The RI 79-9 form is issued by the United States Office of Personnel Management and is vital for CSRS and FERS Annuitants, Survivor Annuitants, and Former Spouse Annuitants looking to cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP). It outlines the steps required for cancellation or suspension and specifies the implications, including the impact on future enrollment eligibility. For those considering altering their FEHBP status, understanding the provisions and requirements detailed in this form is essential.
To ensure your health coverage needs are met without jeopardizing future eligibility, make sure to review the RI 79-9 form thoroughly. Click the button below to get started with filling out your form.
In navigating the complexities of managing health benefits post-retirement or during transitions in life circumstances, forms like the RI 79-9 become pivotal. This document, issued by the United States Office of Personnel Management (OPM), primarily serves CSRS and FERS Annuitants, Survivor Annuitants, and Former Spouse Annuitants, who wish to either cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP). A crucial aspect covered is the acknowledgment of the Affordable Care Act's stipulation on maintaining minimum essential coverage, underscoring the serious implications of altering one’s FEHBP status. Whether individuals aim to be covered under a family member's FEHBP enrollment, are moving to a Medicare Advantage health plan, or qualify for TRICARE, Peace Corps, CHAMPVA, or a similar state-sponsored program due to changes in life circumstances, the RI 79-9 form guides through the necessary steps and the foreseeable consequences of such decisions. Importantly, it highlights the potential for reenrollment in the FEHBP under certain conditions, emphasizing the importance of timely and informed decisions backed by adequate documentation. Through careful structuring, the form aims to ensure annuitants are well-informed about the potential impacts of their decisions on future health benefits eligibility—an imperative process in safeguarding one’s healthcare rights and alternatives post-retirement or during significant life transitions.
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
Filling out the RI 79-9 form is a crucial step for federal retirees or their beneficiaries who wish to cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP) under certain circumstances. It’s essential to be mindful of the implications of such a decision, especially regarding future eligibility for reenrollment. Here are the steps needed to properly complete the form:
Accurately completing and submitting the RI 79-9 form is vital for ensuring that your health benefits are managed according to your current needs and eligibility. Throughout this process, remember to keep a copy of the completed form and any correspondence for your records.
What is the RI 79-9 form used for?
The RI 79-9 form is a document that the United States Office of Personnel Management (OPM) requires from annuitants, survivor annuitants, and former spouse annuitants who want to cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP). This form serves as confirmation of the request to cancel or suspend the health benefits under specific conditions detailed within the form itself.
Who needs to fill out the RI 79-9 form?
Annuitants, survivor annuitants, and former spouse annuitants under the Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS) who wish to cancel or suspend their FEHBP enrollment need to complete the RI 79-9 form. This includes those looking to be covered under a family member's FEHBP enrollment, enrolled in a Medicare Advantage health plan, use TRICARE, TRICARE for Life, Peace Corps, CHAMPVA, or are eligible for coverage under Medicaid or a similar state-sponsored program of medical assistance for the needy.
Can I reenroll in FEHBP after canceling or suspending my enrollment?
Yes, but reenrollment options depend on the reason for the cancellation or suspension. If the cancellation was for being covered under a family member's FEHBP enrollment, reenrollment is possible if that coverage ends for any reason, provided the coverage was continuous. If enrollment was suspended due to eligibility for other specified programs (such as Medicare Advantage, TRICARE, CHAMPVA, Medicaid), reenrollment is possible during an annual open season, or upon involuntary loss of the other coverage, under certain conditions. However, canceling FEHBP coverage for reasons not specified in part A of the form means reenrollment in FEHBP is not allowed.
What documentation is required to suspend FEHBP enrollment due to Medicare Advantage, TRICARE, or Medicaid eligibility?
To suspend FEHBP enrollment for these reasons, appropriate evidence of eligibility is mandatory. For Medicare Advantage, proof of the effective date of the Medicare Advantage plan coverage is needed. For TRICARE or TRICARE for Life, a copy of the Uniformed Services Identification (I.D.) card and, if applicable, the Medicare card showing enrollment in Parts A and B, is required. For CHAMPVA, the CHAMPVA Authorization Card is necessary. Likewise, for Medicaid or similar state-sponsored programs, an enrollment card or letter of eligibility showing the effective date of coverage is required.
What happens if I don’t submit the RI 79-9 form?
If the RI 79-9 form is not submitted, the request to cancel or suspend FEHBP enrollment will not be processed. This means you will remain enrolled in FEHBP and continue to be responsible for any premiums associated with your coverage. It is critical to send a completed and signed form to OPM to ensure that your health benefits enrollment aligns with your current needs and circumstances.
Filling out a complex form like the RI 79-9, which addresses the cancellation or suspension of Federal Employees Health Benefits Program (FEHBP) enrollment for CSRS and FERS annuitants, survivor annuitants, and former spouse annuitants, requires careful attention to detail. However, mistakes can easily occur, leading to unintended consequences. One common mistake is failing to provide adequate supporting documentation for the cancellation or suspension request. This oversight can delay the processing of the request, as the Office of Personnel Management (OPM) requires proof, such as a spouse's SF 2809 form for cancellation due to coverage under a family member's enrollment or documentation of Medicare Advantage health plan enrollment for suspension reasons.
Another error individuals make is not understanding the impact of their decision on future eligibility. Some do not realize that choosing to cancel FEHBP coverage for reasons other than being covered under a family member's plan results in permanent ineligibility to reenroll in FEHBP. It's critical to fully comprehend the implications, particularly the loss of the free 31-day extension of coverage for converting to an individual health benefits contract or enrolling for Temporary Continuation of Coverage, which is forfeited upon cancellation for reasons other than those outlined in Block A.
Mistakenly suspending FEHBP enrollment for ineligible reasons is yet another error. The form specifies that enrollment can only be suspended for enrollment in a Medicare Advantage plan, TRICARE, CHAMPVA, Medicaid, or similar programs. Misinterpreting eligibility for these programs can result in an unsuccessful suspension request, as the form clearly states that Medicare Parts A and B alone do not qualify for suspension of FEHBP.
A lack of clarity about the effective date of suspension or cancellation is also a common mistake. For cancellations, the form advises that the enrollment ends at the close of business on the date specified or, if no date is given, at the end of the month in which the request was processed. Suspensions work similarly, but the timing of the documentation submission can influence the effective date. Failing to carefully consider or accurately communicate the desired effective date can lead to misunderstandings and potential gaps in coverage.
Not checking the correct block that corresponds to the specific reason for cancellation or suspension is a simple yet significant error. This form is designed to ensure that the applicant's intentions are clear, so ticking the wrong box can lead to the request being processed incorrectly, impacting the annuitant's, survivor annuitant's, or former spouse annuitant's health coverage and potential reenrollment capabilities.
Underestimating the significance of the Individual Shared Responsibility Provision under the Affordable Care Act (ACA) constitutes yet another mistake. Those who cancel their FEHBP enrollment without securing other minimum essential coverage (MEC) may find themselves non-compliant with the ACA, facing potential tax penalties. This oversight underscores the importance of being informed about health care law requirements when considering FEHBP enrollment changes.
Lastly, failing to contact OPM or Medicare for clarification on complex aspects of the form leads to errors. Individuals often proceed with their requests based on misunderstandings that could have been cleared up with a simple enquiry. The form itself provides contact numbers for OPM and Medicare, encouraging applicants to reach out with questions to ensure their actions align with their intentions and the rules governing FEHBP enrollment cancellation and suspension.
When dealing with federal employee benefits, particularly around the topic of health insurance decisions like suspensions or cancellations with the RI 79-9 form, having the right documentation is key to ensuring the process goes smoothly. Alongside the RI 79-9 form, there are several other forms and documents that individuals may need to consider to manage their health benefits effectively or address other benefits-related matters. Below is a list of forms often used in conjunction with the RI 79-9 form.
Understanding the use and requirements of these forms and documents can be incredibly beneficial for federal employees or annuitants managing their health benefits. It's important for individuals to pay careful attention to the details of each form, ensure timely submission, and keep copies of all documents for their records. Proper management of these forms not only helps maintain continuous health coverage but also ensures compliance with federal regulations and policies regarding health benefits.
The Standard Form 2809, Health Benefits Registration Form, plays a pivotal role for Federal employees, similar to the RI 79-9, by managing health benefits under the Federal Employees Health Benefits Program (FEHBP). It facilitates enrollment changes, such as switching from self-only to family coverage or vice versa, acting as a critical instrument for updating an individual’s health insurance status, akin to the RI 79-9’s purpose in changing health benefits status due to specific life changes.
The Medicare Advantage Enrollment Form parallels the RI 79-9 by serving individuals looking to modify their healthcare coverage. For RI 79-9 users suspending FEHBP to join a Medicare Advantage plan, the action reflects a similar purpose—adjusting one’s health coverage to suit current needs, underscoring the form's role in enabling significant healthcare transitions based on eligibility for alternative programs.
TRICARE or CHAMPVA Application Forms share a common purpose with the RI 79-9 form for individuals transitioning their health care coverage to these military or veterans' health care services. Like the RI 79-9, these forms facilitate a shift in healthcare coverage based on eligibility, illustrating how various forms serve as gateways to tailored health insurance options tied to an individual's specific circumstances or affiliations.
Medicaid Application Forms and the RI 79-9 are integrated by their function of altering healthcare coverage in response to an individual’s changing eligibility, particularly for those seeking coverage through Medicaid or similar state-sponsored programs. Both documents underscore the interplay between personal situation changes and healthcare coverage adaptation, highlighting a shared utility in navigating public health options.
The Form SF 2808, Designation of Beneficiary (Civil Service Retirement System), though focused on retirement benefits, interlinks with the RI 79-9 in terms of planning for future eventualities and managing federal benefits. It emphasizes the continuity of consideration given to how federal employees' choices, including health coverage adjustments, integrate into broader life planning.
Application for Immediate Retirement forms for CSRS and FERS participants tie closely with the RI 79-9, as both concern significant transitions for federal employees or annuitants. While the retirement forms pertain to pension benefits, the RI 79-9 addresses health coverage during similar pivotal life stages, highlighting the comprehensive approach to managing federal benefits during major life changes.
The Application for 10-Point Veteran Preference (SF 15) connects with the RI 79-9 through its role in facilitating benefits based on eligibility. Although the SF 15 specifically aids veterans in employment and benefits entitlements, it shares with the RI 79-9 the essential function of ensuring individuals receive the benefits for which they are eligible, including considerations that might affect health coverage decisions.
The OPM Form 1203-FX, used to apply for federal jobs, intersects with the RI 79-9 in the broader scope of federal benefits and employment management. While seemingly focused on employment, the form indirectly impacts benefits decisions, including healthcare enrollment or suspension, illuminating the interconnectedness of employment status and benefits eligibility among federal employees.
Request for Employment Information in Connection with Claim for Disability Benefits forms serve a similar administrative function to the RI 79-9, aiding individuals in navigating through health-related benefits adjustments due to disability. Both forms underscore the crucial role documentation plays in validating eligibility for certain benefits or program adjustments, reflecting the broader ecosystem of forms assisting individuals in managing their health coverage in tandem with their specific life circumstances.
When filling out the RI 79-9 form, it is important to follow specific guidelines to ensure the process is done correctly and efficiently. Here is a list of dos and don'ts to assist you:
Adhering to these guidelines will help to ensure that your request to cancel or suspend your Federal Employees Health Benefits Program enrollment is processed smoothly and without unnecessary delay.
The RI 79-9 form is a critical document for those navigating their Federal Employees Health Benefits Program (FEHBP) coverage options, yet it's often surrounded by misconceptions that can lead to confusion and potentially costly mistakes. Let's clarify some of these misunderstandings.
Many people wrongly believe that once they cancel their FEHBP coverage, they can never get it back. While it's true that cancellation usually means you cannot reenroll except in specific circumstances, there are exceptions. For example, if you cancel to be covered under a family member's FEHBP enrollment, you may resume your own enrollment if you lose coverage under your family member's plan.
Some confuse the terms "suspension" and "cancellation," thinking they lead to the same outcome. However, suspending your FEHBP coverage for certain reasons like Medicare Advantage Plan enrollment or Medicaid eligibility allows you to reenroll during the annual open season or if you lose your other coverage.
There's a belief that you can suspend your FEHBP enrollment for any personal reason. In reality, suspension is only permitted for specific circumstances, such as enrollment in Medicare Advantage plans, TRICARE, or similar programs, and not simply because you wish to opt-out temporarily.
Another common error is thinking that you can suspend or cancel your FEHBP enrollment without providing documentation. The form clearly requires proof, such as evidence of Medicare Advantage health plan coverage or TRICARE eligibility, to process these requests correctly.
Some people expect their suspension or cancellation requests to be processed immediately upon submission. However, the effectiveness of cancellation or suspension depends on timely submission of the form and accompanying documentation, as well as specific start dates of alternative coverage.
It's mistakenly thought that the RI 79-9 form applies to all federal employees. This form is specifically designed for CSRS and FERS Annuitants, Survivor Annuitants, and Former Spouse Annuitants. Active federal employees use different forms for their health benefits changes.
Finally, there's a misconception that cancelling FEHBP enrollment has no impact on compliance with the Affordable Care Act's (ACA) requirement for minimum essential coverage (MEC). Cancelling FEHBP could affect your ACA compliance, urging the need to have alternative MEC.
Understanding the true nature and implications of suspending or cancelling FEHBP coverage through the RI 79-9 form is crucial for making informed decisions. Misinterpretations can lead to unintended lapses in coverage or eligibility issues, emphasizing the importance of closely reviewing the form's instructions and consulting with benefits administrators or legal advisors as needed.
Understanding the process of filling out and using the RI 79-9 form is essential for managing your Federal Employees Health Benefits Program (FEHBP) enrollment. Here are key takeaways to guide you through this process:
Completing the RI 79-9 form requires careful consideration of your healthcare coverage needs and timing. Every action taken regarding FEHBP enrollment has significant consequences on your eligibility and potential future healthcare benefits. Always ensure that your decisions are well-informed and documented to uphold your health coverage rights.
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