PEBB Eligible Employees: ACTION REQUIRED!! – Spousal Surcharge Attestation for 2015

You MUST complete a spousal attestation for the 2015 plan year, if you have or will have a spouse or registered domestic partner enrolled on your PEBB medical coverage in 2015.    The attestation must be completed between November 1st through 30th.

If you are an existing subscriber whose spouse or registered domestic partner is already enrolled on your PEBB medical coverage:

  • Attest via your HCA My Account starting November 1, 2014, OR
  • Complete and submit the 2015 Premium Surcharge Change Form*. Use the 2015 Premium Surcharge Help Sheet to fill out the form.

If you are a new or existing subscriber whose spouse or registered domestic partner is not enrolled in PEBB medical coverage in 2014, but will be enrolled effective January 1, 2015:

  • Complete and submit the Open Enrollment 2015 enrollment/change form.*   Use the 2015 Premium Surcharge Help Sheet to fill out the form.

*The forms will be available no later than November 3, 2014 at https://wsu.edu/OpenEnrollment2015.

Failure to attest/re-attest during Open Enrollment will result in a $50 per month surcharge applied to your monthly premium. You will not be able to have this charge removed unless there is a Special Open Enrollment event (change in your spouse’s job, divorce, etc.)

For more information or to ask questions, please contact HRS at 509-335-4521 or email hrs@wsu.edu.

By Communications staff, Washington State University

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