WSDP Fee Breakdown
Working Spouse/Domestic Partner Fee by Employee Pay Schedule and Salary Range:
| Pay Range | Per Pay Fee |
|---|---|
| $80,500 or less | $30 |
| $80.500.01-$150,000 | $45 |
| $150,000.01 or more | $60 |
| Pay Range | Per Pay Fee |
|---|---|
| $80,500 or less | $36 |
| $80.500.01-$150,000 | $54 |
| $150,000.01 or more | $72 |
| Pay Range | Per 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)