Federal Employees' Group Life Insurance Program

Life Insurance Election

Use:

Federal employees use this form to sign up for or cancel life insurance coverage. New Federal employees in eligible positions are automatically covered by Basic insurance and do not need to use this form if they want only the Basic coverage. Annuitants do not use this form.

Electronic Copies:

• PDF Fillable Version:
• Acrobat 4 Version [145 KB]
• Acrobat 3 Version[160 KB]

To use the Adobe Acrobat forms you need the commercial Acrobat software or the free downloadable Acrobat Reader. You can fill in this form on your computer screen before you print it.

Paper Copies:

Employees:

Request a paper copy of this form from your servicing Human Resources Office.

Agencies:

Use your internal agency procedures for ordering Standard Forms.
Paper copies of this form are NOT available from OPM.