2012 COVERED LIVES/ASSESSMENTS/SURCHARGES

REGION COUNTIES 2012 INDIVIDUAL COVERED LIVES ANNUAL ASSESSMENT 2012 FAMILY COVERED LIVES ANNUAL ASSESSMENT 2012 ALTERNATIVE PER UNIT OF PYMT SURCHARGE ∗
New York City Bronx
Kings
New York
Queens
Richmond
$194.51 $641.89 27.28%
Long Island Nassau
Suffolk
$ 57.83 $190.85 13.89%
Northern Metro Columbia
Delaware
Dutchess
Orange
Putnam
Rockland
Sullivan
Ulster
Westchester
$ 33.13 $109.33 9.31%
Northeastern Albany
Clinton
Essex
Fulton
Greene
Montgomery
Rensselaer
Saratoga
Schenectady
Schoharie
Warren
Washington
$ 38.89 $128.32 8.42%
Utica/Watertown Chenango
Franklin
Hamilton
Herkimer
Jefferson
Lewis Madison
Oneida
Oswego
Otsego
St. Lawrence
$ 8.29 $ 27.37 2.25%
Central Broome
Cayuga
Chemung
Cortland
Onondaga
Schuyler
Steuben
Tioga
Tompkins
$ 50.44 $166.44 9.57%
Rochester Livingston
Monroe
Ontario
Seneca
Wayne
Yates
$ 96.10 $317.13 18.62%
Western Allegany
Cattaraugus
Chautauqua
Erie
Genesee
Niagara
Orleans
Wyoming
$ 36.04 $118.92 6.78%

∗ This would be in addition to the surcharges reflected in Attachment 4.