Direct Premium Remittance System (DPRS)

SF 2810 and Original SF 2809 for Transfer Enrollees

To transfer out of Employment, Retirement, Death, and Employees' Compensation, the following forms are required:

• SF 2810, Notice of Change in Health Benefits Enrollment
• SF 2809, Health Benefits Election Form (Original)

Transfer Out

Note: The Agencies need to include the original SF 2809, Health Benefits Election Form. The Agencies must verify the address and phone number on the original SF 2809 for accuracy.