CLER for NFC

Last Name

Conditional, alphanumeric, 25 positions

Enter the last name of the person who is enrolled in FEHB and whose FEHB coverage will cover the family member who is suspending his/her own FEHB coverage. If the enrollee who is providing the coverage has a title (e.g., Jr, Sr, I, II, III), it should be entered after the last name without punctuation (e.g., Smith Jr or Smith III).

Note: If the radio button next to "Will be Covered Under the Enrollment of" is selected, this field must be completed; otherwise, do not complete this field.