United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter 

Number: 05-407 Date: 11-15-05 

Subject: 2005 Federal Employees Health Benefits (FEHB) Program Open Season: 

Conducting the Open Season 

GENERAL 

FEHB Guides 

This year the Member Survey results included in the guides will show the actual percentage of 

members satisfied with their health plan and services received from health plan providers as 

measured by the Consumers Assessment of Health Plan Survey (CAHPS)1 . Previously, OPM 

used graphical symbols to indicate whether a plan’s ratings on the various CAHPS measures 

were: Average, Above Average, or Below Average compared to a national average. Plan ratings 

are now reported on a 0 to 100 scale. See the “Picking a Health Plan” Section of the Guide for 

additional information. 

 

FEHB Website 

Visitors to our website will find it informative and easy to use. You can link to most of our 

topics directly from our home page at: http://www.opm.gov/insure/health/index.asp. We expect 

to have all FEHB Guides and plan brochures available for downloading prior to start of Open 

Season. We encourage you and your employees to use the FEHB website during the 2005 Open 

Season. You may find all Open Season related Benefits Administration Letters (400 Series 

BAL) at: http://www.opm.gov/asd/htm/bal05.asp. 

COUNSELING EMPLOYEES 

Agencies are responsible for counseling employees who ask for help on health benefits matters. 

Counseling should be limited to answering questions about the FEHB Program including 

questions on premium conversion and the application of the FEHB law and regulations to 

particular circumstances. FEHB Guides provide summary information that is designed to help 

 

1 CAHPS is a registered trademark of the Agency for Healthcare Research and 

Quality (AHRQ). 
employees narrow their choices of health plans, not to make final decisions. You should refer 

employees to the actual plan brochures for specific information vital to making an informed 

decision. If employees have benefit questions, refer them to the brochure of the plan in question. 

If the answers cannot be found in the brochure, instruct the employee to contact the health plan 

directly. Do not refer employees to the plans if their questions concern subjects other than 

benefits. Agencies, not the health plans, are responsible for answering questions about FEHB 

enrollment rules, such as which dependents are eligible for coverage and when coverage begins 

and ends. If you do not know the answer, contact your agency’s headquarters insurance officer. 

PLAN TERMINATIONS 

In BAL 05-405, which can be viewed at: http://www.opm.gov/asd/htm/2005/05-405.asp, we 

informed you of plans that are dropping out of the FEHB Program, or that are dropping a service 

area with or without separate enrollment codes at the end of 2005. We strongly recommend that 

you distribute the list of terminating plans to all employees so they can check to see whether 

their plan will continue to be valid in 2006. 

An employee whose plan will not participate in the Program next year must enroll in another 

plan to continue FEHB coverage in 2006. You should monitor employees who are covered by 

these terminating plans and follow up with those who have not submitted a change of enrollment 

before the end of Open Season. 

PLAN MERGERS 

Presently, there are no participating plans that are planning to merge operations for 2006. We 

will update you if the situation changes. 

STANDARD FORM (SF) 2809 

This form is available as a screen-fillable Adobe Acrobat PDF file on the FEHB website at: 

http://www.opm.gov/forms/pdf_fill/sf2809.pdf. Using the free downloadable Adobe Acrobat 

reader, employees may complete the form on the screen and then print it out already completed. 

Please note, however; that if you are using the free Acrobat reader software you cannot save the 

form with the information that is typed in it on the screen. You need the commercial Adobe 

Acrobat program in order to save the form with the data. 
ANNUITANT INQUIRIES 

Some annuitants who retire from your agency may contact you asking for an SF 2809. 

CSRS and FERS – The Office of Personnel Management (OPM) does not use the SF 2809 for 

annuitant Open Season changes for Civil Service Retirement System (CSRS) or Federal 

Employees Retirement System (FERS) annuitants. These annuitants should be directed to call 

our toll-free service, Open Season Express. Instructions for using Open Season Express are 

included in the Open Season package sent to each enrolled CSRS and FERS annuitant before 

Open Season. If an annuitant loses or does not receive the package, they can get one by calling 

our Retirement Information Office in the Washington, DC metropolitan area at 202-606-0500 or 

outside the Washington, DC metropolitan area at 1-88-US-OPM-RET (1-888-767-6738). 

Those who have access to a TDD machine may call our toll-free Retirement Information Office 

TDD number at: 1-800-878-5707. 

Annuitants should always provide their CSA/CSF retirement claim number and/or their Social 

Security Number when communicating with OPM for any reason. 

Other retirement systems – These annuitants should contact their retirement system for the 

proper registration form. 

OWCP – Former employees receiving benefits from the Office of Workers’ Compensation 

should contact the OWCP office that maintains their FEHB records. 

CARRIER ACCESS 

Health Fairs – We strongly encourage agencies to hold Open Season health fairs and to permit 

representatives of FEHB carriers to address groups of employees on their plans’ benefits, 

methods of obtaining services, and similar matters. When holding health fairs, remember: 

• Carrier representatives are expected to confine their presentations to benefit provisions 

and claims procedures of the FEHB plan they represent. Questions that do not pertain to 

benefits or claims should be referred to agency insurance officials. 

• You should also include information about the Federal Flexible Spending Account 

Program (FSAFEDS). The FSAFEDS Open Season is at the same time as the 

FEHB Open Season, November 14 through December 12, 2005. Any 

employees wanting information on FSAFEDS should visit the website at 

www.fsafeds.com or contact a benefits counselor at 1-877-FSAFEDS (372-3337), TTY 

1-800-952-0450. All FSAFEDS enrollments must be completed via the website or by 

phone with a benefits counselor. Employees currently participating in FSAFEDS must 

re-enroll during Open Season if they wish to participate in the 2006 benefit period. 

Enrollees now have 14-1/2 months to spend their annual allotment, decreasing the chance 
that they might forfeit funds. The maximum annual allotment for a health care FSA 

increases to $5,000 for 2006. 

OTHER COMPANIES 

You may be contacted by insurance companies that do not participate in the FEHB Program but 

wish to sell other types of “supplemental” policies to Federal employees. These companies 

sometimes send marketing material to you and ask that you distribute it. They may ask to be 

invited to the agency’s health fairs or even show up uninvited. We strongly discourage you from 

assisting in the marketing efforts of these companies, including companies FEHB carriers may 

have contracted with for particular benefits. You should limit access to your premises to health 

plans that actually participate in the FEHB Program, i.e., those plans listed in the FEHB Guide 

and representatives of the FSAFEDS Program and the Federal Long Term Care Insurance 

Program (FLTCIP). Please contact Bart Turney at SHPS, the administrator of FSAFEDS, at 

fsafeds-hr@shps.com to request FSAFEDS marketing materials and/or participation at your 

health fairs. Please contact Elizabeth Callahan at Long Term Care Partners, the administrator of 

the FLTCIP, at (603) 433-4560 to request materials and/or participation at health fairs. 

OPEN SEASON ACTIONS 

Permissible Actions – The following enrollment action changes may be made during Open 

Season: 

• An eligible employee who is not enrolled may elect to enroll in FEHB. 

• An eligible employee who elects to enroll in FEHB may also elect to waive 

participation in premium conversion. Participation in premium conversion is 

automatic.

• An enrollee may change from one plan or option to another, from self only to self and 

family, or make any combination of these changes. 

• An enrollee who currently participates in premium conversion may waive participation 

or if they had previously waived premium conversion, may elect to begin participation. 

• An enrollee may cancel their enrollment or change from self and family to self only 

New enrollments and enrollment changes for permissible reasons other than the Open Season 

can 

be made as usual between the dates of November 14 through December 12, 2005. However, 

these changes may have different effective dates than Open Season actions and should not be 

mistakenly identified as such. 

Whether an employee is enrolling or changing enrollment based on Open Season or some other 

Qualifying Life Event (QLE), it is important that the correct event Code be noted on the SF 2809 

so that the correct effective date will be assigned. 

Timely Actions 

You must receive an SF 2809 no later than close of business on December 12, 2005, for it to be 

considered timely filed as an Open Season enrollment or change. 
If you have employees enrolling or changing through Employee Express they must do so no later 

than 12:00 a.m. on December 13, 2005. 

Belated Actions 

You have the authority to accept late elections if you determine that an employee was unable 

to submit an SF 2809 on time due to circumstances beyond the employee’s control. While we 

normally encourage you to make limited use of this authority, we recommend that you take a 

liberal view in cases where an employee’s plan is terminating its FEHB participation. 

If you decide to accept an employee’s late election, write “Belated Open Season 

enrollment/change” in the “Remarks” section of the SF 2809. You must attach to copy 1 

(Official Personnel Folder) of the SF 2809 the employee’s statement explaining why they could 

not register on time or add your own note if the reason was an agency problem. 

If you decide that the delay in filing is not due to a cause beyond the employee’s control, do not 

accept the employee’s late request. You must notify the employee in writing that you are not 

approving the late enrollment. You should give the reason for your denial and include a 

statement of the employee’s right to request reconsideration within 30 days after the date of your 

notice. 

EFFECTIVE DATES 

From not enrolled to enrolled – Effective the first day of the first pay period which begins on 

or after January 1, 2006, and which follows a pay period in any part of which the employee was 

in pay status. The enrollment of a new employee who happens to elect coverage between 

November 14 through December 12, 2005 is effective the same as for all new employees; i.e., 

the first day of the first pay period after the employing office receives the SF 2809. 

Enrollment change – Effective the first day of the first pay period which begins on or after 

January 1, 2006, regardless of whether the employee was in pay status during the preceding pay 

period. 

Premium Conversion Change in Election – Effective the first day of the first pay period which 

begins on or after January 1, 2006. 

Belated Open Season enrollment action – Effective retroactive to the first day of the first pay 

period which begins on or after January 1, 2006. This effective date is the same as that of an 

Open Season change filed on time. If the belated change is from not enrolled to enrolled, the 

requirement of having been in pay status during the preceding pay period must also be met. 

Belated Open Season enrollment actions are automatically subject to premium conversion. 

Since IRS rules allow for no retroactive adjustments to taxable income, the effective date of 
premium conversion can not be retroactive. This means that any additional withholding for 

retroactive premiums that are due must be made with after-tax dollars. For an example of the 

impact of a belated change on taxable income, please see:

www.opm.gov/insure/health/pretaxfehb/qanda/03.asp. 

Cancellation – An Open Season cancellation is effective at midnight of the day before the first 

day of the first pay period that begins in the next year. 

Outside of Open Season, enrollees who participate in premium conversion may only cancel their 

FEHB coverage due to a qualifying life event. Enrollees who waived participation in premium 

conversion may cancel their health insurance at any time without waiting for a Qualifying Life 

Event or an Open Season. 

Cancellation – Agencies should be sure to counsel employees about the consequences of 

canceling their enrollment. Remember that an employee must have been covered under the 

FEHB Program continuously for the five years of service immediately before retirement or if 

less than five years for all periods of service during which he/she was eligible for FEHB 

coverage in order to continue FEHB coverage after retirement. 

If an employee is canceling his/her enrollment in order to be picked up as a family member by a 

spouse’s Open Season enrollment, be sure to coordinate the effective date of the cancellation 

with the effective date of the spouse’s enrollment to prevent a break in coverage. 

AGENCY ACTIONS 

Prompt Processing – It is important that you process Open Season enrollments and enrollment 

changes promptly. Payroll offices should process enrollee and carrier copies of SF 2809 daily. 

• You must notify gaining carriers of new enrollments so they can complete the 

paperwork necessary to provide coverage for the employee and covered family members 

and issue identification cards to the new enrollees. 

• You must notify losing carriers as soon as possible of enrollment terminations so they 

do not guarantee or provide benefits to ineligible employees or family members. 

Verification of Employee Coverage – Employees become concerned when they do not receive 

their identification cards from a new plan within a short time after the end of Open Season. If an 

employee asks you about this, you should contact the payroll office to determine when the 

carrier was notified of the change. If more than three weeks have passed since the payroll office 

sent the SF 2809 to the carrier, contact the carrier to determine the reason for the delay and relay 

the employee’s request for identification cards. 

An employee may need verification of coverage under his/her plan before the carrier processes 

the enrollment or enrollment change. You should verify that the employee is covered under the 

plan and inform the requesting party (e.g., carrier, doctor, hospital) of the effective date of the 
coverage. You should also remind employees that their copy of the SF 2809 is acceptable as 

proof of enrollment until they receive their identification cards from the plan. 

Employees who make Open Season changes electronically via Employee Express and who do 

not 

receive new identification cards by the effective date of the change may obtain a letter 

confirming their coverage by calling the Employee Express Help Desk at (912) 757-3030, or by 

requesting your help. 

Enrollment Reconciliations

The large number of enrollment actions taken during Open Season increases the chance of errors 

being made by agencies or by carriers in updating records. Any errors will be identified as 

discrepancies through the Centralized Enrollment Reconciliation System (CLER) during the 

March 2006 reconciliation cycle. It is very important that agencies work with the carriers to 

correct these discrepancies. The reconciliation process is critical to ensure that carriers receive 

the proper premium payments and that enrollees are properly reflected on plans’ records. 

Sincerely, 

 Robert F. Danbeck 

 Associate Director 

 for Human Resources Products and Services