SF 2809 is the Standard Form that the U.S. Office of Personnel Management (OPM) provides for enrolling in, changing, cancelling or suspending coverage under the Federal Employees Health Benefits (FEHB) Program. Employees, certain annuitants, former spouses under the Spouse Equity law and people eligible for Temporary Continuation of Coverage (TCC) use it, each within the time limits set by the qualifying event. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form and its instructions are published by OPM, and the completed form goes to your employing office.
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What is SF 2809?
SF 2809, the Employee Health Benefits Registration Form, is the Office of Personnel Management (OPM) form used to enroll in, change, cancel or suspend coverage under the Federal Employees Health Benefits (FEHB) Program, or to elect not to enroll.
The title printed on the form itself is Health Benefits Election Form, and it carries OMB No. 3206-0160. The version described here is marked Revised November 2019, and the form states that the previous edition is not usable. OPM's list of standard forms names it Employee Health Benefits Registration Form.
The form has nine parts:
- Part A: enrollee and family member information.
- Part B: the FEHB plan you are currently enrolled in.
- Part C: the plan you are enrolling in or changing to.
- Part D: the event that permits you to enroll, change or cancel.
- Parts E, F and G: election not to enroll (employees only), cancellation, and suspension (annuitants and former spouses only).
- Part H: signature.
- Part I: agency or retirement system use only.
The instructions include the Table of Permissible Changes in Enrollment, based on 5 CFR Parts 890 and 892, which lists the event codes you enter in Part D and the time limit for each. Completing the form produces an enrollment election that your employing office processes; it does not choose a plan for you.
SF 2809 is not for CSRS or FERS annuitants, who use form OPM 2809 instead.
Who needs to file SF 2809?
Four groups may use SF 2809:
- Employees eligible to enroll in, or currently enrolled in, the FEHB Program. Employees automatically participate in premium conversion unless they waive it.
- Annuitants in retirement systems other than the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS), including people receiving monthly compensation from the Office of Workers' Compensation Programs (OWCP).
- Former spouses eligible to enroll in, or enrolled in, FEHB under the Spouse Equity law or similar statutes.
- Individuals eligible for Temporary Continuation of Coverage (TCC): former employees who separated from service, children who lose FEHB coverage, and former spouses not eligible under the Spouse Equity group.
Do not use this form if you are a CSRS or FERS annuitant, or a former spouse or child of a CSRS/FERS annuitant. Use form OPM 2809, available at www.opm.gov/forms/OPM-forms, or call the Retirement Information Office toll-free at 1-888-767-6738. CSRS and FERS annuitants who want to cancel or suspend use form RI 79-9 instead.
Part E (election not to enroll) is for employees only, and Part G (suspension) is for annuitants and former spouses only. If you register for someone else under written authorization, or as the court-appointed guardian of a former spouse or TCC-eligible individual, you sign Part H and attach the proof.
When to file SF 2809
File SF 2809 when the event or opportunity you enter in Part D occurs, within the time limit the Table of Permissible Changes gives for that event code. Examples from the table:
- Employees' initial opportunity to enroll: within 60 days after becoming eligible.
- Open season: as announced by OPM.
- Change in family status for employees in premium conversion: within 60 days after the change, and you may enroll or change beginning 31 days before the event.
- Annuitants and former spouses: generally from 31 days before through 60 days after the event.
- TCC enrollment: within 60 days after the qualifying event or receiving notice of eligibility, whichever is later.
Most enrollments and changes outside open season take effect on the first day of the pay period after your employing office receives the form, following a pay period in which you were in pay status at any time. Your employing office gives the exact date. United States Postal Service employees should consult their employing office, because their rules may differ.
Documents you need
- Written authorization from the person you are registering for, attached to the form, if you sign Part H on someone else's behalf.
- Evidence of court-appointed guardianship, if you register as guardian for a former spouse eligible under the Spouse Equity provisions or for an individual eligible for TCC.
- A separate sheet listing any additional family members, attached to the form, if you need more space than Part A provides.
- Adequate medical certification that a mental or physical disability began before the child's 26th birthday and prevents self-support, for a disabled child age 26 or older; your employing office gives details.
- Documentation of eligibility for the non-FEHB program (such as Medicare Advantage, Medicaid, TRICARE, CHAMPVA or Peace Corps), if you suspend under Part G, sent to the office that maintains your enrollment.
- Any other certification or documentation your employing office requires for a family member, for example a foster child.
How to fill out SF 2809
Enter enrollee identification
In Part A, enter your name (last, first, middle initial) in item 1, Social Security Number in item 2, date of birth in item 3 as mm/dd/yyyy, sex in item 4 and your answer to item 5. If you are separated but not divorced, you are still married.
Add address and Medicare details
Enter your home mailing address with ZIP Code in item 6. If you have Medicare, check Part A, B and/or D in item 7, including prescription drug coverage under Part D, and enter your Medicare Beneficiary Identifier in item 8.
Report other insurance
In item 9 check Yes or No for insurance other than Medicare. If Yes, complete item 10. If the other coverage is FEHB, check the FEHB box and stop; contact your Human Resources office or retirement system immediately.
Give contact information
Enter your email address in item 11 and your preferred telephone number in item 12.
List eligible family members
Complete items 13 to 24 only for Self Plus One or Self and Family. Give each member's name, SSN (leave item 14 blank if none), birth date, sex, relationship code in item 17 (such as 01 Spouse or 19 Child under age 26), address if different, Medicare and other-insurance details. Use a separate sheet for more members.
Enter your current plan
In Part B, enter the plan name and enrollment code from your plan ID card. Complete it if you are changing, cancelling or suspending.
Enter the plan you want
In Part C, enter the plan name and enrollment code from the front cover of the plan brochure. The code shows the plan, option and whether it is Self Only, Self Plus One or Self and Family.
Enter the qualifying event
In Part D, enter the event code from the Table of Permissible Changes in item 1 and the event date in item 2 as mm/dd/yyyy. For a new enrollment, use the date you became eligible; for open season, the date open season begins.
Mark an election, cancellation or suspension
Place an X in Part E only if you are an employee who does not want to enroll, in Part F only to cancel, or in Part G only if you are an annuitant or former spouse suspending coverage. Leave these blank for an ordinary enrollment or change.
Sign and date Part H
Sign (do not print) in item 1 and enter the date in item 2 as mm/dd/yyyy. If you sign for someone else, attach the written authorization or guardianship evidence.
Review and download the PDF
Leave Part I blank for the agency, check that every entry matches your plan brochure and ID card, then download or print the completed PDF from FillingPDF and give it to your employing office as described under How to submit.
How to submit SF 2809
Give the completed, signed SF 2809 to your employing office, or use your agency's electronic enrollment system if it offers one. The form prints no mailing address.
- Employing office: the table lists the employing office as the place to file. This means the office of an agency or retirement system responsible for your health benefits actions. Annuitants and former spouses file with the office that maintains their enrollment.
- Electronic enrollment: many agencies let employees make changes by touch-tone telephone or computer through Employee Express or another automated system instead of the form. If you are not sure it is available to you, ask your employing office.
Attach any required proof with the form: written authorization if you register for someone else, evidence of court-appointed guardianship, a separate sheet for extra family members, and documentation of other coverage if you suspend. Part I is completed by the agency or retirement system, which distributes copies to the Official Personnel Folder, new and old carriers, the payroll office and the enrollee. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Using SF 2809 as a CSRS or FERS annuitant, or as a former spouse or child of one; the form directs you to form OPM 2809.
- Using SF 2809 to cancel or suspend as a CSRS or FERS annuitant instead of form RI 79-9, Health Benefits Cancellation/Suspension Confirmation.
- Leaving Part B blank when you are changing, cancelling or suspending; you must enter your current plan name and enrollment code.
- Checking the FEHB box in item 10 and not contacting your Human Resources office or retirement system at once; it signals a dual coverage situation.
- Printing your name in Part H instead of signing, or leaving it unsigned; the agency cannot process the request without this part.
- Writing in Part I, which is for agency or retirement system use only.
- Choosing Self Plus One without completing the family member information for your designated family member; the election cannot be processed.
- Listing a parent or other relative as a family member; other relatives are not eligible even if they live with you.
- Cancelling without reading the cancellation warnings: no 31-day extension or conversion applies, and family members who lose coverage are not eligible for TCC.
Frequently asked questions
What is SF 2809 used for?
SF 2809 is the OPM form for enrolling or reenrolling in the FEHB Program, switching the designated family member, changing or cancelling an enrollment, or suspending it (annuitants and former spouses only). Employees can also use it to elect not to enroll.
Who should not use SF 2809?
CSRS and FERS annuitants, and former spouses and children of CSRS/FERS annuitants, should not use it. They use form OPM 2809, or form RI 79-9 to cancel or suspend. For help, call the Retirement Information Office at 1-888-767-6738.
Can I fill out SF 2809 online?
Yes. You can fill out SF 2809 online on FillingPDF and download or print the completed PDF. FillingPDF is an independent service and does not submit the form; you give it to your employing office or use your agency's electronic system.
Where do I submit SF 2809?
File it with your employing office, the office responsible for health benefits actions at your agency or retirement system. Many agencies let employees make changes through Employee Express or another automated system instead; ask your employing office if you are unsure.
How long do I have to file after a qualifying life event?
It depends on the event code in Part D. For most employee family-status changes it is within 60 days after the change. Annuitants and former spouses generally file from 31 days before through 60 days after the event. Open season dates are announced by OPM.
Can I cancel my FEHB enrollment at any time with SF 2809?
Not always. Employees in premium conversion may cancel only during open season or after a Qualifying Life Event. Employees who waived premium conversion, annuitants, former spouses and TCC enrollees may cancel at any time, but cancelling ends the 31-day extension and conversion rights.
Who counts as an eligible family member on SF 2809?
A spouse and children under age 26, including adopted children, stepchildren, recognized natural children and foster children living with you in a regular parent-child relationship. A disabled child 26 or older may qualify with medical certification. Parents and other relatives are not eligible.
When does my FEHB enrollment change take effect?
Except for open season, most enrollments and changes take effect on the first day of the pay period after your employing office receives SF 2809, following a pay period in which you were in pay status. Your employing office can give you the specific date.
Is SF 2809 the same as the Health Benefits Election Form?
Yes. The title printed on the form is Health Benefits Election Form, while OPM's list of standard forms names SF 2809 the Employee Health Benefits Registration Form. Both refer to the same form, Revised November 2019.
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