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Surcharge Rates / Calculation Sheets

Surcharges Rates

Physicians and Hospitals
Nursing Homes
Other Health Care Providers
Reporting Endorsement Factors

Calculation Sheets/Forms

Hospital_Calculation_Sheet_2024-2025
Nursing_Home_Calc_Sheet_2024-2025
Hospital_Calculation_Sheet_2021-2024
Nursing_Home_Calc_Sheet_2021-2024
Locum Tenens Calculation Sheet  
Self-Insured Hospital Filing Instructions
PCF Certificate of Insurance Form
PCF Certificate of Insurance Form - Editable PDF