FEGLI PROGRAM BOOKLET

For Federal Employees 

50TH ANNIVERSARY EDITION 

Federal Employees’ Group Life Insurance Program 

BASIC LIFE + 

OPTION A 

Standard 

OPTION B 

Additional 

OPTION C 

Family 

FE 76-21 

Revised August 2004 

Previous versions (RI 76-21) not usable 

Administered by the 
This Booklet provides general information for employees about the Federal 

Employees’ Group Life Insurance (FEGLI) Program. You can get detailed 

information in the FEGLI Handbook (RI 76-26), which is available only in 

electronic format, at www.opm.gov/insure/life. While some information for annuitants 

is provided here, annuitants can visit www.opm.gov/retire for more information 

about FEGLI benefits in retirement. 
TABLE OF CONTENTS 

INTRODUCTION 

Life Insurance Means Peace of Mind for You and Your Family............................................. 4


FEGLI Service Standards........................................................................................................ 4


How Do I Choose the Right Amount of Life Insurance?......................................................... 5


GENERAL INFORMATION 

Who Is Eligible?...................................................................................................................... 6


When Does My Coverage Begin?............................................................................................. 6


What Is Basic Insurance and How Much Does it Cost? ......................................................... 6


What If I Want Optional Insurance and How Much Does it Cost?......................................... 7


Option A — Standard ........................................................................................................ 7


Option B—Additional....................................................................................................... 8


Option C — Family ............................................................................................................ 9


What Is Accidental Death and Dismemberment (AD&D) Insurance? ................................. 10

AD&D Schedule of Losses................................................................................................ 10

What If I Want to Change My Life Insurance Coverage? ..................................................... 11


Open Season ................................................................................................................... 11


Providing Medical Information ........................................................................................ 11


Life Event ....................................................................................................................... 12


When Will My Life Insurance Stop? ..................................................................................... 13


Will I Be Entitled to a Temporary Extension of My Life Insurance? ................................... 14


Can I Voluntarily Cancel My Life Insurance?........................................................................ 14


What Happens to My Life Insurance Coverage When I Retire? ............................................. 14


Miscellaneous Provisions....................................................................................................... 18


Assignment ...................................................................................................................... 18


Break in Service............................................................................................................... 18


Conversion ....................................................................................................................... 19


Direct Payment of Premiums............................................................................................ 19


Incontestability................................................................................................................ 20


Living Benefits................................................................................................................. 20


Nonpay Status .................................................................................................................. 20


Reconsideration............................................................................................................... 20


Workers’ Compensation .................................................................................................... 20


Who Gets the Money after I Die? .......................................................................................... 21


How Should Someone File a Claim? ...................................................................................... 22


How Are Benefits Paid?......................................................................................................... 23


SUMMARY................................................................................................................................. 24


LIFE INSURANCE WORKSHEET........................................................................................... 25


SAMPLE ELECTION FORM..................................................................................................... 26


CHANGES AND CLARIFICATIONS...................................................................................... 27


LIFE INSURANCE FORMS ...................................................................................................... 29


3 
INTRODUCTION 

Life Insurance Means Peace of Mind for You and Your Family 

Almost everyone needs life insurance; how much is for you to decide. Through the


Federal Employees’ Group Life Insurance (FEGLI) Program, you have several


choices in selecting the amount of life insurance that’s right for you. FEGLI offers:


Basic insurance: equal to your salary rounded up to the next even thousand,


plus two thousand dollars, and


Three types of Optional insurance:


Option A — Standard, in the amount of $10,000;


Option B —Additional, in an amount from one to five times your annual rate


of basic pay after rounding your salary up to the next even $1,000;


Option C —Family, one to five multiples of coverage for your spouse and 


your eligible dependent children. Each multiple is equal to $5,000 for the


death of your spouse and $2,500 for the death of each eligible dependent child.


Some important points to keep in mind: 

• If eligible, you are automatically covered under Basic life insurance, unless 

you waive it. 

• You must take action, within strict time limits, to elect Optional insurance. 

If you elect it when you are first eligible, you can get it without having to 

provide medical information to prove insurability. 

• The FEGLI Program offers group rates and convenient payroll deductions. 

• The Government pays one-third of the cost of your Basic life insurance. You 

pay 100% of the cost of Optional insurance. 

• FEGLI is group term insurance. It does not have any cash or paid-up value. 

You cannot get a loan by borrowing from this insurance. 

• The amount of life insurance one needs varies by individual. Some general 

guidelines to help you calculate your needs are on page 5. 

FEGLI Service Standards 

• When you use material published about the FEGLI Program, you will find 

that it is clear, factual, and gives you the information you need. 

• Once a claim for benefits is fully documented, the Office of Federal Employees’ 

Group Life Insurance (OFEGLI) will generally pay it within 10 working days. 

• OFEGLI will respond to correspondence within 30 days of receipt of your 

letter. If we need more information before giving you an answer, we will send 

you an interim response. 

• We will assist you and your beneficiaries in a prompt, accurate, and courteous 

manner. 

4 
How Do I Choose the Right Amount of Life Insurance? 

Purchasing life insurance is a personal decision that only you can make. You should first 

consider the funds your survivors will need for immediate expenses, such as: 

uninsured medical costs, funeral expenses, lawyers’ fees to settle an estate, debts, 

and taxes. Young single people, who often don’t buy life insurance because they 

have no dependents, should consider that funeral expenses can amount to thousands 

of dollars and should be provided for in some way. 

Here are some very general guidelines that may help you. Not everyone will 

need the same amount of life insurance. Fill in the blanks to estimate your family’s 

needs. If a particular line doesn’t apply, or you think it is too much coverage, 

just skip it. These results are just rules of thumb. For a complete analysis of 

your needs, you may want to consult a financial planner. How Much 

Do I Need? 

So you’ve decided 

that life insurance 

is a good idea. Now 

you’ll want to 

determine how much 

you’ll need. This 

simple chart can 

help you come up 

with an estimate. 

Fill in the blanks to 

estimate your 

family’s needs. 

LIFE INSURANCE...HOW MUCH DO I NEED? 

1. Multiple of your annual income (in dollars) that you wish to

provide your family if something were to happen to you* $ (1) 

2. Annual expenses above and beyond daily living costs for you and 

your dependents (e.g., tuition, care for a disabled child or parent) + (2) 

3. Emergency funds (3 to 6 months of living expenses) + (3) 

4. Estimated amount for your funeral expenses 

(U.S. average is $5,000 to $10,000)† + (4) 

5. Total the estimate of your family’s needs (add lines 1 through 4) = (5) 

6. 

market funds, existing life insurance) – (6) 

Your total liquid assets (e.g., savings accounts, CDs, money 

7. Subtract line 6 from line 5 and enter the difference here: = $ (7) 

The net result (line 7) is an estimate of the shortfall your family could face upon your death. 

Remember, these results are just rules of thumb. For a complete analysis of your needs, you 

may want to consult a financial planner. The maximum coverage on your life available 

through FEGLI is about six times your salary (or about seven times for enrollees age 35 or 

under), through a combination of Basic, the Extra Benefit, Option A ($10,000), and Option B 

(maximum of 5 times your salary). See the rest of this Booklet for details. 

* Most life insurance consultants recommend at least five times your annual income. 

Source: Kiplinger’s (Kiplinger.com, Jan., 2003). 

† Source: AARP, Funeral and Burial Costs, 2002. 

Consider the Way Things Are... 

In addition to completing the calculation above, there are some other situations 

you might want to consider when determining how much life insurance you 

need. Remember to take into account whether you have: 

• a spouse and/or dependent children; 

• an aging parent and/or a disabled relative who depends on you for support; 

• savings and/or accumulated debt; 

• a sizable estate and/or a business. 

Be sure to reevaluate your life insurance needs periodically. If you think 

you need more coverage, see page 11 for more information. 5 
GENERAL INFORMATION 

Who Is Eligible? 

Most Federal employees, including part-time employees, are eligible for Federal 

Employees’ Group Life Insurance (FEGLI). If you have a question about 

eligibility, see your human resources office. Participation is entirely voluntary. 

However, if you are eligible, you are automatically covered under Basic insurance, 

unless you waive this coverage. You will have Optional insurance only if you 

elect it. Remember, there are strict time limits to elect Optional insurance. 

When Does My Coverage Begin? 

Basic life insurance coverage for new employees is effective on the first day you 

are in a pay and duty status in an eligible position, unless you waive this 

coverage before the end of your first pay period. After your first pay period, you 

may cancel Basic at any time; the cancellation will be effective at the end of the 

last day of the pay period in which your human resources office receives your 

cancellation. 

Optional insurance for new employees is effective on the first day you are 

in a pay and duty status in an eligible position on or after the day your human 

resources office receives your election. You only have 31 days from the date 

of your appointment to an eligible position to elect Optional insurance. Your 

opportunities to enroll in Optional insurance after those 31 days are limited. 

See page 11. 

Pay and duty status means you are not on annual leave, sick leave, donated 

leave, excused absence, or otherwise absent from duty. 

New employees must complete a Life Insurance Election (SF 2817) to cancel 

Basic insurance or to elect Optional insurance. If you do not complete an election 

form, you will automatically be covered under Basic insurance only, and your 

agency will withhold premiums from your pay. 

What Is Basic Insurance and How Much Does it Cost? 

Basic insurance provides term life insurance at group rates. The Federal 

Government pays one-third of the cost of your Basic insurance. If you are 

eligible, you are automatically covered under Basic insurance, unless you 

waive this coverage. 

Your Basic Insurance Amount (BIA) is equal to the greater of (a) your annual 

rate of basic pay rounded up to the next even $1,000 plus $2,000, or (b) $10,000. 

Basic insurance also provides an Extra Benefit to employees under age 45, at no 

additional cost. This Extra Benefit doubles the amount of Basic insurance payable 

if you die when you are age 35 or younger. The Extra Benefit decreases 10% each 

year until there is no Extra Benefit if you die at age 45 or older. 

You may use the life insurance worksheet on page 25 to compute your BIA and, 

if applicable, your Extra Benefit. 

6 
HOW MUCH DO I PAY FOR BASIC INSURANCE?* 

PAYROLL METHOD WITHHOLDING FOR EACH $1,000 INSURANCE 

Biweekly $0.150 

Monthly $0.325 

What if I Want Optional Insurance and How Much Does it Cost? 

While Basic insurance may be enough coverage for some people, many others 

want more protection. That’s why the Federal Employees’ Group Life Insurance 

(FEGLI) Program also offers Optional insurance: Option A—Standard, 

Option B—Additional, and Option C—Family. You must have or elect Basic 

in order to elect any Optional insurance coverage. You pay the full cost for all 

Optional insurance. 

Enrollment in Optional insurance is not automatic. If you want Optional 

insurance as a new employee, you must submit a completed Life Insurance 

Election (SF 2817) to your human resources office within 31 days from the date 

of your appointment to an eligible position. Your opportunities to enroll in 

Optional insurance after those 31 days are limited. See page 11. 

OPTION A 

Standard 

You may elect Option A — Standard in the amount of $10,000. 

HOW MUCH DOES OPTION A COST?* 

Biweekly Monthly 

$ 0.30 $ 0.65 

35 – 39 0.40 0.87 

40 – 44 0.60 

45 – 49 0.90 

50 – 54 3.03 

55 – 59 2.70 5.85 

60 and over 6.00 

WITHHOLDING FOR $10,000 INSURANCE 

Your Age Group** 

Under 35 

1.30 

1.95 

1.40 

13.00 

* These are the rates through 2005. They may change in future years. For more


information, see the FEGLI website at www.opm.gov/insure/life.


** For insurance withholding purposes, we assume you reach these ages on the first day 

of the pay period that starts after your birthday. 

7 
GENERAL INFORMATION 

OPTION B 

Additional 

You may elect Option B—Additional in an amount equal to one, two, three, four or 

five times your annual rate of basic pay (after rounding up to the next even $1,000). 

HOW MUCH DOES OPTION B COST?* 

2004 2005 

Biweekly Monthly Biweekly Monthly 

$0.03 $0.065 $0.03 $0.065 

35 – 39 0.04 0.087 0.04 0.087 

40 – 44 0.06 0.06 

45 – 49 0.09 0.09 

50 – 54 0.303 0.303 

55 – 59 0.28 0.607 0.28 0.607 

60 – 64 0.60 0.60 

65 – 69 0.72 

2.232 2.600 

75 – 79 3.098 3.900 

80 and over 3.965 2.40 5.200 

WITHHOLDING FOR EACH $1,000 INSURANCE 

Your Age Group** 

Under 35 

0.130 0.130 

0.195 0.195 

0.14 0.14 

1.300 1.300 

0.71 1.538 1.560 

70 – 74 1.03 1.20 

1.43 1.80 

1.83 

*	 These are the rates through 2005. They may change in future years. For more


information, see the FEGLI website at www.opm.gov/insure/life.


**	 For insurance withholding purposes, we assume you reach these ages on the first 

day of the pay period that starts after your birthday. 

Consider this 	 Bob, a 38-year-old Federal employee, is married with three children. He wants to get the 

example	 maximum amount of Option B he can. He chooses five times his annual pay of $39,500 

(rounded to $40,000), which totals $200,000. He is paid on a biweekly basis. Therefore, 

his cost is $8.00 biweekly ($0.04 x 200). Refer to the worksheet on page 25 for more 

information, or see the FEGLI Calculator at www.opm.gov/insure/life. 

8 
OPTION C 

Family 

You may elect Option C—Family to insure your spouse and your eligible 

dependent children. When you elect Option C, all of your eligible family 

members are automatically covered. You may elect either one, two, three, four, 

or five multiples of coverage. Each multiple is equal to $5,000 for your spouse 

and $2,500 for each of your eligible dependent children. 

For example, if you elect three multiples, that means that if your spouse dies, 

you would receive $15,000 (3 times $5,000). If one of your eligible dependent 

children dies, you would receive $7,500 (3 times $2,500). 

Each multiple is a unit. For example, if you elect two multiples, that means you 

have two multiples on your spouse and two multiples on your eligible dependent 

children. You cannot elect a number of multiples for your spouse that is different 

from the number of multiples for your eligible dependent children. 

To be eligible, dependent children must be unmarried and under age 22, or if age 

22 or over, incapable of self-support because of a mental or physical disability that 

existed before the child reached age 22. Eligible dependent children include your 

natural children, adopted children, stepchildren (if they live with you in a regular 

parent-child relationship), recognized natural children, and foster children (if they 

live with you in a regular parent-child relationship). Grandchildren are not 

covered unless they qualify as foster children. Stillborn children are not covered. 

If you have any questions about eligible family members, please consult your 

human resources office. That office is responsible for determining eligibility. 

Option C benefits are paid to you; you cannot designate a beneficiary. 

HOW MUCH DOES OPTION C COST?* 

Biweekly Monthly 

$ 0.27 $0.59 

35 – 39 0.34 

40 – 44 0.46 

45 – 49 0.60 

50 – 54 0.90 

55 – 59 

60 – 64 2.60 5.63 

65 – 69 3.00 6.50 

3.40 

75 – 79 4.50 9.75 

80 and over 6.00 

WITHHOLDING FOR EACH MULTIPLE 

Your Age Group** 

Under 35 

0.74 

1.00 

1.30 

1.95 

1.45 3.14 

70 – 74 7.37 

13.00 

*	 These are the rates through 2005. They may change in future years. For more


information, see the FEGLI website at www.opm.gov/insure/life.


**	 For insurance withholding purposes, we assume you reach these ages on the first 

day of the pay period that starts after your birthday. 

9 
GENERAL INFORMATION 

What Is Accidental Death and Dismemberment (AD&D) Insurance? 

Accidental Death and Dismemberment (AD&D) insurance provides funds in the 

event of a fatal accident or an accident that results in the loss of a limb or eyesight. 

For benefits to be paid, the death or loss must occur not more than one year from 

the date of the accident and be a direct result of bodily injury sustained from that 

accident, independent of all other causes. 

AD&D insurance is automatically included in Basic insurance at no additional cost. 

It is equal to your Basic Insurance Amount (BIA), and does not include the Extra 

Benefit. AD&D insurance is also automatically included in Option A in the amount 

of $10,000 at no additional cost. Option B and Option C do not include AD&D 

insurance. Accidental death benefits are paid in addition to other FEGLI benefits 

that may be payable. AD&D coverage stops when your employment ends. It does not 

carry into retirement. 

The following is a list of covered losses under AD&D insurance and the 

corresponding amounts payable: 

AD&D SCHEDULE OF LOSSES 

For the Loss of The Amount Payable is 

Life Full amount 

Two or more Members* Full amount 

One Member* 50% of Full amount 

* A Member is a hand, foot, or the sight in one eye. 

Note: For all losses resulting from any one accident, no more than the Full amount 

is payable. 

The Office of Federal Employees’ Group Life Insurance (OFEGLI) will not pay 

AD&D benefits if your death or loss in any way results from, is caused by, or is 

contributed to by: 

• physical or mental illness;

• the diagnosis of or treatment of physical or mental illness;

• ptomaine or bacterial infection (however, OFEGLI will pay AD&D benefits if 

the loss is caused by an accidentally sustained external wound); 

• a war (declared or undeclared), any act of war, or any armed aggression 

against the United States in which nuclear weapons are actually being used; 

• a war (declared or undeclared), any act of war, or any armed aggression or 

insurrection in which you are in actual combat at the time bodily injuries are 

sustained; 

• suicide or attempted suicide;

• injuring yourself on purpose;

• illegal or illegally obtained drugs that you administer to yourself;

• driving a vehicle while intoxicated, as defined by the laws of the jurisdiction in 

which you were operating the vehicle. 

10 
What If I Want to Change My Life Insurance Coverage? 

If you waived Basic insurance or did not elect Optional insurance when you were 

first hired, or you simply want different coverage than you have now, you have 

three opportunities to make changes: during an Open Season, by providing 

medical information, or by experiencing a life event. 

Open Season 

An Open Season is relatively rare. Your human resources office will give you 

more details about any upcoming Open Seasons whenever they’re scheduled. 

The 1999 and 2004 Open Seasons are the most recent. 

Providing Medical Information 

As long as at least one year has passed since the effective date of your last 

waiver of life insurance coverage, you may provide satisfactory medical 

information at your own expense using the Request for Life Insurance 

(SF 2822). The SF 2822 is available only on the FEGLI website. You can 

download the form at www.opm.gov/insure/life. You and your agency must 

complete part of the form. Then you take the form to your physician or other 

medical professional. He or she will examine you, complete the rest of the form, 

and send the form to the Office of Federal Employees’ Group Life Insurance 

(OFEGLI). If OFEGLI approves your request, you will automatically get Basic 

insurance (unless, of course, you already have Basic). You will have 31 days from 

the approval date to elect Option A and/or elect Option B or increase your 

Option B multiples (up to a total of 5) by completing a Life Insurance Election 

(SF 2817) and submitting it to your human resources office. 

You cannot elect Option C or increase your Option C multiples by providing medical 

information—you can get Option C based on a life event, as described on page 12. 

However, even if you previously elected Option C— Family and are changing other 

Optional coverage, you must sign for Option C again in order to keep it. If you 

do not sign for it, you have waived/cancelled it. For example, let’s assume you 

already have Basic and three multiples of Option C and you want Option A. You 

complete the SF 2822 and provide medical information, and OFEGLI approves 

your request. Then you complete the SF 2817. You must sign for Basic, Option 

A, and ALSO three multiples of Option C even though you’re not newly electing 

Option C. If you don’t sign for your current Option C coverage again, you have 

waived/cancelled it. 

Your Basic insurance coverage will be effective on the first day you are in a pay 

and duty status, on or after the date OFEGLI approves your request. Your 

Option A and/or Option B coverage will be effective on the first day you are in a 

pay and duty status, on or after the date OFEGLI approves your request and 

your human resources office receives your Life Insurance Election (SF 2817) 

electing such coverage. You must be in a pay and duty status within 31 days after 

OFEGLI approves your request for the coverage to be effective; otherwise, 

OFEGLI’s approval is void, and you will have to start over. 11 
GENERAL INFORMATION 

Life Event 

If you already have Basic, you may elect Option B and/or Option C, or increase 

your multiples of Option B and/or Option C, within 60 days of experiencing a 

qualifying life event. A qualifying life event means marriage, divorce, the 

death of your spouse, or the birth or adoption of a child. You must complete a 

Life Insurance Election (SF 2817) and submit it to your human resources office. 

The charts below show the types and amounts of coverage you can elect based 

on life events. You cannot elect Basic or Option A based on a life event. 

If you waived your Basic coverage and subsequently experience a qualifying 

life event less than a year after the waiver took effect, you must still wait a 

year from the effective date of your previous waiver before you can provide 

satisfactory medical information to elect Basic insurance. If approved, you 

automatically are enrolled in Basic, and you have 31 days to elect Option B 

and /or Option C. 

LIFE EVENT NUMBER OF MULTIPLES YOU MAY ELECT 

(BUT NO MORE THAN 5 T TO AL) 

Marriage and eligible children) you gain from the marriage. 

Divorce The total number of your eligible children. 

Death of 

Spouse The total number of your eligible children. 

Birth or 

Adoption of 

Children 

The total number of eligible children* born or 

adopted in this event. 

Before the Event 

The 1st date you are 

in a pay and duty 

status, on or after 

the event. 

After the Event 

The date your human 

resources office 

receives the form 

AND you are in a pay 

and duty status. 

The number of additional family members (spouse 

EFFECTIVE DATE OF COVERAGE 

WHEN SF 2817 IS SUBMITTED: 

On or W

OPTION B — ADDITIONAL 

ithin 60 Days 

MULTIPLES YOU MAY ELECT WITH A LIFE EVENT 

* Acquiring a foster child does not count as a life event. See page 9 of this Booklet for more information about 

eligible children. 

OPTION C — FAMILY MULTIPLES YOU MAY ELECT WITH A LIFE EVENT 

EFFECTIVE DATE OF COVERAGE 

WHEN SF 2817 IS SUBMITTED: 

LIFE EVENT NUMBER OF MULTIPLES YOU MAY ELECT 

(BUT NO MORE THAN 5 TOTAL) Before the Event On or Within 60 Days 

After the Event 

Marriage 

The date your human 

Divorce The date of the event, resources office 

Death of 

Spouse 

Birth or 

From one to five multiples for any life event. regardless of your 

pay and duty status. 

receives the form, 

regardless of your 

pay and duty status. 

Adoption of 

Children 

12 
LIFE EVENT 

Basic Depends on details of Open Season YES NO 

Option A* Same as Basic YES NO 

Option B* Same as Basic YES YES 

Option C* Same as Basic NO YES 

OPEN SEASON 

(SF 2822) 

SUMMARY OF WHEN YOU CAN ADD COVERAGE 

COVERAGE 

PROVIDING MEDICAL 

INFORMATION 

* You must have or elect Basic to elect Optional. 

When Will My Life Insurance Stop? 

Your life insurance coverage (including Accidental Death and Dismemberment 

[AD&D] insurance) as an employee will stop on the earliest of the following 

dates: 

• The date you separate from Federal service (although you may be eligible to 

continue coverage as an annuitant or while in receipt of workers’ compensation 

benefits). 

• The date you transfer to an excluded position. Check with your human 

resources office; in some cases, you may be eligible to keep your coverage. 

• The end of a period of 12 months in nonpay status* (although you may be 

eligible to continue coverage while in receipt of workers’ compensation 

benefits). The 12 months may be continuous or broken by periods of less than 

four consecutive months of pay status. 

• The end of the last day of the last pay period in which your agency withheld life 

insurance premiums from your pay, if your agency determines that for the next 

six months or more your pay will be insufficient to cover the withholdings, and 

you decide that you do not want to pay the premiums directly. 

• The end of the last day of the pay period in which your human resources office 

receives your Life Insurance Election (SF 2817) on which you voluntarily 

waive/cancel some or all life insurance. Only the coverage you waive/cancel 

stops, although if you cancel Basic, you automatically cancel all forms of 

insurance. 

• The date the Government’s life insurance contract ends. 

Note: You are responsible for knowing when your insurance stops. 

* For military reservists who separate from service for military duty, your life insurance 

ends at the end of 12 months in nonpay status, or 90 days after your military service 

ends, whichever comes first. During this period, your coverage is free. 

13 
GENERAL INFORMATION 

Will I Be Entitled to a Temporary Extension of My Life Insurance? 

Yes, under certain circumstances. You will have a temporary extension of coverage 

for 31 days after your life insurance terminates, unless you voluntarily waive/cancel 

coverage, or your annuity or workers’ compensation benefits terminate. This 

temporary extension of coverage does not include AD&D insurance. No premiums 

or Government contributions are required during this temporary extension. 

See the FEGLI Handbook (RI 76-26), which is available in electronic format 

only, at www.opm.gov/insure/life for more details. If you are not entitled to continue 

your coverage, you may convert your FEGLI coverage to an individual policy 

(see Conversion on page 19). 

Can I Voluntarily Cancel My Life Insurance? 

You may voluntarily waive/cancel Basic, Option A, Option B, or Option C or reduce 

multiples of Option B and/or Option C at any time by completing a Life Insurance 

Election (SF 2817)*. Simply sign only for the insurance you wish to keep. If you 

do not sign for a particular type of insurance, you have waived/cancelled it. 

If you cancel Basic, you automatically cancel all forms of Optional insurance. 

The life insurance coverage you cancel stops at the end of the pay period in 

which your human resources office receives your election form cancelling the 

coverage. Exception: If you cancel Option C because you no longer have any 

eligible family members, the effective date of the cancellation is retroactive to 

the end of the pay period in which you ceased to have any eligible family 

members. You will not have a temporary extension of coverage nor the right to 

convert any insurance that you voluntarily cancel (see Conversion on page 19). 

What Happens to My Life Insurance Coverage When I Retire? 

Your coverage will automatically continue when you retire if: 

• You retire on an immediate annuity and had the coverage for: 

• 	The five years of service immediately before the starting date of your 

annuity or, for annuitants retiring under the Federal Employees Retirement 

System (FERS) who postpone receiving their annuity, the five years 

immediately before their separation date for annuity purposes, or 

• 	All period(s) of service during which that coverage was available to you 

if it’s less than five years, and 

• You†do not convert the coverage to a private policy (see Conversion on page 19). 

If you meet the rules listed above for continuing your coverage into retirement, 

you will have several choices of how much insurance you wish to carry after 

you retire. 

* Unless you have assigned your coverage, in which case only the assignee(s) may cancel your 

coverage. See Assignment on page 18. 

† or your assignee(s), if applicable. See Assignment on page 18. 

14 
Basic Insurance in Retirement 

The amount of your Basic insurance in retirement is your BIA (Basic Insurance 

Amount) at the time you separated as an employee. This amount continues 

until you reach age 65, after which it may reduce based on the election options 

described below. You will not have Accidental Death and Dismemberment 

coverage in retirement. 

When you retire, you must choose the type of reduction you want by completing a 

Continuation of Life Insurance Coverage as a Retiree or Compensationer (SF 2818) 

provided by your human resources office. For Basic insurance, you must choose 

75% Reduction, 50% Reduction, or No Reduction. You can change to 75% Reduction 

at any time; your coverage will be as if you had originally elected 75% Reduction 

and your “extra premium” will stop. You will not receive a refund of premiums. 

• What is 75% Reduction? 

This means your Basic insurance will reduce by 2% of the pre-retirement 

amount each month. The reduction starts at the beginning of the second 

month after your 65th birthday or at retirement, whichever is later. Your 

Basic insurance will continue to reduce until 25% of the pre-retirement 

amount remains. Your Basic insurance is free once it starts to reduce. 

• What is 50% Reduction? 

This means your Basic insurance will reduce by 1% of the pre-retirement 

amount each month. The reduction starts at the beginning of the second 

month after your 65th birthday or at retirement, whichever is later. Your 

Basic insurance will continue to reduce until 50% of the pre-retirement 

amount remains. When you turn 65, your “regular” premium for Basic 

insurance stops, but you continue to pay an extra premium for this choice. 

See the chart on page 17 for these premiums. 

• What is No Reduction? 

This means your Basic insurance will not reduce. When you turn 65, your 

“regular” premium for Basic insurance stops, but you continue to pay an extra 

premium for this choice. See the chart on page 17 for these premiums. 

Optional Insurance in Retirement 

The amount of your Optional insurance in retirement depends on the options you 

had at the time you separated as an employee. This amount continues until you 

reach age 65, unless you elect No Reduction (for Option B and Option C only.) 

• Option A — Standard: 

If you are eligible to continue Option A into retirement, it will reduce by 2% 

of the pre-retirement amount each month until it reaches 25% of the 

pre-retirement amount. The reduction starts at the beginning of the second 

month after your 65th birthday or at retirement, whichever is later. Option A 

is free once it starts to reduce. 

You cannot choose No Reduction for Option A. 

15 
GENERAL INFORMATION 

If you are eligible to continue Option B and/or Option C into retirement, you 

must choose whether you want these options to reduce, as explained below. 

• Option B — Additional: 

If you retire before age 65, you have two choices at retirement: Full Reduction 

for all of your multiples or No Reduction for all of your multiples. At age 

65, or at retirement, if later, you will be able to choose the number of 

multiples that will reduce. 

If you choose Full Reduction, the value of your Full Reduction Option B 

multiples will reduce by 2% of the pre-retirement amount each month 

for 50 months, at which time coverage on those multiples will end. The 

reduction starts at the beginning of the second month after your 65th 

birthday or at retirement, whichever is later. Option B Full Reduction 

multiples are free once the reductions start. 

If you choose No Reduction, the value of your No Reduction Option B 

multiples will not reduce. You will continue to pay the full premium 

for all No Reduction multiples until you die, change those multiples to 

Full Reduction, or cancel those multiples. If you choose No Reduction, 

you can change to Full Reduction at any time.* However, if you change to 

Full Reduction after you reach age 65, the level of coverage you have will 

be as if you had originally elected Full Reduction. You will not receive a 

refund of premiums. 

• Option C—Family: 

If you retire before age 65, you have two choices at retirement: Full Reduction 

for all of your multiples or No Reduction for all of your multiples. At age 

65, or at retirement, if later, you will be able to choose the number of 

multiples that will reduce. 

If you choose Full Reduction, the value of your Full Reduction Option C 

multiples will reduce by 2% of the pre-retirement amount each month 

for 50 months, at which time coverage on those multiples will end. The 

reduction starts at the beginning of the second month after your 65th 

birthday or at retirement, whichever is later. Option C Full Reduction 

multiples are free once the reductions start. 

If you choose No Reduction, the value of your No Reduction Option C 

multiples will not reduce. You will continue to pay the full premium 

for all No Reduction multiples until you die, change those multiples to 

Full Reduction, or cancel those multiples. If you choose No Reduction, 

you can change to Full Reduction at any time. However, if you change to 

Full Reduction after you reach age 65, the level of coverage you have will 

be as if you had originally elected Full Reduction. You will not receive a 

refund of premiums. 

* Unless you have assigned your coverage, in which case only your assignee(s) may change 

from No Reduction to Full Reduction. See Assignment on page 18. 

16 
BASIC INSURANCE — ANNUITANTS*

COST FOR EACH $1,000 OF YOUR BASIC INSURANCE AMOUNT1 

MONTHLY 

75% Reduction — reduces 2% of the BIA1 each 

month after you reach age 65,3 until 25% of the 

amount at retirement remains. 

50% Reduction — reduces 1% of the BIA1 each 

month after you reach age 65,3 until 50% of the 

amount at retirement remains. 

No Reduction 1 remains for life. 

$0.3250 N/A $0.3250 N/A 

$0.3250 $0.60 $0.9250 $0.60 

$0.3250 

Regular 

Premium 

Extra Premium 

for 50% or No 

Reduction 

Age 65,2 

Continuing for Life 

— 100% of the BIA $1.83 $2.155 $1.83 

Total Cost 

After You Reach 

Before You Reach Age 65 You Pay the TOTAL of 

BOTH the Regular Premium and the Extra Premium YOU HAVE FULL COVERAGE 

TO AGE 65 THEN: 

BASIC INSURANCE — COMPENSATIONERS*

COST FOR EACH $1,000 OF YOUR BASIC INSURANCE AMOUNT1 

EVERY 28 DAYS 

75% Reduction — reduces 2% of the BIA1 each 

month after you reach age 65,3 until 25% of the 

amount at retirement remains. 

50% Reduction — reduces 1% of the BIA1 each 

month after you reach age 65,3 until 50% of the 

amount at retirement remains. 

No Reduction 1 remains for life. 

$0.30 N/A $0.30 N/A 

$0.30 $0.56 $0.86 $0.56 

$0.30 

Regular 

Premium 

Extra Premium 

for 50% or No 

Reduction 

Age 65,2 

Continuing for Life 

— 100% of the BIA $1.68 $1.98 $1.68 

Total Cost 

After You Reach 

Before You Reach Age 65 You Pay the TOTAL of 

BOTH the Regular Premium and the Extra Premium YOU HAVE FULL COVERAGE 

TO AGE 65 THEN: 

* These are the rates through 2005. They may change in future years. For more information, see the FEGLI website at 

www.opm.gov/insure/life. 

1 Basic Insurance Amount (BIA)—Your final annual rate of basic pay, rounded to the next even $1,000, plus $2,000 

(or a minimum of $10,000) (or the post-election BIA you had after your election of a partial Living Benefit—see 

page 20). Your BIA does not include the Extra Benefit or Accidental Death and Dismemberment coverage. 

2 The regular premium automatically stops on the first day of the month after you reach age 65. If you retire after 

reaching 65, you do not pay the regular premium. 

3 The reduction starts at the beginning of the second month after your 65th birthday or at retirement, whichever is later. 

17 
GENERAL INFORMATION 

Miscellaneous Provisions 

Assignment 

Assignment means that you give ownership and control of your Basic, Option A, 

and Option B life insurance coverage to someone else. You cannot assign Option C. 

The insurance is still on your life and you must continue to pay for the coverage, 

but someone else “owns” and controls your coverage. You may assign your life 

insurance coverage to an individual, a corporation, or an irrevocable trust. If you 

want to assign your life insurance, you can do so by completing an Assignment, 

Federal Employees’ Group Life Insurance (RI 76-10). Your decision to assign your 

life insurance coverage is irrevocable; you cannot cancel your assignment if you 

change your mind. 

Only you can assign your life insurance coverage; a court-appointed guardian or 

someone with your power of attorney or other fiduciary may not. Your 

assignee(s) may reassign your life insurance coverage. 

Enrollees generally assign insurance to comply with the requirements of a court 

order upon divorce, for inheritance tax purposes, to get money before death 

(such as for terminally ill and chronically ill persons), or to satisfy a debt. 

If you assign your insurance, you give up your rights to convert your coverage 

(see Conversion on page 19), to designate beneficiaries, and to cancel your 

coverage. Only your assignee(s) may convert your coverage, designate 

beneficiaries, and cancel your coverage. 

If you assign your life insurance coverage, neither you nor your assignee may 

elect Living Benefits (see page 20). 

A court decree, court order, or court-approved property settlement agreement 

incident to your court decree of divorce, annulment, or legal separation may 

direct you to assign your life insurance coverage to a specified person, unless 

you have previously made an assignment. However, such a court decree, order, 

or agreement would not serve as the assignment itself. You must still complete 

a valid Assignment, Federal Employees’ Group Life Insurance (RI 76-10). If 

you do not, the life insurance may not be paid according to the court decree, order, 

or agreement. 

See Assignment, Federal Employees’ Group Life Insurance (RI 76-10) for more 

information, or the FEGLI Handbook (RI 76-26), which is available in electronic 

format only, at www.opm.gov/insure/life. 

Break in Service 

When you return to work after a break in service of less than 180 days, your 

human resources office will automatically give you the same coverage that you 

had in your prior position. You can elect other coverage during an Open Season, 

by providing satisfactory medical information or by experiencing a qualifying 

life event as described on pages 11 and 12. 

18 
When you return to work after a break in service of 180 days or more, you will 

automatically get Basic insurance (even if you previously waived it) and the 

same Optional insurance (if applicable) that you had in your prior position. In 

addition, you may elect Optional insurance or increase the multiples of Optional 

insurance (if you don’t already have the maximum) within 31 days of your 

appointment to an eligible position. If you don’t make an election regarding 

Optional insurance, your human resources office will automatically reinstate the 

same coverage you had in your prior position. 

If you experienced a qualifying life event during your break in service, you will 

have 31 days from the date of your reinstatement or 60 days from the date of 

the event, whichever gives you more time, to elect or increase the multiples of 

Option B or Option C. 

Conversion 

When Federal Employees’ Group Life Insurance (FEGLI) coverage as an 

employee stops and you are entitled to a 31-day extension of coverage (as stated 

on page 14), you may convert your FEGLI coverage to an individual policy. The 

conversion coverage is effective at the end of the 31-day extension of coverage, 

regardless of when you apply. You will not have to answer any medical questions. 

You may wish to convert your life insurance coverage if you do not qualify to 

carry it into retirement or compensation. 

You may convert to an individual policy an amount less than or equal to the total 

of your Basic and Optional insurance (if applicable). However, you may not convert 

coverage if (1) you continue that same coverage as a retired employee or 

compensationer, or (2) you return to Government service in a position in which 

you are eligible for FEGLI coverage within three calendar days after you left 

Government service, or (3) your insurance ends because you voluntarily 

waive/cancel coverage, or (4) the Government’s life insurance contract ends, or 

(5) your annuity or compensation stops.

If you assign your insurance, you give up your right to convert your coverage.


Only your assignee(s) may convert your insurance coverage.


Your agency should notify you of your conversion rights when your life


insurance coverage ends. However, you are responsible for finding out whether 

you qualify to convert your insurance coverage and for getting the necessary 

forms and information from your human resources office. You must act promptly, 

since you only have 31 days in which to convert your coverage. 

Direct Payment of Premiums 

If your pay is too low to allow a withholding for life insurance premiums and 

your human resources office expects this situation to last more than six months, 

you will have a choice. You can choose either to terminate some or all of your 

insurance coverage or to continue the coverage and pay the premiums directly. 

Contact your human resources office for further details. 

19 
GENERAL INFORMATION 

Incontestability 

If your agency enrolls you in some FEGLI coverage by mistake, the 

Incontestability provision may apply. If your erroneous coverage and the 

applicable premium withholdings have been in force for at least two years in 

your lifetime before the error is discovered, then that erroneous coverage 

becomes valid. Please see your human resources office if you think that the 

Incontestability provision applies to you. 

Living Benefits 

You may elect to receive a full or partial lump sum payment of your Basic insurance 

(living benefits) if you are terminally ill and your treating physician provides 

a documented medical prognosis that your life expectancy is nine months or 

less. To apply for living benefits, call OFEGLI at 800-633-4542. See the 

FEGLI Handbook (RI 76-26), which is available only in electronic format, at 

www.opm.gov/insure/life for more details. 

Nonpay Status 

Your life insurance coverage continues automatically at no cost to you for the first 

12 months in nonpay status. Exception: If you are receiving workers’ compensation 

benefits during these first 12 months, your continued coverage will not be free . The 

U.S. Department of Labor will withhold premiums from your workers’ compensation

payments. Your coverage as an employee will terminate after 12 months of nonpay 

status, or when you separate from your agency, if earlier. The 12 months may be 

continuous or broken by periods of less than four consecutive months of pay status. 

When your coverage terminates, you will have the right to convert your coverage 

to an individual policy or continue coverage as a compensationer, if eligible. 

For military reservists who separate from service for military duty, your life insurance 

ends at the end of 12 months in nonpay status, or 90 days after your military service 

ends, whichever comes first. During this period, your coverage is free. 

Please see your human resources office for more details. It is your responsibility 

to know when your coverage terminates. 

Reconsideration 

You are entitled to reconsideration of an agency decision to deny your election 

of one or more life insurance coverages or the opportunity to change coverage 

multiples. The reconsideration process applies only to enrollment issues. You 

have 30 days from the date of your agency’s initial decision in which to request 

reconsideration. 

You should send your request for reconsideration to the agency address shown 

in the initial decision letter you receive from your human resources office. 

Workers’ Compensation 

You may be eligible to continue your group coverage while receiving workers’ 

compensation payments from the U.S. Department of Labor, under certain conditions. 

20 
These conditions are: 

• You had the coverage for: 

• The five years of service immediately before the date your workers’


compensation benefits started (Note: You do not start counting the 


five years from when you began leave without pay), or


• All periods of service during which that coverage was available to you 

if it’s less than five years, and 

• You did not convert the coverage to a private policy (see Conversion on page 19). 

If you meet the rules for continuing coverage while in receipt of workers’ 

compensation benefits, you will have several choices of how much insurance you 

wish to carry after you are age 65. Please see your human resources office if you 

are receiving workers’ compensation benefits. 

Who Gets the Money after I Die? 

When you die, the Office of Federal Employees’ Group Life Insurance 

(OFEGLI) will pay life insurance benefits in a particular order, set by law: 

• If you assigned ownership of your life insurance by filing an Assignment, Federal 

Employees’ Group Life Insurance (RI 76-10), OFEGLI will pay benefits: 

First, to the beneficiary(ies) designated by your assignee(s), if any; 

Second, if there is no such beneficiary, to your assignee(s). 

• If you did not assign ownership and there is a valid court order (see page 22) 

on file, OFEGLI will pay benefits in accordance with that court order. 

• If you did not assign ownership and there is no valid court order (see page 22) 

on file, OFEGLI will pay benefits: 

First, to the beneficiary(ies) you designated; 

Second, if there is no such beneficiary, to your widow or widower; 

Third, if none of the above, to your child or children, with the share of any 

deceased child distributed among descendants of that child (a court will 

usually have to appoint a guardian to receive payment for a minor child); 

Fourth, if none of the above, to your parents in equal shares or the entire 

amount to your surviving parent; 

Fifth, if none of the above, to the executor or administrator of your estate; 

Sixth, if none of the above, to your other next of kin as determined under the 

laws of the state where you lived. 

If you want payment to be made differently from the order listed above, and you 

have not assigned your life insurance and a valid court order is not on file, you 

must designate a beneficiary. A court-appointed guardian, or someone with your 

power of attorney, or other fiduciary may not designate a beneficiary for your 

insurance. However, if you are satisfied with the order of payment listed above, 

you do not need to do anything. 

21
GENERAL INFORMATION 

If there is a valid court order on file, you may not change or submit a


designation of beneficiary unless the person(s) named in the decree, order, or


agreement agrees in writing, or unless the decree, order, or agreement is


modified.


A valid court order refers to a certified court decree, court order, or court-approved


property settlement agreement incident to your court decree of divorce, annulment,


or legal separation that your human resources office receives on or after July 22, 1998,


and before your death (if you are an employee, or a compensationer during the 


first 12 months of nonpay status) or the Office of Personnel Management receives


on or after July 22, 1998, and before your death (if you are an annuitant, or a


compensationer after the first 12 months of nonpay status). Such an order must


expressly provide for someone to receive your FEGLI benefits. If a valid court


order is on file, it takes precedence over previously filed designations, and


you cannot file subsequent designations.


You cannot designate beneficiaries if you have assigned your insurance. Only the


assignee(s) may designate beneficiaries.


If you wish to make a designation for your Federal Employees’ Group Life


Insurance (FEGLI), you should complete a Designation of Beneficiary (SF 2823)


and submit it to your human resources office. Your human resources office must


receive the form before you die.


A designation made in any other document is valid only if the document specifies


your FEGLI benefits, is signed by you, and otherwise meets the requirements


of a valid FEGLI designation of beneficiary.


If you decide to file a designation, be sure it remains accurate and reflects 


your intentions. You should review your designation periodically, and file a new 


designation whenever a beneficiary’s address changes. Failure to do so may 


mean that the Office of Federal Employees’ Group Life Insurance (OFEGLI)


may not be able to locate your beneficiaries and therefore cannot pay them the


death benefits.


How Should Someone File a Claim? 

Your beneficiary or other survivor should contact your human resources office 

for a Claim for Death Benefits (FE-6), or download a copy from the FEGLI 

website at www.opm.gov/insure/life. The completed claim form should be submitted 

along with a certified death certificate to your human resources office or, if 

instructed, directly to OFEGLI. 

If you have Option C and an insured family member dies, contact your human 

resources office for a Statement of Claim-Option C, Family Life Insurance 

(FE-6 DEP) which contains further instructions, or download a copy from the 

FEGLI website. 

22 
How Are Benefits Paid? 

As the insured person, you receive any living benefits or accidental 

dismemberment benefits that may be payable. You cannot designate a 

beneficiary(ies) for these benefits. 

If an insured family member dies, you receive any Option C benefits that may be 

payable. You cannot designate a beneficiary(ies) for Option C. 

If you die while insured, your beneficiary(ies) or other survivors will receive 

your Basic, Option A and/or Option B benefits. Depending on the amount, the 

Office of Federal Employees’ Group Life Insurance (OFEGLI) will either send 

them a check or create a Total Control Account (money market option) in their 

name. This account, like a regular money market account with a checkbook, 

earns interest from the day it is opened. The payee(s) may close the account 

immediately or write checks for any amount at any time (from $250 up to the 

entire balance), with no charge. You needn’t take any action—OFEGLI will 

automatically send your beneficiary(ies) or other survivors detailed information 

about the form of payment when benefits are payable. 

Someone who wrongfully causes your death cannot receive payment of death 

benefits. In addition, please refer to the list of exclusions on page 10 for 

Accidental Death and Dismemberment benefits. 

23 
SUMMARY 

• If eligible, you are automatically enrolled in Basic insurance, unless you waive 

it. 

• You must elect Optional insurance, within strict time limits, if you want it. 

• You must be enrolled in or elect Basic insurance in order to elect Optional 

insurance. 

• The Government pays one-third of the cost of your Basic life insurance. You 

pay 100% of the cost of Optional insurance. 

• You can voluntarily waive/cancel insurance coverage at any time unless you 

have assigned your coverage. If you cancel Basic insurance, you automatically 

cancel all forms of Optional insurance. 

• For some types of coverage, you can elect more coverage by submitting 

satisfactory medical information or by experiencing a qualifying life event. 

• Open Seasons are held infrequently. The 1999 and 2004 Open Seasons are the 

most recent. 

• It is your responsibility to know the amount of your coverage, when it starts, when 

it stops, and who is entitled to payment of the death benefits. 

TABLE OF EFFECTIVE DATES – NEWLY ELIGIBLE FEDERAL EMPLOYEES 

BASIC COVERAGE 

If You Do Nothing 

If You WAIVE* it DURING 

Your First Pay Period 

If You WAIVE* it AFTER 

Your First Pay Period 

Coverage Begins on the first day you‘re in 

a pay and duty status. 

Your coverage is voided. Ends on the last day of the pay 

period in which your agency 

receives your waiver. 

Deductions Begin the first pay period you‘re 

in a pay and duty status. 

No deductions. End after the last day of the pay 

period in which your agency 

receives your waiver. 

OPTIONAL COVERAGE

If You Do Nothing 

If You Elect* it Within the 31 Days 

After Your Appointment to an 

Eligible Position 

If You Want it After 

Those 31 Days 

Coverage 

Deductions 

No Coverage 

No Deductions 

Begins on the first day you’re in a 

pay and duty status on or after 

the date your agency receives 

your election. 

Begin the first pay period you’re 

in a pay and duty status after your 

Your Opportunities to Elect 

Optional Coverage After 

Those 31 Days are Limited. 

See pages 11 – 12

agency receives your election. 

* “Elect it” and “Waive it” means your agency received a properly completed SF 2817 “Life Insurance Election” 

from you. 

24 
LIFE INSURANCE WORKSHEET 

How much 

insurance How much 

Instructions you have Instructions it costs 

BASIC 7a. Divide the amount in line 5 by $1,000. 

1. Enter your annual rate of basic pay. $

7b. If you are paid biweekly, multiply line 7a by $0.150. $ 

If you are paid monthly, multiply line 7a by $0.325. 2. If not an even thousand, round up to the next even thousand. $ This is how much you pay for Basic (the Extra Benefit based 

on your age at death is provided at no additional cost to you). 3. Add $2,000. +$2,000 

Your Age Age Multiplication Factor 

35 or under 2.0 

36 1.9 

4. Add the amounts in lines 2 and 3. $ 

There is no 37 1.8 5. Enter the amount in line 4, or $10,000, whichever is greater. $ 38 1.7 additional cost

39 1.6 to you for the 6. Enter the Age Multiplication Factor* 40 1.5 Extra Benefit. 41 1.4 

42 1.3 

43 1.2 

(from the table at the right). 

7. Multiply the amount in line 5 times the amount in line 6. $ 

44 1.1 This is the total amount of Basic you have at your present age.* 45 and over 1.0 

OPTION A — STANDARD 

8. Enter $10,000. $ 8a. Enter the Option A cost for your age group from page 7. This is how much you pay for Option A. $ 

OPTION B — ADDITIONAL 

9. Enter the amount in line 2. $ 11a. Divide the amount in line 11 by $1,000. 

10. Enter the number of multiples you elect (1, 2, 3, 4, or 5). 11b. Enter the Option B cost for your age group from page 8. $

11c. Multiply the amount in line 11a times the amount 

This is the amount of your Option B coverage.

11. Multiply the amount in line 9 times the amount in line 10. $ 

in line 11b. This is how much you pay for Option B. $ 

OPTION C — FAMILY 

12. You may choose from 1 to 5 multiples of Family Coverage. 12a. Enter the Option C cost for your age group from page 9. $_______ 

Each multiple is equal to $5,000 for your spouse and Enter the number of multiples you want (from 1 to 5). x _______ $2,500 for each of your eligible children.

Multiply the cost by the number of multiples and enter that amount at right. $ 

13a. Add the amounts in lines 7b, 8a, 11c, and 12a. $ 

This is the total amount of insurance on your life. 

13. Add the amounts in lines 7, 8, and 11. $ 

This is the total withholding for the life insurance you have 

on your life and your family. 

* The age multiplication factor that is used to calculate death benefits corresponds to your age at the time of your 

death. You are calculating the amount of insurance that you have at your present age. 

Note: Refer to pages 7, 8, and 9 for the withholding rates for Option A, Option B and Option C insurance, respectively. You 

may refer to the FEGLI Calculator at www.opm.gov/insure/life. With this online calculator you can rapidly and conveniently: 

• Determine the face value of various combinations of FEGLI coverage. 

• Calculate the premiums for the various combinations of FEGLI coverage, and see how choosing different Options can 

change the amount of life insurance and the premiums. 

• See how the life insurance carried into retirement will change over time. 

25 
SAMPLE ELECTION FORM 

When you have completed your election, submit it to your human resources office. Your confirmation of your election, 

plus this Booklet, serve as your certificate of insurance. 

Some agencies may process life insurance elections electronically. Contact your human resources office for more 

information on how they will process your election. 

Give your name 

and identifying 

information. 

(999) 999-9999 

Sign for the 99/99/9999

insurance you have 

and wish to keep 

and for any new 

insurance you are 

eligible for and 

wish to elect 

(anything you don’t X 

sign for is 

waived/cancelled). 

Your Name 99/99/9999 999 99 9999 

Your Agency City, State 99999 

X 

Your Signature 

Your Signature Your Signature Your Signature OR 99/99/9999 99/99/9999 99/99/9999 

If you do not want 

any insurance, you 

must sign here. 

Your Signature 99/99/9999 

26 
CHANGES AND CLARIFICATIONS 

This Booklet differs from the previous version (RI 76-21 dated January 2001) in the following ways: 

Revised Premiums and Age Groups effective January 1, 2003: 

• This Booklet reflects reduced premiums for Basic insurance and for several of 

the Option B age bands, effective January 1, 2003. In addition, we added 

additional age bands and premiums for Option B. The previous upper age 

group was “60 and over.” We added five new age groups: 60-64, 65-69, 70-74, 

75-79, and 80 and over. The Option B premiums are being phased in over a 

three-year period from 2003-2005, as described in the chart on page 8. 

• This Booklet reflects additional age bands and premiums for Option C, effective 

January 1, 2003. The previous upper age group was “70 and over.” We added 

three new age groups: 70-74, 75-79, and 80 and over. The Option C age bands 

and premiums are described in the chart on page 9. 

Changes due to Public Law 105-311, enacted October 30, 1998: 

• We revised the life events chart on page 12 to clarify changes to the number of 

multiples of Option C. 

• We clarified the number of Option C multiples you can elect in the case of a 

life event. You can elect any number of multiples up to the total allowable 

(which is five multiples), regardless of the number of family members you have 

or acquired. 

• We deleted language explaining Portability. The provision of the law that 

authorized Portability coverage expired April 24, 2002. Portability of Option B 

for employees whose life insurance terminated is no longer available. 

Other Clarifications and Revisions: 

• We revised the list of exclusions for payment of Accidental Death and 

Dismemberment (AD&D) benefits as follows: 

— We included driving a vehicle while intoxicated as defined by the laws of 

the jurisdiction in which you were operating the vehicle; 

— We deleted hernia. 

• We amended the timeframe for an employee to file a claim for Accidental 

Death and Dismemberment based on the date of injury from 90 days to “not 

more than one year from the date of the accident.” 

• We added a footnote for “When Will My Insurance Stop?” on page 13 to clarify the 

FEGLI termination date for employees separated for military duty as reservists. 

27 
• We added more information under “What Happens to My Life Insurance

Coverage When I Retire?”, including a brief description of the choices you will 

have if you qualify to carry FEGLI coverage into retirement. 

• This Booklet reflects our continued emphasis on the time limits for electing 

Optional insurance, converting your insurance, and otherwise making changes 

in your coverage. 

• This Booklet reflects our continued emphasis on reminding employees that 

any coverage not signed for is considered waived/cancelled. You are responsible 

for knowing what your insurance coverage is, its cost, when it terminates, 

and who is entitled to payment of the death benefits. 

• This Booklet reflects our continued emphasis on clarity and plain language. 

28 
29 

Unless otherwise noted, the following life insurance forms and publications are 

available at 

resources office. Some agencies have automated versions of some of these forms. 

SF 2817 Life Insurance Election 

Continuation of Life Insurance Coverage As an Annuitant or Compensationer 

SF 2819 Notice of Conversion Privilege 

SF 2820 

SF 2821 Agency Certification of Insurance Status 

SF 2822* Request for Insurance 

SF 2823 Designation of Beneficiary

OPM 1482 

RI 76-10 Assignment, Federal Employees’ Group Life Insurance 

FE-6 Claim for Death Benefits 

FE-6DEP Statement of Claim — Option C 

FE-7 Claim for Accidental Dismemberment 

FE-8† Claim for Living Benefits

RI 76-12 FEGLI Pamphlet for Retirees 

FE 76-20 FEGLI Program Booklet (U.S. Postal Service) 

FE 76-21 FEGLI Program Booklet (Federal) 

RI 76-26* FEGLI Handbook

† 

calling 1-800-633-4542. 

LIFE INSURANCE FORMS 

www.opm.gov/insure/life. You may also wish to check with your human 

Standard Forms 

SF 2818

Certification of Insured Employee’s Retired Status

Office of Personnel Management Forms 

Agency Certification of Status of Reemployed Annuitants 

Office of Federal Employees’ Group Life Insurance Forms 

Booklets, Pamphlets, and Handbooks 

* Available in electronic format only at www.opm.gov/insure/life. 

Available only from the Office of Federal Employees’ Group Life Insurance (OFEGLI) by 
FOR MORE INFORMATION 

— Visit the FEGLI website at 

— Read the FEGLI Handbook (RI 76-26) at 

— Visit your human resources office 

— * 

0405-4645 1900028416 (0704) Printed in U.S.A. 

www.opm.gov/insure/life

www.opm.gov/insure/life

Send an email message to the Office of Personnel Management (OPM) at fegli@opm.gov

*Please note: OPM does not have any information about whether you are enrolled in 

the FEGLI Program and what types of coverage, if any, you currently have. It also 

does not have any information about your designation of beneficiary. If you need any 

of that information, you must contact your human resources office directly. 

Place 

Proper 

Postage