The RI 79 9 form is a crucial document for individuals enrolled in the Federal Employees Health Benefits Program (FEHBP) who wish to cancel or suspend their health benefits coverage. This form provides options for annuitants, survivor annuitants, and former spouse annuitants to manage their health benefits effectively. It’s important to understand the implications of your choices, as some actions may affect your future enrollment eligibility.
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The RI 79 9 form plays a crucial role for individuals navigating their health benefits under the Federal Employees Health Benefits Program (FEHBP). This form is specifically designed for annuitants, survivor annuitants, and former spouse annuitants who wish to cancel or suspend their FEHBP enrollment. It outlines the necessary steps and requirements for making such changes, ensuring that individuals are fully informed about the implications of their decisions. The form presents various options, allowing users to indicate whether they are canceling their coverage to enroll under a family member’s plan, for reasons unrelated to family coverage, or suspending their enrollment due to eligibility for Medicare Advantage, TRICARE, or state-sponsored programs like Medicaid. It is essential for individuals to read the instructions carefully and provide the required documentation, as this will determine their future eligibility for reenrollment. By understanding the nuances of this form, individuals can make informed choices regarding their health coverage and avoid unintended consequences that may arise from their selections.
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
RETIREMENT OPERATIONS
WASHINGTON, DC 20415-3532
For CSRS and FERS Annuitants, Survivor Annuitants, and Former Spouse Annuitants
Date
Claim number
CS
Health Benefits Cancellation/Suspension Confirmation
You asked us to cancel or suspend your enrollment in the Federal Employees Health Benefits Program (FEHBP). Please read the front and back of this form and check only the ONE block that applies to you. Please note that the Affordable Care Act (ACA) requires that individuals maintain minimum essential coverage (MEC). For more information, please visit the IRS website at www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision. Because many annuitants who cancel their FEHBP enrollments will not be eligible to reenroll, we want to be sure you are fully informed about the effect of any action you take. We will not process your request until you sign, date, and return this form indicating that you understand how your request will affect your future FEHBP enrollment eligibility. Any Questions? Call OPM at 1-888-767-6738.
A.I am cancelling my FEHBP enrollment to be covered under a family member's FEHBP enrollment.
If you are cancelling your FEHBP enrollment because you will be covered under your spouse's FEHBP enrollment and your spouse is a Federal employee, please include with this form a copy of your spouse's SF 2809, Health Benefits Registration Form, showing the change to a family enrollment. If your spouse is an annuitant, please give us your spouse's name and annuity claim number.
Spouse's name (Last, first, middle)
Spouse's claim number
If you cancel FEHBP coverage for this reason, we will coordinate the effective date with the effective date of your new coverage under your spouse's enrollment.
Reenrollment eligibility: As long as you are continuously covered as a family member on your spouse's FEHBP enrollment, you will be eligible to resume your own enrollment if your coverage under your spouse's enrollment ends for any reason.
B. I am cancelling my FEHBP coverage for reasons other than the situation described in part A.
We will cancel your enrollment effective the end of the month in which we receive this signed and dated form. Any health benefits premiums you pay for a period after the cancellation effective date will be refunded in one of your future monthly annuity payments.
Reenrollment eligibility: If you check this block to cancel your FEHB enrollment, you will not be eligible to reenroll in the FEHBP. Additionally, if you cancel your FEHBP enrollment, you and any family members covered by your enrollment will not be entitled to the free 31-day extension of coverage to convert to an individual health benefits contract or to enroll for Temporary Continuation of Coverage.
I certify that I have read and understand the information on cancelling FEHBP coverage. I understand that if I checked block B, I will never again be eligible to enroll in the Federal Employees Health Benefits Program.
Signature
Daytime Telephone No. (including area code)
SUSPENSION INFORMATION IS SHOWN ON THE REVERSE
Previous editions are not usable.
RI 79-9 Revised August 2014
C. I am suspending my Federal Employees Health Benefits Program (FEHBP) enrollment because I am enrolled in a Medicare Advantage health plan. Please note: Medicare Parts A and B are not the same as a Medicare Advantage health plan. You CANNOT suspend your FEHBP enrollment if you are covered by Medicare Parts A and/or B only. Any
Questions: Call Medicare at 1-800-633-4227.
These Medicare Advantage health plans are Health Maintenance Organizations or Fee-For-Service plans approved by the Centers for Medicare and Medicaid Services (CMS). If you are enrolled in a Medicare supplemental plan and are not sure if it qualifies as a Medicare Advantage health plan, call Medicare at the number shown above. To suspend your FEHBP coverage for this reason, you must give us documentation that shows the effective date of your Medicare Advantage health plan coverage. If we receive this form within 31 days before to 31 days after the effective date of your Medicare Advantage health plan enrollment, we will suspend your FEHBP coverage at the close of business the day before your Medicare Advantage health plan enrollment begins. Otherwise, we will suspend your FEHBP coverage at the end of the month in which we receive your documentation.
D. I am suspending my FEHBP enrollment to use TRICARE, TRICARE for Life (enrollees over age 65 with Medicare Parts A and B), Peace Corps, or CHAMPVA. Please suspend my FEHBP enrollment effective
_______________________________. (Carefully consider the effective date of your suspension. Once we process your request, we are not able to change the effective date.)
To suspend your FEHBP coverage for this reason, you must give us evidence of your eligibility for TRICARE, TRICARE for Life, Peace Corps, or CHAMPVA. Please send us a copy of your Uniformed Services Identification (I.D.) card and if over age 65, you must also send us a copy of your Medicare card showing enrollment in both Medicare Parts A and B (required for TRICARE for Life). To document your eligibility for CHAMPVA, please send us a copy of your CHAMPVA Authorization Card (A-card). Please tell us the date you want to suspend your FEHBP to use TRICARE, TRICARE for Life, Peace Corps, or CHAMPVA. Special note: If we receive this signed form and the eligibility documentation within 31 days before to 31 days after the date you designate above, we will suspend your FEHBP coverage on that date. Otherwise, we will suspend your FEHBP coverage at the end of the month in which we receive your documentation.
E. I am suspending my FEHBP enrollment because I am eligible for coverage under Medicaid or a similar state-sponsored program of medical assistance for the needy.
To suspend your FEHBP coverage for this reason, you must give us evidence of your eligibility for Medicaid or a similar state-sponsored program of medical assistance for the needy. You may send us a copy of an enrollment card or a letter of eligibility which shows the effective date of your Medicaid or similar state-sponsored program coverage. If we receive this signed form and documentation within 31 days before to 31 days after the effective date of your Medicaid or similar state-sponsored enrollment, we will suspend your FEHBP coverage at the close of business the day before your Medicaid or state-sponsored program coverage begins. Otherwise, we will suspend your FEHBP coverage at the end of the month in which we receive your documentation.
The following information applies to blocks C, D and E.
Reenrollment: You may voluntarily reenroll in the FEHBP during an annual open season. We will send you an open season package each year with instructions on how to reenroll. If you don't want to reenroll, disregard your open season material.
If you involuntarily lose your coverage under one of the programs mentioned above, you can reenroll in the FEHBP effective the day after your coverage ends. You must provide evidence of your involuntary loss of coverage. Your request to reenroll must be received at the Office of Personnel Management (OPM) within the period beginning 31 days before and ending 60 days after your coverage ends. Otherwise, you must wait until open season to reenroll.
I certify that I have read and understand the information on suspending FEHBP coverage. I have checked the block relating to my suspension, and I have enclosed the appropriate documentation.
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Reverse of RI 79-9 Revised August 2014
Once you've completed the RI 79 9 form, the next step is to send it back to the Office of Personnel Management (OPM). Make sure to keep a copy for your records. It’s important to double-check that you’ve filled everything out correctly to avoid delays in processing your request.
The RI 79 9 form is used to cancel or suspend enrollment in the Federal Employees Health Benefits Program (FEHBP). It is specifically designed for CSRS and FERS annuitants, survivor annuitants, and former spouse annuitants.
You should read the instructions on the front and back of the form carefully. Check the block that applies to your situation: whether you are canceling your enrollment to be covered under a family member's FEHBP enrollment, canceling for other reasons, or suspending your enrollment for specific programs like Medicare or TRICARE.
If you cancel your enrollment, it will be effective at the end of the month in which OPM receives your signed form. Note that you will not be eligible to reenroll in the FEHBP, and you will lose the free 31-day extension of coverage.
Yes, you can suspend your enrollment if you are eligible for coverage under Medicare Advantage, TRICARE, Medicaid, or similar programs. You must provide documentation proving your eligibility for these programs when submitting the form.
Documentation varies based on the reason for suspension. For Medicare Advantage, provide proof of enrollment. For TRICARE, submit your Uniformed Services ID card and Medicare card if applicable. For Medicaid, include an enrollment card or letter of eligibility.
You must submit the form within 31 days before or after the effective date of your new coverage if you are suspending your FEHBP enrollment. If you miss this window, your suspension will take effect at the end of the month in which OPM receives your documentation.
Yes, any health benefits premiums paid after the cancellation effective date will be refunded in your future monthly annuity payments.
If you suspend your enrollment, you may reenroll during the annual open season. If you involuntarily lose coverage under another program, you can reenroll immediately, provided you submit your request within the specified time frame.
You can reach the Office of Personnel Management at 1-888-767-6738 for any questions related to the RI 79 9 form or your FEHBP enrollment.
Filling out the RI 79-9 form can be a straightforward process, but many individuals make common mistakes that can delay their requests or lead to complications. Understanding these mistakes can help ensure a smoother experience.
One frequent error is not reading the entire form carefully. The RI 79-9 form contains important information on the implications of canceling or suspending health benefits. Skipping over the details can lead to misunderstandings about eligibility for future enrollment or coverage. It is crucial to review both the front and back of the form thoroughly.
Another mistake is failing to check the correct block that applies to the individual’s situation. The form has specific sections for cancellation and suspension, and selecting the wrong option can result in the request being processed incorrectly. Always double-check to ensure the right block is marked before submission.
In addition, many people neglect to include necessary documentation. For instance, if you are canceling coverage because you will be covered under a family member’s plan, you must provide a copy of the spouse's Health Benefits Registration Form. Without this documentation, the request cannot be processed.
People also often forget to sign and date the form. This step is essential, as the Office of Personnel Management will not process any requests that lack a signature or date. Taking a moment to complete this final step can save time and prevent frustration.
Another common oversight is not providing a daytime telephone number. Including this information is important, as it allows the Office of Personnel Management to reach you if there are any questions or issues with your submission.
Some individuals misinterpret the eligibility requirements for reenrollment after cancellation or suspension. For example, if you cancel your FEHBP enrollment for reasons other than being covered under a spouse’s plan, you may not be eligible to reenroll. Understanding these rules can help prevent future complications.
Moreover, people sometimes fail to submit the form within the required timeframe. For suspensions related to Medicare Advantage plans, documentation must be submitted within 31 days before or after the effective date of the new coverage. Missing this window can lead to delays in processing.
Finally, many applicants overlook the importance of keeping copies of submitted forms and documentation. Having a record of what was sent can be invaluable in case any issues arise later. It is always a good practice to maintain a personal copy for reference.
By being aware of these common mistakes, individuals can approach the RI 79-9 form with greater confidence and clarity, ensuring their requests are processed smoothly and efficiently.
The RI 79 9 form is a crucial document for individuals navigating their health benefits under the Federal Employees Health Benefits Program (FEHBP). Alongside this form, there are several other documents that may be necessary or helpful in the process of managing health benefits, particularly during cancellations or suspensions. Below is a list of these documents, each accompanied by a brief description to aid in understanding their purpose.
Understanding these documents and their purposes can greatly assist individuals in managing their health benefits effectively. Proper documentation ensures that requests are processed smoothly and that individuals maintain their eligibility for future health coverage options.
When filling out the RI 79-9 form, it's essential to be careful and thorough. Here are some important do's and don'ts to keep in mind:
Misconceptions about the RI 79 9 form can lead to confusion and potential issues with health benefits enrollment. Here are five common misconceptions:
Many believe that cancelling their Federal Employees Health Benefits Program (FEHBP) enrollment allows for easy reinstatement. In fact, if you cancel for reasons other than transferring to a spouse's coverage, you lose eligibility to reenroll.
This is incorrect. Suspension is only possible if you are enrolled in a Medicare Advantage plan, not just Medicare Parts A and B.
Individuals must submit the form within specific time frames. For suspensions related to Medicare Advantage, documentation must be submitted within 31 days before or after the effective date of enrollment.
Those who cancel their FEHBP enrollment do not qualify for the free 31-day extension to convert to an individual health benefits contract or to enroll for Temporary Continuation of Coverage.
Once the request to suspend enrollment is processed, the effective date cannot be changed. It is crucial to carefully consider the effective date when submitting the form.
Filling out the RI 79-9 form is an important process for individuals looking to cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP). Here are key takeaways regarding this form: