Fillable Standard Form 2809 Health Benefits Election Form printable
Standard Form 2809. For agency distribution of copies, see page 5. • enroll or reenroll in the fehb program;
Fillable Standard Form 2809 Health Benefits Election Form printable
Or enroll or reenroll in the fehb program; Or • cancel your fehb enrollment; Or cancel your fehb enrollment; Report of withholdings and contributions for health benefits, life insurance, and retirement: Report of withholdings and contributions for health benefits by enrollment code •children and former spouses who are eligible for temporary continuation of coverage. Notice of change in health benefits enrollment: Chapter 89, title 5, u.s. Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment; •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers.
Notice of change in health benefits enrollment: Web who may use opm form 2809. Or elect not to enroll in the fehb program (employees only); Report of withholdings and contributions for health benefits, life insurance, and retirement: Enroll in the fehb program; Web uses for standard form (sf) 2809 use this form to: By human capital november 1, 2019. Or • suspend your fehb enrollment (annuitants or former spouses only). For agency distribution of copies, see page 5. Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment; • switch designated eligible family member;
