Get Fehb Premium Conversion Waiver

The FEHB Premium Conversion Waiver is an important document for employees seeking to manage their health benefits premiums effectively. This guide will provide clear, step-by-step instructions on how to fill out this form online, ensuring that users can complete it accurately and confidently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the FEHB Premium Conversion Waiver and open it in your selected editor.
2. Begin by filling out the participant information section. This includes your last name, first name, middle initial, agency or bureau name, agency or bureau address, social security number, and office phone number.
3. In the election to waive participation section, indicate your decision to waive pre-tax treatment by checking the appropriate box. You will need to sign and date this section. Ensure that you specify whether this is your initial opportunity or if you are waiving participation during the FEHB Open Season or due to a qualifying life event.
4. If you are restoring participation in premium conversion, navigate to the subsequent section and mark your intention to have your FEHB premiums deducted on a pre-tax basis. As with the previous section, an accompanying signature and date are required. Again, indicate if this is during the Open Season or due to a qualifying life event.
5. The final section will be completed by payroll or personnel staff, which includes approval or disapproval and their signature and date, as well as the effective date of the decision made.
6. After reviewing all the information for accuracy, you can save your changes. Options to download, print, or share the form may also be available depending on your chosen editor.

Take the next step in managing your health benefits by completing the FEHB Premium Conversion Waiver online today.