U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce
Insurance Services Programs
FEHB Handbook
Forms and Brochures
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Each employing office must keep a supply of the following FEHB forms on hand to meet anticipated needs:
Forms for employee use:
- Health Benefits Election Form (SF 2809)
- Notice of Change in Health Benefits Enrollment (SF 2810)
- Guide to Federal Employees Health Benefits Plans (FEHB Guide) (RI 70-1 for Federal Civilian employees; RI 70-2 for Postal employees; RI 70-5 for spouse equity and TCC eligibles; RI 70-8 for temporary employees eligible to enroll under 5 U.S.C. 8906a; or RI 70-10 for visually impaired employees). This Guide is updated yearly.
- Temporary Continuation of Coverage (TCC) under the Federal Employees Health Benefits Program (RI 79-27)
Forms for employing office use:
- Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement (Lockbox) (SF 2812-L)
- Supplemental Semiannual Headcount Report (OPM Form 1523)
The carrier of your plan will send you its brochure before the beginning of each
contract year. Your employing office must keep a supply of FEHB Program carriers' plan brochures on
hand for your reference. Since the FEHB Guide does not contain a complete description of plan benefits, you need
to review the plan brochures so you will have enough information to make an informed
choice. The OPM Web Site (www.opm.gov/insure)
has helpful information about the FEHB Program. You can download the FEHB Guide and plan
brochures. The Web Site also has links to carrier web sites. Before the annual open season begins, OPM arranges to have supplies of the FEHB Guide
(RI 70-1, RI 70-5, RI 70-8, or RI 70-10, as applicable) shipped to agency-designated
distribution points, except for RI 70-2, which is printed and distributed by the U.S.
Postal Service. The quantities are based on information the agency provides to OPM. Each fee-for-service plan distributes a supply of reference brochures to each
agency's designated distribution point. This distribution point then ships the brochures
to the installations it serves throughout the world. Agency installations order HMO brochures directly from the HMOs, in a quantity
determined in accordance with information provided by OPM. The plans then ship these
brochures directly to the installation where they are available to you for reference. Employing offices obtain Standard Forms 2809 and 2810 directly from GSA supply centers, just as they do other OPM
Standard Forms. Agencies do not need to maintain an internal procurement and distribution
network for FEHB forms. Agencies may reproduce Standard Forms 2812-L and OPM Form 1523. RI 79-27 is available to agencies by ordering from OPM riders
issued at least annually. The General Services Administration (GSA) allows the use of PC-based, agency-generated
substitute forms, and OPM will accept substitute health benefits forms that meet GSA and
OPM requirements. Substitute forms must meet the general requirements established by GSA (41 CFR Part
201-9 and Bulletin B-3, 12g Electronic Generation of Standard and Optional Forms,
as amended) and the requirements specified here. Substitute forms must be approved by OPM prior to their use. The electronic reproduction must be complete, containing all instructions and questions
that appear on the current official form. The wording and punctuation of all items,
instructions, and identifying information must match exactly. No data element may be added
to or deleted from the form. The sequence and format for each item on the form must be
reproduced to the highest degree possible. Each item must print on the page in
approximately the same location. The approval form must include the vendor/agency name and
the OPM approval expiration date at the bottom of each page. Automated forms should be generated with black ink on white paper that is 8.5"
wide and 11" long. Agencies may photocopy standard forms that have carbon copies to create the needed
copies when the original and the copy are identical. The original form must have an
original signature. Copies may have a photocopy of the signature. Agencies that develop substitute forms packages must submit a complete printed set of
the forms and a fully functional copy of the program to OPM prior to actual use of the
forms. OPM will issue approvals for one-year periods to ensure that the forms remain
current. Send requests for approval to Retirement and Insurance Service, Forms Analysis and Design, Room 4H28, 1900 E Street, NW, Washington, DC 20415. Agencies that have developed, or plan to develop, automated forms that are populated
from internal automated systems, and/or can store input to a data base, should contact OPM
for information on direct data transmission via disk, tape, telephone or the Internet.
Agencies may submit their plans to the address shown above, by email to cbenson@opm.gov, or call (202) 606-0623. If a form is revised during the year, OPM will notify the substitute forms developer of
the revision and the deadline for revision of the program. Adobe Acrobat versions of most FEHB forms are available on OPM's website at www.opm.gov/forms/index.htm. Your employing office may allow you to make Open Season and other health benefits
changes though "Employee Express" or another electronic method. Call your
employing office for more information. page:
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