Get (fehb) Premium Conversion Waiver/election Form - Army

The (FEHB) Premium Conversion Waiver/Election Form provides employees with the option to elect or waive pre-tax treatment of their health benefits premiums. This guide will walk you through the process of completing the form online, ensuring a smooth and accurate submission.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. In the 'Participant Information' section, enter your last name, first name, middle initial, agency or bureau name, agency or bureau address, social security number, and office phone number.
3. Proceed to the 'Election to Waive Participation in Premium Conversion' section. Indicate your desire to waive participation by selecting the corresponding checkbox and sign and date the form. Specify if this is your initial opportunity to waive, during the FEHB Open Season, or due to a Qualifying Life Event.
4. If you are opting to restore participation in premium conversion, navigate to the 'Election to Restore Participation in Premium Conversion' section. Indicate your choice to have your FEHB premiums deducted on a pre-tax basis by selecting the appropriate checkbox. Sign and date this section as well, noting if you are making this election during the FEHB Open Season or due to a Qualifying Life Event.
5. In the 'To Be Completed by Payroll/Personnel Staff' section, ensure that an authorized agency official reviews the form, marking it as approved or disapproved. This section must be signed and dated by the official.
6. Once all sections are completed, you can save changes, download, print, or share the form as necessary to ensure it is submitted to your employing office.

Complete your (FEHB) Premium Conversion Waiver/Election Form online today to ensure your health benefits are adjusted according to your preferences.