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Spousal plan calculator

Use the Spousal Plan Calculator to determine if you need to pay the spousal surcharge.

Download the calculator now

How to use the Spousal Plan Calculator

If you answered YES to ALL of the questions on the PEBB Premium Surcharge Attestation Help Sheet (pdf) or the online spousal plan questionnaire (2020), answer the questions in the PEBB 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.

Use the Summary of Benefits and Coverage from your spouse's or state-registered domestic partner's employer-sponsored medical plan(s) to answer the Spousal Plan Calculator questions. The plan(s) must:

  • Serve your spouse's or state-registered domestic partner's county of residence, and
  • Cost less than $108.31 (2020) for the employee's share of the monthly premium.

Complete the calculator for each medical plan that meets the criteria above, one plan at a time. Then click Calculate. If you are entering more than one plan, and at lease one results in "You will have to pay the surcharge," then you will have to pay the surcharge.

Need help?

These pages will help you answer the questions in the Spousal Plan Calculator.

Help for question 1

Help for question 2

Help for question 3

Help for question 4

Help for question 5

Help for question 6

Help for question 7

Complete your attestation:

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


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

Note: University of Washington employees must attest through Workday.