Search results
Comprehensive list of Forms and Documents. Alphabetical list of PEIA forms and documents . Documents for Benefit Coordinators
Basic Life (Complete Online) Change-in-Address Form (Complete Online) Change-in-Status Form (Compl ete Online) Please note, to update your Mountaineer Flexible Benefits elections after a change-in-status event, you must complete an Enrollment Form with FBMC.
PART 1 - File in Official Personnel Folder U.S. Office of Personnel Management www.opm.gov/healthcare-insurance/life-insurance Previous edition is usable. Standard Form 2817 Revised September 2021 Instructions for Agencies 1. Who Should File This Form? New employees eligible for life insurance who want optional insurance or no insurance.
Download Fillable Form Sf-2817 In Pdf - The Latest Version Applicable For 2024. Fill Out The Life Insurance Election Online And Print It Out For Free.
Full instructions can be found here. ***If you have previously had PEIA as your insurance carrier, you are unable to use Manage My Benefits to log in and enroll. Please see your HR department to fill out paper enrollment forms. Preferred Provider Benefit (PPB) Plans. Comprehensive Care Program Enrollment Form.
Title: SF-2817 Life Insurance Election - Federal Employees Group Life Insurance Program Author: U.S. Department of State Subject: SF-2817 Life Insurance Election - Federal Employees Group Life Insurance Program
The employee's copy of this form, when completed by the employing office, together with the FEGLI Program Booklet (FE 76-21 or FE 76-20 for U.S. Postal Service employees) constitute the employee's Certificate (proof) of Insurance.
