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If you have selected a designated medical provider, we must allow a credit Of 2.5%. If you are eligible for schedule rating, <br />the 2.5% credit must be included in the total schedule credit or debit, subject to the 25% maximum limitation. <br />If you are not eligible for experience or schedule rating, the 2.5% credit will be applied, in addition to the premium credit <br />applicable. The combined premium credit and the 2.5% credit for selection of a designated medical provider shall not <br />exceed 12.5% <br />Schedule <br />% Premium Credit Certified Risk Management Program/Designated Medical Provider <br />Form WC 05 04 03 Printed in U.S.A. <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />--� Risk janagement Analyst <br />