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Health Benefits Registration Form For Use Only by Annuitants and Former Spouses of Annuitants
This form is used by annuitants and former spouses to elect, cancel, or change health benefits enrollment during periods other than open season. IF YOU EXPERIENCE PROBLEMS OPENING THIS FORM, try using the RIGHT button on your mouse, click on the PDF/F icon and select "Save target as" from the resulting menu. Save the form file to your hard drive or a local network drive. Then open the file directly using Adobe Reader 5.0 or above. Using this method, you will avoid trying to open the file through your internet browser.
Form #:  OPM 2809
Agency:  Office of Personnel Management
  TYPE PAGES SIZE (KB) CAPABILITY WHAT'S
NEEDED
pdf Both Form and Instructions 12   [3] Fillable + Printable Adobe Reader Download  

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