Spousal coverage surcharge
A $50Â premium surcharge may apply to you if you have a spouse or state-registered domestic partner enrolled on your SEBB medical coverage.
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What is the spouse or state-registered domestic partner coverage premium surcharge?
A $50 premium surcharge will be charged, in addition to your monthly medical plan premium, if you have a spouse or state-registered domestic partner (SRDP) enrolled on your SEBB medical coverage and they have elected not to enroll in their employer-based group medical insurance that is comparable to the PEBB Program’s Uniform Medical Plan (UMP) Classic. The comparison must be to the PEBB Program’s UMP Classic, even if you are not enrolled in that plan.
Who needs to attest?
You need to attest to this premium surcharge if you are enrolling your spouse or SRDP on your SEBB medical coverage.
You do not need to attest if you are not enrolling your spouse or SRDPÂ on your SEBB medical. The premium surcharge does not apply to you.
How do I attest?
Step one: find out if you need to attest
Use the Premium Surcharge Attestation Help Sheet (pdf)Â to determine if the surcharge applies to you.
- You WILL NOTÂ be charged the premium surcharge if you:
- Answer NO to ANY of the questions in SEBB My Account, on the help sheet AND
- Check NO in SEBB My Account, on your enrollment/change form, or on your Premium Surcharge Attestation Change form. (If you check YES, you will be charged surcharge.)
- You WILL be charged the premium surcharge if you:
- Answer YES to ALL of the questions on the help sheet. In addition, you will need to:
- Ask your spouse or SRDP to ask their employer for a Summary of Benefits and Coverage (SBC) for all medical plans that service the county of residence for them, and have a monthly premium of $137.76 (2023) per month for the employee.
- Use the SBC information to answer the questions in the Spousal Plan Calculator (interactive tool) or (pdf) to determine if the surcharge applies to you.
- Answer YES to ALL of the questions on the help sheet. In addition, you will need to:
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.
Step two: complete your attestation
- Employees: Sign into SEBB My Account and select Attestations. Answer Yes or No to the questions 1 through 6.
- SEBB Continuation Coverage subscribers: Use the election/change form for COBRA or Unpaid Leave.
Check the boxes on the appropriate enrollment/change form or submit the Premium Surcharge Attestation Change form.
What happens if I do not attest?
If you have a spouse or SRDP enrolled on your SEBB medical coverage and you do not attest, you will be charged the $50 premium surcharge in addition to your medical plan premium.
Do I need to attest every year?
If you cover your spouse or SRDP on your SEBB medical coverage for next year, you may need to reattest to the spousal surcharge during open enrollment.
How do I report a change (reattest)?
If you cover your spouse or SRDP on your SEBB medical coverage for next year, you may need to reattest to the spousal surcharge during open enrollment.
Step one: find out if you need to attest
Use the Premium Surcharge Attestation Help Sheet (pdf)Â to determine if the surcharge applies to you.
- You WILL NOT be charged the premium surcharge if you:
- Answer NO to ANY of the questions on the help sheet, AND
- Check NO on your enrollment/change form or Premium Surcharge Attestation Change form. (If you check YES, you will be charged the surcharge.)
- You WILL be charged the premium surcharge if you:
- Answer YES to ALL of the questions on the help sheet. In addition, you will need to:
- Ask your spouse or SRDP to ask their employer for a Summary of Benefits and Coverage (SBC) for all medical plans that service their county of residence and that have a monthly premium of or $137.76 (2023) per month for the employee.
- Use the SBC information to answer the questions in the Spousal Plan Calculator (interactive tool) or (pdf) to determine if the surcharge applies to you.
- Answer YES to ALL of the questions on the help sheet. In addition, you will need to:
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.
Step two: complete your attestation
- If adding a spouse or SRDP to your SEBB medical, you must respond to the spousal coverage surcharge using SEBB My Account or the appropriate enrollment/change form. SEBB Continuation Coverage subscribers: Use the election/change form for COBRA or Unpaid Leave..
- If you are reporting a change, complete the Premium Surcharge Attestation Change form.
When can I report a change?
You can only report a change to this surcharge in the following situations:
- When adding a spouse or SRDP to your SEBB medical coverage.
- Within 31 days of the day you regain eligibility for the employer contribution toward SEBBÂ benefits.
- Within 60 days of a change in your spouse’s or SRDP’s employer-based group medical insurance.
When will my attestation change take effect?
If you submit a change that results in incurring the premium surcharge, the change is effective the first of the month following the status change. If the status change occurs on the first of the month, then the change begins on that day.
If the change results in removal of the premium surcharge, the change is effective the first day of the month after receipt of the attestation. If the status change occurs on the first of the month, then the change begins that day.