| 基礎日額 | 年間保険料 | 事務費 | 合計金額 |
| 6,000 | 39,420 | 3,000 | 42,420 |
| 7,000 | 45,990 | 3,000 | 48,990 |
| 8,000 | 52,560 | 3,000 | 55,560 |
| 9,000 | 59,130 | 3,000 | 62,130 |
| 10,000 | 65,700 | 3,000 | 68,700 |
| 12,000 | 78,840 | 3,000 | 81,840 |
| 14,000 | 91,980 | 3,000 | 94,980 |
| 16,000 | 105,120 | 3,000 | 108,120 |
| 18,000 | 118,260 | 3,000 | 121,260 |
| 20,000 | 131,400 | 3,000 | 134,400 |
| 22,000 | 144,540 | 3,000 | 147,540 |
| 24,000 | 157,680 | 3,000 | 160,680 |
| 25,000 | 164,250 | 3,000 | 167,250 |