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Sf 2809 2004 form-2026
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- Click ‘Get Form’ to open the SF 2809 in the editor.
- Begin with Part A, where you will enter your personal information. Fill in your name, Social Security number, and date of birth clearly.
- In Part B, provide details about your current health plan. Enter the plan name and enrollment code as specified on your plan brochure.
- Move to Part C to select a new plan if you are changing your enrollment. Again, input the plan name and enrollment code.
- For event-related changes, complete Part D by entering the appropriate event code that corresponds to your qualifying life event.
- If you wish to cancel or suspend your enrollment, navigate to Parts E and F respectively and mark the appropriate boxes.
- Finally, sign in Part H to certify that all information is accurate before submitting the form through our platform for processing.
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Related links
Note: You cannot enroll in a FEDVIP plan using the Health Benefits Election Form (SF. 2809) or through an agency self-service system, such as EmployeeRead more
The October 2004 edition supersedes all previous editions of this form and makes obsolete the Annuitant/OWCP Health. Benefits Election Form, SF 2809-1. SF 2809Read more
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