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Spousal plan calculator

How to use the Spousal Plan Calculator

If you answered YES to ALL of the questions on the SEBB Premium Surcharge Attestation Help Sheet (pdf) or the online spousal plan questionnaire 2020 or 2021, answer the questions in the SEBB Spousal Plan Calculator (interactive tool) or (pdf) to determine if you must pay the surcharge.

Note: If you use the interactive version of the Spousal Plan Calculator, you must click Enable Content for the calculator to work. Do not print or submit the interactive tool.

Use the Summary of Benefits and Coverage from your spouse's or state-registered domestic partner's employer-sponsored medical plans to answer the Spousal Plan Calculator questions. The plans must:

Serve your spouse's or state-registered domestic partner's county of residence, and
Cost less than $108.31 (2020) or $109.26 (2021) for the employee's share of the monthly premium.

Complete the calculator for each medical plan that meets the criteria above, one plan at a time. Then click Calculate. If you are entering more than one plan, and at least one results in "You will have to pay the surcharge," then you will have to pay the surcharge.

Need help?

These pages will help you answer the questions in the Spousal Plan Calculator.

Complete your attestation

Log in to SEBB My Account.
If adding a spouse or state-registered domestic partner to your SEBB medical plan, you must respond to the spousal coverage surcharge using SEBB My Account or on the appropriate enrollment/change form.
If you are reporting a change, complete the SEBB Premium Surcharge Attestation Change form and submit as directed on the form.