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Dear Benefits Administrators,
The Health Care Authority (HCA) is updating how the spouse or state-registered domestic partner (SRDP) premium surcharge is applied. Effective January 1, 2025, the surcharge no longer applies when a SEBB employee covers a spouse or SRDP who is eligible as a PEBB employee but waives PEBB health plan coverage for their spouse's SEBB coverage. This also applies in reverse situations (i.e., PEBB eligible employee covering a spouse/SRDP eligible for SEBB). Please review the following and take action to provide a refund to affected employees.
Example: Bill is a SEBB eligible employee who has enrolled his spouse, Tina, in his SEBB medical, dental, and vision coverage. Tina is a PEBB eligible employee enrolled in SEBB coverage who has waived her PEBB medical, dental, and vision to be enrolled on Bill's SEBB coverage.
What we’re doing
HCA is applying this change retroactively to January 1, 2025. Refunds will be issued to employers with affected employees who:
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Covered a spouse/SRDP under their SEBB health plan coverage, and
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The spouse/SRDP waived their PEBB coverage, and
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The employee either attested “Yes” or failed to attest and incurred the surcharge
Refunds will be issued to the applicable employers as a credit on their next invoice.
HCA has updated the attestations in Benefits 24/7 for affected employees to reflect this policy change going forward.
Mailing to affected employees
HCA will send affected employees (approximately 75) a formal letter explaining the policy change and the refund process.
Document updates
Question 5 on the surcharge attestation is being revised. If the coverage offered by the spouse/SRDP's employer is through the SEBB or PEBB Program, then the answer to question 5 should be "No".
Online forms and enrollment documents are being updated for the 2025 plan year. Updated print materials will not be available until later this fall when they’re printed for 2026.
What we need from you
Employers who are issued refunds are responsible for refunding employees through their normal refund processes.
Going forward, when receiving completed printed attestation or enrollment forms, please confirm the response to question 5 with the employee as applicable. When entering enrollment for a spouse/SRDP, Benefits 24/7 will indicate if the spouse is already enrolled in PEBB coverage.
Thank you for your attention to this matter. For further clarification or assistance, please reach out to our Outreach & Training team via HCA Support or call 1-800-700-1555.
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