Form SF 2809, Health Benefits Election Form
Standard Form 2809. Pdf versions of forms use adobe reader ™. Or suspend your fehb enrollment (annuitants or former spouses only).
Notice of change in health. Web data standards request form: Web who may use opm form 2809. Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment; Web health benefits election form. Web health benefits election form form approved: Web uses for standard form (sf) 2809 use this form to: Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment; Chapter 89, title 5, u.s. Previous edition is not usable.
For agency distribution of copies, see page 5. Web data standards request form: Web uses for standard form (sf) 2809 use this form to: Or cancel your fehb enrollment; Employee health benefits registration form: For agency distribution of copies, see page 5. Web who may use opm form 2809. Notice of change in health benefits enrollment: •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers. Instructions for completing opm 2809. Notice of change in health.
