OMB control number
SF 2809 Federal Employees Health Benefits Program Election Form; OPM 2809 Health Benefits Election Form
OMB 3206-0160 · OPM.
The SF 2809 is used to enroll, elect not to enroll, change, suspend or cancel your health insurance coverage in the Federal Employees Health Benefits (FEHB) Program which includes FEHB and Postal Service Health Benefits (PSHB) plans. A different form (OPM 2809) is used by annuitants retired under the Civil Service Retirement System (CSRS) or Federal Employees' Retirement System (FERS), electing or changing either there FEHB or Postal Service Health Benefit (PSHB) coverage under the FEHB Program as well as the following: children and former spouses who are eligible for temporary continuation of coverage; former spouses; survivor annuitants under CSRS or FERS; an OPM appointed representative payee or court appointed guardian of the eligible member.
The latest form for SF 2809 Federal Employees Health Benefits Program Election Form; OPM 2809 Health Benefits Election Form expires 2027-11-30 and can be found here.
Document Name |
|---|
Form and Instruction |
Form and Instruction |
Form and Instruction |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Supporting Statement A |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Form OPM 2809 Health Benefits Election Form
Form SF 2809 Federal Employees Health Benefits Program Election Form
Form SF 2809 Health Benefits Election Form
Health Benefits Election Form