Date of Revision	The revised form is dated July 1999.
Purpose of Revision	We revised the form to conform to the 1997 changes to FEHB regulations that simplified and clarified the opportunities to enroll and change enrollment. The revised SF 2809, Employee Health Benefits Election Form, will be used by employees, former employees and former dependents eligible to enroll under the Temporary Continuation of Coverage or Spouse Equity provisions of FEHB law. We also created a new form, Annuitant/OWCP Health Benefits Election Form (SF 2809-1) for use by annuitants of other retirement systems for Federal employees and compensationers. We have provided additional information on this form in Benefits Administration Letter 99-216.
Previous Editions	Previous editions of SF 2809 are not usable.
When Available	The revised SF 2809 will be available at the beginning of October from the General Services Administration's Federal Supply Service using the normal FEDSTRIP/MILSTRIP procedures as specified by your agency's procurement or acquisition office. (FEDSTRIP/MILSTRIP is the ordering procedure used by agencies to procure items from the GSA Federal Supply Depot.) The revised SF 2809 will soon be available on the OPM FEHB website at www.opm.gov/insure.
Stock Number and Cost	The National Stock Number for SF 2809 is 7540-01-231-6227. The cost is $15.62 per hundred. .
Transition Help	As you know, the old SF 2809 used numbers to designate the events that permitted enrollment or change of enrollment. The revised form uses a code consisting of a number and a letter so that the events could be grouped by category of enrollee as they are in the regulations. The number signifies the category of enrollee, and the letter signifies the event. The enrollee categories are: - Employee - Annuitant (not shown on SF 2809) - Former Spouse - Temporary Continuation of Coverage We believe these new event codes will make it easier for enrollees to find the event applicable to their specific situation. To ease the transition for agencies, we have attached two versions of a chart that translates the old event number from the 1992 SF 2809 into the new event code. The first chart lists the events from the August 1992 SF 2809 and shows both the old and new event codes. The second chart provides a further breakdown of the new codes by category of enrollee. For example, an open season change that was previously event #1 would now be 1B for employees, 2A for annuitants, 3B for former spouses, and 4B for TCC enrollees. The 1997 regulations created several new events for which there is no old event number; therefore these new events are not shown on the attached charts. For example, an employee's initial opportunity to enroll is event 1A. In addition, the 1997 regulations combined several of the old events, so that old event numbers 5, 6, 7, 11, 12, 15, 16, 17 and 20 are now event F or G under the new enrollee categories. Charts #1 and #2 give complete information on old and new codes and associated events. If you need assistance in understanding the new SF 2809, please call our Information Staff on (202) 606-0191. You may also send Email about the new SF 2809 to Barbara Myers at bdmyers@opm.gov.

Abby L. Block, Chief Insurance Policy    and Information Division

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