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Health Benefits Enrollment Registration Form

Monday, December 18, 2023

If you were hired on or after October 1, 1987, you participate in the District healthcare program. Complete this form 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.

You can send the completed form and any required attachments by fax to (202) 566 -5001 or by mailing your documents to:

DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001

Retiree Health Insurance Information for Medicare Eligible Retirees
For additional information about this topic, please view the following page: Health Insurance Information for Medicare Eligible Retirees

If you have further questions, please contact the DCRB Member Services Center by clicking on the Ask Member Services link, or by phone at (202) 343-3272 Monday – Friday from 8:30 am to 5:00 pm.