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Spousal coverage surcharge

A $50 premium surcharge may apply to you if you have a spouse or state-registered domestic partner (SRDP) enrolled on your medical coverage.

How do I attest (respond)?

Step one: find out if you need to attest

Use the Premium Surcharge Attestation Help Sheet (pdf) or the online spousal plan questionnaire (2021) to determine if you must pay the surcharge.

  • You WILL NOT be charged the premium surcharge if you
  • You MAY be charged the premium surcharge if you:
    • Answer YES to ALL of the questions on the help sheet or questionnaire. To determine whether you will be charged the premium surcharge, you will need to:
      • Ask your spouse or state-registered domestic partner (SRDP) for a Summary of Benefits and Coverage (SBC) for all medical plans that service their county of residence, and have a monthly premium of  less than $109.26 (2021) or $114.01 (2022) per month for the employee.
      • Use the 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 boxes on the appropriate enrollment/change form or submit the Premium Surcharge Attestation Change form.

Note: Pierce County, Washington State University, and University of Washington employees must attest through Workday.

Who needs to attest (respond)?

You need to respond to this surcharge if you are enrolling your spouse or SRDP on your medical coverage 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 (unpaid leave)

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 SRDP on your medical coverage. 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 SRDP on your medical coverage.

What happens if I do not respond?

You will be charged the $50 premium surcharge in addition to your medical plan premium if you have a spouse or SRDP enrolled on your medical coverage.

How do I report a change (reattest)?

If you plan to continue medical coverage for your spouse or SRDP for the next year, you must reattest to the spousal surcharge during open enrollment.

Step one: find out if you need to attest

Use the PEBB Premium Surcharge Attestation Help Sheet (pdf) or the online spousal plan questionnaire (2021) to determine if you must pay the surcharge.

  • You WILL NOT be charged the premium surcharge if you:
  • You MAY be charged the premium surcharge if you:
    • Answer YES to ALL of the questions on the help sheet or questionnaire. To determine whether you will be charged the premium surcharge,  you will need to:
      • Ask your spouse or SRDP for a Summary of Benefits and Coverage (SBC) for all medical plans that service their county of residence, and have a monthly premium of less than $109.26 (2021) or $114.01 (2022) per month for the employee.
      • Use the SBC information to answer the questions in the Spousal Plan Calculator (interactive tool) or (pdf) to determine if the surcharge applies.

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

Note: Pierce County, Washington State University, and University of Washington employees must reattest through Workday.

When can I report a change?

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

  • When adding a spouse or SRDP to your PEBB medical benefits.
  • During open enrollment.
  • Within 31 days of the day you regain eligibility for the employer contribution toward PEBB benefits.
  • Within 60 days of the event: If there is a change in your spouse’s or SRDP's employer-based group medical insurance.

Note: Pierce County, Washington State University, and University of Washington employees must report a change through Workday.

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 SRDP coverage premium surcharge?

A monthly $50 surcharge will apply in addition to your medical plan premium if you have a spouse or SRDP enrolled on your medical coverage, 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

Employees: Your payroll or benefits office

All other subscribers: The PEBB Program