WebMay 3, 2024 · SF 2809, Health Benefits Election FormPart A - Enrollee and Family Member's Information. Enter last, first, and middle initial. Enter Social Security number (SSN). Separated employee, child, or ex-spouse's SSN. Enter Date of Birth (mm/dd/yyyy). Separated employee, child, or ex-spouse's date of birth (Month, Day, and Year). WebWhen an employee experiences a qualifying life event (QLE) as described below, changes to the employee's FEHB coverage ( including change to Self Only and cancellation) and premium conversion election may be permitted, so long as they are because of and consistent with the QLEs.
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WebMar 17, 2024 · Employers should maintain benefits records such as plan documents, form 5500, financial statements, election forms, plan termination records, trust reports, 401 (k) forms, COBRA documentation, and other benefits documentation for six years following employee separation from the organization. How Should Employers Manage Records? WebHealth Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 Revised November 2015 U.S. Office of Personnel Management. Previous edition is not usable. Federal Employees. Health Benefits Program. For agency distribution of copies, see page 5 . of the instructions. Part A - Enrollee and Family Member Information send teams recording to external users
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WebNov 1, 2024 · Standard Form 2809, Health Benefits Election Form, is used by Federal employees, annuitants other than those under the Civil Service Retirement System … Webaccount at www.ers.state.tx.us or send this form to your benefits coordinator. If you are a Health and Human Services Enterprise employee, you may send this form to HHS … WebFeb 14, 2024 · After your first 60 days of employment, complete and submit SF- 2809 (FEHB – Health Benefits Election Form) to the Retirement and Benefits Portal or mail original to U.S. Customs and Border Protection, Retirement and Benefits Advisory Services (RABAS), 90K Street NE, 5th Floor, Washington, DC 20249, Mail Stop 1400. send teens \u0026 kids to relatives mod