Forms & publications

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Spousal plan calculator form 2018

50-027-2018

Use this noninteractive form if you answered 'YES' to all the questions in the 2018 Premium Surcharge Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form

Spousal plan calculator form 2019

50-027-2019

Use this form if you answered 'YES' to all the questions in the 2019 Premium Surcharge Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.

Form

Spousal plan calculator tool 2018 (xls)

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 Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form

Spousal plan calculator tool 2019 (xls)

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 Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form