Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.

HCA is closed Thursday, November 26 and Friday, November 27. All Apple Health (Medicaid), PEBB, and SEBB customer services phones lines will be down after 5 p.m. Wednesday, November 25 through Monday morning, November 30.

Spousal plan questionnaire 2021

 
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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 SEBB medical plan, you don’t need to complete this questionnaire. This surcharge does not apply to you.

If you have a spouse or SRDP enrolled on your 2021 SEBB 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 in SEBB My Account (for school employees) or on your 2021 enrollment/change form (for SEBB Continuation Coverage members).