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Health Benefits Election form (SF 2809) - OPM
Health Benefits Election Form. Form Approved: OMB No. 3206-0160. Standard Form 2809. Revised November 2015. Previous edition is not usable. Uses for ...

OPM Form 2809
Health Benefits Election Form. Form Approved: OMB No. 3206-0141. Who May Use OPM Form 2809. • Annuitants ..... Date of birth (mm/dd/yyyy). 4. Sex. M. F. 5.

Health Benefits Election FormStandard Form (SF) 2809 - OPM
The Standard Form 2809 was written for Federal employees and not all ... guidance explains how to complete the Health Benefits Election Form (SF 2809) as a.

Employee Health Benefits Election Form
Employee Health Benefits Election Form. Form Approved: OMB No. 3206-0160. Standard Form 2809. Revised July 1999. Previous editions are not usable.

SF 2809 - Aetna Federal Plans
Health Benefits Election Form. Uses for Standard Form (SF) 2809. Use this form to: • Enroll or reenroll in the FEHB Program; or. • Elect not to enroll in the FEHB ...

Direct Premium Remittance System (DPRS) - National Finance Center
New Enrollee SF 2809 Part A Family Information . ..... Agencies are currently completing on the hard copy SF 2809 form will be entered into the DPRW.

Federal Employees Health Benefits (FEHB) Facts
enrollment form as verification of the family member's eligibility. The family .... You may use the Health Benefits Election form (SF 2809) to request a new ...

Employee Benefits - NCUA
permit enrollment is outlined on the form SF-2809 and also on the health ... federal employees and it is also in Outlook's public folders under Forms, OPM.

Program. Election period from date of appointment. If received in HR by. Earliest can be effective. Federal Employees Health. Benefits (FEHB). • Form: SF-2809.

Guide to Federal Benefits for Temporary Continuation - House.gov
Do not complete an SF 2809, Health Benefits Election Form, or enter ... You must use an SF 2809 or an agency selfservice enrollment system to make this.

Federal Benefits Fast Facts for Certain Full-Time - NIH HR
Jan 11, 2015 ... Health Benefits Election form, SF-2809 and submit it WRD, Benefits and Payroll Liaison. Branch (BPLB), Building 31, Room B3C23. A.

2016 GEHA High and Standard Option Plan Brochure
A fee-for-service (high and standard option) health plan with a preferred provider ... Standard Form 2809, Health Benefits Registration Form, evidencing.

HR/RET - RNet - Department of State
Statement (Form Page 2 of 2), certified copies of the marriage certificate, your ... for your new spouse, please complete the Standard Form 2809, Health Benefits.

Temporary Hire Pay and Benefits Information - Usgs
FORM: Complete the SF 2809 form found online at www.opm.gov/forms/pdf_fill/ sf2809.pdf. Return form even if you are not electing coverage. Event code in Part  ...

Federal Employee Health Benefits Form at the time of hire, providing notification of ... To enroll the casual, the Health Benefits Election Form (SF-2809) will be ...

FEHB Program Enrollment Eligibility - Office of Human Resources
Dec 31, 2014 ... Employees may elect FEHB coverage beginning January 1, 2015, through submission of. Standard Form (SF) 2809, revised in November 2014 ...

Offering Casuals Federal Employee Health Benefits - Bureau of
Jan 1, 2017 ... calendar year, the casual can re-enroll by submitting a new Health Benefits Election Form (SF-. 2809) to the CPC. The casual may elect to ...

Employee Checklist for Retirement - TSA HR Access
Apr 18, 2016 ... Submit new SF 2809 Health Benefits Election form if FEHB is impacted. NOTE: Your current enrollment code for your new health benefit plan ...

SF 3107 - DoDEA
Complete form SF 3107-2, Spouse's Consent to Survivor Election, and attach it to your ...... SF 2809. Employee Health Benefits Election Form. SF 2810. Notice of ...

U.S. Department of Energy New Employee Orientation FORMS
Phone Number: New Employee Orientation Forms to be issued and collected by HR Orientation Team: ... Health Benefits Election Form – SF‐2809 (return within.