.00 16,004.23 110.00 15,997.70 110.00 15,991.17 110.00 15,984.63 110.00 15,978.10 110.00 15,971.57 110.00 15,965.03 $4,275,000 $4,275,500 110.00 16,006.11 110.00 15,999.58 110.00 15,993.04 110.00 15,986.51 110.00 15,979.98 110.00 15,973.44 110.00 15,966.91 $4,275,500 $4,276,000 110.00 16,007.98 110.00 16,001.45 110.00 15,994.92 110.00 15,988.38 110.00 15,981.85 110.00 15,975.32 110.00 15,968.78 $4,276,000 $4,276,500 110.00 16,009.86 110.00 16,003.33 110.00 15,996.79 110.00 15,990.26 110.00 15,983.73 110.00 15,977.19 110.00 15,970.66 $4,276,500 $4,277,000 110.00 16,011.73 110.00 16,005.20 110.00 15,998.67 110.00 15,992.13 110.00 15,985.60 110.00 15,979.07 110.00 15,972.53 $4,277,000 $4,277,500 110.00 16,013.61 110.00 16,007.08 110.00 16,000.54 110.00 15,994.01 110.00 15,987.48 110.00 15,980.94 110.00 15,974.41 $4,277,500 $4,278,000 110.00 16,015.48 110.00 16,008.95 110.00 16,002.42 110.00 15,995.88 110.00 15,989.35 110.00 15,982.82 110.00 15,976.28 $4,278,000 $4,278,500 110.00 16,017.36 110.00 16,010.83 110.00 16,004.29 110.00 15,997.76 110.00 15,991.23 110.00 15,984.69 110.00 15,978.16 $4,278,500 $4,279,000 110.00 16,019.23 110.00 16,012.70 110.00 16,006.17 110.00 15,999.63 110.00 15,993.10 110.00 15,986.57 110.00 15,980.03 $4,279,000 $4,279,500 110.00 16,021.11 110.00 16,014.58 110.00 16,008.04 110.00 16,001.51 110.00 15,994.98 110.00 15,988.44 110.00 15,981.91 $4,279,500 $4,280,000 110.00 16,022.98 110.00 16,016.45 110.00 16,009.92 110.00 16,003.38 110.00 15,996.85 110.00 15,990.32 110.00 15,983.78 $4,280,000 $4,280,500 110.00 16,024.86 110.00 16,018.33 110.00 16,011.79 110.00 16,005.26 110.00 15,998.73 110.00 15,992.19 110.00 15,985.66 $4,280,500 $4,281,000 110.00 16,026.73 110.00 16,020.20 110.00 16,013.67 110.00 16,007.13 110.00 16,000.60 110.00 15,994.07 110.00 15,987.53 $4,281,000 $4,281,500 110.00 16,028.61 110.00 16,022.08 110.00 16,015.54 110.00 16,009.01 110.00 16,002.48 110.00 15,995.94 110.00 15,989.41 $4,281,500 $4,282,000 110.00 16,030.48 110.00 16,023.95 110.00 16,017.42 110.00 16,010.88 110.00 16,004.35 110.00 15,997.82 110.00 15,991.28 $4,282,000 $4,282,500 110.00 16,032.36 110.00 16,025.83 110.00 16,019.29 110.00 16,012.76 110.00 16,006.23 110.00 15,999.69 110.00 15,993.16 $4,282,500 $4,283,000 110.00 16,034.23 110.00 16,027.70 110.00 16,021.17 110.00 16,014.63 110.00 16,008.10 110.00 16,001.57 110.00 15,995.03 $4,283,000 $4,283,500 110.00 16,036.11 110.00 16,029.58 110.00 16,023.04 110.00 16,016.51 110.00 16,009.98 110.00 16,003.44 110.00 15,996.91 $4,283,500 $4,284,000 110.00 16,037.98 110.00 16,031.45 110.00 16,024.92 110.00 16,018.38 110.00 16,011.85 110.00 16,005.32 110.00 15,998.78

NJEIS Family Cost Participation Table Page 87 of 12 Effective July 1, 2015

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

$4,284,000 $4,284,500 110.00 16,039.86 110.00 16,033.33 110.00 16,026.79 110.00 16,020.26 110.00 16,013.73 110.00 16,007.19 110.00 16,000.66 $4,284,500 $4,285,000 110.00 16,041.73 110.00 16,035.20 110.00 16,028.67 110.00 16,022.13 110.00 16,015.60 110.00 16,009.07 110.00 16,002.53 $4,285,000 $4,285,500 110.00 16,043.61 110.00 16,037.08 110.00 16,030.54 110.00 16,024.01 110.00 16,017.48 110.00 16,010.94 110.00 16,004.41 $4,285,500 $4,286,000 110.00 16,045.48 110.00 16,038.95 110.00 16,032.42 110.00 16,025.88 110.00 16,019.35 110.00 16,012.82 110.00 16,006.28 $4,286,000 $4,286,500 110.00 16,047.36 110.00 16,040.83 110.00 16,034.29 110.00 16,027.76 110.00 16,021.23 110.00 16,014.69 110.00 16,008.16 $4,286,500 $4,287,000 110.00 16,049.23 110.00 16,042.70 110.00 16,036.17 110.00 16,029.63 110.00 16,023.10 110.00 16,016.57 110.00 16,010.03 $4,287,000 $4,287,500 110.00 16,051.11 110.00 16,044.58 110.00 16,038.04 110.00 16,031.51 110.00 16,024.98 110.00 16,018.44 110.00 16,011.91 $4,287,500 $4,288,000 110.00 16,052.98 110.00 16,046.45 110.00 16,039.92 110.00 16,033.38 110.00 16,026.85 110.00 16,020.32 110.00 16,013.78 $4,288,000 $4,288,500 110.00 16,054.86 110.00 16,048.33 110.00 16,041.79 110.00 16,035.26 110.00 16,028.73 110.00 16,022.19 110.00 16,015.66 $4,288,500 $4,289,000 110.00 16,056.73 110.00 16,050.20 110.00 16,043.67 110.00 16,037.13 110.00 16,030.60 110.00 16,024.07 110.00 16,017.53 $4,289,000 $4,289,500 110.00 16,058.61 110.00 16,052.08 110.00 16,045.54 110.00 16,039.01 110.00 16,032.48 110.00 16,025.94 110.00 16,019.41 $4,289,500 $4,290,000 110.00 16,060.48 110.00 16,053.95 110.00 16,047.42 110.00 16,040.88 110.00 16,034.35 110.00 16,027.82 110.00 16,021.28 $4,290,000 $4,290,500 110.00 16,062.36 110.00 16,055.83 110.00 16,049.29 110.00 16,042.76 110.00 16,036.23 110.00 16,029.69 110.00 16,023.16 $4,290,500 $4,291,000 110.00 16,064.23 110.00 16,057.70 110.00 16,051.17 110.00 16,044.63 110.00 16,038.10 110.00 16,031.57 110.00 16,025.03 $4,291,000 $4,291,500 110.00 16,066.11 110.00 16,059.58 110.00 16,053.04 110.00 16,046.51 110.00 16,039.98 110.00 16,033.44 110.00 16,026.91 $4,291,500 $4,292,000 110.00 16,067.98 110.00 16,061.45 110.00 16,054.92 110.00 16,048.38 110.00 16,041.85 110.00 16,035.32 110.00 16,028.78 $4,292,000 $4,292,500 110.00 16,069.86 110.00 16,063.33 110.00 16,056.79 110.00 16,050.26 110.00 16,043.73 110.00 16,037.19 110.00 16,030.66 $4,292,500 $4,293,000 110.00 16,071.73 110.00 16,065.20 110.00 16,058.67 110.00 16,052.13 110.00 16,045.60 110.00 16,039.07 110.00 16,032.53 $4,293,000 $4,293,500 110.00 16,073.61 110.00 16,067.08 110.00 16,060.54 110.00 16,054.01 110.00 16,047.48 110.00 16,040.94 110.00 16,034.41 $4,293,500 $4,294,000 110.00 16,075.48 110.00 16,068.95 110.00 16,062.42 110.00 16,055.88 110.00 16,049.35 110.00 16,042.82 110.00 16,036.28 $4,294,000 $4,294,500 110.00 16,077.36 110.00 16,070.83 110.00 16,064.29 110.00 16,057.76 110.00 16,051.23 110.00 16,044.69 110.00 16,038.16 $4,294,500 $4,295,000 110.00 16,079.23 110.00 16,072.70 110.00 16,066.17 110.00 16,059.63 110.00 16,053.10 110.00 16,046.57 110.00 16,040.03 $4,295,000 $4,295,500 110.00 16,081.11 110.00 16,074.58 110.00 16,068.04 110.00 16,061.51 110.00 16,054.98 110.00 16,048.44 110.00 16,041.91 $4,295,500 $4,296,000 110.00 16,082.98 110.00 16,076.45 110.00 16,069.92 110.00 16,063.38 110.00 16,056.85 110.00 16,050.32 110.00 16,043.78 $4,296,000 $4,296,500 110.00 16,084.86 110.00 16,078.33 110.00 16,071.79 110.00 16,065.26 110.00 16,058.73 110.00 16,052.19 110.00 16,045.66 $4,296,500 $4,297,000 110.00 16,086.73 110.00 16,080.20 110.00 16,073.67 110.00 16,067.13 110.00 16,060.60 110.00 16,054.07 110.00 16,047.53 $4,297,000 $4,297,500 110.00 16,088.61 110.00 16,082.08 110.00 16,075.54 110.00 16,069.01 110.00 16,062.48 110.00 16,055.94 110.00 16,049.41 $4,297,500 $4,298,000 110.00 16,090.48 110.00 16,083.95 110.00 16,077.42 110.00 16,070.88 110.00 16,064.35 110.00 16,057.82 110.00 16,051.28 $4,298,000 $4,298,500 110.00 16,092.36 110.00 16,085.83 110.00 16,079.29 110.00 16,072.76 110.00 16,066.23 110.00 16,059.69 110.00 16,053.16 $4,298,500 $4,299,000 110.00 16,094.23 110.00 16,087.70 110.00 16,081.17 110.00 16,074.63 110.00 16,068.10 110.00 16,061.57 110.00 16,055.03 $4,299,000 $4,299,500 110.00 16,096.11 110.00 16,089.58 110.00 16,083.04 110.00 16,076.51 110.00 16,069.98 110.00 16,063.44 110.00 16,056.91 $4,299,500 $4,300,000 110.00 16,097.98 110.00 16,091.45 110.00 16,084.92 110.00 16,078.38 110.00 16,071.85 110.00 16,065.32 110.00 16,058.78 $4,300,000 $4,300,500 110.00 16,099.86 110.00 16,093.33 110.00 16,086.79 110.00 16,080.26 110.00 16,073.73 110.00 16,067.19 110.00 16,060.66 $4,300,500 $4,301,000 110.00 16,101.73 110.00 16,095.20 110.00 16,088.67 110.00 16,082.13 110.00 16,075.60 110.00 16,069.07 110.00 16,062.53 $4,301,000 $4,301,500 110.00 16,103.61 110.00 16,097.08 110.00 16,090.54 110.00 16,084.01 110.00 16,077.48 110.00 16,070.94 110.00 16,064.41 $4,301,500 $4,302,000 110.00 16,105.48 110.00 16,098.95 110.00 16,092.42 110.00 16,085.88 110.00 16,079.35 110.00 16,072.82 110.00 16,066.28 $4,302,000 $4,302,500 110.00 16,107.36 110.00 16,100.83 110.00 16,094.29 110.00 16,087.76 110.00 16,081.23 110.00 16,074.69 110.00 16,068.16 $4,302,500 $4,303,000 110.00 16,109.23 110.00 16,102.70 110.00 16,096.17 110.00 16,089.63 110.00 16,083.10 110.00 16,076.57 110.00 16,070.03 $4,303,000 $4,303,500 110.00 16,111.11 110.00 16,104.58 110.00 16,098.04 110.00 16,091.51 110.00 16,084.98 110.00 16,078.44 110.00 16,071.91 $4,303,500 $4,304,000 110.00 16,112.98 110.00 16,106.45 110.00 16,099.92 110.00 16,093.38 110.00 16,086.85 110.00 16,080.32 110.00 16,073.78 $4,304,000 $4,304,500 110.00 16,114.86 110.00 16,108.33 110.00 16,101.79 110.00 16,095.26 110.00 16,088.73 110.00 16,082.19 110.00 16,075.66 $4,304,500 $4,305,000 110.00 16,116.73 110.00 16,110.20 110.00 16,103.67 110.00 16,097.13 110.00 16,090.60 110.00 16,084.07 110.00 16,077.53 $4,305,000 $4,305,500 110.00 16,118.61 110.00 16,112.08 110.00 16,105.54 110.00 16,099.01 110.00 16,092.48 110.00 16,085.94 110.00 16,079.41 $4,305,500 $4,306,000 110.00 16,120.48 110.00 16,113.95 110.00 16,107.42 110.00 16,100.88 110.00 16,094.35 110.00 16,087.82 110.00 16,081.28 $4,306,000 $4,306,500 110.00 16,122.36 110.00 16,115.83 110.00 16,109.29 110.00 16,102.76 110.00 16,096.23 110.00 16,089.69 110.00 16,083.16 $4,306,500 $4,307,000 110.00 16,124.23 110.00 16,117.70 110.00 16,111.17 110.00 16,104.63 110.00 16,098.10 110.00 16,091.57 110.00 16,085.03 $4,307,000 $4,307,500 110.00 16,126.11 110.00 16,119.58 110.00 16,113.04 110.00 16,106.51 110.00 16,099.98 110.00 16,093.44 110.00 16,086.91 $4,307,500 $4,308,000 110.00 16,127.98 110.00 16,121.45 110.00 16,114.92 110.00 16,108.38 110.00 16,101.85 110.00 16,095.32 110.00 16,088.78 $4,308,000 $4,308,500 110.00 16,129.86 110.00 16,123.33 110.00 16,116.79 110.00 16,110.26 110.00 16,103.73 110.00 16,097.19 110.00 16,090.66 $4,308,500 $4,309,000 110.00 16,131.73 110.00 16,125.20 110.00 16,118.67 110.00 16,112.13 110.00 16,105.60 110.00 16,099.07 110.00 16,092.53 $4,309,000 $4,309,500 110.00 16,133.61 110.00 16,127.08 110.00 16,120.54 110.00 16,114.01 110.00 16,107.48 110.00 16,100.94 110.00 16,094.41 $4,309,500 $4,310,000 110.00 16,135.48 110.00 16,128.95 110.00 16,122.42 110.00 16,115.88 110.00 16,109.35 110.00 16,102.82 110.00 16,096.28 $4,310,000 $4,310,500 110.00 16,137.36 110.00 16,130.83 110.00 16,124.29 110.00 16,117.76 110.00 16,111.23 110.00 16,104.69 110.00 16,098.16 $4,310,500 $4,311,000 110.00 16,139.23 110.00 16,132.70 110.00 16,126.17 110.00 16,119.63 110.00 16,113.10 110.00 16,106.57 110.00 16,100.03 $4,311,000 $4,311,500 110.00 16,141.11 110.00 16,134.58 110.00 16,128.04 110.00 16,121.51 110.00 16,114.98 110.00 16,108.44 110.00 16,101.91 $4,311,500 $4,312,000 110.00 16,142.98 110.00 16,136.45 110.00 16,129.92 110.00 16,123.38 110.00 16,116.85 110.00 16,110.32 110.00 16,103.78 $4,312,000 $4,312,500 110.00 16,144.86 110.00 16,138.33 110.00 16,131.79 110.00 16,125.26 110.00 16,118.73 110.00 16,112.19 110.00 16,105.66 $4,312,500 $4,313,000 110.00 16,146.73 110.00 16,140.20 110.00 16,133.67 110.00 16,127.13 110.00 16,120.60 110.00 16,114.07 110.00 16,107.53 $4,313,000 $4,313,500 110.00 16,148.61 110.00 16,142.08 110.00 16,135.54 110.00 16,129.01 110.00 16,122.48 110.00 16,115.94 110.00 16,109.41 $4,313,500 $4,314,000 110.00 16,150.48 110.00 16,143.95 110.00 16,137.42 110.00 16,130.88 110.00 16,124.35 110.00 16,117.82 110.00 16,111.28 $4,314,000 $4,314,500 110.00 16,152.36 110.00 16,145.83 110.00 16,139.29 110.00 16,132.76 110.00 16,126.23 110.00 16,119.69 110.00 16,113.16 $4,314,500 $4,315,000 110.00 16,154.23 110.00 16,147.70 110.00 16,141.17 110.00 16,134.63 110.00 16,128.10 110.00 16,121.57 110.00 16,115.03 $4,315,000 $4,315,500 110.00 16,156.11 110.00 16,149.58 110.00 16,143.04 110.00 16,136.51 110.00 16,129.98 110.00 16,123.44 110.00 16,116.91 $4,315,500 $4,316,000 110.00 16,157.98 110.00 16,151.45 110.00 16,144.92 110.00 16,138.38 110.00 16,131.85 110.00 16,125.32 110.00 16,118.78 $4,316,000 $4,316,500 110.00 16,159.86 110.00 16,153.33 110.00 16,146.79 110.00 16,140.26 110.00 16,133.73 110.00 16,127.19 110.00 16,120.66 $4,316,500 $4,317,000 110.00 16,161.73 110.00 16,155.20 110.00 16,148.67 110.00 16,142.13 110.00 16,135.60 110.00 16,129.07 110.00 16,122.53 $4,317,000 $4,317,500 110.00 16,163.61 110.00 16,157.08 110.00 16,150.54 110.00 16,144.01 110.00 16,137.48 110.00 16,130.94 110.00 16,124.41 $4,317,500 $4,318,000 110.00 16,165.48 110.00 16,158.95 110.00 16,152.42 110.00 16,145.88 110.00 16,139.35 110.00 16,132.82 110.00 16,126.28 $4,318,000 $4,318,500 110.00 16,167.36 110.00 16,160.83 110.00 16,154.29 110.00 16,147.76 110.00 16,141.23 110.00 16,134.69 110.00 16,128.16 $4,318,500 $4,319,000 110.00 16,169.23 110.00 16,162.70 110.00 16,156.17 110.00 16,149.63 110.00 16,143.10 110.00 16,136.57 110.00 16,130.03 $4,319,000 $4,319,500 110.00 16,171.11 110.00 16,164.58 110.00 16,158.04 110.00 16,151.51 110.00 16,144.98 110.00 16,138.44 110.00 16,131.91 $4,319,500 $4,320,000 110.00 16,172.98 110.00 16,166.45 110.00 16,159.92 110.00 16,153.38 110.00 16,146.85 110.00 16,140.32 110.00 16,133.78 $4,320,000 $4,320,500 110.00 16,174.86 110.00 16,168.33 110.00 16,161.79 110.00 16,155.26 110.00 16,148.73 110.00 16,142.19 110.00 16,135.66 $4,320,500 $4,321,000 110.00 16,176.73 110.00 16,170.20 110.00 16,163.67 110.00 16,157.13 110.00 16,150.60 110.00 16,144.07 110.00 16,137.53 $4,321,000 $4,321,500 110.00 16,178.61 110.00 16,172.08 110.00 16,165.54 110.00 16,159.01 110.00 16,152.48 110.00 16,145.94 110.00 16,139.41 $4,321,500 $4,322,000 110.00 16,180.48 110.00 16,173.95 110.00 16,167.42 110.00 16,160.88 110.00 16,154.35 110.00 16,147.82 110.00 16,141.28 $4,322,000 $4,322,500 110.00 16,182.36 110.00 16,175.83 110.00 16,169.29 110.00 16,162.76 110.00 16,156.23 110.00 16,149.69 110.00 16,143.16 $4,322,500 $4,323,000 110.00 16,184.23 110.00 16,177.70 110.00 16,171.17 110.00 16,164.63 110.00 16,158.10 110.00 16,151.57 110.00 16,145.03 $4,323,000 $4,323,500 110.00 16,186.11 110.00 16,179.58 110.00 16,173.04 110.00 16,166.51 110.00 16,159.98 110.00 16,153.44 110.00 16,146.91 $4,323,500 $4,324,000 110.00 16,187.98 110.00 16,181.45 110.00 16,174.92 110.00 16,168.38 110.00 16,161.85 110.00 16,155.32 110.00 16,148.78 $4,324,000 $4,324,500 110.00 16,189.86 110.00 16,183.33 110.00 16,176.79 110.00 16,170.26 110.00 16,163.73 110.00 16,157.19 110.00 16,150.66 $4,324,500 $4,325,000 110.00 16,191.73 110.00 16,185.20 110.00 16,178.67 110.00 16,172.13 110.00 16,165.60 110.00 16,159.07 110.00 16,152.53 $4,325,000 $4,325,500 110.00 16,193.61 110.00 16,187.08 110.00 16,180.54 110.00 16,174.01 110.00 16,167.48 110.00 16,160.94 110.00 16,154.41 $4,325,500 $4,326,000 110.00 16,195.48 110.00 16,188.95 110.00 16,182.42 110.00 16,175.88 110.00 16,169.35 110.00 16,162.82 110.00 16,156.28 $4,326,000 $4,326,500 110.00 16,197.36 110.00 16,190.83 110.00 16,184.29 110.00 16,177.76 110.00 16,171.23 110.00 16,164.69 110.00 16,158.16 $4,326,500 $4,327,000 110.00 16,199.23 110.00 16,192.70 110.00 16,186.17 110.00 16,179.63 110.00 16,173.10 110.00 16,166.57 110.00 16,160.03 $4,327,000 $4,327,500 110.00 16,201.11 110.00 16,194.58 110.00 16,188.04 110.00 16,181.51 110.00 16,174.98 110.00 16,168.44 110.00 16,161.91 $4,327,500 $4,328,000 110.00 16,202.98 110.00 16,196.45 110.00 16,189.92 110.00 16,183.38 110.00 16,176.85 110.00 16,170.32 110.00 16,163.78 $4,328,000 $4,328,500 110.00 16,204.86 110.00 16,198.33 110.00 16,191.79 110.00 16,185.26 110.00 16,178.73 110.00 16,172.19 110.00 16,165.66 $4,328,500 $4,329,000 110.00 16,206.73 110.00 16,200.20 110.00 16,193.67 110.00 16,187.13 110.00 16,180.60 110.00 16,174.07 110.00 16,167.53 $4,329,000 $4,329,500 110.00 16,208.61 110.00 16,202.08 110.00 16,195.54 110.00 16,189.01 110.00 16,182.48 110.00 16,175.94 110.00 16,169.41 $4,329,500 $4,330,000 110.00 16,210.48 110.00 16,203.95 110.00 16,197.42 110.00 16,190.88 110.00 16,184.35 110.00 16,177.82 110.00 16,171.28 $4,330,000 $4,330,500 110.00 16,212.36 110.00 16,205.83 110.00 16,199.29 110.00 16,192.76 110.00 16,186.23 110.00 16,179.69 110.00 16,173.16 $4,330,500 $4,331,000 110.00 16,214.23 110.00 16,207.70 110.00 16,201.17 110.00 16,194.63 110.00 16,188.10 110.00 16,181.57 110.00 16,175.03 $4,331,000 $4,331,500 110.00 16,216.11 110.00 16,209.58 110.00 16,203.04 110.00 16,196.51 110.00 16,189.98 110.00 16,183.44 110.00 16,176.91 $4,331,500 $4,332,000 110.00 16,217.98 110.00 16,211.45 110.00 16,204.92 110.00 16,198.38 110.00 16,191.85 110.00 16,185.32 110.00 16,178.78 $4,332,000 $4,332,500 110.00 16,219.86 110.00 16,213.33 110.00 16,206.79 110.00 16,200.26 110.00 16,193.73 110.00 16,187.19 110.00 16,180.66 $4,332,500 $4,333,000 110.00 16,221.73 110.00 16,215.20 110.00 16,208.67 110.00 16,202.13 110.00 16,195.60 110.00 16,189.07 110.00 16,182.53 $4,333,000 $4,333,500 110.00 16,223.61 110.00 16,217.08 110.00 16,210.54 110.00 16,204.01 110.00 16,197.48 110.00 16,190.94 110.00 16,184.41 $4,333,500 $4,334,000 110.00 16,225.48 110.00 16,218.95 110.00 16,212.42 110.00 16,205.88 110.00 16,199.35 110.00 16,192.82 110.00 16,186.28 $4,334,000 $4,334,500 110.00 16,227.36 110.00 16,220.83 110.00 16,214.29 110.00 16,207.76 110.00 16,201.23 110.00 16,194.69 110.00 16,188.16 $4,334,500 $4,335,000 110.00 16,229.23 110.00 16,222.70 110.00 16,216.17 110.00 16,209.63 110.00 16,203.10 110.00 16,196.57 110.00 16,190.03

NJEIS Family Cost Participation Table Page 88 of 12 Effective July 1, 2015

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

$4,335,000 $4,335,500 110.00 16,231.11 110.00 16,224.58 110.00 16,218.04 110.00 16,211.51 110.00 16,204.98 110.00 16,198.44 110.00 16,191.91 $4,335,500 $4,336,000 110.00 16,232.98 110.00 16,226.45 110.00 16,219.92 110.00 16,213.38 110.00 16,206.85 110.00 16,200.32 110.00 16,193.78 $4,336,000 $4,336,500 110.00 16,234.86 110.00 16,228.33 110.00 16,221.79 110.00 16,215.26 110.00 16,208.73 110.00 16,202.19 110.00 16,195.66 $4,336,500 $4,337,000 110.00 16,236.73 110.00 16,230.20 110.00 16,223.67 110.00 16,217.13 110.00 16,210.60 110.00 16,204.07 110.00 16,197.53 $4,337,000 $4,337,500 110.00 16,238.61 110.00 16,232.08 110.00 16,225.54 110.00 16,219.01 110.00 16,212.48 110.00 16,205.94 110.00 16,199.41 $4,337,500 $4,338,000 110.00 16,240.48 110.00 16,233.95 110.00 16,227.42 110.00 16,220.88 110.00 16,214.35 110.00 16,207.82 110.00 16,201.28 $4,338,000 $4,338,500 110.00 16,242.36 110.00 16,235.83 110.00 16,229.29 110.00 16,222.76 110.00 16,216.23 110.00 16,209.69 110.00 16,203.16 $4,338,500 $4,339,000 110.00 16,244.23 110.00 16,237.70 110.00 16,231.17 110.00 16,224.63 110.00 16,218.10 110.00 16,211.57 110.00 16,205.03 $4,339,000 $4,339,500 110.00 16,246.11 110.00 16,239.58 110.00 16,233.04 110.00 16,226.51 110.00 16,219.98 110.00 16,213.44 110.00 16,206.91 $4,339,500 $4,340,000 110.00 16,247.98 110.00 16,241.45 110.00 16,234.92 110.00 16,228.38 110.00 16,221.85 110.00 16,215.32 110.00 16,208.78 $4,340,000 $4,340,500 110.00 16,249.86 110.00 16,243.33 110.00 16,236.79 110.00 16,230.26 110.00 16,223.73 110.00 16,217.19 110.00 16,210.66 $4,340,500 $4,341,000 110.00 16,251.73 110.00 16,245.20 110.00 16,238.67 110.00 16,232.13 110.00 16,225.60 110.00 16,219.07 110.00 16,212.53 $4,341,000 $4,341,500 110.00 16,253.61 110.00 16,247.08 110.00 16,240.54 110.00 16,234.01 110.00 16,227.48 110.00 16,220.94 110.00 16,214.41 $4,341,500 $4,342,000 110.00 16,255.48 110.00 16,248.95 110.00 16,242.42 110.00 16,235.88 110.00 16,229.35 110.00 16,222.82 110.00 16,216.28 $4,342,000 $4,342,500 110.00 16,257.36 110.00 16,250.83 110.00 16,244.29 110.00 16,237.76 110.00 16,231.23 110.00 16,224.69 110.00 16,218.16 $4,342,500 $4,343,000 110.00 16,259.23 110.00 16,252.70 110.00 16,246.17 110.00 16,239.63 110.00 16,233.10 110.00 16,226.57 110.00 16,220.03 $4,343,000 $4,343,500 110.00 16,261.11 110.00 16,254.58 110.00 16,248.04 110.00 16,241.51 110.00 16,234.98 110.00 16,228.44 110.00 16,221.91 $4,343,500 $4,344,000 110.00 16,262.98 110.00 16,256.45 110.00 16,249.92 110.00 16,243.38 110.00 16,236.85 110.00 16,230.32 110.00 16,223.78 $4,344,000 $4,344,500 110.00 16,264.86 110.00 16,258.33 110.00 16,251.79 110.00 16,245.26 110.00 16,238.73 110.00 16,232.19 110.00 16,225.66 $4,344,500 $4,345,000 110.00 16,266.73 110.00 16,260.20 110.00 16,253.67 110.00 16,247.13 110.00 16,240.60 110.00 16,234.07 110.00 16,227.53 $4,345,000 $4,345,500 110.00 16,268.61 110.00 16,262.08 110.00 16,255.54 110.00 16,249.01 110.00 16,242.48 110.00 16,235.94 110.00 16,229.41 $4,345,500 $4,346,000 110.00 16,270.48 110.00 16,263.95 110.00 16,257.42 110.00 16,250.88 110.00 16,244.35 110.00 16,237.82 110.00 16,231.28 $4,346,000 $4,346,500 110.00 16,272.36 110.00 16,265.83 110.00 16,259.29 110.00 16,252.76 110.00 16,246.23 110.00 16,239.69 110.00 16,233.16 $4,346,500 $4,347,000 110.00 16,274.23 110.00 16,267.70 110.00 16,261.17 110.00 16,254.63 110.00 16,248.10 110.00 16,241.57 110.00 16,235.03 $4,347,000 $4,347,500 110.00 16,276.11 110.00 16,269.58 110.00 16,263.04 110.00 16,256.51 110.00 16,249.98 110.00 16,243.44 110.00 16,236.91 $4,347,500 $4,348,000 110.00 16,277.98 110.00 16,271.45 110.00 16,264.92 110.00 16,258.38 110.00 16,251.85 110.00 16,245.32 110.00 16,238.78 $4,348,000 $4,348,500 110.00 16,279.86 110.00 16,273.33 110.00 16,266.79 110.00 16,260.26 110.00 16,253.73 110.00 16,247.19 110.00 16,240.66 $4,348,500 $4,349,000 110.00 16,281.73 110.00 16,275.20 110.00 16,268.67 110.00 16,262.13 110.00 16,255.60 110.00 16,249.07 110.00 16,242.53 $4,349,000 $4,349,500 110.00 16,283.61 110.00 16,277.08 110.00 16,270.54 110.00 16,264.01 110.00 16,257.48 110.00 16,250.94 110.00 16,244.41 $4,349,500 $4,350,000 110.00 16,285.48 110.00 16,278.95 110.00 16,272.42 110.00 16,265.88 110.00 16,259.35 110.00 16,252.82 110.00 16,246.28 $4,350,000 $4,350,500 110.00 16,287.36 110.00 16,280.83 110.00 16,274.29 110.00 16,267.76 110.00 16,261.23 110.00 16,254.69 110.00 16,248.16 $4,350,500 $4,351,000 110.00 16,289.23 110.00 16,282.70 110.00 16,276.17 110.00 16,269.63 110.00 16,263.10 110.00 16,256.57 110.00 16,250.03 $4,351,000 $4,351,500 110.00 16,291.11 110.00 16,284.58 110.00 16,278.04 110.00 16,271.51 110.00 16,264.98 110.00 16,258.44 110.00 16,251.91 $4,351,500 $4,352,000 110.00 16,292.98 110.00 16,286.45 110.00 16,279.92 110.00 16,273.38 110.00 16,266.85 110.00 16,260.32 110.00 16,253.78 $4,352,000 $4,352,500 110.00 16,294.86 110.00 16,288.33 110.00 16,281.79 110.00 16,275.26 110.00 16,268.73 110.00 16,262.19 110.00 16,255.66 $4,352,500 $4,353,000 110.00 16,296.73 110.00 16,290.20 110.00 16,283.67 110.00 16,277.13 110.00 16,270.60 110.00 16,264.07 110.00 16,257.53 $4,353,000 $4,353,500 110.00 16,298.61 110.00 16,292.08 110.00 16,285.54 110.00 16,279.01 110.00 16,272.48 110.00 16,265.94 110.00 16,259.41 $4,353,500 $4,354,000 110.00 16,300.48 110.00 16,293.95 110.00 16,287.42 110.00 16,280.88 110.00 16,274.35 110.00 16,267.82 110.00 16,261.28 $4,354,000 $4,354,500 110.00 16,302.36 110.00 16,295.83 110.00 16,289.29 110.00 16,282.76 110.00 16,276.23 110.00 16,269.69 110.00 16,263.16 $4,354,500 $4,355,000 110.00 16,304.23 110.00 16,297.70 110.00 16,291.17 110.00 16,284.63 110.00 16,278.10 110.00 16,271.57 110.00 16,265.03 $4,355,000 $4,355,500 110.00 16,306.11 110.00 16,299.58 110.00 16,293.04 110.00 16,286.51 110.00 16,279.98 110.00 16,273.44 110.00 16,266.91 $4,355,500 $4,356,000 110.00 16,307.98 110.00 16,301.45 110.00 16,294.92 110.00 16,288.38 110.00 16,281.85 110.00 16,275.32 110.00 16,268.78 $4,356,000 $4,356,500 110.00 16,309.86 110.00 16,303.33 110.00 16,296.79 110.00 16,290.26 110.00 16,283.73 110.00 16,277.19 110.00 16,270.66 $4,356,500 $4,357,000 110.00 16,311.73 110.00 16,305.20 110.00 16,298.67 110.00 16,292.13 110.00 16,285.60 110.00 16,279.07 110.00 16,272.53 $4,357,000 $4,357,500 110.00 16,313.61 110.00 16,307.08 110.00 16,300.54 110.00 16,294.01 110.00 16,287.48 110.00 16,280.94 110.00 16,274.41 $4,357,500 $4,358,000 110.00 16,315.48 110.00 16,308.95 110.00 16,302.42 110.00 16,295.88 110.00 16,289.35 110.00 16,282.82 110.00 16,276.28 $4,358,000 $4,358,500 110.00 16,317.36 110.00 16,310.83 110.00 16,304.29 110.00 16,297.76 110.00 16,291.23 110.00 16,284.69 110.00 16,278.16 $4,358,500 $4,359,000 110.00 16,319.23 110.00 16,312.70 110.00 16,306.17 110.00 16,299.63 110.00 16,293.10 110.00 16,286.57 110.00 16,280.03 $4,359,000 $4,359,500 110.00 16,321.11 110.00 16,314.58 110.00 16,308.04 110.00 16,301.51 110.00 16,294.98 110.00 16,288.44 110.00 16,281.91 $4,359,500 $4,360,000 110.00 16,322.98 110.00 16,316.45 110.00 16,309.92 110.00 16,303.38 110.00 16,296.85 110.00 16,290.32 110.00 16,283.78 $4,360,000 $4,360,500 110.00 16,324.86 110.00 16,318.33 110.00 16,311.79 110.00 16,305.26 110.00 16,298.73 110.00 16,292.19 110.00 16,285.66 $4,360,500 $4,361,000 110.00 16,326.73 110.00 16,320.20 110.00 16,313.67 110.00 16,307.13 110.00 16,300.60 110.00 16,294.07 110.00 16,287.53 $4,361,000 $4,361,500 110.00 16,328.61 110.00 16,322.08 110.00 16,315.54 110.00 16,309.01 110.00 16,302.48 110.00 16,295.94 110.00 16,289.41 $4,361,500 $4,362,000 110.00 16,330.48 110.00 16,323.95 110.00 16,317.42 110.00 16,310.88 110.00 16,304.35 110.00 16,297.82 110.00 16,291.28 $4,362,000 $4,362,500 110.00 16,332.36 110.00 16,325.83 110.00 16,319.29 110.00 16,312.76 110.00 16,306.23 110.00 16,299.69 110.00 16,293.16 $4,362,500 $4,363,000 110.00 16,334.23 110.00 16,327.70 110.00 16,321.17 110.00 16,314.63 110.00 16,308.10 110.00 16,301.57 110.00 16,295.03 $4,363,000 $4,363,500 110.00 16,336.11 110.00 16,329.58 110.00 16,323.04 110.00 16,316.51 110.00 16,309.98 110.00 16,303.44 110.00 16,296.91 $4,363,500 $4,364,000 110.00 16,337.98 110.00 16,331.45 110.00 16,324.92 110.00 16,318.38 110.00 16,311.85 110.00 16,305.32 110.00 16,298.78 $4,364,000 $4,364,500 110.00 16,339.86 110.00 16,333.33 110.00 16,326.79 110.00 16,320.26 110.00 16,313.73 110.00 16,307.19 110.00 16,300.66 $4,364,500 $4,365,000 110.00 16,341.73 110.00 16,335.20 110.00 16,328.67 110.00 16,322.13 110.00 16,315.60 110.00 16,309.07 110.00 16,302.53 $4,365,000 $4,365,500 110.00 16,343.61 110.00 16,337.08 110.00 16,330.54 110.00 16,324.01 110.00 16,317.48 110.00 16,310.94 110.00 16,304.41 $4,365,500 $4,366,000 110.00 16,345.48 110.00 16,338.95 110.00 16,332.42 110.00 16,325.88 110.00 16,319.35 110.00 16,312.82 110.00 16,306.28 $4,366,000 $4,366,500 110.00 16,347.36 110.00 16,340.83 110.00 16,334.29 110.00 16,327.76 110.00 16,321.23 110.00 16,314.69 110.00 16,308.16 $4,366,500 $4,367,000 110.00 16,349.23 110.00 16,342.70 110.00 16,336.17 110.00 16,329.63 110.00 16,323.10 110.00 16,316.57 110.00 16,310.03 $4,367,000 $4,367,500 110.00 16,351.11 110.00 16,344.58 110.00 16,338.04 110.00 16,331.51 110.00 16,324.98 110.00 16,318.44 110.00 16,311.91 $4,367,500 $4,368,000 110.00 16,352.98 110.00 16,346.45 110.00 16,339.92 110.00 16,333.38 110.00 16,326.85 110.00 16,320.32 110.00 16,313.78 $4,368,000 $4,368,500 110.00 16,354.86 110.00 16,348.33 110.00 16,341.79 110.00 16,335.26 110.00 16,328.73 110.00 16,322.19 110.00 16,315.66 $4,368,500 $4,369,000 110.00 16,356.73 110.00 16,350.20 110.00 16,343.67 110.00 16,337.13 110.00 16,330.60 110.00 16,324.07 110.00 16,317.53 $4,369,000 $4,369,500 110.00 16,358.61 110.00 16,352.08 110.00 16,345.54 110.00 16,339.01 110.00 16,332.48 110.00 16,325.94 110.00 16,319.41 $4,369,500 $4,370,000 110.00 16,360.48 110.00 16,353.95 110.00 16,347.42 110.00 16,340.88 110.00 16,334.35 110.00 16,327.82 110.00 16,321.28 $4,370,000 $4,370,500 110.00 16,362.36 110.00 16,355.83 110.00 16,349.29 110.00 16,342.76 110.00 16,336.23 110.00 16,329.69 110.00 16,323.16 $4,370,500 $4,371,000 110.00 16,364.23 110.00 16,357.70 110.00 16,351.17 110.00 16,344.63 110.00 16,338.10 110.00 16,331.57 110.00 16,325.03 $4,371,000 $4,371,500 110.00 16,366.11 110.00 16,359.58 110.00 16,353.04 110.00 16,346.51 110.00 16,339.98 110.00 16,333.44 110.00 16,326.91 $4,371,500 $4,372,000 110.00 16,367.98 110.00 16,361.45 110.00 16,354.92 110.00 16,348.38 110.00 16,341.85 110.00 16,335.32 110.00 16,328.78 $4,372,000 $4,372,500 110.00 16,369.86 110.00 16,363.33 110.00 16,356.79 110.00 16,350.26 110.00 16,343.73 110.00 16,337.19 110.00 16,330.66 $4,372,500 $4,373,000 110.00 16,371.73 110.00 16,365.20 110.00 16,358.67 110.00 16,352.13 110.00 16,345.60 110.00 16,339.07 110.00 16,332.53 $4,373,000 $4,373,500 110.00 16,373.61 110.00 16,367.08 110.00 16,360.54 110.00 16,354.01 110.00 16,347.48 110.00 16,340.94 110.00 16,334.41 $4,373,500 $4,374,000 110.00 16,375.48 110.00 16,368.95 110.00 16,362.42 110.00 16,355.88 110.00 16,349.35 110.00 16,342.82 110.00 16,336.28 $4,374,000 $4,374,500 110.00 16,377.36 110.00 16,370.83 110.00 16,364.29 110.00 16,357.76 110.00 16,351.23 110.00 16,344.69 110.00 16,338.16 $4,374,500 $4,375,000 110.00 16,379.23 110.00 16,372.70 110.00 16,366.17 110.00 16,359.63 110.00 16,353.10 110.00 16,346.57 110.00 16,340.03 $4,375,000 $4,375,500 110.00 16,381.11 110.00 16,374.58 110.00 16,368.04 110.00 16,361.51 110.00 16,354.98 110.00 16,348.44 110.00 16,341.91 $4,375,500 $4,376,000 110.00 16,382.98 110.00 16,376.45 110.00 16,369.92 110.00 16,363.38 110.00 16,356.85 110.00 16,350.32 110.00 16,343.78 $4,376,000 $4,376,500 110.00 16,384.86 110.00 16,378.33 110.00 16,371.79 110.00 16,365.26 110.00 16,358.73 110.00 16,352.19 110.00 16,345.66 $4,376,500 $4,377,000 110.00 16,386.73 110.00 16,380.20 110.00 16,373.67 110.00 16,367.13 110.00 16,360.60 110.00 16,354.07 110.00 16,347.53 $4,377,000 $4,377,500 110.00 16,388.61 110.00 16,382.08 110.00 16,375.54 110.00 16,369.01 110.00 16,362.48 110.00 16,355.94 110.00 16,349.41 $4,377,500 $4,378,000 110.00 16,390.48 110.00 16,383.95 110.00 16,377.42 110.00 16,370.88 110.00 16,364.35 110.00 16,357.82 110.00 16,351.28 $4,378,000 $4,378,500 110.00 16,392.36 110.00 16,385.83 110.00 16,379.29 110.00 16,372.76 110.00 16,366.23 110.00 16,359.69 110.00 16,353.16 $4,378,500 $4,379,000 110.00 16,394.23 110.00 16,387.70 110.00 16,381.17 110.00 16,374.63 110.00 16,368.10 110.00 16,361.57 110.00 16,355.03 $4,379,000 $4,379,500 110.00 16,396.11 110.00 16,389.58 110.00 16,383.04 110.00 16,376.51 110.00 16,369.98 110.00 16,363.44 110.00 16,356.91 $4,379,500 $4,380,000 110.00 16,397.98 110.00 16,391.45 110.00 16,384.92 110.00 16,378.38 110.00 16,371.85 110.00 16,365.32 110.00 16,358.78 $4,380,000 $4,380,500 110.00 16,399.86 110.00 16,393.33 110.00 16,386.79 110.00 16,380.26 110.00 16,373.73 110.00 16,367.19 110.00 16,360.66 $4,380,500 $4,381,000 110.00 16,401.73 110.00 16,395.20 110.00 16,388.67 110.00 16,382.13 110.00 16,375.60 110.00 16,369.07 110.00 16,362.53 $4,381,000 $4,381,500 110.00 16,403.61 110.00 16,397.08 110.00 16,390.54 110.00 16,384.01 110.00 16,377.48 110.00 16,370.94 110.00 16,364.41 $4,381,500 $4,382,000 110.00 16,405.48 110.00 16,398.95 110.00 16,392.42 110.00 16,385.88 110.00 16,379.35 110.00 16,372.82 110.00 16,366.28 $4,382,000 $4,382,500 110.00 16,407.36 110.00 16,400.83 110.00 16,394.29 110.00 16,387.76 110.00 16,381.23 110.00 16,374.69 110.00 16,368.16 $4,382,500 $4,383,000 110.00 16,409.23 110.00 16,402.70 110.00 16,396.17 110.00 16,389.63 110.00 16,383.10 110.00 16,376.57 110.00 16,370.03 $4,383,000 $4,383,500 110.00 16,411.11 110.00 16,404.58 110.00 16,398.04 110.00 16,391.51 110.00 16,384.98 110.00 16,378.44 110.00 16,371.91 $4,383,500 $4,384,000 110.00 16,412.98 110.00 16,406.45 110.00 16,399.92 110.00 16,393.38 110.00 16,386.85 110.00 16,380.32 110.00 16,373.78 $4,384,000 $4,384,500 110.00 16,414.86 110.00 16,408.33 110.00 16,401.79 110.00 16,395.26 110.00 16,388.73 110.00 16,382.19 110.00 16,375.66 $4,384,500 $4,385,000 110.00 16,416.73 110.00 16,410.20 110.00 16,403.67 110.00 16,397.13 110.00 16,390.60 110.00 16,384.07 110.00 16,377.53 $4,385,000 $4,385,500 110.00 16,418.61 110.00 16,412.08 110.00 16,405.54 110.00 16,399.01 110.00 16,392.48 110.00 16,385.94 110.00 16,379.41 $4,385,500 $4,386,000 110.00 16,420.48 110.00 16,413.95 110.00 16,407.42 110.00 16,400.88 110.00 16,394.35 110.00 16,387.82 110.00 16,381.28

NJEIS Family Cost Participation Table Page 89 of 12 Effective July 1, 2015

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

$4,386,000 $4,386,500 110.00 16,422.36 110.00 16,415.83 110.00 16,409.29 110.00 16,402.76 110.00 16,396.23 110.00 16,389.69 110.00 16,383.16 $4,386,500 $4,387,000 110.00 16,424.23 110.00 16,417.70 110.00 16,411.17 110.00 16,404.63 110.00 16,398.10 110.00 16,391.57 110.00 16,385.03 $4,387,000 $4,387,500 110.00 16,426.11 110.00 16,419.58 110.00 16,413.04 110.00 16,406.51 110.00 16,399.98 110.00 16,393.44 110.00 16,386.91 $4,387,500 $4,388,000 110.00 16,427.98 110.00 16,421.45 110.00 16,414.92 110.00 16,408.38 110.00 16,401.85 110.00 16,395.32 110.00 16,388.78 $4,388,000 $4,388,500 110.00 16,429.86 110.00 16,423.33 110.00 16,416.79 110.00 16,410.26 110.00 16,403.73 110.00 16,397.19 110.00 16,390.66 $4,388,500 $4,389,000 110.00 16,431.73 110.00 16,425.20 110.00 16,418.67 110.00 16,412.13 110.00 16,405.60 110.00 16,399.07 110.00 16,392.53 $4,389,000 $4,389,500 110.00 16,433.61 110.00 16,427.08 110.00 16,420.54 110.00 16,414.01 110.00 16,407.48 110.00 16,400.94 110.00 16,394.41 $4,389,500 $4,390,000 110.00 16,435.48 110.00 16,428.95 110.00 16,422.42 110.00 16,415.88 110.00 16,409.35 110.00 16,402.82 110.00 16,396.28 $4,390,000 $4,390,500 110.00 16,437.36 110.00 16,430.83 110.00 16,424.29 110.00 16,417.76 110.00 16,411.23 110.00 16,404.69 110.00 16,398.16 $4,390,500 $4,391,000 110.00 16,439.23 110.00 16,432.70 110.00 16,426.17 110.00 16,419.63 110.00 16,413.10 110.00 16,406.57 110.00 16,400.03 $4,391,000 $4,391,500 110.00 16,441.11 110.00 16,434.58 110.00 16,428.04 110.00 16,421.51 110.00 16,414.98 110.00 16,408.44 110.00 16,401.91 $4,391,500 $4,392,000 110.00 16,442.98 110.00 16,436.45 110.00 16,429.92 110.00 16,423.38 110.00 16,416.85 110.00 16,410.32 110.00 16,403.78 $4,392,000 $4,392,500 110.00 16,444.86 110.00 16,438.33 110.00 16,431.79 110.00 16,425.26 110.00 16,418.73 110.00 16,412.19 110.00 16,405.66 $4,392,500 $4,393,000 110.00 16,446.73 110.00 16,440.20 110.00 16,433.67 110.00 16,427.13 110.00 16,420.60 110.00 16,414.07 110.00 16,407.53 $4,393,000 $4,393,500 110.00 16,448.61 110.00 16,442.08 110.00 16,435.54 110.00 16,429.01 110.00 16,422.48 110.00 16,415.94 110.00 16,409.41 $4,393,500 $4,394,000 110.00 16,450.48 110.00 16,443.95 110.00 16,437.42 110.00 16,430.88 110.00 16,424.35 110.00 16,417.82 110.00 16,411.28 $4,394,000 $4,394,500 110.00 16,452.36 110.00 16,445.83 110.00 16,439.29 110.00 16,432.76 110.00 16,426.23 110.00 16,419.69 110.00 16,413.16 $4,394,500 $4,395,000 110.00 16,454.23 110.00 16,447.70 110.00 16,441.17 110.00 16,434.63 110.00 16,428.10 110.00 16,421.57 110.00 16,415.03 $4,395,000 $4,395,500 110.00 16,456.11 110.00 16,449.58 110.00 16,443.04 110.00 16,436.51 110.00 16,429.98 110.00 16,423.44 110.00 16,416.91 $4,395,500 $4,396,000 110.00 16,457.98 110.00 16,451.45 110.00 16,444.92 110.00 16,438.38 110.00 16,431.85 110.00 16,425.32 110.00 16,418.78 $4,396,000 $4,396,500 110.00 16,459.86 110.00 16,453.33 110.00 16,446.79 110.00 16,440.26 110.00 16,433.73 110.00 16,427.19 110.00 16,420.66 $4,396,500 $4,397,000 110.00 16,461.73 110.00 16,455.20 110.00 16,448.67 110.00 16,442.13 110.00 16,435.60 110.00 16,429.07 110.00 16,422.53 $4,397,000 $4,397,500 110.00 16,463.61 110.00 16,457.08 110.00 16,450.54 110.00 16,444.01 110.00 16,437.48 110.00 16,430.94 110.00 16,424.41 $4,397,500 $4,398,000 110.00 16,465.48 110.00 16,458.95 110.00 16,452.42 110.00 16,445.88 110.00 16,439.35 110.00 16,432.82 110.00 16,426.28 $4,398,000 $4,398,500 110.00 16,467.36 110.00 16,460.83 110.00 16,454.29 110.00 16,447.76 110.00 16,441.23 110.00 16,434.69 110.00 16,428.16 $4,398,500 $4,399,000 110.00 16,469.23 110.00 16,462.70 110.00 16,456.17 110.00 16,449.63 110.00 16,443.10 110.00 16,436.57 110.00 16,430.03 $4,399,000 $4,399,500 110.00 16,471.11 110.00 16,464.58 110.00 16,458.04 110.00 16,451.51 110.00 16,444.98 110.00 16,438.44 110.00 16,431.91 $4,399,500 $4,400,000 110.00 16,472.98 110.00 16,466.45 110.00 16,459.92 110.00 16,453.38 110.00 16,446.85 110.00 16,440.32 110.00 16,433.78 $4,400,000 $4,400,500 110.00 16,474.86 110.00 16,468.33 110.00 16,461.79 110.00 16,455.26 110.00 16,448.73 110.00 16,442.19 110.00 16,435.66 $4,400,500 $4,401,000 110.00 16,476.73 110.00 16,470.20 110.00 16,463.67 110.00 16,457.13 110.00 16,450.60 110.00 16,444.07 110.00 16,437.53 $4,401,000 $4,401,500 110.00 16,478.61 110.00 16,472.08 110.00 16,465.54 110.00 16,459.01 110.00 16,452.48 110.00 16,445.94 110.00 16,439.41 $4,401,500 $4,402,000 110.00 16,480.48 110.00 16,473.95 110.00 16,467.42 110.00 16,460.88 110.00 16,454.35 110.00 16,447.82 110.00 16,441.28 $4,402,000 $4,402,500 110.00 16,482.36 110.00 16,475.83 110.00 16,469.29 110.00 16,462.76 110.00 16,456.23 110.00 16,449.69 110.00 16,443.16 $4,402,500 $4,403,000 110.00 16,484.23 110.00 16,477.70 110.00 16,471.17 110.00 16,464.63 110.00 16,458.10 110.00 16,451.57 110.00 16,445.03 $4,403,000 $4,403,500 110.00 16,486.11 110.00 16,479.58 110.00 16,473.04 110.00 16,466.51 110.00 16,459.98 110.00 16,453.44 110.00 16,446.91 $4,403,500 $4,404,000 110.00 16,487.98 110.00 16,481.45 110.00 16,474.92 110.00 16,468.38 110.00 16,461.85 110.00 16,455.32 110.00 16,448.78 $4,404,000 $4,404,500 110.00 16,489.86 110.00 16,483.33 110.00 16,476.79 110.00 16,470.26 110.00 16,463.73 110.00 16,457.19 110.00 16,450.66 $4,404,500 $4,405,000 110.00 16,491.73 110.00 16,485.20 110.00 16,478.67 110.00 16,472.13 110.00 16,465.60 110.00 16,459.07 110.00 16,452.53 $4,405,000 $4,405,500 110.00 16,493.61 110.00 16,487.08 110.00 16,480.54 110.00 16,474.01 110.00 16,467.48 110.00 16,460.94 110.00 16,454.41 $4,405,500 $4,406,000 110.00 16,495.48 110.00 16,488.95 110.00 16,482.42 110.00 16,475.88 110.00 16,469.35 110.00 16,462.82 110.00 16,456.28 $4,406,000 $4,406,500 110.00 16,497.36 110.00 16,490.83 110.00 16,484.29 110.00 16,477.76 110.00 16,471.23 110.00 16,464.69 110.00 16,458.16 $4,406,500 $4,407,000 110.00 16,499.23 110.00 16,492.70 110.00 16,486.17 110.00 16,479.63 110.00 16,473.10 110.00 16,466.57 110.00 16,460.03 $4,407,000 $4,407,500 110.00 16,501.11 110.00 16,494.58 110.00 16,488.04 110.00 16,481.51 110.00 16,474.98 110.00 16,468.44 110.00 16,461.91 $4,407,500 $4,408,000 110.00 16,502.98 110.00 16,496.45 110.00 16,489.92 110.00 16,483.38 110.00 16,476.85 110.00 16,470.32 110.00 16,463.78 $4,408,000 $4,408,500 110.00 16,504.86 110.00 16,498.33 110.00 16,491.79 110.00 16,485.26 110.00 16,478.73 110.00 16,472.19 110.00 16,465.66 $4,408,500 $4,409,000 110.00 16,506.73 110.00 16,500.20 110.00 16,493.67 110.00 16,487.13 110.00 16,480.60 110.00 16,474.07 110.00 16,467.53 $4,409,000 $4,409,500 110.00 16,508.61 110.00 16,502.08 110.00 16,495.54 110.00 16,489.01 110.00 16,482.48 110.00 16,475.94 110.00 16,469.41 $4,409,500 $4,410,000 110.00 16,510.48 110.00 16,503.95 110.00 16,497.42 110.00 16,490.88 110.00 16,484.35 110.00 16,477.82 110.00 16,471.28 $4,410,000 $4,410,500 110.00 16,512.36 110.00 16,505.83 110.00 16,499.29 110.00 16,492.76 110.00 16,486.23 110.00 16,479.69 110.00 16,473.16 $4,410,500 $4,411,000 110.00 16,514.23 110.00 16,507.70 110.00 16,501.17 110.00 16,494.63 110.00 16,488.10 110.00 16,481.57 110.00 16,475.03 $4,411,000 $4,411,500 110.00 16,516.11 110.00 16,509.58 110.00 16,503.04 110.00 16,496.51 110.00 16,489.98 110.00 16,483.44 110.00 16,476.91 $4,411,500 $4,412,000 110.00 16,517.98 110.00 16,511.45 110.00 16,504.92 110.00 16,498.38 110.00 16,491.85 110.00 16,485.32 110.00 16,478.78 $4,412,000 $4,412,500 110.00 16,519.86 110.00 16,513.33 110.00 16,506.79 110.00 16,500.26 110.00 16,493.73 110.00 16,487.19 110.00 16,480.66 $4,412,500 $4,413,000 110.00 16,521.73 110.00 16,515.20 110.00 16,508.67 110.00 16,502.13 110.00 16,495.60 110.00 16,489.07 110.00 16,482.53 $4,413,000 $4,413,500 110.00 16,523.61 110.00 16,517.08 110.00 16,510.54 110.00 16,504.01 110.00 16,497.48 110.00 16,490.94 110.00 16,484.41 $4,413,500 $4,414,000 110.00 16,525.48 110.00 16,518.95 110.00 16,512.42 110.00 16,505.88 110.00 16,499.35 110.00 16,492.82 110.00 16,486.28 $4,414,000 $4,414,500 110.00 16,527.36 110.00 16,520.83 110.00 16,514.29 110.00 16,507.76 110.00 16,501.23 110.00 16,494.69 110.00 16,488.16 $4,414,500 $4,415,000 110.00 16,529.23 110.00 16,522.70 110.00 16,516.17 110.00 16,509.63 110.00 16,503.10 110.00 16,496.57 110.00 16,490.03 $4,415,000 $4,415,500 110.00 16,531.11 110.00 16,524.58 110.00 16,518.04 110.00 16,511.51 110.00 16,504.98 110.00 16,498.44 110.00 16,491.91 $4,415,500 $4,416,000 110.00 16,532.98 110.00 16,526.45 110.00 16,519.92 110.00 16,513.38 110.00 16,506.85 110.00 16,500.32 110.00 16,493.78 $4,416,000 $4,416,500 110.00 16,534.86 110.00 16,528.33 110.00 16,521.79 110.00 16,515.26 110.00 16,508.73 110.00 16,502.19 110.00 16,495.66 $4,416,500 $4,417,000 110.00 16,536.73 110.00 16,530.20 110.00 16,523.67 110.00 16,517.13 110.00 16,510.60 110.00 16,504.07 110.00 16,497.53 $4,417,000 $4,417,500 110.00 16,538.61 110.00 16,532.08 110.00 16,525.54 110.00 16,519.01 110.00 16,512.48 110.00 16,505.94 110.00 16,499.41 $4,417,500 $4,418,000 110.00 16,540.48 110.00 16,533.95 110.00 16,527.42 110.00 16,520.88 110.00 16,514.35 110.00 16,507.82 110.00 16,501.28 $4,418,000 $4,418,500 110.00 16,542.36 110.00 16,535.83 110.00 16,529.29 110.00 16,522.76 110.00 16,516.23 110.00 16,509.69 110.00 16,503.16 $4,418,500 $4,419,000 110.00 16,544.23 110.00 16,537.70 110.00 16,531.17 110.00 16,524.63 110.00 16,518.10 110.00 16,511.57 110.00 16,505.03 $4,419,000 $4,419,500 110.00 16,546.11 110.00 16,539.58 110.00 16,533.04 110.00 16,526.51 110.00 16,519.98 110.00 16,513.44 110.00 16,506.91 $4,419,500 $4,420,000 110.00 16,547.98 110.00 16,541.45 110.00 16,534.92 110.00 16,528.38 110.00 16,521.85 110.00 16,515.32 110.00 16,508.78 $4,420,000 $4,420,500 110.00 16,549.86 110.00 16,543.33 110.00 16,536.79 110.00 16,530.26 110.00 16,523.73 110.00 16,517.19 110.00 16,510.66 $4,420,500 $4,421,000 110.00 16,551.73 110.00 16,545.20 110.00 16,538.67 110.00 16,532.13 110.00 16,525.60 110.00 16,519.07 110.00 16,512.53 $4,421,000 $4,421,500 110.00 16,553.61 110.00 16,547.08 110.00 16,540.54 110.00 16,534.01 110.00 16,527.48 110.00 16,520.94 110.00 16,514.41 $4,421,500 $4,422,000 110.00 16,555.48 110.00 16,548.95 110.00 16,542.42 110.00 16,535.88 110.00 16,529.35 110.00 16,522.82 110.00 16,516.28 $4,422,000 $4,422,500 110.00 16,557.36 110.00 16,550.83 110.00 16,544.29 110.00 16,537.76 110.00 16,531.23 110.00 16,524.69 110.00 16,518.16 $4,422,500 $4,423,000 110.00 16,559.23 110.00 16,552.70 110.00 16,546.17 110.00 16,539.63 110.00 16,533.10 110.00 16,526.57 110.00 16,520.03 $4,423,000 $4,423,500 110.00 16,561.11 110.00 16,554.58 110.00 16,548.04 110.00 16,541.51 110.00 16,534.98 110.00 16,528.44 110.00 16,521.91 $4,423,500 $4,424,000 110.00 16,562.98 110.00 16,556.45 110.00 16,549.92 110.00 16,543.38 110.00 16,536.85 110.00 16,530.32 110.00 16,523.78 $4,424,000 $4,424,500 110.00 16,564.86 110.00 16,558.33 110.00 16,551.79 110.00 16,545.26 110.00 16,538.73 110.00 16,532.19 110.00 16,525.66 $4,424,500 $4,425,000 110.00 16,566.73 110.00 16,560.20 110.00 16,553.67 110.00 16,547.13 110.00 16,540.60 110.00 16,534.07 110.00 16,527.53 $4,425,000 $4,425,500 110.00 16,568.61 110.00 16,562.08 110.00 16,555.54 110.00 16,549.01 110.00 16,542.48 110.00 16,535.94 110.00 16,529.41 $4,425,500 $4,426,000 110.00 16,570.48 110.00 16,563.95 110.00 16,557.42 110.00 16,550.88 110.00 16,544.35 110.00 16,537.82 110.00 16,531.28 $4,426,000 $4,426,500 110.00 16,572.36 110.00 16,565.83 110.00 16,559.29 110.00 16,552.76 110.00 16,546.23 110.00 16,539.69 110.00 16,533.16 $4,426,500 $4,427,000 110.00 16,574.23 110.00 16,567.70 110.00 16,561.17 110.00 16,554.63 110.00 16,548.10 110.00 16,541.57 110.00 16,535.03 $4,427,000 $4,427,500 110.00 16,576.11 110.00 16,569.58 110.00 16,563.04 110.00 16,556.51 110.00 16,549.98 110.00 16,543.44 110.00 16,536.91 $4,427,500 $4,428,000 110.00 16,577.98 110.00 16,571.45 110.00 16,564.92 110.00 16,558.38 110.00 16,551.85 110.00 16,545.32 110.00 16,538.78 $4,428,000 $4,428,500 110.00 16,579.86 110.00 16,573.33 110.00 16,566.79 110.00 16,560.26 110.00 16,553.73 110.00 16,547.19 110.00 16,540.66 $4,428,500 $4,429,000 110.00 16,581.73 110.00 16,575.20 110.00 16,568.67 110.00 16,562.13 110.00 16,555.60 110.00 16,549.07 110.00 16,542.53 $4,429,000 $4,429,500 110.00 16,583.61 110.00 16,577.08 110.00 16,570.54 110.00 16,564.01 110.00 16,557.48 110.00 16,550.94 110.00 16,544.41 $4,429,500 $4,430,000 110.00 16,585.48 110.00 16,578.95 110.00 16,572.42 110.00 16,565.88 110.00 16,559.35 110.00 16,552.82 110.00 16,546.28 $4,430,000 $4,430,500 110.00 16,587.36 110.00 16,580.83 110.00 16,574.29 110.00 16,567.76 110.00 16,561.23 110.00 16,554.69 110.00 16,548.16 $4,430,500 $4,431,000 110.00 16,589.23 110.00 16,582.70 110.00 16,576.17 110.00 16,569.63 110.00 16,563.10 110.00 16,556.57 110.00 16,550.03 $4,431,000 $4,431,500 110.00 16,591.11 110.00 16,584.58 110.00 16,578.04 110.00 16,571.51 110.00 16,564.98 110.00 16,558.44 110.00 16,551.91 $4,431,500 $4,432,000 110.00 16,592.98 110.00 16,586.45 110.00 16,579.92 110.00 16,573.38 110.00 16,566.85 110.00 16,560.32 110.00 16,553.78 $4,432,000 $4,432,500 110.00 16,594.86 110.00 16,588.33 110.00 16,581.79 110.00 16,575.26 110.00 16,568.73 110.00 16,562.19 110.00 16,555.66 $4,432,500 $4,433,000 110.00 16,596.73 110.00 16,590.20 110.00 16,583.67 110.00 16,577.13 110.00 16,570.60 110.00 16,564.07 110.00 16,557.53 $4,433,000 $4,433,500 110.00 16,598.61 110.00 16,592.08 110.00 16,585.54 110.00 16,579.01 110.00 16,572.48 110.00 16,565.94 110.00 16,559.41 $4,433,500 $4,434,000 110.00 16,600.48 110.00 16,593.95 110.00 16,587.42 110.00 16,580.88 110.00 16,574.35 110.00 16,567.82 110.00 16,561.28 $4,434,000 $4,434,500 110.00 16,602.36 110.00 16,595.83 110.00 16,589.29 110.00 16,582.76 110.00 16,576.23 110.00 16,569.69 110.00 16,563.16 $4,434,500 $4,435,000 110.00 16,604.23 110.00 16,597.70 110.00 16,591.17 110.00 16,584.63 110.00 16,578.10 110.00 16,571.57 110.00 16,565.03 $4,435,000 $4,435,500 110.00 16,606.11 110.00 16,599.58 110.00 16,593.04 110.00 16,586.51 110.00 16,579.98 110.00 16,573.44 110.00 16,566.91 $4,435,500 $4,436,000 110.00 16,607.98 110.00 16,601.45 110.00 16,594.92 110.00 16,588.38 110.00 16,581.85 110.00 16,575.32 110.00 16,568.78 $4,436,000 $4,436,500 110.00 16,609.86 110.00 16,603.33 110.00 16,596.79 110.00 16,590.26 110.00 16,583.73 110.00 16,577.19 110.00 16,570.66 $4,436,500 $4,437,000 110.00 16,611.73 110.00 16,605.20 110.00 16,598.67 110.00 16,592.13 110.00 16,585.60 110.00 16,579.07 110.00 16,572.53

NJEIS Family Cost Participation Table Page 90 of 12 Effective July 1, 2015

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

$4,437,000 $4,437,500 110.00 16,613.61 110.00 16,607.08 110.00 16,600.54 110.00 16,594.01 110.00 16,587.48 110.00 16,580.94 110.00 16,574.41 $4,437,500 $4,438,000 110.00 16,615.48 110.00 16,608.95 110.00 16,602.42 110.00 16,595.88 110.00 16,589.35 110.00 16,582.82 110.00 16,576.28 $4,438,000 $4,438,500 110.00 16,617.36 110.00 16,610.83 110.00 16,604.29 110.00 16,597.76 110.00 16,591.23 110.00 16,584.69 110.00 16,578.16 $4,438,500 $4,439,000 110.00 16,619.23 110.00 16,612.70 110.00 16,606.17 110.00 16,599.63 110.00 16,593.10 110.00 16,586.57 110.00 16,580.03 $4,439,000 $4,439,500 110.00 16,621.11 110.00 16,614.58 110.00 16,608.04 110.00 16,601.51 110.00 16,594.98 110.00 16,588.44 110.00 16,581.91 $4,439,500 $4,440,000 110.00 16,622.98 110.00 16,616.45 110.00 16,609.92 110.00 16,603.38 110.00 16,596.85 110.00 16,590.32 110.00 16,583.78 $4,440,000 $4,440,500 110.00 16,624.86 110.00 16,618.33 110.00 16,611.79 110.00 16,605.26 110.00 16,598.73 110.00 16,592.19 110.00 16,585.66 $4,440,500 $4,441,000 110.00 16,626.73 110.00 16,620.20 110.00 16,613.67 110.00 16,607.13 110.00 16,600.60 110.00 16,594.07 110.00 16,587.53 $4,441,000 $4,441,500 110.00 16,628.61 110.00 16,622.08 110.00 16,615.54 110.00 16,609.01 110.00 16,602.48 110.00 16,595.94 110.00 16,589.41 $4,441,500 $4,442,000 110.00 16,630.48 110.00 16,623.95 110.00 16,617.42 110.00 16,610.88 110.00 16,604.35 110.00 16,597.82 110.00 16,591.28 $4,442,000 $4,442,500 110.00 16,632.36 110.00 16,625.83 110.00 16,619.29 110.00 16,612.76 110.00 16,606.23 110.00 16,599.69 110.00 16,593.16 $4,442,500 $4,443,000 110.00 16,634.23 110.00 16,627.70 110.00 16,621.17 110.00 16,614.63 110.00 16,608.10 110.00 16,601.57 110.00 16,595.03 $4,443,000 $4,443,500 110.00 16,636.11 110.00 16,629.58 110.00 16,623.04 110.00 16,616.51 110.00 16,609.98 110.00 16,603.44 110.00 16,596.91 $4,443,500 $4,444,000 110.00 16,637.98 110.00 16,631.45 110.00 16,624.92 110.00 16,618.38 110.00 16,611.85 110.00 16,605.32 110.00 16,598.78 $4,444,000 $4,444,500 110.00 16,639.86 110.00 16,633.33 110.00 16,626.79 110.00 16,620.26 110.00 16,613.73 110.00 16,607.19 110.00 16,600.66 $4,444,500 $4,445,000 110.00 16,641.73 110.00 16,635.20 110.00 16,628.67 110.00 16,622.13 110.00 16,615.60 110.00 16,609.07 110.00 16,602.53 $4,445,000 $4,445,500 110.00 16,643.61 110.00 16,637.08 110.00 16,630.54 110.00 16,624.01 110.00 16,617.48 110.00 16,610.94 110.00 16,604.41 $4,445,500 $4,446,000 110.00 16,645.48 110.00 16,638.95 110.00 16,632.42 110.00 16,625.88 110.00 16,619.35 110.00 16,612.82 110.00 16,606.28 $4,446,000 $4,446,500 110.00 16,647.36 110.00 16,640.83 110.00 16,634.29 110.00 16,627.76 110.00 16,621.23 110.00 16,614.69 110.00 16,608.16 $4,446,500 $4,447,000 110.00 16,649.23 110.00 16,642.70 110.00 16,636.17 110.00 16,629.63 110.00 16,623.10 110.00 16,616.57 110.00 16,610.03 $4,447,000 $4,447,500 110.00 16,651.11 110.00 16,644.58 110.00 16,638.04 110.00 16,631.51 110.00 16,624.98 110.00 16,618.44 110.00 16,611.91 $4,447,500 $4,448,000 110.00 16,652.98 110.00 16,646.45 110.00 16,639.92 110.00 16,633.38 110.00 16,626.85 110.00 16,620.32 110.00 16,613.78 $4,448,000 $4,448,500 110.00 16,654.86 110.00 16,648.33 110.00 16,641.79 110.00 16,635.26 110.00 16,628.73 110.00 16,622.19 110.00 16,615.66 $4,448,500 $4,449,000 110.00 16,656.73 110.00 16,650.20 110.00 16,643.67 110.00 16,637.13 110.00 16,630.60 110.00 16,624.07 110.00 16,617.53 $4,449,000 $4,449,500 110.00 16,658.61 110.00 16,652.08 110.00 16,645.54 110.00 16,639.01 110.00 16,632.48 110.00 16,625.94 110.00 16,619.41 $4,449,500 $4,450,000 110.00 16,660.48 110.00 16,653.95 110.00 16,647.42 110.00 16,640.88 110.00 16,634.35 110.00 16,627.82 110.00 16,621.28 $4,450,000 $4,450,500 110.00 16,662.36 110.00 16,655.83 110.00 16,649.29 110.00 16,642.76 110.00 16,636.23 110.00 16,629.69 110.00 16,623.16 $4,450,500 $4,451,000 110.00 16,664.23 110.00 16,657.70 110.00 16,651.17 110.00 16,644.63 110.00 16,638.10 110.00 16,631.57 110.00 16,625.03 $4,451,000 $4,451,500 110.00 16,666.11 110.00 16,659.58 110.00 16,653.04 110.00 16,646.51 110.00 16,639.98 110.00 16,633.44 110.00 16,626.91 $4,451,500 $4,452,000 110.00 16,667.98 110.00 16,661.45 110.00 16,654.92 110.00 16,648.38 110.00 16,641.85 110.00 16,635.32 110.00 16,628.78 $4,452,000 $4,452,500 110.00 16,669.86 110.00 16,663.33 110.00 16,656.79 110.00 16,650.26 110.00 16,643.73 110.00 16,637.19 110.00 16,630.66 $4,452,500 $4,453,000 110.00 16,671.73 110.00 16,665.20 110.00 16,658.67 110.00 16,652.13 110.00 16,645.60 110.00 16,639.07 110.00 16,632.53 $4,453,000 $4,453,500 110.00 16,673.61 110.00 16,667.08 110.00 16,660.54 110.00 16,654.01 110.00 16,647.48 110.00 16,640.94 110.00 16,634.41 $4,453,500 $4,454,000 110.00 16,675.48 110.00 16,668.95 110.00 16,662.42 110.00 16,655.88 110.00 16,649.35 110.00 16,642.82 110.00 16,636.28 $4,454,000 $4,454,500 110.00 16,677.36 110.00 16,670.83 110.00 16,664.29 110.00 16,657.76 110.00 16,651.23 110.00 16,644.69 110.00 16,638.16 $4,454,500 $4,455,000 110.00 16,679.23 110.00 16,672.70 110.00 16,666.17 110.00 16,659.63 110.00 16,653.10 110.00 16,646.57 110.00 16,640.03 $4,455,000 $4,455,500 110.00 16,681.11 110.00 16,674.58 110.00 16,668.04 110.00 16,661.51 110.00 16,654.98 110.00 16,648.44 110.00 16,641.91 $4,455,500 $4,456,000 110.00 16,682.98 110.00 16,676.45 110.00 16,669.92 110.00 16,663.38 110.00 16,656.85 110.00 16,650.32 110.00 16,643.78 $4,456,000 $4,456,500 110.00 16,684.86 110.00 16,678.33 110.00 16,671.79 110.00 16,665.26 110.00 16,658.73 110.00 16,652.19 110.00 16,645.66 $4,456,500 $4,457,000 110.00 16,686.73 110.00 16,680.20 110.00 16,673.67 110.00 16,667.13 110.00 16,660.60 110.00 16,654.07 110.00 16,647.53 $4,457,000 $4,457,500 110.00 16,688.61 110.00 16,682.08 110.00 16,675.54 110.00 16,669.01 110.00 16,662.48 110.00 16,655.94 110.00 16,649.41 $4,457,500 $4,458,000 110.00 16,690.48 110.00 16,683.95 110.00 16,677.42 110.00 16,670.88 110.00 16,664.35 110.00 16,657.82 110.00 16,651.28 $4,458,000 $4,458,500 110.00 16,692.36 110.00 16,685.83 110.00 16,679.29 110.00 16,672.76 110.00 16,666.23 110.00 16,659.69 110.00 16,653.16 $4,458,500 $4,459,000 110.00 16,694.23 110.00 16,687.70 110.00 16,681.17 110.00 16,674.63 110.00 16,668.10 110.00 16,661.57 110.00 16,655.03 $4,459,000 $4,459,500 110.00 16,696.11 110.00 16,689.58 110.00 16,683.04 110.00 16,676.51 110.00 16,669.98 110.00 16,663.44 110.00 16,656.91 $4,459,500 $4,460,000 110.00 16,697.98 110.00 16,691.45 110.00 16,684.92 110.00 16,678.38 110.00 16,671.85 110.00 16,665.32 110.00 16,658.78 $4,460,000 $4,460,500 110.00 16,699.86 110.00 16,693.33 110.00 16,686.79 110.00 16,680.26 110.00 16,673.73 110.00 16,667.19 110.00 16,660.66 $4,460,500 $4,461,000 110.00 16,701.73 110.00 16,695.20 110.00 16,688.67 110.00 16,682.13 110.00 16,675.60 110.00 16,669.07 110.00 16,662.53 $4,461,000 $4,461,500 110.00 16,703.61 110.00 16,697.08 110.00 16,690.54 110.00 16,684.01 110.00 16,677.48 110.00 16,670.94 110.00 16,664.41 $4,461,500 $4,462,000 110.00 16,705.48 110.00 16,698.95 110.00 16,692.42 110.00 16,685.88 110.00 16,679.35 110.00 16,672.82 110.00 16,666.28 $4,462,000 $4,462,500 110.00 16,707.36 110.00 16,700.83 110.00 16,694.29 110.00 16,687.76 110.00 16,681.23 110.00 16,674.69 110.00 16,668.16 $4,462,500 $4,463,000 110.00 16,709.23 110.00 16,702.70 110.00 16,696.17 110.00 16,689.63 110.00 16,683.10 110.00 16,676.57 110.00 16,670.03 $4,463,000 $4,463,500 110.00 16,711.11 110.00 16,704.58 110.00 16,698.04 110.00 16,691.51 110.00 16,684.98 110.00 16,678.44 110.00 16,671.91 $4,463,500 $4,464,000 110.00 16,712.98 110.00 16,706.45 110.00 16,699.92 110.00 16,693.38 110.00 16,686.85 110.00 16,680.32 110.00 16,673.78 $4,464,000 $4,464,500 110.00 16,714.86 110.00 16,708.33 110.00 16,701.79 110.00 16,695.26 110.00 16,688.73 110.00 16,682.19 110.00 16,675.66 $4,464,500 $4,465,000 110.00 16,716.73 110.00 16,710.20 110.00 16,703.67 110.00 16,697.13 110.00 16,690.60 110.00 16,684.07 110.00 16,677.53 $4,465,000 $4,465,500 110.00 16,718.61 110.00 16,712.08 110.00 16,705.54 110.00 16,699.01 110.00 16,692.48 110.00 16,685.94 110.00 16,679.41 $4,465,500 $4,466,000 110.00 16,720.48 110.00 16,713.95 110.00 16,707.42 110.00 16,700.88 110.00 16,694.35 110.00 16,687.82 110.00 16,681.28 $4,466,000 $4,466,500 110.00 16,722.36 110.00 16,715.83 110.00 16,709.29 110.00 16,702.76 110.00 16,696.23 110.00 16,689.69 110.00 16,683.16 $4,466,500 $4,467,000 110.00 16,724.23 110.00 16,717.70 110.00 16,711.17 110.00 16,704.63 110.00 16,698.10 110.00 16,691.57 110.00 16,685.03 $4,467,000 $4,467,500 110.00 16,726.11 110.00 16,719.58 110.00 16,713.04 110.00 16,706.51 110.00 16,699.98 110.00 16,693.44 110.00 16,686.91 $4,467,500 $4,468,000 110.00 16,727.98 110.00 16,721.45 110.00 16,714.92 110.00 16,708.38 110.00 16,701.85 110.00 16,695.32 110.00 16,688.78 $4,468,000 $4,468,500 110.00 16,729.86 110.00 16,723.33 110.00 16,716.79 110.00 16,710.26 110.00 16,703.73 110.00 16,697.19 110.00 16,690.66 $4,468,500 $4,469,000 110.00 16,731.73 110.00 16,725.20 110.00 16,718.67 110.00 16,712.13 110.00 16,705.60 110.00 16,699.07 110.00 16,692.53 $4,469,000 $4,469,500 110.00 16,733.61 110.00 16,727.08 110.00 16,720.54 110.00 16,714.01 110.00 16,707.48 110.00 16,700.94 110.00 16,694.41 $4,469,500 $4,470,000 110.00 16,735.48 110.00 16,728.95 110.00 16,722.42 110.00 16,715.88 110.00 16,709.35 110.00 16,702.82 110.00 16,696.28 $4,470,000 $4,470,500 110.00 16,737.36 110.00 16,730.83 110.00 16,724.29 110.00 16,717.76 110.00 16,711.23 110.00 16,704.69 110.00 16,698.16 $4,470,500 $4,471,000 110.00 16,739.23 110.00 16,732.70 110.00 16,726.17 110.00 16,719.63 110.00 16,713.10 110.00 16,706.57 110.00 16,700.03 $4,471,000 $4,471,500 110.00 16,741.11 110.00 16,734.58 110.00 16,728.04 110.00 16,721.51 110.00 16,714.98 110.00 16,708.44 110.00 16,701.91 $4,471,500 $4,472,000 110.00 16,742.98 110.00 16,736.45 110.00 16,729.92 110.00 16,723.38 110.00 16,716.85 110.00 16,710.32 110.00 16,703.78 $4,472,000 $4,472,500 110.00 16,744.86 110.00 16,738.33 110.00 16,731.79 110.00 16,725.26 110.00 16,718.73 110.00 16,712.19 110.00 16,705.66 $4,472,500 $4,473,000 110.00 16,746.73 110.00 16,740.20 110.00 16,733.67 110.00 16,727.13 110.00 16,720.60 110.00 16,714.07 110.00 16,707.53 $4,473,000 $4,473,500 110.00 16,748.61 110.00 16,742.08 110.00 16,735.54 110.00 16,729.01 110.00 16,722.48 110.00 16,715.94 110.00 16,709.41 $4,473,500 $4,474,000 110.00 16,750.48 110.00 16,743.95 110.00 16,737.42 110.00 16,730.88 110.00 16,724.35 110.00 16,717.82 110.00 16,711.28 $4,474,000 $4,474,500 110.00 16,752.36 110.00 16,745.83 110.00 16,739.29 110.00 16,732.76 110.00 16,726.23 110.00 16,719.69 110.00 16,713.16 $4,474,500 $4,475,000 110.00 16,754.23 110.00 16,747.70 110.00 16,741.17 110.00 16,734.63 110.00 16,728.10 110.00 16,721.57 110.00 16,715.03 $4,475,000 $4,475,500 110.00 16,756.11 110.00 16,749.58 110.00 16,743.04 110.00 16,736.51 110.00 16,729.98 110.00 16,723.44 110.00 16,716.91 $4,475,500 $4,476,000 110.00 16,757.98 110.00 16,751.45 110.00 16,744.92 110.00 16,738.38 110.00 16,731.85 110.00 16,725.32 110.00 16,718.78 $4,476,000 $4,476,500 110.00 16,759.86 110.00 16,753.33 110.00 16,746.79 110.00 16,740.26 110.00 16,733.73 110.00 16,727.19 110.00 16,720.66 $4,476,500 $4,477,000 110.00 16,761.73 110.00 16,755.20 110.00 16,748.67 110.00 16,742.13 110.00 16,735.60 110.00 16,729.07 110.00 16,722.53 $4,477,000 $4,477,500 110.00 16,763.61 110.00 16,757.08 110.00 16,750.54 110.00 16,744.01 110.00 16,737.48 110.00 16,730.94 110.00 16,724.41 $4,477,500 $4,478,000 110.00 16,765.48 110.00 16,758.95 110.00 16,752.42 110.00 16,745.88 110.00 16,739.35 110.00 16,732.82 110.00 16,726.28 $4,478,000 $4,478,500 110.00 16,767.36 110.00 16,760.83 110.00 16,754.29 110.00 16,747.76 110.00 16,741.23 110.00 16,734.69 110.00 16,728.16 $4,478,500 $4,479,000 110.00 16,769.23 110.00 16,762.70 110.00 16,756.17 110.00 16,749.63 110.00 16,743.10 110.00 16,736.57 110.00 16,730.03 $4,479,000 $4,479,500 110.00 16,771.11 110.00 16,764.58 110.00 16,758.04 110.00 16,751.51 110.00 16,744.98 110.00 16,738.44 110.00 16,731.91 $4,479,500 $4,480,000 110.00 16,772.98 110.00 16,766.45 110.00 16,759.92 110.00 16,753.38 110.00 16,746.85 110.00 16,740.32 110.00 16,733.78 $4,480,000 $4,480,500 110.00 16,774.86 110.00 16,768.33 110.00 16,761.79 110.00 16,755.26 110.00 16,748.73 110.00 16,742.19 110.00 16,735.66 $4,480,500 $4,481,000 110.00 16,776.73 110.00 16,770.20 110.00 16,763.67 110.00 16,757.13 110.00 16,750.60 110.00 16,744.07 110.00 16,737.53 $4,481,000 $4,481,500 110.00 16,778.61 110.00 16,772.08 110.00 16,765.54 110.00 16,759.01 110.00 16,752.48 110.00 16,745.94 110.00 16,739.41 $4,481,500 $4,482,000 110.00 16,780.48 110.00 16,773.95 110.00 16,767.42 110.00 16,760.88 110.00 16,754.35 110.00 16,747.82 110.00 16,741.28 $4,482,000 $4,482,500 110.00 16,782.36 110.00 16,775.83 110.00 16,769.29 110.00 16,762.76 110.00 16,756.23 110.00 16,749.69 110.00 16,743.16 $4,482,500 $4,483,000 110.00 16,784.23 110.00 16,777.70 110.00 16,771.17 110.00 16,764.63 110.00 16,758.10 110.00 16,751.57 110.00 16,745.03 $4,483,000 $4,483,500 110.00 16,786.11 110.00 16,779.58 110.00 16,773.04 110.00 16,766.51 110.00 16,759.98 110.00 16,753.44 110.00 16,746.91 $4,483,500 $4,484,000 110.00 16,787.98 110.00 16,781.45 110.00 16,774.92 110.00 16,768.38 110.00 16,761.85 110.00 16,755.32 110.00 16,748.78 $4,484,000 $4,484,500 110.00 16,789.86 110.00 16,783.33 110.00 16,776.79 110.00 16,770.26 110.00 16,763.73 110.00 16,757.19 110.00 16,750.66 $4,484,500 $4,485,000 110.00 16,791.73 110.00 16,785.20 110.00 16,778.67 110.00 16,772.13 110.00 16,765.60 110.00 16,759.07 110.00 16,752.53 $4,485,000 $4,485,500 110.00 16,793.61 110.00 16,787.08 110.00 16,780.54 110.00 16,774.01 110.00 16,767.48 110.00 16,760.94 110.00 16,754.41 $4,485,500 $4,486,000 110.00 16,795.48 110.00 16,788.95 110.00 16,782.42 110.00 16,775.88 110.00 16,769.35 110.00 16,762.82 110.00 16,756.28 $4,486,000 $4,486,500 110.00 16,797.36 110.00 16,790.83 110.00 16,784.29 110.00 16,777.76 110.00 16,771.23 110.00 16,764.69 110.00 16,758.16 $4,486,500 $4,487,000 110.00 16,799.23 110.00 16,792.70 110.00 16,786.17 110.00 16,779.63 110.00 16,773.10 110.00 16,766.57 110.00 16,760.03 $4,487,000 $4,487,500 110.00 16,801.11 110.00 16,794.58 110.00 16,788.04 110.00 16,781.51 110.00 16,774.98 110.00 16,768.44 110.00 16,761.91 $4,487,500 $4,488,000 110.00 16,802.98 110.00 16,796.45 110.00 16,789.92 110.00 16,783.38 110.00 16,776.85 110.00 16,770.32 110.00 16,763.78

NJEIS Family Cost Participation Table Page 91 of 12 Effective July 1, 2015

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

$4,488,000 $4,488,500 110.00 16,804.86 110.00 16,798.33 110.00 16,791.79 110.00 16,785.26 110.00 16,778.73 110.00 16,772.19 110.00 16,765.66 $4,488,500 $4,489,000 110.00 16,806.73 110.00 16,800.20 110.00 16,793.67 110.00 16,787.13 110.00 16,780.60 110.00 16,774.07 110.00 16,767.53 $4,489,000 $4,489,500 110.00 16,808.61 110.00 16,802.08 110.00 16,795.54 110.00 16,789.01 110.00 16,782.48 110.00 16,775.94 110.00 16,769.41 $4,489,500 $4,490,000 110.00 16,810.48 110.00 16,803.95 110.00 16,797.42 110.00 16,790.88 110.00 16,784.35 110.00 16,777.82 110.00 16,771.28 $4,490,000 $4,490,500 110.00 16,812.36 110.00 16,805.83 110.00 16,799.29 110.00 16,792.76 110.00 16,786.23 110.00 16,779.69 110.00 16,773.16 $4,490,500 $4,491,000 110.00 16,814.23 110.00 16,807.70 110.00 16,801.17 110.00 16,794.63 110.00 16,788.10 110.00 16,781.57 110.00 16,775.03 $4,491,000 $4,491,500 110.00 16,816.11 110.00 16,809.58 110.00 16,803.04 110.00 16,796.51 110.00 16,789.98 110.00 16,783.44 110.00 16,776.91 $4,491,500 $4,492,000 110.00 16,817.98 110.00 16,811.45 110.00 16,804.92 110.00 16,798.38 110.00 16,791.85 110.00 16,785.32 110.00 16,778.78 $4,492,000 $4,492,500 110.00 16,819.86 110.00 16,813.33 110.00 16,806.79 110.00 16,800.26 110.00 16,793.73 110.00 16,787.19 110.00 16,780.66 $4,492,500 $4,493,000 110.00 16,821.73 110.00 16,815.20 110.00 16,808.67 110.00 16,802.13 110.00 16,795.60 110.00 16,789.07 110.00 16,782.53 $4,493,000 $4,493,500 110.00 16,823.61 110.00 16,817.08 110.00 16,810.54 110.00 16,804.01 110.00 16,797.48 110.00 16,790.94 110.00 16,784.41 $4,493,500 $4,494,000 110.00 16,825.48 110.00 16,818.95 110.00 16,812.42 110.00 16,805.88 110.00 16,799.35 110.00 16,792.82 110.00 16,786.28 $4,494,000 $4,494,500 110.00 16,827.36 110.00 16,820.83 110.00 16,814.29 110.00 16,807.76 110.00 16,801.23 110.00 16,794.69 110.00 16,788.16 $4,494,500 $4,495,000 110.00 16,829.23 110.00 16,822.70 110.00 16,816.17 110.00 16,809.63 110.00 16,803.10 110.00 16,796.57 110.00 16,790.03 $4,495,000 $4,495,500 110.00 16,831.11 110.00 16,824.58 110.00 16,818.04 110.00 16,811.51 110.00 16,804.98 110.00 16,798.44 110.00 16,791.91 $4,495,500 $4,496,000 110.00 16,832.98 110.00 16,826.45 110.00 16,819.92 110.00 16,813.38 110.00 16,806.85 110.00 16,800.32 110.00 16,793.78 $4,496,000 $4,496,500 110.00 16,834.86 110.00 16,828.33 110.00 16,821.79 110.00 16,815.26 110.00 16,808.73 110.00 16,802.19 110.00 16,795.66 $4,496,500 $4,497,000 110.00 16,836.73 110.00 16,830.20 110.00 16,823.67 110.00 16,817.13 110.00 16,810.60 110.00 16,804.07 110.00 16,797.53 $4,497,000 $4,497,500 110.00 16,838.61 110.00 16,832.08 110.00 16,825.54 110.00 16,819.01 110.00 16,812.48 110.00 16,805.94 110.00 16,799.41 $4,497,500 $4,498,000 110.00 16,840.48 110.00 16,833.95 110.00 16,827.42 110.00 16,820.88 110.00 16,814.35 110.00 16,807.82 110.00 16,801.28 $4,498,000 $4,498,500 110.00 16,842.36 110.00 16,835.83 110.00 16,829.29 110.00 16,822.76 110.00 16,816.23 110.00 16,809.69 110.00 16,803.16 $4,498,500 $4,499,000 110.00 16,844.23 110.00 16,837.70 110.00 16,831.17 110.00 16,824.63 110.00 16,818.10 110.00 16,811.57 110.00 16,805.03 $4,499,000 $4,499,500 110.00 16,846.11 110.00 16,839.58 110.00 16,833.04 110.00 16,826.51 110.00 16,819.98 110.00 16,813.44 110.00 16,806.91 $4,499,500 $4,500,000 110.00 16,847.98 110.00 16,841.45 110.00 16,834.92 110.00 16,828.38 110.00 16,821.85 110.00 16,815.32 110.00 16,808.78 $4,500,000 $4,500,500 110.00 16,849.86 110.00 16,843.33 110.00 16,836.79 110.00 16,830.26 110.00 16,823.73 110.00 16,817.19 110.00 16,810.66 $4,500,500 $4,501,000 110.00 16,851.73 110.00 16,845.20 110.00 16,838.67 110.00 16,832.13 110.00 16,825.60 110.00 16,819.07 110.00 16,812.53 $4,501,000 $4,501,500 110.00 16,853.61 110.00 16,847.08 110.00 16,840.54 110.00 16,834.01 110.00 16,827.48 110.00 16,820.94 110.00 16,814.41 $4,501,500 $4,502,000 110.00 16,855.48 110.00 16,848.95 110.00 16,842.42 110.00 16,835.88 110.00 16,829.35 110.00 16,822.82 110.00 16,816.28 $4,502,000 $4,502,500 110.00 16,857.36 110.00 16,850.83 110.00 16,844.29 110.00 16,837.76 110.00 16,831.23 110.00 16,824.69 110.00 16,818.16 $4,502,500 $4,503,000 110.00 16,859.23 110.00 16,852.70 110.00 16,846.17 110.00 16,839.63 110.00 16,833.10 110.00 16,826.57 110.00 16,820.03 $4,503,000 $4,503,500 110.00 16,861.11 110.00 16,854.58 110.00 16,848.04 110.00 16,841.51 110.00 16,834.98 110.00 16,828.44 110.00 16,821.91 $4,503,500 $4,504,000 110.00 16,862.98 110.00 16,856.45 110.00 16,849.92 110.00 16,843.38 110.00 16,836.85 110.00 16,830.32 110.00 16,823.78 $4,504,000 $4,504,500 110.00 16,864.86 110.00 16,858.33 110.00 16,851.79 110.00 16,845.26 110.00 16,838.73 110.00 16,832.19 110.00 16,825.66 $4,504,500 $4,505,000 110.00 16,866.73 110.00 16,860.20 110.00 16,853.67 110.00 16,847.13 110.00 16,840.60 110.00 16,834.07 110.00 16,827.53 $4,505,000 $4,505,500 110.00 16,868.61 110.00 16,862.08 110.00 16,855.54 110.00 16,849.01 110.00 16,842.48 110.00 16,835.94 110.00 16,829.41 $4,505,500 $4,506,000 110.00 16,870.48 110.00 16,863.95 110.00 16,857.42 110.00 16,850.88 110.00 16,844.35 110.00 16,837.82 110.00 16,831.28 $4,506,000 $4,506,500 110.00 16,872.36 110.00 16,865.83 110.00 16,859.29 110.00 16,852.76 110.00 16,846.23 110.00 16,839.69 110.00 16,833.16 $4,506,500 $4,507,000 110.00 16,874.23 110.00 16,867.70 110.00 16,861.17 110.00 16,854.63 110.00 16,848.10 110.00 16,841.57 110.00 16,835.03 $4,507,000 $4,507,500 110.00 16,876.11 110.00 16,869.58 110.00 16,863.04 110.00 16,856.51 110.00 16,849.98 110.00 16,843.44 110.00 16,836.91 $4,507,500 $4,508,000 110.00 16,877.98 110.00 16,871.45 110.00 16,864.92 110.00 16,858.38 110.00 16,851.85 110.00 16,845.32 110.00 16,838.78 $4,508,000 $4,508,500 110.00 16,879.86 110.00 16,873.33 110.00 16,866.79 110.00 16,860.26 110.00 16,853.73 110.00 16,847.19 110.00 16,840.66 $4,508,500 $4,509,000 110.00 16,881.73 110.00 16,875.20 110.00 16,868.67 110.00 16,862.13 110.00 16,855.60 110.00 16,849.07 110.00 16,842.53 $4,509,000 $4,509,500 110.00 16,883.61 110.00 16,877.08 110.00 16,870.54 110.00 16,864.01 110.00 16,857.48 110.00 16,850.94 110.00 16,844.41 $4,509,500 $4,510,000 110.00 16,885.48 110.00 16,878.95 110.00 16,872.42 110.00 16,865.88 110.00 16,859.35 110.00 16,852.82 110.00 16,846.28 $4,510,000 $4,510,500 110.00 16,887.36 110.00 16,880.83 110.00 16,874.29 110.00 16,867.76 110.00 16,861.23 110.00 16,854.69 110.00 16,848.16 $4,510,500 $4,511,000 110.00 16,889.23 110.00 16,882.70 110.00 16,876.17 110.00 16,869.63 110.00 16,863.10 110.00 16,856.57 110.00 16,850.03 $4,511,000 $4,511,500 110.00 16,891.11 110.00 16,884.58 110.00 16,878.04 110.00 16,871.51 110.00 16,864.98 110.00 16,858.44 110.00 16,851.91 $4,511,500 $4,512,000 110.00 16,892.98 110.00 16,886.45 110.00 16,879.92 110.00 16,873.38 110.00 16,866.85 110.00 16,860.32 110.00 16,853.78 $4,512,000 $4,512,500 110.00 16,894.86 110.00 16,888.33 110.00 16,881.79 110.00 16,875.26 110.00 16,868.73 110.00 16,862.19 110.00 16,855.66 $4,512,500 $4,513,000 110.00 16,896.73 110.00 16,890.20 110.00 16,883.67 110.00 16,877.13 110.00 16,870.60 110.00 16,864.07 110.00 16,857.53 $4,513,000 $4,513,500 110.00 16,898.61 110.00 16,892.08 110.00 16,885.54 110.00 16,879.01 110.00 16,872.48 110.00 16,865.94 110.00 16,859.41 $4,513,500 $4,514,000 110.00 16,900.48 110.00 16,893.95 110.00 16,887.42 110.00 16,880.88 110.00 16,874.35 110.00 16,867.82 110.00 16,861.28 $4,514,000 $4,514,500 110.00 16,902.36 110.00 16,895.83 110.00 16,889.29 110.00 16,882.76 110.00 16,876.23 110.00 16,869.69 110.00 16,863.16 $4,514,500 $4,515,000 110.00 16,904.23 110.00 16,897.70 110.00 16,891.17 110.00 16,884.63 110.00 16,878.10 110.00 16,871.57 110.00 16,865.03 $4,515,000 $4,515,500 110.00 16,906.11 110.00 16,899.58 110.00 16,893.04 110.00 16,886.51 110.00 16,879.98 110.00 16,873.44 110.00 16,866.91 $4,515,500 $4,516,000 110.00 16,907.98 110.00 16,901.45 110.00 16,894.92 110.00 16,888.38 110.00 16,881.85 110.00 16,875.32 110.00 16,868.78 $4,516,000 $4,516,500 110.00 16,909.86 110.00 16,903.33 110.00 16,896.79 110.00 16,890.26 110.00 16,883.73 110.00 16,877.19 110.00 16,870.66 $4,516,500 $4,517,000 110.00 16,911.73 110.00 16,905.20 110.00 16,898.67 110.00 16,892.13 110.00 16,885.60 110.00 16,879.07 110.00 16,872.53 $4,517,000 $4,517,500 110.00 16,913.61 110.00 16,907.08 110.00 16,900.54 110.00 16,894.01 110.00 16,887.48 110.00 16,880.94 110.00 16,874.41 $4,517,500 $4,518,000 110.00 16,915.48 110.00 16,908.95 110.00 16,902.42 110.00 16,895.88 110.00 16,889.35 110.00 16,882.82 110.00 16,876.28 $4,518,000 $4,518,500 110.00 16,917.36 110.00 16,910.83 110.00 16,904.29 110.00 16,897.76 110.00 16,891.23 110.00 16,884.69 110.00 16,878.16 $4,518,500 $4,519,000 110.00 16,919.23 110.00 16,912.70 110.00 16,906.17 110.00 16,899.63 110.00 16,893.10 110.00 16,886.57 110.00 16,880.03 $4,519,000 $4,519,500 110.00 16,921.11 110.00 16,914.58 110.00 16,908.04 110.00 16,901.51 110.00 16,894.98 110.00 16,888.44 110.00 16,881.91 $4,519,500 $4,520,000 110.00 16,922.98 110.00 16,916.45 110.00 16,909.92 110.00 16,903.38 110.00 16,896.85 110.00 16,890.32 110.00 16,883.78 $4,520,000 $4,520,500 110.00 16,924.86 110.00 16,918.33 110.00 16,911.79 110.00 16,905.26 110.00 16,898.73 110.00 16,892.19 110.00 16,885.66 $4,520,500 $4,521,000 110.00 16,926.73 110.00 16,920.20 110.00 16,913.67 110.00 16,907.13 110.00 16,900.60 110.00 16,894.07 110.00 16,887.53 $4,521,000 $4,521,500 110.00 16,928.61 110.00 16,922.08 110.00 16,915.54 110.00 16,909.01 110.00 16,902.48 110.00 16,895.94 110.00 16,889.41 $4,521,500 $4,522,000 110.00 16,930.48 110.00 16,923.95 110.00 16,917.42 110.00 16,910.88 110.00 16,904.35 110.00 16,897.82 110.00 16,891.28 $4,522,000 $4,522,500 110.00 16,932.36 110.00 16,925.83 110.00 16,919.29 110.00 16,912.76 110.00 16,906.23 110.00 16,899.69 110.00 16,893.16 $4,522,500 $4,523,000 110.00 16,934.23 110.00 16,927.70 110.00 16,921.17 110.00 16,914.63 110.00 16,908.10 110.00 16,901.57 110.00 16,895.03 $4,523,000 $4,523,500 110.00 16,936.11 110.00 16,929.58 110.00 16,923.04 110.00 16,916.51 110.00 16,909.98 110.00 16,903.44 110.00 16,896.91 $4,523,500 $4,524,000 110.00 16,937.98 110.00 16,931.45 110.00 16,924.92 110.00 16,918.38 110.00 16,911.85 110.00 16,905.32 110.00 16,898.78 $4,524,000 $4,524,500 110.00 16,939.86 110.00 16,933.33 110.00 16,926.79 110.00 16,920.26 110.00 16,913.73 110.00 16,907.19 110.00 16,900.66 $4,524,500 $4,525,000 110.00 16,941.73 110.00 16,935.20 110.00 16,928.67 110.00 16,922.13 110.00 16,915.60 110.00 16,909.07 110.00 16,902.53 $4,525,000 $4,525,500 110.00 16,943.61 110.00 16,937.08 110.00 16,930.54 110.00 16,924.01 110.00 16,917.48 110.00 16,910.94 110.00 16,904.41 $4,525,500 $4,526,000 110.00 16,945.48 110.00 16,938.95 110.00 16,932.42 110.00 16,925.88 110.00 16,919.35 110.00 16,912.82 110.00 16,906.28 $4,526,000 $4,526,500 110.00 16,947.36 110.00 16,940.83 110.00 16,934.29 110.00 16,927.76 110.00 16,921.23 110.00 16,914.69 110.00 16,908.16 $4,526,500 $4,527,000 110.00 16,949.23 110.00 16,942.70 110.00 16,936.17 110.00 16,929.63 110.00 16,923.10 110.00 16,916.57 110.00 16,910.03 $4,527,000 $4,527,500 110.00 16,951.11 110.00 16,944.58 110.00 16,938.04 110.00 16,931.51 110.00 16,924.98 110.00 16,918.44 110.00 16,911.91 $4,527,500 $4,528,000 110.00 16,952.98 110.00 16,946.45 110.00 16,939.92 110.00 16,933.38 110.00 16,926.85 110.00 16,920.32 110.00 16,913.78 $4,528,000 $4,528,500 110.00 16,954.86 110.00 16,948.33 110.00 16,941.79 110.00 16,935.26 110.00 16,928.73 110.00 16,922.19 110.00 16,915.66 $4,528,500 $4,529,000 110.00 16,956.73 110.00 16,950.20 110.00 16,943.67 110.00 16,937.13 110.00 16,930.60 110.00 16,924.07 110.00 16,917.53 $4,529,000 $4,529,500 110.00 16,958.61 110.00 16,952.08 110.00 16,945.54 110.00 16,939.01 110.00 16,932.48 110.00 16,925.94 110.00 16,919.41 $4,529,500 $4,530,000 110.00 16,960.48 110.00 16,953.95 110.00 16,947.42 110.00 16,940.88 110.00 16,934.35 110.00 16,927.82 110.00 16,921.28 $4,530,000 $4,530,500 110.00 16,962.36 110.00 16,955.83 110.00 16,949.29 110.00 16,942.76 110.00 16,936.23 110.00 16,929.69 110.00 16,923.16 $4,530,500 $4,531,000 110.00 16,964.23 110.00 16,957.70 110.00 16,951.17 110.00 16,944.63 110.00 16,938.10 110.00 16,931.57 110.00 16,925.03 $4,531,000 $4,531,500 110.00 16,966.11 110.00 16,959.58 110.00 16,953.04 110.00 16,946.51 110.00 16,939.98 110.00 16,933.44 110.00 16,926.91 $4,531,500 $4,532,000 110.00 16,967.98 110.00 16,961.45 110.00 16,954.92 110.00 16,948.38 110.00 16,941.85 110.00 16,935.32 110.00 16,928.78 $4,532,000 $4,532,500 110.00 16,969.86 110.00 16,963.33 110.00 16,956.79 110.00 16,950.26 110.00 16,943.73 110.00 16,937.19 110.00 16,930.66 $4,532,500 $4,533,000 110.00 16,971.73 110.00 16,965.20 110.00 16,958.67 110.00 16,952.13 110.00 16,945.60 110.00 16,939.07 110.00 16,932.53 $4,533,000 $4,533,500 110.00 16,973.61 110.00 16,967.08 110.00 16,960.54 110.00 16,954.01 110.00 16,947.48 110.00 16,940.94 110.00 16,934.41 $4,533,500 $4,534,000 110.00 16,975.48 110.00 16,968.95 110.00 16,962.42 110.00 16,955.88 110.00 16,949.35 110.00 16,942.82 110.00 16,936.28 $4,534,000 $4,534,500 110.00 16,977.36 110.00 16,970.83 110.00 16,964.29 110.00 16,957.76 110.00 16,951.23 110.00 16,944.69 110.00 16,938.16 $4,534,500 $4,535,000 110.00 16,979.23 110.00 16,972.70 110.00 16,966.17 110.00 16,959.63 110.00 16,953.10 110.00 16,946.57 110.00 16,940.03 $4,535,000 $4,535,500 110.00 16,981.11 110.00 16,974.58 110.00 16,968.04 110.00 16,961.51 110.00 16,954.98 110.00 16,948.44 110.00 16,941.91 $4,535,500 $4,536,000 110.00 16,982.98 110.00 16,976.45 110.00 16,969.92 110.00 16,963.38 110.00 16,956.85 110.00 16,950.32 110.00 16,943.78 $4,536,000 $4,536,500 110.00 16,984.86 110.00 16,978.33 110.00 16,971.79 110.00 16,965.26 110.00 16,958.73 110.00 16,952.19 110.00 16,945.66 $4,536,500 $4,537,000 110.00 16,986.73 110.00 16,980.20 110.00 16,973.67 110.00 16,967.13 110.00 16,960.60 110.00 16,954.07 110.00 16,947.53 $4,537,000 $4,537,500 110.00 16,988.61 110.00 16,982.08 110.00 16,975.54 110.00 16,969.01 110.00 16,962.48 110.00 16,955.94 110.00 16,949.41 $4,537,500 $4,538,000 110.00 16,990.48 110.00 16,983.95 110.00 16,977.42 110.00 16,970.88 110.00 16,964.35 110.00 16,957.82 110.00 16,951.28 $4,538,000 $4,538,500 110.00 16,992.36 110.00 16,985.83 110.00 16,979.29 110.00 16,972.76 110.00 16,966.23 110.00 16,959.69 110.00 16,953.16 $4,538,500 $4,539,000 110.00 16,994.23 110.00 16,987.70 110.00 16,981.17 110.00 16,974.63 110.00 16,968.10 110.00 16,961.57 110.00 16,955.03

NJEIS Family Cost Participation Table Page 92 of 12 Effective July 1, 2015

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

$4,539,000 $4,539,500 110.00 16,996.11 110.00 16,989.58 110.00 16,983.04 110.00 16,976.51 110.00 16,969.98 110.00 16,963.44 110.00 16,956.91 $4,539,500 $4,540,000 110.00 16,997.98 110.00 16,991.45 110.00 16,984.92 110.00 16,978.38 110.00 16,971.85 110.00 16,965.32 110.00 16,958.78 $4,540,000 $4,540,500 110.00 16,999.86 110.00 16,993.33 110.00 16,986.79 110.00 16,980.26 110.00 16,973.73 110.00 16,967.19 110.00 16,960.66 $4,540,500 $4,541,000 110.00 17,001.73 110.00 16,995.20 110.00 16,988.67 110.00 16,982.13 110.00 16,975.60 110.00 16,969.07 110.00 16,962.53 $4,541,000 $4,541,500 110.00 17,003.61 110.00 16,997.08 110.00 16,990.54 110.00 16,984.01 110.00 16,977.48 110.00 16,970.94 110.00 16,964.41 $4,541,500 $4,542,000 110.00 17,005.48 110.00 16,998.95 110.00 16,992.42 110.00 16,985.88 110.00 16,979.35 110.00 16,972.82 110.00 16,966.28 $4,542,000 $4,542,500 110.00 17,007.36 110.00 17,000.83 110.00 16,994.29 110.00 16,987.76 110.00 16,981.23 110.00 16,974.69 110.00 16,968.16 $4,542,500 $4,543,000 110.00 17,009.23 110.00 17,002.70 110.00 16,996.17 110.00 16,989.63 110.00 16,983.10 110.00 16,976.57 110.00 16,970.03 $4,543,000 $4,543,500 110.00 17,011.11 110.00 17,004.58 110.00 16,998.04 110.00 16,991.51 110.00 16,984.98 110.00 16,978.44 110.00 16,971.91 $4,543,500 $4,544,000 110.00 17,012.98 110.00 17,006.45 110.00 16,999.92 110.00 16,993.38 110.00 16,986.85 110.00 16,980.32 110.00 16,973.78 $4,544,000 $4,544,500 110.00 17,014.86 110.00 17,008.33 110.00 17,001.79 110.00 16,995.26 110.00 16,988.73 110.00 16,982.19 110.00 16,975.66 $4,544,500 $4,545,000 110.00 17,016.73 110.00 17,010.20 110.00 17,003.67 110.00 16,997.13 110.00 16,990.60 110.00 16,984.07 110.00 16,977.53 $4,545,000 $4,545,500 110.00 17,018.61 110.00 17,012.08 110.00 17,005.54 110.00 16,999.01 110.00 16,992.48 110.00 16,985.94 110.00 16,979.41 $4,545,500 $4,546,000 110.00 17,020.48 110.00 17,013.95 110.00 17,007.42 110.00 17,000.88 110.00 16,994.35 110.00 16,987.82 110.00 16,981.28 $4,546,000 $4,546,500 110.00 17,022.36 110.00 17,015.83 110.00 17,009.29 110.00 17,002.76 110.00 16,996.23 110.00 16,989.69 110.00 16,983.16 $4,546,500 $4,547,000 110.00 17,024.23 110.00 17,017.70 110.00 17,011.17 110.00 17,004.63 110.00 16,998.10 110.00 16,991.57 110.00 16,985.03 $4,547,000 $4,547,500 110.00 17,026.11 110.00 17,019.58 110.00 17,013.04 110.00 17,006.51 110.00 16,999.98 110.00 16,993.44 110.00 16,986.91 $4,547,500 $4,548,000 110.00 17,027.98 110.00 17,021.45 110.00 17,014.92 110.00 17,008.38 110.00 17,001.85 110.00 16,995.32 110.00 16,988.78 $4,548,000 $4,548,500 110.00 17,029.86 110.00 17,023.33 110.00 17,016.79 110.00 17,010.26 110.00 17,003.73 110.00 16,997.19 110.00 16,990.66 $4,548,500 $4,549,000 110.00 17,031.73 110.00 17,025.20 110.00 17,018.67 110.00 17,012.13 110.00 17,005.60 110.00 16,999.07 110.00 16,992.53 $4,549,000 $4,549,500 110.00 17,033.61 110.00 17,027.08 110.00 17,020.54 110.00 17,014.01 110.00 17,007.48 110.00 17,000.94 110.00 16,994.41 $4,549,500 $4,550,000 110.00 17,035.48 110.00 17,028.95 110.00 17,022.42 110.00 17,015.88 110.00 17,009.35 110.00 17,002.82 110.00 16,996.28 $4,550,000 $4,550,500 110.00 17,037.36 110.00 17,030.83 110.00 17,024.29 110.00 17,017.76 110.00 17,011.23 110.00 17,004.69 110.00 16,998.16 $4,550,500 $4,551,000 110.00 17,039.23 110.00 17,032.70 110.00 17,026.17 110.00 17,019.63 110.00 17,013.10 110.00 17,006.57 110.00 17,000.03 $4,551,000 $4,551,500 110.00 17,041.11 110.00 17,034.58 110.00 17,028.04 110.00 17,021.51 110.00 17,014.98 110.00 17,008.44 110.00 17,001.91 $4,551,500 $4,552,000 110.00 17,042.98 110.00 17,036.45 110.00 17,029.92 110.00 17,023.38 110.00 17,016.85 110.00 17,010.32 110.00 17,003.78 $4,552,000 $4,552,500 110.00 17,044.86 110.00 17,038.33 110.00 17,031.79 110.00 17,025.26 110.00 17,018.73 110.00 17,012.19 110.00 17,005.66 $4,552,500 $4,553,000 110.00 17,046.73 110.00 17,040.20 110.00 17,033.67 110.00 17,027.13 110.00 17,020.60 110.00 17,014.07 110.00 17,007.53 $4,553,000 $4,553,500 110.00 17,048.61 110.00 17,042.08 110.00 17,035.54 110.00 17,029.01 110.00 17,022.48 110.00 17,015.94 110.00 17,009.41 $4,553,500 $4,554,000 110.00 17,050.48 110.00 17,043.95 110.00 17,037.42 110.00 17,030.88 110.00 17,024.35 110.00 17,017.82 110.00 17,011.28 $4,554,000 $4,554,500 110.00 17,052.36 110.00 17,045.83 110.00 17,039.29 110.00 17,032.76 110.00 17,026.23 110.00 17,019.69 110.00 17,013.16 $4,554,500 $4,555,000 110.00 17,054.23 110.00 17,047.70 110.00 17,041.17 110.00 17,034.63 110.00 17,028.10 110.00 17,021.57 110.00 17,015.03 $4,555,000 $4,555,500 110.00 17,056.11 110.00 17,049.58 110.00 17,043.04 110.00 17,036.51 110.00 17,029.98 110.00 17,023.44 110.00 17,016.91 $4,555,500 $4,556,000 110.00 17,057.98 110.00 17,051.45 110.00 17,044.92 110.00 17,038.38 110.00 17,031.85 110.00 17,025.32 110.00 17,018.78 $4,556,000 $4,556,500 110.00 17,059.86 110.00 17,053.33 110.00 17,046.79 110.00 17,040.26 110.00 17,033.73 110.00 17,027.19 110.00 17,020.66 $4,556,500 $4,557,000 110.00 17,061.73 110.00 17,055.20 110.00 17,048.67 110.00 17,042.13 110.00 17,035.60 110.00 17,029.07 110.00 17,022.53 $4,557,000 $4,557,500 110.00 17,063.61 110.00 17,057.08 110.00 17,050.54 110.00 17,044.01 110.00 17,037.48 110.00 17,030.94 110.00 17,024.41 $4,557,500 $4,558,000 110.00 17,065.48 110.00 17,058.95 110.00 17,052.42 110.00 17,045.88 110.00 17,039.35 110.00 17,032.82 110.00 17,026.28 $4,558,000 $4,558,500 110.00 17,067.36 110.00 17,060.83 110.00 17,054.29 110.00 17,047.76 110.00 17,041.23 110.00 17,034.69 110.00 17,028.16 $4,558,500 $4,559,000 110.00 17,069.23 110.00 17,062.70 110.00 17,056.17 110.00 17,049.63 110.00 17,043.10 110.00 17,036.57 110.00 17,030.03 $4,559,000 $4,559,500 110.00 17,071.11 110.00 17,064.58 110.00 17,058.04 110.00 17,051.51 110.00 17,044.98 110.00 17,038.44 110.00 17,031.91 $4,559,500 $4,560,000 110.00 17,072.98 110.00 17,066.45 110.00 17,059.92 110.00 17,053.38 110.00 17,046.85 110.00 17,040.32 110.00 17,033.78 $4,560,000 $4,560,500 110.00 17,074.86 110.00 17,068.33 110.00 17,061.79 110.00 17,055.26 110.00 17,048.73 110.00 17,042.19 110.00 17,035.66 $4,560,500 $4,561,000 110.00 17,076.73 110.00 17,070.20 110.00 17,063.67 110.00 17,057.13 110.00 17,050.60 110.00 17,044.07 110.00 17,037.53 $4,561,000 $4,561,500 110.00 17,078.61 110.00 17,072.08 110.00 17,065.54 110.00 17,059.01 110.00 17,052.48 110.00 17,045.94 110.00 17,039.41 $4,561,500 $4,562,000 110.00 17,080.48 110.00 17,073.95 110.00 17,067.42 110.00 17,060.88 110.00 17,054.35 110.00 17,047.82 110.00 17,041.28 $4,562,000 $4,562,500 110.00 17,082.36 110.00 17,075.83 110.00 17,069.29 110.00 17,062.76 110.00 17,056.23 110.00 17,049.69 110.00 17,043.16 $4,562,500 $4,563,000 110.00 17,084.23 110.00 17,077.70 110.00 17,071.17 110.00 17,064.63 110.00 17,058.10 110.00 17,051.57 110.00 17,045.03 $4,563,000 $4,563,500 110.00 17,086.11 110.00 17,079.58 110.00 17,073.04 110.00 17,066.51 110.00 17,059.98 110.00 17,053.44 110.00 17,046.91 $4,563,500 $4,564,000 110.00 17,087.98 110.00 17,081.45 110.00 17,074.92 110.00 17,068.38 110.00 17,061.85 110.00 17,055.32 110.00 17,048.78 $4,564,000 $4,564,500 110.00 17,089.86 110.00 17,083.33 110.00 17,076.79 110.00 17,070.26 110.00 17,063.73 110.00 17,057.19 110.00 17,050.66 $4,564,500 $4,565,000 110.00 17,091.73 110.00 17,085.20 110.00 17,078.67 110.00 17,072.13 110.00 17,065.60 110.00 17,059.07 110.00 17,052.53 $4,565,000 $4,565,500 110.00 17,093.61 110.00 17,087.08 110.00 17,080.54 110.00 17,074.01 110.00 17,067.48 110.00 17,060.94 110.00 17,054.41 $4,565,500 $4,566,000 110.00 17,095.48 110.00 17,088.95 110.00 17,082.42 110.00 17,075.88 110.00 17,069.35 110.00 17,062.82 110.00 17,056.28 $4,566,000 $4,566,500 110.00 17,097.36 110.00 17,090.83 110.00 17,084.29 110.00 17,077.76 110.00 17,071.23 110.00 17,064.69 110.00 17,058.16 $4,566,500 $4,567,000 110.00 17,099.23 110.00 17,092.70 110.00 17,086.17 110.00 17,079.63 110.00 17,073.10 110.00 17,066.57 110.00 17,060.03 $4,567,000 $4,567,500 110.00 17,101.11 110.00 17,094.58 110.00 17,088.04 110.00 17,081.51 110.00 17,074.98 110.00 17,068.44 110.00 17,061.91 $4,567,500 $4,568,000 110.00 17,102.98 110.00 17,096.45 110.00 17,089.92 110.00 17,083.38 110.00 17,076.85 110.00 17,070.32 110.00 17,063.78 $4,568,000 $4,568,500 110.00 17,104.86 110.00 17,098.33 110.00 17,091.79 110.00 17,085.26 110.00 17,078.73 110.00 17,072.19 110.00 17,065.66 $4,568,500 $4,569,000 110.00 17,106.73 110.00 17,100.20 110.00 17,093.67 110.00 17,087.13 110.00 17,080.60 110.00 17,074.07 110.00 17,067.53 $4,569,000 $4,569,500 110.00 17,108.61 110.00 17,102.08 110.00 17,095.54 110.00 17,089.01 110.00 17,082.48 110.00 17,075.94 110.00 17,069.41 $4,569,500 $4,570,000 110.00 17,110.48 110.00 17,103.95 110.00 17,097.42 110.00 17,090.88 110.00 17,084.35 110.00 17,077.82 110.00 17,071.28 $4,570,000 $4,570,500 110.00 17,112.36 110.00 17,105.83 110.00 17,099.29 110.00 17,092.76 110.00 17,086.23 110.00 17,079.69 110.00 17,073.16 $4,570,500 $4,571,000 110.00 17,114.23 110.00 17,107.70 110.00 17,101.17 110.00 17,094.63 110.00 17,088.10 110.00 17,081.57 110.00 17,075.03 $4,571,000 $4,571,500 110.00 17,116.11 110.00 17,109.58 110.00 17,103.04 110.00 17,096.51 110.00 17,089.98 110.00 17,083.44 110.00 17,076.91 $4,571,500 $4,572,000 110.00 17,117.98 110.00 17,111.45 110.00 17,104.92 110.00 17,098.38 110.00 17,091.85 110.00 17,085.32 110.00 17,078.78 $4,572,000 $4,572,500 110.00 17,119.86 110.00 17,113.33 110.00 17,106.79 110.00 17,100.26 110.00 17,093.73 110.00 17,087.19 110.00 17,080.66 $4,572,500 $4,573,000 110.00 17,121.73 110.00 17,115.20 110.00 17,108.67 110.00 17,102.13 110.00 17,095.60 110.00 17,089.07 110.00 17,082.53 $4,573,000 $4,573,500 110.00 17,123.61 110.00 17,117.08 110.00 17,110.54 110.00 17,104.01 110.00 17,097.48 110.00 17,090.94 110.00 17,084.41 $4,573,500 $4,574,000 110.00 17,125.48 110.00 17,118.95 110.00 17,112.42 110.00 17,105.88 110.00 17,099.35 110.00 17,092.82 110.00 17,086.28 $4,574,000 $4,574,500 110.00 17,127.36 110.00 17,120.83 110.00 17,114.29 110.00 17,107.76 110.00 17,101.23 110.00 17,094.69 110.00 17,088.16 $4,574,500 $4,575,000 110.00 17,129.23 110.00 17,122.70 110.00 17,116.17 110.00 17,109.63 110.00 17,103.10 110.00 17,096.57 110.00 17,090.03 $4,575,000 $4,575,500 110.00 17,131.11 110.00 17,124.58 110.00 17,118.04 110.00 17,111.51 110.00 17,104.98 110.00 17,098.44 110.00 17,091.91 $4,575,500 $4,576,000 110.00 17,132.98 110.00 17,126.45 110.00 17,119.92 110.00 17,113.38 110.00 17,106.85 110.00 17,100.32 110.00 17,093.78 $4,576,000 $4,576,500 110.00 17,134.86 110.00 17,128.33 110.00 17,121.79 110.00 17,115.26 110.00 17,108.73 110.00 17,102.19 110.00 17,095.66 $4,576,500 $4,577,000 110.00 17,136.73 110.00 17,130.20 110.00 17,123.67 110.00 17,117.13 110.00 17,110.60 110.00 17,104.07 110.00 17,097.53 $4,577,000 $4,577,500 110.00 17,138.61 110.00 17,132.08 110.00 17,125.54 110.00 17,119.01 110.00 17,112.48 110.00 17,105.94 110.00 17,099.41 $4,577,500 $4,578,000 110.00 17,140.48 110.00 17,133.95 110.00 17,127.42 110.00 17,120.88 110.00 17,114.35 110.00 17,107.82 110.00 17,101.28 $4,578,000 $4,578,500 110.00 17,142.36 110.00 17,135.83 110.00 17,129.29 110.00 17,122.76 110.00 17,116.23 110.00 17,109.69 110.00 17,103.16 $4,578,500 $4,579,000 110.00 17,144.23 110.00 17,137.70 110.00 17,131.17 110.00 17,124.63 110.00 17,118.10 110.00 17,111.57 110.00 17,105.03 $4,579,000 $4,579,500 110.00 17,146.11 110.00 17,139.58 110.00 17,133.04 110.00 17,126.51 110.00 17,119.98 110.00 17,113.44 110.00 17,106.91 $4,579,500 $4,580,000 110.00 17,147.98 110.00 17,141.45 110.00 17,134.92 110.00 17,128.38 110.00 17,121.85 110.00 17,115.32 110.00 17,108.78 $4,580,000 $4,580,500 110.00 17,149.86 110.00 17,143.33 110.00 17,136.79 110.00 17,130.26 110.00 17,123.73 110.00 17,117.19 110.00 17,110.66 $4,580,500 $4,581,000 110.00 17,151.73 110.00 17,145.20 110.00 17,138.67 110.00 17,132.13 110.00 17,125.60 110.00 17,119.07 110.00 17,112.53 $4,581,000 $4,581,500 110.00 17,153.61 110.00 17,147.08 110.00 17,140.54 110.00 17,134.01 110.00 17,127.48 110.00 17,120.94 110.00 17,114.41 $4,581,500 $4,582,000 110.00 17,155.48 110.00 17,148.95 110.00 17,142.42 110.00 17,135.88 110.00 17,129.35 110.00 17,122.82 110.00 17,116.28 $4,582,000 $4,582,500 110.00 17,157.36 110.00 17,150.83 110.00 17,144.29 110.00 17,137.76 110.00 17,131.23 110.00 17,124.69 110.00 17,118.16 $4,582,500 $4,583,000 110.00 17,159.23 110.00 17,152.70 110.00 17,146.17 110.00 17,139.63 110.00 17,133.10 110.00 17,126.57 110.00 17,120.03 $4,583,000 $4,583,500 110.00 17,161.11 110.00 17,154.58 110.00 17,148.04 110.00 17,141.51 110.00 17,134.98 110.00 17,128.44 110.00 17,121.91 $4,583,500 $4,584,000 110.00 17,162.98 110.00 17,156.45 110.00 17,149.92 110.00 17,143.38 110.00 17,136.85 110.00 17,130.32 110.00 17,123.78 $4,584,000 $4,584,500 110.00 17,164.86 110.00 17,158.33 110.00 17,151.79 110.00 17,145.26 110.00 17,138.73 110.00 17,132.19 110.00 17,125.66 $4,584,500 $4,585,000 110.00 17,166.73 110.00 17,160.20 110.00 17,153.67 110.00 17,147.13 110.00 17,140.60 110.00 17,134.07 110.00 17,127.53 $4,585,000 $4,585,500 110.00 17,168.61 110.00 17,162.08 110.00 17,155.54 110.00 17,149.01 110.00 17,142.48 110.00 17,135.94 110.00 17,129.41 $4,585,500 $4,586,000 110.00 17,170.48 110.00 17,163.95 110.00 17,157.42 110.00 17,150.88 110.00 17,144.35 110.00 17,137.82 110.00 17,131.28 $4,586,000 $4,586,500 110.00 17,172.36 110.00 17,165.83 110.00 17,159.29 110.00 17,152.76 110.00 17,146.23 110.00 17,139.69 110.00 17,133.16 $4,586,500 $4,587,000 110.00 17,174.23 110.00 17,167.70 110.00 17,161.17 110.00 17,154.63 110.00 17,148.10 110.00 17,141.57 110.00 17,135.03 $4,587,000 $4,587,500 110.00 17,176.11 110.00 17,169.58 110.00 17,163.04 110.00 17,156.51 110.00 17,149.98 110.00 17,143.44 110.00 17,136.91 $4,587,500 $4,588,000 110.00 17,177.98 110.00 17,171.45 110.00 17,164.92 110.00 17,158.38 110.00 17,151.85 110.00 17,145.32 110.00 17,138.78 $4,588,000 $4,588,500 110.00 17,179.86 110.00 17,173.33 110.00 17,166.79 110.00 17,160.26 110.00 17,153.73 110.00 17,147.19 110.00 17,140.66 $4,588,500 $4,589,000 110.00 17,181.73 110.00 17,175.20 110.00 17,168.67 110.00 17,162.13 110.00 17,155.60 110.00 17,149.07 110.00 17,142.53 $4,589,000 $4,589,500 110.00 17,183.61 110.00 17,177.08 110.00 17,170.54 110.00 17,164.01 110.00 17,157.48 110.00 17,150.94 110.00 17,144.41 $4,589,500 $4,590,000 110.00 17,185.48 110.00 17,178.95 110.00 17,172.42 110.00 17,165.88 110.00 17,159.35 110.00 17,152.82 110.00 17,146.28

NJEIS Family Cost Participation Table Page 93 of 12 Effective July 1, 2015

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

$4,590,000 $4,590,500 110.00 17,187.36 110.00 17,180.83 110.00 17,174.29 110.00 17,167.76 110.00 17,161.23 110.00 17,154.69 110.00 17,148.16 $4,590,500 $4,591,000 110.00 17,189.23 110.00 17,182.70 110.00 17,176.17 110.00 17,169.63 110.00 17,163.10 110.00 17,156.57 110.00 17,150.03 $4,591,000 $4,591,500 110.00 17,191.11 110.00 17,184.58 110.00 17,178.04 110.00 17,171.51 110.00 17,164.98 110.00 17,158.44 110.00 17,151.91 $4,591,500 $4,592,000 110.00 17,192.98 110.00 17,186.45 110.00 17,179.92 110.00 17,173.38 110.00 17,166.85 110.00 17,160.32 110.00 17,153.78 $4,592,000 $4,592,500 110.00 17,194.86 110.00 17,188.33 110.00 17,181.79 110.00 17,175.26 110.00 17,168.73 110.00 17,162.19 110.00 17,155.66 $4,592,500 $4,593,000 110.00 17,196.73 110.00 17,190.20 110.00 17,183.67 110.00 17,177.13 110.00 17,170.60 110.00 17,164.07 110.00 17,157.53 $4,593,000 $4,593,500 110.00 17,198.61 110.00 17,192.08 110.00 17,185.54 110.00 17,179.01 110.00 17,172.48 110.00 17,165.94 110.00 17,159.41 $4,593,500 $4,594,000 110.00 17,200.48 110.00 17,193.95 110.00 17,187.42 110.00 17,180.88 110.00 17,174.35 110.00 17,167.82 110.00 17,161.28 $4,594,000 $4,594,500 110.00 17,202.36 110.00 17,195.83 110.00 17,189.29 110.00 17,182.76 110.00 17,176.23 110.00 17,169.69 110.00 17,163.16 $4,594,500 $4,595,000 110.00 17,204.23 110.00 17,197.70 110.00 17,191.17 110.00 17,184.63 110.00 17,178.10 110.00 17,171.57 110.00 17,165.03 $4,595,000 $4,595,500 110.00 17,206.11 110.00 17,199.58 110.00 17,193.04 110.00 17,186.51 110.00 17,179.98 110.00 17,173.44 110.00 17,166.91 $4,595,500 $4,596,000 110.00 17,207.98 110.00 17,201.45 110.00 17,194.92 110.00 17,188.38 110.00 17,181.85 110.00 17,175.32 110.00 17,168.78 $4,596,000 $4,596,500 110.00 17,209.86 110.00 17,203.33 110.00 17,196.79 110.00 17,190.26 110.00 17,183.73 110.00 17,177.19 110.00 17,170.66 $4,596,500 $4,597,000 110.00 17,211.73 110.00 17,205.20 110.00 17,198.67 110.00 17,192.13 110.00 17,185.60 110.00 17,179.07 110.00 17,172.53 $4,597,000 $4,597,500 110.00 17,213.61 110.00 17,207.08 110.00 17,200.54 110.00 17,194.01 110.00 17,187.48 110.00 17,180.94 110.00 17,174.41 $4,597,500 $4,598,000 110.00 17,215.48 110.00 17,208.95 110.00 17,202.42 110.00 17,195.88 110.00 17,189.35 110.00 17,182.82 110.00 17,176.28 $4,598,000 $4,598,500 110.00 17,217.36 110.00 17,210.83 110.00 17,204.29 110.00 17,197.76 110.00 17,191.23 110.00 17,184.69 110.00 17,178.16 $4,598,500 $4,599,000 110.00 17,219.23 110.00 17,212.70 110.00 17,206.17 110.00 17,199.63 110.00 17,193.10 110.00 17,186.57 110.00 17,180.03 $4,599,000 $4,599,500 110.00 17,221.11 110.00 17,214.58 110.00 17,208.04 110.00 17,201.51 110.00 17,194.98 110.00 17,188.44 110.00 17,181.91 $4,599,500 $4,600,000 110.00 17,222.98 110.00 17,216.45 110.00 17,209.92 110.00 17,203.38 110.00 17,196.85 110.00 17,190.32 110.00 17,183.78 $4,600,000 $4,600,500 110.00 17,224.86 110.00 17,218.33 110.00 17,211.79 110.00 17,205.26 110.00 17,198.73 110.00 17,192.19 110.00 17,185.66 $4,600,500 $4,601,000 110.00 17,226.73 110.00 17,220.20 110.00 17,213.67 110.00 17,207.13 110.00 17,200.60 110.00 17,194.07 110.00 17,187.53 $4,601,000 $4,601,500 110.00 17,228.61 110.00 17,222.08 110.00 17,215.54 110.00 17,209.01 110.00 17,202.48 110.00 17,195.94 110.00 17,189.41 $4,601,500 $4,602,000 110.00 17,230.48 110.00 17,223.95 110.00 17,217.42 110.00 17,210.88 110.00 17,204.35 110.00 17,197.82 110.00 17,191.28 $4,602,000 $4,602,500 110.00 17,232.36 110.00 17,225.83 110.00 17,219.29 110.00 17,212.76 110.00 17,206.23 110.00 17,199.69 110.00 17,193.16 $4,602,500 $4,603,000 110.00 17,234.23 110.00 17,227.70 110.00 17,221.17 110.00 17,214.63 110.00 17,208.10 110.00 17,201.57 110.00 17,195.03 $4,603,000 $4,603,500 110.00 17,236.11 110.00 17,229.58 110.00 17,223.04 110.00 17,216.51 110.00 17,209.98 110.00 17,203.44 110.00 17,196.91 $4,603,500 $4,604,000 110.00 17,237.98 110.00 17,231.45 110.00 17,224.92 110.00 17,218.38 110.00 17,211.85 110.00 17,205.32 110.00 17,198.78 $4,604,000 $4,604,500 110.00 17,239.86 110.00 17,233.33 110.00 17,226.79 110.00 17,220.26 110.00 17,213.73 110.00 17,207.19 110.00 17,200.66 $4,604,500 $4,605,000 110.00 17,241.73 110.00 17,235.20 110.00 17,228.67 110.00 17,222.13 110.00 17,215.60 110.00 17,209.07 110.00 17,202.53 $4,605,000 $4,605,500 110.00 17,243.61 110.00 17,237.08 110.00 17,230.54 110.00 17,224.01 110.00 17,217.48 110.00 17,210.94 110.00 17,204.41 $4,605,500 $4,606,000 110.00 17,245.48 110.00 17,238.95 110.00 17,232.42 110.00 17,225.88 110.00 17,219.35 110.00 17,212.82 110.00 17,206.28 $4,606,000 $4,606,500 110.00 17,247.36 110.00 17,240.83 110.00 17,234.29 110.00 17,227.76 110.00 17,221.23 110.00 17,214.69 110.00 17,208.16 $4,606,500 $4,607,000 110.00 17,249.23 110.00 17,242.70 110.00 17,236.17 110.00 17,229.63 110.00 17,223.10 110.00 17,216.57 110.00 17,210.03 $4,607,000 $4,607,500 110.00 17,251.11 110.00 17,244.58 110.00 17,238.04 110.00 17,231.51 110.00 17,224.98 110.00 17,218.44 110.00 17,211.91 $4,607,500 $4,608,000 110.00 17,252.98 110.00 17,246.45 110.00 17,239.92 110.00 17,233.38 110.00 17,226.85 110.00 17,220.32 110.00 17,213.78 $4,608,000 $4,608,500 110.00 17,254.86 110.00 17,248.33 110.00 17,241.79 110.00 17,235.26 110.00 17,228.73 110.00 17,222.19 110.00 17,215.66 $4,608,500 $4,609,000 110.00 17,256.73 110.00 17,250.20 110.00 17,243.67 110.00 17,237.13 110.00 17,230.60 110.00 17,224.07 110.00 17,217.53 $4,609,000 $4,609,500 110.00 17,258.61 110.00 17,252.08 110.00 17,245.54 110.00 17,239.01 110.00 17,232.48 110.00 17,225.94 110.00 17,219.41 $4,609,500 $4,610,000 110.00 17,260.48 110.00 17,253.95 110.00 17,247.42 110.00 17,240.88 110.00 17,234.35 110.00 17,227.82 110.00 17,221.28 $4,610,000 $4,610,500 110.00 17,262.36 110.00 17,255.83 110.00 17,249.29 110.00 17,242.76 110.00 17,236.23 110.00 17,229.69 110.00 17,223.16 $4,610,500 $4,611,000 110.00 17,264.23 110.00 17,257.70 110.00 17,251.17 110.00 17,244.63 110.00 17,238.10 110.00 17,231.57 110.00 17,225.03 $4,611,000 $4,611,500 110.00 17,266.11 110.00 17,259.58 110.00 17,253.04 110.00 17,246.51 110.00 17,239.98 110.00 17,233.44 110.00 17,226.91 $4,611,500 $4,612,000 110.00 17,267.98 110.00 17,261.45 110.00 17,254.92 110.00 17,248.38 110.00 17,241.85 110.00 17,235.32 110.00 17,228.78 $4,612,000 $4,612,500 110.00 17,269.86 110.00 17,263.33 110.00 17,256.79 110.00 17,250.26 110.00 17,243.73 110.00 17,237.19 110.00 17,230.66 $4,612,500 $4,613,000 110.00 17,271.73 110.00 17,265.20 110.00 17,258.67 110.00 17,252.13 110.00 17,245.60 110.00 17,239.07 110.00 17,232.53 $4,613,000 $4,613,500 110.00 17,273.61 110.00 17,267.08 110.00 17,260.54 110.00 17,254.01 110.00 17,247.48 110.00 17,240.94 110.00 17,234.41 $4,613,500 $4,614,000 110.00 17,275.48 110.00 17,268.95 110.00 17,262.42 110.00 17,255.88 110.00 17,249.35 110.00 17,242.82 110.00 17,236.28 $4,614,000 $4,614,500 110.00 17,277.36 110.00 17,270.83 110.00 17,264.29 110.00 17,257.76 110.00 17,251.23 110.00 17,244.69 110.00 17,238.16 $4,614,500 $4,615,000 110.00 17,279.23 110.00 17,272.70 110.00 17,266.17 110.00 17,259.63 110.00 17,253.10 110.00 17,246.57 110.00 17,240.03 $4,615,000 $4,615,500 110.00 17,281.11 110.00 17,274.58 110.00 17,268.04 110.00 17,261.51 110.00 17,254.98 110.00 17,248.44 110.00 17,241.91 $4,615,500 $4,616,000 110.00 17,282.98 110.00 17,276.45 110.00 17,269.92 110.00 17,263.38 110.00 17,256.85 110.00 17,250.32 110.00 17,243.78 $4,616,000 $4,616,500 110.00 17,284.86 110.00 17,278.33 110.00 17,271.79 110.00 17,265.26 110.00 17,258.73 110.00 17,252.19 110.00 17,245.66 $4,616,500 $4,617,000 110.00 17,286.73 110.00 17,280.20 110.00 17,273.67 110.00 17,267.13 110.00 17,260.60 110.00 17,254.07 110.00 17,247.53 $4,617,000 $4,617,500 110.00 17,288.61 110.00 17,282.08 110.00 17,275.54 110.00 17,269.01 110.00 17,262.48 110.00 17,255.94 110.00 17,249.41 $4,617,500 $4,618,000 110.00 17,290.48 110.00 17,283.95 110.00 17,277.42 110.00 17,270.88 110.00 17,264.35 110.00 17,257.82 110.00 17,251.28 $4,618,000 $4,618,500 110.00 17,292.36 110.00 17,285.83 110.00 17,279.29 110.00 17,272.76 110.00 17,266.23 110.00 17,259.69 110.00 17,253.16 $4,618,500 $4,619,000 110.00 17,294.23 110.00 17,287.70 110.00 17,281.17 110.00 17,274.63 110.00 17,268.10 110.00 17,261.57 110.00 17,255.03 $4,619,000 $4,619,500 110.00 17,296.11 110.00 17,289.58 110.00 17,283.04 110.00 17,276.51 110.00 17,269.98 110.00 17,263.44 110.00 17,256.91 $4,619,500 $4,620,000 110.00 17,297.98 110.00 17,291.45 110.00 17,284.92 110.00 17,278.38 110.00 17,271.85 110.00 17,265.32 110.00 17,258.78 $4,620,000 $4,620,500 110.00 17,299.86 110.00 17,293.33 110.00 17,286.79 110.00 17,280.26 110.00 17,273.73 110.00 17,267.19 110.00 17,260.66 $4,620,500 $4,621,000 110.00 17,301.73 110.00 17,295.20 110.00 17,288.67 110.00 17,282.13 110.00 17,275.60 110.00 17,269.07 110.00 17,262.53 $4,621,000 $4,621,500 110.00 17,303.61 110.00 17,297.08 110.00 17,290.54 110.00 17,284.01 110.00 17,277.48 110.00 17,270.94 110.00 17,264.41 $4,621,500 $4,622,000 110.00 17,305.48 110.00 17,298.95 110.00 17,292.42 110.00 17,285.88 110.00 17,279.35 110.00 17,272.82 110.00 17,266.28 $4,622,000 $4,622,500 110.00 17,307.36 110.00 17,300.83 110.00 17,294.29 110.00 17,287.76 110.00 17,281.23 110.00 17,274.69 110.00 17,268.16 $4,622,500 $4,623,000 110.00 17,309.23 110.00 17,302.70 110.00 17,296.17 110.00 17,289.63 110.00 17,283.10 110.00 17,276.57 110.00 17,270.03 $4,623,000 $4,623,500 110.00 17,311.11 110.00 17,304.58 110.00 17,298.04 110.00 17,291.51 110.00 17,284.98 110.00 17,278.44 110.00 17,271.91 $4,623,500 $4,624,000 110.00 17,312.98 110.00 17,306.45 110.00 17,299.92 110.00 17,293.38 110.00 17,286.85 110.00 17,280.32 110.00 17,273.78 $4,624,000 $4,624,500 110.00 17,314.86 110.00 17,308.33 110.00 17,301.79 110.00 17,295.26 110.00 17,288.73 110.00 17,282.19 110.00 17,275.66 $4,624,500 $4,625,000 110.00 17,316.73 110.00 17,310.20 110.00 17,303.67 110.00 17,297.13 110.00 17,290.60 110.00 17,284.07 110.00 17,277.53 $4,625,000 $4,625,500 110.00 17,318.61 110.00 17,312.08 110.00 17,305.54 110.00 17,299.01 110.00 17,292.48 110.00 17,285.94 110.00 17,279.41 $4,625,500 $4,626,000 110.00 17,320.48 110.00 17,313.95 110.00 17,307.42 110.00 17,300.88 110.00 17,294.35 110.00 17,287.82 110.00 17,281.28 $4,626,000 $4,626,500 110.00 17,322.36 110.00 17,315.83 110.00 17,309.29 110.00 17,302.76 110.00 17,296.23 110.00 17,289.69 110.00 17,283.16 $4,626,500 $4,627,000 110.00 17,324.23 110.00 17,317.70 110.00 17,311.17 110.00 17,304.63 110.00 17,298.10 110.00 17,291.57 110.00 17,285.03 $4,627,000 $4,627,500 110.00 17,326.11 110.00 17,319.58 110.00 17,313.04 110.00 17,306.51 110.00 17,299.98 110.00 17,293.44 110.00 17,286.91 $4,627,500 $4,628,000 110.00 17,327.98 110.00 17,321.45 110.00 17,314.92 110.00 17,308.38 110.00 17,301.85 110.00 17,295.32 110.00 17,288.78 $4,628,000 $4,628,500 110.00 17,329.86 110.00 17,323.33 110.00 17,316.79 110.00 17,310.26 110.00 17,303.73 110.00 17,297.19 110.00 17,290.66 $4,628,500 $4,629,000 110.00 17,331.73 110.00 17,325.20 110.00 17,318.67 110.00 17,312.13 110.00 17,305.60 110.00 17,299.07 110.00 17,292.53 $4,629,000 $4,629,500 110.00 17,333.61 110.00 17,327.08 110.00 17,320.54 110.00 17,314.01 110.00 17,307.48 110.00 17,300.94 110.00 17,294.41 $4,629,500 $4,630,000 110.00 17,335.48 110.00 17,328.95 110.00 17,322.42 110.00 17,315.88 110.00 17,309.35 110.00 17,302.82 110.00 17,296.28 $4,630,000 $4,630,500 110.00 17,337.36 110.00 17,330.83 110.00 17,324.29 110.00 17,317.76 110.00 17,311.23 110.00 17,304.69 110.00 17,298.16 $4,630,500 $4,631,000 110.00 17,339.23 110.00 17,332.70 110.00 17,326.17 110.00 17,319.63 110.00 17,313.10 110.00 17,306.57 110.00 17,300.03 $4,631,000 $4,631,500 110.00 17,341.11 110.00 17,334.58 110.00 17,328.04 110.00 17,321.51 110.00 17,314.98 110.00 17,308.44 110.00 17,301.91 $4,631,500 $4,632,000 110.00 17,342.98 110.00 17,336.45 110.00 17,329.92 110.00 17,323.38 110.00 17,316.85 110.00 17,310.32 110.00 17,303.78 $4,632,000 $4,632,500 110.00 17,344.86 110.00 17,338.33 110.00 17,331.79 110.00 17,325.26 110.00 17,318.73 110.00 17,312.19 110.00 17,305.66 $4,632,500 $4,633,000 110.00 17,346.73 110.00 17,340.20 110.00 17,333.67 110.00 17,327.13 110.00 17,320.60 110.00 17,314.07 110.00 17,307.53 $4,633,000 $4,633,500 110.00 17,348.61 110.00 17,342.08 110.00 17,335.54 110.00 17,329.01 110.00 17,322.48 110.00 17,315.94 110.00 17,309.41 $4,633,500 $4,634,000 110.00 17,350.48 110.00 17,343.95 110.00 17,337.42 110.00 17,330.88 110.00 17,324.35 110.00 17,317.82 110.00 17,311.28 $4,634,000 $4,634,500 110.00 17,352.36 110.00 17,345.83 110.00 17,339.29 110.00 17,332.76 110.00 17,326.23 110.00 17,319.69 110.00 17,313.16 $4,634,500 $4,635,000 110.00 17,354.23 110.00 17,347.70 110.00 17,341.17 110.00 17,334.63 110.00 17,328.10 110.00 17,321.57 110.00 17,315.03 $4,635,000 $4,635,500 110.00 17,356.11 110.00 17,349.58 110.00 17,343.04 110.00 17,336.51 110.00 17,329.98 110.00 17,323.44 110.00 17,316.91 $4,635,500 $4,636,000 110.00 17,357.98 110.00 17,351.45 110.00 17,344.92 110.00 17,338.38 110.00 17,331.85 110.00 17,325.32 110.00 17,318.78 $4,636,000 $4,636,500 110.00 17,359.86 110.00 17,353.33 110.00 17,346.79 110.00 17,340.26 110.00 17,333.73 110.00 17,327.19 110.00 17,320.66 $4,636,500 $4,637,000 110.00 17,361.73 110.00 17,355.20 110.00 17,348.67 110.00 17,342.13 110.00 17,335.60 110.00 17,329.07 110.00 17,322.53 $4,637,000 $4,637,500 110.00 17,363.61 110.00 17,357.08 110.00 17,350.54 110.00 17,344.01 110.00 17,337.48 110.00 17,330.94 110.00 17,324.41 $4,637,500 $4,638,000 110.00 17,365.48 110.00 17,358.95 110.00 17,352.42 110.00 17,345.88 110.00 17,339.35 110.00 17,332.82 110.00 17,326.28 $4,638,000 $4,638,500 110.00 17,367.36 110.00 17,360.83 110.00 17,354.29 110.00 17,347.76 110.00 17,341.23 110.00 17,334.69 110.00 17,328.16 $4,638,500 $4,639,000 110.00 17,369.23 110.00 17,362.70 110.00 17,356.17 110.00 17,349.63 110.00 17,343.10 110.00 17,336.57 110.00 17,330.03 $4,639,000 $4,639,500 110.00 17,371.11 110.00 17,364.58 110.00 17,358.04 110.00 17,351.51 110.00 17,344.98 110.00 17,338.44 110.00 17,331.91 $4,639,500 $4,640,000 110.00 17,372.98 110.00 17,366.45 110.00 17,359.92 110.00 17,353.38 110.00 17,346.85 110.00 17,340.32 110.00 17,333.78 $4,640,000 $4,640,500 110.00 17,374.86 110.00 17,368.33 110.00 17,361.79 110.00 17,355.26 110.00 17,348.73 110.00 17,342.19 110.00 17,335.66 $4,640,500 $4,641,000 110.00 17,376.73 110.00 17,370.20 110.00 17,363.67 110.00 17,357.13 110.00 17,350.60 110.00 17,344.07 110.00 17,337.53

NJEIS Family Cost Participation Table Page 94 of 12 Effective July 1, 2015

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

$4,641,000 $4,641,500 110.00 17,378.61 110.00 17,372.08 110.00 17,365.54 110.00 17,359.01 110.00 17,352.48 110.00 17,345.94 110.00 17,339.41 $4,641,500 $4,642,000 110.00 17,380.48 110.00 17,373.95 110.00 17,367.42 110.00 17,360.88 110.00 17,354.35 110.00 17,347.82 110.00 17,341.28 $4,642,000 $4,642,500 110.00 17,382.36 110.00 17,375.83 110.00 17,369.29 110.00 17,362.76 110.00 17,356.23 110.00 17,349.69 110.00 17,343.16 $4,642,500 $4,643,000 110.00 17,384.23 110.00 17,377.70 110.00 17,371.17 110.00 17,364.63 110.00 17,358.10 110.00 17,351.57 110.00 17,345.03 $4,643,000 $4,643,500 110.00 17,386.11 110.00 17,379.58 110.00 17,373.04 110.00 17,366.51 110.00 17,359.98 110.00 17,353.44 110.00 17,346.91 $4,643,500 $4,644,000 110.00 17,387.98 110.00 17,381.45 110.00 17,374.92 110.00 17,368.38 110.00 17,361.85 110.00 17,355.32 110.00 17,348.78 $4,644,000 $4,644,500 110.00 17,389.86 110.00 17,383.33 110.00 17,376.79 110.00 17,370.26 110.00 17,363.73 110.00 17,357.19 110.00 17,350.66 $4,644,500 $4,645,000 110.00 17,391.73 110.00 17,385.20 110.00 17,378.67 110.00 17,372.13 110.00 17,365.60 110.00 17,359.07 110.00 17,352.53 $4,645,000 $4,645,500 110.00 17,393.61 110.00 17,387.08 110.00 17,380.54 110.00 17,374.01 110.00 17,367.48 110.00 17,360.94 110.00 17,354.41 $4,645,500 $4,646,000 110.00 17,395.48 110.00 17,388.95 110.00 17,382.42 110.00 17,375.88 110.00 17,369.35 110.00 17,362.82 110.00 17,356.28 $4,646,000 $4,646,500 110.00 17,397.36 110.00 17,390.83 110.00 17,384.29 110.00 17,377.76 110.00 17,371.23 110.00 17,364.69 110.00 17,358.16 $4,646,500 $4,647,000 110.00 17,399.23 110.00 17,392.70 110.00 17,386.17 110.00 17,379.63 110.00 17,373.10 110.00 17,366.57 110.00 17,360.03 $4,647,000 $4,647,500 110.00 17,401.11 110.00 17,394.58 110.00 17,388.04 110.00 17,381.51 110.00 17,374.98 110.00 17,368.44 110.00 17,361.91 $4,647,500 $4,648,000 110.00 17,402.98 110.00 17,396.45 110.00 17,389.92 110.00 17,383.38 110.00 17,376.85 110.00 17,370.32 110.00 17,363.78 $4,648,000 $4,648,500 110.00 17,404.86 110.00 17,398.33 110.00 17,391.79 110.00 17,385.26 110.00 17,378.73 110.00 17,372.19 110.00 17,365.66 $4,648,500 $4,649,000 110.00 17,406.73 110.00 17,400.20 110.00 17,393.67 110.00 17,387.13 110.00 17,380.60 110.00 17,374.07 110.00 17,367.53 $4,649,000 $4,649,500 110.00 17,408.61 110.00 17,402.08 110.00 17,395.54 110.00 17,389.01 110.00 17,382.48 110.00 17,375.94 110.00 17,369.41 $4,649,500 $4,650,000 110.00 17,410.48 110.00 17,403.95 110.00 17,397.42 110.00 17,390.88 110.00 17,384.35 110.00 17,377.82 110.00 17,371.28 $4,650,000 $4,650,500 110.00 17,412.36 110.00 17,405.83 110.00 17,399.29 110.00 17,392.76 110.00 17,386.23 110.00 17,379.69 110.00 17,373.16 $4,650,500 $4,651,000 110.00 17,414.23 110.00 17,407.70 110.00 17,401.17 110.00 17,394.63 110.00 17,388.10 110.00 17,381.57 110.00 17,375.03 $4,651,000 $4,651,500 110.00 17,416.11 110.00 17,409.58 110.00 17,403.04 110.00 17,396.51 110.00 17,389.98 110.00 17,383.44 110.00 17,376.91 $4,651,500 $4,652,000 110.00 17,417.98 110.00 17,411.45 110.00 17,404.92 110.00 17,398.38 110.00 17,391.85 110.00 17,385.32 110.00 17,378.78 $4,652,000 $4,652,500 110.00 17,419.86 110.00 17,413.33 110.00 17,406.79 110.00 17,400.26 110.00 17,393.73 110.00 17,387.19 110.00 17,380.66 $4,652,500 $4,653,000 110.00 17,421.73 110.00 17,415.20 110.00 17,408.67 110.00 17,402.13 110.00 17,395.60 110.00 17,389.07 110.00 17,382.53 $4,653,000 $4,653,500 110.00 17,423.61 110.00 17,417.08 110.00 17,410.54 110.00 17,404.01 110.00 17,397.48 110.00 17,390.94 110.00 17,384.41 $4,653,500 $4,654,000 110.00 17,425.48 110.00 17,418.95 110.00 17,412.42 110.00 17,405.88 110.00 17,399.35 110.00 17,392.82 110.00 17,386.28 $4,654,000 $4,654,500 110.00 17,427.36 110.00 17,420.83 110.00 17,414.29 110.00 17,407.76 110.00 17,401.23 110.00 17,394.69 110.00 17,388.16 $4,654,500 $4,655,000 110.00 17,429.23 110.00 17,422.70 110.00 17,416.17 110.00 17,409.63 110.00 17,403.10 110.00 17,396.57 110.00 17,390.03 $4,655,000 $4,655,500 110.00 17,431.11 110.00 17,424.58 110.00 17,418.04 110.00 17,411.51 110.00 17,404.98 110.00 17,398.44 110.00 17,391.91 $4,655,500 $4,656,000 110.00 17,432.98 110.00 17,426.45 110.00 17,419.92 110.00 17,413.38 110.00 17,406.85 110.00 17,400.32 110.00 17,393.78 $4,656,000 $4,656,500 110.00 17,434.86 110.00 17,428.33 110.00 17,421.79 110.00 17,415.26 110.00 17,408.73 110.00 17,402.19 110.00 17,395.66 $4,656,500 $4,657,000 110.00 17,436.73 110.00 17,430.20 110.00 17,423.67 110.00 17,417.13 110.00 17,410.60 110.00 17,404.07 110.00 17,397.53 $4,657,000 $4,657,500 110.00 17,438.61 110.00 17,432.08 110.00 17,425.54 110.00 17,419.01 110.00 17,412.48 110.00 17,405.94 110.00 17,399.41 $4,657,500 $4,658,000 110.00 17,440.48 110.00 17,433.95 110.00 17,427.42 110.00 17,420.88 110.00 17,414.35 110.00 17,407.82 110.00 17,401.28 $4,658,000 $4,658,500 110.00 17,442.36 110.00 17,435.83 110.00 17,429.29 110.00 17,422.76 110.00 17,416.23 110.00 17,409.69 110.00 17,403.16 $4,658,500 $4,659,000 110.00 17,444.23 110.00 17,437.70 110.00 17,431.17 110.00 17,424.63 110.00 17,418.10 110.00 17,411.57 110.00 17,405.03 $4,659,000 $4,659,500 110.00 17,446.11 110.00 17,439.58 110.00 17,433.04 110.00 17,426.51 110.00 17,419.98 110.00 17,413.44 110.00 17,406.91 $4,659,500 $4,660,000 110.00 17,447.98 110.00 17,441.45 110.00 17,434.92 110.00 17,428.38 110.00 17,421.85 110.00 17,415.32 110.00 17,408.78 $4,660,000 $4,660,500 110.00 17,449.86 110.00 17,443.33 110.00 17,436.79 110.00 17,430.26 110.00 17,423.73 110.00 17,417.19 110.00 17,410.66 $4,660,500 $4,661,000 110.00 17,451.73 110.00 17,445.20 110.00 17,438.67 110.00 17,432.13 110.00 17,425.60 110.00 17,419.07 110.00 17,412.53 $4,661,000 $4,661,500 110.00 17,453.61 110.00 17,447.08 110.00 17,440.54 110.00 17,434.01 110.00 17,427.48 110.00 17,420.94 110.00 17,414.41 $4,661,500 $4,662,000 110.00 17,455.48 110.00 17,448.95 110.00 17,442.42 110.00 17,435.88 110.00 17,429.35 110.00 17,422.82 110.00 17,416.28 $4,662,000 $4,662,500 110.00 17,457.36 110.00 17,450.83 110.00 17,444.29 110.00 17,437.76 110.00 17,431.23 110.00 17,424.69 110.00 17,418.16 $4,662,500 $4,663,000 110.00 17,459.23 110.00 17,452.70 110.00 17,446.17 110.00 17,439.63 110.00 17,433.10 110.00 17,426.57 110.00 17,420.03 $4,663,000 $4,663,500 110.00 17,461.11 110.00 17,454.58 110.00 17,448.04 110.00 17,441.51 110.00 17,434.98 110.00 17,428.44 110.00 17,421.91 $4,663,500 $4,664,000 110.00 17,462.98 110.00 17,456.45 110.00 17,449.92 110.00 17,443.38 110.00 17,436.85 110.00 17,430.32 110.00 17,423.78 $4,664,000 $4,664,500 110.00 17,464.86 110.00 17,458.33 110.00 17,451.79 110.00 17,445.26 110.00 17,438.73 110.00 17,432.19 110.00 17,425.66 $4,664,500 $4,665,000 110.00 17,466.73 110.00 17,460.20 110.00 17,453.67 110.00 17,447.13 110.00 17,440.60 110.00 17,434.07 110.00 17,427.53 $4,665,000 $4,665,500 110.00 17,468.61 110.00 17,462.08 110.00 17,455.54 110.00 17,449.01 110.00 17,442.48 110.00 17,435.94 110.00 17,429.41 $4,665,500 $4,666,000 110.00 17,470.48 110.00 17,463.95 110.00 17,457.42 110.00 17,450.88 110.00 17,444.35 110.00 17,437.82 110.00 17,431.28 $4,666,000 $4,666,500 110.00 17,472.36 110.00 17,465.83 110.00 17,459.29 110.00 17,452.76 110.00 17,446.23 110.00 17,439.69 110.00 17,433.16 $4,666,500 $4,667,000 110.00 17,474.23 110.00 17,467.70 110.00 17,461.17 110.00 17,454.63 110.00 17,448.10 110.00 17,441.57 110.00 17,435.03 $4,667,000 $4,667,500 110.00 17,476.11 110.00 17,469.58 110.00 17,463.04 110.00 17,456.51 110.00 17,449.98 110.00 17,443.44 110.00 17,436.91 $4,667,500 $4,668,000 110.00 17,477.98 110.00 17,471.45 110.00 17,464.92 110.00 17,458.38 110.00 17,451.85 110.00 17,445.32 110.00 17,438.78 $4,668,000 $4,668,500 110.00 17,479.86 110.00 17,473.33 110.00 17,466.79 110.00 17,460.26 110.00 17,453.73 110.00 17,447.19 110.00 17,440.66 $4,668,500 $4,669,000 110.00 17,481.73 110.00 17,475.20 110.00 17,468.67 110.00 17,462.13 110.00 17,455.60 110.00 17,449.07 110.00 17,442.53 $4,669,000 $4,669,500 110.00 17,483.61 110.00 17,477.08 110.00 17,470.54 110.00 17,464.01 110.00 17,457.48 110.00 17,450.94 110.00 17,444.41 $4,669,500 $4,670,000 110.00 17,485.48 110.00 17,478.95 110.00 17,472.42 110.00 17,465.88 110.00 17,459.35 110.00 17,452.82 110.00 17,446.28 $4,670,000 $4,670,500 110.00 17,487.36 110.00 17,480.83 110.00 17,474.29 110.00 17,467.76 110.00 17,461.23 110.00 17,454.69 110.00 17,448.16 $4,670,500 $4,671,000 110.00 17,489.23 110.00 17,482.70 110.00 17,476.17 110.00 17,469.63 110.00 17,463.10 110.00 17,456.57 110.00 17,450.03 $4,671,000 $4,671,500 110.00 17,491.11 110.00 17,484.58 110.00 17,478.04 110.00 17,471.51 110.00 17,464.98 110.00 17,458.44 110.00 17,451.91 $4,671,500 $4,672,000 110.00 17,492.98 110.00 17,486.45 110.00 17,479.92 110.00 17,473.38 110.00 17,466.85 110.00 17,460.32 110.00 17,453.78 $4,672,000 $4,672,500 110.00 17,494.86 110.00 17,488.33 110.00 17,481.79 110.00 17,475.26 110.00 17,468.73 110.00 17,462.19 110.00 17,455.66 $4,672,500 $4,673,000 110.00 17,496.73 110.00 17,490.20 110.00 17,483.67 110.00 17,477.13 110.00 17,470.60 110.00 17,464.07 110.00 17,457.53 $4,673,000 $4,673,500 110.00 17,498.61 110.00 17,492.08 110.00 17,485.54 110.00 17,479.01 110.00 17,472.48 110.00 17,465.94 110.00 17,459.41 $4,673,500 $4,674,000 110.00 17,500.48 110.00 17,493.95 110.00 17,487.42 110.00 17,480.88 110.00 17,474.35 110.00 17,467.82 110.00 17,461.28 $4,674,000 $4,674,500 110.00 17,502.36 110.00 17,495.83 110.00 17,489.29 110.00 17,482.76 110.00 17,476.23 110.00 17,469.69 110.00 17,463.16 $4,674,500 $4,675,000 110.00 17,504.23 110.00 17,497.70 110.00 17,491.17 110.00 17,484.63 110.00 17,478.10 110.00 17,471.57 110.00 17,465.03 $4,675,000 $4,675,500 110.00 17,506.11 110.00 17,499.58 110.00 17,493.04 110.00 17,486.51 110.00 17,479.98 110.00 17,473.44 110.00 17,466.91 $4,675,500 $4,676,000 110.00 17,507.98 110.00 17,501.45 110.00 17,494.92 110.00 17,488.38 110.00 17,481.85 110.00 17,475.32 110.00 17,468.78 $4,676,000 $4,676,500 110.00 17,509.86 110.00 17,503.33 110.00 17,496.79 110.00 17,490.26 110.00 17,483.73 110.00 17,477.19 110.00 17,470.66 $4,676,500 $4,677,000 110.00 17,511.73 110.00 17,505.20 110.00 17,498.67 110.00 17,492.13 110.00 17,485.60 110.00 17,479.07 110.00 17,472.53 $4,677,000 $4,677,500 110.00 17,513.61 110.00 17,507.08 110.00 17,500.54 110.00 17,494.01 110.00 17,487.48 110.00 17,480.94 110.00 17,474.41 $4,677,500 $4,678,000 110.00 17,515.48 110.00 17,508.95 110.00 17,502.42 110.00 17,495.88 110.00 17,489.35 110.00 17,482.82 110.00 17,476.28 $4,678,000 $4,678,500 110.00 17,517.36 110.00 17,510.83 110.00 17,504.29 110.00 17,497.76 110.00 17,491.23 110.00 17,484.69 110.00 17,478.16 $4,678,500 $4,679,000 110.00 17,519.23 110.00 17,512.70 110.00 17,506.17 110.00 17,499.63 110.00 17,493.10 110.00 17,486.57 110.00 17,480.03 $4,679,000 $4,679,500 110.00 17,521.11 110.00 17,514.58 110.00 17,508.04 110.00 17,501.51 110.00 17,494.98 110.00 17,488.44 110.00 17,481.91 $4,679,500 $4,680,000 110.00 17,522.98 110.00 17,516.45 110.00 17,509.92 110.00 17,503.38 110.00 17,496.85 110.00 17,490.32 110.00 17,483.78 $4,680,000 $4,680,500 110.00 17,524.86 110.00 17,518.33 110.00 17,511.79 110.00 17,505.26 110.00 17,498.73 110.00 17,492.19 110.00 17,485.66 $4,680,500 $4,681,000 110.00 17,526.73 110.00 17,520.20 110.00 17,513.67 110.00 17,507.13 110.00 17,500.60 110.00 17,494.07 110.00 17,487.53 $4,681,000 $4,681,500 110.00 17,528.61 110.00 17,522.08 110.00 17,515.54 110.00 17,509.01 110.00 17,502.48 110.00 17,495.94 110.00 17,489.41 $4,681,500 $4,682,000 110.00 17,530.48 110.00 17,523.95 110.00 17,517.42 110.00 17,510.88 110.00 17,504.35 110.00 17,497.82 110.00 17,491.28 $4,682,000 $4,682,500 110.00 17,532.36 110.00 17,525.83 110.00 17,519.29 110.00 17,512.76 110.00 17,506.23 110.00 17,499.69 110.00 17,493.16 $4,682,500 $4,683,000 110.00 17,534.23 110.00 17,527.70 110.00 17,521.17 110.00 17,514.63 110.00 17,508.10 110.00 17,501.57 110.00 17,495.03 $4,683,000 $4,683,500 110.00 17,536.11 110.00 17,529.58 110.00 17,523.04 110.00 17,516.51 110.00 17,509.98 110.00 17,503.44 110.00 17,496.91 $4,683,500 $4,684,000 110.00 17,537.98 110.00 17,531.45 110.00 17,524.92 110.00 17,518.38 110.00 17,511.85 110.00 17,505.32 110.00 17,498.78 $4,684,000 $4,684,500 110.00 17,539.86 110.00 17,533.33 110.00 17,526.79 110.00 17,520.26 110.00 17,513.73 110.00 17,507.19 110.00 17,500.66 $4,684,500 $4,685,000 110.00 17,541.73 110.00 17,535.20 110.00 17,528.67 110.00 17,522.13 110.00 17,515.60 110.00 17,509.07 110.00 17,502.53 $4,685,000 $4,685,500 110.00 17,543.61 110.00 17,537.08 110.00 17,530.54 110.00 17,524.01 110.00 17,517.48 110.00 17,510.94 110.00 17,504.41 $4,685,500 $4,686,000 110.00 17,545.48 110.00 17,538.95 110.00 17,532.42 110.00 17,525.88 110.00 17,519.35 110.00 17,512.82 110.00 17,506.28 $4,686,000 $4,686,500 110.00 17,547.36 110.00 17,540.83 110.00 17,534.29 110.00 17,527.76 110.00 17,521.23 110.00 17,514.69 110.00 17,508.16 $4,686,500 $4,687,000 110.00 17,549.23 110.00 17,542.70 110.00 17,536.17 110.00 17,529.63 110.00 17,523.10 110.00 17,516.57 110.00 17,510.03 $4,687,000 $4,687,500 110.00 17,551.11 110.00 17,544.58 110.00 17,538.04 110.00 17,531.51 110.00 17,524.98 110.00 17,518.44 110.00 17,511.91 $4,687,500 $4,688,000 110.00 17,552.98 110.00 17,546.45 110.00 17,539.92 110.00 17,533.38 110.00 17,526.85 110.00 17,520.32 110.00 17,513.78 $4,688,000 $4,688,500 110.00 17,554.86 110.00 17,548.33 110.00 17,541.79 110.00 17,535.26 110.00 17,528.73 110.00 17,522.19 110.00 17,515.66 $4,688,500 $4,689,000 110.00 17,556.73 110.00 17,550.20 110.00 17,543.67 110.00 17,537.13 110.00 17,530.60 110.00 17,524.07 110.00 17,517.53 $4,689,000 $4,689,500 110.00 17,558.61 110.00 17,552.08 110.00 17,545.54 110.00 17,539.01 110.00 17,532.48 110.00 17,525.94 110.00 17,519.41 $4,689,500 $4,690,000 110.00 17,560.48 110.00 17,553.95 110.00 17,547.42 110.00 17,540.88 110.00 17,534.35 110.00 17,527.82 110.00 17,521.28 $4,690,000 $4,690,500 110.00 17,562.36 110.00 17,555.83 110.00 17,549.29 110.00 17,542.76 110.00 17,536.23 110.00 17,529.69 110.00 17,523.16 $4,690,500 $4,691,000 110.00 17,564.23 110.00 17,557.70 110.00 17,551.17 110.00 17,544.63 110.00 17,538.10 110.00 17,531.57 110.00 17,525.03 $4,691,000 $4,691,500 110.00 17,566.11 110.00 17,559.58 110.00 17,553.04 110.00 17,546.51 110.00 17,539.98 110.00 17,533.44 110.00 17,526.91 $4,691,500 $4,692,000 110.00 17,567.98 110.00 17,561.45 110.00 17,554.92 110.00 17,548.38 110.00 17,541.85 110.00 17,535.32 110.00 17,528.78

NJEIS Family Cost Participation Table Page 95 of 12 Effective July 1, 2015

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

$4,692,000 $4,692,500 110.00 17,569.86 110.00 17,563.33 110.00 17,556.79 110.00 17,550.26 110.00 17,543.73 110.00 17,537.19 110.00 17,530.66 $4,692,500 $4,693,000 110.00 17,571.73 110.00 17,565.20 110.00 17,558.67 110.00 17,552.13 110.00 17,545.60 110.00 17,539.07 110.00 17,532.53 $4,693,000 $4,693,500 110.00 17,573.61 110.00 17,567.08 110.00 17,560.54 110.00 17,554.01 110.00 17,547.48 110.00 17,540.94 110.00 17,534.41 $4,693,500 $4,694,000 110.00 17,575.48 110.00 17,568.95 110.00 17,562.42 110.00 17,555.88 110.00 17,549.35 110.00 17,542.82 110.00 17,536.28 $4,694,000 $4,694,500 110.00 17,577.36 110.00 17,570.83 110.00 17,564.29 110.00 17,557.76 110.00 17,551.23 110.00 17,544.69 110.00 17,538.16 $4,694,500 $4,695,000 110.00 17,579.23 110.00 17,572.70 110.00 17,566.17 110.00 17,559.63 110.00 17,553.10 110.00 17,546.57 110.00 17,540.03 $4,695,000 $4,695,500 110.00 17,581.11 110.00 17,574.58 110.00 17,568.04 110.00 17,561.51 110.00 17,554.98 110.00 17,548.44 110.00 17,541.91 $4,695,500 $4,696,000 110.00 17,582.98 110.00 17,576.45 110.00 17,569.92 110.00 17,563.38 110.00 17,556.85 110.00 17,550.32 110.00 17,543.78 $4,696,000 $4,696,500 110.00 17,584.86 110.00 17,578.33 110.00 17,571.79 110.00 17,565.26 110.00 17,558.73 110.00 17,552.19 110.00 17,545.66 $4,696,500 $4,697,000 110.00 17,586.73 110.00 17,580.20 110.00 17,573.67 110.00 17,567.13 110.00 17,560.60 110.00 17,554.07 110.00 17,547.53 $4,697,000 $4,697,500 110.00 17,588.61 110.00 17,582.08 110.00 17,575.54 110.00 17,569.01 110.00 17,562.48 110.00 17,555.94 110.00 17,549.41 $4,697,500 $4,698,000 110.00 17,590.48 110.00 17,583.95 110.00 17,577.42 110.00 17,570.88 110.00 17,564.35 110.00 17,557.82 110.00 17,551.28 $4,698,000 $4,698,500 110.00 17,592.36 110.00 17,585.83 110.00 17,579.29 110.00 17,572.76 110.00 17,566.23 110.00 17,559.69 110.00 17,553.16 $4,698,500 $4,699,000 110.00 17,594.23 110.00 17,587.70 110.00 17,581.17 110.00 17,574.63 110.00 17,568.10 110.00 17,561.57 110.00 17,555.03 $4,699,000 $4,699,500 110.00 17,596.11 110.00 17,589.58 110.00 17,583.04 110.00 17,576.51 110.00 17,569.98 110.00 17,563.44 110.00 17,556.91 $4,699,500 $4,700,000 110.00 17,597.98 110.00 17,591.45 110.00 17,584.92 110.00 17,578.38 110.00 17,571.85 110.00 17,565.32 110.00 17,558.78 $4,700,000 $4,700,500 110.00 17,599.86 110.00 17,593.33 110.00 17,586.79 110.00 17,580.26 110.00 17,573.73 110.00 17,567.19 110.00 17,560.66 $4,700,500 $4,701,000 110.00 17,601.73 110.00 17,595.20 110.00 17,588.67 110.00 17,582.13 110.00 17,575.60 110.00 17,569.07 110.00 17,562.53 $4,701,000 $4,701,500 110.00 17,603.61 110.00 17,597.08 110.00 17,590.54 110.00 17,584.01 110.00 17,577.48 110.00 17,570.94 110.00 17,564.41 $4,701,500 $4,702,000 110.00 17,605.48 110.00 17,598.95 110.00 17,592.42 110.00 17,585.88 110.00 17,579.35 110.00 17,572.82 110.00 17,566.28 $4,702,000 $4,702,500 110.00 17,607.36 110.00 17,600.83 110.00 17,594.29 110.00 17,587.76 110.00 17,581.23 110.00 17,574.69 110.00 17,568.16 $4,702,500 $4,703,000 110.00 17,609.23 110.00 17,602.70 110.00 17,596.17 110.00 17,589.63 110.00 17,583.10 110.00 17,576.57 110.00 17,570.03 $4,703,000 $4,703,500 110.00 17,611.11 110.00 17,604.58 110.00 17,598.04 110.00 17,591.51 110.00 17,584.98 110.00 17,578.44 110.00 17,571.91 $4,703,500 $4,704,000 110.00 17,612.98 110.00 17,606.45 110.00 17,599.92 110.00 17,593.38 110.00 17,586.85 110.00 17,580.32 110.00 17,573.78 $4,704,000 $4,704,500 110.00 17,614.86 110.00 17,608.33 110.00 17,601.79 110.00 17,595.26 110.00 17,588.73 110.00 17,582.19 110.00 17,575.66 $4,704,500 $4,705,000 110.00 17,616.73 110.00 17,610.20 110.00 17,603.67 110.00 17,597.13 110.00 17,590.60 110.00 17,584.07 110.00 17,577.53 $4,705,000 $4,705,500 110.00 17,618.61 110.00 17,612.08 110.00 17,605.54 110.00 17,599.01 110.00 17,592.48 110.00 17,585.94 110.00 17,579.41 $4,705,500 $4,706,000 110.00 17,620.48 110.00 17,613.95 110.00 17,607.42 110.00 17,600.88 110.00 17,594.35 110.00 17,587.82 110.00 17,581.28 $4,706,000 $4,706,500 110.00 17,622.36 110.00 17,615.83 110.00 17,609.29 110.00 17,602.76 110.00 17,596.23 110.00 17,589.69 110.00 17,583.16 $4,706,500 $4,707,000 110.00 17,624.23 110.00 17,617.70 110.00 17,611.17 110.00 17,604.63 110.00 17,598.10 110.00 17,591.57 110.00 17,585.03 $4,707,000 $4,707,500 110.00 17,626.11 110.00 17,619.58 110.00 17,613.04 110.00 17,606.51 110.00 17,599.98 110.00 17,593.44 110.00 17,586.91 $4,707,500 $4,708,000 110.00 17,627.98 110.00 17,621.45 110.00 17,614.92 110.00 17,608.38 110.00 17,601.85 110.00 17,595.32 110.00 17,588.78 $4,708,000 $4,708,500 110.00 17,629.86 110.00 17,623.33 110.00 17,616.79 110.00 17,610.26 110.00 17,603.73 110.00 17,597.19 110.00 17,590.66 $4,708,500 $4,709,000 110.00 17,631.73 110.00 17,625.20 110.00 17,618.67 110.00 17,612.13 110.00 17,605.60 110.00 17,599.07 110.00 17,592.53 $4,709,000 $4,709,500 110.00 17,633.61 110.00 17,627.08 110.00 17,620.54 110.00 17,614.01 110.00 17,607.48 110.00 17,600.94 110.00 17,594.41 $4,709,500 $4,710,000 110.00 17,635.48 110.00 17,628.95 110.00 17,622.42 110.00 17,615.88 110.00 17,609.35 110.00 17,602.82 110.00 17,596.28 $4,710,000 $4,710,500 110.00 17,637.36 110.00 17,630.83 110.00 17,624.29 110.00 17,617.76 110.00 17,611.23 110.00 17,604.69 110.00 17,598.16 $4,710,500 $4,711,000 110.00 17,639.23 110.00 17,632.70 110.00 17,626.17 110.00 17,619.63 110.00 17,613.10 110.00 17,606.57 110.00 17,600.03 $4,711,000 $4,711,500 110.00 17,641.11 110.00 17,634.58 110.00 17,628.04 110.00 17,621.51 110.00 17,614.98 110.00 17,608.44 110.00 17,601.91 $4,711,500 $4,712,000 110.00 17,642.98 110.00 17,636.45 110.00 17,629.92 110.00 17,623.38 110.00 17,616.85 110.00 17,610.32 110.00 17,603.78 $4,712,000 $4,712,500 110.00 17,644.86 110.00 17,638.33 110.00 17,631.79 110.00 17,625.26 110.00 17,618.73 110.00 17,612.19 110.00 17,605.66 $4,712,500 $4,713,000 110.00 17,646.73 110.00 17,640.20 110.00 17,633.67 110.00 17,627.13 110.00 17,620.60 110.00 17,614.07 110.00 17,607.53 $4,713,000 $4,713,500 110.00 17,648.61 110.00 17,642.08 110.00 17,635.54 110.00 17,629.01 110.00 17,622.48 110.00 17,615.94 110.00 17,609.41 $4,713,500 $4,714,000 110.00 17,650.48 110.00 17,643.95 110.00 17,637.42 110.00 17,630.88 110.00 17,624.35 110.00 17,617.82 110.00 17,611.28 $4,714,000 $4,714,500 110.00 17,652.36 110.00 17,645.83 110.00 17,639.29 110.00 17,632.76 110.00 17,626.23 110.00 17,619.69 110.00 17,613.16 $4,714,500 $4,715,000 110.00 17,654.23 110.00 17,647.70 110.00 17,641.17 110.00 17,634.63 110.00 17,628.10 110.00 17,621.57 110.00 17,615.03 $4,715,000 $4,715,500 110.00 17,656.11 110.00 17,649.58 110.00 17,643.04 110.00 17,636.51 110.00 17,629.98 110.00 17,623.44 110.00 17,616.91 $4,715,500 $4,716,000 110.00 17,657.98 110.00 17,651.45 110.00 17,644.92 110.00 17,638.38 110.00 17,631.85 110.00 17,625.32 110.00 17,618.78 $4,716,000 $4,716,500 110.00 17,659.86 110.00 17,653.33 110.00 17,646.79 110.00 17,640.26 110.00 17,633.73 110.00 17,627.19 110.00 17,620.66 $4,716,500 $4,717,000 110.00 17,661.73 110.00 17,655.20 110.00 17,648.67 110.00 17,642.13 110.00 17,635.60 110.00 17,629.07 110.00 17,622.53 $4,717,000 $4,717,500 110.00 17,663.61 110.00 17,657.08 110.00 17,650.54 110.00 17,644.01 110.00 17,637.48 110.00 17,630.94 110.00 17,624.41 $4,717,500 $4,718,000 110.00 17,665.48 110.00 17,658.95 110.00 17,652.42 110.00 17,645.88 110.00 17,639.35 110.00 17,632.82 110.00 17,626.28 $4,718,000 $4,718,500 110.00 17,667.36 110.00 17,660.83 110.00 17,654.29 110.00 17,647.76 110.00 17,641.23 110.00 17,634.69 110.00 17,628.16 $4,718,500 $4,719,000 110.00 17,669.23 110.00 17,662.70 110.00 17,656.17 110.00 17,649.63 110.00 17,643.10 110.00 17,636.57 110.00 17,630.03 $4,719,000 $4,719,500 110.00 17,671.11 110.00 17,664.58 110.00 17,658.04 110.00 17,651.51 110.00 17,644.98 110.00 17,638.44 110.00 17,631.91 $4,719,500 $4,720,000 110.00 17,672.98 110.00 17,666.45 110.00 17,659.92 110.00 17,653.38 110.00 17,646.85 110.00 17,640.32 110.00 17,633.78 $4,720,000 $4,720,500 110.00 17,674.86 110.00 17,668.33 110.00 17,661.79 110.00 17,655.26 110.00 17,648.73 110.00 17,642.19 110.00 17,635.66 $4,720,500 $4,721,000 110.00 17,676.73 110.00 17,670.20 110.00 17,663.67 110.00 17,657.13 110.00 17,650.60 110.00 17,644.07 110.00 17,637.53 $4,721,000 $4,721,500 110.00 17,678.61 110.00 17,672.08 110.00 17,665.54 110.00 17,659.01 110.00 17,652.48 110.00 17,645.94 110.00 17,639.41 $4,721,500 $4,722,000 110.00 17,680.48 110.00 17,673.95 110.00 17,667.42 110.00 17,660.88 110.00 17,654.35 110.00 17,647.82 110.00 17,641.28 $4,722,000 $4,722,500 110.00 17,682.36 110.00 17,675.83 110.00 17,669.29 110.00 17,662.76 110.00 17,656.23 110.00 17,649.69 110.00 17,643.16 $4,722,500 $4,723,000 110.00 17,684.23 110.00 17,677.70 110.00 17,671.17 110.00 17,664.63 110.00 17,658.10 110.00 17,651.57 110.00 17,645.03 $4,723,000 $4,723,500 110.00 17,686.11 110.00 17,679.58 110.00 17,673.04 110.00 17,666.51 110.00 17,659.98 110.00 17,653.44 110.00 17,646.91 $4,723,500 $4,724,000 110.00 17,687.98 110.00 17,681.45 110.00 17,674.92 110.00 17,668.38 110.00 17,661.85 110.00 17,655.32 110.00 17,648.78 $4,724,000 $4,724,500 110.00 17,689.86 110.00 17,683.33 110.00 17,676.79 110.00 17,670.26 110.00 17,663.73 110.00 17,657.19 110.00 17,650.66 $4,724,500 $4,725,000 110.00 17,691.73 110.00 17,685.20 110.00 17,678.67 110.00 17,672.13 110.00 17,665.60 110.00 17,659.07 110.00 17,652.53 $4,725,000 $4,725,500 110.00 17,693.61 110.00 17,687.08 110.00 17,680.54 110.00 17,674.01 110.00 17,667.48 110.00 17,660.94 110.00 17,654.41 $4,725,500 $4,726,000 110.00 17,695.48 110.00 17,688.95 110.00 17,682.42 110.00 17,675.88 110.00 17,669.35 110.00 17,662.82 110.00 17,656.28 $4,726,000 $4,726,500 110.00 17,697.36 110.00 17,690.83 110.00 17,684.29 110.00 17,677.76 110.00 17,671.23 110.00 17,664.69 110.00 17,658.16 $4,726,500 $4,727,000 110.00 17,699.23 110.00 17,692.70 110.00 17,686.17 110.00 17,679.63 110.00 17,673.10 110.00 17,666.57 110.00 17,660.03 $4,727,000 $4,727,500 110.00 17,701.11 110.00 17,694.58 110.00 17,688.04 110.00 17,681.51 110.00 17,674.98 110.00 17,668.44 110.00 17,661.91 $4,727,500 $4,728,000 110.00 17,702.98 110.00 17,696.45 110.00 17,689.92 110.00 17,683.38 110.00 17,676.85 110.00 17,670.32 110.00 17,663.78 $4,728,000 $4,728,500 110.00 17,704.86 110.00 17,698.33 110.00 17,691.79 110.00 17,685.26 110.00 17,678.73 110.00 17,672.19 110.00 17,665.66 $4,728,500 $4,729,000 110.00 17,706.73 110.00 17,700.20 110.00 17,693.67 110.00 17,687.13 110.00 17,680.60 110.00 17,674.07 110.00 17,667.53 $4,729,000 $4,729,500 110.00 17,708.61 110.00 17,702.08 110.00 17,695.54 110.00 17,689.01 110.00 17,682.48 110.00 17,675.94 110.00 17,669.41 $4,729,500 $4,730,000 110.00 17,710.48 110.00 17,703.95 110.00 17,697.42 110.00 17,690.88 110.00 17,684.35 110.00 17,677.82 110.00 17,671.28 $4,730,000 $4,730,500 110.00 17,712.36 110.00 17,705.83 110.00 17,699.29 110.00 17,692.76 110.00 17,686.23 110.00 17,679.69 110.00 17,673.16 $4,730,500 $4,731,000 110.00 17,714.23 110.00 17,707.70 110.00 17,701.17 110.00 17,694.63 110.00 17,688.10 110.00 17,681.57 110.00 17,675.03 $4,731,000 $4,731,500 110.00 17,716.11 110.00 17,709.58 110.00 17,703.04 110.00 17,696.51 110.00 17,689.98 110.00 17,683.44 110.00 17,676.91 $4,731,500 $4,732,000 110.00 17,717.98 110.00 17,711.45 110.00 17,704.92 110.00 17,698.38 110.00 17,691.85 110.00 17,685.32 110.00 17,678.78 $4,732,000 $4,732,500 110.00 17,719.86 110.00 17,713.33 110.00 17,706.79 110.00 17,700.26 110.00 17,693.73 110.00 17,687.19 110.00 17,680.66 $4,732,500 $4,733,000 110.00 17,721.73 110.00 17,715.20 110.00 17,708.67 110.00 17,702.13 110.00 17,695.60 110.00 17,689.07 110.00 17,682.53 $4,733,000 $4,733,500 110.00 17,723.61 110.00 17,717.08 110.00 17,710.54 110.00 17,704.01 110.00 17,697.48 110.00 17,690.94 110.00 17,684.41 $4,733,500 $4,734,000 110.00 17,725.48 110.00 17,718.95 110.00 17,712.42 110.00 17,705.88 110.00 17,699.35 110.00 17,692.82 110.00 17,686.28 $4,734,000 $4,734,500 110.00 17,727.36 110.00 17,720.83 110.00 17,714.29 110.00 17,707.76 110.00 17,701.23 110.00 17,694.69 110.00 17,688.16 $4,734,500 $4,735,000 110.00 17,729.23 110.00 17,722.70 110.00 17,716.17 110.00 17,709.63 110.00 17,703.10 110.00 17,696.57 110.00 17,690.03 $4,735,000 $4,735,500 110.00 17,731.11 110.00 17,724.58 110.00 17,718.04 110.00 17,711.51 110.00 17,704.98 110.00 17,698.44 110.00 17,691.91 $4,735,500 $4,736,000 110.00 17,732.98 110.00 17,726.45 110.00 17,719.92 110.00 17,713.38 110.00 17,706.85 110.00 17,700.32 110.00 17,693.78 $4,736,000 $4,736,500 110.00 17,734.86 110.00 17,728.33 110.00 17,721.79 110.00 17,715.26 110.00 17,708.73 110.00 17,702.19 110.00 17,695.66 $4,736,500 $4,737,000 110.00 17,736.73 110.00 17,730.20 110.00 17,723.67 110.00 17,717.13 110.00 17,710.60 110.00 17,704.07 110.00 17,697.53 $4,737,000 $4,737,500 110.00 17,738.61 110.00 17,732.08 110.00 17,725.54 110.00 17,719.01 110.00 17,712.48 110.00 17,705.94 110.00 17,699.41 $4,737,500 $4,738,000 110.00 17,740.48 110.00 17,733.95 110.00 17,727.42 110.00 17,720.88 110.00 17,714.35 110.00 17,707.82 110.00 17,701.28 $4,738,000 $4,738,500 110.00 17,742.36 110.00 17,735.83 110.00 17,729.29 110.00 17,722.76 110.00 17,716.23 110.00 17,709.69 110.00 17,703.16 $4,738,500 $4,739,000 110.00 17,744.23 110.00 17,737.70 110.00 17,731.17 110.00 17,724.63 110.00 17,718.10 110.00 17,711.57 110.00 17,705.03 $4,739,000 $4,739,500 110.00 17,746.11 110.00 17,739.58 110.00 17,733.04 110.00 17,726.51 110.00 17,719.98 110.00 17,713.44 110.00 17,706.91 $4,739,500 $4,740,000 110.00 17,747.98 110.00 17,741.45 110.00 17,734.92 110.00 17,728.38 110.00 17,721.85 110.00 17,715.32 110.00 17,708.78 $4,740,000 $4,740,500 110.00 17,749.86 110.00 17,743.33 110.00 17,736.79 110.00 17,730.26 110.00 17,723.73 110.00 17,717.19 110.00 17,710.66 $4,740,500 $4,741,000 110.00 17,751.73 110.00 17,745.20 110.00 17,738.67 110.00 17,732.13 110.00 17,725.60 110.00 17,719.07 110.00 17,712.53 $4,741,000 $4,741,500 110.00 17,753.61 110.00 17,747.08 110.00 17,740.54 110.00 17,734.01 110.00 17,727.48 110.00 17,720.94 110.00 17,714.41 $4,741,500 $4,742,000 110.00 17,755.48 110.00 17,748.95 110.00 17,742.42 110.00 17,735.88 110.00 17,729.35 110.00 17,722.82 110.00 17,716.28 $4,742,000 $4,742,500 110.00 17,757.36 110.00 17,750.83 110.00 17,744.29 110.00 17,737.76 110.00 17,731.23 110.00 17,724.69 110.00 17,718.16 $4,742,500 $4,743,000 110.00 17,759.23 110.00 17,752.70 110.00 17,746.17 110.00 17,739.63 110.00 17,733.10 110.00 17,726.57 110.00 17,720.03

NJEIS Family Cost Participation Table Page 96 of 12 Effective July 1, 2015

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

$4,743,000 $4,743,500 110.00 17,761.11 110.00 17,754.58 110.00 17,748.04 110.00 17,741.51 110.00 17,734.98 110.00 17,728.44 110.00 17,721.91 $4,743,500 $4,744,000 110.00 17,762.98 110.00 17,756.45 110.00 17,749.92 110.00 17,743.38 110.00 17,736.85 110.00 17,730.32 110.00 17,723.78 $4,744,000 $4,744,500 110.00 17,764.86 110.00 17,758.33 110.00 17,751.79 110.00 17,745.26 110.00 17,738.73 110.00 17,732.19 110.00 17,725.66 $4,744,500 $4,745,000 110.00 17,766.73 110.00 17,760.20 110.00 17,753.67 110.00 17,747.13 110.00 17,740.60 110.00 17,734.07 110.00 17,727.53 $4,745,000 $4,745,500 110.00 17,768.61 110.00 17,762.08 110.00 17,755.54 110.00 17,749.01 110.00 17,742.48 110.00 17,735.94 110.00 17,729.41 $4,745,500 $4,746,000 110.00 17,770.48 110.00 17,763.95 110.00 17,757.42 110.00 17,750.88 110.00 17,744.35 110.00 17,737.82 110.00 17,731.28 $4,746,000 $4,746,500 110.00 17,772.36 110.00 17,765.83 110.00 17,759.29 110.00 17,752.76 110.00 17,746.23 110.00 17,739.69 110.00 17,733.16 $4,746,500 $4,747,000 110.00 17,774.23 110.00 17,767.70 110.00 17,761.17 110.00 17,754.63 110.00 17,748.10 110.00 17,741.57 110.00 17,735.03 $4,747,000 $4,747,500 110.00 17,776.11 110.00 17,769.58 110.00 17,763.04 110.00 17,756.51 110.00 17,749.98 110.00 17,743.44 110.00 17,736.91 $4,747,500 $4,748,000 110.00 17,777.98 110.00 17,771.45 110.00 17,764.92 110.00 17,758.38 110.00 17,751.85 110.00 17,745.32 110.00 17,738.78 $4,748,000 $4,748,500 110.00 17,779.86 110.00 17,773.33 110.00 17,766.79 110.00 17,760.26 110.00 17,753.73 110.00 17,747.19 110.00 17,740.66 $4,748,500 $4,749,000 110.00 17,781.73 110.00 17,775.20 110.00 17,768.67 110.00 17,762.13 110.00 17,755.60 110.00 17,749.07 110.00 17,742.53 $4,749,000 $4,749,500 110.00 17,783.61 110.00 17,777.08 110.00 17,770.54 110.00 17,764.01 110.00 17,757.48 110.00 17,750.94 110.00 17,744.41 $4,749,500 $4,750,000 110.00 17,785.48 110.00 17,778.95 110.00 17,772.42 110.00 17,765.88 110.00 17,759.35 110.00 17,752.82 110.00 17,746.28 $4,750,000 $4,750,500 110.00 17,787.36 110.00 17,780.83 110.00 17,774.29 110.00 17,767.76 110.00 17,761.23 110.00 17,754.69 110.00 17,748.16 $4,750,500 $4,751,000 110.00 17,789.23 110.00 17,782.70 110.00 17,776.17 110.00 17,769.63 110.00 17,763.10 110.00 17,756.57 110.00 17,750.03 $4,751,000 $4,751,500 110.00 17,791.11 110.00 17,784.58 110.00 17,778.04 110.00 17,771.51 110.00 17,764.98 110.00 17,758.44 110.00 17,751.91 $4,751,500 $4,752,000 110.00 17,792.98 110.00 17,786.45 110.00 17,779.92 110.00 17,773.38 110.00 17,766.85 110.00 17,760.32 110.00 17,753.78 $4,752,000 $4,752,500 110.00 17,794.86 110.00 17,788.33 110.00 17,781.79 110.00 17,775.26 110.00 17,768.73 110.00 17,762.19 110.00 17,755.66 $4,752,500 $4,753,000 110.00 17,796.73 110.00 17,790.20 110.00 17,783.67 110.00 17,777.13 110.00 17,770.60 110.00 17,764.07 110.00 17,757.53 $4,753,000 $4,753,500 110.00 17,798.61 110.00 17,792.08 110.00 17,785.54 110.00 17,779.01 110.00 17,772.48 110.00 17,765.94 110.00 17,759.41 $4,753,500 $4,754,000 110.00 17,800.48 110.00 17,793.95 110.00 17,787.42 110.00 17,780.88 110.00 17,774.35 110.00 17,767.82 110.00 17,761.28 $4,754,000 $4,754,500 110.00 17,802.36 110.00 17,795.83 110.00 17,789.29 110.00 17,782.76 110.00 17,776.23 110.00 17,769.69 110.00 17,763.16 $4,754,500 $4,755,000 110.00 17,804.23 110.00 17,797.70 110.00 17,791.17 110.00 17,784.63 110.00 17,778.10 110.00 17,771.57 110.00 17,765.03 $4,755,000 $4,755,500 110.00 17,806.11 110.00 17,799.58 110.00 17,793.04 110.00 17,786.51 110.00 17,779.98 110.00 17,773.44 110.00 17,766.91 $4,755,500 $4,756,000 110.00 17,807.98 110.00 17,801.45 110.00 17,794.92 110.00 17,788.38 110.00 17,781.85 110.00 17,775.32 110.00 17,768.78 $4,756,000 $4,756,500 110.00 17,809.86 110.00 17,803.33 110.00 17,796.79 110.00 17,790.26 110.00 17,783.73 110.00 17,777.19 110.00 17,770.66 $4,756,500 $4,757,000 110.00 17,811.73 110.00 17,805.20 110.00 17,798.67 110.00 17,792.13 110.00 17,785.60 110.00 17,779.07 110.00 17,772.53 $4,757,000 $4,757,500 110.00 17,813.61 110.00 17,807.08 110.00 17,800.54 110.00 17,794.01 110.00 17,787.48 110.00 17,780.94 110.00 17,774.41 $4,757,500 $4,758,000 110.00 17,815.48 110.00 17,808.95 110.00 17,802.42 110.00 17,795.88 110.00 17,789.35 110.00 17,782.82 110.00 17,776.28 $4,758,000 $4,758,500 110.00 17,817.36 110.00 17,810.83 110.00 17,804.29 110.00 17,797.76 110.00 17,791.23 110.00 17,784.69 110.00 17,778.16 $4,758,500 $4,759,000 110.00 17,819.23 110.00 17,812.70 110.00 17,806.17 110.00 17,799.63 110.00 17,793.10 110.00 17,786.57 110.00 17,780.03 $4,759,000 $4,759,500 110.00 17,821.11 110.00 17,814.58 110.00 17,808.04 110.00 17,801.51 110.00 17,794.98 110.00 17,788.44 110.00 17,781.91 $4,759,500 $4,760,000 110.00 17,822.98 110.00 17,816.45 110.00 17,809.92 110.00 17,803.38 110.00 17,796.85 110.00 17,790.32 110.00 17,783.78 $4,760,000 $4,760,500 110.00 17,824.86 110.00 17,818.33 110.00 17,811.79 110.00 17,805.26 110.00 17,798.73 110.00 17,792.19 110.00 17,785.66 $4,760,500 $4,761,000 110.00 17,826.73 110.00 17,820.20 110.00 17,813.67 110.00 17,807.13 110.00 17,800.60 110.00 17,794.07 110.00 17,787.53 $4,761,000 $4,761,500 110.00 17,828.61 110.00 17,822.08 110.00 17,815.54 110.00 17,809.01 110.00 17,802.48 110.00 17,795.94 110.00 17,789.41 $4,761,500 $4,762,000 110.00 17,830.48 110.00 17,823.95 110.00 17,817.42 110.00 17,810.88 110.00 17,804.35 110.00 17,797.82 110.00 17,791.28 $4,762,000 $4,762,500 110.00 17,832.36 110.00 17,825.83 110.00 17,819.29 110.00 17,812.76 110.00 17,806.23 110.00 17,799.69 110.00 17,793.16 $4,762,500 $4,763,000 110.00 17,834.23 110.00 17,827.70 110.00 17,821.17 110.00 17,814.63 110.00 17,808.10 110.00 17,801.57 110.00 17,795.03 $4,763,000 $4,763,500 110.00 17,836.11 110.00 17,829.58 110.00 17,823.04 110.00 17,816.51 110.00 17,809.98 110.00 17,803.44 110.00 17,796.91 $4,763,500 $4,764,000 110.00 17,837.98 110.00 17,831.45 110.00 17,824.92 110.00 17,818.38 110.00 17,811.85 110.00 17,805.32 110.00 17,798.78 $4,764,000 $4,764,500 110.00 17,839.86 110.00 17,833.33 110.00 17,826.79 110.00 17,820.26 110.00 17,813.73 110.00 17,807.19 110.00 17,800.66 $4,764,500 $4,765,000 110.00 17,841.73 110.00 17,835.20 110.00 17,828.67 110.00 17,822.13 110.00 17,815.60 110.00 17,809.07 110.00 17,802.53 $4,765,000 $4,765,500 110.00 17,843.61 110.00 17,837.08 110.00 17,830.54 110.00 17,824.01 110.00 17,817.48 110.00 17,810.94 110.00 17,804.41 $4,765,500 $4,766,000 110.00 17,845.48 110.00 17,838.95 110.00 17,832.42 110.00 17,825.88 110.00 17,819.35 110.00 17,812.82 110.00 17,806.28 $4,766,000 $4,766,500 110.00 17,847.36 110.00 17,840.83 110.00 17,834.29 110.00 17,827.76 110.00 17,821.23 110.00 17,814.69 110.00 17,808.16 $4,766,500 $4,767,000 110.00 17,849.23 110.00 17,842.70 110.00 17,836.17 110.00 17,829.63 110.00 17,823.10 110.00 17,816.57 110.00 17,810.03 $4,767,000 $4,767,500 110.00 17,851.11 110.00 17,844.58 110.00 17,838.04 110.00 17,831.51 110.00 17,824.98 110.00 17,818.44 110.00 17,811.91 $4,767,500 $4,768,000 110.00 17,852.98 110.00 17,846.45 110.00 17,839.92 110.00 17,833.38 110.00 17,826.85 110.00 17,820.32 110.00 17,813.78 $4,768,000 $4,768,500 110.00 17,854.86 110.00 17,848.33 110.00 17,841.79 110.00 17,835.26 110.00 17,828.73 110.00 17,822.19 110.00 17,815.66 $4,768,500 $4,769,000 110.00 17,856.73 110.00 17,850.20 110.00 17,843.67 110.00 17,837.13 110.00 17,830.60 110.00 17,824.07 110.00 17,817.53 $4,769,000 $4,769,500 110.00 17,858.61 110.00 17,852.08 110.00 17,845.54 110.00 17,839.01 110.00 17,832.48 110.00 17,825.94 110.00 17,819.41 $4,769,500 $4,770,000 110.00 17,860.48 110.00 17,853.95 110.00 17,847.42 110.00 17,840.88 110.00 17,834.35 110.00 17,827.82 110.00 17,821.28 $4,770,000 $4,770,500 110.00 17,862.36 110.00 17,855.83 110.00 17,849.29 110.00 17,842.76 110.00 17,836.23 110.00 17,829.69 110.00 17,823.16 $4,770,500 $4,771,000 110.00 17,864.23 110.00 17,857.70 110.00 17,851.17 110.00 17,844.63 110.00 17,838.10 110.00 17,831.57 110.00 17,825.03 $4,771,000 $4,771,500 110.00 17,866.11 110.00 17,859.58 110.00 17,853.04 110.00 17,846.51 110.00 17,839.98 110.00 17,833.44 110.00 17,826.91 $4,771,500 $4,772,000 110.00 17,867.98 110.00 17,861.45 110.00 17,854.92 110.00 17,848.38 110.00 17,841.85 110.00 17,835.32 110.00 17,828.78 $4,772,000 $4,772,500 110.00 17,869.86 110.00 17,863.33 110.00 17,856.79 110.00 17,850.26 110.00 17,843.73 110.00 17,837.19 110.00 17,830.66 $4,772,500 $4,773,000 110.00 17,871.73 110.00 17,865.20 110.00 17,858.67 110.00 17,852.13 110.00 17,845.60 110.00 17,839.07 110.00 17,832.53 $4,773,000 $4,773,500 110.00 17,873.61 110.00 17,867.08 110.00 17,860.54 110.00 17,854.01 110.00 17,847.48 110.00 17,840.94 110.00 17,834.41 $4,773,500 $4,774,000 110.00 17,875.48 110.00 17,868.95 110.00 17,862.42 110.00 17,855.88 110.00 17,849.35 110.00 17,842.82 110.00 17,836.28 $4,774,000 $4,774,500 110.00 17,877.36 110.00 17,870.83 110.00 17,864.29 110.00 17,857.76 110.00 17,851.23 110.00 17,844.69 110.00 17,838.16 $4,774,500 $4,775,000 110.00 17,879.23 110.00 17,872.70 110.00 17,866.17 110.00 17,859.63 110.00 17,853.10 110.00 17,846.57 110.00 17,840.03 $4,775,000 $4,775,500 110.00 17,881.11 110.00 17,874.58 110.00 17,868.04 110.00 17,861.51 110.00 17,854.98 110.00 17,848.44 110.00 17,841.91 $4,775,500 $4,776,000 110.00 17,882.98 110.00 17,876.45 110.00 17,869.92 110.00 17,863.38 110.00 17,856.85 110.00 17,850.32 110.00 17,843.78 $4,776,000 $4,776,500 110.00 17,884.86 110.00 17,878.33 110.00 17,871.79 110.00 17,865.26 110.00 17,858.73 110.00 17,852.19 110.00 17,845.66 $4,776,500 $4,777,000 110.00 17,886.73 110.00 17,880.20 110.00 17,873.67 110.00 17,867.13 110.00 17,860.60 110.00 17,854.07 110.00 17,847.53 $4,777,000 $4,777,500 110.00 17,888.61 110.00 17,882.08 110.00 17,875.54 110.00 17,869.01 110.00 17,862.48 110.00 17,855.94 110.00 17,849.41 $4,777,500 $4,778,000 110.00 17,890.48 110.00 17,883.95 110.00 17,877.42 110.00 17,870.88 110.00 17,864.35 110.00 17,857.82 110.00 17,851.28 $4,778,000 $4,778,500 110.00 17,892.36 110.00 17,885.83 110.00 17,879.29 110.00 17,872.76 110.00 17,866.23 110.00 17,859.69 110.00 17,853.16 $4,778,500 $4,779,000 110.00 17,894.23 110.00 17,887.70 110.00 17,881.17 110.00 17,874.63 110.00 17,868.10 110.00 17,861.57 110.00 17,855.03 $4,779,000 $4,779,500 110.00 17,896.11 110.00 17,889.58 110.00 17,883.04 110.00 17,876.51 110.00 17,869.98 110.00 17,863.44 110.00 17,856.91 $4,779,500 $4,780,000 110.00 17,897.98 110.00 17,891.45 110.00 17,884.92 110.00 17,878.38 110.00 17,871.85 110.00 17,865.32 110.00 17,858.78 $4,780,000 $4,780,500 110.00 17,899.86 110.00 17,893.33 110.00 17,886.79 110.00 17,880.26 110.00 17,873.73 110.00 17,867.19 110.00 17,860.66 $4,780,500 $4,781,000 110.00 17,901.73 110.00 17,895.20 110.00 17,888.67 110.00 17,882.13 110.00 17,875.60 110.00 17,869.07 110.00 17,862.53 $4,781,000 $4,781,500 110.00 17,903.61 110.00 17,897.08 110.00 17,890.54 110.00 17,884.01 110.00 17,877.48 110.00 17,870.94 110.00 17,864.41 $4,781,500 $4,782,000 110.00 17,905.48 110.00 17,898.95 110.00 17,892.42 110.00 17,885.88 110.00 17,879.35 110.00 17,872.82 110.00 17,866.28 $4,782,000 $4,782,500 110.00 17,907.36 110.00 17,900.83 110.00 17,894.29 110.00 17,887.76 110.00 17,881.23 110.00 17,874.69 110.00 17,868.16 $4,782,500 $4,783,000 110.00 17,909.23 110.00 17,902.70 110.00 17,896.17 110.00 17,889.63 110.00 17,883.10 110.00 17,876.57 110.00 17,870.03 $4,783,000 $4,783,500 110.00 17,911.11 110.00 17,904.58 110.00 17,898.04 110.00 17,891.51 110.00 17,884.98 110.00 17,878.44 110.00 17,871.91 $4,783,500 $4,784,000 110.00 17,912.98 110.00 17,906.45 110.00 17,899.92 110.00 17,893.38 110.00 17,886.85 110.00 17,880.32 110.00 17,873.78 $4,784,000 $4,784,500 110.00 17,914.86 110.00 17,908.33 110.00 17,901.79 110.00 17,895.26 110.00 17,888.73 110.00 17,882.19 110.00 17,875.66 $4,784,500 $4,785,000 110.00 17,916.73 110.00 17,910.20 110.00 17,903.67 110.00 17,897.13 110.00 17,890.60 110.00 17,884.07 110.00 17,877.53 $4,785,000 $4,785,500 110.00 17,918.61 110.00 17,912.08 110.00 17,905.54 110.00 17,899.01 110.00 17,892.48 110.00 17,885.94 110.00 17,879.41 $4,785,500 $4,786,000 110.00 17,920.48 110.00 17,913.95 110.00 17,907.42 110.00 17,900.88 110.00 17,894.35 110.00 17,887.82 110.00 17,881.28 $4,786,000 $4,786,500 110.00 17,922.36 110.00 17,915.83 110.00 17,909.29 110.00 17,902.76 110.00 17,896.23 110.00 17,889.69 110.00 17,883.16 $4,786,500 $4,787,000 110.00 17,924.23 110.00 17,917.70 110.00 17,911.17 110.00 17,904.63 110.00 17,898.10 110.00 17,891.57 110.00 17,885.03 $4,787,000 $4,787,500 110.00 17,926.11 110.00 17,919.58 110.00 17,913.04 110.00 17,906.51 110.00 17,899.98 110.00 17,893.44 110.00 17,886.91 $4,787,500 $4,788,000 110.00 17,927.98 110.00 17,921.45 110.00 17,914.92 110.00 17,908.38 110.00 17,901.85 110.00 17,895.32 110.00 17,888.78 $4,788,000 $4,788,500 110.00 17,929.86 110.00 17,923.33 110.00 17,916.79 110.00 17,910.26 110.00 17,903.73 110.00 17,897.19 110.00 17,890.66 $4,788,500 $4,789,000 110.00 17,931.73 110.00 17,925.20 110.00 17,918.67 110.00 17,912.13 110.00 17,905.60 110.00 17,899.07 110.00 17,892.53 $4,789,000 $4,789,500 110.00 17,933.61 110.00 17,927.08 110.00 17,920.54 110.00 17,914.01 110.00 17,907.48 110.00 17,900.94 110.00 17,894.41 $4,789,500 $4,790,000 110.00 17,935.48 110.00 17,928.95 110.00 17,922.42 110.00 17,915.88 110.00 17,909.35 110.00 17,902.82 110.00 17,896.28 $4,790,000 $4,790,500 110.00 17,937.36 110.00 17,930.83 110.00 17,924.29 110.00 17,917.76 110.00 17,911.23 110.00 17,904.69 110.00 17,898.16 $4,790,500 $4,791,000 110.00 17,939.23 110.00 17,932.70 110.00 17,926.17 110.00 17,919.63 110.00 17,913.10 110.00 17,906.57 110.00 17,900.03 $4,791,000 $4,791,500 110.00 17,941.11 110.00 17,934.58 110.00 17,928.04 110.00 17,921.51 110.00 17,914.98 110.00 17,908.44 110.00 17,901.91 $4,791,500 $4,792,000 110.00 17,942.98 110.00 17,936.45 110.00 17,929.92 110.00 17,923.38 110.00 17,916.85 110.00 17,910.32 110.00 17,903.78 $4,792,000 $4,792,500 110.00 17,944.86 110.00 17,938.33 110.00 17,931.79 110.00 17,925.26 110.00 17,918.73 110.00 17,912.19 110.00 17,905.66 $4,792,500 $4,793,000 110.00 17,946.73 110.00 17,940.20 110.00 17,933.67 110.00 17,927.13 110.00 17,920.60 110.00 17,914.07 110.00 17,907.53 $4,793,000 $4,793,500 110.00 17,948.61 110.00 17,942.08 110.00 17,935.54 110.00 17,929.01 110.00 17,922.48 110.00 17,915.94 110.00 17,909.41 $4,793,500 $4,794,000 110.00 17,950.48 110.00 17,943.95 110.00 17,937.42 110.00 17,930.88 110.00 17,924.35 110.00 17,917.82 110.00 17,911.28

NJEIS Family Cost Participation Table Page 97 of 12 Effective July 1, 2015

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

$4,794,000 $4,794,500 110.00 17,952.36 110.00 17,945.83 110.00 17,939.29 110.00 17,932.76 110.00 17,926.23 110.00 17,919.69 110.00 17,913.16 $4,794,500 $4,795,000 110.00 17,954.23 110.00 17,947.70 110.00 17,941.17 110.00 17,934.63 110.00 17,928.10 110.00 17,921.57 110.00 17,915.03 $4,795,000 $4,795,500 110.00 17,956.11 110.00 17,949.58 110.00 17,943.04 110.00 17,936.51 110.00 17,929.98 110.00 17,923.44 110.00 17,916.91 $4,795,500 $4,796,000 110.00 17,957.98 110.00 17,951.45 110.00 17,944.92 110.00 17,938.38 110.00 17,931.85 110.00 17,925.32 110.00 17,918.78 $4,796,000 $4,796,500 110.00 17,959.86 110.00 17,953.33 110.00 17,946.79 110.00 17,940.26 110.00 17,933.73 110.00 17,927.19 110.00 17,920.66 $4,796,500 $4,797,000 110.00 17,961.73 110.00 17,955.20 110.00 17,948.67 110.00 17,942.13 110.00 17,935.60 110.00 17,929.07 110.00 17,922.53 $4,797,000 $4,797,500 110.00 17,963.61 110.00 17,957.08 110.00 17,950.54 110.00 17,944.01 110.00 17,937.48 110.00 17,930.94 110.00 17,924.41 $4,797,500 $4,798,000 110.00 17,965.48 110.00 17,958.95 110.00 17,952.42 110.00 17,945.88 110.00 17,939.35 110.00 17,932.82 110.00 17,926.28 $4,798,000 $4,798,500 110.00 17,967.36 110.00 17,960.83 110.00 17,954.29 110.00 17,947.76 110.00 17,941.23 110.00 17,934.69 110.00 17,928.16 $4,798,500 $4,799,000 110.00 17,969.23 110.00 17,962.70 110.00 17,956.17 110.00 17,949.63 110.00 17,943.10 110.00 17,936.57 110.00 17,930.03 $4,799,000 $4,799,500 110.00 17,971.11 110.00 17,964.58 110.00 17,958.04 110.00 17,951.51 110.00 17,944.98 110.00 17,938.44 110.00 17,931.91 $4,799,500 $4,800,000 110.00 17,972.98 110.00 17,966.45 110.00 17,959.92 110.00 17,953.38 110.00 17,946.85 110.00 17,940.32 110.00 17,933.78 $4,800,000 $4,800,500 110.00 17,974.86 110.00 17,968.33 110.00 17,961.79 110.00 17,955.26 110.00 17,948.73 110.00 17,942.19 110.00 17,935.66 $4,800,500 $4,801,000 110.00 17,976.73 110.00 17,970.20 110.00 17,963.67 110.00 17,957.13 110.00 17,950.60 110.00 17,944.07 110.00 17,937.53 $4,801,000 $4,801,500 110.00 17,978.61 110.00 17,972.08 110.00 17,965.54 110.00 17,959.01 110.00 17,952.48 110.00 17,945.94 110.00 17,939.41 $4,801,500 $4,802,000 110.00 17,980.48 110.00 17,973.95 110.00 17,967.42 110.00 17,960.88 110.00 17,954.35 110.00 17,947.82 110.00 17,941.28 $4,802,000 $4,802,500 110.00 17,982.36 110.00 17,975.83 110.00 17,969.29 110.00 17,962.76 110.00 17,956.23 110.00 17,949.69 110.00 17,943.16 $4,802,500 $4,803,000 110.00 17,984.23 110.00 17,977.70 110.00 17,971.17 110.00 17,964.63 110.00 17,958.10 110.00 17,951.57 110.00 17,945.03 $4,803,000 $4,803,500 110.00 17,986.11 110.00 17,979.58 110.00 17,973.04 110.00 17,966.51 110.00 17,959.98 110.00 17,953.44 110.00 17,946.91 $4,803,500 $4,804,000 110.00 17,987.98 110.00 17,981.45 110.00 17,974.92 110.00 17,968.38 110.00 17,961.85 110.00 17,955.32 110.00 17,948.78 $4,804,000 $4,804,500 110.00 17,989.86 110.00 17,983.33 110.00 17,976.79 110.00 17,970.26 110.00 17,963.73 110.00 17,957.19 110.00 17,950.66 $4,804,500 $4,805,000 110.00 17,991.73 110.00 17,985.20 110.00 17,978.67 110.00 17,972.13 110.00 17,965.60 110.00 17,959.07 110.00 17,952.53 $4,805,000 $4,805,500 110.00 17,993.61 110.00 17,987.08 110.00 17,980.54 110.00 17,974.01 110.00 17,967.48 110.00 17,960.94 110.00 17,954.41 $4,805,500 $4,806,000 110.00 17,995.48 110.00 17,988.95 110.00 17,982.42 110.00 17,975.88 110.00 17,969.35 110.00 17,962.82 110.00 17,956.28 $4,806,000 $4,806,500 110.00 17,997.36 110.00 17,990.83 110.00 17,984.29 110.00 17,977.76 110.00 17,971.23 110.00 17,964.69 110.00 17,958.16 $4,806,500 $4,807,000 110.00 17,999.23 110.00 17,992.70 110.00 17,986.17 110.00 17,979.63 110.00 17,973.10 110.00 17,966.57 110.00 17,960.03 $4,807,000 $4,807,500 110.00 18,001.11 110.00 17,994.58 110.00 17,988.04 110.00 17,981.51 110.00 17,974.98 110.00 17,968.44 110.00 17,961.91 $4,807,500 $4,808,000 110.00 18,002.98 110.00 17,996.45 110.00 17,989.92 110.00 17,983.38 110.00 17,976.85 110.00 17,970.32 110.00 17,963.78 $4,808,000 $4,808,500 110.00 18,004.86 110.00 17,998.33 110.00 17,991.79 110.00 17,985.26 110.00 17,978.73 110.00 17,972.19 110.00 17,965.66 $4,808,500 $4,809,000 110.00 18,006.73 110.00 18,000.20 110.00 17,993.67 110.00 17,987.13 110.00 17,980.60 110.00 17,974.07 110.00 17,967.53 $4,809,000 $4,809,500 110.00 18,008.61 110.00 18,002.08 110.00 17,995.54 110.00 17,989.01 110.00 17,982.48 110.00 17,975.94 110.00 17,969.41 $4,809,500 $4,810,000 110.00 18,010.48 110.00 18,003.95 110.00 17,997.42 110.00 17,990.88 110.00 17,984.35 110.00 17,977.82 110.00 17,971.28 $4,810,000 $4,810,500 110.00 18,012.36 110.00 18,005.83 110.00 17,999.29 110.00 17,992.76 110.00 17,986.23 110.00 17,979.69 110.00 17,973.16 $4,810,500 $4,811,000 110.00 18,014.23 110.00 18,007.70 110.00 18,001.17 110.00 17,994.63 110.00 17,988.10 110.00 17,981.57 110.00 17,975.03 $4,811,000 $4,811,500 110.00 18,016.11 110.00 18,009.58 110.00 18,003.04 110.00 17,996.51 110.00 17,989.98 110.00 17,983.44 110.00 17,976.91 $4,811,500 $4,812,000 110.00 18,017.98 110.00 18,011.45 110.00 18,004.92 110.00 17,998.38 110.00 17,991.85 110.00 17,985.32 110.00 17,978.78 $4,812,000 $4,812,500 110.00 18,019.86 110.00 18,013.33 110.00 18,006.79 110.00 18,000.26 110.00 17,993.73 110.00 17,987.19 110.00 17,980.66 $4,812,500 $4,813,000 110.00 18,021.73 110.00 18,015.20 110.00 18,008.67 110.00 18,002.13 110.00 17,995.60 110.00 17,989.07 110.00 17,982.53 $4,813,000 $4,813,500 110.00 18,023.61 110.00 18,017.08 110.00 18,010.54 110.00 18,004.01 110.00 17,997.48 110.00 17,990.94 110.00 17,984.41 $4,813,500 $4,814,000 110.00 18,025.48 110.00 18,018.95 110.00 18,012.42 110.00 18,005.88 110.00 17,999.35 110.00 17,992.82 110.00 17,986.28 $4,814,000 $4,814,500 110.00 18,027.36 110.00 18,020.83 110.00 18,014.29 110.00 18,007.76 110.00 18,001.23 110.00 17,994.69 110.00 17,988.16 $4,814,500 $4,815,000 110.00 18,029.23 110.00 18,022.70 110.00 18,016.17 110.00 18,009.63 110.00 18,003.10 110.00 17,996.57 110.00 17,990.03 $4,815,000 $4,815,500 110.00 18,031.11 110.00 18,024.58 110.00 18,018.04 110.00 18,011.51 110.00 18,004.98 110.00 17,998.44 110.00 17,991.91 $4,815,500 $4,816,000 110.00 18,032.98 110.00 18,026.45 110.00 18,019.92 110.00 18,013.38 110.00 18,006.85 110.00 18,000.32 110.00 17,993.78 $4,816,000 $4,816,500 110.00 18,034.86 110.00 18,028.33 110.00 18,021.79 110.00 18,015.26 110.00 18,008.73 110.00 18,002.19 110.00 17,995.66 $4,816,500 $4,817,000 110.00 18,036.73 110.00 18,030.20 110.00 18,023.67 110.00 18,017.13 110.00 18,010.60 110.00 18,004.07 110.00 17,997.53 $4,817,000 $4,817,500 110.00 18,038.61 110.00 18,032.08 110.00 18,025.54 110.00 18,019.01 110.00 18,012.48 110.00 18,005.94 110.00 17,999.41 $4,817,500 $4,818,000 110.00 18,040.48 110.00 18,033.95 110.00 18,027.42 110.00 18,020.88 110.00 18,014.35 110.00 18,007.82 110.00 18,001.28 $4,818,000 $4,818,500 110.00 18,042.36 110.00 18,035.83 110.00 18,029.29 110.00 18,022.76 110.00 18,016.23 110.00 18,009.69 110.00 18,003.16 $4,818,500 $4,819,000 110.00 18,044.23 110.00 18,037.70 110.00 18,031.17 110.00 18,024.63 110.00 18,018.10 110.00 18,011.57 110.00 18,005.03 $4,819,000 $4,819,500 110.00 18,046.11 110.00 18,039.58 110.00 18,033.04 110.00 18,026.51 110.00 18,019.98 110.00 18,013.44 110.00 18,006.91 $4,819,500 $4,820,000 110.00 18,047.98 110.00 18,041.45 110.00 18,034.92 110.00 18,028.38 110.00 18,021.85 110.00 18,015.32 110.00 18,008.78 $4,820,000 $4,820,500 110.00 18,049.86 110.00 18,043.33 110.00 18,036.79 110.00 18,030.26 110.00 18,023.73 110.00 18,017.19 110.00 18,010.66 $4,820,500 $4,821,000 110.00 18,051.73 110.00 18,045.20 110.00 18,038.67 110.00 18,032.13 110.00 18,025.60 110.00 18,019.07 110.00 18,012.53 $4,821,000 $4,821,500 110.00 18,053.61 110.00 18,047.08 110.00 18,040.54 110.00 18,034.01 110.00 18,027.48 110.00 18,020.94 110.00 18,014.41 $4,821,500 $4,822,000 110.00 18,055.48 110.00 18,048.95 110.00 18,042.42 110.00 18,035.88 110.00 18,029.35 110.00 18,022.82 110.00 18,016.28 $4,822,000 $4,822,500 110.00 18,057.36 110.00 18,050.83 110.00 18,044.29 110.00 18,037.76 110.00 18,031.23 110.00 18,024.69 110.00 18,018.16 $4,822,500 $4,823,000 110.00 18,059.23 110.00 18,052.70 110.00 18,046.17 110.00 18,039.63 110.00 18,033.10 110.00 18,026.57 110.00 18,020.03 $4,823,000 $4,823,500 110.00 18,061.11 110.00 18,054.58 110.00 18,048.04 110.00 18,041.51 110.00 18,034.98 110.00 18,028.44 110.00 18,021.91 $4,823,500 $4,824,000 110.00 18,062.98 110.00 18,056.45 110.00 18,049.92 110.00 18,043.38 110.00 18,036.85 110.00 18,030.32 110.00 18,023.78 $4,824,000 $4,824,500 110.00 18,064.86 110.00 18,058.33 110.00 18,051.79 110.00 18,045.26 110.00 18,038.73 110.00 18,032.19 110.00 18,025.66 $4,824,500 $4,825,000 110.00 18,066.73 110.00 18,060.20 110.00 18,053.67 110.00 18,047.13 110.00 18,040.60 110.00 18,034.07 110.00 18,027.53 $4,825,000 $4,825,500 110.00 18,068.61 110.00 18,062.08 110.00 18,055.54 110.00 18,049.01 110.00 18,042.48 110.00 18,035.94 110.00 18,029.41 $4,825,500 $4,826,000 110.00 18,070.48 110.00 18,063.95 110.00 18,057.42 110.00 18,050.88 110.00 18,044.35 110.00 18,037.82 110.00 18,031.28 $4,826,000 $4,826,500 110.00 18,072.36 110.00 18,065.83 110.00 18,059.29 110.00 18,052.76 110.00 18,046.23 110.00 18,039.69 110.00 18,033.16 $4,826,500 $4,827,000 110.00 18,074.23 110.00 18,067.70 110.00 18,061.17 110.00 18,054.63 110.00 18,048.10 110.00 18,041.57 110.00 18,035.03 $4,827,000 $4,827,500 110.00 18,076.11 110.00 18,069.58 110.00 18,063.04 110.00 18,056.51 110.00 18,049.98 110.00 18,043.44 110.00 18,036.91 $4,827,500 $4,828,000 110.00 18,077.98 110.00 18,071.45 110.00 18,064.92 110.00 18,058.38 110.00 18,051.85 110.00 18,045.32 110.00 18,038.78 $4,828,000 $4,828,500 110.00 18,079.86 110.00 18,073.33 110.00 18,066.79 110.00 18,060.26 110.00 18,053.73 110.00 18,047.19 110.00 18,040.66 $4,828,500 $4,829,000 110.00 18,081.73 110.00 18,075.20 110.00 18,068.67 110.00 18,062.13 110.00 18,055.60 110.00 18,049.07 110.00 18,042.53 $4,829,000 $4,829,500 110.00 18,083.61 110.00 18,077.08 110.00 18,070.54 110.00 18,064.01 110.00 18,057.48 110.00 18,050.94 110.00 18,044.41 $4,829,500 $4,830,000 110.00 18,085.48 110.00 18,078.95 110.00 18,072.42 110.00 18,065.88 110.00 18,059.35 110.00 18,052.82 110.00 18,046.28 $4,830,000 $4,830,500 110.00 18,087.36 110.00 18,080.83 110.00 18,074.29 110.00 18,067.76 110.00 18,061.23 110.00 18,054.69 110.00 18,048.16 $4,830,500 $4,831,000 110.00 18,089.23 110.00 18,082.70 110.00 18,076.17 110.00 18,069.63 110.00 18,063.10 110.00 18,056.57 110.00 18,050.03 $4,831,000 $4,831,500 110.00 18,091.11 110.00 18,084.58 110.00 18,078.04 110.00 18,071.51 110.00 18,064.98 110.00 18,058.44 110.00 18,051.91 $4,831,500 $4,832,000 110.00 18,092.98 110.00 18,086.45 110.00 18,079.92 110.00 18,073.38 110.00 18,066.85 110.00 18,060.32 110.00 18,053.78 $4,832,000 $4,832,500 110.00 18,094.86 110.00 18,088.33 110.00 18,081.79 110.00 18,075.26 110.00 18,068.73 110.00 18,062.19 110.00 18,055.66 $4,832,500 $4,833,000 110.00 18,096.73 110.00 18,090.20 110.00 18,083.67 110.00 18,077.13 110.00 18,070.60 110.00 18,064.07 110.00 18,057.53 $4,833,000 $4,833,500 110.00 18,098.61 110.00 18,092.08 110.00 18,085.54 110.00 18,079.01 110.00 18,072.48 110.00 18,065.94 110.00 18,059.41 $4,833,500 $4,834,000 110.00 18,100.48 110.00 18,093.95 110.00 18,087.42 110.00 18,080.88 110.00 18,074.35 110.00 18,067.82 110.00 18,061.28 $4,834,000 $4,834,500 110.00 18,102.36 110.00 18,095.83 110.00 18,089.29 110.00 18,082.76 110.00 18,076.23 110.00 18,069.69 110.00 18,063.16 $4,834,500 $4,835,000 110.00 18,104.23 110.00 18,097.70 110.00 18,091.17 110.00 18,084.63 110.00 18,078.10 110.00 18,071.57 110.00 18,065.03 $4,835,000 $4,835,500 110.00 18,106.11 110.00 18,099.58 110.00 18,093.04 110.00 18,086.51 110.00 18,079.98 110.00 18,073.44 110.00 18,066.91 $4,835,500 $4,836,000 110.00 18,107.98 110.00 18,101.45 110.00 18,094.92 110.00 18,088.38 110.00 18,081.85 110.00 18,075.32 110.00 18,068.78 $4,836,000 $4,836,500 110.00 18,109.86 110.00 18,103.33 110.00 18,096.79 110.00 18,090.26 110.00 18,083.73 110.00 18,077.19 110.00 18,070.66 $4,836,500 $4,837,000 110.00 18,111.73 110.00 18,105.20 110.00 18,098.67 110.00 18,092.13 110.00 18,085.60 110.00 18,079.07 110.00 18,072.53 $4,837,000 $4,837,500 110.00 18,113.61 110.00 18,107.08 110.00 18,100.54 110.00 18,094.01 110.00 18,087.48 110.00 18,080.94 110.00 18,074.41 $4,837,500 $4,838,000 110.00 18,115.48 110.00 18,108.95 110.00 18,102.42 110.00 18,095.88 110.00 18,089.35 110.00 18,082.82 110.00 18,076.28 $4,838,000 $4,838,500 110.00 18,117.36 110.00 18,110.83 110.00 18,104.29 110.00 18,097.76 110.00 18,091.23 110.00 18,084.69 110.00 18,078.16 $4,838,500 $4,839,000 110.00 18,119.23 110.00 18,112.70 110.00 18,106.17 110.00 18,099.63 110.00 18,093.10 110.00 18,086.57 110.00 18,080.03 $4,839,000 $4,839,500 110.00 18,121.11 110.00 18,114.58 110.00 18,108.04 110.00 18,101.51 110.00 18,094.98 110.00 18,088.44 110.00 18,081.91 $4,839,500 $4,840,000 110.00 18,122.98 110.00 18,116.45 110.00 18,109.92 110.00 18,103.38 110.00 18,096.85 110.00 18,090.32 110.00 18,083.78 $4,840,000 $4,840,500 110.00 18,124.86 110.00 18,118.33 110.00 18,111.79 110.00 18,105.26 110.00 18,098.73 110.00 18,092.19 110.00 18,085.66 $4,840,500 $4,841,000 110.00 18,126.73 110.00 18,120.20 110.00 18,113.67 110.00 18,107.13 110.00 18,100.60 110.00 18,094.07 110.00 18,087.53 $4,841,000 $4,841,500 110.00 18,128.61 110.00 18,122.08 110.00 18,115.54 110.00 18,109.01 110.00 18,102.48 110.00 18,095.94 110.00 18,089.41 $4,841,500 $4,842,000 110.00 18,130.48 110.00 18,123.95 110.00 18,117.42 110.00 18,110.88 110.00 18,104.35 110.00 18,097.82 110.00 18,091.28 $4,842,000 $4,842,500 110.00 18,132.36 110.00 18,125.83 110.00 18,119.29 110.00 18,112.76 110.00 18,106.23 110.00 18,099.69 110.00 18,093.16 $4,842,500 $4,843,000 110.00 18,134.23 110.00 18,127.70 110.00 18,121.17 110.00 18,114.63 110.00 18,108.10 110.00 18,101.57 110.00 18,095.03 $4,843,000 $4,843,500 110.00 18,136.11 110.00 18,129.58 110.00 18,123.04 110.00 18,116.51 110.00 18,109.98 110.00 18,103.44 110.00 18,096.91 $4,843,500 $4,844,000 110.00 18,137.98 110.00 18,131.45 110.00 18,124.92 110.00 18,118.38 110.00 18,111.85 110.00 18,105.32 110.00 18,098.78 $4,844,000 $4,844,500 110.00 18,139.86 110.00 18,133.33 110.00 18,126.79 110.00 18,120.26 110.00 18,113.73 110.00 18,107.19 110.00 18,100.66 $4,844,500 $4,845,000 110.00 18,141.73 110.00 18,135.20 110.00 18,128.67 110.00 18,122.13 110.00 18,115.60 110.00 18,109.07 110.00 18,102.53

NJEIS Family Cost Participation Table Page 98 of 12 Effective July 1, 2015

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

$4,845,000 $4,845,500 110.00 18,143.61 110.00 18,137.08 110.00 18,130.54 110.00 18,124.01 110.00 18,117.48 110.00 18,110.94 110.00 18,104.41 $4,845,500 $4,846,000 110.00 18,145.48 110.00 18,138.95 110.00 18,132.42 110.00 18,125.88 110.00 18,119.35 110.00 18,112.82 110.00 18,106.28 $4,846,000 $4,846,500 110.00 18,147.36 110.00 18,140.83 110.00 18,134.29 110.00 18,127.76 110.00 18,121.23 110.00 18,114.69 110.00 18,108.16 $4,846,500 $4,847,000 110.00 18,149.23 110.00 18,142.70 110.00 18,136.17 110.00 18,129.63 110.00 18,123.10 110.00 18,116.57 110.00 18,110.03 $4,847,000 $4,847,500 110.00 18,151.11 110.00 18,144.58 110.00 18,138.04 110.00 18,131.51 110.00 18,124.98 110.00 18,118.44 110.00 18,111.91 $4,847,500 $4,848,000 110.00 18,152.98 110.00 18,146.45 110.00 18,139.92 110.00 18,133.38 110.00 18,126.85 110.00 18,120.32 110.00 18,113.78 $4,848,000 $4,848,500 110.00 18,154.86 110.00 18,148.33 110.00 18,141.79 110.00 18,135.26 110.00 18,128.73 110.00 18,122.19 110.00 18,115.66 $4,848,500 $4,849,000 110.00 18,156.73 110.00 18,150.20 110.00 18,143.67 110.00 18,137.13 110.00 18,130.60 110.00 18,124.07 110.00 18,117.53 $4,849,000 $4,849,500 110.00 18,158.61 110.00 18,152.08 110.00 18,145.54 110.00 18,139.01 110.00 18,132.48 110.00 18,125.94 110.00 18,119.41 $4,849,500 $4,850,000 110.00 18,160.48 110.00 18,153.95 110.00 18,147.42 110.00 18,140.88 110.00 18,134.35 110.00 18,127.82 110.00 18,121.28 $4,850,000 $4,850,500 110.00 18,162.36 110.00 18,155.83 110.00 18,149.29 110.00 18,142.76 110.00 18,136.23 110.00 18,129.69 110.00 18,123.16 $4,850,500 $4,851,000 110.00 18,164.23 110.00 18,157.70 110.00 18,151.17 110.00 18,144.63 110.00 18,138.10 110.00 18,131.57 110.00 18,125.03 $4,851,000 $4,851,500 110.00 18,166.11 110.00 18,159.58 110.00 18,153.04 110.00 18,146.51 110.00 18,139.98 110.00 18,133.44 110.00 18,126.91 $4,851,500 $4,852,000 110.00 18,167.98 110.00 18,161.45 110.00 18,154.92 110.00 18,148.38 110.00 18,141.85 110.00 18,135.32 110.00 18,128.78 $4,852,000 $4,852,500 110.00 18,169.86 110.00 18,163.33 110.00 18,156.79 110.00 18,150.26 110.00 18,143.73 110.00 18,137.19 110.00 18,130.66 $4,852,500 $4,853,000 110.00 18,171.73 110.00 18,165.20 110.00 18,158.67 110.00 18,152.13 110.00 18,145.60 110.00 18,139.07 110.00 18,132.53 $4,853,000 $4,853,500 110.00 18,173.61 110.00 18,167.08 110.00 18,160.54 110.00 18,154.01 110.00 18,147.48 110.00 18,140.94 110.00 18,134.41 $4,853,500 $4,854,000 110.00 18,175.48 110.00 18,168.95 110.00 18,162.42 110.00 18,155.88 110.00 18,149.35 110.00 18,142.82 110.00 18,136.28 $4,854,000 $4,854,500 110.00 18,177.36 110.00 18,170.83 110.00 18,164.29 110.00 18,157.76 110.00 18,151.23 110.00 18,144.69 110.00 18,138.16 $4,854,500 $4,855,000 110.00 18,179.23 110.00 18,172.70 110.00 18,166.17 110.00 18,159.63 110.00 18,153.10 110.00 18,146.57 110.00 18,140.03 $4,855,000 $4,855,500 110.00 18,181.11 110.00 18,174.58 110.00 18,168.04 110.00 18,161.51 110.00 18,154.98 110.00 18,148.44 110.00 18,141.91 $4,855,500 $4,856,000 110.00 18,182.98 110.00 18,176.45 110.00 18,169.92 110.00 18,163.38 110.00 18,156.85 110.00 18,150.32 110.00 18,143.78 $4,856,000 $4,856,500 110.00 18,184.86 110.00 18,178.33 110.00 18,171.79 110.00 18,165.26 110.00 18,158.73 110.00 18,152.19 110.00 18,145.66 $4,856,500 $4,857,000 110.00 18,186.73 110.00 18,180.20 110.00 18,173.67 110.00 18,167.13 110.00 18,160.60 110.00 18,154.07 110.00 18,147.53 $4,857,000 $4,857,500 110.00 18,188.61 110.00 18,182.08 110.00 18,175.54 110.00 18,169.01 110.00 18,162.48 110.00 18,155.94 110.00 18,149.41 $4,857,500 $4,858,000 110.00 18,190.48 110.00 18,183.95 110.00 18,177.42 110.00 18,170.88 110.00 18,164.35 110.00 18,157.82 110.00 18,151.28 $4,858,000 $4,858,500 110.00 18,192.36 110.00 18,185.83 110.00 18,179.29 110.00 18,172.76 110.00 18,166.23 110.00 18,159.69 110.00 18,153.16 $4,858,500 $4,859,000 110.00 18,194.23 110.00 18,187.70 110.00 18,181.17 110.00 18,174.63 110.00 18,168.10 110.00 18,161.57 110.00 18,155.03 $4,859,000 $4,859,500 110.00 18,196.11 110.00 18,189.58 110.00 18,183.04 110.00 18,176.51 110.00 18,169.98 110.00 18,163.44 110.00 18,156.91 $4,859,500 $4,860,000 110.00 18,197.98 110.00 18,191.45 110.00 18,184.92 110.00 18,178.38 110.00 18,171.85 110.00 18,165.32 110.00 18,158.78 $4,860,000 $4,860,500 110.00 18,199.86 110.00 18,193.33 110.00 18,186.79 110.00 18,180.26 110.00 18,173.73 110.00 18,167.19 110.00 18,160.66 $4,860,500 $4,861,000 110.00 18,201.73 110.00 18,195.20 110.00 18,188.67 110.00 18,182.13 110.00 18,175.60 110.00 18,169.07 110.00 18,162.53 $4,861,000 $4,861,500 110.00 18,203.61 110.00 18,197.08 110.00 18,190.54 110.00 18,184.01 110.00 18,177.48 110.00 18,170.94 110.00 18,164.41 $4,861,500 $4,862,000 110.00 18,205.48 110.00 18,198.95 110.00 18,192.42 110.00 18,185.88 110.00 18,179.35 110.00 18,172.82 110.00 18,166.28 $4,862,000 $4,862,500 110.00 18,207.36 110.00 18,200.83 110.00 18,194.29 110.00 18,187.76 110.00 18,181.23 110.00 18,174.69 110.00 18,168.16 $4,862,500 $4,863,000 110.00 18,209.23 110.00 18,202.70 110.00 18,196.17 110.00 18,189.63 110.00 18,183.10 110.00 18,176.57 110.00 18,170.03 $4,863,000 $4,863,500 110.00 18,211.11 110.00 18,204.58 110.00 18,198.04 110.00 18,191.51 110.00 18,184.98 110.00 18,178.44 110.00 18,171.91 $4,863,500 $4,864,000 110.00 18,212.98 110.00 18,206.45 110.00 18,199.92 110.00 18,193.38 110.00 18,186.85 110.00 18,180.32 110.00 18,173.78 $4,864,000 $4,864,500 110.00 18,214.86 110.00 18,208.33 110.00 18,201.79 110.00 18,195.26 110.00 18,188.73 110.00 18,182.19 110.00 18,175.66 $4,864,500 $4,865,000 110.00 18,216.73 110.00 18,210.20 110.00 18,203.67 110.00 18,197.13 110.00 18,190.60 110.00 18,184.07 110.00 18,177.53 $4,865,000 $4,865,500 110.00 18,218.61 110.00 18,212.08 110.00 18,205.54 110.00 18,199.01 110.00 18,192.48 110.00 18,185.94 110.00 18,179.41 $4,865,500 $4,866,000 110.00 18,220.48 110.00 18,213.95 110.00 18,207.42 110.00 18,200.88 110.00 18,194.35 110.00 18,187.82 110.00 18,181.28 $4,866,000 $4,866,500 110.00 18,222.36 110.00 18,215.83 110.00 18,209.29 110.00 18,202.76 110.00 18,196.23 110.00 18,189.69 110.00 18,183.16 $4,866,500 $4,867,000 110.00 18,224.23 110.00 18,217.70 110.00 18,211.17 110.00 18,204.63 110.00 18,198.10 110.00 18,191.57 110.00 18,185.03 $4,867,000 $4,867,500 110.00 18,226.11 110.00 18,219.58 110.00 18,213.04 110.00 18,206.51 110.00 18,199.98 110.00 18,193.44 110.00 18,186.91 $4,867,500 $4,868,000 110.00 18,227.98 110.00 18,221.45 110.00 18,214.92 110.00 18,208.38 110.00 18,201.85 110.00 18,195.32 110.00 18,188.78 $4,868,000 $4,868,500 110.00 18,229.86 110.00 18,223.33 110.00 18,216.79 110.00 18,210.26 110.00 18,203.73 110.00 18,197.19 110.00 18,190.66 $4,868,500 $4,869,000 110.00 18,231.73 110.00 18,225.20 110.00 18,218.67 110.00 18,212.13 110.00 18,205.60 110.00 18,199.07 110.00 18,192.53 $4,869,000 $4,869,500 110.00 18,233.61 110.00 18,227.08 110.00 18,220.54 110.00 18,214.01 110.00 18,207.48 110.00 18,200.94 110.00 18,194.41 $4,869,500 $4,870,000 110.00 18,235.48 110.00 18,228.95 110.00 18,222.42 110.00 18,215.88 110.00 18,209.35 110.00 18,202.82 110.00 18,196.28 $4,870,000 $4,870,500 110.00 18,237.36 110.00 18,230.83 110.00 18,224.29 110.00 18,217.76 110.00 18,211.23 110.00 18,204.69 110.00 18,198.16 $4,870,500 $4,871,000 110.00 18,239.23 110.00 18,232.70 110.00 18,226.17 110.00 18,219.63 110.00 18,213.10 110.00 18,206.57 110.00 18,200.03 $4,871,000 $4,871,500 110.00 18,241.11 110.00 18,234.58 110.00 18,228.04 110.00 18,221.51 110.00 18,214.98 110.00 18,208.44 110.00 18,201.91 $4,871,500 $4,872,000 110.00 18,242.98 110.00 18,236.45 110.00 18,229.92 110.00 18,223.38 110.00 18,216.85 110.00 18,210.32 110.00 18,203.78 $4,872,000 $4,872,500 110.00 18,244.86 110.00 18,238.33 110.00 18,231.79 110.00 18,225.26 110.00 18,218.73 110.00 18,212.19 110.00 18,205.66 $4,872,500 $4,873,000 110.00 18,246.73 110.00 18,240.20 110.00 18,233.67 110.00 18,227.13 110.00 18,220.60 110.00 18,214.07 110.00 18,207.53 $4,873,000 $4,873,500 110.00 18,248.61 110.00 18,242.08 110.00 18,235.54 110.00 18,229.01 110.00 18,222.48 110.00 18,215.94 110.00 18,209.41 $4,873,500 $4,874,000 110.00 18,250.48 110.00 18,243.95 110.00 18,237.42 110.00 18,230.88 110.00 18,224.35 110.00 18,217.82 110.00 18,211.28 $4,874,000 $4,874,500 110.00 18,252.36 110.00 18,245.83 110.00 18,239.29 110.00 18,232.76 110.00 18,226.23 110.00 18,219.69 110.00 18,213.16 $4,874,500 $4,875,000 110.00 18,254.23 110.00 18,247.70 110.00 18,241.17 110.00 18,234.63 110.00 18,228.10 110.00 18,221.57 110.00 18,215.03 $4,875,000 $4,875,500 110.00 18,256.11 110.00 18,249.58 110.00 18,243.04 110.00 18,236.51 110.00 18,229.98 110.00 18,223.44 110.00 18,216.91 $4,875,500 $4,876,000 110.00 18,257.98 110.00 18,251.45 110.00 18,244.92 110.00 18,238.38 110.00 18,231.85 110.00 18,225.32 110.00 18,218.78 $4,876,000 $4,876,500 110.00 18,259.86 110.00 18,253.33 110.00 18,246.79 110.00 18,240.26 110.00 18,233.73 110.00 18,227.19 110.00 18,220.66 $4,876,500 $4,877,000 110.00 18,261.73 110.00 18,255.20 110.00 18,248.67 110.00 18,242.13 110.00 18,235.60 110.00 18,229.07 110.00 18,222.53 $4,877,000 $4,877,500 110.00 18,263.61 110.00 18,257.08 110.00 18,250.54 110.00 18,244.01 110.00 18,237.48 110.00 18,230.94 110.00 18,224.41 $4,877,500 $4,878,000 110.00 18,265.48 110.00 18,258.95 110.00 18,252.42 110.00 18,245.88 110.00 18,239.35 110.00 18,232.82 110.00 18,226.28 $4,878,000 $4,878,500 110.00 18,267.36 110.00 18,260.83 110.00 18,254.29 110.00 18,247.76 110.00 18,241.23 110.00 18,234.69 110.00 18,228.16 $4,878,500 $4,879,000 110.00 18,269.23 110.00 18,262.70 110.00 18,256.17 110.00 18,249.63 110.00 18,243.10 110.00 18,236.57 110.00 18,230.03 $4,879,000 $4,879,500 110.00 18,271.11 110.00 18,264.58 110.00 18,258.04 110.00 18,251.51 110.00 18,244.98 110.00 18,238.44 110.00 18,231.91 $4,879,500 $4,880,000 110.00 18,272.98 110.00 18,266.45 110.00 18,259.92 110.00 18,253.38 110.00 18,246.85 110.00 18,240.32 110.00 18,233.78 $4,880,000 $4,880,500 110.00 18,274.86 110.00 18,268.33 110.00 18,261.79 110.00 18,255.26 110.00 18,248.73 110.00 18,242.19 110.00 18,235.66 $4,880,500 $4,881,000 110.00 18,276.73 110.00 18,270.20 110.00 18,263.67 110.00 18,257.13 110.00 18,250.60 110.00 18,244.07 110.00 18,237.53 $4,881,000 $4,881,500 110.00 18,278.61 110.00 18,272.08 110.00 18,265.54 110.00 18,259.01 110.00 18,252.48 110.00 18,245.94 110.00 18,239.41 $4,881,500 $4,882,000 110.00 18,280.48 110.00 18,273.95 110.00 18,267.42 110.00 18,260.88 110.00 18,254.35 110.00 18,247.82 110.00 18,241.28 $4,882,000 $4,882,500 110.00 18,282.36 110.00 18,275.83 110.00 18,269.29 110.00 18,262.76 110.00 18,256.23 110.00 18,249.69 110.00 18,243.16 $4,882,500 $4,883,000 110.00 18,284.23 110.00 18,277.70 110.00 18,271.17 110.00 18,264.63 110.00 18,258.10 110.00 18,251.57 110.00 18,245.03 $4,883,000 $4,883,500 110.00 18,286.11 110.00 18,279.58 110.00 18,273.04 110.00 18,266.51 110.00 18,259.98 110.00 18,253.44 110.00 18,246.91 $4,883,500 $4,884,000 110.00 18,287.98 110.00 18,281.45 110.00 18,274.92 110.00 18,268.38 110.00 18,261.85 110.00 18,255.32 110.00 18,248.78 $4,884,000 $4,884,500 110.00 18,289.86 110.00 18,283.33 110.00 18,276.79 110.00 18,270.26 110.00 18,263.73 110.00 18,257.19 110.00 18,250.66 $4,884,500 $4,885,000 110.00 18,291.73 110.00 18,285.20 110.00 18,278.67 110.00 18,272.13 110.00 18,265.60 110.00 18,259.07 110.00 18,252.53 $4,885,000 $4,885,500 110.00 18,293.61 110.00 18,287.08 110.00 18,280.54 110.00 18,274.01 110.00 18,267.48 110.00 18,260.94 110.00 18,254.41 $4,885,500 $4,886,000 110.00 18,295.48 110.00 18,288.95 110.00 18,282.42 110.00 18,275.88 110.00 18,269.35 110.00 18,262.82 110.00 18,256.28 $4,886,000 $4,886,500 110.00 18,297.36 110.00 18,290.83 110.00 18,284.29 110.00 18,277.76 110.00 18,271.23 110.00 18,264.69 110.00 18,258.16 $4,886,500 $4,887,000 110.00 18,299.23 110.00 18,292.70 110.00 18,286.17 110.00 18,279.63 110.00 18,273.10 110.00 18,266.57 110.00 18,260.03 $4,887,000 $4,887,500 110.00 18,301.11 110.00 18,294.58 110.00 18,288.04 110.00 18,281.51 110.00 18,274.98 110.00 18,268.44 110.00 18,261.91 $4,887,500 $4,888,000 110.00 18,302.98 110.00 18,296.45 110.00 18,289.92 110.00 18,283.38 110.00 18,276.85 110.00 18,270.32 110.00 18,263.78 $4,888,000 $4,888,500 110.00 18,304.86 110.00 18,298.33 110.00 18,291.79 110.00 18,285.26 110.00 18,278.73 110.00 18,272.19 110.00 18,265.66 $4,888,500 $4,889,000 110.00 18,306.73 110.00 18,300.20 110.00 18,293.67 110.00 18,287.13 110.00 18,280.60 110.00 18,274.07 110.00 18,267.53 $4,889,000 $4,889,500 110.00 18,308.61 110.00 18,302.08 110.00 18,295.54 110.00 18,289.01 110.00 18,282.48 110.00 18,275.94 110.00 18,269.41 $4,889,500 $4,890,000 110.00 18,310.48 110.00 18,303.95 110.00 18,297.42 110.00 18,290.88 110.00 18,284.35 110.00 18,277.82 110.00 18,271.28 $4,890,000 $4,890,500 110.00 18,312.36 110.00 18,305.83 110.00 18,299.29 110.00 18,292.76 110.00 18,286.23 110.00 18,279.69 110.00 18,273.16 $4,890,500 $4,891,000 110.00 18,314.23 110.00 18,307.70 110.00 18,301.17 110.00 18,294.63 110.00 18,288.10 110.00 18,281.57 110.00 18,275.03 $4,891,000 $4,891,500 110.00 18,316.11 110.00 18,309.58 110.00 18,303.04 110.00 18,296.51 110.00 18,289.98 110.00 18,283.44 110.00 18,276.91 $4,891,500 $4,892,000 110.00 18,317.98 110.00 18,311.45 110.00 18,304.92 110.00 18,298.38 110.00 18,291.85 110.00 18,285.32 110.00 18,278.78 $4,892,000 $4,892,500 110.00 18,319.86 110.00 18,313.33 110.00 18,306.79 110.00 18,300.26 110.00 18,293.73 110.00 18,287.19 110.00 18,280.66 $4,892,500 $4,893,000 110.00 18,321.73 110.00 18,315.20 110.00 18,308.67 110.00 18,302.13 110.00 18,295.60 110.00 18,289.07 110.00 18,282.53 $4,893,000 $4,893,500 110.00 18,323.61 110.00 18,317.08 110.00 18,310.54 110.00 18,304.01 110.00 18,297.48 110.00 18,290.94 110.00 18,284.41 $4,893,500 $4,894,000 110.00 18,325.48 110.00 18,318.95 110.00 18,312.42 110.00 18,305.88 110.00 18,299.35 110.00 18,292.82 110.00 18,286.28 $4,894,000 $4,894,500 110.00 18,327.36 110.00 18,320.83 110.00 18,314.29 110.00 18,307.76 110.00 18,301.23 110.00 18,294.69 110.00 18,288.16 $4,894,500 $4,895,000 110.00 18,329.23 110.00 18,322.70 110.00 18,316.17 110.00 18,309.63 110.00 18,303.10 110.00 18,296.57 110.00 18,290.03 $4,895,000 $4,895,500 110.00 18,331.11 110.00 18,324.58 110.00 18,318.04 110.00 18,311.51 110.00 18,304.98 110.00 18,298.44 110.00 18,291.91 $4,895,500 $4,896,000 110.00 18,332.98 110.00 18,326.45 110.00 18,319.92 110.00 18,313.38 110.00 18,306.85 110.00 18,300.32 110.00 18,293.78

NJEIS Family Cost Participation Table Page 99 of 12 Effective July 1, 2015

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

$4,896,000 $4,896,500 110.00 18,334.86 110.00 18,328.33 110.00 18,321.79 110.00 18,315.26 110.00 18,308.73 110.00 18,302.19 110.00 18,295.66 $4,896,500 $4,897,000 110.00 18,336.73 110.00 18,330.20 110.00 18,323.67 110.00 18,317.13 110.00 18,310.60 110.00 18,304.07 110.00 18,297.53 $4,897,000 $4,897,500 110.00 18,338.61 110.00 18,332.08 110.00 18,325.54 110.00 18,319.01 110.00 18,312.48 110.00 18,305.94 110.00 18,299.41 $4,897,500 $4,898,000 110.00 18,340.48 110.00 18,333.95 110.00 18,327.42 110.00 18,320.88 110.00 18,314.35 110.00 18,307.82 110.00 18,301.28 $4,898,000 $4,898,500 110.00 18,342.36 110.00 18,335.83 110.00 18,329.29 110.00 18,322.76 110.00 18,316.23 110.00 18,309.69 110.00 18,303.16 $4,898,500 $4,899,000 110.00 18,344.23 110.00 18,337.70 110.00 18,331.17 110.00 18,324.63 110.00 18,318.10 110.00 18,311.57 110.00 18,305.03 $4,899,000 $4,899,500 110.00 18,346.11 110.00 18,339.58 110.00 18,333.04 110.00 18,326.51 110.00 18,319.98 110.00 18,313.44 110.00 18,306.91 $4,899,500 $4,900,000 110.00 18,347.98 110.00 18,341.45 110.00 18,334.92 110.00 18,328.38 110.00 18,321.85 110.00 18,315.32 110.00 18,308.78 $4,900,000 $4,900,500 110.00 18,349.86 110.00 18,343.33 110.00 18,336.79 110.00 18,330.26 110.00 18,323.73 110.00 18,317.19 110.00 18,310.66 $4,900,500 $4,901,000 110.00 18,351.73 110.00 18,345.20 110.00 18,338.67 110.00 18,332.13 110.00 18,325.60 110.00 18,319.07 110.00 18,312.53 $4,901,000 $4,901,500 110.00 18,353.61 110.00 18,347.08 110.00 18,340.54 110.00 18,334.01 110.00 18,327.48 110.00 18,320.94 110.00 18,314.41 $4,901,500 $4,902,000 110.00 18,355.48 110.00 18,348.95 110.00 18,342.42 110.00 18,335.88 110.00 18,329.35 110.00 18,322.82 110.00 18,316.28 $4,902,000 $4,902,500 110.00 18,357.36 110.00 18,350.83 110.00 18,344.29 110.00 18,337.76 110.00 18,331.23 110.00 18,324.69 110.00 18,318.16 $4,902,500 $4,903,000 110.00 18,359.23 110.00 18,352.70 110.00 18,346.17 110.00 18,339.63 110.00 18,333.10 110.00 18,326.57 110.00 18,320.03 $4,903,000 $4,903,500 110.00 18,361.11 110.00 18,354.58 110.00 18,348.04 110.00 18,341.51 110.00 18,334.98 110.00 18,328.44 110.00 18,321.91 $4,903,500 $4,904,000 110.00 18,362.98 110.00 18,356.45 110.00 18,349.92 110.00 18,343.38 110.00 18,336.85 110.00 18,330.32 110.00 18,323.78 $4,904,000 $4,904,500 110.00 18,364.86 110.00 18,358.33 110.00 18,351.79 110.00 18,345.26 110.00 18,338.73 110.00 18,332.19 110.00 18,325.66 $4,904,500 $4,905,000 110.00 18,366.73 110.00 18,360.20 110.00 18,353.67 110.00 18,347.13 110.00 18,340.60 110.00 18,334.07 110.00 18,327.53 $4,905,000 $4,905,500 110.00 18,368.61 110.00 18,362.08 110.00 18,355.54 110.00 18,349.01 110.00 18,342.48 110.00 18,335.94 110.00 18,329.41 $4,905,500 $4,906,000 110.00 18,370.48 110.00 18,363.95 110.00 18,357.42 110.00 18,350.88 110.00 18,344.35 110.00 18,337.82 110.00 18,331.28 $4,906,000 $4,906,500 110.00 18,372.36 110.00 18,365.83 110.00 18,359.29 110.00 18,352.76 110.00 18,346.23 110.00 18,339.69 110.00 18,333.16 $4,906,500 $4,907,000 110.00 18,374.23 110.00 18,367.70 110.00 18,361.17 110.00 18,354.63 110.00 18,348.10 110.00 18,341.57 110.00 18,335.03 $4,907,000 $4,907,500 110.00 18,376.11 110.00 18,369.58 110.00 18,363.04 110.00 18,356.51 110.00 18,349.98 110.00 18,343.44 110.00 18,336.91 $4,907,500 $4,908,000 110.00 18,377.98 110.00 18,371.45 110.00 18,364.92 110.00 18,358.38 110.00 18,351.85 110.00 18,345.32 110.00 18,338.78 $4,908,000 $4,908,500 110.00 18,379.86 110.00 18,373.33 110.00 18,366.79 110.00 18,360.26 110.00 18,353.73 110.00 18,347.19 110.00 18,340.66 $4,908,500 $4,909,000 110.00 18,381.73 110.00 18,375.20 110.00 18,368.67 110.00 18,362.13 110.00 18,355.60 110.00 18,349.07 110.00 18,342.53 $4,909,000 $4,909,500 110.00 18,383.61 110.00 18,377.08 110.00 18,370.54 110.00 18,364.01 110.00 18,357.48 110.00 18,350.94 110.00 18,344.41 $4,909,500 $4,910,000 110.00 18,385.48 110.00 18,378.95 110.00 18,372.42 110.00 18,365.88 110.00 18,359.35 110.00 18,352.82 110.00 18,346.28 $4,910,000 $4,910,500 110.00 18,387.36 110.00 18,380.83 110.00 18,374.29 110.00 18,367.76 110.00 18,361.23 110.00 18,354.69 110.00 18,348.16 $4,910,500 $4,911,000 110.00 18,389.23 110.00 18,382.70 110.00 18,376.17 110.00 18,369.63 110.00 18,363.10 110.00 18,356.57 110.00 18,350.03 $4,911,000 $4,911,500 110.00 18,391.11 110.00 18,384.58 110.00 18,378.04 110.00 18,371.51 110.00 18,364.98 110.00 18,358.44 110.00 18,351.91 $4,911,500 $4,912,000 110.00 18,392.98 110.00 18,386.45 110.00 18,379.92 110.00 18,373.38 110.00 18,366.85 110.00 18,360.32 110.00 18,353.78 $4,912,000 $4,912,500 110.00 18,394.86 110.00 18,388.33 110.00 18,381.79 110.00 18,375.26 110.00 18,368.73 110.00 18,362.19 110.00 18,355.66 $4,912,500 $4,913,000 110.00 18,396.73 110.00 18,390.20 110.00 18,383.67 110.00 18,377.13 110.00 18,370.60 110.00 18,364.07 110.00 18,357.53 $4,913,000 $4,913,500 110.00 18,398.61 110.00 18,392.08 110.00 18,385.54 110.00 18,379.01 110.00 18,372.48 110.00 18,365.94 110.00 18,359.41 $4,913,500 $4,914,000 110.00 18,400.48 110.00 18,393.95 110.00 18,387.42 110.00 18,380.88 110.00 18,374.35 110.00 18,367.82 110.00 18,361.28 $4,914,000 $4,914,500 110.00 18,402.36 110.00 18,395.83 110.00 18,389.29 110.00 18,382.76 110.00 18,376.23 110.00 18,369.69 110.00 18,363.16 $4,914,500 $4,915,000 110.00 18,404.23 110.00 18,397.70 110.00 18,391.17 110.00 18,384.63 110.00 18,378.10 110.00 18,371.57 110.00 18,365.03 $4,915,000 $4,915,500 110.00 18,406.11 110.00 18,399.58 110.00 18,393.04 110.00 18,386.51 110.00 18,379.98 110.00 18,373.44 110.00 18,366.91 $4,915,500 $4,916,000 110.00 18,407.98 110.00 18,401.45 110.00 18,394.92 110.00 18,388.38 110.00 18,381.85 110.00 18,375.32 110.00 18,368.78 $4,916,000 $4,916,500 110.00 18,409.86 110.00 18,403.33 110.00 18,396.79 110.00 18,390.26 110.00 18,383.73 110.00 18,377.19 110.00 18,370.66 $4,916,500 $4,917,000 110.00 18,411.73 110.00 18,405.20 110.00 18,398.67 110.00 18,392.13 110.00 18,385.60 110.00 18,379.07 110.00 18,372.53 $4,917,000 $4,917,500 110.00 18,413.61 110.00 18,407.08 110.00 18,400.54 110.00 18,394.01 110.00 18,387.48 110.00 18,380.94 110.00 18,374.41 $4,917,500 $4,918,000 110.00 18,415.48 110.00 18,408.95 110.00 18,402.42 110.00 18,395.88 110.00 18,389.35 110.00 18,382.82 110.00 18,376.28 $4,918,000 $4,918,500 110.00 18,417.36 110.00 18,410.83 110.00 18,404.29 110.00 18,397.76 110.00 18,391.23 110.00 18,384.69 110.00 18,378.16 $4,918,500 $4,919,000 110.00 18,419.23 110.00 18,412.70 110.00 18,406.17 110.00 18,399.63 110.00 18,393.10 110.00 18,386.57 110.00 18,380.03 $4,919,000 $4,919,500 110.00 18,421.11 110.00 18,414.58 110.00 18,408.04 110.00 18,401.51 110.00 18,394.98 110.00 18,388.44 110.00 18,381.91 $4,919,500 $4,920,000 110.00 18,422.98 110.00 18,416.45 110.00 18,409.92 110.00 18,403.38 110.00 18,396.85 110.00 18,390.32 110.00 18,383.78 $4,920,000 $4,920,500 110.00 18,424.86 110.00 18,418.33 110.00 18,411.79 110.00 18,405.26 110.00 18,398.73 110.00 18,392.19 110.00 18,385.66 $4,920,500 $4,921,000 110.00 18,426.73 110.00 18,420.20 110.00 18,413.67 110.00 18,407.13 110.00 18,400.60 110.00 18,394.07 110.00 18,387.53 $4,921,000 $4,921,500 110.00 18,428.61 110.00 18,422.08 110.00 18,415.54 110.00 18,409.01 110.00 18,402.48 110.00 18,395.94 110.00 18,389.41 $4,921,500 $4,922,000 110.00 18,430.48 110.00 18,423.95 110.00 18,417.42 110.00 18,410.88 110.00 18,404.35 110.00 18,397.82 110.00 18,391.28 $4,922,000 $4,922,500 110.00 18,432.36 110.00 18,425.83 110.00 18,419.29 110.00 18,412.76 110.00 18,406.23 110.00 18,399.69 110.00 18,393.16 $4,922,500 $4,923,000 110.00 18,434.23 110.00 18,427.70 110.00 18,421.17 110.00 18,414.63 110.00 18,408.10 110.00 18,401.57 110.00 18,395.03 $4,923,000 $4,923,500 110.00 18,436.11 110.00 18,429.58 110.00 18,423.04 110.00 18,416.51 110.00 18,409.98 110.00 18,403.44 110.00 18,396.91 $4,923,500 $4,924,000 110.00 18,437.98 110.00 18,431.45 110.00 18,424.92 110.00 18,418.38 110.00 18,411.85 110.00 18,405.32 110.00 18,398.78 $4,924,000 $4,924,500 110.00 18,439.86 110.00 18,433.33 110.00 18,426.79 110.00 18,420.26 110.00 18,413.73 110.00 18,407.19 110.00 18,400.66 $4,924,500 $4,925,000 110.00 18,441.73 110.00 18,435.20 110.00 18,428.67 110.00 18,422.13 110.00 18,415.60 110.00 18,409.07 110.00 18,402.53 $4,925,000 $4,925,500 110.00 18,443.61 110.00 18,437.08 110.00 18,430.54 110.00 18,424.01 110.00 18,417.48 110.00 18,410.94 110.00 18,404.41 $4,925,500 $4,926,000 110.00 18,445.48 110.00 18,438.95 110.00 18,432.42 110.00 18,425.88 110.00 18,419.35 110.00 18,412.82 110.00 18,406.28 $4,926,000 $4,926,500 110.00 18,447.36 110.00 18,440.83 110.00 18,434.29 110.00 18,427.76 110.00 18,421.23 110.00 18,414.69 110.00 18,408.16 $4,926,500 $4,927,000 110.00 18,449.23 110.00 18,442.70 110.00 18,436.17 110.00 18,429.63 110.00 18,423.10 110.00 18,416.57 110.00 18,410.03 $4,927,000 $4,927,500 110.00 18,451.11 110.00 18,444.58 110.00 18,438.04 110.00 18,431.51 110.00 18,424.98 110.00 18,418.44 110.00 18,411.91 $4,927,500 $4,928,000 110.00 18,452.98 110.00 18,446.45 110.00 18,439.92 110.00 18,433.38 110.00 18,426.85 110.00 18,420.32 110.00 18,413.78 $4,928,000 $4,928,500 110.00 18,454.86 110.00 18,448.33 110.00 18,441.79 110.00 18,435.26 110.00 18,428.73 110.00 18,422.19 110.00 18,415.66 $4,928,500 $4,929,000 110.00 18,456.73 110.00 18,450.20 110.00 18,443.67 110.00 18,437.13 110.00 18,430.60 110.00 18,424.07 110.00 18,417.53 $4,929,000 $4,929,500 110.00 18,458.61 110.00 18,452.08 110.00 18,445.54 110.00 18,439.01 110.00 18,432.48 110.00 18,425.94 110.00 18,419.41 $4,929,500 $4,930,000 110.00 18,460.48 110.00 18,453.95 110.00 18,447.42 110.00 18,440.88 110.00 18,434.35 110.00 18,427.82 110.00 18,421.28 $4,930,000 $4,930,500 110.00 18,462.36 110.00 18,455.83 110.00 18,449.29 110.00 18,442.76 110.00 18,436.23 110.00 18,429.69 110.00 18,423.16 $4,930,500 $4,931,000 110.00 18,464.23 110.00 18,457.70 110.00 18,451.17 110.00 18,444.63 110.00 18,438.10 110.00 18,431.57 110.00 18,425.03 $4,931,000 $4,931,500 110.00 18,466.11 110.00 18,459.58 110.00 18,453.04 110.00 18,446.51 110.00 18,439.98 110.00 18,433.44 110.00 18,426.91 $4,931,500 $4,932,000 110.00 18,467.98 110.00 18,461.45 110.00 18,454.92 110.00 18,448.38 110.00 18,441.85 110.00 18,435.32 110.00 18,428.78 $4,932,000 $4,932,500 110.00 18,469.86 110.00 18,463.33 110.00 18,456.79 110.00 18,450.26 110.00 18,443.73 110.00 18,437.19 110.00 18,430.66 $4,932,500 $4,933,000 110.00 18,471.73 110.00 18,465.20 110.00 18,458.67 110.00 18,452.13 110.00 18,445.60 110.00 18,439.07 110.00 18,432.53 $4,933,000 $4,933,500 110.00 18,473.61 110.00 18,467.08 110.00 18,460.54 110.00 18,454.01 110.00 18,447.48 110.00 18,440.94 110.00 18,434.41 $4,933,500 $4,934,000 110.00 18,475.48 110.00 18,468.95 110.00 18,462.42 110.00 18,455.88 110.00 18,449.35 110.00 18,442.82 110.00 18,436.28 $4,934,000 $4,934,500 110.00 18,477.36 110.00 18,470.83 110.00 18,464.29 110.00 18,457.76 110.00 18,451.23 110.00 18,444.69 110.00 18,438.16 $4,934,500 $4,935,000 110.00 18,479.23 110.00 18,472.70 110.00 18,466.17 110.00 18,459.63 110.00 18,453.10 110.00 18,446.57 110.00 18,440.03 $4,935,000 $4,935,500 110.00 18,481.11 110.00 18,474.58 110.00 18,468.04 110.00 18,461.51 110.00 18,454.98 110.00 18,448.44 110.00 18,441.91 $4,935,500 $4,936,000 110.00 18,482.98 110.00 18,476.45 110.00 18,469.92 110.00 18,463.38 110.00 18,456.85 110.00 18,450.32 110.00 18,443.78 $4,936,000 $4,936,500 110.00 18,484.86 110.00 18,478.33 110.00 18,471.79 110.00 18,465.26 110.00 18,458.73 110.00 18,452.19 110.00 18,445.66 $4,936,500 $4,937,000 110.00 18,486.73 110.00 18,480.20 110.00 18,473.67 110.00 18,467.13 110.00 18,460.60 110.00 18,454.07 110.00 18,447.53 $4,937,000 $4,937,500 110.00 18,488.61 110.00 18,482.08 110.00 18,475.54 110.00 18,469.01 110.00 18,462.48 110.00 18,455.94 110.00 18,449.41 $4,937,500 $4,938,000 110.00 18,490.48 110.00 18,483.95 110.00 18,477.42 110.00 18,470.88 110.00 18,464.35 110.00 18,457.82 110.00 18,451.28 $4,938,000 $4,938,500 110.00 18,492.36 110.00 18,485.83 110.00 18,479.29 110.00 18,472.76 110.00 18,466.23 110.00 18,459.69 110.00 18,453.16 $4,938,500 $4,939,000 110.00 18,494.23 110.00 18,487.70 110.00 18,481.17 110.00 18,474.63 110.00 18,468.10 110.00 18,461.57 110.00 18,455.03 $4,939,000 $4,939,500 110.00 18,496.11 110.00 18,489.58 110.00 18,483.04 110.00 18,476.51 110.00 18,469.98 110.00 18,463.44 110.00 18,456.91 $4,939,500 $4,940,000 110.00 18,497.98 110.00 18,491.45 110.00 18,484.92 110.00 18,478.38 110.00 18,471.85 110.00 18,465.32 110.00 18,458.78 $4,940,000 $4,940,500 110.00 18,499.86 110.00 18,493.33 110.00 18,486.79 110.00 18,480.26 110.00 18,473.73 110.00 18,467.19 110.00 18,460.66 $4,940,500 $4,941,000 110.00 18,501.73 110.00 18,495.20 110.00 18,488.67 110.00 18,482.13 110.00 18,475.60 110.00 18,469.07 110.00 18,462.53 $4,941,000 $4,941,500 110.00 18,503.61 110.00 18,497.08 110.00 18,490.54 110.00 18,484.01 110.00 18,477.48 110.00 18,470.94 110.00 18,464.41 $4,941,500 $4,942,000 110.00 18,505.48 110.00 18,498.95 110.00 18,492.42 110.00 18,485.88 110.00 18,479.35 110.00 18,472.82 110.00 18,466.28 $4,942,000 $4,942,500 110.00 18,507.36 110.00 18,500.83 110.00 18,494.29 110.00 18,487.76 110.00 18,481.23 110.00 18,474.69 110.00 18,468.16 $4,942,500 $4,943,000 110.00 18,509.23 110.00 18,502.70 110.00 18,496.17 110.00 18,489.63 110.00 18,483.10 110.00 18,476.57 110.00 18,470.03 $4,943,000 $4,943,500 110.00 18,511.11 110.00 18,504.58 110.00 18,498.04 110.00 18,491.51 110.00 18,484.98 110.00 18,478.44 110.00 18,471.91 $4,943,500 $4,944,000 110.00 18,512.98 110.00 18,506.45 110.00 18,499.92 110.00 18,493.38 110.00 18,486.85 110.00 18,480.32 110.00 18,473.78 $4,944,000 $4,944,500 110.00 18,514.86 110.00 18,508.33 110.00 18,501.79 110.00 18,495.26 110.00 18,488.73 110.00 18,482.19 110.00 18,475.66 $4,944,500 $4,945,000 110.00 18,516.73 110.00 18,510.20 110.00 18,503.67 110.00 18,497.13 110.00 18,490.60 110.00 18,484.07 110.00 18,477.53 $4,945,000 $4,945,500 110.00 18,518.61 110.00 18,512.08 110.00 18,505.54 110.00 18,499.01 110.00 18,492.48 110.00 18,485.94 110.00 18,479.41 $4,945,500 $4,946,000 110.00 18,520.48 110.00 18,513.95 110.00 18,507.42 110.00 18,500.88 110.00 18,494.35 110.00 18,487.82 110.00 18,481.28 $4,946,000 $4,946,500 110.00 18,522.36 110.00 18,515.83 110.00 18,509.29 110.00 18,502.76 110.00 18,496.23 110.00 18,489.69 110.00 18,483.16 $4,946,500 $4,947,000 110.00 18,524.23 110.00 18,517.70 110.00 18,511.17 110.00 18,504.63 110.00 18,498.10 110.00 18,491.57 110.00 18,485.03

NJEIS Family Cost Participation Table Page 100 of 12 Effective July 1, 2015

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

$4,947,000 $4,947,500 110.00 18,526.11 110.00 18,519.58 110.00 18,513.04 110.00 18,506.51 110.00 18,499.98 110.00 18,493.44 110.00 18,486.91 $4,947,500 $4,948,000 110.00 18,527.98 110.00 18,521.45 110.00 18,514.92 110.00 18,508.38 110.00 18,501.85 110.00 18,495.32 110.00 18,488.78 $4,948,000 $4,948,500 110.00 18,529.86 110.00 18,523.33 110.00 18,516.79 110.00 18,510.26 110.00 18,503.73 110.00 18,497.19 110.00 18,490.66 $4,948,500 $4,949,000 110.00 18,531.73 110.00 18,525.20 110.00 18,518.67 110.00 18,512.13 110.00 18,505.60 110.00 18,499.07 110.00 18,492.53 $4,949,000 $4,949,500 110.00 18,533.61 110.00 18,527.08 110.00 18,520.54 110.00 18,514.01 110.00 18,507.48 110.00 18,500.94 110.00 18,494.41 $4,949,500 $4,950,000 110.00 18,535.48 110.00 18,528.95 110.00 18,522.42 110.00 18,515.88 110.00 18,509.35 110.00 18,502.82 110.00 18,496.28 $4,950,000 $4,950,500 110.00 18,537.36 110.00 18,530.83 110.00 18,524.29 110.00 18,517.76 110.00 18,511.23 110.00 18,504.69 110.00 18,498.16 $4,950,500 $4,951,000 110.00 18,539.23 110.00 18,532.70 110.00 18,526.17 110.00 18,519.63 110.00 18,513.10 110.00 18,506.57 110.00 18,500.03 $4,951,000 $4,951,500 110.00 18,541.11 110.00 18,534.58 110.00 18,528.04 110.00 18,521.51 110.00 18,514.98 110.00 18,508.44 110.00 18,501.91 $4,951,500 $4,952,000 110.00 18,542.98 110.00 18,536.45 110.00 18,529.92 110.00 18,523.38 110.00 18,516.85 110.00 18,510.32 110.00 18,503.78 $4,952,000 $4,952,500 110.00 18,544.86 110.00 18,538.33 110.00 18,531.79 110.00 18,525.26 110.00 18,518.73 110.00 18,512.19 110.00 18,505.66 $4,952,500 $4,953,000 110.00 18,546.73 110.00 18,540.20 110.00 18,533.67 110.00 18,527.13 110.00 18,520.60 110.00 18,514.07 110.00 18,507.53 $4,953,000 $4,953,500 110.00 18,548.61 110.00 18,542.08 110.00 18,535.54 110.00 18,529.01 110.00 18,522.48 110.00 18,515.94 110.00 18,509.41 $4,953,500 $4,954,000 110.00 18,550.48 110.00 18,543.95 110.00 18,537.42 110.00 18,530.88 110.00 18,524.35 110.00 18,517.82 110.00 18,511.28 $4,954,000 $4,954,500 110.00 18,552.36 110.00 18,545.83 110.00 18,539.29 110.00 18,532.76 110.00 18,526.23 110.00 18,519.69 110.00 18,513.16 $4,954,500 $4,955,000 110.00 18,554.23 110.00 18,547.70 110.00 18,541.17 110.00 18,534.63 110.00 18,528.10 110.00 18,521.57 110.00 18,515.03 $4,955,000 $4,955,500 110.00 18,556.11 110.00 18,549.58 110.00 18,543.04 110.00 18,536.51 110.00 18,529.98 110.00 18,523.44 110.00 18,516.91 $4,955,500 $4,956,000 110.00 18,557.98 110.00 18,551.45 110.00 18,544.92 110.00 18,538.38 110.00 18,531.85 110.00 18,525.32 110.00 18,518.78 $4,956,000 $4,956,500 110.00 18,559.86 110.00 18,553.33 110.00 18,546.79 110.00 18,540.26 110.00 18,533.73 110.00 18,527.19 110.00 18,520.66 $4,956,500 $4,957,000 110.00 18,561.73 110.00 18,555.20 110.00 18,548.67 110.00 18,542.13 110.00 18,535.60 110.00 18,529.07 110.00 18,522.53 $4,957,000 $4,957,500 110.00 18,563.61 110.00 18,557.08 110.00 18,550.54 110.00 18,544.01 110.00 18,537.48 110.00 18,530.94 110.00 18,524.41 $4,957,500 $4,958,000 110.00 18,565.48 110.00 18,558.95 110.00 18,552.42 110.00 18,545.88 110.00 18,539.35 110.00 18,532.82 110.00 18,526.28 $4,958,000 $4,958,500 110.00 18,567.36 110.00 18,560.83 110.00 18,554.29 110.00 18,547.76 110.00 18,541.23 110.00 18,534.69 110.00 18,528.16 $4,958,500 $4,959,000 110.00 18,569.23 110.00 18,562.70 110.00 18,556.17 110.00 18,549.63 110.00 18,543.10 110.00 18,536.57 110.00 18,530.03 $4,959,000 $4,959,500 110.00 18,571.11 110.00 18,564.58 110.00 18,558.04 110.00 18,551.51 110.00 18,544.98 110.00 18,538.44 110.00 18,531.91 $4,959,500 $4,960,000 110.00 18,572.98 110.00 18,566.45 110.00 18,559.92 110.00 18,553.38 110.00 18,546.85 110.00 18,540.32 110.00 18,533.78 $4,960,000 $4,960,500 110.00 18,574.86 110.00 18,568.33 110.00 18,561.79 110.00 18,555.26 110.00 18,548.73 110.00 18,542.19 110.00 18,535.66 $4,960,500 $4,961,000 110.00 18,576.73 110.00 18,570.20 110.00 18,563.67 110.00 18,557.13 110.00 18,550.60 110.00 18,544.07 110.00 18,537.53 $4,961,000 $4,961,500 110.00 18,578.61 110.00 18,572.08 110.00 18,565.54 110.00 18,559.01 110.00 18,552.48 110.00 18,545.94 110.00 18,539.41 $4,961,500 $4,962,000 110.00 18,580.48 110.00 18,573.95 110.00 18,567.42 110.00 18,560.88 110.00 18,554.35 110.00 18,547.82 110.00 18,541.28 $4,962,000 $4,962,500 110.00 18,582.36 110.00 18,575.83 110.00 18,569.29 110.00 18,562.76 110.00 18,556.23 110.00 18,549.69 110.00 18,543.16 $4,962,500 $4,963,000 110.00 18,584.23 110.00 18,577.70 110.00 18,571.17 110.00 18,564.63 110.00 18,558.10 110.00 18,551.57 110.00 18,545.03 $4,963,000 $4,963,500 110.00 18,586.11 110.00 18,579.58 110.00 18,573.04 110.00 18,566.51 110.00 18,559.98 110.00 18,553.44 110.00 18,546.91 $4,963,500 $4,964,000 110.00 18,587.98 110.00 18,581.45 110.00 18,574.92 110.00 18,568.38 110.00 18,561.85 110.00 18,555.32 110.00 18,548.78 $4,964,000 $4,964,500 110.00 18,589.86 110.00 18,583.33 110.00 18,576.79 110.00 18,570.26 110.00 18,563.73 110.00 18,557.19 110.00 18,550.66 $4,964,500 $4,965,000 110.00 18,591.73 110.00 18,585.20 110.00 18,578.67 110.00 18,572.13 110.00 18,565.60 110.00 18,559.07 110.00 18,552.53 $4,965,000 $4,965,500 110.00 18,593.61 110.00 18,587.08 110.00 18,580.54 110.00 18,574.01 110.00 18,567.48 110.00 18,560.94 110.00 18,554.41 $4,965,500 $4,966,000 110.00 18,595.48 110.00 18,588.95 110.00 18,582.42 110.00 18,575.88 110.00 18,569.35 110.00 18,562.82 110.00 18,556.28 $4,966,000 $4,966,500 110.00 18,597.36 110.00 18,590.83 110.00 18,584.29 110.00 18,577.76 110.00 18,571.23 110.00 18,564.69 110.00 18,558.16 $4,966,500 $4,967,000 110.00 18,599.23 110.00 18,592.70 110.00 18,586.17 110.00 18,579.63 110.00 18,573.10 110.00 18,566.57 110.00 18,560.03 $4,967,000 $4,967,500 110.00 18,601.11 110.00 18,594.58 110.00 18,588.04 110.00 18,581.51 110.00 18,574.98 110.00 18,568.44 110.00 18,561.91 $4,967,500 $4,968,000 110.00 18,602.98 110.00 18,596.45 110.00 18,589.92 110.00 18,583.38 110.00 18,576.85 110.00 18,570.32 110.00 18,563.78 $4,968,000 $4,968,500 110.00 18,604.86 110.00 18,598.33 110.00 18,591.79 110.00 18,585.26 110.00 18,578.73 110.00 18,572.19 110.00 18,565.66 $4,968,500 $4,969,000 110.00 18,606.73 110.00 18,600.20 110.00 18,593.67 110.00 18,587.13 110.00 18,580.60 110.00 18,574.07 110.00 18,567.53 $4,969,000 $4,969,500 110.00 18,608.61 110.00 18,602.08 110.00 18,595.54 110.00 18,589.01 110.00 18,582.48 110.00 18,575.94 110.00 18,569.41 $4,969,500 $4,970,000 110.00 18,610.48 110.00 18,603.95 110.00 18,597.42 110.00 18,590.88 110.00 18,584.35 110.00 18,577.82 110.00 18,571.28 $4,970,000 $4,970,500 110.00 18,612.36 110.00 18,605.83 110.00 18,599.29 110.00 18,592.76 110.00 18,586.23 110.00 18,579.69 110.00 18,573.16 $4,970,500 $4,971,000 110.00 18,614.23 110.00 18,607.70 110.00 18,601.17 110.00 18,594.63 110.00 18,588.10 110.00 18,581.57 110.00 18,575.03 $4,971,000 $4,971,500 110.00 18,616.11 110.00 18,609.58 110.00 18,603.04 110.00 18,596.51 110.00 18,589.98 110.00 18,583.44 110.00 18,576.91 $4,971,500 $4,972,000 110.00 18,617.98 110.00 18,611.45 110.00 18,604.92 110.00 18,598.38 110.00 18,591.85 110.00 18,585.32 110.00 18,578.78 $4,972,000 $4,972,500 110.00 18,619.86 110.00 18,613.33 110.00 18,606.79 110.00 18,600.26 110.00 18,593.73 110.00 18,587.19 110.00 18,580.66 $4,972,500 $4,973,000 110.00 18,621.73 110.00 18,615.20 110.00 18,608.67 110.00 18,602.13 110.00 18,595.60 110.00 18,589.07 110.00 18,582.53 $4,973,000 $4,973,500 110.00 18,623.61 110.00 18,617.08 110.00 18,610.54 110.00 18,604.01 110.00 18,597.48 110.00 18,590.94 110.00 18,584.41 $4,973,500 $4,974,000 110.00 18,625.48 110.00 18,618.95 110.00 18,612.42 110.00 18,605.88 110.00 18,599.35 110.00 18,592.82 110.00 18,586.28 $4,974,000 $4,974,500 110.00 18,627.36 110.00 18,620.83 110.00 18,614.29 110.00 18,607.76 110.00 18,601.23 110.00 18,594.69 110.00 18,588.16 $4,974,500 $4,975,000 110.00 18,629.23 110.00 18,622.70 110.00 18,616.17 110.00 18,609.63 110.00 18,603.10 110.00 18,596.57 110.00 18,590.03 $4,975,000 $4,975,500 110.00 18,631.11 110.00 18,624.58 110.00 18,618.04 110.00 18,611.51 110.00 18,604.98 110.00 18,598.44 110.00 18,591.91 $4,975,500 $4,976,000 110.00 18,632.98 110.00 18,626.45 110.00 18,619.92 110.00 18,613.38 110.00 18,606.85 110.00 18,600.32 110.00 18,593.78 $4,976,000 $4,976,500 110.00 18,634.86 110.00 18,628.33 110.00 18,621.79 110.00 18,615.26 110.00 18,608.73 110.00 18,602.19 110.00 18,595.66 $4,976,500 $4,977,000 110.00 18,636.73 110.00 18,630.20 110.00 18,623.67 110.00 18,617.13 110.00 18,610.60 110.00 18,604.07 110.00 18,597.53 $4,977,000 $4,977,500 110.00 18,638.61 110.00 18,632.08 110.00 18,625.54 110.00 18,619.01 110.00 18,612.48 110.00 18,605.94 110.00 18,599.41 $4,977,500 $4,978,000 110.00 18,640.48 110.00 18,633.95 110.00 18,627.42 110.00 18,620.88 110.00 18,614.35 110.00 18,607.82 110.00 18,601.28 $4,978,000 $4,978,500 110.00 18,642.36 110.00 18,635.83 110.00 18,629.29 110.00 18,622.76 110.00 18,616.23 110.00 18,609.69 110.00 18,603.16 $4,978,500 $4,979,000 110.00 18,644.23 110.00 18,637.70 110.00 18,631.17 110.00 18,624.63 110.00 18,618.10 110.00 18,611.57 110.00 18,605.03 $4,979,000 $4,979,500 110.00 18,646.11 110.00 18,639.58 110.00 18,633.04 110.00 18,626.51 110.00 18,619.98 110.00 18,613.44 110.00 18,606.91 $4,979,500 $4,980,000 110.00 18,647.98 110.00 18,641.45 110.00 18,634.92 110.00 18,628.38 110.00 18,621.85 110.00 18,615.32 110.00 18,608.78 $4,980,000 $4,980,500 110.00 18,649.86 110.00 18,643.33 110.00 18,636.79 110.00 18,630.26 110.00 18,623.73 110.00 18,617.19 110.00 18,610.66 $4,980,500 $4,981,000 110.00 18,651.73 110.00 18,645.20 110.00 18,638.67 110.00 18,632.13 110.00 18,625.60 110.00 18,619.07 110.00 18,612.53 $4,981,000 $4,981,500 110.00 18,653.61 110.00 18,647.08 110.00 18,640.54 110.00 18,634.01 110.00 18,627.48 110.00 18,620.94 110.00 18,614.41 $4,981,500 $4,982,000 110.00 18,655.48 110.00 18,648.95 110.00 18,642.42 110.00 18,635.88 110.00 18,629.35 110.00 18,622.82 110.00 18,616.28 $4,982,000 $4,982,500 110.00 18,657.36 110.00 18,650.83 110.00 18,644.29 110.00 18,637.76 110.00 18,631.23 110.00 18,624.69 110.00 18,618.16 $4,982,500 $4,983,000 110.00 18,659.23 110.00 18,652.70 110.00 18,646.17 110.00 18,639.63 110.00 18,633.10 110.00 18,626.57 110.00 18,620.03 $4,983,000 $4,983,500 110.00 18,661.11 110.00 18,654.58 110.00 18,648.04 110.00 18,641.51 110.00 18,634.98 110.00 18,628.44 110.00 18,621.91 $4,983,500 $4,984,000 110.00 18,662.98 110.00 18,656.45 110.00 18,649.92 110.00 18,643.38 110.00 18,636.85 110.00 18,630.32 110.00 18,623.78 $4,984,000 $4,984,500 110.00 18,664.86 110.00 18,658.33 110.00 18,651.79 110.00 18,645.26 110.00 18,638.73 110.00 18,632.19 110.00 18,625.66 $4,984,500 $4,985,000 110.00 18,666.73 110.00 18,660.20 110.00 18,653.67 110.00 18,647.13 110.00 18,640.60 110.00 18,634.07 110.00 18,627.53 $4,985,000 $4,985,500 110.00 18,668.61 110.00 18,662.08 110.00 18,655.54 110.00 18,649.01 110.00 18,642.48 110.00 18,635.94 110.00 18,629.41 $4,985,500 $4,986,000 110.00 18,670.48 110.00 18,663.95 110.00 18,657.42 110.00 18,650.88 110.00 18,644.35 110.00 18,637.82 110.00 18,631.28 $4,986,000 $4,986,500 110.00 18,672.36 110.00 18,665.83 110.00 18,659.29 110.00 18,652.76 110.00 18,646.23 110.00 18,639.69 110.00 18,633.16 $4,986,500 $4,987,000 110.00 18,674.23 110.00 18,667.70 110.00 18,661.17 110.00 18,654.63 110.00 18,648.10 110.00 18,641.57 110.00 18,635.03 $4,987,000 $4,987,500 110.00 18,676.11 110.00 18,669.58 110.00 18,663.04 110.00 18,656.51 110.00 18,649.98 110.00 18,643.44 110.00 18,636.91 $4,987,500 $4,988,000 110.00 18,677.98 110.00 18,671.45 110.00 18,664.92 110.00 18,658.38 110.00 18,651.85 110.00 18,645.32 110.00 18,638.78 $4,988,000 $4,988,500 110.00 18,679.86 110.00 18,673.33 110.00 18,666.79 110.00 18,660.26 110.00 18,653.73 110.00 18,647.19 110.00 18,640.66 $4,988,500 $4,989,000 110.00 18,681.73 110.00 18,675.20 110.00 18,668.67 110.00 18,662.13 110.00 18,655.60 110.00 18,649.07 110.00 18,642.53 $4,989,000 $4,989,500 110.00 18,683.61 110.00 18,677.08 110.00 18,670.54 110.00 18,664.01 110.00 18,657.48 110.00 18,650.94 110.00 18,644.41 $4,989,500 $4,990,000 110.00 18,685.48 110.00 18,678.95 110.00 18,672.42 110.00 18,665.88 110.00 18,659.35 110.00 18,652.82 110.00 18,646.28 $4,990,000 $4,990,500 110.00 18,687.36 110.00 18,680.83 110.00 18,674.29 110.00 18,667.76 110.00 18,661.23 110.00 18,654.69 110.00 18,648.16 $4,990,500 $4,991,000 110.00 18,689.23 110.00 18,682.70 110.00 18,676.17 110.00 18,669.63 110.00 18,663.10 110.00 18,656.57 110.00 18,650.03 $4,991,000 $4,991,500 110.00 18,691.11 110.00 18,684.58 110.00 18,678.04 110.00 18,671.51 110.00 18,664.98 110.00 18,658.44 110.00 18,651.91 $4,991,500 $4,992,000 110.00 18,692.98 110.00 18,686.45 110.00 18,679.92 110.00 18,673.38 110.00 18,666.85 110.00 18,660.32 110.00 18,653.78 $4,992,000 $4,992,500 110.00 18,694.86 110.00 18,688.33 110.00 18,681.79 110.00 18,675.26 110.00 18,668.73 110.00 18,662.19 110.00 18,655.66 $4,992,500 $4,993,000 110.00 18,696.73 110.00 18,690.20 110.00 18,683.67 110.00 18,677.13 110.00 18,670.60 110.00 18,664.07 110.00 18,657.53 $4,993,000 $4,993,500 110.00 18,698.61 110.00 18,692.08 110.00 18,685.54 110.00 18,679.01 110.00 18,672.48 110.00 18,665.94 110.00 18,659.41 $4,993,500 $4,994,000 110.00 18,700.48 110.00 18,693.95 110.00 18,687.42 110.00 18,680.88 110.00 18,674.35 110.00 18,667.82 110.00 18,661.28 $4,994,000 $4,994,500 110.00 18,702.36 110.00 18,695.83 110.00 18,689.29 110.00 18,682.76 110.00 18,676.23 110.00 18,669.69 110.00 18,663.16 $4,994,500 $4,995,000 110.00 18,704.23 110.00 18,697.70 110.00 18,691.17 110.00 18,684.63 110.00 18,678.10 110.00 18,671.57 110.00 18,665.03 $4,995,000 $4,995,500 110.00 18,706.11 110.00 18,699.58 110.00 18,693.04 110.00 18,686.51 110.00 18,679.98 110.00 18,673.44 110.00 18,666.91 $4,995,500 $4,996,000 110.00 18,707.98 110.00 18,701.45 110.00 18,694.92 110.00 18,688.38 110.00 18,681.85 110.00 18,675.32 110.00 18,668.78 $4,996,000 $4,996,500 110.00 18,709.86 110.00 18,703.33 110.00 18,696.79 110.00 18,690.26 110.00 18,683.73 110.00 18,677.19 110.00 18,670.66 $4,996,500 $4,997,000 110.00 18,711.73 110.00 18,705.20 110.00 18,698.67 110.00 18,692.13 110.00 18,685.60 110.00 18,679.07 110.00 18,672.53 $4,997,000 $4,997,500 110.00 18,713.61 110.00 18,707.08 110.00 18,700.54 110.00 18,694.01 110.00 18,687.48 110.00 18,680.94 110.00 18,674.41 $4,997,500 $4,998,000 110.00 18,715.48 110.00 18,708.95 110.00 18,702.42 110.00 18,695.88 110.00 18,689.35 110.00 18,682.82 110.00 18,676.28

NJEIS Family Cost Participation Table Page 101 of 12 Effective July 1, 2015

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

$4,998,000 $4,998,500 110.00 18,717.36 110.00 18,710.83 110.00 18,704.29 110.00 18,697.76 110.00 18,691.23 110.00 18,684.69 110.00 18,678.16 $4,998,500 $4,999,000 110.00 18,719.23 110.00 18,712.70 110.00 18,706.17 110.00 18,699.63 110.00 18,693.10 110.00 18,686.57 110.00 18,680.03 $4,999,000 $4,999,500 110.00 18,721.11 110.00 18,714.58 110.00 18,708.04 110.00 18,701.51 110.00 18,694.98 110.00 18,688.44 110.00 18,681.91 $4,999,500 $5,000,000 110.00 18,722.98 110.00 18,716.45 110.00 18,709.92 110.00 18,703.38 110.00 18,696.85 110.00 18,690.32 110.00 18,683.78 $5,000,000 $5,000,500 110.00 18,724.86 110.00 18,718.33 110.00 18,711.79 110.00 18,705.26 110.00 18,698.73 110.00 18,692.19 110.00 18,685.66 $5,000,500 $5,001,000 110.00 18,726.73 110.00 18,720.20 110.00 18,713.67 110.00 18,707.13 110.00 18,700.60 110.00 18,694.07 110.00 18,687.53 $5,001,000 $5,001,500 110.00 18,728.61 110.00 18,722.08 110.00 18,715.54 110.00 18,709.01 110.00 18,702.48 110.00 18,695.94 110.00 18,689.41 $5,001,500 $5,002,000 110.00 18,730.48 110.00 18,723.95 110.00 18,717.42 110.00 18,710.88 110.00 18,704.35 110.00 18,697.82 110.00 18,691.28 $5,002,000 $5,002,500 110.00 18,732.36 110.00 18,725.83 110.00 18,719.29 110.00 18,712.76 110.00 18,706.23 110.00 18,699.69 110.00 18,693.16 $5,002,500 $5,003,000 110.00 18,734.23 110.00 18,727.70 110.00 18,721.17 110.00 18,714.63 110.00 18,708.10 110.00 18,701.57 110.00 18,695.03 $5,003,000 $5,003,500 110.00 18,736.11 110.00 18,729.58 110.00 18,723.04 110.00 18,716.51 110.00 18,709.98 110.00 18,703.44 110.00 18,696.91 $5,003,500 $5,004,000 110.00 18,737.98 110.00 18,731.45 110.00 18,724.92 110.00 18,718.38 110.00 18,711.85 110.00 18,705.32 110.00 18,698.78 $5,004,000 $5,004,500 110.00 18,739.86 110.00 18,733.33 110.00 18,726.79 110.00 18,720.26 110.00 18,713.73 110.00 18,707.19 110.00 18,700.66 $5,004,500 $5,005,000 110.00 18,741.73 110.00 18,735.20 110.00 18,728.67 110.00 18,722.13 110.00 18,715.60 110.00 18,709.07 110.00 18,702.53 $5,005,000 $5,005,500 110.00 18,743.61 110.00 18,737.08 110.00 18,730.54 110.00 18,724.01 110.00 18,717.48 110.00 18,710.94 110.00 18,704.41 $5,005,500 $5,006,000 110.00 18,745.48 110.00 18,738.95 110.00 18,732.42 110.00 18,725.88 110.00 18,719.35 110.00 18,712.82 110.00 18,706.28

NJEIS Family Cost Participation Table Page 102 of 12 Effective July 1, 2015