OPM 2809, Health Benefits Election Form

OMB 3206-0141

OMB 3206-0141

OPM Form 2809 is used by annuitants and former spouses to elect, cancel, suspend, or change health benefits enrollment during periods other than open season. Note: The Privacy Act Statement has been revised due to a systematic review by our Chief Privacy Officer. Also, the term "Claim Number" has been replaced with "Beneficiary Identifier".

The latest form for OPM 2809, Health Benefits Election Form expires 2023-04-30 and can be found here.

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