Find information on the open enrollment page that’s right for you: PEBB retirees, PEBB employees and PEBB continuation coverage subscribers, and SEBB employees and SEBB continuation coverage subscribers.
A $50 premium surcharge may apply to you if you have a spouse or state-registered domestic partner enrolled on your SEBB medical coverage.
A $50 premium surcharge will be charged, in addition to your monthly medical plan premium, if you have a spouse or state-registered domestic partner (SRDP) enrolled on your SEBB medical coverage and they chose not to enroll in their employer-based group medical insurance that is comparable to the PEBB Program’s Uniform Medical Plan (UMP) Classic. The comparison must be to the PEBB Program’s UMP Classic, even if you are not enrolled in that plan.
You must attest (respond) to the premium surcharge to tell us whether it applies to your account.
You must respond to this premium surcharge if you enroll your spouse or SRDP on your SEBB medical coverage.
You do not need to attest if you do not enroll your spouse or SRDP on your SEBB medical. The surcharge will not apply to your account.
Respond to the surcharge on your enrollment form, change form, or in Benefits 24/7 when you enroll your spouse or SRDP.
Answer the six questions on your enrollment form, change form, or in Benefits 24/7 to find out if the surcharge applies. You may also need to use the Spousal Plan Calculator (interactive tool) or (pdf).
If you answer NO to ANY of the questions the surcharge does not apply.
If you answer YES to ALL six questions you will need to:
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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.
Sign in to Benefits 24/7 and select Attestations. Answer Yes or No to the questions 1 through 6. Or check the boxes on your enrollment/change form.
You will be charged the $50 premium surcharge in addition to your monthly medical premium if you have a spouse or SRDP enrolled on your medical coverage.
If you will cover your spouse or SRDP on your medical coverage for the next plan year, you may need to attest to the surcharge during open enrollment. You will get a letter from the SEBB Program if you need to attest. You are required to attest during open enrollment if you currently pay the $50 monthly premium surcharge or are not paying the surcharge because you attested your spouse's or SRDP's employer-based medical coverage was not comparable to UMP Classic.
You can only report a change to this surcharge in the following situations:
Use Benefits 24/7 or Premium Surcharge Attestation Change form.
If you answer NO to ANY of the questions, the surcharge does not apply.
If you answer YES to ALL six questions you will need to:
Changes that result in a premium surcharge will be effective the first day of the month after the date of the status change. If that day is the first of the month, the change begins that day.
If the change results in removal of the premium surcharge, the change is effective the first day of the month after your attestation is received. If that day is the first of the month, the change begins that day.
Exception: If attesting during annual open enrollment, any change is effective January 1 of the following year.