OPM SF 2809 2011 free printable template

Health Benefits Election Form Approved: OMB No. 3206-0160 Uses for Standard Form (SF) 2809 Use this form to: Item 8. If you have Medicare, enter your Medicare Claim Number. This number is on your

How to fill out OPM SF 2809

How to fill out OPM SF 2809

1. Obtain the OPM SF 2809 form from the official OPM website or your human resources office.
2. Fill in your personal information at the top of the form, including your name, address, and Social Security number.
3. Select the appropriate options for your health benefits enrollment, indicating whether you are enrolling for the first time, making a change, or canceling coverage.
4. Complete the section regarding the type of health benefits plan you wish to enroll in.
5. If applicable, provide information about dependents you wish to enroll under your plan.
6. Read the certification statement carefully and sign and date the form where indicated.
7. Submit the completed form to your agency's human resources office or benefits administrator.

Who needs OPM SF 2809?

1. Federal employees who want to enroll in, change, or cancel their health benefits in the Federal Employees Health Benefits Program (FEHBP).
2. Retired federal employees and their dependents needing to manage their health benefits.
3. Individuals who are eligible for health benefits coverage and need to make updates or adjustments.

• Who needs Health Benefits Election Form?
• What is Health Benefits Election Form for?
• Is Health Benefits Election Form accompanied by other forms?
• • When is Health Benefits Election Form due?
  • How do I fill out Health Benefits Election Form?
  • Where do I send Health Benefits Election Form?

Who needs Health Benefits Election Form?

Form SF 2809 referred to as Health Benefits Election form. It is a part of Federal Employees’ Health Benefits Program that offers a wide choice of health plans. Form SF 2809 is created for employees, annuitants except for the members of the Civil Service retirement System or Federal Employees Retirement System, former spouses and children who’ve lost their FEB coverage.  

What is Health Benefits Election Form for?

The purpose of the Form SF 2809 is to give all FEB members opportunity to change their health plan or its specific options, enroll in a new plan or cancel the current enrollment. The information that an individual provides on the form is then used by the authorities to make corresponding changes.

Is Health Benefits Election Form accompanied by other forms?

An individual who’d like to enroll in a new health plan that is a part of the FEB program may be asked to provide proof of their eligibility. Such documents are sent upon request.

When is Health Benefits Election Form due?

The best time for health plan changes is from mid-November to mid-December. Outside this season, the changes are allowed only due to specific circumstances referred to as Qualified Life Events. Such changes must be requested 30 days before the events or 60 days within the events.

How do I fill out Health Benefits Election Form?

An individual must provide full personal information including name, address, SSN, date of birth, marital status and the information about family members. The individual then has to choose whether they want to change FEB plan, to enroll in a new one or cancel the current one. There is a separate box for each option. If an individual wants to change FEB plan, they must provide enter code and provide the reasoning for such a change.

Where do I send Health Benefits Election Form?

Once Form SF 2809 is complete it must be sent to the individual’s employing office.

Instructions and Help about OPM SF 2809

Hello everybody in this video I will share with you how to create a fillable form and Word 2011 for Mac in order to make this form you're going to have to show the development ribbon to do that you go toward references, and you click on the icon ribbons, and you're going to have to find the developer ribbon here it is, and you take it, and you say okay and as you can see the developer ribbon when you click on it, you will find making the form options here for example you can insert the frame and inside this frame there will be a forum example I will Center this one developer let's see this one will be named and then after that we want a text when people can fill in what they have to what they have to write, so we add text book as text box em next let's see gender let's see it's a checkbox and then let's see male when they can take their male or female and let's see here we hold the country and a combo box and then double-click on the combo box in order to be able to fill the options you want let's see you can add Sweden add France add, and you can change the option here between moving for example if you want France to be before Sweden and so on we can say ok, and then you can add as much as you want for this one when you say protect form anyone who's going to be receiving this form they won't be able to change the text they'd only be able to add in the areas that say supposed to be added in UK they can choose between here male and female they can take their option and name some chill, so it can be like this, and then you can save it, and you can send it to people, so they can fill the form and send it back to you thanks for watching

People Also Ask about

What is SF 2809 used for?

OPM Form 2809 is used by annuitants and former spouses to elect, cancel, suspend, or change health benefits enrollment during periods other than open season. Note: The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer.

What is USPS 2809 form?

Former spouses eligible to enroll for health benefits coverage under the FEHB Program must enroll for coverage by completing SF 2809. Former spouses complete Part A of the form using their own name, date of birth, and Social Security number.

What is health benefits election form?

OPM 2809, Health Benefits Election form, is used by annuitants and former spouses to elect, cancel, suspend, or change health benefits enrollment during periods other than open season.

What is a Form SF 2809?

The SF 2809 was written for all Federal employees and not all parts of the SF 2809 apply to tribal employees. You must complete the SF 2809 in order to: • enroll in the FEHB Program during your Initial Enrollment Opportunity. • enroll, change, or cancel your FEHB enrollment during the annual Open Season.

What is the fax number for Fehb enrollment?

PostalEASE FEHB and FSA worksheets may also be sent to the HRSSC via fax at 651–994-3543.

For pdfFiller’s FAQs

How can I send OPM SF 2809 for eSignature?

When you're ready to share your OPM SF 2809, you can send it to other people and get the eSigned document back just as quickly. Share your PDF by email, fax, text message, or USPS mail. You can also notarize your PDF on the web. You don't have to leave your account to do this.

How do I complete OPM SF 2809 online?

pdfFiller has made it easy to fill out and sign OPM SF 2809. You can use the solution to change and move PDF content, add fields that can be filled in, and sign the document electronically. Start a free trial of pdfFiller, the best tool for editing and filling in documents.

How do I make edits in OPM SF 2809 without leaving Chrome?

OPM SF 2809 can be edited, filled out, and signed with the pdfFiller Google Chrome Extension. You can open the editor right from a Google search page with just one click. Fillable documents can be done on any web-connected device without leaving Chrome.

What is OPM SF 2809?

OPM SF 2809 is a standard form used by federal employees to enroll in health insurance and make changes to their health benefits under the Federal Employees Health Benefits (FEHB) Program.

Who is required to file OPM SF 2809?

Federal employees who wish to enroll in or make changes to their health benefits coverage under the FEHB program are required to file OPM SF 2809.

How to fill out OPM SF 2809?

To fill out OPM SF 2809, you need to provide your personal information, select the type of enrollment (new, change, or cancellation), provide information about your health plan options, and sign the form to certify its accuracy.

What is the purpose of OPM SF 2809?

The purpose of OPM SF 2809 is to facilitate the enrollment and management of health benefits for federal employees, ensuring that they can enroll, change, or cancel their health insurance plans as needed.

What information must be reported on OPM SF 2809?

The information that must be reported on OPM SF 2809 includes the employee's name, Social Security number, agency, type of enrollment, selected health plan, and any dependents being enrolled or removed from coverage.