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Surcharge Rates / Calculation Sheets

Surcharge Rates

760 IAC 6-1-9 Surcharge for physicians and hospitals
Nursing Homes
Other Health Care Providers
Rule 21 Rates
Reporting Endorsement Factors

Calculation Sheets/Forms

Hospital_Calculation_Sheet

Nursing_Home_Calc_Sheet

Locum Tenens Calculation Sheet

Self-Insured Hospital Filing Instructions
PCF Certificate of Insurance Form - Editable PDF