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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;
- SF-2809 FEHB Health Benefits Election Form
Federal Employees Health Benefits Program SF-2809 Election Form Use this form to enroll, elect not to enroll, change, suspend or cancel your health insurance coverage in the Federal Employees Health Benefits (FEHB) Program which includes FEHB and Postal Service Health Benefits (PSHB) plans
- SF-2809 FEHB Health Benefits Election Form - OMB 3206-0160
OMB 3206-0160 ICR 202410-3206-002 Document 147622601 Document SF-2809 FEHB Health Benefits Election Form ICR 202410-3206-002 · OMB 3206-0160 · Object 147622601 This document may belong to an older filing More recent activity for OMB 3206-0160: 2025-04-02 · No material or nonsubstantive change to a currently approved collection Document
- FEHB SF 2809 Health Benefits Application form - USGS. gov
FEHB SF 2809 Health Benefits Application form By Human Capital November 1, 2019 sf2809_rev Nov2019 pdf (1 75 MB)
- Health Benefits Election Form OMB No. 3206-0160
INSTRUCTIONS FOR COMPLETING THE SF 2809 Part A — Enrollee and Family Member Information
- SF-2809 Health Benefits Election Form - Federal Employees Health . . .
SF-2809 Health Benefits Election Form Federal Employees Health Benefits Program To obtain this form go to http: www opm gov Forms pdf_fill sf2809 pdf
- SF 2809, Health Benefits Election Form - National Finance Center
SF 2809, Health Benefits Election Form Last Updated: 3 9 2021 8:52:34 AM This topic has been updated to replace SF 2809 with the latest version The Medicare Claim Number field has been changed to Medicare Beneficiary Identifier See Appendix II, Instructions on Completing the SF 2809 for detailed instructions on completing SF 2809
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