Standard Form 2809. •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers. Web fehb sf 2809 health benefits application form.
Form SF 2809, Health Benefits Election Form
Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment; Web fehb sf 2809 health benefits application form. Employee health benefits registration form: Health benefits registration form (only for use by annuitants and former spouses of annuitants) opm 2810: Notice of change in health benefits enrollment: Or • cancel your fehb enrollment; Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment; • switch designated eligible family member; Or enroll or reenroll in the fehb program; Report of withholdings and contributions for health benefits by enrollment code
Employee health benefits registration form: Enroll in the fehb program; •children and former spouses who are eligible for temporary continuation of coverage. For agency distribution of copies, see page 5. • enroll or reenroll in the fehb program; Or enroll or reenroll in the fehb program; Or • suspend your fehb enrollment (annuitants or former spouses only). Web data standards request form: Or suspend your fehb enrollment (annuitants or former spouses only). Report of withholdings and contributions for health benefits, life insurance, and retirement: Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment;
