NOTICES
DEPARTMENT OF PUBLIC WELFARE
Income Limits and Co-payments for the Subsidized Child Care Program
[43 Pa.B. 2515]
[Saturday, May 4, 2013]This notice increases the income limits codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale effective May 6, 2013 (based on the 2013 Federal Poverty Income Guidelines)) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). This increase is effective May 6, 2013.
Section 3041.107(b) of 55 Pa. Code requires the Department of Public Welfare to update the co-payment schedule in 55 Pa. Code Chapter 3041, Appendix B to reflect changes in the Federal Poverty Income Guidelines (FPIG). Effective May 6, 2013, the income guidelines for the subsidized child care program are increased due to increases in the FPIG. Under section 408.3 of the Public Welfare Code (62 P. S. § 408.3), the co-payment schedule is adjusted to reflect the increases. Chapter 3041, Appendix B of 55 Pa. Code also establishes the family co-payment levels according to the family's computed annual income and lists the weekly family co-payment based on the annual family income.
BEVERLY D. MACKERETH,
Acting SecretaryFiscal Note: 14-NOT-815. No fiscal impact; (8) recommends adoption.
CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE EFFECTIVE MAY 6, 2013
(BASED ON THE 2013 FEDERAL POVERTY INCOME GUIDELINES)
Weekly Family Size: 1 Weekly Family Size: 2 Weekly Family Size: 3 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $9,490 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $9,490.01 $11,490 $10.00 $8,660.01 $13,000 $10.00 $8,660.01 $13,900 $15.00 $11,490.01 $13,490 $16.00 $13,000.01 $13,250 $17.00 $13,900.01 $15,570 $20.00 $13,490.01 $15,490 $20.00 $13,250.01 $15,510 $22.00 $15,570.01 $17,570 $25.00 $15,490.01 $17,490 $24.00 $15,510.01 $17,510 $27.00 $17,570.01 $19,530 $30.00 $17,490.01 $19,490 $28.00 $17,510.01 $19,510 $31.00 $19,530.01 $21,530 $35.00 $19,490.01 $21,490 $32.00 $19,510.01 $21,510 $35.00 $21,530.01 $23,530 $40.00 $21,490.01 $23,490 $36.00 $21,510.01 $23,510 $39.00 $23,530.01 $25,530 $45.00 $23,490.01 $25,490 $41.00 $23,510.01 $25,510 $43.00 $25,530.01 $27,530 $50.00 $25,490.01 $27,002 $46.00 $25,510.01 $27,510 $48.00 $27,530.01 $29,530 $51.00 $27,510.01 $29,510 $53.00 $29,530.01 $31,530 $57.00 $29,510.01 $31,510 $58.00 $31,530.01 $33,530 $63.00 $31,510.01 $33,510 $63.00 $33,530.01 $35,530 $69.00 $33,510.01 $35,510 $68.00 $35,530.01 $37,530 $74.00 $35,510.01 $36,449 $73.00 $37,530.01 $39,530 $79.00 $39,530.01 $41,530 $85.00 $41,530.01 $43,530 $90.00 $43,530.01 $45,530 $95.00 $45,530.01 $45,896 200% FPIG $22,980 200% FPIG $31,020 200% FPIG $39,060
Weekly Family Size: 4 Weekly Family Size: 5 Weekly Family Size: 6 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $15,000 $10.00 $8,660.01 $15,600 $10.00 $8,660.01 $17,000 $18.00 $15,000.01 $17,250 $18.00 $15,600.01 $17,500 $20.00 $17,000.01 $19,000 $23.00 $17,250.01 $19,550 $21.00 $17,500.01 $19,570 $23.00 $19,000.01 $21,590 $28.00 $19,550.01 $21,550 $27.00 $19,570.01 $21,570 $28.00 $21,590.01 $23,590 $33.00 $21,550.01 $23,550 $31.00 $21,570.01 $23,570 $32.00 $23,590.01 $25,590 $37.00 $23,550.01 $25,550 $35.00 $23,570.01 $25,570 $36.00 $25,590.01 $27,590 $41.00 $25,550.01 $27,550 $39.00 $25,570.01 $27,570 $40.00 $27,590.01 $29,590 $45.00 $27,550.01 $29,550 $43.00 $27,570.01 $29,570 $45.00 $29,590.01 $31,590 $49.00 $29,550.01 $31,550 $47.00 $29,570.01 $31,570 $49.00 $31,590.01 $33,590 $53.00 $31,550.01 $33,550 $51.00 $31,570.01 $33,570 $53.00 $33,590.01 $35,590 $58.00 $33,550.01 $35,550 $55.00 $33,570.01 $35,570 $57.00 $35,590.01 $37,590 $63.00 $35,550.01 $37,550 $59.00 $35,570.01 $37,570 $61.00 $37,590.01 $39,590 $68.00 $37,550.01 $39,550 $63.00 $37,570.01 $39,570 $65.00 $39,590.01 $41,590 $73.00 $39,550.01 $41,550 $68.00 $39,570.01 $41,570 $69.00 $41,590.01 $43,590 $78.00 $41,550.01 $43,550 $73.00 $41,570.01 $43,570 $73.00 $43,590.01 $45,590 $83.00 $43,550.01 $45,550 $78.00 $43,570.01 $45,570 $78.00 $45,590.01 $47,590 $89.00 $45,550.01 $47,550 $83.00 $45,570.01 $47,570 $83.00 $47,590.01 $49,590 $95.00 $47,550.01 $49,550 $88.00 $47,570.01 $49,570 $88.00 $49,590.01 $51,590 $101.00 $49,550.01 $51,550 $93.00 $49,570.01 $51,570 $93.00 $51,590.01 $53,590 $107.00 $51,550.01 $53,550 $98.00 $51,570.01 $53,570 $98.00 $53,590.01 $55,590 $112.00 $53,550.01 $55,343 $103.00 $53,570.01 $55,570 $103.00 $55,590.01 $57,590 $109.00 $55,570.01 $57,570 $108.00 $57,590.01 $59,590 $115.00 $57,570.01 $59,570 $113.00 $59,590.01 $61,590 $121.00 $59,570.01 $61,570 $119.00 $61,590.01 $63,590 $127.00 $61,570.01 $63,570 $125.00 $63,590.01 $65,590 $133.00 $63,570.01 $64,790 $131.00 $65,590.01 $67,590 $137.00 $67,590.01 $69,590 $143.00 $69,590.01 $71,590 $149.00 $71,590.01 $73,590 $154.00 $73,590.01 $74,237 200% FPIG $47,100 200% FPIG $55,140 200% FPIG $63,180
Weekly Family Size: 7 Weekly Family Size: 8 Weekly Family Size: 9 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $17,600 $10.00 $8,660.01 $18,800 $10.00 $8,660.01 $19,700 $21.00 $17,600.01 $20,600 $22.00 $18,800.01 $22,000 $23.00 $19,700.01 $23,700 $25.00 $20,600.01 $23,610 $26.00 $22,000.01 $25,630 $28.00 $23,700.01 $27,650 $30.00 $23,610.01 $25,610 $32.00 $25,630.01 $27,630 $34.00 $27,650.01 $29,650 $34.00 $25,610.01 $27,610 $36.00 $27,630.01 $29,630 $38.00 $29,650.01 $31,650 $38.00 $27,610.01 $29,610 $40.00 $29,630.01 $31,630 $42.00 $31,650.01 $33,650 $42.00 $29,610.01 $31,610 $44.00 $31,630.01 $33,630 $46.00 $33,650.01 $35,650 $46.00 $31,610.01 $33,610 $48.00 $33,630.01 $35,630 $50.00 $35,650.01 $37,650 $51.00 $33,610.01 $35,610 $52.00 $35,630.01 $37,630 $54.00 $37,650.01 $39,650 $55.00 $35,610.01 $37,610 $57.00 $37,630.01 $39,630 $59.00 $39,650.01 $41,650 $59.00 $37,610.01 $39,610 $61.00 $39,630.01 $41,630 $64.00 $41,650.01 $43,650 $63.00 $39,610.01 $41,610 $65.00 $41,630.01 $43,630 $68.00 $43,650.01 $45,650 $67.00 $41,610.01 $43,610 $69.00 $43,630.01 $45,630 $72.00 $45,650.01 $47,650 $71.00 $43,610.01 $45,610 $73.00 $45,630.01 $47,630 $76.00 $47,650.01 $49,650 $75.00 $45,610.01 $47,610 $77.00 $47,630.01 $49,630 $80.00 $49,650.01 $51,650 $79.00 $47,610.01 $49,610 $81.00 $49,630.01 $51,630 $84.00 $51,650.01 $53,650 $84.00 $49,610.01 $51,610 $85.00 $51,630.01 $53,630 $88.00 $53,650.01 $55,650 $89.00 $51,610.01 $53,610 $89.00 $53,630.01 $55,630 $92.00 $55,650.01 $57,650 $94.00 $53,610.01 $55,610 $94.00 $55,630.01 $57,630 $96.00 $57,650.01 $59,650 $99.00 $55,610.01 $57,610 $99.00 $57,630.01 $59,630 $101.00 $59,650.01 $61,650 $104.00 $57,610.01 $59,610 $104.00 $59,630.01 $61,630 $106.00 $61,650.01 $63,650 $109.00 $59,610.01 $61,610 $109.00 $61,630.01 $63,630 $111.00 $63,650.01 $65,650 $114.00 $61,610.01 $63,610 $114.00 $63,630.01 $65,630 $116.00 $65,650.01 $67,650 $119.00 $63,610.01 $65,610 $119.00 $65,630.01 $67,630 $121.00 $67,650.01 $69,650 $124.00 $65,610.01 $67,610 $124.00 $67,630.01 $69,630 $126.00 $69,650.01 $71,650 $129.00 $67,610.01 $69,610 $129.00 $69,630.01 $71,630 $131.00 $71,650.01 $73,650 $135.00 $69,610.01 $71,610 $134.00 $71,630.01 $73,630 $136.00 $73,650.01 $75,650 $141.00 $71,610.01 $73,610 $139.00 $73,630.01 $75,630 $141.00 $75,650.01 $77,650 $147.00 $73,610.01 $75,610 $144.00 $75,630.01 $77,630 $146.00 $77,650.01 $79,650 $153.00 $75,610.01 $77,610 $150.00 $77,630.01 $79,630 $151.00 $79,650.01 $81,650 $159.00 $77,610.01 $79,610 $156.00 $79,630.01 $81,630 $156.00 $81,650.01 $83,650 $165.00 $79,610.01 $81,610 $162.00 $81,630.01 $83,630 $161.00 $83,650.01 $85,650 $171.00 $81,610.01 $83,684 $168.00 $83,630.01 $85,630 $167.00 $85,650.01 $87,650 $174.00 $85,630.01 $87,630 $173.00 $87,650.01 $89,650 $180.00 $87,630.01 $89,630 $179.00 $89,650.01 $91,650 $186.00 $89,630.01 $91,630 $185.00 $91,650.01 $93,650 $192.00 $91,630.01 $93,131 $191.00 $93,650.01 $95,650 $197.00 $95,650.01 $97,650 $203.00 $97,650.01 $99,650 $208.00 $99,650.01 $101,650 $213.00 $101,650.01 $102,578 200% FPIG $71,220 200% FPIG $79,260 200% FPIG $87,300
Weekly Family Size: 10 Weekly Family Size: 11 Weekly Family Size: 12 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $20,500 $10.00 $8,660.01 $21,500 $10.00 $8,660.01 $22,500 $24.00 $20,500.01 $25,000 $25.00 $21,500.01 $26,500 $26.00 $22,500.01 $28,000 $30.00 $25,000.01 $29,670 $32.00 $26,500.01 $31,690 $33.00 $28,000.01 $33,710 $37.00 $29,670.01 $31,670 $39.00 $31,690.01 $33,690 $41.00 $33,710.01 $35,710 $41.00 $31,670.01 $33,670 $43.00 $33,690.01 $35,690 $45.00 $35,710.01 $37,710 $45.00 $33,670.01 $35,670 $47.00 $35,690.01 $37,690 $49.00 $37,710.01 $39,710 $49.00 $35,670.01 $37,670 $51.00 $37,690.01 $39,690 $53.00 $39,710.01 $41,710 $53.00 $37,670.01 $39,670 $55.00 $39,690.01 $41,690 $57.00 $41,710.01 $43,710 $57.00 $39,670.01 $41,670 $59.00 $41,690.01 $43,690 $61.00 $43,710.01 $45,710 $61.00 $41,670.01 $43,670 $63.00 $43,690.01 $45,690 $65.00 $45,710.01 $47,710 $65.00 $43,670.01 $45,670 $67.00 $45,690.01 $47,690 $69.00 $47,710.01 $49,710 $70.00 $45,670.01 $47,670 $71.00 $47,690.01 $49,690 $73.00 $49,710.01 $51,710 $74.00 $47,670.01 $49,670 $76.00 $49,690.01 $51,690 $77.00 $51,710.01 $53,710 $78.00 $49,670.01 $51,670 $80.00 $51,690.01 $53,690 $82.00 $53,710.01 $55,710 $82.00 $51,670.01 $53,670 $84.00 $53,690.01 $55,690 $86.00 $55,710.01 $57,710 $86.00 $53,670.01 $55,670 $88.00 $55,690.01 $57,690 $90.00 $57,710.01 $59,710 $90.00 $55,670.01 $57,670 $92.00 $57,690.01 $59,690 $94.00 $59,710.01 $61,710 $94.00 $57,670.01 $59,670 $96.00 $59,690.01 $61,690 $98.00 $61,710.01 $63,710 $98.00 $59,670.01 $61,670 $100.00 $61,690.01 $63,690 $102.00 $63,710.01 $65,710 $102.00 $61,670.01 $63,670 $104.00 $63,690.01 $65,690 $106.00 $65,710.01 $67,710 $106.00 $63,670.01 $65,670 $108.00 $65,690.01 $67,690 $110.00 $67,710.01 $69,710 $111.00 $65,670.01 $67,670 $112.00 $67,690.01 $69,690 $114.00 $69,710.01 $71,710 $116.00 $67,670.01 $69,670 $116.00 $69,690.01 $71,690 $118.00 $71,710.01 $73,710 $121.00 $69,670.01 $71,670 $121.00 $71,690.01 $73,690 $122.00 $73,710.01 $75,710 $126.00 $71,670.01 $73,670 $126.00 $73,690.01 $75,690 $126.00 $75,710.01 $77,710 $131.00 $73,670.01 $75,670 $131.00 $75,690.01 $77,690 $131.00 $77,710.01 $79,710 $136.00 $75,670.01 $77,670 $136.00 $77,690.01 $79,690 $136.00 $79,710.01 $81,710 $141.00 $77,670.01 $79,670 $141.00 $79,690.01 $81,690 $141.00 $81,710.01 $83,710 $146.00 $79,670.01 $81,670 $146.00 $81,690.01 $83,690 $146.00 $83,710.01 $85,710 $151.00 $81,670.01 $83,670 $151.00 $83,690.01 $85,690 $151.00 $85,710.01 $87,710 $156.00 $83,670.01 $85,670 $156.00 $85,690.01 $87,690 $156.00 $87,710.01 $89,710 $161.00 $85,670.01 $87,670 $161.00 $87,690.01 $89,690 $161.00 $89,710.01 $91,710 $166.00 $87,670.01 $89,670 $166.00 $89,690.01 $91,690 $166.00 $91,710.01 $93,710 $171.00 $89,670.01 $91,670 $171.00 $91,690.01 $93,690 $171.00 $93,710.01 $95,710 $177.00 $91,670.01 $93,670 $176.00 $93,690.01 $95,690 $176.00 $95,710.01 $97,710 $183.00 $93,670.01 $95,670 $181.00 $95,690.01 $97,690 $181.00 $97,710.01 $99,710 $189.00 $95,670.01 $97,670 $186.00 $97,690.01 $99,690 $186.00 $99,710.01 $101,710 $195.00 $97,670.01 $99,670 $192.00 $99,690.01 $101,690 $191.00 $101,710.01 $103,710 $201.00 $99,670.01 $101,670 $198.00 $101,690.01 $103,690 $196.00 $103,710.01 $105,710 $207.00 $101,670.01 $103,670 $204.00 $103,690.01 $105,690 $201.00 $105,710.01 $107,710 $213.00 $103,670.01 $105,670 $210.00 $105,690.01 $107,690 $206.00 $107,710.01 $109,710 $219.00 $105,670.01 $107,670 $216.00 $107,690.01 $109,690 $212.00 $109,710.01 $111,710 $225.00 $107,670.01 $109,670 $222.00 $109,690.01 $111,690 $218.00 $111,710.01 $113,710 $230.00 $109,670.01 $112,025 $228.00 $111,690.01 $113,690 $224.00 $113,710.01 $115,710 $234.00 $113,690.01 $115,690 $230.00 $115,710.01 $117,710 $240.00 $115,690.01 $117,690 $236.00 $117,710.01 $119,710 $246.00 $117,690.01 $119,690 $242.00 $119,710.01 $121,710 $251.00 $119,690.01 $121,472 $248.00 $121,710.01 $123,710 $254.00 $123,710.01 $125,710 $260.00 $125,710.01 $127,710 $266.00 $127,710.01 $129,710 $272.00 $129,710.01 $130,919 200% FPIG $95,340 200% FPIG $103,380 200% FPIG $111,420
Weekly Family Size: 13 Weekly Family Size: 14 Weekly Family Size: 15 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $23,400 $10.00 $8,660.01 $24,250 $10.00 $8,660.01 $26,000 $27.00 $23,400.01 $29,500 $28.00 $24,250.01 $30,300 $30.00 $26,000.01 $33,030 $35.00 $29,500.01 $35,730 $36.00 $30,300.01 $37,750 $39.00 $33,030.01 $39,770 $44.00 $35,730.01 $37,730 $46.00 $37,750.01 $39,750 $48.00 $39,770.01 $41,770 $47.00 $37,730.01 $39,730 $49.00 $39,750.01 $41,750 $51.00 $41,770.01 $43,770 $51.00 $39,730.01 $41,730 $53.00 $41,750.01 $43,750 $55.00 $43,770.01 $45,770 $55.00 $41,730.01 $43,730 $57.00 $43,750.01 $45,750 $59.00 $45,770.01 $47,770 $59.00 $43,730.01 $45,730 $61.00 $45,750.01 $47,750 $63.00 $47,770.01 $49,770 $63.00 $45,730.01 $47,730 $65.00 $47,750.01 $49,750 $67.00 $49,770.01 $51,770 $67.00 $47,730.01 $49,730 $69.00 $49,750.01 $51,750 $71.00 $51,770.01 $53,770 $71.00 $49,730.01 $51,730 $73.00 $51,750.01 $53,750 $75.00 $53,770.01 $55,770 $75.00 $51,730.01 $53,730 $77.00 $53,750.01 $55,750 $79.00 $55,770.01 $57,770 $79.00 $53,730.01 $55,730 $81.00 $55,750.01 $57,750 $83.00 $57,770.01 $59,770 $83.00 $55,730.01 $57,730 $85.00 $57,750.01 $59,750 $87.00 $59,770.01 $61,770 $88.00 $57,730.01 $59,730 $90.00 $59,750.01 $61,750 $91.00 $61,770.01 $63,770 $92.00 $59,730.01 $61,730 $95.00 $61,750.01 $63,750 $96.00 $63,770.01 $65,770 $96.00 $61,730.01 $63,730 $99.00 $63,750.01 $65,750 $101.00 $65,770.01 $67,770 $100.00 $63,730.01 $65,730 $103.00 $65,750.01 $67,750 $105.00 $67,770.01 $69,770 $104.00 $65,730.01 $67,730 $107.00 $67,750.01 $69,750 $109.00 $69,770.01 $71,770 $108.00 $67,730.01 $69,730 $111.00 $69,750.01 $71,750 $113.00 $71,770.01 $73,770 $112.00 $69,730.01 $71,730 $115.00 $71,750.01 $73,750 $117.00 $73,770.01 $75,770 $116.00 $71,730.01 $73,730 $119.00 $73,750.01 $75,750 $121.00 $75,770.01 $77,770 $120.00 $73,730.01 $75,730 $123.00 $75,750.01 $77,750 $125.00 $77,770.01 $79,770 $124.00 $75,730.01 $77,730 $127.00 $77,750.01 $79,750 $129.00 $79,770.01 $81,770 $128.00 $77,730.01 $79,730 $131.00 $79,750.01 $81,750 $133.00 $81,770.01 $83,770 $132.00 $79,730.01 $81,730 $135.00 $81,750.01 $83,750 $137.00 $83,770.01 $85,770 $136.00 $81,730.01 $83,730 $139.00 $83,750.01 $85,750 $141.00 $85,770.01 $87,770 $141.00 $83,730.01 $85,730 $144.00 $85,750.01 $87,750 $145.00 $87,770.01 $89,770 $146.00 $85,730.01 $87,730 $149.00 $87,750.01 $89,750 $149.00 $89,770.01 $91,770 $151.00 $87,730.01 $89,730 $154.00 $89,750.01 $91,750 $154.00 $91,770.01 $93,770 $156.00 $89,730.01 $91,730 $159.00 $91,750.01 $93,750 $159.00 $93,770.01 $95,770 $161.00 $91,730.01 $93,730 $164.00 $93,750.01 $95,750 $164.00 $95,770.01 $97,770 $166.00 $93,730.01 $95,730 $169.00 $95,750.01 $97,750 $169.00 $97,770.01 $99,770 $171.00 $95,730.01 $97,730 $174.00 $97,750.01 $99,750 $174.00 $99,770.01 $101,770 $176.00 $97,730.01 $99,730 $179.00 $99,750.01 $101,750 $179.00 $101,770.01 $103,770 $181.00 $99,730.01 $101,730 $184.00 $101,750.01 $103,750 $184.00 $103,770.01 $105,770 $186.00 $101,730.01 $103,730 $189.00 $103,750.01 $105,750 $189.00 $105,770.01 $107,770 $191.00 $103,730.01 $105,730 $194.00 $105,750.01 $107,750 $194.00 $107,770.01 $109,770 $196.00 $105,730.01 $107,730 $199.00 $107,750.01 $109,750 $199.00 $109,770.01 $111,770 $201.00 $107,730.01 $109,730 $204.00 $109,750.01 $111,750 $204.00 $111,770.01 $113,770 $206.00 $109,730.01 $111,730 $209.00 $111,750.01 $113,750 $209.00 $113,770.01 $115,770 $211.00 $111,730.01 $113,730 $214.00 $113,750.01 $115,750 $214.00 $115,770.01 $117,770 $216.00 $113,730.01 $115,730 $219.00 $115,750.01 $117,750 $219.00 $117,770.01 $119,770 $221.00 $115,730.01 $117,730 $224.00 $117,750.01 $119,750 $224.00 $119,770.01 $121,770 $227.00 $117,730.01 $119,730 $229.00 $119,750.01 $121,750 $229.00 $121,770.01 $123,770 $233.00 $119,730.01 $121,730 $235.00 $121,750.01 $123,750 $234.00 $123,770.01 $125,770 $239.00 $121,730.01 $123,730 $241.00 $123,750.01 $125,750 $239.00 $125,770.01 $127,770 $245.00 $123,730.01 $125,730 $247.00 $125,750.01 $127,750 $244.00 $127,770.01 $129,770 $251.00 $125,730.01 $127,730 $253.00 $127,750.01 $129,750 $250.00 $129,770.01 $131,770 $257.00 $127,730.01 $129,730 $259.00 $129,750.01 $131,750 $256.00 $131,770.01 $133,770 $263.00 $129,730.01 $131,730 $265.00 $131,750.01 $133,750 $262.00 $133,770.01 $135,770 $269.00 $131,730.01 $133,730 $271.00 $133,750.01 $135,750 $268.00 $135,770.01 $137,770 $275.00 $133,730.01 $135,730 $277.00 $135,750.01 $137,750 $274.00 $137,770.01 $139,770 $281.00 $135,730.01 $137,730 $283.00 $137,750.01 $139,750 $280.00 $139,770.01 $141,770 $287.00 $137,730.01 $139,730 $289.00 $139,750.01 $141,750 $286.00 $141,770.01 $143,770 $293.00 $139,730.01 $140,366 $295.00 $141,750.01 $143,750 $292.00 $143,770.01 $145,770 $301.00 $143,750.01 $145,750 $298.00 $145,770.01 $147,770 $306.00 $145,750.01 $147,750 $304.00 $147,770.01 $149,770 $311.00 $147,750.01 $149,813 $310.00 $149,770.01 $151,770 $316.00 $151,770.01 $153,770 $322.00 $153,770.01 $155,770 $327.00 $155,770.01 $157,770 $332.00 $157,770.01 $159,260 200% FPIG $119,460 200% FPIG $127,500 200% FPIG $135,540
Weekly Family Size: 16 Weekly Family Size: 17 Weekly Family Size: 18 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $27,700 $10.00 $8,660.01 $28,600 $10.00 $8,660.01 $29,500 $32.00 $27,700.01 $35,750 $33.00 $28,600.01 $36,800 $35.00 $29,500.01 $38,500 $42.00 $35,750.01 $43,790 $43.00 $36,800.01 $45,810 $46.00 $38,500.01 $47,830 $52.00 $43,790.01 $45,790 $55.00 $45,810.01 $47,810 $58.00 $47,830.01 $49,830 $56.00 $45,790.01 $47,790 $59.00 $47,810.01 $49,810 $61.00 $49,830.01 $51,830 $60.00 $47,790.01 $49,790 $63.00 $49,810.01 $51,810 $65.00 $51,830.01 $53,830 $64.00 $49,790.01 $51,790 $67.00 $51,810.01 $53,810 $69.00 $53,830.01 $55,830 $68.00 $51,790.01 $53,790 $71.00 $53,810.01 $55,810 $73.00 $55,830.01 $57,830 $72.00 $53,790.01 $55,790 $75.00 $55,810.01 $57,810 $77.00 $57,830.01 $59,830 $76.00 $55,790.01 $57,790 $79.00 $57,810.01 $59,810 $81.00 $59,830.01 $61,830 $80.00 $57,790.01 $59,790 $83.00 $59,810.01 $61,810 $85.00 $61,830.01 $63,830 $84.00 $59,790.01 $61,790 $87.00 $61,810.01 $63,810 $89.00 $63,830.01 $65,830 $88.00 $61,790.01 $63,790 $91.00 $63,810.01 $65,810 $93.00 $65,830.01 $67,830 $92.00 $63,790.01 $65,790 $95.00 $65,810.01 $67,810 $97.00 $67,830.01 $69,830 $97.00 $65,790.01 $67,790 $99.00 $67,810.01 $69,810 $101.00 $69,830.01 $71,830 $102.00 $67,790.01 $69,790 $103.00 $69,810.01 $71,810 $105.00 $71,830.01 $73,830 $107.00 $69,790.01 $71,790 $108.00 $71,810.01 $73,810 $109.00 $73,830.01 $75,830 $111.00 $71,790.01 $73,790 $113.00 $73,810.01 $75,810 $114.00 $75,830.01 $77,830 $115.00 $73,790.01 $75,790 $117.00 $75,810.01 $77,810 $119.00 $77,830.01 $79,830 $119.00 $75,790.01 $77,790 $121.00 $77,810.01 $79,810 $123.00 $79,830.01 $81,830 $123.00 $77,790.01 $79,790 $125.00 $79,810.01 $81,810 $127.00 $81,830.01 $83,830 $127.00 $79,790.01 $81,790 $129.00 $81,810.01 $83,810 $131.00 $83,830.01 $85,830 $131.00 $81,790.01 $83,790 $133.00 $83,810.01 $85,810 $135.00 $85,830.01 $87,830 $135.00 $83,790.01 $85,790 $137.00 $85,810.01 $87,810 $139.00 $87,830.01 $89,830 $139.00 $85,790.01 $87,790 $141.00 $87,810.01 $89,810 $143.00 $89,830.01 $91,830 $143.00 $87,790.01 $89,790 $145.00 $89,810.01 $91,810 $147.00 $91,830.01 $93,830 $147.00 $89,790.01 $91,790 $149.00 $91,810.01 $93,810 $151.00 $93,830.01 $95,830 $151.00 $91,790.01 $93,790 $153.00 $93,810.01 $95,810 $155.00 $95,830.01 $97,830 $155.00 $93,790.01 $95,790 $157.00 $95,810.01 $97,810 $159.00 $97,830.01 $99,830 $159.00 $95,790.01 $97,790 $161.00 $97,810.01 $99,810 $163.00 $99,830.01 $101,830 $164.00 $97,790.01 $99,790 $165.00 $99,810.01 $101,810 $167.00 $101,830.01 $103,830 $169.00 $99,790.01 $101,790 $169.00 $101,810.01 $103,810 $171.00 $103,830.01 $105,830 $174.00 $101,790.01 $103,790 $174.00 $103,810.01 $105,810 $175.00 $105,830.01 $107,830 $179.00 $103,790.01 $105,790 $179.00 $105,810.01 $107,810 $179.00 $107,830.01 $109,830 $184.00 $105,790.01 $107,790 $184.00 $107,810.01 $109,810 $184.00 $109,830.01 $111,830 $189.00 $107,790.01 $109,790 $189.00 $109,810.01 $111,810 $189.00 $111,830.01 $113,830 $194.00 $109,790.01 $111,790 $194.00 $111,810.01 $113,810 $194.00 $113,830.01 $115,830 $199.00 $111,790.01 $113,790 $199.00 $113,810.01 $115,810 $199.00 $115,830.01 $117,830 $204.00 $113,790.01 $115,790 $204.00 $115,810.01 $117,810 $204.00 $117,830.01 $119,830 $209.00 $115,790.01 $117,790 $209.00 $117,810.01 $119,810 $209.00 $119,830.01 $121,830 $214.00 $117,790.01 $119,790 $214.00 $119,810.01 $121,810 $214.00 $121,830.01 $123,830 $219.00 $119,790.01 $121,790 $219.00 $121,810.01 $123,810 $219.00 $123,830.01 $125,830 $224.00 $121,790.01 $123,790 $224.00 $123,810.01 $125,810 $224.00 $125,830.01 $127,830 $229.00 $123,790.01 $125,790 $229.00 $125,810.01 $127,810 $229.00 $127,830.01 $129,830 $234.00 $125,790.01 $127,790 $234.00 $127,810.01 $129,810 $234.00 $129,830.01 $131,830 $239.00 $127,790.01 $129,790 $239.00 $129,810.01 $131,810 $239.00 $131,830.01 $133,830 $244.00 $129,790.01 $131,790 $244.00 $131,810.01 $133,810 $244.00 $133,830.01 $135,830 $249.00 $131,790.01 $133,790 $249.00 $133,810.01 $135,810 $249.00 $135,830.01 $137,830 $254.00 $133,790.01 $135,790 $254.00 $135,810.01 $137,810 $254.00 $137,830.01 $139,830 $259.00 $135,790.01 $137,790 $259.00 $137,810.01 $139,810 $259.00 $139,830.01 $141,830 $264.00 $137,790.01 $139,790 $264.00 $139,810.01 $141,810 $264.00 $141,830.01 $143,830 $270.00 $139,790.01 $141,790 $269.00 $141,810.01 $143,810 $269.00 $143,830.01 $145,830 $276.00 $141,790.01 $143,790 $274.00 $143,810.01 $145,810 $274.00 $145,830.01 $147,830 $282.00 $143,790.01 $145,790 $280.00 $145,810.01 $147,810 $279.00 $147,830.01 $149,830 $288.00 $145,790.01 $147,790 $286.00 $147,810.01 $149,810 $284.00 $149,830.01 $151,830 $294.00 $147,790.01 $149,790 $292.00 $149,810.01 $151,810 $289.00 $151,830.01 $153,830 $300.00 $149,790.01 $151,790 $298.00 $151,810.01 $153,810 $295.00 $153,830.01 $155,830 $306.00 $151,790.01 $153,790 $304.00 $153,810.01 $155,810 $301.00 $155,830.01 $157,830 $312.00 $153,790.01 $155,790 $310.00 $155,810.01 $157,810 $307.00 $157,830.01 $159,830 $318.00 $155,790.01 $157,790 $316.00 $157,810.01 $159,810 $313.00 $159,830.01 $161,830 $324.00 $157,790.01 $159,790 $322.00 $159,810.01 $161,810 $319.00 $161,830.01 $163,830 $330.00 $159,790.01 $161,790 $328.00 $161,810.01 $163,810 $325.00 $163,830.01 $165,830 $336.00 $161,790.01 $163,790 $334.00 $163,810.01 $165,810 $331.00 $165,830.01 $167,830 $342.00 $163,790.01 $165,790 $340.00 $165,810.01 $167,810 $337.00 $167,830.01 $169,830 $348.00 $165,790.01 $167,790 $346.00 $167,810.01 $169,810 $343.00 $169,830.01 $171,830 $353.00 $167,790.01 $168,707 $352.00 $169,810.01 $171,810 $349.00 $171,830.01 $173,830 $358.00 $171,810.01 $173,810 $355.00 $173,830.01 $175,830 $364.00 $173,810.01 $175,810 $361.00 $175,830.01 $177,830 $369.00 $175,810.01 $178,154 $367.00 $177,830.01 $179,830 $373.00 $179,830.01 $181,830 $379.00 $181,830.01 $183,830 $385.00 $183,830.01 $185,830 $390.00 $185,830.01 $187,601 200% FPIG $143,580 200% FPIG $151,620 200% FPIG $159,660
Weekly Family Size: 19 Weekly Family Size: 20 Weekly Family Size: 21 Co-pay Annual Income Co-pay Annual Income Co-pay Annual Income $5.00 Less than: $8,660 $5.00 Less than: $8,660 $5.00 Less than: $8,660 $10.00 $8,660.01 $30,300 $10.00 $8,660.01 $31,230 $10.00 $8,660.01 $33,070 $35.00 $30,300.01 $40,300 $37.00 $31,230.01 $41,330 $39.00 $33,070.01 $43,400 $48.00 $40,300.01 $49,850 $49.00 $41,330.01 $51,870 $52.00 $43,400.01 $53,890 $60.00 $49,850.01 $51,850 $62.00 $51,870.01 $53,870 $65.00 $53,890.01 $55,890 $63.00 $51,850.01 $53,850 $65.00 $53,870.01 $55,870 $68.00 $55,890.01 $57,890 $67.00 $53,850.01 $55,850 $69.00 $55,870.01 $57,870 $71.00 $57,890.01 $59,890 $71.00 $55,850.01 $57,850 $73.00 $57,870.01 $59,870 $75.00 $59,890.01 $61,890 $75.00 $57,850.01 $59,850 $77.00 $59,870.01 $61,870 $79.00 $61,890.01 $63,890 $79.00 $59,850.01 $61,850 $81.00 $61,870.01 $63,870 $83.00 $63,890.01 $65,890 $83.00 $61,850.01 $63,850 $85.00 $63,870.01 $65,870 $87.00 $65,890.01 $67,890 $87.00 $63,850.01 $65,850 $89.00 $65,870.01 $67,870 $91.00 $67,890.01 $69,890 $91.00 $65,850.01 $67,850 $93.00 $67,870.01 $69,870 $95.00 $69,890.01 $71,890 $95.00 $67,850.01 $69,850 $97.00 $69,870.01 $71,870 $99.00 $71,890.01 $73,890 $99.00 $69,850.01 $71,850 $101.00 $71,870.01 $73,870 $103.00 $73,890.01 $75,890 $103.00 $71,850.01 $73,850 $105.00 $73,870.01 $75,870 $107.00 $75,890.01 $77,890 $107.00 $73,850.01 $75,850 $109.00 $75,870.01 $77,870 $111.00 $77,890.01 $79,890 $111.00 $75,850.01 $77,850 $113.00 $77,870.01 $79,870 $115.00 $79,890.01 $81,890 $115.00 $77,850.01 $79,850 $117.00 $79,870.01 $81,870 $119.00 $81,890.01 $83,890 $120.00 $79,850.01 $81,850 $122.00 $81,870.01 $83,870 $123.00 $83,890.01 $85,890 $125.00 $81,850.01 $83,850 $127.00 $83,870.01 $85,870 $128.00 $85,890.01 $87,890 $129.00 $83,850.01 $85,850 $132.00 $85,870.01 $87,870 $133.00 $87,890.01 $89,890 $133.00 $85,850.01 $87,850 $136.00 $87,870.01 $89,870 $138.00 $89,890.01 $91,890 $137.00 $87,850.01 $89,850 $140.00 $89,870.01 $91,870 $142.00 $91,890.01 $93,890 $141.00 $89,850.01 $91,850 $144.00 $91,870.01 $93,870 $146.00 $93,890.01 $95,890 $145.00 $91,850.01 $93,850 $148.00 $93,870.01 $95,870 $150.00 $95,890.01 $97,890 $149.00 $93,850.01 $95,850 $152.00 $95,870.01 $97,870 $154.00 $97,890.01 $99,890 $153.00 $95,850.01 $97,850 $156.00 $97,870.01 $99,870 $158.00 $99,890.01 $101,890 $157.00 $97,850.01 $99,850 $160.00 $99,870.01 $101,870 $162.00 $101,890.01 $103,890 $161.00 $99,850.01 $101,850 $164.00 $101,870.01 $103,870 $166.00 $103,890.01 $105,890 $165.00 $101,850.01 $103,850 $168.00 $103,870.01 $105,870 $170.00 $105,890.01 $107,890 $169.00 $103,850.01 $105,850 $172.00 $105,870.01 $107,870 $174.00 $107,890.01 $109,890 $173.00 $105,850.01 $107,850 $176.00 $107,870.01 $109,870 $178.00 $109,890.01 $111,890 $177.00 $107,850.01 $109,850 $180.00 $109,870.01 $111,870 $182.00 $111,890.01 $113,890 $181.00 $109,850.01 $111,850 $184.00 $111,870.01 $113,870 $186.00 $113,890.01 $115,890 $185.00 $111,850.01 $113,850 $188.00 $113,870.01 $115,870 $190.00 $115,890.01 $117,890 $189.00 $113,850.01 $115,850 $192.00 $115,870.01 $117,870 $194.00 $117,890.01 $119,890 $194.00 $115,850.01 $117,850 $196.00 $117,870.01 $119,870 $198.00 $119,890.01 $121,890 $199.00 $117,850.01 $119,850 $201.00 $119,870.01 $121,870 $202.00 $121,890.01 $123,890 $204.00 $119,850.01 $121,850 $206.00 $121,870.01 $123,870 $207.00 $123,890.01 $125,890 $209.00 $121,850.01 $123,850 $211.00 $123,870.01 $125,870 $212.00 $125,890.01 $127,890 $214.00 $123,850.01 $125,850 $216.00 $125,870.01 $127,870 $217.00 $127,890.01 $129,890 $219.00 $125,850.01 $127,850 $221.00 $127,870.01 $129,870 $222.00 $129,890.01 $131,890 $224.00 $127,850.01 $129,850 $226.00 $129,870.01 $131,870 $227.00 $131,890.01 $133,890 $229.00 $129,850.01 $131,850 $231.00 $131,870.01 $133,870 $232.00 $133,890.01 $135,890 $234.00 $131,850.01 $133,850 $236.00 $133,870.01 $135,870 $237.00 $135,890.01 $137,890 $239.00 $133,850.01 $135,850 $241.00 $135,870.01 $137,870 $242.00 $137,890.01 $139,890 $244.00 $135,850.01 $137,850 $246.00 $137,870.01 $139,870 $247.00 $139,890.01 $141,890 $249.00 $137,850.01 $139,850 $251.00 $139,870.01 $141,870 $252.00 $141,890.01 $143,890 $254.00 $139,850.01 $141,850 $256.00 $141,870.01 $143,870 $257.00 $143,890.01 $145,890 $259.00 $141,850.01 $143,850 $261.00 $143,870.01 $145,870 $262.00 $145,890.01 $147,890 $264.00 $143,850.01 $145,850 $266.00 $145,870.01 $147,870 $267.00 $147,890.01 $149,890 $269.00 $145,850.01 $147,850 $271.00 $147,870.01 $149,870 $272.00 $149,890.01 $151,890 $274.00 $147,850.01 $149,850 $276.00 $149,870.01 $151,870 $277.00 $151,890.01 $153,890 $279.00 $149,850.01 $151,850 $281.00 $151,870.01 $153,870 $282.00 $153,890.01 $155,890 $284.00 $151,850.01 $153,850 $286.00 $153,870.01 $155,870 $287.00 $155,890.01 $157,890 $289.00 $153,850.01 $155,850 $291.00 $155,870.01 $157,870 $292.00 $157,890.01 $159,890 $294.00 $155,850.01 $157,850 $296.00 $157,870.01 $159,870 $297.00 $159,890.01 $161,890 $299.00 $157,850.01 $159,850 $301.00 $159,870.01 $161,870 $302.00 $161,890.01 $163,890 $304.00 $159,850.01 $161,850 $306.00 $161,870.01 $163,870 $307.00 $163,890.01 $165,890 $309.00 $161,850.01 $163,850 $311.00 $163,870.01 $165,870 $312.00 $165,890.01 $167,890 $315.00 $163,850.01 $165,850 $316.00 $165,870.01 $167,870 $317.00 $167,890.01 $169,890 $321.00 $165,850.01 $167,850 $321.00 $167,870.01 $169,870 $322.00 $169,890.01 $171,890 $327.00 $167,850.01 $169,850 $327.00 $169,870.01 $171,870 $327.00 $171,890.01 $173,890 $333.00 $169,850.01 $171,850 $333.00 $171,870.01 $173,870 $332.00 $173,890.01 $175,890 $339.00 $171,850.01 $173,850 $339.00 $173,870.01 $175,870 $338.00 $175,890.01 $177,890 $345.00 $173,850.01 $175,850 $345.00 $175,870.01 $177,870 $344.00 $177,890.01 $179,890 $351.00 $175,850.01 $177,850 $351.00 $177,870.01 $179,870 $350.00 $179,890.01 $181,890 $357.00 $177,850.01 $179,850 $357.00 $179,870.01 $181,870 $356.00 $181,890.01 $183,890 $363.00 $179,850.01 $181,850 $363.00 $181,870.01 $183,870 $362.00 $183,890.01 $185,890 $369.00 $181,850.01 $183,850 $369.00 $183,870.01 $185,870 $368.00 $185,890.01 $187,890 $375.00 $183,850.01 $185,850 $375.00 $185,870.01 $187,870 $374.00 $187,890.01 $189,890 $381.00 $185,850.01 $187,850 $381.00 $187,870.01 $189,870 $380.00 $189,890.01 $191,890 $387.00 $187,850.01 $189,850 $387.00 $189,870.01 $191,870 $386.00 $191,890.01 $193,890 $393.00 $189,850.01 $191,850 $393.00 $191,870.01 $193,870 $392.00 $193,890.01 $195,890 $399.00 $191,850.01 $193,850 $399.00 $193,870.01 $195,870 $398.00 $195,890.01 $197,890 $405.00 $193,850.01 $195,850 $405.00 $195,870.01 $197,870 $404.00 $197,890.01 $199,890 $411.00 $195,850.01 $197,048 $411.00 $197,870.01 $199,870 $410.00 $199,890.01 $201,890 $417.00 $199,870.01 $201,870 $416.00 $201,890.01 $203,890 $423.00 $201,870.01 $203,870 $422.00 $203,890.01 $205,890 $428.00 $203,870.01 $205,870 $428.00 $205,890.01 $207,890 $433.00 $205,870.01 $206,495 $434.00 $207,890.01 $209,890 $439.00 $209,890.01 $211,890 $444.00 $211,890.01 $213,890 $449.00 $213,890.01 $215,942 200% FPIG $167,700 200% FPIG $175,740 200% FPIG $183,780
[Pa.B. Doc. No. 13-826. Filed for public inspection May 3, 2013, 9:00 a.m.]
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