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Pebb premium surcharge attestation

Web2024 PEBB Premium Surcharge Attestation Help Sheet Use the information below to determine whether the premium surcharges apply to you. Then attest (respond) in the … WebAug 10, 2024 · Newly eligible employees, employees regaining eligibility, returning from waived status, or enrolling/changing a spouse or dependent in PEBB medical (age 13 or older) must attest on the PEBB Premium Surcharge Attestation Form. Be sure to communicate with your payroll processor before entering retroactive changes to an …

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PEBB Program policy 31-2: Use of PEBB premium surcharge …

WebNov 23, 2024 · The 2024 PEBB annual open enrollment ends Tuesday, Nov. 30. If you are planning to make changes to your medical or dental plan, add or remove a dependent, update your spouse or state-registered domestic partner (SRDP) premium surcharge attestation, or reduce your employee-paid long-term disability (LTD) benefit, remove a … WebFree or low-cost heal service WebPremium Surcharge Attestation Form Submit this form to report whether the Public Employees Benefits Board (PEBB) Program tobacco use and spouse or domestic partner coverage premium surcharges apply to you. Important: If you do not respond by May 15, 2014, you will automatically pay surcharges starting on July 1, 2014. clearwater resorts

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Pebb premium surcharge attestation

PEBB Premium Surcharge Attestation Change Form …

WebPEBB Premium Surcharge Attestation Help Sheet (HCA 50-0226) PEBB Spousal Plan Calculator (HCA 50-0027) PEBB Employee Enrollment Guide (HCA 50-0100) PEBB Retiree … WebPEBB My Account login. Log into My Account to view your coverage and premium surcharge information, get your statement of insurance, and make open enrollment changes. To …

Pebb premium surcharge attestation

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WebNov 9, 2024 · The medical premium for your spouse or SDRP’s employer-based medical coverage was $114.01 or more. To confirm if you need to attest, log into PEBB My Account. How to attest If you are required to attest, log into PEBB My Account and select Attestations or use the 2024 PEBB Premium Surcharge Attestation Change Form . WebPEBB Employee Benefit Group . Dependent Verification - acceptable documents. You may also need to submit: PEBB Declaration of Tax Status form (for state-registered domestic …

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WebUse a pebb premium surcharge attestation help sheet template to make your document workflow more streamlined. Show details How it works Open form follow the instructions Easily sign the form with your finger Send filled & signed form or save Rate form 4.8 Satisfied 217 votes be ready to get more Create this form in 5 minutes or less Get Form Webin the Medicare risk pool as described in RCW 41.05.080(3), is determining if a premium surcharge will be applied for a spouse or state registered domestic partner enrolled in PEBB medical. Policy: 1. A subscriber must use the PEBB Premium Surcharge Attestation Help Sheet and if directed by the help sheet, the PEBB Spousal Plan Calculator ...

WebTobacco use premium surcharge. Response required if you are enrolling your spouse or SRDP in medical coverage. If you check Yes or do not check any boxes below, you will be charged the $25 premium surcharge. See the 2024 PEBB Premium Surcharge Attestation Help Sheet available at . hca.wa.gov/pebb-retirees . for instructions on how to respond.

WebSpouse or partner surcharge A surcharge applies when your spouse or partner has a job that offers them employer-based group medical insurance, but they decline it and enroll on … bluetooth headphones cutting out pcWebThe PEBB Program requires a $25-per-account premium surcharge in addition to your monthly medical premium if you or an enrolled dependent (age 13 or older) uses a … bluetooth headphones cutting out senseWebIf an attestation is not received within 31 days of hire/eligibility date, or within 60 days of a special open enrollment event, the employee will incur the $25 tobacco use premium surcharge, and will also incur the $50 spouse or domestic partner premium surcharge if the employee has a spouse or domestic partner enrolled on their account. bluetooth headphones damage to brain