Article Structure
The RI 79 9 form is essential for individuals involved in the Federal Employees Health Benefits Program (FEHBP), particularly for retirees and annuitants. This form provides a structured way for annuitants, survivor annuitants, and former spouse annuitants to either cancel or suspend their health benefits enrollment. It emphasizes the importance of maintaining minimum essential coverage, as mandated by the Affordable Care Act. Applicants must understand that cancelling their FEHBP enrollment can lead to significant implications, potentially affecting their future enrollment eligibility. The form contains specific sections for various situations, such as cancelling coverage to enroll under a family member’s plan or opting for suspension due to Medicare Advantage, TRICARE, or Medicaid eligibility. Each section has clear requirements for documentation and emphasizes the need for careful consideration of the effective dates of any changes. To ensure a smooth process, individuals must sign and date the form to indicate their understanding of its contents, especially how their choices may impact both their current health coverage and future options.
Ri 79 9 Example
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
RETIREMENT OPERATIONS
WASHINGTON, DC
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
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
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) |
Date |
|
|
SUSPENSION INFORMATION IS SHOWN ON THE REVERSE
Previous editions are not usable.
RI
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
These Medicare Advantage health plans are Health Maintenance Organizations or
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
E.
I am suspending my FEHBP enrollment because I am eligible for coverage under Medicaid or a similar
To suspend your FEHBP coverage for this reason, you must give us evidence of your eligibility for Medicaid or a similar
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.
Signature
Daytime Telephone No. (including area code)
Date
SAVE
CLEAR
Reverse of RI
Form Characteristics
| Fact Title | Detail |
|---|---|
| Governing Authority | The RI 79-9 form is regulated by the Office of Personnel Management (OPM). |
| Target Audience | This form is for CSRS and FERS Annuitants, as well as Survivor Annuitants and Former Spouse Annuitants. |
| Cancellation Reasons | Cancellation can occur either to enroll under a family member's FEHBP or for other personal reasons. |
| Reenrollment Eligibility | If you cancel for a reason other than enrolling with a family member, you cannot reenroll in the FEHBP. |
| Health Coverage Compliance | The Affordable Care Act requires maintaining minimum essential coverage; this is a crucial consideration before cancellation. |
| Suspension Options | You can suspend your FEHBP enrollment due to Medicare Advantage, TRICARE, or Medicaid eligibility. |
| Documentation Requirements | For suspensions, you must provide documentation verifying eligibility for the new health coverage. |
| Effective Dates | Suspensions can take effect immediately or at the end of the month, depending on the documentation's timing. |
| Contact Information | For questions, OPM can be reached at 1-888-767-6738. |
Guidelines on Utilizing Ri 79 9
Filling out the RI 79 9 form is an important step if you wish to cancel or suspend your enrollment in the Federal Employees Health Benefits Program (FEHBP). Be sure to read the entire form carefully to understand how your decision will impact your future benefits. Follow the steps below to complete the form correctly.
- Obtain the RI 79 9 form from the Office of Personnel Management (OPM) website or your HR department.
- Carefully read the front and back of the form to familiarize yourself with the instructions and implications of your choice.
- Identify which block applies to you: A, B, C, D, or E, and check only that one box.
- If you checked Block A, provide your spouse's name and annuity claim number, along with a copy of their SF 2809 form.
- If you checked Block C, D, or E, gather the necessary documentation proving your eligibility for the corresponding coverage.
- Indicate the effective date for your suspension if applicable in Block D or E, being careful to choose an appropriate date.
- Sign and date the form to confirm that you understand the consequences of your cancellation or suspension.
- Include your daytime telephone number including the area code.
- Make a copy of the completed form and your supporting documentation for your records.
- Return the signed form and any necessary documents to the address provided on the form.
Once you have submitted the form, the OPM will process your request. Keep in mind the timeframe for effective cancellation or suspension based on the date you submit your documentation. If you have questions, reach out to OPM at the provided contact number.
What You Should Know About This Form
What is the purpose of the RI 79 9 form?
The RI 79 9 form is used by annuitants, survivor annuitants, and former spouse annuitants to cancel or suspend their enrollment in the Federal Employees Health Benefits Program (FEHBP). This process is crucial for individuals looking to make changes to their health insurance coverage.
What should I do if I am canceling my FEHBP enrollment to enroll in a family member's FEHBP?
If you are canceling your FEHBP enrollment because you will be covered under a family member's FEHBP, you need to include a copy of their SF 2809 form, which is the Health Benefits Registration Form. This documentation is necessary for proper processing. You will remain eligible for your own FEHBP enrollment if your coverage under the family member's plan ends for any reason.
What happens if I cancel my FEHBP coverage for reasons other than enrolling in a family member's plan?
If you cancel your coverage for other reasons, your enrollment will end at the end of the month in which OPM receives your completed form. Keep in mind that you will not have the option to reenroll in FEHBP in the future. This means you and your covered family members will also lose the free 31-day extension of coverage typically provided for conversion to an individual health plan.
How can I suspend my FEHBP enrollment due to Medicare Advantage?
You can suspend your FEHBP enrollment if you are enrolled in a Medicare Advantage plan. Provide documentation showing the effective date of your Medicare Advantage coverage. To ensure suspension occurs as intended, submit this form within 31 days before or after your Medicare enrollment date. If submitted outside this timeframe, your suspension will take effect at the end of the month when OPM receives your documentation.
What options do I have for reenrollment after suspending my FEHBP coverage?
If you suspend your enrollment for eligible reasons, you can voluntarily reenroll during the annual open season. If you experience an involuntary loss of your other coverage, you may reenroll immediately, provided you submit your request and supporting evidence within a specified timeframe. If you miss this window, you will need to wait until the next open season to reenroll.
Common mistakes
Completing the RI 79-9 form can be a straightforward process, but several common mistakes can lead to complications in your application. The first mistake often involves failing to read the instructions carefully. Skimming through the information can cause individuals to overlook important details about eligibility and documentation requirements. Understanding whether you fall into one of the categories—cancellation or suspension—is vital. A clear comprehension of the guidelines helps in making the right choice and ensures a smoother application process.
Another frequent error is skipping the necessary documentation. When requesting a cancellation or suspension, applicants must provide supporting documents that confirm their eligibility. For example, if you are suspending your enrollment due to Medicare Advantage, including proof of that coverage is essential. Without the right documents, your request may be delayed or denied, leading to confusion and frustration. Always double-check that you've attached all required paperwork before submitting the form.
Additionally, many people neglect to sign and date their forms. This small step is crucial. An unsigned or undated form will not be processed, which can lead to delays in your cancellation or suspension. Confirm that you’ve completed this step before submitting the form. This simple check can save you time and ensure your request is handled promptly.
Lastly, failing to submit the form within the specified time frame often results in missed opportunities. Each reason for cancellation or suspension comes with a timing requirement. For instance, to suspend your coverage due to eligibility for Medicaid, documentation must be received within 31 days before or after the effective date. If this timeline is overlooked, you may lose your chance to suspend your FEHBP coverage. Planning ahead and being mindful of deadlines helps you navigate the process more effectively.
Documents used along the form
The RI 79-9 form is an important document utilized in the process of cancelling or suspending your enrollment in the Federal Employees Health Benefits Program (FEHBP). While this form plays a key role, it often goes hand-in-hand with several other documents that support your health benefits decisions. Below is a list of related forms and documents that may be required or helpful when working with the RI 79-9.
- SF 2809 - Health Benefits Registration Form: This document is essential when enrolling or changing enrollment in health benefits, particularly when transitioning to a family member's coverage.
- Medicare Enrollment Documentation: If you’re taking advantage of Medicare, you’ll need proof of your enrollment—specifically for those switching to a Medicare Advantage plan.
- TRICARE Eligibility Evidence: To suspend your FEHBP coverage for TRICARE participation, you’ll need documentation proving your eligibility, such as a Uniformed Services Identification card.
- CHAMPVA Authorization Card: For those eligible for CHAMPVA, providing a copy of the Authorization Card (A-card) is necessary for the suspension process.
- Medicaid Eligibility Verification: This could be an enrollment card or an official letter confirming your eligibility for Medicaid or a similar state-sponsored medical assistance program.
- Open Season Package: Each year during the open season, you'll receive this package with instructions on how to reenroll, if you choose to do so after a suspension.
- Letter of Involuntary Loss of Coverage: If applicable, this letter indicates that you involuntarily lost coverage from another program, allowing you to reenroll in FEHBP without waiting for the open season.
- Documentation of Coverage Start Dates: For various reasons, such as enrolling in new programs, having the effective dates documented can simplify managing your health coverage transitions.
Navigating health benefits can be complex, but having the right documents on hand makes the process smoother. Understanding how each document interacts with the RI 79-9 form helps ensure you make informed decisions about your health coverage and maintain eligibility for future benefits. Always keep these forms organized and accessible for whenever they might be needed.
Similar forms
The RI 79 9 form is a vital document related to the Federal Employees Health Benefits Program (FEHBP). It allows individuals to cancel or suspend their health insurance enrollment under certain circumstances. Several other documents serve similar purposes in managing health coverage. Here is a list of four documents comparable to the RI 79 9 form:
- SF 2809, Health Benefits Registration Form: This form is used for new enrollments, changes, or cancellations of health benefits. Like the RI 79 9, it leads to necessary adjustments in health coverage, ensuring that the right information is recorded for ongoing benefits management.
- Medicare Enrollment Application (Form CMS-40B): This form enables individuals to enroll in Medicare or change their current enrollment status. Similar to the RI 79 9, it requires careful consideration of coverage options and impacts future eligibility for benefits, ensuring that individuals make informed decisions.
- TRICARE Application for Health Benefits: This application is essential for current or retired military personnel and their families who wish to obtain healthcare coverage through TRICARE. Just as the RI 79 9 manages suspensions and cancellations in FEHBP, this application manages health coverage through military benefits.
- CHIP Application for Health Coverage: The Children’s Health Insurance Program (CHIP) application allows families to apply for health coverage for their children. Similar to the RI 79 9, the CHIP application considers eligibility criteria and benefits, aiming to provide support for those needing health insurance for their dependents.
Dos and Don'ts
When filling out the RI 79-9 form, adherence to certain guidelines is essential to ensure your application processes smoothly. Below are some things to keep in mind:
- Do read the entire form carefully. Understanding each section will help you complete it correctly.
- Do check only one box that applies to your situation to avoid confusion and delays.
- Do include all required documentation. Missing paperwork can lead to rejection of your request.
- Do sign and date the form before submitting it. Your signature indicates that you understand the implications of your cancellation or suspension.
- Don't leave any sections blank unless instructed to do so. Incomplete information can lead to processing delays.
- Don't rush through the form. Taking your time helps prevent mistakes that could require you to start over.
- Don't forget to keep a copy of the completed form for your records. This can be helpful for future reference.
- Don't submit the form without ensuring that all eligibility requirements are met. This could affect your health benefits eligibility.
Misconceptions
Misconceptions about the RI 79 9 form can lead to confusion regarding health benefits. Here are common misunderstandings:
- Misconception 1: Completing the RI 79 9 form guarantees instant cancellation or suspension of health benefits.
- Misconception 2: Cancelling FEHBP coverage means individuals can easily reenroll at any time.
- Misconception 3: Anyone can suspend their enrollment if they are enrolled in Medicare Parts A or B.
- Misconception 4: Suspending FEHBP coverage means complete loss of benefits.
- Misconception 5: All documentation requirements are optional.
- Misconception 6: You can choose any effective date for enrollment suspension.
- Misconception 7: Individuals will receive benefits even after cancellation for a period.
- Misconception 8: Enrollment in TRICARE allows automatic suspension of FEHBP coverage.
- Misconception 9: Once you choose to cancel FEHBP coverage, there are no options to regain it.
In reality, the processing of requests only occurs after the form is signed, dated, and returned. Full information is crucial.
This is incorrect; cancellation under certain conditions means individuals lose eligibility for future reenrollment.
This is not true. Suspension is only possible if enrolled in a Medicare Advantage health plan, not merely Medicare Parts A or B.
Suspending benefits allows for coverage under other programs and does not equate to loss.
Documentation is necessary to support any request for cancellation or suspension. Without it, requests cannot be processed.
The effective date must be carefully selected, as it cannot be changed once the request is processed.
Cancellation occurs at the end of the month in which the signed form is received, with no benefits applicable afterward.
Evidence is required to verify eligibility for TRICARE or related programs to facilitate suspension.
Voluntary reenrollment is available during open seasons or if one involuntarily loses coverage under qualifying programs.
Key takeaways
The RI 79 9 form is crucial for managing your Federal Employees Health Benefits Program (FEHBP) enrollment decisions. Here are ten key takeaways to help you navigate this process:
- Read Carefully: Review both sides of the form thoroughly before filling it out. Understanding all sections is essential.
- One Selection Only: Check only one block that applies to your situation to ensure proper processing of your request.
- Impact of Cancellation: If you choose to cancel your coverage, be aware that it may affect your eligibility for future enrollment in FEHBP.
- Cancellation with Spouse Coverage: If cancelling for coverage under a spouse’s FEHBP, attach the spouse’s SF 2809 form.
- Reenrollment Rules: Know that cancellation for reasons other than coverage under a spouse means you cannot reenroll in FEHBP later.
- Suspending Coverage: You can suspend your coverage for Medicare Advantage, TRICARE, or Medicaid but need to provide appropriate documentation.
- Timing Matters: Submit your form and necessary documents within the specified timeframe to guarantee the desired suspension date.
- Documentation Required: Always provide documentation to support your request, such as enrollment cards or eligibility letters.
- Annual Open Season: You can voluntarily reenroll during the annual open season, which the OPM notifies you about.
- Customer Service: If you have questions, call OPM or Medicare for assistance. Getting clarity before submitting your form can save time.
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