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  • SF2809 - Health Benefits Election Form
    Instead, use form OPM 2809, which is available at www opm gov forms OPM-forms, or call the Retirement Information Office toll-free at 1-888-767-6738 Former spouses eligible to enroll in or currently enrolled in the FEHB Program under the Spouse Equity law or similar statutes
  • Health Benefits Election Form
    Who May Use OPM Form 2809 Annuitants retired under the Civil Service Retirement System (CSRS) or Federal Employees' Retirement System (FERS), electing or changing either their FEHB or Postal Service Health Benefit (PSHB) coverage under the FEHB Program;
  • Form Approved: Employee Health Benefits Election Form
    At Part D of the SF 2809, Health Benefits Election Form, you must designate your two-character event code (for example, 1A) and the date of the event using numbers to show month, day, and complete year; e g , 06 30 1998
  • Forms and Brochures - U. S. Office of Personnel Management
    Employing offices obtain Standard Forms 2809 and 2810 directly from GSA supply centers, just as they do other OPM Standard Forms Agencies do not need to maintain an internal procurement and distribution network for FEHB forms
  • Eligibility Enrollment
    Health Benefits Election Form (SF 2809) (PDF file) If an employee dies, he she will not have an FEHB Self Plus One or Self and Family enrollment for his her survivors to continue, even if he she is eligible for a survivor annuity
  • OPM Forms - U. S. Office of Personnel Management
    Welcome to opm gov Browse and download your choice of form (s) issued by the Office of Personnel Management
  • Notice of Change in Health Benefits Enrollment
    This form covers health benefits actions except enrollments, changes from one plan to another, changes of coverage within a plan, and cancellations, all of which are processed on the Health Benefits Registration Form (OPM Form 2809)
  • BAL 24-103 - Process Change for Open Season Elections Effective After . . .
    If a retiring employee submits an FEHB Open Season SF 2809 prior to the beginning of the Open Season enrollment period (e g , October retirement), then the agency will need to delay submission of the SF 2809 to the Carrier until after Open Season begins
  • Enroll - U. S. Office of Personnel Management
    Compensationers may review and or download the SF 2809 They may send a written request for an Open Season enrollment change to the Office of Workers' Compensation Programs at this address:
  • Health Benefits Election FormStandard Form (SF) 2809 GuidanceFor Tribal . . .
    This guidance explains how to complete the Health Benefits Election Form (SF 2809) as a tribal employee The SF 2809 was written for all Federal employees and not all parts of the SF 2809 apply to tribal employees





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