PEBB - Spouse or Domestic Partner Coverage Premium Surcharge

 Take action now

Log in to My Account to update your responses to the premium surcharges now.

New employee or retiree?

See information on attestation and how to submit your enrollment forms under How to Enroll

About the spouse or domestic partner
coverage premium surcharge​

A monthly $50 surcharge will be required in addition to your premium if you have a spouse or domestic partner enrolled on your PEBB medical coverage, and your spouse or domestic partner has chosen not to enroll in medical coverage through his or her employer that is comparable to Uniform Medical Plan (UMP) Classic.

 

  Frequently asked questions

 

Do you have a spouse or domestic partner enrolled on your PEBB medical coverage?

YES

 

NO 

  Use the Spousal Plan Questionnaire   
  to find out if you have to pay this surcharge.

  Complete the Premium Surcharge Attestation Form

This surcharge doesn't apply to your account.

You don't need to respond.

If you did not fully respond to the surcharge between April 1 and May 15, 2014, or need to change your attestation:

To respond during this time period:​ ​Follow these steps:

July 1 – August 29, 2014​

​Go to My Account to attest. (You will need to register as a new user if you haven’t registered since October 1, 2013.)

What will happen? If you respond that the spousal coverage surcharge does not apply, we will refund any surcharge(s) paid in July and/or August.

August 30, 2014 or later​

​You can attest using the Premium Surcharge Change Form, available on the Forms page starting August 30, 2014.

What will happen? If you respond that the spousal coverage surcharge does not apply, this will affect only surcharges starting the first of the month after your employer (if an employee) or the PEBB Program (all others) receive the form. If you submit the form on the first day of the month, the changes begin that day.

You will not qualify for a refund of any surcharge(s) paid in July and/or August 2014.

  

 What’s considered a change for my spouse or domestic partner coverage attestation?