General Premium Surcharge Information
1. What are “surcharges” and who is requiring them?
The surcharges are extra costs that have been added to faculty, staff, and some non-student PEBB benefit eligible WSU employees’ standard monthly medical premiums, effective July 1, 2014. The state Legislature included the surcharge requirement in the state budget signed into law on June 30, 2013.
2. How much are the premium surcharges?
Tobacco Surcharge: A monthly $25 per account premium surcharge will be applied if an employee or any covered member of their family uses tobacco products.
Spouse or Domestic Partner Coverage Surcharge: A $50 per month premium surcharge will be applied if an employee’s spouse/registered domestic partner is enrolled on the employee’s WSU/PEBB plan, and the spouse/registered domestic partner elected to waive his or her own employer-based group health coverage which is comparable to the WSU/PEBB Uniform Medical Plan.
3. As a new employee, what happens if I do not attest to the premium surcharges?
An attestation in your Medical & Dental Enrollment/Change form is required for all new benefit eligible employees enrolling in medical coverage. You have 31 days from your date of hire/benefit eligibility to submit this form.
If no form is submitted:
Tobacco Use Surcharge: Your account will default to a “Yes” answer, and you will be charged the Tobacco Surcharge of $25.00 per month.
Spousal Coverage Surcharge: If you enroll a spouse/registered domestic partner on your coverage, but do not address the spousal surcharge, you will be defaulted to “Yes, your spouse/registered domestic partner does have comparable coverage available, and has chosen to enroll on your PEBB account”, and you will be charged the Spousal Surcharge of $50.00 per month.
4. When do the surcharges need to be addressed?
All new, benefit eligible employees will need to address the surcharges. Paperwork to do so is included in your new employee benefits packet.
Any existing employees who experience a change in tobacco status for themselves or a covered family member need to complete a new Surcharge Attestation form, and submit the form to HRS.
Any existing employee whose covered spouse experiences a change in the medical plans offered through their employer, please contact HRS at (509)335-4521 or email@example.com to determine if a new Surcharge Attestation form is required.
5. Will the premium surcharges be split and collected from each paycheck?
6. I wasn’t aware I needed to attest or defaulted and now have a premium surcharge being collected from my paycheck. What can I do to remove the surcharges?
Tobacco Surcharge: If you and all of your covered family members are non-tobacco users, you can submit a Premium Surcharge Change Sheet to update your account. This update will take effect the first of the month following the date the form is submitted. Appeal options are available if you would like to request this change be made retroactively. Please contact HRS at (509)335-4521 or hrs@wsu.
Spousal Coverage Surcharge: If you are carrying your spouse/registered domestic partner and their coverage is less than the comparable value to the Uniform Medical Plan (UMP) Classic, you can submit a Premium Surcharge Change Sheet to update your account. This update will take effect the first of the month following the date the form is submitted. Appeal options are available if you would like to request this change be made retroactively. Please contact HRS at (509)335-4521 or hrs@wsu.
7. How will the premium surcharge(s) be collected if I work less than 12 months of the year?
Similar to your regular medical and life insurance premiums, the surcharges for the summer/cyclic break will generally be collected the last pay period(s) prior to your summer or cyclic break, which for most individuals will be on the May 25th paycheck.
8. If I am off work and lose eligibility for employer-paid benefits, and self-pay to maintain my coverage, do the surcharges still apply?
Yes, the surcharges will be added to the self-pay premiums.
9. Are the surcharges related to the Affordable Care Act?
No. They are a state Legislature decision.
10. What if I waived medical coverage, but I am enrolled in and my family uses the Flexible Spending Account?
You are not subject to either of the surcharges, due to your waiving your WSU/PEBB coverage.
Spouse or Registered Domestic Partner Coverage Surcharge Information
11. If I do not have a spouse/registered domestic partner enrolled on my WSU/PEBB coverage, will I have to respond to the spouse/registered domestic partner premium surcharge question?
No. When responding to the Premium Surcharge questions, only employees with a spouse/registered domestic partner covered on their WSU/PEBB plan will be prompted to answer the spouse/registered domestic partner coverage premium surcharge question.
12. How will WSU know if my spouse/registered domestic partner has waived coverage elsewhere?
Existing employees attested to the status and level of your spouse/registered domestic partner’s own employer-based group health coverage, if any, via an online questionnaire through your HCA “My Account“.
New employees will attest to the status and level of your spouse/registered domestic partner’s own employer-based group health coverage, if any, via the paper Premium Surcharge Change Sheet.
13. What sort of question(s) will be asked for the spouse/registered domestic partner coverage premium surcharge? How will I know if my spouse/registered domestic partner’s employer-based group health coverage is comparable to the WSU/PEBB Uniform Medical Plan (UMP) Classic?
You will be asked if your spouse/registered domestic partner:
1. Is eligible for medical coverage through their employer.
2. Has an employer who offers a medical plan that serves their county of residence.
3. Has chosen not to enroll in their employer plan.
4.. Has coverage that is not through another PEBB program.
5. Their share of the medical premium under their employer plan is less than $84.56 per month.
If the answer to all of the above is “yes”, you may have to pay the spousal surcharge. Please obtain a copy of your spouse/registered domestic partner’s “Summary of Benefits and Coverage”, and be prepared to answer additional questions through HCA’s Spousal Plan Calculator.
14. Will a premium surcharge be applied if my covered spouse/registered domestic partner was also offered their own WSU/PEBB coverage, and elected to waive their coverage?
No. The premium surcharge will not be applied if your spouse/registered domestic partner waived WSU/PEBB coverage.
15. Will a premium surcharge be applied if my spouse/registered domestic partner is enrolled in both my WSU/PEBB coverage as well as their own non-WSU/PEBB employer-based group health coverage?
No. The premium surcharge will not be applied if your spouse/registered domestic partner is enrolled in both your WSU/PEBB coverage and their own non-WSU/PEBB employer-based group health coverage.
16. What if I am carrying my spouse/registered domestic partner and their employer-based group health coverage increases in value in the future so that it is of comparable value to the Uniform Medical Plan (UMP) Classic?
If in the future, your spouse/registered domestic partner’s employer-based group health coverage changes to be of comparable value to the Uniform Medical Plan (UMP) Classic, you can elect to waive them from your coverage at that time. Please contact the Pullman HRS office as soon as possible to adjust your account.
17. Why is the Uniform Medical Plan (UMP) Classic being used as the comparison plan for the spouse/registered domestic partner coverage premium surcharge, instead of a Group Health or Kaiser plan?
The Uniform Medical Plan (UMP) Classic is being used as the comparison plan, since it is the PEBB plan with the largest enrollment.
The surcharge legislation required the PEBB Program to add “…a surcharge of not less than $50 per month to the premiums due from members who cover a spouse or domestic partner where the spouse or domestic partner has chosen not to enroll in other employer-based group health insurance that has benefits and premiums with an actuarial value of not less than 95 percent of the actuarial value of the public employees’ benefits board (PEBB) plan with the largest enrollment.”
18. My spouse/registered domestic partner is retired and deferred Medicare Part B to enroll under my WSU/PEBB coverage. Do I have to pay the spouse or domestic partner coverage premium surcharge?
No. The premium surcharge will not apply if your covered spouse/registered domestic partner has waived/deferred Medicare Part B to enroll in your WSU/PEBB coverage.
19. I do not want to pay the spouse/registered domestic partner coverage premium surcharge. Can I remove them from my medical coverage?
Yes. Changes can be made to your plan(s) each year during Open Enrollment, which takes place in the month of November, with changes taking effect the following January 1. If you would like to make changes outside of Open Enrollment, you may do so if you experience a life changing event that triggers a special open enrollment. Please visit Benefit Changes or contact HRS at (509)335-4521 to see if you are eligible to make benefit changes.
Tobacco Use Surcharge Information
20. Who is considered a tobacco user?
A tobacco user is someone who has used any tobacco products within the last two months. However, this does not include tobacco use for religious or ceremonial purposes.
Tobacco includes any product made with or derived from tobacco that is intended for human consumption, including any component, part or accessory of a tobacco product. This includes, but is not limited to, cigars, cigarettes, chewing tobacco, snuff and other tobacco products. It does not include FDA approved quit aids or e-cigarettes at this time.
21. How will HCA/WSU know if I or my family are tobacco users?
Existing employees attested to their tabacco use status, as well as any other family members covered under the employee’s health insurance, via an online questionnaire through your HCA “My Account“, or by completing a Premium Surcharge Change Sheet.
25. Are there smoking cessation programs available?
Yes, available through your PEBB medical plan. There may be no cost for the programs depending upon the services received. Please contact your medical plan or read your Certificate of Coverage for more information about this benefit.
26. Should I respond if my family members and I don’t use tobacco?
Yes. If you do not answer the tobacco use surcharge question(s), you will be defaulted to the “tobacco user” category and will be assessed the tobacco use surcharge.
27. I’m an employee who waived WSU/PEBB medical coverage, but I do have WSU/PEBB dental coverage for myself and my family members. If I or one of my family members uses tobacco, do I have to pay the tobacco surcharge?
No. The surcharge will not apply.
28. I’m an employee enrolled in WSU/PEBB medical coverage. My dependent uses tobacco, but they are only enrolled on dental coverage. Do I still have to pay the surcharge?
No. The surcharge will not apply.
29. I have two family members on my account who use tobacco. Does that mean I have to pay the premium surcharge twice?
No. You will only be charged the $25 premium surcharge once per month, regardless of how many family members use tobacco products.
30. My dependent uses tobacco, but doesn’t live with me. Do I still have to pay the premium surcharge?
Yes. The tobacco use surcharge applies whether your covered dependents live with you or not.
31. What if I or my family are current tobacco users, but become tobacco free in the future?
If you and/or a covered family member is currently a tobacco user, but in the future stops using tobacco products, you can request to have the tobacco use surcharge removed once you or your covered family member are tobacco free for at least two months. This is only applicable if you and all your covered family members do not use tobacco at that point.
32. What if I or a family member start using tobacco in the future?
If you and/or a covered family member begins using tobacco, please contact HRS Pullman to update your previous attestation. Your tobacco use surcharge will then begin to be collected from your future pay.
34. I only smoke a cigar once or twice a year, am I considered a smoker?
The definition of a tobacco user is someone who has used any tobacco product within the last two months.