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Omb no 3206 0141 2011 form

Omb no 3206 0141 2011 form-2026

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The document is a Health Benefits Election Form (SF 2809) used by federal employees to enroll, change, or cancel their participation in the Federal Employees Health Benefits (FEHB) Program. It outlines eligibility criteria for employees, annuitants, former spouses, and individuals eligible for Temporary Continuation of Coverage (TCC). The form includes sections for personal information, current and desired health plans, qualifying life events that permit changes in enrollment, and instructions for completing the form. It emphasizes the importance of not being covered under more than one FEHB enrollment and provides guidance on how to handle dual coverage situations.

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Click ‘Get Form’ to open it in the editor.
Begin with Part A, where you will enter your personal information including your name, Social Security number, and date of birth. Ensure all details are accurate.
In Part B, if applicable, indicate the FEHB plan you are currently enrolled in by entering the plan name and enrollment code.
Proceed to Part C to specify the FEHB plan you wish to enroll in or change to. Again, provide the plan name and enrollment code.
For Part D, select the event that permits you to enroll or change your coverage. Enter the corresponding event code and date.
If you do not wish to enroll, complete Part E by marking the appropriate box and signing in Part H.
Finally, review all entries for accuracy before submitting your form through our platform for processing.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (82 Votes)
2015	4.3 Satisfied (340 Votes)
2014	4.4 Satisfied (802 Votes)
2011	4 Satisfied (24 Votes)
2011	4.4 Satisfied (226 Votes)
2004	4 Satisfied (49 Votes)

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What is the health benefits election form?

The SF 2809 was written for all Federal employees and not all parts of the SF 2809 apply to tribal employees. You must complete the SF 2809 in order to: enroll in the FEHB Program during your Initial Enrollment Opportunity. enroll, change, or cancel your FEHB enrollment during the annual Open Season.

How do I find my FEHb enrollment code in OPM?

Enrollment codes are found on the front cover of each plans brochure.

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