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Spousal Plan Calculator Form (PEBB) 2024 (pdf)

This is the 2024 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are enrolling a spouse or state-registered domestic partner.

50-0027
Form

Spousal Surcharge Calculator Tool (PEBB) 2024 (xls)

This is the 2024 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are enrolling a spouse or state-registered domestic partner.

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