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If we receive this signed form and documentation within 31 days before to 31 days after the effective date of your Medicaid or similar state-sponsored enrollment, we will suspend your FEHBP coverage at the close of business the day before your Medicaid or state-sponsored program coverage begins.
you the form you need to use to confirm this in writing. If you prefer, you can write to us at: U.S. Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045.
Uses for Standard Form (SF) 2809 Use this form to: \u2022 Switch designated eligible family member; or. Enroll or reenroll in the FEHB Program; or. Elect not to enroll in the FEHB Program (employees only); or. Change your FEHB enrollment; or.
Federal Employees Health Benefits (FEHB) Program http://www.opm.gov/healthcare- insurance/healthcare/ FEHB provides comprehensive health insurance.
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you the form you need to use to confirm this in writing. If you prefer, you can write to us at: U.S. Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045.
This will avoid processing delays. Send the last two pages of the SF-2809 to us by emailing APHIS.Open.Season@usda.gov OR fax it to us at (612) 336-3545.
This will avoid processing delays. Send the last two pages of the SF-2809 to us by emailing APHIS.Open.Season@usda.gov OR fax it to us at (612) 336-3545.
Send comments regarding our time estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel Management, Retirement Services Publications Team, (3206-0160), Washington, D.C. 20415-0001. The OMB number, 3206-0160 is currently valid.
Definition: Enrollment code of the Federal Employees Health Benefit (FEHB) in which the employee is currently enrolled. The first two digits of the code indicate the health plan name. The last digit indicates the plan type, either individual or family plan.

opm form 2809 pdf