FEHB SF 28091 1999 Fill and Sign Printable Template Online US
Standard Form 2809. Or cancel your fehb enrollment; Or suspend your fehb enrollment (annuitants or former spouses only).
• switch designated eligible family member; Report of withholdings and contributions for health benefits, life insurance, and retirement: Or • cancel your fehb enrollment; Or cancel your fehb enrollment; Web uses for standard form (sf) 2809 use this form to: Health benefits registration form (only for use by annuitants and former spouses of annuitants) opm 2810: Notice of change in health benefits enrollment: •annuitants retired under the civil service retirement system (csrs) or federal employees retirement system (fers) •survivor annuitants under csrs or fers. Pdf versions of forms use adobe reader ™. Or • suspend your fehb enrollment (annuitants or former spouses only).
•children and former spouses who are eligible for temporary continuation of coverage. Instructions for completing opm 2809. Web uses for standard form (sf) 2809 use this form to: Or elect not to enroll in the fehb program (employees only); Or cancel your fehb enrollment; 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; Employee health benefits registration form: Web health benefits election form. Previous edition is not usable. Web health benefits election form uses for standard form (sf) 2809 use this form to:
