Eligibility
Eligibility for Life Insurance
Basic Insurance
As a Federal employee, you automatically have Basic insurance, unless you waive it. Exception: some employees are excluded from life insurance coverage by law or regulation.
Optional Insurance
Optional insurance is not automatic; you must specifically elect it.
You can elect Optional insurance if:
- You have Basic insurance;
- You don't have a waiver of that type of Optional
insurance still in effect (or a waiver of that
number of Option B or Option C multiples still in effect);
and
- Your periodic pay, after all other deductions, is
enough to cover the full cost.
Employees Excluded from Coverage
Exclusions by Law
You are excluded from life insurance coverage by law when:
- You are an employee of a corporation supervised
by the Farm Credit Administration, if private
interests elect or appoint a member of the board
of directors.
- You are not a citizen or national of the United
States and your permanent duty station is outside
the United States. Exception: you are
eligible for life insurance coverage if you met
the definition of employee on September 30, 1979,
by service in an Executive agency (as defined in
5 U.S.C. 105), the United States Postal Service,
or the Smithsonian Institution in the area which
was then known as the Canal Zone.
- You are a teacher in a Department of Defense
dependents school overseas, if employed by the
Federal Government in a nonteaching position
during the recess period between school years.
- You were first employed by the
Government of the District of Columbia on or
after October 1, 1987. Exceptions: you
are eligible for life insurance coverage if you
are:
- An employee of St. Elizabeth's Hospital, who
accepts employment with the District of Columbia
Government following Federal employment without a
break in service, as provided in section 6 of Pub.
L. 98-621;
- An employee of the DC Control Board (District of
Columbia Financial Responsibility and Management
Assistance Authority), who makes an election
under the Technical Corrections to Financial
Responsibility and Management Assistance Act
(section 153 of Pub. L. 104-134) to be considered
a Federal employee for life insurance and other
benefits purposes (employees of the DC Control
Board who are former Federal employees are
subject to the provisions of this Handbook
concerning cancelling
waivers);
- The Corrections Trustee or the Pretrial Services,
Parole, Adult Probation and
Offender Supervision Trustee or an employee of
those Trustees who accepts employment with the
District of Columbia government within 3 days
after separating from the Federal Government;
- Effective October 1, 1997, a judicial or
nonjudicial employee of the District of Columbia
Courts, as provided by Pub. L. 105-33; or
- Effective April 1, 1999, an employee of the Public Defender Service of the District of Columbia, as provided by Pub. L. 105-274.
Exclusions by Regulation
You are excluded from life insurance coverage by regulation when:
- You are serving under an appointment limited to 1
year or less. Exceptions: you are
eligible for life insurance coverage if:
- your full-time or part-time temporary appointment
has a regular tour of duty and follows a position
in which you were insured, with a break in
service of no more than 3 days (unless during
that prior position you had already completed 12
months in nonpay status);
- you are an acting postmaster;
- you are a Presidential appointee appointed to
fill an unexpired term; or
- you are a temporary employee who receives a
provisional appointment as defined in 5 CFR
316.403.
- You are employed for an uncertain or purely
temporary period, employed for brief periods at
intervals, or are expected to work less than 6
months in each year. Exception: you are
eligible for life insurance coverage if you are
employed under an Office of Personnel Management
approved career-related work-study program under
Schedule B lasting at least 1 year and in pay
status for at least one-third of the total period
of time from the date of your first appointment
to the completion of the work-study program.
- You are an intermittent employee (a non-full-time
employee without a regularly scheduled tour of
duty). Exception: you are eligible for
life insurance coverage if your appointment
follows, with a break in service of no more than
3 days, a position in which you were insured and
to which you are expected to return (unless
during that prior position you had already
completed 12 months in nonpay status).
- Your pay, on an annual basis, is $12 a year or
less.
- You are a beneficiary or patient employee in a
Government hospital or home.
- You are paid on a contract or fee basis. Exception:
you are eligible for life insurance coverage when
you are a United States citizen, appointed by a
contract between you and the Federal employing
authority which requires your personal service,
and paid on the basis of units of time.
- You are paid on a piecework basis. Exception:
you are eligible for life insurance coverage when
your work schedule provides for full-time or
part-time service with a regularly scheduled tour
of duty.
OPM makes the final determination
about whether the above categories apply to a specific
employee or group of employees, after your employing
office's initial
decision and reconsideration.
Concurrent Employment
Eligibility
If you are legally serving in more than one position
at the same time - whether in the same or in different
agencies - you are eligible for life insurance coverage
as long as at least one of your positions is not
excluded.
- You are not eligible to continue coverage when you have completed 12 months of nonpay status from the only position that entitled you to life insurance coverage.
- You are eligible to continue coverage when you have completed 12 months of nonpay status from the excluded position. At the end of the 12 months, the amount of coverage is no longer based on the combined salary, but only on the salary from the covered position.
- When you separate from the covered position, you are eligible to continue coverage in the excluded position, based on the salary in that position.
- If you take a temporary position while in nonpay status, your coverage is based on the higher salary. Your employing office will withhold premiums from salary in your temporary position. At the end of 12 months in nonpay status, your coverage will terminate.
Example
Liz is on leave without pay from her part-time
position that conveys FEGLI coverage. She also holds a
temporary appointment that is excluded from FEGLI
coverage. Her 12 months of nonpay status are up on March
31, 2000. At that time, her life insurance coverage will
end, subject to the 31-day extension of coverage and
conversion privilege.
Amount of Insurance
The amount of Basic and Option B insurance depends on
the sum
of the annual pay for all of your positions,
including the annual pay for a position excluded from
life insurance coverage. The agency which pays the higher salary does the withholding and pays the Government contribution.
Exception: if you are in nonpay status from one position, the agency that is still paying salary does the withholdings and pays the Government contribution.
Concurrent employment does not affect the amount of Option A or Option C coverage.
Multiple
Rate Employee with Part-time Flexible Schedule Appointment
When you are a multiple rate employee who holds more
than one appointment, with at least one of them being a
part-time flexible schedule appointment in the Postal
field service, the amount of Basic and Option B insurance
is based
on the higher (highest) of the pay rates.
Initial Decision and Reconsideration
Initial Decision
Your employing office has the initial responsibility
for determining whether you are eligible to elect or
increase life insurance. This determination is an initial
decision when your employing office gives it to you in writing
and informs you of the right to an independent level of
review (reconsideration) by the appropriate agency
office.
Exception: The Office of Federal Employees'
Group Life Insurance (OFEGLI) determines your eligibility
to cancel a waiver based on medical evidence of
insurability and your eligibility for Living Benefits.
There is no reconsideration right for these decisions.
Reconsideration Right
You have the right to ask your employing office to
reconsider its initial decision denying life insurance
coverage or the opportunity to change coverage. The
reconsideration process applies only to enrollment
issues. Your employing office cannot make decisions about
payment of claims (the Office of Federal Employees' Group
Life Insurance makes these decisions).
The reconsideration review determines if your
employing office acted properly and in accordance with
the law and regulations in its initial decision. Initial
decisions that comply with law and regulations cannot be
overturned by reconsideration.
Example
Cathy, who had waived Optional life insurance
coverage, separates from service and is reemployed less
than 180 days later. Upon her reemployment, she attempts
to elect Option B. Her employing office denies the
election. This initial decision cannot be overruled by
reconsideration, because by regulation previous waivers
remain in effect when an employee goes from one agency to
another with a break in service of less than 180 days.
How to Request Reconsideration
If you wish to request a reconsideration of an initial
decision, you must make your request in writing. The
request must include:
- Your full name and address
- Your date of birth
- Your Social Security number
- The reason(s) for the request
- A copy of the written initial decision.
Time Limit
You must make the request for reconsideration within
30 calendar days from the date of the initial decision.
This time limit can be extended when you show that you
were not notified of the time limit and were not
otherwise aware of it or that you were unable, due to
reasons beyond your control, to make the request within
the time limit.
Who Does the
Reconsideration?
Agencies are responsible for performing
reconsiderations. A reconsideration must take place at or
above the level at which the initial decision was made.
Final Decision
After reconsideration, your employing office must
issue a final decision. This decision must be in writing
and must fully state the findings.
Effective Date
When your employing office decides that you should
have been allowed to enroll or change enrollment, it
accepts a Life
Insurance Election form (SF 2817)
from you making the change.
Generally, changes made upon reconsideration are made
prospectively. In some cases, the law or regulations
provide for retroactive effective dates. In these cases,
there is no need for your employing office to decide
whether a retroactive effective date is appropriate.
In certain cases, your employing office may consider
your request that the change be made retroactive to an
earlier date, generally the date it would have been
effective if you had been able to make a timely election.
Correction of Errors
Employing Office
Your employing office can correct administrative
errors regarding coverage or changes in coverage at any
time. When retroactive corrections are made, your
employing office must determine whether the proper amount
of life insurance deductions were made from your pay. It
must submit any uncollected deductions and any applicable
Government contributions to the Office of Personnel
Management for deposit in the Employees' Life Insurance
Fund.
See "Errors
Involving Current Employees - Underdeductions" for information on collection and waiver of deductions.
Exception: If the administrative error was
made before January 1, 1995, your employing office does
not have the authority to issue a reconsideration decision (unless the
error was an underdeduction or overdeduction of premiums - your employing office has the
authority to correct these errors). Instead, you must request reconsideration from OPM,
Center for Retirement and Insurance Services, Insurance Services
Programs, P.O. Box 707, Washington, DC 20044.
OPM
The Office of Personnel Management can order
correction of an administrative error after reviewing
evidence that it would be against equity and good
conscience not to do so. A request for review should
be sent to OPM,
Center for Retirement and Insurance Services, Insurance Services
Programs, P.O. Box 707, Washington, DC 20044.
Incontestability
Incontestability is allowing erroneous coverage to remain in effect under certain condtions. Those conditions are:
- the coverage must have been in effect for at least 2 years before the error is discovered, and
- you must have paid the applicable premiums for the erroneous coverage while it was in effect.
Both conditions must be met for incontestability to apply.
If you don't want the erroneous coverage, you can cancel it. However, the cancellation is prospective. There is no refund of premiums.
Example
Dean, who had previously waived coverage,
transfers from one agency to another without a break in
service and is allowed to elect insurance at the new
agency. This is an agency error. However, if more than
two years pass before the error is discovered, and if Dean paid the applicable premiums during that time, his
erroneous election must be allowed to stand.
Once your employing office or retirement system determines that your
enrollment should be allowed to stand, it must prepare
a note to the file explaining the details of the error,
the date it occurred, the date it was discovered, and the
fact that your enrollment is now valid due to
incontestability.
Enrollments that are allowed to stand due to
incontestability become valid enrollments. If you
were enrolled in the FEGLI Program for at least the five
years immediately prior to retirement (or for all opportunities to be enrolled), even if the enrollment was in
error but was allowed to stand, you are entitled to carry
the enrollment into retirement.
Upon your retirement, your employing office must
forward the note explaining the details of the validated
enrollment along with the Life Insurance Election form (SF 2817) to the retirement
system. If there is no SF 2817, the employing office must provide an explanatory note to the file to be forwarded
to the retirement system. The employing office should also provide a note in the "remarks" section of
the Agency Certification of Insurance Status (SF 2821)
explaining that incontestability was used to
ratify an erroneous enrollment.