|
Servicemembers' and Veterans' Group Life Insurance Handbook
APPENDICES
APPENDIX A: SGLI and VGLI Forms
APPENDIX B: Addresses for Branch of Service Casualty Offices
APPENDIX C: Premium Rate Tables for VGLI
APPENDIX D: Premium Rate Tables for Spousal Coverage
APPENDIX E: Premium Rates for SGLI and Traumatic Injury Coverage
APPENDIX F: Conditions Excluded from TSGLI Coverage
APPENDIX A: SGLI and VGLI Forms
1. SGLV 8283, Claim for Death Benefits (SGLI/VGLI)
2. SGLV 8283A, Claim for Family Coverage Death Benefits (SGLI)
3. SGLV 8284, Servicemember/Veteran Accelerated Benefits Option Form
4. SGLV 8284A, Servicemember Family Coverage Accelerated Benefits Option Form
5. SGLV 8285, Request for Insurance (SGLI)
6. SGLV 8285A, Request for Family Coverage for Spouse (SGLI)
7. SGLV 8286, Servicemembers' Group Life Insurance Election & Certificate*
8. SGLV 8286A, Family Coverage Election (SGLI)
9. SGLV 8700, Report of Death of Family Member
10. SGLV 8714, Application for Veterans' Group Life Insurance
11. SGLV 8721, Beneficiary Designation Form (VGLI)
12. Application for SGLI Disability Extension
13. GL.2005.261 - Traumatic SGLI Certification Form
APPENDIX B: Addresses for Branch of Service Casualty Offices
| |
Active Duty |
Reserves/National Guard |
| Army |
US Army Human Resources Command
Casualty Operations Division
Attn: AHRC-PEC
200 Stovall Street
Alexandria, VA 22331 |
U.S. Army Human Resources Command
ATTN: AHRC-PSP-A
9700 Page Boulevard
St. Louis, MO 63132-1547 |
| Navy |
Bureau of Naval Personnel Casualty Section, PERS-623
5720 Integrity Drive
Millington, TN 38055-0621 |
Bureau of Naval Personnel Casualty Section, PERS-623
5720 Integrity Drive
Millington, TN 38055-0621 |
| Marine Corps |
Commandant, U.S. Marine Corps
HQ, U.S. Marine Corps
Manpower and Reserve Affairs
Casualty Section (MRC)
3280 Russell Road
Quantico, VA 22134-5143
|
Commandant, U.S. Marine Corps
HQ, U.S. Marine Corps
Manpower and Reserve Affairs
Casualty Section (MRC)
3280 Russell Road
Quantico, VA 22134-5143 |
| Air Force & Air Reserves/National Guard |
Department of the Air Force Attn: AFPC/DPWCS
550 C Street West, Suite 14
Randolph Field AFB
San Antonio, TX 78150-6001 |
HQ ARPC-DPSSE
Entitlements & Casualty Branch
6760 East Irvington Place #4000
Denver, CO 80280-4000 |
| Coast Guard |
Commandant (G-WPM-2)
U.S. Coast Guard
2100 Second Street, NW
Washington, DC 20593-0001
|
|
| Public Health Service |
Public Health Service
Attn: Division of Commissioned Personnel
Parklawn Building
5600 Fishers Lane
Rockville, MD 20852 |
|
| NOAA |
NOAA
Commissioned Personnel Division
1315 East-West Highway
Room 12100
Silver Spring, MD 20910-3285 |
|
APPENDIX C: Premium Rate Tables for VGLI
(for policies with effective/renewal dates before 10/01/02)
| Coverage |
Monthly |
Quarterly |
Semi-annually |
Annually |
Monthly |
Quarterly |
Semi-annually |
Annually |
Monthly |
Quarterly |
Semi-annually |
Annually |
| $250,000.00 |
20.00 |
58.50 |
115.50 |
228.00 |
27.50 |
80.44 |
158.81 |
313.50 |
35.00 |
102.38 |
202.13 |
399.00 |
| 240,000.00 |
19.20 |
56.16 |
110.88 |
218.88 |
26.40 |
77.22 |
152.46 |
300.96 |
33.60 |
98.28 |
194.04 |
383.04 |
| 230,000.00 |
18.40 |
53.82 |
106.26 |
209.76 |
25.30 |
74.00 |
146.11 |
288.42 |
32.20 |
94.19 |
185.96 |
367.08 |
| 220,000.00 |
17.60 |
51.48 |
101.64 |
200.64 |
24.20 |
70.79 |
139.76 |
275.88 |
30.80 |
90.09 |
177.87 |
351.12 |
| 210,000.00 |
16.80 |
49.14 |
97.02 |
191.52 |
23.10 |
67.57 |
133.40 |
263.34 |
29.40 |
86.00 |
169.79 |
335.16 |
| 200,000.00 |
16.00 |
46.80 |
92.40 |
182.40 |
22.00 |
64.35 |
127.05 |
250.80 |
28.00 |
81.90 |
161.70 |
319.20 |
| 190,000.00 |
15.20 |
44.46 |
87.78 |
173.28 |
20.90 |
61.13 |
120.70 |
238.26 |
26.60 |
77.81 |
153.62 |
303.24 |
| 180,000.00 |
14.40 |
42.12 |
83.16 |
164.16 |
19.80 |
57.92 |
114.35 |
225.72 |
25.20 |
73.71 |
145.53 |
287.28 |
| 170,000.00 |
13.60 |
39.78 |
78.54 |
155.04 |
18.70 |
54.70 |
107.99 |
213.18 |
23.80 |
69.62 |
137.45 |
271.32 |
| 160,000.00 |
12.80 |
37.44 |
73.92 |
145.92 |
17.60 |
51.48 |
101.64 |
200.64 |
22.40 |
65.52 |
129.36 |
255.36 |
| 150,000.00 |
12.00 |
35.10 |
69.30 |
136.80 |
16.50 |
48.26 |
95.29 |
188.10 |
21.00 |
61.43 |
121.28 |
239.40 |
| 140,000.00 |
11.20 |
32.76 |
64.68 |
127.68 |
15.40 |
45.05 |
88.94 |
175.56 |
19.60 |
57.33 |
113.19 |
223.44 |
| 130,000.00 |
10.40 |
30.42 |
60.06 |
118.56 |
14.30 |
41.83 |
82.58 |
163.02 |
18.20 |
53.24 |
105.11 |
207.48 |
| 120,000.00 |
9.60 |
28.08 |
55.44 |
109.44 |
13.20 |
38.61 |
76.23 |
150.48 |
16.80 |
49.14 |
97.02 |
191.52 |
| 110,000.00 |
8.80 |
25.74 |
50.82 |
100.32 |
12.10 |
35.39 |
69.88 |
137.94 |
15.40 |
45.05 |
88.94 |
175.56 |
| 100,000.00 |
8.00 |
23.40 |
46.20 |
91.20 |
11.00 |
32.18 |
63.53 |
125.40 |
14.00 |
40.95 |
80.85 |
159.60 |
| 90,000.00 |
7.20 |
21.06 |
41.58 |
82.08 |
9.90 |
28.96 |
57.17 |
112.86 |
12.60 |
36.86 |
72.77 |
143.64 |
| 80,000.00 |
6.40 |
18.72 |
36.96 |
72.96 |
8.80 |
25.74 |
50.82 |
100.32 |
11.20 |
32.76 |
64.68 |
127.68 |
| 70,000.00 |
5.60 |
16.38 |
32.34 |
63.84 |
7.70 |
22.52 |
44.47 |
87.78 |
9.80 |
28.67 |
56.60 |
111.72 |
| 60,000.00 |
4.80 |
14.04 |
27.72 |
54.72 |
6.60 |
19.31 |
38.12 |
75.24 |
8.40 |
24.57 |
48.51 |
95.76 |
| 50,000.00 |
4.00 |
11.70 |
23.10 |
45.60 |
5.50 |
16.09 |
31.76 |
62.70 |
7.00 |
20.48 |
40.43 |
79.80 |
| 40,000.00 |
3.20 |
9.36 |
18.48 |
36.48 |
4.40 |
12.87 |
25.41 |
50.16 |
5.60 |
16.38 |
32.34 |
63.84 |
| 30,000.00 |
2.40 |
7.02 |
13.86 |
27.36 |
3.30 |
9.65 |
19.06 |
37.62 |
4.20 |
12.29 |
24.26 |
47.88 |
| 20,000.00 |
1.60 |
4.68 |
9.24 |
18.24 |
2.20 |
6.44 |
12.71 |
25.08 |
2.80 |
8.19 |
16.17 |
31.92 |
| 10,000.00 |
0.80 |
2.34 |
4.62 |
9.12 |
1.10 |
3.22 |
6.35 |
12.54 |
1.40 |
4.10 |
8.09 |
15.96 |
VGLI Premium Rate Chart
(for policies with effective/renewal dates of 10/01/02 or
later)
| |
MONTHLY |
QUARTERLY |
SEMI-ANNUAL |
ANNUAL |
MONTHLY |
QUARTERLY |
SEMI-ANNUAL |
ANNUAL |
MONTHLY |
QUARTERLY |
SEMI-ANNUAL |
ANNUAL |
| $400,000 |
$32.00 |
$93.60 |
$184.80 |
$364.80 |
$44.00 |
$128.70 |
$254.10 |
$501.60 |
$56.00 |
$163.80 |
$323.40 |
$638.40 |
| 390,000 |
$31.20 |
$91.26 |
$180.18 |
$355.68 |
$42.90 |
$125.48 |
$247.75 |
$489.06 |
$54.60 |
$159.71 |
$315.32 |
$622.44 |
| 380,000 |
$30.40 |
$88.92 |
$175.56 |
$346.56 |
$41.80 |
$122.27 |
$241.40 |
$476.52 |
$53.20 |
$155.61 |
$307.23 |
$606.48 |
| 370,000 |
$29.60 |
$86.58 |
$170.94 |
$337.44 |
$40.70 |
$119.05 |
$235.04 |
$463.98 |
$51.80 |
$151.52 |
$299.15 |
$590.52 |
| 360,000 |
$28.80 |
$84.24 |
$166.32 |
$328.32 |
$39.60 |
$115.83 |
$228.69 |
$451.44 |
$50.40 |
$147.42 |
$291.06 |
$574.56 |
| 350,000 |
$28.00 |
$81.90 |
$161.70 |
$319.20 |
$38.50 |
$112.61 |
$222.34 |
$438.90 |
$49.00 |
$143.33 |
$282.98 |
$558.60 |
| 340,000 |
$27.20 |
$79.56 |
$157.08 |
$310.08 |
$37.40 |
$109.40 |
$215.99 |
$426.36 |
$47.60 |
$139.23 |
$274.89 |
$542.64 |
| 330,000 |
$26.40 |
$77.22 |
$152.46 |
$300.96 |
$36.30 |
$106.18 |
$209.63 |
$413.82 |
$46.20 |
$135.14 |
$266.81 |
$526.68 |
| 320,000 |
$25.60 |
$74.88 |
$147.84 |
$291.84 |
$35.20 |
$102.96 |
$203.28 |
$401.28 |
$44.80 |
$131.04 |
$258.72 |
$510.72 |
| 310,000 |
$24.80 |
$72.54 |
$143.22 |
$282.72 |
$34.10 |
$99.74 |
$196.93 |
$388.74 |
$43.40 |
$126.95 |
$250.64 |
$494.76 |
| 300,000 |
$24.00 |
$70.20 |
$138.60 |
$273.60 |
$33.00 |
$96.53 |
$190.58 |
$376.20 |
$42.00 |
$122.85 |
$242.55 |
$478.80 |
| 290,000 |
$23.20 |
$67.86 |
$133.98 |
$264.48 |
$31.90 |
$93.31 |
$184.22 |
$363.66 |
$40.60 |
$118.76 |
$234.47 |
$462.84 |
| 280,000 |
$22.40 |
$65.52 |
$129.36 |
$255.36 |
$30.80 |
$90.09 |
$177.87 |
$351.12 |
$39.20 |
$114.66 |
$226.38 |
$446.88 |
| 270,000 |
$21.60 |
$63.18 |
$124.74 |
$246.24 |
$29.70 |
$86.87 |
$171.52 |
$338.58 |
$37.80 |
$110.57 |
$218.30 |
$430.92 |
| 260,000 |
$20.80 |
$60.84 |
$120.12 |
$237.12 |
$28.60 |
$83.66 |
$165.17 |
$326.04 |
$36.40 |
$106.47 |
$210.21 |
$414.96 |
| 250,000 |
$20.00 |
$58.50 |
$115.50 |
$228.00 |
$27.50 |
$80.44 |
$158.81 |
$313.50 |
$35.00 |
$102.38 |
$202.13 |
$399.00 |
| 240,000 |
$19.20 |
$56.16 |
$110.88 |
$218.88 |
$26.40 |
$77.22 |
$152.46 |
$300.96 |
$33.60 |
$98.28 |
$194.04 |
$383.04 |
| 230,000 |
$18.40 |
$53.82 |
$106.26 |
$209.76 |
$25.30 |
$74.00 |
$146.11 |
$288.42 |
$32.20 |
$94.19 |
$185.96 |
$367.08 |
| 220,000 |
$17.60 |
$51.48 |
$101.64 |
$200.64 |
$24.20 |
$70.79 |
$139.76 |
$275.88 |
$30.80 |
$90.09 |
$177.87 |
$351.12 |
| 210,000 |
$16.80 |
$49.14 |
$97.02 |
$191.52 |
$23.10 |
$67.57 |
$133.40 |
$263.34 |
$29.40 |
$86.00 |
$169.79 |
$335.16 |
| 200,000 |
$16.00 |
$46.80 |
$92.40 |
$182.40 |
$22.00 |
$64.35 |
$127.05 |
$250.80 |
$28.00 |
$81.90 |
$161.70 |
$319.20 |
| 190,000 |
$15.20 |
$44.46 |
$87.78 |
$173.28 |
$20.90 |
$61.13 |
$120.70 |
$238.26 |
$26.60 |
$77.81 |
$153.62 |
$303.24 |
| 180,000 |
$14.40 |
$42.12 |
$83.16 |
$164.16 |
$19.80 |
$57.92 |
$114.35 |
$225.72 |
$25.20 |
$73.71 |
$145.53 |
$287.28 |
| 170,000 |
$13.60 |
$39.78 |
$78.54 |
$155.04 |
$18.70 |
$54.70 |
$107.99 |
$213.18 |
$23.80 |
$69.62 |
$137.45 |
$271.32 |
| 160,000 |
$12.80 |
$37.44 |
$73.92 |
$145.92 |
$17.60 |
$51.48 |
$101.64 |
$200.64 |
$22.40 |
$65.52 |
$129.36 |
$255.36 |
| 150,000 |
$12.00 |
$35.10 |
$69.30 |
$136.80 |
$16.50 |
$48.26 |
$95.29 |
$188.10 |
$21.00 |
$61.43 |
$121.28 |
$239.40 |
| 140,000 |
$11.20 |
$32.76 |
$64.68 |
$127.68 |
$15.40 |
$45.05 |
$88.94 |
$175.56 |
$19.60 |
$57.33 |
$113.19 |
$223.44 |
| 130,000 |
$10.40 |
$30.42 |
$60.06 |
$118.56 |
$14.30 |
$41.83 |
$82.58 |
$163.02 |
$18.20 |
$53.24 |
$105.11 |
$207.48 |
| 120,000 |
$9.60 |
$28.08 |
$55.44 |
$109.44 |
$13.20 |
$38.61 |
$76.23 |
$150.48 |
$16.80 |
$49.14 |
$97.02 |
$191.52 |
| 110,000 |
$8.80 |
$25.74 |
$50.82 |
$100.32 |
$12.10 |
$35.39 |
$69.88 |
$137.94 |
$15.40 |
$45.05 |
$88.94 |
$175.56 |
| 100,000 |
$8.00 |
$23.40 |
$46.20 |
$91.20 |
$11.00 |
$32.18 |
$63.53 |
$125.40 |
$14.00 |
$40.95 |
$80.85 |
$159.60 |
| 90,000 |
$7.20 |
$21.06 |
$41.58 |
$82.08 |
$9.90 |
$28.96 |
$57.17 |
$112.86 |
$12.60 |
$36.86 |
$72.77 |
$143.64 |
| 80,000 |
$6.40 |
$18.72 |
$36.96 |
$72.96 |
$8.80 |
$25.74 |
$50.82 |
$100.32 |
$11.20 |
$32.76 |
$64.68 |
$127.68 |
| 70,000 |
$5.60 |
$16.38 |
$32.34 |
$63.84 |
$7.70 |
$22.52 |
$44.47 |
$87.78 |
$9.80 |
$28.67 |
$56.60 |
$111.72 |
| 60,000 |
$4.80 |
$14.04 |
$27.72 |
$54.72 |
$6.60 |
$19.31 |
$38.12 |
$75.24 |
$8.40 |
$24.57 |
$48.51 |
$95.76 |
| 50,000 |
$4.00 |
$11.70 |
$23.10 |
$45.60 |
$5.50 |
$16.09 |
$31.76 |
$62.70 |
$7.00 |
$20.48 |
$40.43 |
$79.80 |
| 40,000 |
$3.20 |
$9.36 |
$18.48 |
$36.48 |
$4.40 |
$12.87 |
$25.41 |
$50.16 |
$5.60 |
$16.38 |
$32.34 |
$63.84 |
| 30,000 |
$2.40 |
$7.02 |
$13.86 |
$27.36 |
$3.30 |
$9.65 |
$19.06 |
$37.62 |
$4.20 |
$12.29 |
$24.26 |
$47.88 |
| 20,000 |
$1.60 |
$4.68 |
$9.24 |
$18.24 |
$2.20 |
$6.44 |
$12.71 |
$25.08 |
$2.80 |
$8.19 |
$16.17 |
$31.92 |
| 10,000 |
$0.80 |
$2.34 |
$4.62 |
$9.12 |
$1.10 |
$3.22 |
$6.35 |
$12.54 |
$1.40 |
$4.10 |
$8.09 |
$15.96 |
APPENDIX D: Premium Rate Table for Spousal Coverage
Monthly Premium Rates - Effective July 1, 2006
| Under 35 |
35-39 |
40-44 |
45-49 |
50-54 |
55-59 |
60 & Over |
| $100,000 |
$5.50 |
$7.00 |
$9.00 |
$14.00 |
$27.00 |
$40.00 |
$52.00 |
| $90,000 |
$4.95 |
$6.30 |
$8.10 |
$12.60 |
$24.30 |
$36.00 |
$46.80 |
| $80,000 |
$4.40 |
$5.60 |
$7.20 |
$11.20 |
$21.60 |
$32.00 |
$41.60 |
| $70,000 |
$3.85 |
$4.90 |
$6.30 |
$9.80 |
$18.90 |
$28.00 |
$36.40 |
| $60,000 |
$3.30 |
$4.20 |
$5.40 |
$8.40 |
$16.20 |
$24.00 |
$31.20 |
| $50,000 |
$2.75 |
$3.50 |
$4.50 |
$7.00 |
$13.50 |
$20.00 |
$26.00 |
| $40,000 |
$2.20 |
$2.80 |
$3.60 |
$5.60 |
$10.80 |
$16.00 |
$20.80 |
| $30,000 |
$1.65 |
$2.10 |
$2.70 |
$4.20 |
$8.10 |
$12.00 |
$15.60 |
| $20,000 |
$1.10 |
$1.40 |
$1.80 |
$2.80 |
$5.40 |
$8.00 |
$10.40 |
| $10,000 |
$0.55 |
$0.70 |
$0.90 |
$1.40 |
$2.70 |
$4.00 |
$5.20 |
APPENDIX E : Premium Rates for SGLI and Traumatic SGLI Coverage
| Full-Time |
$.070 per $10,000 per month
This equates to a monthly premium of:
$3.50 for $50,000 of coverage
$7.00 for $100,000 of coverage
$10.50 for $150,000 of coverage
$14.00 for $200,000 of coverage
$17.50 for $250,000 of coverage
$21.00 for $300,000 of coverage
$24.50 for $350,000 of coverage
$28.00 for $400,000 of coverage |
$1.00 per month
You must have Basic SGLI coverage to obtain Traumatic Injury coverage. |
| Part-Time |
$.070 per $10,000 per year
This equates to an annual premium of:
$3.50 for $50,000 of coverage
$7.00 for $100,000 of coverage
$10.50 for $150,000 of coverage
$14.00 for $200,000 of coverage
$17.50 for $250,000 of coverage
$21.00 for $300,000 of coverage
$24.50 for $350,000 of coverage
$28.00 for $400,000 of coverage
Funeral Honors Duty Premium:
$.25 per $100,000
1 Day Muster Premium:
$.25 per $100,000 |
$1.00 per year
Funeral Honors Duty Premium:
Free - No charge
1 Day Muster Premium:
Free - No charge |
APPENDIX F: Conditions Excluded from TSGLI Coverage
The TSGLI benefit will not be paid if a scheduled loss is due to a traumatic injury:
Caused by:
- The member's attempted suicide, while sane or insane
- An intentionally self-inflicted injury or an attempt to inflict such injury
- Medical or surgical treatment of an illness or disease
- Willful use of an illegal or controlled substance, unless administered or consumed on the advice of a medical doctor; or
Sustained while a member was committing or attempting to commit a felony.
Additionally, the benefit will not be paid for a scheduled loss resulting from:
- A physical or mental illness or disease, whether or not caused by a traumatic injury, other than a pyogenic (wound) infection or physical illness or disease caused by biological, chemical, or radiological weapons or accidental ingestion of a contaminated substance; or
- A mental disorder whether or not caused by a traumatic injury.
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