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Health and Life Insurance Forms

Health Care Forms

If you were hired prior to October 1, 1987, you participate in the Federal health care program. The following form should be used to enroll in the Federal Plan upon retirement or to make changes in your coverage during Open Enrollment periods or upon a change in family status:

Federal Health Benefits Election Form [PDF]

If you were hired on or after October 1, 1987, you participate in the District health care program. The following form should be used to enroll in the District Plan upon retirement or to make changes in your coverage during Open Enrollment periods or upon a change in family status:

District Health Benefits Registration Form [PDF]

If you have further questions, please contact DCRB Member Services at the number below, or call the Member Services toll-free number at 1(866) 456-3272.

 

Federal Employees' Group Life Insurance (FEGLI) Program Forms

Designation of Beneficiary Form [PDF]

Life Insurance Election Form [PDF]

Service Contact: 
Member Services Center
Contact Email: 
Contact Phone: 
(202) 343-3272
Contact Fax: 
(202) 566-5001
Contact TTY: 
711