Spousal Plan Calculator Tool (SEBB) 2021 (xls)

This is the 2021 SEBB 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 (SEBB) 2022 (xls)

This is the 2022 SEBB 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