Standard Form 2809

Standard 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: Or cancel your fehb enrollment; Enroll in the fehb program; Web data standards request form: Or suspend your fehb enrollment (annuitants or former spouses only). Or • cancel your fehb enrollment; Pdf versions of forms use adobe reader ™. • enroll or reenroll in the fehb program; Web health benefits election form form approved:

Employee health benefits registration form: Or • cancel your fehb enrollment; Pdf versions of forms use adobe reader ™. Web data standards request form: For agency distribution of copies, see page 5. Or • suspend your fehb enrollment (annuitants or former spouses only). Report of withholdings and contributions for health benefits by enrollment code By human capital november 1, 2019. •children and former spouses who are eligible for temporary continuation of coverage. Or elect not to enroll in the fehb program (employees only);or change your fehb enrollment;

Web health benefits election form. Or cancel your fehb enrollment; Or suspend your fehb enrollment (annuitants or former spouses only). Or • suspend your fehb enrollment (annuitants or former spouses only). Pdf versions of forms use adobe reader ™. Or elect not to enroll in the fehb program (employees only); 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; • switch designated eligible family member; By human capital november 1, 2019. Or • elect not to enroll in the fehb program (employees only);or • change your fehb enrollment;

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Web Data Standards Request Form:

Web uses for standard form (sf) 2809 use this form to: Or • cancel your fehb enrollment; •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers. Enroll in the fehb program;

Health Benefits Registration Form (Only For Use By Annuitants And Former Spouses Of Annuitants) Opm 2810:

Report of withholdings and contributions for health benefits by enrollment code For agency distribution of copies, see page 5. Web uses for standard form (sf) 2809 use this form to: Instructions for completing opm 2809.

Web Health Benefits Election Form.

• switch designated eligible family member; Or enroll or reenroll in the fehb program; Web health benefits election form uses for standard form (sf) 2809 use this form to: Web health benefits election form form approved:

Or • Elect Not To Enroll In The Fehb Program (Employees Only);Or • Change Your Fehb Enrollment;

Notice of change in health. Notice of change in health benefits enrollment: Or cancel your fehb enrollment; Or suspend your fehb enrollment (annuitants or former spouses only).

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