Due to COVID-19, HCA’s lobby is closed. Learn more about HCA's customer service options during the pandemic.

If you are displaced or impacted by flooding, all PEBB and SEBB medical plans are allowing prescription refills before the refill date.

Spousal plan questionnaire 2022

 
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Use this questionnaire to determine if you need to pay a premium surcharge for your spouse or state-registered domestic partner (SRDP).

If you don’t have a spouse or SRDP on your PEBB medical plan, you don’t need to complete this questionnaire – this surcharge doesn’t apply to you.

If you have a spouse or SRDP enrolled on your 2022 PEBB medical plan, you must:

  1. Answer YES to question 1 (the only option)
  2. YES or NO to questions 2- 6

    AND
  3. Check the corresponding boxes on your 2022 enrollment/change form or 2022 Premium Surcharge Attestation Change form and return to your payroll or benefits office (employees) or the PEBB Program (retirees and continuation coverage only).