Premium surcharges

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

The Legislature requires two premium surcharges that employees will pay for, if applicable, in addition to their monthly medical plan premium (WAC 182-30-050):

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

What if SEBB medical is waived?

The surcharges do not apply when SEBB 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 SEBB medical, uses a tobacco product.

"Tobacco use" means any use of tobacco products within the past two months. It does not include the religious or ceremonial use of tobacco. Learn more about tobacco use and what tobacco products apply on the School employees website.

Employees are not required to attest (respond) to the tobacco use surcharge if SEBB 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 SEBB Medical plan must attest (respond) 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 SEBB benefits.
  • No later than 60 days after a qualifying special open enrollment event, which allows the employee to enroll in SEBB medical after waiving or allows for the enrollment of a dependent in SEBB medical. Proof of the qualifying event is required (SEBB Policy Addendum 45-2A).
How do employees attest to the tobacco surcharge?

Employees attest to the tobacco use surcharge using SEBB My Account or the appropriate School Employee Enrollment form. To attest, they’ll need to select Yes or No for themselves and each dependent enrolled in SEBB medical who is age 13 or older.

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

Employees enrolled in SEBB medical who do not attest (respond) 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 SEBB 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 SEBB medical plan’s tobacco cessation program.
How do employees report a change (reattest) to the tobacco surcharge?

Employees may reattest to their tobacco use at any time throughout the year by:

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 SEBB medical, and
  • The spouse/SRDP has chosen not to enroll in medical coverage available through their own employer, which is comparable to the Public Employees Benefits Board (PEBB) Program’s UMP Classic plan.

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

When are employees required to attest to the spousal surcharge?

All employees who enroll a spouse/SRDP in their SEBB 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 SEBB benefits.
  • No later than 60 days after a qualifying special open enrollment event which allows for the enrollment of a spouse/SRDP in SEBB medical. Proof of the qualifying event is required (SEBB 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 SEBB My Account or the appropriate School Employee Enrollment form. Benefits administrators (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.

To download and edit the Spousal Plan Calculator:

  • Open this link in your web browser: Spousal Plan Calculator
  • Select “File” from the menu bar, then select “Save As”, and “Download a Copy”.
  • Locate and open the excel document you just downloaded.
  • Once the document is open on your computer, select “File” again from the menu bar.
  • Select “Info” then click on the “Enable Editing” button.
  • You should now be able to make changes to the document.

To edit the Spousal Plan Calculator in your web browser: 

  • Open this link in your web browser: Spousal Plan Calculator
  • Select “Edit a Copy” from the menu bar.
  • You will then be prompted to sign into your Microsoft One Drive account. You must be signed in to One Drive to edit the document in your web browser.
  • Once signed in to your One Drive account the document will reload in your web browser and will allow edits to be made.

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

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

Employees who enroll their spouse/SRDP in a SEBB 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 SEBB My Account 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 may use SEBB My Account or the current year’s Premium Surcharge Attestation Change form.
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 status change.
    • If the status change occurs 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 SEBB Program will notify the employee by mailing:

  • An initial letter in October, and
  • A reminder letter by early December.

Employees will have the following time frames to reattest:

  • Annual OE, using SEBB My Account or the following year’s Premium Surcharge Attestation Change form.
  • After annual OE through December 31, using the following year’s Premium Surcharge Attestation Change form.

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 SEBB Program provides access to an attestations report for employers in SEBB My Account, which includes the first and last names of employees who are required to reattest during annual open enrollment along with the last four of their social security numbers.

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 in SEBB My Account at any time throughout the year. However, the report will not reflect the employees who are required to reattest for the upcoming year until the start of annual open enrollment.

BAs with access to SEBB My Account can generate the report by following these steps:

  • Log into SEBB My Account as a benefits administrator.
  • Select the Reports tile from the Admin Dashboard or select the tab titled Reports.
  • In the dropdown menu, select the "Subscribers who need to reattest” report.
  • Select the “Run report” button.

You can either view the reporting in SEBB My Account or download the report in Excel format.

Contact

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