OPM Form 2809 is the Health Benefits Election Form used to enroll in, change, or cancel coverage under the Federal Employees Health Benefits (FEHB) Program. To use it correctly, pick the version that matches your status, file within an approved window, enter the right plan and event codes, sign it, and send it to your agency’s human resources office or, if you’re retired, to OPM’s Retirement Operations Center.
Pick the Right Version Before You Start
OPM publishes two nearly identical forms. Active federal employees use SF-2809, a fillable PDF on the OPM website.1U.S. Office of Personnel Management. OPM Form SF 2809 – Health Benefits Election Form Retired annuitants and survivor annuitants use OPM Form 2809, most recently revised in April 2025.2Office of Personnel Management. Federal Employees Health Benefits Program Health Benefits Election Form Same information, different rules and instructions. Submitting the wrong one will delay processing.
When You Can File
The form is only accepted during a valid enrollment window. Outside those windows it will be rejected no matter how well you complete it.
Your First 60 Days
New federal employees have 60 days from the date they become eligible to elect FEHB coverage or decline it in writing.3eCFR. 5 CFR 890.301 – Opportunities for Employees to Enroll or Change Enrollment; Effective Dates Miss it and you generally wait until Open Season unless a qualifying life event opens a new window. Use event code 1A for an initial enrollment.1U.S. Office of Personnel Management. OPM Form SF 2809 – Health Benefits Election Form
Open Season
The Federal Benefits Open Season is an annual window, typically in November, when any eligible employee or annuitant can enroll, switch plans, or change coverage tiers without a special reason. The next Open Season is expected in November 2026.4U.S. Office of Personnel Management. 2025 Federal Benefits Open Season Open Season changes use event code 1B.
Qualifying Life Events
Between Open Seasons, you can only file if a qualifying life event changes your insurance needs. The form lists more than a dozen event codes. The ones you’ll see most often:5U.S. Office of Personnel Management. Enrollment
- 1C, change in family status: marriage, divorce, birth or adoption, death of a spouse or dependent, or a child aging out at 26.
- 1D, change in employment status: reemployment after a break of more than three days, or return to pay status from unpaid leave if coverage lapsed.
- 1E, change affecting insurance cost: moving between part-time and full-time, or moving from a temporary appointment to one that receives the government premium contribution.
- 1F, return from uniformed service.
- 1I, moving outside your FEHB HMO’s service area.
- 1L, becoming entitled to Medicare and wanting to switch plans or options.
- 1M, loss of other coverage, whether under another FEHB enrollment or a different group plan.
You’ll need documentation proving the event happened, such as a marriage certificate, birth certificate, or court order. The date on the form must match the legal document exactly. Your HR office or retirement system generally requires the documentation within 60 days of the event.3eCFR. 5 CFR 890.301 – Opportunities for Employees to Enroll or Change Enrollment; Effective Dates
How to Fill Out Each Part
The employee form runs from Part A through Part I; the annuitant form runs through Part G. Use the fillable PDF rather than printing and handwriting. Illegible entries get kicked back.
Part A: Enrollee Information
Enter your full legal name, Social Security number, date of birth, sex, marital status, and mailing address. The revised form also asks whether you’re covered by Medicare and which parts (A, B, C, or D), plus your Medicare Beneficiary Identifier. If you carry insurance other than Medicare, indicate whether it’s TRICARE, another FEHB or PSHB enrollment, or something else, and give the policy number.2Office of Personnel Management. Federal Employees Health Benefits Program Health Benefits Election Form Add an email address and phone number so OPM or your agency can reach you about processing issues.
Part B: Family Members
If you’re electing Self Plus One or Self and Family, list each covered family member with name, Social Security number, date of birth, sex, relationship to you, and address if different from yours. Each family member gets the same Medicare and other-insurance questions from Part A. Use additional sheets if you run out of space.2Office of Personnel Management. Federal Employees Health Benefits Program Health Benefits Election Form
Parts C and D: Current Plan and New Plan
Part C is your current FEHB plan’s enrollment code. Leave it blank if you’re enrolling for the first time. Part D is the enrollment code for the plan you’re selecting or moving to. Each code is three digits: a two-character plan code plus a one-digit suffix that reflects coverage type. Self Only ends in 1 or 4, Self Plus One ends in 3 or 6, and Self and Family ends in 2 or 5.6U.S. Office of Personnel Management. 2026 FEHB Plan Results Find the correct code in OPM’s plan comparison tool or in the plan brochure. One wrong digit puts you in the wrong plan or tier, so double-check before signing.
Part E: Event Code
Enter the code that matches your reason for enrolling or changing, along with the date the event occurred. If the code doesn’t match the situation, the form is rejected.1U.S. Office of Personnel Management. OPM Form SF 2809 – Health Benefits Election Form
Part F: Cancel or Suspend
Only complete Part F if you’re canceling or suspending coverage. Skip it entirely if you’re enrolling or changing plans. The section asks you to check the specific reason: canceling because you’re covered under someone else’s FEHB enrollment, or suspending because you’re joining a Medicare Advantage plan, TRICARE, CHAMPVA, Medicaid, or Peace Corps coverage.
Read the difference between suspension and cancellation carefully before you check a box. Annuitants who suspend can reenroll in FEHB during a future Open Season. Annuitants who cancel can never reenroll.1U.S. Office of Personnel Management. OPM Form SF 2809 – Health Benefits Election Form To suspend, attach documentation proving your enrollment in the other program. That documentation must reach the retirement system within 31 days before or after the effective date of the other enrollment. If you’re later dropped involuntarily from a Medicare Advantage plan, you can reenroll in FEHB immediately without waiting for Open Season.7U.S. Office of Personnel Management. Annuitants
Signature
Sign and date the enrollee signature section. Your agency or retirement system cannot process the form without it. If someone else is submitting on your behalf under a written authorization, that person signs and attaches the authorization. A court-appointed guardian signing for a former spouse or a person eligible for Temporary Continuation of Coverage must attach evidence of guardianship.1U.S. Office of Personnel Management. OPM Form SF 2809 – Health Benefits Election Form On the employee version, an authorized agency official also signs a separate section confirming your eligibility.
Where to Send It
Active Employees
Many agencies let employees make FEHB elections electronically through Employee Express during Open Season and for some qualifying life events. If your event isn’t available in the system, work with your benefits specialist and submit a paper SF-2809 to your HR office.8U.S. Geological Survey. Federal Employees Health Benefits (FEHB) Program Some agencies use HR Links, MyPay, or another platform. Confirm with your HR office which system applies.
Annuitants
During Open Season, retired annuitants can make changes through OPM’s online portal at retireefehb.opm.gov. Outside that portal, mail a completed OPM Form 2809 to:
Retirement Operations Center
U.S. Office of Personnel Management
P.O. Box 45
Boyers, PA 16017-00452Office of Personnel Management. Federal Employees Health Benefits Program Health Benefits Election Form
Keep a copy of everything you send. If a dispute later arises about your coverage start date or plan selection, your copy of the processed form is the evidence that settles it.
When Your Coverage Starts
For employees filing during the initial 60-day window, coverage can begin as early as the first pay period in which the employing office receives the form, as long as you’re in pay status during that period. If the form arrives later, coverage starts on the first day of the first pay period beginning after the employing office receives it.9Regulations.gov. Federal Employees Health Benefits Program Open Season elections typically take effect at the start of the first pay period in January that follows. A processed copy is usually returned to you or placed in your Official Personnel Folder as a permanent record.