Standard Form 2809. Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment; 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;
Adding a 2809 Record
Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment; Web uses for standard form (sf) 2809 use this form to: By human capital november 1, 2019. For agency distribution of copies, see page 5. Previous edition is not usable. •children and former spouses who are eligible for temporary continuation of coverage. • switch designated eligible family member; Report of withholdings and contributions for health benefits, life insurance, and retirement: Enroll in the fehb program; Pdf versions of forms use adobe reader ™.
Or cancel your fehb enrollment; Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment; Web who may use opm form 2809. Web fehb sf 2809 health benefits application form. Chapter 89, title 5, u.s. Or • suspend your fehb enrollment (annuitants or former spouses only). Notice of change in health. Or elect not to enroll in the fehb program (employees only); Instructions for completing opm 2809. •children and former spouses who are eligible for temporary continuation of coverage. Employee health benefits registration form:
