Centralized Enrollment Clearinghouse System (CLER) for Agencies

Adding a 2809 Record

The Add function allows users to add 2809 records.

To Add a 2809 Record:

1. Select the Forms tab on the CLER Main Menu. The Forms Main Page is displayed.

   

2. Select 2809 on the Forms tab. The Form 2809 page is displayed.

   

3. Select the Add button on the Form 2809 page to display the Form 2809 Add (Part A) page.

   

4. Complete the following fields for Form 2809 Part A:

   Payroll Office ID

   Year

   Quarter

   Personnel Office ID

   Nature of Action

   Last Name

   First Name

   Initial

   Address Line 1

   Address Line 2

   Address Line 3

   City

   State

   Zip

   Foreign Country

   SSN

   Date of Birth

   Sex

   Married

   Other Insurance

   Policyholder Last Name

   Policyholder First Name

   Policyholder Initial

   Medicare You

   Medicare Spouse

   TRICARE/CHAMPUS

   Other

5. Select the Save Form button. If no errors occur, a popup appears to confirm the record has been added.

   OR

   Select the Clear Data button to clear the form and select the Cancel button to return to the previous page.

   

6. Select the OK button to close the popup.
7. Select Part A Continued on the Form 2809 Add page (if applicable).

   

8. Complete the following fields on the Form 2809 Add Part A Continued (if applicable):

   Last Name

   First Name

   Initial

   Date of Birth

   Code

   SSN

   Sex

   Zip

   Note: The process can be repeated on Lines 1-10 for additional family members of the enrolling employee.

9. Select the Save Form button to save changes.

   OR

   Select the Clear Data button to clear the form and select the Cancel button to return to the previous page.

10. Select Parts B - H on the Form 2809 Add page to display the Parts B - H page.

    

11. Complete the following applicable fields on the Form 2809 Add Parts B - H page:

    Part B - Present Plan Name

    Part B - Present Enrollment Code

    Part C - New Plan Name

    Part C - New Enrollment Code

    Part D - Event That Permits Change

    Part D - Date

    Part H - Date of Action

    Part H - Phone

12. Select the Save Form button to save changes.

    OR

    Select the Clear Data button to clear the form and select the Cancel button to return to the previous page.

    Note: An asterisk (*) indicates a required field. The Plan Name and Enrollment Code fields in Part B are marked with * when Start or Change is selected in the Nature of Action field in Part A. The Last Name, First Name, Date of Birth, Code, SSN, and Sex fields in Part B are marked with * when the third position of the enrollment code entered in the Enrollment Code field in Part B is 2 or 5, indicating family coverage.

13. Select Part I on the Form 2809 Add Page to display the Part I page.

    

14. Complete the following fields on the Form 2809 Add Part I page if applicable:

    Agency Name

    Address Line 1

    Address Line 2

    Address Line 3

    City

    State

    Zip

    Foreign Country

    Agency ID

    Personnel Office ID

    Authorized Official Last Name

    Authorized Official First Name

    Authorized Official Initial

    Contact (Personnel) Last Name

    Contact (Personnel) First Name

    Contact (Personnel) Initial

    Contact (Personnel) Phone

    Contact (Payroll) Last Name

    Contact (Payroll) First Name

    Contact (Payroll) Initial

    Contact (Payroll) Phone

    Effective Date

    Date Received

    Report #

    Remarks

15. Select the Save Form button. If no errors occur, a popup appears to confirm the record has been added.

    OR

    Select the Clear Data button to clear the form and select Cancel to return to the previous page.

    

16. Select the OK button to close the popup.