PEBB - Spouse or Domestic Partner Coverage Premium Surcharge

Need to change or update?

Use the Premium Surcharge Change Form. You cannot change or update your surcharge attestation on My Account at this time.

New employee or retiree?

See 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.

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.