United States

Office of 

Personnel Management

The Federal Government’s Human Resources Agency

Retirement and Insurance Service

 Benefits Administration Letter

 

Number: 99-216 Date: October 14, 1999

Subject: Federal Employees Health Benefits (FEHB) Program: Annuitant/OWCP

Health Benefits Election Form (SF 2809-1))

Date of Form The new form is dated July 1999.

Purpose of Form We created a new Annuitant/OWCP Health Benefits Election Form, 

SF 2809-1 for use by annuitants of retirement systems other than the Civil

Service Retirement System (CSRS) or Federal Employees Retirement

System (FERS), including individuals receiving monthly compensation

from the Office of Workers’ Compensation Programs. The new form will

also be used by former dependents of these annuitants who are eligible for

coverage under the Temporary Continuation of Coverage or Spouse Equity

provisions of FEHB law.

The new form conforms to the 1997 changes to FEHB regulations that 

simplified and clarified the opportunities to enroll and change enrollment. 

It contains information specifically for annuitants and their former

dependents.

We also revised the SF 2809, Health Benefits Election Form, for use by 

employees, former employees and former dependents eligible to enroll

under the Temporary Continuation of Coverage or Spouse Equity

provisions of FEHB law. We have provided information on SF 2809 in

Benefits Administration Letter 99-215.

Previous Editions There are no previous editions of SF 2809-1.

 

Civil Service Federal Employees Federal Employees Federal Employees

Retirement Group Life Health Benefits Retirement

System Insurance Program System
2

When Available The new SF 2809-1 is available from the General Services

Administration’s Federal Supply Service using the normal

FEDSTRIP/MILSTRIP procedures as specified by your agency’s

procurement or acquisition office. (FEDSTRIP/MILSTRIP is the

ordering procedure used by agencies to procure items from the GSA

Federal Supply Depot.)

The new SF 2809-1 will soon be available on the OPM FEHB website at

www.opm.gov/insure.

Stock Number and The National Stock Number for SF 2809-1 is 7540-01-466-9084. 

Cost The cost is $4.75 per package of 25. . 

Transition Help As you know, the old SF 2809 used numbers to designate the events that

permitted enrollment or change of enrollment. The revised SF 2809 and

the new SF 2809-1 use a code consisting of a number and a letter so that

the events could be grouped by category of enrollee as they are in the

regulations. The number signifies the category of enrollee, and the letter

signifies the event. The enrollee categories are:

1 - Employee (not shown on SF 2809-1)

2 - Annuitant 

3 - Former Spouse

4 - Temporary Continuation of Coverage

We believe these new event codes will make it easier for enrollees to find

the event applicable to their specific situation. To ease the transition for

OWCP and other retirement systems, we have attached two versions of a

chart that translates the old event number from the 1992 SF 2809 into

the new event code. 

The first chart lists the events from the old form and shows both the old

and new event codes. The second chart provides a further breakdown of

the new codes by category of enrollee. For example, an open season

change that was previously event #1 would now be 1B for employees,

2A for annuitants, 3B for former spouses, and 4B for TCC enrollees. 

The 1997 regulations created several new events for which there is no

old event number; therefore these new events are not shown on the

charts. For example, a surviving child whose survivor annuity terminated

because of marriage and later was restored may reenroll under event 2E. 

In addition, the 1997 regulations combined several of the old events, so
3

that old event numbers 2 and 3 are now event B, C, or D under the new

enrollee categories. Charts #1 and #2 give complete information on old

and new codes and associated events.

If you need assistance in understanding the new SF 2809-1, please call

our Information Staff on (202) 606-0191. You may also send Email

about the new SF 2809-1 to Barbara Myers at bdmyers@opm.gov.

Abby L. Block, Chief

Insurance Policy 

 and Information Division

Attachments
Chart #1

4

Event Old

Code

New Code

Open season 1 1B, 2A, 3B, 4B

Marital status change 2 1C, 2B, 4C

Other family status change 3 1C, 2B, 3C, 4C, 4D

Move from HMO area 4 1J, 2I, 3I, 4H

Membership in employee organization terminates 5 1G, 2G, 3G, 4F

Employee, annuitant, or former spouse loses other FEHB

coverage for reasons other than cancellation or change to 

self only;

Employee loses other federally sponsored coverage

6 1G, 2F, 3F

Employee, annuitant or former spouse loses other FEHB

coverage due to change to self only 

7 1G, 2F, 3F

Employee transfers to or from overseas post of duty 8 1F

Employee returns to active civilian duty;

Annuitant separates from military service

9 1D, 2K

Plan stops participating in FEHB program 10 1H, 2H, 3H, 4G

Spouse’s self only enrollment terminates 11 1G, 2F

Employee loses coverage under parent’s non-Federal plan 12 1G

Employee retires from overseas post of duty 13 2J

Enrollee becomes eligible for Medicare 14 1K, 2L, 3J, 4I

Enrollee’s child loses other FEHB coverage 15 1G, 2G, 3F, 4F

Employee or family member loses Medicaid coverage 16 1G, 3G, 4F

Employee, annuitant or former spouse loses other FEHB

coverage due to cancellation

17 1G, 2F, 3F
Chart #1

Event Old

Code

New Code

5

Employee changes from full-time to part-time career

employment

18 1D

Employee or spouses loses coverage under spouse’s nonFederal health plan when spouse terminates employment to

accompany employee who is reassigned out of commuting area

19 1I

Loss of coverage under non-Federal health plan 20 1G, 2G, 3G, 4F

Former spouse enrolls under Spouse Equity Act 21 3A

Temporary employee completes one year of service in

accordance with 5 U.S.C. 8906a

22 1L

Temporary employee, eligible under 5 U.S.C. 8906a, changes to

nontemporary appointment

23 1D

Employee is separated from service and eligible for TCC 24 4A

Enrollee’s child ceases to be an unmarried dependent child 25 4A
Chart #2

6

Event Old

Code

New Code

Employee Annuitant Former

Spouse 

TCC

Open season 1 1B 2A 3B 4B

Marital status change 2 1C 2B 4C

Other family status change 3 1C 2B 3C 4C, 4D

Move from HMO area 4 1J 2I 3I 4H

Membership in employee organization

terminates

5 1G 2G 3G 4F

Employee, annuitant, or former spouse loses

other FEHB coverage for reasons other than

cancellation or change to self only;

Employee loses other federally sponsored

coverage

6 1G 2F 3F

Employee, annuitant or former spouse loses

other FEHB coverage due to change to self

only 

7 1G 2F 3F

Employee transfers to or from overseas post of

duty

8 1F

Employee returns to active civilian duty;

Annuitant separates from military service

9 1D 2K

Plan stops participating in FEHB program 10 1H 2H 3H 4G

Spouse’s self only enrollment terminates 11 1G 2F
Chart #2

Event Old

Code

New Code

7

Employee Annuitant Former

Spouse

TCC

Employee loses coverage under parent’s nonFederal plan12 1G

Employee retires from overseas post of duty 13 2J

Enrollee becomes eligible for Medicare 14 1K 2L 3J 4I

Enrollee’s child loses other FEHB coverage 15 1G 2G 3F 4F

Employee or family member loses Medicaid

coverage

16 1G 3G 4F

Employee, annuitant or former spouse loses

other FEHB coverage due to cancellation

17 1G 2F 3F

Employee changes from full-time to part-time

career employment

18 1D

Employee or spouses loses coverage under

spouse’s non-Federal health plan when spouse

terminates employment to accompany

employee who is reassigned out of commuting

area

19 1I

Loss of coverage under non-Federal health

plan

20 1G 2G 3G 4F

Former spouse enrolls under Spouse Equity

Act

21 3A
Chart #2

Event Old

Code

New Code

8

Employee Annuitant Former

Spouse

TCC

Temporary employee completes one year of

service in accordance with 5 U.S.C. 8906a

22 1L

Temporary employee, eligible under 5 U.S.C.

8906a, changes to nontemporary appointment

23 1D

Employee is separated from service and

eligible for TCC

24 4A

Enrollee’s child ceases to be an unmarried

dependent child

25 4A