Spousal coverage surcharge

A $50 monthly surcharge may apply to you if you have a spouse or state-registered domestic partner enrolled on your PEBB Program medical.

How do I attest (respond)?

Step one: Find out if you need to attest

Use the Premium Surcharge Help Sheet (pdf) or spousal plan questionnaire (online) to determine if you must pay the surcharge.

  • You WILL NOT have to pay the surcharge if you
  • You WILL have to pay the surcharge if you:
    • Answer YES to ALL of the questions on the help sheet or questionnaire. In addition, you will need to:
      • Ask your spouse or state-registered domestic partner to ask his or her employer for a 2017 Summary of Benefits and Coverage (SBC) for all medical plans that service the county of residence for your spouse or state-registered domestic partner, and have a monthly premium of $98.81 per month for the employee.
      • Use the 2017 SBC information to answer the questions in the Spousal Plan Calculator (interactive tool) or (pdf) to determine if you must pay the surcharge.
Note: If you use the interactive version of the spousal plan calculator, you must click Enable Content for the calculator to work. Do not print or submit the interactive tool.

Step two: Complete your attestation

Check the corresponding box(es) on the appropriate enrollment/change form or complete the Premium Surcharge Change form and submit as directed on the form.

Who needs to attest (respond)?

You need to respond to this surcharge if you are enrolling your spouse or state-registered domestic partner on your PEBB Program medical and you are one of the following medical plan subscribers:

  • Employee
  • Retiree not enrolled in Medicare Part A and Part B
  • COBRA not enrolled in Medicare Part A and Part B
  • Continuation Coverage (formerly LWOP)

You do not need to respond if you are not one of the subscribers listed above, or if you are not enrolling your spouse or state-registered domestic partner on your PEBB Program medical. The surcharge will not apply to your account.

Who does not need to attest (respond)?

You do not need to respond if:

  • You are not one of the subscribers listed above, or
  • If you are not enrolling your spouse or state-registered domestic partner on your PEBB Program medical.

What happens if I do not respond?

You will pay a monthly $50 surcharge in addition to your medical plan premium if you have a spouse or state-registered domestic partner enrolled on your PEBB Program medical.

How do I report a change (reattest)?

If you plan to continue PEBB medical coverage for your spouse or state-registered domestic partner for the next year, you must reattest to the spousal surcharge during the PEBB Program's annual open enrollment (November 1-30).

Step one: Find out if you need to attest

Use the Premium Surcharge Help Sheet (pdf) or spousal plan questionnaire (online) to determine if you must pay the surcharge.

  • You will not have to pay the surcharge if you:
  • You will have to pay the surcharge if you:
    • Answer YES to ALL of the questions on the help sheet or questionnaire. In addition,  you will need to:
      • Ask your spouse or state-registered domestic partner to ask his or her employer for a 2017 Summary of Benefits and Coverage (SBC) for all medical plans that service the county of residence for your spouse or state-registered domestic partner, and have a monthly premium of $98.81 per month for the employee.
      • Use the 2017 SBC information to answer the questions in the Spousal Plan Calculator (interactive tool) or (pdf) to determine if you must pay the surcharge.
Note: If you use the interactive version of the spousal plan calculator, you must click Enable Content for the calculator to work. Do not print or submit the interactive tool.

Step two: Complete your attestation

  • If adding a spouse or state-registered domestic partner to your PEBB Program medical, you must respond to the spousal coverage surcharge using the appropriate enrollment/change form.
  • If you are reporting a change, complete the Premium Surcharge Change form and submit as directed on the form.

    OR

  • Log in to My Account (only during the PEBB Program's annual open enrollment period November 1-30).

When can I report a change?

You can only report a change to this surcharge in the following situations:

  • When adding a spouse or state-registered domestic partner: To your PEBB Program medical benefits.
  • During the PEBB Program's annual open enrollment: November 1–30.
  • Within 31 days of the day you regain eligibility for the employer contribution: Toward PEBB Program benefits.
  • Within 60 days of the event: If there is a change in your spouse’s or state-registered domestic partner’s employer-based group medical insurance.

When will my attestation or change take effect?

If you submit a change that results in incurring the premium surcharge, the change is effective the first of the month following the status change. If that day is the first of the month, then the change begins on that day.

If the change results in removal of the premium surcharge, the change is effective the first of the month following receipt of the attestation. If that day is the first of the month, then the change begins that day.

What is the spouse or state-registered domestic partner coverage premium surcharge?

A monthly $50 surcharge will apply in addition to your medical plan premium if you have a spouse or state-registered domestic partner enrolled on your PEBB medical, and they have elected not to enroll in their 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.)

You must attest (respond) to the premium surcharge to find out whether it applies to your account.

Contact

Your personnel, payroll, or benefits office