About the spouse or registered domestic partner coverage premium surcharge
A monthly $50 surcharge is required in addition to your premium if you have a spouse or registered domestic partner enrolled on your PEBB medical coverage, and your spouse or registered domestic partner has chosen not to enroll in employer-based group medical insurance that is comparable to Uniform Medical Plan (UMP) Classic. (Comparison must be to UMP Classic even if you are not enrolled in the plan.)
Who needs to attest?
You need to attest to this surcharge if you are enrolling your spouse or registered domestic partner on your PEBB medical coverage and you are one of the following subscribers:
- Retiree not enrolled in Medicare Part A and Part B
- COBRA not enrolled in Medicare Part A and Part B
- Leave Without Pay (LWOP)
You do not need to attest if you are not one of these subscribers, or if you are not enrolling your spouse or registered domestic partner on your PEBB medical coverage. This surcharge doesn’t apply to your account.
What happens if I don’t attest?
You will pay a monthly $50 surcharge if you have a spouse or registered domestic partner enrolled on your medical coverage.
How do I attest for 2015?
Use My Account for the effective date of January 1, 2015.
Tools to help attest for 2015
Note: When you launch the 2015 Spousal Plan Calculator interactive tool, you must click Enable Content for the calculator to work. Do not print or submit the interactive tool.
How do I attest for 2014?
New or existing subscriber who is enrolling a spouse or registered domestic partner on their PEBB medical coverage in November or December 2014 must complete and submit the appropriate 2014 enrollment form AND the Premium Surcharge Attestation Form (use this Surcharge Help Sheet to fill out the form).
Due to changes in premiums for the UMP Classic, your attestation for 2014 cannot carry over to 2015. Complete and submit the 2015 Premium Surcharge Change Form to attest for 2015.
Tools to help attest for 2014
When do my attestations (or changes) take effect?
Generally, attestation changes will affect surcharges starting the first of the month after the changes were received. If attestation changes are received on the first day of the month, the change begins that day. Attestation changes for the 2015 spouse or registered domestic partner coverage surcharge will be effective January 1, 2015.