Federal Employees' Group Life Insurance Program

FEGLI Handbook

Records and Forms

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• Records
• Semiannual Headcount
• Forms
• Substitute Forms
• Electronic Forms

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RECORDS

Your insurance forms must be filed in your Official Personnel Folder and kept as a permanent record, unless a form contains specific instructions to do something different.

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SEMIANNUAL HEADCOUNT

Payroll offices must report the number of employees covered under FEGLI twice a year - for the last payroll paid in the first 15 days of March and the first 15 days of September for which withholdings and contributions are submitted.

The form used for this report is OPM Form 1523. The report includes the number of employees from whom withholdings were made for each type of pay period, as well as the number of insured employees in nonpay status from whom no withholdings were made.

OPM Form 1523 must be submitted with either the original or a copy of the report used to submit withholdings and contributions information.

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FORMS

• Forms to Be Stocked
• Obtaining Forms

Forms to Be Stocked

Each employing office must keep a supply of the following FEGLI forms on hand to meet anticipated needs:

• Life Insurance Election (SF 2817)
• Continuation of Life Insurance Coverage (SF 2818)
• Notice of Conversion Privilege (SF 2819)
• Agency Certification of Insurance Status (SF 2821)
• Request for Insurance (SF 2822)
• Designation of Beneficiary (SF 2823)
• Agency Certification of Status of Reemployed Annuitants (OPM 1482)
• Supplemental Semiannual Headcount Report (OPM 1523)
• Claim for Death Benefits (FE-6)
• Statement of Claim, Option C - Family Life Insurance (FE-6 DEP)
• Assignment of Federal Employees' Group Life Insurance (RI 76-10)
• FEGLI Booklet (RI 76-21)

The Claim for Accidental Means Dismemberment Benefits form (FE-7) should not be stocked but can be obtained from the Office of Federal Employees' Group Life Insurance when needed.

In addition, employing offices of agencies with a retirement system other than CSRS and FERS must stock the Certification of Insured Employee's Retired Status form (SF 2820), and employing offices must stock the Report of Withholdings and Contributions for Health Benefits, Life Insurance and Retirement form (SF 2812) if they have authorization to report withholdings on this form.

Obtaining Forms

Forms beginning with SF:

Employing offices may order these forms from GSA/FSS using the normal FEDSTRIP/MILSTRIP procedures [footnote] as specified by each agency's procurement or acquisitions office. Exception: Since the Certification of Insured Employee's Retired Status (SF 2820) has such a limited distribution - being used only by agencies administering a retirement system other than CSRS and FERS - agencies that use it must order this form from OPM, Retirement and Insurance Service, Forms Analysis and Design, 1900 E Street, NW, Washington, DC, 20415 (or fax 202-606-0910).

Forms beginning with OPM:

These forms must be ordered by the agency headquarters officer who normally requisitions forms and supplies for the entire agency. That person must order these forms from OPM, Retirement and Insurance Service, Forms Analysis and Design, 1900 E Street, NW, Washington, DC, 20415 (or fax 202-606-0910).

Forms beginning with FE:

These forms must be ordered by the agency headquarters insurance officer. That person must order these forms from the Office of Federal Employees' Group Life Insurance, Attention: Forms Ordering Desk, P. O. Box 2627, Jersey City, NJ 07303-2627 (or fax 201-395-7950).

Forms beginning with RI:

These forms are available only through OPM's rider system and can be ordered only by the agency headquarters insurance officer. Periodically, OPM will notify agency headquarters officers of the opportunity to purchase publications through the rider system. Exception: the FEGLI Booklet (RI 76-21) must be ordered from OFEGLI.

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SUBSTITUTE FORMS

• Policy
• General Requirements
• Form-specific Requirements
• Copies
• Approval Procedure

Policy

The General Services Administration (GSA) allows the use of PC-based, agency-generated substitute forms, and OPM will accept substitute life insurance forms that meet GSA and OPM requirements. This only applies to forms that begin with "SF."

General Requirements

Substitute forms must meet the general requirements established by GSA (41 CFR Part 201-9 and FIRMR Bulletin B-3, 12g Electronic Generation of Standard and Optional Forms, as amended) and the requirements specified here. Substitute forms must be approved by OPM prior to their use.

The electronic reproduction must be complete, containing all instructions and questions that appear on the current official form. The wording and punctuation of all items, instructions, and identifying information must match exactly. No data element may be added to or deleted from the form. The sequence and format for each item on the form must be reproduced to the highest degree possible. Each item must print on the page in approximately the same location. The approval form must include the vendor/agency name and the OPM approval expiration date at the bottom of each page.

Form-Specific Requirements

Blue colored paper is preferred, but not required, for all life insurance forms. The automated forms should be generated with black ink on paper that is 8.5" wide and 11" long.

• Life Insurance Election form (SF 2817): must produce separately the front of Part 1 and Part 2 because they are not identical. The front of Part 3 may be photocopied. The instructions must be on the reverse of the part to which they apply, or attached to the part.
• Continuation of Life Insurance Coverage (SF 2818): must print all four pages.
• Notice of Conversion Privilege (SF 2819): must print the form on the front and back of one page.
• Agency Certification of Insurance Status (SF 2821): the instructions must be on the reverse of the part to which they apply, or attached to it.
• Request for Insurance (SF 2822): must print the front and the back of the form on two separate pages.
• Designation of Beneficiary (SF 2823): the instructions must be on the reverse of the part to which they apply, or attached to it.

No other life insurance forms may be substituted.

Copies

Standard forms that have carbon copies may be photocopied to create the needed copies when the original and the copy are identical. The original form must have an original signature. Copies may have a photocopy of the signature.

Approval Procedure

Agencies that develop substitute forms packages must submit a complete printed set of the forms and a fully functional copy of the program to OPM prior to actual use of the forms. OPM will issue approvals for one-year periods to ensure that the forms remain current.

Requests for approval should be sent to Retirement and Insurance Service, Agency Services Division, Room 4351, 1900 E Street, NW, Washington, DC 20415.

Agencies that have developed, or plan to develop automated forms that are populated from internal automated systems, and/or can store input to a data base, should contact OPM for information on direct data transmission via disk, tape, telephone or the Internet. Agencies may submit their plans to the address shown above or call 202-606-0788.

If a form is revised during the year, OPM will notify the substitute forms developer of the revision and the deadline for revision of the program.

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ELECTRONIC FORMS

                   

FOOTNOTE:

* This is a Federal procurement procedure.

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