WSDP Fee Breakdown

Working Spouse/Domestic Partner Fee by Employee Pay Schedule and Salary Range:

12-month Employee
Pay RangePer Pay Fee
$80,500 or less$30
$80.500.01-$150,000$45
$150,000.01 or more$60
10-month Employee
Pay RangePer Pay Fee
$80,500 or less$36
$80.500.01-$150,000$54
$150,000.01 or more$72
9-month Employee
Pay RangePer Pay Fee
$80,500 or less$40
$80.500.01-$150,000$60
$150,000.01 or more$80

2025 AFFIDAVIT OF WORKING SPOUSE/DOMESTIC PARTNER INSURANCE STATUS (DynamicForm)

2024 Affidavit of Working Spouse/Domestic Partner Insurance Status (PDF)