HCA’s lobby is now open for walk-in customer service. Learn about customer service options.
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 2022 SEBB medical plan, you must: