Premium surcharges

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

The Legislature requires two premium surcharges that employees will pay for, if applicable, in addition to their monthly medical plan premium (WAC 182-08-185):

  • Tobacco use premium surcharge
  • Spouse or state-registered domestic partner coverage premium surcharge

What if PEBB medical is waived?

The surcharges do not apply when PEBB medical is waived.

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 use surcharge by completing and submitting the appropriate PEBB Employee Enrollment/Change form to their payroll or benefits office.

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:

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 by completing and submitting the appropriate PEBB Employee Enrollment/Change form to their payroll or benefits office. Benefits administrators (BAs) may need to assist employees in determining if the spousal surcharge applies.

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

The Spousal Coverage Surcharge webpage and calculator are designed to assist in determining if the surcharge applies.

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?

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.

Employees will have the following time frames to reattest:

  • November 1-30 (annual OE), using PEBB My Account or the following year’s Premium Surcharge Attestation Change form.
  • November 1-December 31, 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 an Attestations Report for employers, which includes the following information:

  • Employee and dependent names and the last four of their social security numbers.
  • Current enrollment information for medical enrollment, tobacco use and spousal premium surcharge attestations.
  • Pending changes for medical enrollment, tobacco use and spousal premium surcharge attestations, and medical and dental plan changes.
  • A key on the top right-hand side that explains the codes (Y, N, D, N/A):
    • Y = Yes for surcharge (the $50 spousal surcharge does apply)
    • N = No for surcharge (the surcharge does not apply)
    • D = Defaulted as "Yes"
      • Employees reflecting a "D" in the Spousal column during annual OE are required to reattest.
    • N/A = Not applicable (individual is not a spouse or is a spouse who is not enrolled in PEBB medical)

Wait until the start of annual OE to access the report.

The report is updated at the beginning of annual open enrollment to reflect the employees who are required to reattest to the spousal surcharge for the upcoming year. 

How do I access the Attestations Report?

The Attestations Report can be accessed at any time throughout the year. However, the report will not reflect the default code for employees who are required to reattest until the start of annual OE (November 1).

BAs with access to the PAY1 insurance system can generate an Attestations Report by logging in to their own PEBB My Account and following these steps.

If Outreach & Training enters enrollment in the insurance system for you, you can send a message through HCA Support to request the Attestations Report.

Contact

Outreach and Training
Benefits administrators contact O&T for eligibility, enrollment, or billing related questions.
1-800-700-1555
Secure messaging: HCA Support