Spousal plan calculator form (PEBB) 2020

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This is the 2020 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2020 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.

Form

Spousal plan calculator tool (PEBB) 2020 (xls)

This is the 2020 spousal plan calculator. Use this interactive calculator tool to determine if the spousal premium surcharge applies to you if you answered 'YES' to all the questions in the Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form