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.

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.

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.

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.