Original number of equal monthly installments | The 14th day of disability Retroactive to first day | Non-retroactive | The 30th day of disability Retroactive to first day | Non-retroactive |
6 | 1.74 | 1.39 | 1.10 | .69 |
7 | 1.84 | 1.56 | 1.30 | .80 |
8 | 1.94 | 1.66 | 1.40 | .89 |
9 | 2.02 | 1.74 | 1.49 | .97 |
10 | 2.10 | 1.82 | 1.58 | 1.05 |
11 | 2.17 | 1.89 | 1.63 | 1.12 |
12 | 2.23 | 1.95 | 1.68 | 1.18 |
13 | 2.29 | 2.01 | 1.72 | 1.24 |
14 | 2.35 | 2.07 | 1.75 | 1.30 |
15 | 2.41 | 2.13 | 1.79 | 1.35 |
16 | 2.46 | 2.18 | 1.82 | 1.40 |
17 | 2.51 | 2.23 | 1.86 | 1.45 |
18 | 2.56 | 2.27 | 1.89 | 1.50 |
19 | 2.60 | 2.32 | 1.91 | 1.54 |
20 | 2.65 | 2.36 | 1.94 | 1.59 |
21 | 2.69 | 2.40 | 1.97 | 1.62 |
22 | 2.73 | 2.44 | 1.99 | 1.64 |
23 | 2.77 | 2.48 | 2.02 | 1.67 |
24 | 2.81 | 2.52 | 2.04 | 1.69 |
25 | 2.85 | 2.56 | 2.06 | 1.71 |
26 | 2.88 | 2.60 | 2.09 | 1.73 |
27 | 2.92 | 2.63 | 2.11 | 1.75 |
28 | 2.95 | 2.67 | 2.13 | 1.77 |
29 | 2.99 | 2.70 | 2.15 | 1.79 |
30 | 3.02 | 2.74 | 2.17 | 1.82 |
31 | 3.06 | 2.77 | 2.19 | 1.83 |
32 | 3.09 | 2.80 | 2.21 | 1.85 |
33 | 3.12 | 2.83 | 2.23 | 1.87 |
34 | 3.15 | 2.86 | 2.25 | 1.89 |
35 | 3.18 | 2.90 | 2.27 | 1.91 |
36 | 3.21 | 2.93 | 2.29 | 1.93 |
37 | 3.24 | 2.96 | 2.30 | 1.94 |
38 | 3.27 | 2.99 | 2.32 | 1.96 |
39 | 3.30 | 3.01 | 2.34 | 1.98 |
40 | 3.33 | 3.04 | 2.35 | 1.99 |
41 | 3.36 | 3.07 | 2.37 | 2.01 |
42 | 3.39 | 3.10 | 2.39 | 2.03 |
43 | 3.41 | 3.13 | 2.40 | 2.04 |
44 | 3.44 | 3.15 | 2.42 | 2.06 |
45 | 3.47 | 3.18 | 2.44 | 2.08 |
46 | 3.50 | 3.21 | 2.45 | 2.09 |
47 | 3.52 | 3.23 | 2.47 | 2.11 |
48 | 3.55 | 3.26 | 2.48 | 2.12 |
49 | 3.57 | 3.29 | 2.50 | 2.14 |
50 | 3.60 | 3.31 | 2.51 | 2.15 |
51 | 3.62 | 3.34 | 2.53 | 2.16 |
52 | 3.65 | 3.36 | 2.54 | 2.18 |
53 | 3.67 | 3.39 | 2.56 | 2.19 |
54 | 3.70 | 3.41 | 2.57 | 2.21 |
55 | 3.72 | 3.43 | 2.58 | 2.22 |
56 | 3.75 | 3.46 | 2.60 | 2.24 |
57 | 3.77 | 3.48 | 2.61 | 2.25 |
58 | 3.79 | 3.51 | 2.63 | 2.26 |
59 | 3.82 | 3.53 | 2.64 | 2.28 |
60 | 3.84 | 3.55 | 2.65 | 2.29 |
61 | 3.88 | 3.58 | 2.68 | 2.30 |
62 | 3.91 | 3.60 | 2.69 | 2.32 |
63 | 3.93 | 3.62 | 2.70 | 2.33 |
64 | 3.95 | 3.64 | 2.72 | 2.34 |
65 | 3.97 | 3.67 | 2.73 | 2.35 |
66 | 4.00 | 3.69 | 2.74 | 2.37 |
67 | 4.02 | 3.71 | 2.76 | 2.38 |
68 | 4.04 | 3.73 | 2.77 | 2.39 |
69 | 4.06 | 3.75 | 2.78 | 2.40 |
70 | 4.08 | 3.77 | 2.79 | 2.42 |
71 | 4.11 | 3.80 | 2.81 | 2.43 |
72 | 4.13 | 3.82 | 2.82 | 2.44 |
73 | 4.15 | 3.84 | 2.83 | 2.45 |
74 | 4.17 | 3.86 | 2.84 | 2.47 |
75 | 4.19 | 3.88 | 2.85 | 2.48 |
76 | 4.21 | 3.90 | 2.87 | 2.49 |
77 | 4.23 | 3.92 | 2.88 | 2.50 |
78 | 4.25 | 3.94 | 2.89 | 2.51 |
79 | 4.27 | 3.96 | 2.90 | 2.52 |
80 | 4.29 | 3.98 | 2.91 | 2.54 |
81 | 4.31 | 4.00 | 2.92 | 2.55 |
82 | 4.33 | 4.02 | 2.94 | 2.56 |
83 | 4.35 | 4.04 | 2.95 | 2.57 |
84 | 4.37 | 4.06 | 2.96 | 2.58 |
85 | 4.39 | 4.08 | 2.97 | 2.59 |
86 | 4.41 | 4.10 | 2.98 | 2.60 |
87 | 4.43 | 4.12 | 2.99 | 2.61 |
88 | 4.45 | 4.14 | 3.00 | 2.63 |
89 | 4.47 | 4.16 | 3.01 | 2.64 |
90 | 4.49 | 4.18 | 3.03 | 2.65 |
91 | 4.51 | 4.20 | 3.04 | 2.66 |
92 | 4.52 | 4.21 | 3.05 | 2.67 |
93 | 4.54 | 4.23 | 3.06 | 2.68 |
94 | 4.56 | 4.25 | 3.07 | 2.69 |
95 | 4.58 | 4.27 | 3.08 | 2.70 |
96 | 4.60 | 4.29 | 3.09 | 2.71 |
97 | 4.62 | 4.31 | 3.10 | 2.72 |
98 | 4.64 | 4.32 | 3.11 | 2.73 |
99 | 4.65 | 4.34 | 3.12 | 2.74 |
100 | 4.67 | 4.36 | 3.13 | 2.75 |
101 | 4.69 | 4.38 | 3.14 | 2.76 |
102 | 4.71 | 4.40 | 3.15 | 2.77 |
103 | 4.73 | 4.41 | 3.16 | 2.78 |
104 | 4.74 | 4.43 | 3.17 | 2.79 |
105 | 4.76 | 4.45 | 3.18 | 2.80 |
106 | 4.78 | 4.47 | 3.19 | 2.81 |
107 | 4.80 | 4.49 | 3.20 | 2.82 |
108 | 4.81 | 4.50 | 3.21 | 2.84 |
109 | 4.83 | 4.52 | 3.22 | 2.84 |
110 | 4.85 | 4.54 | 3.23 | 2.85 |
111 | 4.86 | 4.55 | 3.24 | 2.86 |
112 | 4.88 | 4.57 | 3.25 | 2.87 |
113 | 4.90 | 4.59 | 3.26 | 2.88 |
114 | 4.92 | 4.61 | 3.27 | 2.89 |
115 | 4.93 | 4.62 | 3.28 | 2.90 |
116 | 4.95 | 4.64 | 3.29 | 2.91 |
117 | 4.97 | 4.66 | 3.30 | 2.92 |
118 | 4.98 | 4.67 | 3.31 | 2.93 |
119 | 5.00 | 4.69 | 3.32 | 2.94 |
120 | 5.02 | 4.71 | 3.33 | 2.95 |
Formula 1.25 x Claim Cost + $.60 (subject to a maximum of 2 x Claim Cost)
Wis. Admin. Code Office of the Commissioner of Insurance, ch. Ins 3, app A