Direct Premium Remittance System (DPRS)

New Enrollee SF 2809 Part A

The SF 2809 Part A is used to establish enrollment of a child of a current employee, enrollment of a separated employee, or initial enrollment of former spouse of current employee.

To Establish a New Enrollment:

1. On the DPRS main menu, enter the enrollee's SSN.

   

2. Select the Add Registration SF2809 button. The SF2809 Part A page is displayed.

   

3. Complete Part A - Enrollee Information fields as follows:

   Note: Required fields are marked with an asterisk.

   Public Law

   Relationship To Employee

   Current Enrollment Plan

   New Enrollment Plan

   First Name

   Middle Initial

   Last Name

   Social Security Number

   Date of Birth

   Sex

   Married

   Country

   Domestic

   Address 1

   Address 2

   City

   State

   Zip

   Home Phone

   Work Phone

   Cell Phone

   Email

   Other Insurance

   Medicare Claim Number

   Other Insurance Name

   Insurance Policy Number

   SON Number

4. After completing the fields, select the Save SF2809 button.

   OR

   Select another part or link of the enrollment pages, and the record will automatically be saved.

   Note: If there are errors upon saving, an error message will appear. A list of the fields that are missing the required information will be displayed. If an error occurred upon saving the record, return to Part A and verify that all fields are completed.