SEBB Message Regarding Surcharges

Tobacco use premium surcharge

You will be charged a $25 tobacco use premium surcharge in addition to your monthly medical plan premium if you or any dependent (age 13 and older) who is enrolled on your SEBB medical coverage uses a tobacco product.

Tobacco use means any use of tobacco products within the past two months. Tobacco use does not include the religious or ceremonial use of tobacco.

You do not have to pay this surcharge if you attest that:

• Neither you nor any of your enrolled dependents age 13 or older use tobacco products.
• You and all your dependents who are tobacco users age 18 and older are enrolled in your medical plan’s tobacco cessation program.
• Tobacco users age 13 to 17 are considered enrolled in a tobacco cessation program if they access information and resources in Smokefree Teen.

Spouse and state-registered domestic partner premium surcharge

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 enrolled on your SEBB medical coverage and they have elected not to enroll in their employer-based group medical insurance that is comparable to the PEBB Program’s Uniform Medical Plan (UMP) Classic.

You need to attest to this premium surcharge if you are enrolling your spouse or state-registered domestic partner on your SEBB medical coverage. You do not need to attest if you are not enrolling your spouse or state-registered domestic partner on your SEBB medical.

Attestation

To attest, log into SEBB My Account before the end on the first annual open enrollment, November 15, 2019. If you do not attest, you will be charged the $25 tobacco use premium surcharge in addition to your monthly premium and the $50 spouse or state-registered domestic partner premium surcharge, if you enrolled your spouse or state-registered domestic partner on your medical coverage.