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ATTACHMENT 2 FEB PROGRAM TABLE 1 PLANS LEAVING THE FEB PROGRAM Enrolled in the terminating plans who do not change their health plan by enrolling in another FEB plan during Open Season will not have
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How to fill out plans leaving form fehb
How to fill out plans leaving form FEHB:
01
First, gather all the necessary information such as your FEHB plan details, personal details, and the reason you are leaving the plan.
02
Start by filling out your personal details, including your name, address, contact information, and your Social Security number.
03
Next, provide information about your current FEHB plan, including the plan name, identification number, and the effective date of coverage.
04
Indicate the reason for leaving the plan by choosing one of the provided options, such as retirement, change in employment, or enrollment in another health insurance plan.
05
If you are enrolling in another health insurance plan, provide details about the new plan, including the name, identification number, and the effective date of coverage.
06
Review the form thoroughly to ensure all the information provided is accurate and complete.
07
Sign and date the form to certify its authenticity.
08
Submit the completed form to the appropriate entity, such as your HR department or the FEHB program office.
Who needs plans leaving form FEHB?
01
Employees who are retiring and wish to discontinue their FEHB coverage.
02
Individuals who are changing employment and need to switch to a different health insurance plan.
03
Individuals who are enrolling in another health insurance plan and therefore need to terminate their FEHB coverage.
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