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Spousal plan calculator
If you answered YES to ALL of the questions on the PEBB Premium Surcharge Attestation Help Sheet (pdf) or the online spousal plan questionnaire 2021, answer the questions in the PEBB Spousal Plan Calculator (interactive tool) or (pdf) to determine if you must pay the surcharge.
Note: If you use the interactive version of the spousal plan calculator, you must click Enable Content for the calculator to work. Do not print or submit the interactive tool.
Use the Summary of Benefits and Coverage from your spouse's or state-registered domestic partner's employer-sponsored medical plans to answer the Spousal Plan Calculator questions. The plans must:
- Serve your spouse's or state-registered domestic partner's county of residence, and
- Cost less than $109.26 (2021) for the employee's share of the monthly premium.
Complete the calculator for each medical plan that meets the criteria above, one plan at a time. Then click Calculate. If you are entering more than one plan, and at lease one results in "You will have to pay the surcharge," then you will have to pay the surcharge.
These pages will help you answer the questions in the Spousal Plan Calculator.
- If adding a spouse or state-registered domestic partner to your PEBB medical plan, you must respond to the spousal coverage surcharge using the appropriate enrollment/change form.
- If you are reporting a change, complete the PEBB Premium Surcharge Attestation Change form and submit as directed on the form.
- Log in to PEBB My Account (only during the PEBB Program's annual open enrollment period).
Note: University of Washington employees must attest through Workday.