FEHB Health Benefits Cancellation/Suspension Confirmation
By using the Health Benefits Cancellation/Suspension Confirmation Form (RI 79-9), you can cancel (rarely recommended) your FEHB coverage OR suspend your FEHB coverage under three specific circumstances as outlined below.
Use the spaces at the top of the form to place your full name and mailing address.
Also, be sure to add your primary telephone number at the bottom of the application.
Enter the date, and your Civil Service Annuity number
(CSA # or CSF #).
Warning. If you want to cancel your FEHB enrollment complete Section A or B of the RI 79-9, but if you do cancel it, you will NOT be eligible to re-enroll in the FEHB program. Additionally, if you cancel your FEHB enrollment, you and any family members covered by your plan 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.
More often, federal retirees, survivor annuitants, and former spouse annuitants "suspend" their FEHB enrollment for one of three (3) reasons:
because they are enrolled in an approved Medicare Advantage health plan;
because they want to use Tricare, Tricare for Life, or ChampVA;
or because they become eligible for Medicaid, or a similar some other state-sponsored program of medical assistance for the needy.
Block C - Medicare Advantage
Things to know about Medicare and your FEHB coverage:
To be eligible for enrollment in a Medicare Advantage plan you must be enrolled in both Medicare Parts A and B (Original Medicare).
If you have family members who are dependent on your FEHB coverage, this will not be a good option for you.
You must select and enroll in your Medicare Advantage health plan. Be sure to select a plan that includes prescription drug coverage.
You cannot "suspend" your FEHB coverage for Original Medicare (Medicare Parts A and B), or for a Medicare Supplemental or Medigap plan. Learn more about Medicare Advantage vs. Supplement, click here.
Complete the OPM RI 79-9, attach a copy of your Medicare Advantage plan enrollment, and send it all to the address below.
Block D - Tricare, Tricare for Life, ChampVA
Block E - Medicaid
OPM's Re-enrollment Eligibility Policy
NOTE FROM NARFE NEW YORK: Be sure to include your primary telephone contact number at the bottom of the form, probably wouldn't hurt to include your email address. We have confirmed the mailing address below with OPM.
Mail your completed RI 79-9 (certified) to:
U.S. Office of Personnel Management (OPM)
1900 E. Street, NW
Attn: RBB (Room 2416)
Washington, DC 20415-0001