Pa. Code tit. 55, pt. II, subpt. C, ch. 140, subch. E, RIGHT TO APPEAL AND FAIR HEARING, app B
Current through Register Vol. 54, No. 49, December 7, 2024
| Family Size | ||||||||
Parents Annual Income Parents Annual Income | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional member |
| $0-$39,999.99 | NO PREMIUM IF INCOME BELOW 200% FPIG | |||||||
| $40-$49,999.99 | $30 | $29 | $27 | $26 | $24 | $0 | $0 | $0 |
| $50-$59,999.99 | $40 | $38 | $36 | $34 | $33 | $31 | $0 | $0 |
| $60-$69,999.99 | $50 | $48 | $45 | $43 | $41 | $39 | $37 | $0 |
| $70-$79,999.99 | $60 | $57 | $54 | $51 | $49 | $46 | $43 | $0 |
| $80-$89,999.99 | $75 | $71 | $68 | $64 | $61 | $58 | $55 | (-$3) |
| $90-$99,999.99 | $100 | $95 | $90 | $86 | $81 | $77 | $73 | (-$4) |
| $100-$109,999.99 | $150 | $143 | $135 | $129 | $122 | $116 | $111 | (-$5) |
| $110-$119,999.99 | $200 | $190 | $181 | $171 | $163 | $155 | $148 | (-$7) |
| $120-$129,999.99 | $250 | $238 | $226 | $214 | $204 | $193 | $185 | (-$8) |
| $130-$139,999.99 | $300 | $285 | $271 | $257 | $244 | $232 | $222 | (-$10) |
| $140-$149,999.99 | $350 | $333 | $316 | $300 | $285 | $271 | $259 | (-$12) |
| $150-$159,999.99 | $400 | $380 | $361 | $343 | $326 | $310 | $297 | (-$13) |
| $160-$169,999.99 | $475 | $451 | $429 | $407 | $387 | $368 | $352 | (-$16) |
| $170-$179,999.99 | $600 | $570 | $542 | $514 | $489 | $464 | $442 | (-$22) |
| $180-$189,999.99 | $675 | $641 | $609 | $579 | $550 | $522 | $497 | (-$25) |
| $190-$199,999.99 | $800 | $760 | $722 | $686 | $652 | $619 | $588 | (-$31) |
| $200-$249,999.99 | $925 | $879 | $835 | $793 | $753 | $716 | $679 | (-$37) |
| $250-$299,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $300-$349,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $350-$399,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $400-$449.999.00 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $450-$499,999.99 | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
| $500,000 + | $1,000 | $950 | $903 | $857 | $815 | $774 | $739 | (-$35) |
Pa. Code tit. 55, pt. II, subpt. C, ch. 140, subch. E, RIGHT TO APPEAL AND FAIR HEARING, app B