Forms & publications

Spousal Plan Calculator (PEBB) 2023 (pdf)

This is the 2023 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2023 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.
  • 50-0027
  • Form

Spousal Plan Calculator form (PEBB) 2022 (pdf)

This is the 2022 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2022 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.
  • 50-0027
  • Form

Spousal Plan Calculator Tool (PEBB) 2023 (xls)

This is the 2023 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2023 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.
  • Form

Spousal Surcharge Calculator Tool (PEBB) 2022 (xls)

This is the 2022 Spousal plan calculator tool. Use this form if you answered 'YES' to all the questions in the 2022 Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.
  • Form