Premium surcharge attestation change form (PEBB) 2020

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This is the 2020 PEBB Premium Surcharge Attestation Change form. Use this form to report a change that affects your surcharge for tobacco use and/or spouse or state-registered domestic partner coverage.

Form

Premium surcharge attestation change form (SEBB) 2020

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This is the 2020 SEBB Premium Surcharge Attestation Change form. Use this form to report a change that affects your surcharge for tobacco use and/or spouse or state-registered domestic partner coverage.

Form

Premium surcharge attestation help sheet (PEBB) 2020

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This is the 2020 Premium Surcharge Attestation Help Sheet. Use the information on this help sheet to attest on your enrollment form or the Premium Surcharge form whether the premium surcharges for tobacco use or spouse/state-registered domestic partner apply.

Form

Premium surcharge attestation help sheet (SEBB) 2020

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This is the 2020 SEBB Premium Surcharge Attestation Help Sheet. Use the information on this help sheet to attest on your enrollment form or the Premium Surcharge form whether the premium surcharges for tobacco use or spouse/state-registered domestic partner apply.

Form

Spousal plan calculator form (PEBB) 2020

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This is the 2020 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 form (SEBB) 2020

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This is the 2020 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 (PEBB) 2020 (xls)

This is the 2020 spousal plan calculator. 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 Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form

Spousal plan calculator tool (SEBB) 2020 (xls)

This is the 2020 spousal plan calculator. 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 SEBB Premium Surcharge Attestation Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your SEBB medical.

Form