Completing OPM Form RI 79-9: FEHB Cancellation or Suspension

OPM Form RI 79-9, the Health Benefits Cancellation/Suspension Confirmation, is how a federal retiree or survivor annuitant under CSRS or FERS tells OPM to either permanently cancel Federal Employees Health Benefits (FEHB) coverage or temporarily suspend it in favor of qualifying alternative coverage. The form does one job: it records your decision and confirms in writing that you understand the consequences. OPM will not act on the request until the signed form arrives.¹

Before anything else, know what RI 79-9 is not. It does not enroll you, change plans, or change your enrollment type between Self Only, Self Plus One, and Self and Family. Those changes go on OPM Form 2809, or through the FEHB Open Season Online portal during Open Season.²³

Cancel or Suspend: Pick the Right Block

The form gives you five checkboxes. Two cancel your coverage; three suspend it. The difference matters more than any other decision on the page.

Block A — Cancel to Join a Family Member’s FEHB

Use Block A when you are dropping your own enrollment because you will be covered under a family member’s FEHB. This cancellation is reversible: if that family member’s coverage later ends for any reason, you can resume your own enrollment.⁴

Block B — Permanent Cancellation

Block B is the block to think hardest about. The certification says you “will never again be eligible to enroll in the Federal Employees Health Benefits Program.”¹ You also give up the 31-day temporary extension of coverage and the right to convert to an individual policy through your carrier.⁵ Family members covered under your enrollment lose their coverage at midnight on the effective date, with no extension. The only route back is reemployment in a federal position that carries FEHB eligibility.

Block C — Suspend for Medicare Advantage

Use Block C when you have enrolled in a Medicare Advantage plan (Medicare Part C), such as Secure Horizons or Kaiser Permanente Senior Advantage. Standard Medicare Parts A and B do not qualify. Being enrolled only in Part A, Part B, or both, is not the same as enrolling in a Medicare Advantage plan, and will not support a suspension under Block C.⁶

Block D — Suspend for TRICARE, TRICARE for Life, Peace Corps, or CHAMPVA

Block D covers uniformed services coverage and CHAMPVA. TRICARE for Life users over 65 need Medicare Parts A and B in addition to their military eligibility.

Block E — Suspend for Medicaid or a Similar State Program

Block E is for retirees who have picked up Medicaid or an equivalent state-sponsored program.

All three suspension options preserve your right to come back into FEHB. Cancellation under Block B does not.

What You Have to Attach

The documentation follows the block:¹

Block A: a copy of the family member’s SF 2809 showing the change to a family enrollment. If that family member is also an annuitant, provide their name and annuity claim number instead.
Block B: nothing beyond your signature on the certification.
Block C: proof of enrollment in the specific Medicare Advantage plan, showing the effective date. A Medicare card by itself is not sufficient.
Block D: a copy of your Uniformed Services ID card; if you are over 65 and using TRICARE for Life, also a copy of your Medicare card showing Parts A and B; for CHAMPVA, a copy of your CHAMPVA Authorization Card.
Block E: a copy of an enrollment card or eligibility letter showing the effective date of your Medicaid or state program coverage.

When the Change Takes Effect

For any suspension, timing decides the effective date. If OPM receives your signed form and documentation within the window from 31 days before to 31 days after your alternative coverage begins, the suspension takes effect at the close of business the day before that alternative coverage starts. Miss that window and the suspension takes effect at the end of the month OPM receives your documentation.⁷ The gap can mean an extra month of FEHB premiums, so mail early.

Filling Out the Form

The form runs two pages. Download the fillable PDF from OPM’s forms page.¹

At the top, enter the date and your CS (Civil Service) claim number, the identifier tied to your annuity account. Then add your name, address, and phone number. The form does not ask for your Social Security Number.

Blocks A and B sit on page one. Blocks C, D, and E sit on page two. Check exactly one. Each block carries its own certification statement, and the language shifts significantly between cancellation and suspension. Read the certification under the block you are checking before you sign, because that is the paragraph that describes what you are giving up.

Sign and date the form at the bottom. Without your signature, OPM will not process it. A representative payee or court-appointed guardian acting for the annuitant should expect OPM to ask for additional authorization documents.

Where to Send It

Mail the signed form and any attachments to OPM’s Retirement Operations Center:

U.S. Office of Personnel Management
Post Office Box 45
Boyers, PA 16017⁸

The form itself lists a Washington address (1900 E Street NW, Room 2416, Washington, DC 20415-0001) and a fax number, 202-606-1640.¹ OPM’s general guidance is to fax only when the form or a customer service specialist provides a fax number, and RI 79-9 does, so faxing is a valid option here.⁸ If you mail it, use a tracked service; OPM will not act until the signed form arrives.

Questions before you submit go to OPM Retirement Services at 1-888-767-6738.¹

Coming Back After a Suspension

If you suspended through Block C, D, or E, OPM sends an Open Season package each year with re-enrollment instructions. You can re-enroll voluntarily during any Open Season; if you do not want to, ignore the package.¹

You can also re-enroll outside Open Season if you involuntarily lose your alternative coverage. Your request must reach OPM within a window starting 31 days before and ending 60 days after that alternative coverage ends, and you will need evidence of the involuntary loss. Miss that window and you wait for the next Open Season. Re-enrollment after involuntary loss takes effect the day after your alternative coverage ends.⁹

If you canceled under Block A to join a family member’s FEHB, you may resume your own enrollment when that family member’s coverage ends for any reason.

1
U.S. Office of Personnel Management. Health Benefits Cancellation/Suspension Confirmation, RI 79-9
2
U.S. Office of Personnel Management. Health Benefits Election Form, OPM 2809
3
U.S. Office of Personnel Management. FEHB Open Season Online
4
Office of Personnel Management. Submission for Review: Health Benefits Cancellation/Suspension Confirmation, RI 79-9
5
U.S. Office of Personnel Management. Termination, Conversion and Temporary Continuation of Coverage
6
OPM Retiree FEHB. Frequently Asked Questions
7
eCFR. 5 CFR 890.304 – Termination of Enrollment
8
U.S. Office of Personnel Management. Contact OPM Retirement Services
9
U.S. Office of Personnel Management. Insurance FAQs