```html
Insurance Premium Calculator
Insurance Premium Calculator
Age Group:
Under 40
Over 40
Family Size:
Self (M)
M+1
M+2
M+3
M+4
M+5
M+6
Outpatient Limit:
30,000
50,000
75,000
Inpatient Limit:
75,000
100,000
200,000
300,000
500,000
Calculate Premium
```