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.)

Do you (or will you) have a spouse or registered domestic partner enrolled on your PEBB medical coverage?

YES

If you are one of the following subscribers, you need to attest to this surcharge:

  • Employee
  • Retiree not enrolled in Medicare Part A and Part B
  • COBRA not enrolled in Medicare Part A and Part B
  • Leave Without Pay

If you are not one of these subscribers, this surcharge doesn’t apply to your account. You don’t need to respond.

NO

The spousal coverage premium surcharge doesn’t apply to your account. You don’t need to respond.

How do I respond to the spouse or registered domestic partner coverage premium surcharge?

To respond for 2015

If you are an existing subscriber whose spouse or registered domestic partner is already enrolled in PEBB medical coverage:

  • Attest on My Account starting November 1, 2014, OR
  • Complete and submit the 2015 Premium Surcharge Change Form starting November 1, 2014. Use the 2015 Premium Surcharge Help Sheet to fill out the form.

If you are an existing subscriber whose spouse or registered domestic partner is not enrolled in PEBB medical coverage in 2014, but is enrolling effective January 1, 2015:

  • Complete and submit the appropriate 2015 enrollment form starting November 1, 2014 as directed on the form. Use the 2015 Premium Surcharge Help Sheet to fill out the form.

If you are a new subscriber whose spouse or registered domestic partner is enrolling in PEBB medical coverage effective January 1, 2015:

  • Complete and submit the appropriate 2015 enrollment form starting November 1, 2014 as directed on the form. Use the 2015 Premium Surcharge Help Sheet to fill out the form.

Tools to help respond for 2015–available November 1, 2014

  • 2015 Premium Surcharge Help Sheet
  • 2015 Spousal Plan Calculator (online tool)
  • 2015 Spousal Plan Calculator (print version)

To respond for 2014

If you are an existing subscriber whose spouse or registered domestic partner is already enrolled in PEBB medical coverage, and you need to change your attestation:

  • Complete and submit the 2014 Premium Surcharge Change Form (use this Surcharge Help Sheet to fill out the form), AND
  • Remember to also attest for 2015 starting November 1, 2014, using either:
    • 2015 Premium Surcharge Change Form. Use the 2015 Premium Surcharge Help Sheet to fill out the form.

If you are an existing subscriber who is enrolling a spouse or registered domestic partner on your PEBB medical coverage in November 2014 or December 2014:

If you are a new subscriber who is enrolling a spouse or registered domestic partner on your PEBB medical coverage in November 2014 or December 2014:

Tools to help respond 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.