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SF2809 - Health Benefits Election Form Authority: OPM is authorized to collect the information requested on this form pursuant to Title 5, U S C Chapter 89 and Title 5 of the Code of Federal Regulations, Part 890 pertaining to enrollment in the Federal Employees Health Benefits (FEHB) Program
Form Approved: Employee Health Benefits Election Form At Part D of the SF 2809, Health Benefits Election Form, you must designate your two-character event code (for example, 1A) and the date of the event using numbers to show month, day, and complete year; e g , 06 30 1998
Health Benefits Election Form The information you provide on this form is needed to document your enrollment in either the Federal Employees Health Benefits (FEHB) or Postal Service Health Benefits (PSHB) plan within the Federal Employees Health Benefits Program (FEHB Program) under chapter 89 of title 5, United States Code
Forms and Brochures - U. S. Office of Personnel Management Employing offices obtain Standard Forms 2809 and 2810 directly from GSA supply centers, just as they do other OPM Standard Forms Agencies do not need to maintain an internal procurement and distribution network for FEHB forms
Standard Forms - U. S. Office of Personnel Management Browse the listing below to download your choice of form (s) On June 26, 2013, the Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional
Eligibility Enrollment - U. S. Office of Personnel Management Health Benefits Election Form (SF 2809) (PDF file) If an employee dies, he she will not have an FEHB Self Plus One or Self and Family enrollment for his her survivors to continue, even if he she is eligible for a survivor annuity
Enroll - U. S. Office of Personnel Management You can submit Standard Form 2809, Employee Health Benefits Election Form (PDF file), to your Human Resources Office (Unless you are in U S Postal Service employee)