HEM Surcharge Appeal Process

If you or did not complete the HEM requirements, the HEM monthly surcharge will be deducted from your October, November and December paychecks.  The monthly surcharge amount will be:

  • $17.50 if either you did not complete the two online e-lessons

IF YOU ARE CHARGED THE SURCHARGE IN ERROR you will need to complete the appeal process to have PEBB remove the surcharge.  If you need assistance in identifying if PEBB identified you or your enrolled spouse/partner as not completing the e-lessons you can contact PEBB at 503.373.1654 or email Employee Benefits at [email protected].


Complete the Appeal form and attach a copy of the e-lesson certificate/confirmation from your plan’s website showing you and/or your enrolled spouse/partner completed the requirement as scheduled.

E-lesson Certificates/Confirmation:

Return form and confirmation to PEBB at:

  • Fax - 503-373-1654
  • Mail - PEBB, 1225 Ferry St SE, Ste B, Salem, OR 97301
  • Email: [email protected].

Additional information can be found on the PEBB website

If you have any questions, please contact Employee Benefits by email at [email protected] or by phone at 541.737.2805.