Federal employees use this form for belated FEGLI 2004 Open Season elections to enroll in the FEGLI Program, or to change/increase their existing coverage. Employees must first receive a written determination from their agency human resources office that they are eligible to make a belated FEGLI 2004 Open Season election. After receiving such determination, employees have 31 days in which to elect coverage on this FE-2004.

• Adobe Acrobat PDF File (281 KB - dated September 2004).
• This form is best viewed in Adobe 6.0.

Employees:

Download the form locally . However, if you can't access the Adobe-Acrobat PDF fillable form, contact your servicing human resources office for more information on how to obtain a copy.

Agencies:

Agencies can download the form locally. The form should be provided to an employee only after making a determination that he/she is eligible to make a belated Open Season election. Copies are NOT available from The Office of Federal Employees' Group Life Insurance (OFEGLI).