OPM Form SF2809 Download Fillable PDF, Health Benefits Registration
Standard Form 2809. Health benefits registration form (only for use by annuitants and former spouses of annuitants) opm 2810: Instructions for completing opm 2809.
OPM Form SF2809 Download Fillable PDF, Health Benefits Registration
Web health benefits election form form approved: Or • suspend your fehb enrollment (annuitants or former spouses only). Report of withholdings and contributions for health benefits by enrollment code Or change your fehb enrollment from self only to self and family and/or from your present plan or option to another plan or option because of an event described in the table beginning on page 6; Health benefits registration form (only for use by annuitants and former spouses of annuitants) opm 2810: For agency distribution of copies, see page 5. Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment; Pdf versions of forms use adobe reader ™. 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. •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers. Or cancel your fehb enrollment; Or elect not to enroll in the fehb program (employees only); Web health benefits election form form approved: Web fehb sf 2809 health benefits application form. Report of withholdings and contributions for health benefits, life insurance, and retirement: For agency distribution of copies, see page 5. Or suspend your fehb enrollment (annuitants or former spouses only). Instructions for completing opm 2809. Or change your fehb enrollment from self only to self and family and/or from your present plan or option to another plan or option because of an event described in the table beginning on page 6;
