I would like to enroll in (Select one at a time):

Dependent Children Health Plan (children age 22-27 or handicapped)

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

Dental & Vision Program

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

Dependent Children Dental & Vision Program (children age 22-27 or handicapped)

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

Employee Benevolent Fund

SAMBA Term Life Insurance

Personal Accident Insurance

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

Disability Income Protection

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

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Note: If you would like to enroll in the federal SAMBA Health Benefit Plan, you must contact your Payroll Office. If you are an annuitant, you must contact OPM (Office of Personnel Management). Click here to be directed to OPM's Website.