Web Procedure Manual

Forms

Forms associated with CLER activities are described below.

Standard Form (SF) 2809, Health Benefits Election Form. This form is used by Federal employees eligible to enroll in or currently enrolled in FEHB; and/or former spouses of Federal employees eligible to enroll in or currently enrolled in FEHB under the Spouse Equity law, and/or individuals eligible for temporary continuation of coverage under FEHB to:

• Enroll eligible persons in FEHB.
• Elect not to enroll in FEHB.
• Change an enrollee’s plan.
• Change coverage within a plan.
• Cancel FEHB enrollment of an enrollee who elected to end his/her coverage though he/she continues to be eligible for it, and no extension of coverage is granted.

SF 2810, Notice of Change in Health Benefits Enrollment. This form is used to:

• Terminate the enrollment of an enrollee employed by the Federal Government who leaves Government service, or an enrollee employed by the Federal Government who exceeds 365 days in non-pay status and is eligible for a 31-day extension of coverage.
• Reinstate enrollment.
• Change the name of an enrollee.
• Change the enrollment to a survivor annuitant.

Note: The 2809 and 2810 options in CLER are formatted to include data elements from the forms listed above, as well as the data elements from the 2809 and 2810 options on the Employee Personal Page (EPP).

CLERP, Security Access Form, Health Benefit Agencies. This form is completed by the Agency's security officer and submitted to NFC’s OSC to request CLER access for the Agency's personnel.