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Search results with tag "Premium surcharge"
2022 Retiree Election Form (Form A)
www.hca.wa.gov2022 PEBB Premium Surcharge Attestation Help Sheet . available at hca.wa.gov/pebb-retirees. for instructions on how to respond. Does the tobacco use premium surcharge apply to you? Check one: No, I am enrolled in Medicare Part A and Part B. The premium surcharge does not apply. Yes, I am subject to the $25 premium surcharge. I have used tobacco ...