Date of Form	The new form is dated July 1999.
Purpose of Form	We created a new Annuitant/OWCP Health Benefits Election Form, SF 2809-1 for use by annuitants of retirement systems other than the Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS), including individuals receiving monthly compensation from the Office of Workers' Compensation Programs. The new form will also be used by former dependents of these annuitants who are eligible for coverage under the Temporary Continuation of Coverage or Spouse Equity provisions of FEHB law. The new form conforms to the 1997 changes to FEHB regulations that simplified and clarified the opportunities to enroll and change enrollment. It contains information specifically for annuitants and their former dependents. We also revised the SF 2809, Health Benefits Election Form, for use by employees, former employees and former dependents eligible to enroll under the Temporary Continuation of Coverage or Spouse Equity provisions of FEHB law. We have provided information on SF 2809 in Benefits Administration Letter 99-215.
Previous Editions	There are no previous editions of SF 2809-1.
When Available	The new SF 2809-1 is available 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 new SF 2809-1 will soon be available on the OPM FEHB website at www.opm.gov/insure.
Stock Number and Cost	The National Stock Number for SF 2809-1 is 7540-01-466-9084. The cost is $4.75 per package of 25.
Transition Help	As you know, the old SF 2809 used numbers to designate the events that permitted enrollment or change of enrollment. The revised SF 2809 and the new SF 2809-1 use 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 (not shown on SF 2809-1) Annuitant 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 OWCP and other retirement systems, 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 old form 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 charts. For example, a surviving child whose survivor annuity terminated because of marriage and later was restored may reenroll under event 2E. In addition, the 1997 regulations combined several of the old events, so that old event numbers 2 and 3 are now event B, C, or D 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 2809-1, please call our Information Staff on (202) 606-0191. You may also send Email about the new SF 2809-1 to Barbara Myers at bdmyers@opm.gov.

Abby L. Block, Chief Insurance Policy    and Information Division

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