Premium surcharges

Information for all employers regarding the premium surcharges associated with enrolling in a Public Employees Benefits Board (PEBB) medical plan.

Tobacco use premium surcharge

A monthly $25 surcharge will be added, in addition to an employee's medical premium, if the employee or any dependent(s), age 13 and older and enrolled in PEBB medical, uses a tobacco product.

"Tobacco use" means any use of tobacco products within the past two months. Learn more about tobacco use and what tobacco products apply on the Public employees website.

Employees are not required to attest (respond) to the tobacco use surcharge if PEBB medical is waived or for dependents who are under age 13.

When are employees required to attest to the tobacco surcharge?

Employees enrolling in a PEBB Medical plan must attest to the tobacco use surcharge for themselves and any dependent(s), age 13 and older who are also being enrolled in the employee's medical plan, during the required time frames:

No later than 31 days after becoming newly eligible or regaining eligibility for the employer contribution toward PEBB benefits.
No later than 60 days after a qualifying special open enrollment event, which allows the employee to enroll in PEBB medical after waiving or allows for the enrollment of a dependent in PEBB medical. Proof of the qualifying event is required (PEBB Policy Addendum 45-2A).

How do employees attest to the tobacco surcharge?

Employees attest to the tobacco surcharge using Benefits 24/7 or the appropriate employee enrollment form.

Employee Enrollment/Change form (2025, 2026)
Employee Enrollment/Change form - medical only (2025, 2026)

Note: Pierce County, Washington State University, and University of Washington employees must attest through Workday.

What if an employee does not attest to the tobacco surcharge?

Employees who enroll in a PEBB medical plan, but do not attest to their tobacco use and their dependent's tobacco use (if applicable) within the required time frame, will default to incur the $25 premium surcharge in addition to their medical plan premium.

When can employees report a change (reattest) to the tobacco surcharge?

Employees may change their or their dependent’s tobacco use attestation at any time throughout the year if:

The employee or any enrolled dependent, age 13 and older, has stopped using tobacco products for two months.
The employee or any enrolled dependent, age 18 and older, enrolls in a PEBB medical plan’s tobacco cessation program.
Any enrolled dependents, age 13-17, access the information and resources in Smokefree Teen.

Employees must change their or their dependent’s tobacco use attestation when:

The employee or any enrolled dependent, age 13 and older, starts using a tobacco product.
The employee or any enrolled dependent, age 13 or older, stops participating in their PEBB medical plan’s tobacco cessation program.

How do employees report a change (reattest) to the tobacco surcharge?

Employees may reattest to their tobacco use by:

Using Benefits 24/7 (at any time throughout the year), or
Completing and submitting the Premium Surcharge Attestation Change form (2025, 2026) to their BA for processing.

Note: Pierce County, Washington State University, and University of Washington employees must reattest through Workday.

When are changes made to the tobacco surcharge effective?

Changes that result in incurring the tobacco use surcharge are effective the first of the month following the status change. If the status change occurs on the first of the month, the change begins that day.

Changes that result in removal of the tobacco use surcharge are effective the first of the month following receipt of the form. If the form is received on the first day of the month, the change begins that day.

Spouse or state-registered domestic partner coverage premium surcharge

A monthly $50 surcharge will be added, in addition to an employee's medical premium if:

The employee is enrolling a spouse or state-registered domestic partner (SRDP) in PEBB medical, and
The spouse/SRDP has chosen not to enroll in medical coverage available through their own employer, which is comparable to the PEBB UMP Classic plan.

Employees are not required to attest (respond) to the surcharge if they are not enrolling a spouse/SRDP in their PEBB medical coverage.

When are employees required to attest to the spousal surcharge?

All employees who enroll a spouse/SRDP in their PEBB medical plan must attest during the required time frames:

No later than 31 days after becoming newly eligible or regaining eligibility for the employer contribution toward PEBB benefits.
No later than 60 days after a qualifying special open enrollment event which allows for the enrollment of a spouse/SRDP in PEBB medical. Proof of the qualifying event is required (PEBB Policy Addendum 45-2A).
No later than 60 days after the spouse’s or SRDP’s employer-based group medical status changes.

How do employees attest to the spousal surcharge?

Employees attest to the spousal surcharge using Benefits 24/7 or by completing and submitting the appropriate PEBB Employee Enrollment/Change form to their Benefits Administrator (BA). BAs may need to assist employees in determining if the spousal surcharge applies.

The Spousal Plan Calculator is designed to assist in determining if the surcharge applies and is available as a pdf (2025, 2026) or excel file (2025, 2026). To use the excel file version, you must click Enable Content button for the calculator to work.

The Spousal Plan Calculator is updated annually. Please remember to download the calculator each year to ensure you are using the correct version.

Note: Pierce County, Washington State University, and University of Washington employees must attest through Workday.

For additional information review these webpages:

What if an employee does not attest to the spousal surcharge?

Employees who enroll their spouse/SRDP in a PEBB medical plan, but do not attest within the required time frame, will default to incur the $50 premium surcharge in addition to their medical plan premium.

When can employees report a change (reattest) to the spousal surcharge?

Employees may reattest during annual open enrollment (OE) (November 1-30). However, some employees may be required to reattest during OE.

Employees must reattest no later than 60 days after their spouse or SRDP’s employer-based group medical status changes.

How do employees report a change (reattest) to the spousal surcharge?

To reattest during annual open enrollment, employees may use Benefits 24/7 or the following year’s Premium Surcharge Attestation Change form.
To reattest at any other time of the year due to a qualifying event, employees use the Premium Surcharge Attestation Change form (2025, 2026).

Pierce County, Washington State University, and University of Washington employees must reattest through Workday.

When are changes made to the spousal surcharge effective?

Changes made outside of annual open enrollment (OE) that result in:

Incurring the spousal surcharge are effective the first of the month following the status change.
- If that date is the first of the month, then it begins that day.
Removal of the spousal surcharge are effective the first of the month following receipt of the form.
- If the form is received on the first day of the month, the change begins that day.

Changes made during annual OE are effective January 1 of the following year.

Employees may be required to reattest to the spousal surcharge during OE

If an employee is required to reattest during annual open enrollment (OE), the PEBB Program will notify the employee by mailing:

An initial letter in October, and
A reminder letter in December.

In addition to the mailings, employee's who log into their Benefits 24/7 account during OE will see a message on their dashboard that informs them if they need to reattest to the spousal surcharge.

Employees will have the following time frames to reattest:

During the annual OE period using Benefits 24/7 or the following year’s Premium Surcharge Attestation Change form.
The day following OE through December 31 of that year, using the following year’s Premium Surcharge Attestation Change form.

Note: Pierce County, Washington State University, and University of Washington employees must reattest through Workday.

What if an employee does not attest during annual OE when required?

Employees who are required to reattest during annual OE, but do not do so by December 31, are automatically defaulted to incur the $50 monthly premium surcharge, effective January 1 of the following year.

How can I learn which employees are required to reattest?

The PEBB Program provides access to a Spousal Re-attestation for an Organization report for BAs in Benefits 24/7, to help BAs determine which employees are required to reattest during that year's annual open enrollment period. The report will list the impacted employee along with information about their spouse/SRDP. The report will provide the following key bits of information:

Last Attestation:
- No = the employee is not currently owing the surcharge
- Yes = the employee is currently owing the surcharge
- Defaulted = This indicates the employee did not attest during the previous years OE period, which resulted in having the employee owe the surcharge.
Attestation Effective Date: This date indicates when the most recent attestation was effective. Most records will display January 1, of the current plan year. Employees who enrolled a spouse after the previous years OE period, or after the first of the current year will display a date other than January 1 of the current year. For example, a June 1 attestation effective date would display for an employee who had coverage effective June 1.
Last Modified or Created Date: This date represents the date that the employees attestation record was last made/updated - by either the employee or the BA. Most of these dates will reflect a date from the previous years OE period.

The Spousal Re-attestation for an Organization report can be accessed using the "Reports" tile in Benefits 24/7 at any time throughout the year. When an employee reattests to the surcharge during OE, they will then fall off the report for the remainder of that plan year. BAs can either view the report in Benefits 24/7 or download it in Excel format.

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