Claims
INFORMATION FOR CLAIMANTS
Claims Processing
Claims for benefits are adjudicated and paid by the Office of Federal Employees' Group Life Insurance (OFEGLI). Any questions about the status of a claim must be directed to that office at P.O. Box 6512, Utica, NY 13504-6512 or 1-800-633-4542. The telephone lines are open from 8:30 AM to 4:00 PM EST. Overseas beneficiaries should call 212-578-2975.
Requirements for Payment of a Claim
OFEGLI can only pay death benefits after it has received:
- Claim for Death Benefits (Form FE-6);
- A certified copy of the death certificate or other satisfactory proof of death; and
- Certification by the employing office for employees, or by OPM's Retirement Operations Center for retirees or compensationers. Such certification must include all supporting documentation, as described below. Agencies use the Agency Certification of Insurance Status (SF 2821).
The supporting documentation must include all of your designations of beneficiary (if any). Your employing office must also send all of your FEGLI election forms, any assignments and any court order(s) on file that direct payment of FEGLI benefits.
A dismemberment claim must include a physician's statement and a Claim for Accidental Means Dismemberment Benefits (FE-7).
Filing a Claim
Active Employee at Time of Death
If you are employed at the time of your death, your family or other individual(s) should provide notification of your death to your employing office. Your employing office will provide a copy of the Claim for Death Benefits (FE-6) to the person(s) who appear eligible to claim benefits, although the agency does not determine who is eligible. Each claimant must submit a separate claim form to your employing office.
Your employing office will forward the claim(s) to OFEGLI, along with the Agency Certification of Insurance Status (SF 2821), all of your completed original designations of beneficiary, any assignment forms, any court orders on file, and any other election forms and documents relating to your insurance status. However, your employing office may tell your survivors/beneficiaries to send their claim forms and other documentation directly to OFEGLI.
OFEGLI will process the claim(s) once it has received the insurance certification from your employing office and the claim form(s) from the claimant(s).
Retired or Receiving Compensation at the Time of Death
If you are retired or insured due to receipt of Federal Workers' Compensation Programs (OWCP) benefits at the time of your death, your claimant(s) should report your death to OPM at 1-888-US-OPM-RET (1-888-767-6738) outside the Washington, DC, metropolitan area or 202-606-0500 within the Washington, DC metropolitan area. Claimants may also report the death online at http://www.opm.gov/insure/life/death_1.asp.
OPM will mail a Claim for Death Benefits (FE-6) form to the person who reports your death. Each claimant must submit a separate claim form to the Office of Federal Employees' Group Life Insurance (OFEGLI) at P.O. Box 6512, Utica, NY 13504-6512, not to OPM. OPM will send certification of the insured's FEGLI coverage to OFEGLI.
OFEGLI will process the claim(s) once it has received the insurance certification from OPM's Retirement Operations Center and the claim form(s) from the claimant(s).
Option C
If you are an employee, and an insured family member dies, you must complete Parts A through C of the Statement of Claim, Opiton C-Family Life Insurance (FE-6 DEP) and provide it, along with a certified copy of the death certificate, to your employing office. Your employing office must complete Part D, Certification of Insurance Status, and send the completed form, with the death certificate, to OFEGLI.
If you are retired or insured as a compensationer, you must send the FE-6 DEP claim form and a certified copy of the death certificate to OPM, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045. OPM will complete Part D of the claim form and send the completed form with the death certificate to OFEGLI.
If you die after your spouse or eligible child(ren) die, but before Option C benefits are paid (whether or not you filed a claim), the person(s) eligible for your Basic insurance benefits may submit a claim for the Option C benefits. If you had assigned your Basic insurance, payment of Option C benefits will be made under the order of precedence, starting with the 2nd on the list (widow or widower).
Death of Child Incapable of Self-Support
OFEGLI can only pay Option C benefits for a child age 22 or over if the deceased child was incapable of self-support because of a mental or physical disability that existed before he/she reached age 22. If you do not have an employing office determination of incapability of self-support on file, or if the determination has expired, you must provide your employing office with the information necessary to make this determination.
This determination is made by your employing office, not OFEGLI.
Limitation on Payment
Benefits will not be paid to someone who wrongfully causes the death of the insured person. For example, if someone wrongfully causes your death, he/she cannot receive Basic, Option A or Option B benefits, even if he/she is otherwise entitled to those benefits. If you wrongfully cause the death of one of your insured family members, you cannot receive Option C benefits for that death.
EMPLOYING OFFICE RESPONSIBILITIES
Inviting Claims
Upon your death or dismemberment, your employing office must promptly contact the person(s) who appear entitled to benefits and provide assistance in filing a claim.
Certification
When you die, your employing office must immediately prepare an Agency Certification of Insurance Status (SF 2821) and send Parts 1 and 2 along with all other supporting documentation, to OFEGLI. Your employing office must keep the original in your Official Personnel Folder (the OPF, or its electronic equivalent) until it receives a claim. Part 3 is the file copy. Your employing office will send the original with the claims filed by your beneficiar(y)ies to OFEGLI. However, to expedite processing, your agency may instead send the certification to OFEGLI without waiting for your beneficiary's(ies') claim forms and direct your beneficiar(y)ies to send their claim(s) directly to OFEGLI.
Claim Review
When your employing office receives a claim, it should verify it has been completed properly.
Your name and date of birth as shown on the claim form must agree with the information on the agency certification. If there is a valid discrepancy, your employing office should attach a statement to the claim verifying that both the claim and the agency certification refer to the same person.
Errors in Certification
If your employing office discovers an error in its certification of your insurance status, it must immediately contact the Office of Federal Employees' Group Life Insurance (OFEGLI) at 1-800-633-4542 (or fax to 315-792-6603 or 312-792-6802) to request that payment based on the incorrect certification not be made. It must send a revised Agency Certification of Insurance Status (SF 2821) showing the correct insurance amount as soon as possible.
Pre-payment Verification
OFEGLI is required to obtain verification before making payment to beneficiaries of insured individuals with $200,000 or more of FEGLI coverage, and, at their discretion, to verify any unclear certification. When seeking pre-payment verification, OFEGLI asks for the insured's current salary, annual salary (if different), and details on enrollment in Optional insurance, if applicable.
Any discrepancies identified in the claims selected for pre-payment verification must be resolved before OFEGLI can authorize payment of benefits.
Employing offices must cooperate with OFEGLI in doing these pre-payment verifications and resolutions of discrepancies. This will ensure timely payments to the beneficiaries.
Death during 31-day Extension of Coverage
If you die after your FEGLI terminates, but within the 31-day extension of coverage, your employing office must make sure that the Agency Certification of Insurance Status (SF 2821) shows the date of and reason for termination of insurance coverage, not the date of your death. The 31-day extension of coverage does not include Accidental Death & Dismemberment (AD&D) coverage.
The 31-day extension only applies to terminated coverage. It does not apply when you voluntarily waive or cancel coverage.
AMOUNT OF DEATH BENEFIT PAYABLE
The amount of death benefit payable is always the amount of insurance in force on the date of your death. It will be based on your annual rate of basic pay and the FEGLI coverage you are enrolled in on the date of death. The "regular" death benefit (Basic and Option A and Option B if applicable) is payable regardless of the cause of death. For employees, accidental death benefits may also be payable, depending on the cause of death. Accidental Death and Dismemberment (AD&D) coverage stops when your employment ends. It does not carry into retirement.
You cannot have more than one amount of each type of insurance in force, even if you are concurrently employed, or even if you were employed under different retirement systems. In the event there seems to be overlapping amounts of insurance, the higher amount will be paid.
Example
Bettina separates from service in a position in which she had Basic insurance of $80,000, Option A, and 1 multiple of Option B worth $78,000. During the 31-day extension of coverage, she is employed in a position where she has Basic coverage of $60,000, Option A, and 1 multiple of Option B worth $58,000. After she starts the new job, but before the end of the 31-day extension, she dies.
Benefits payable will be based on the Basic and Option B insurance she had from her first employment, since that is the higher amount; Option A benefits are $10,000. (If her death was the result of an accident, however, the amount of benefits payable would be increased by $70,000: $60,000 accidental death benefit under Basic insurance from her second position and $10,000 accidental death benefit under Option A from her second position.)
Exception: If you are a reemployed annuitant at the time of your death, the Option B coverage that you chose to carry (either your annuitant coverage or your coverage as an employee) will be paid, regardless of which is the higher amount.
Example
Roger retires from his position with the Tennessee Valley Authority (TVA), in which he had Basic insurance worth $36, 000 that he was eligible to carry into his TVA-retirement. Two years later he is employed in a position with the Social Security Administration (SSA) under the Federal Employees Retirement System (FERS), where he has Basic coverage worth $40,000 and Option A worth $10,000.
Even though he receives annuity or salary under two different retirement systems, he is only entitled to carry one amount of each type of FEGLI insurance, so his coverage should be treated the same as if he were a reemployed annuitant. His coverage as an annuitant under TVA is suspended while he is "reemployed", and he pays premiums for the coverage under the FERS position. If he is reemployed at the time of his death, benefits payable are based on the higher of the two coverages. If he retires from his FERS position and is eligible to continue his SSA-acquired FEGLI coverage into retirement, he must choose between the two coverages.
TIMELY NOTICE AND FILING OF CLAIMS FOR ACCIDENTAL DISMEMBERMENT
Filing of Claim
A claim for accidental dismemberment benefits, with proof of the loss, must be submitted within one year of the loss, on the FE-7 (Claim for Accidental Means Dismemberment Benefits).
Late Filing
If it is not possible to file a claim within the specified times, you must file your claim as soon as reasonably possible, along with an explanation of the delay. OFEGLI will determine if the explanation is satisfactory enough to allow payment of benefits.
PAYMENT OF CLAIMS
Payments of Less Than $5,000
Beneficiaries receiving less than $5,000 will receive a single check for the entire amount.
Payments of $5,000 or More
Beneficiaries receiving $5,000 or more will automatically receive a money market account checkbook. The amount of the FEGLI payment will be in the account.
FEGLI proceeds begin earning interest immediately upon establishment of the account. Beneficiaries may write checks for $250 or more, up to the full amount in the account, as soon as they receive their checkbook.
OFEGLI will provide beneficiaries with detailed information about the account when their accounts are established.
If a beneficiary does not want the interest-bearing money market account, he/she may request a check instead, at the time he/she files their claim.
Federal Income Tax
Life insurance proceeds are not considered taxable income for the recipients for personal income tax purposes. Interest paid on FEGLI proceeds is reportable as income for Federal Income tax purposes. The Office of Federal Employees' Group Life Insurance pays interest on claims from the date of the insured's death to the date of the payment. OFEGLI pays a maximum of two years interest, even if the time from date of death to date of payment is over two years. You may wish to consult your tax advisor for further advice.
PAYMENT TO A MINOR
Life insurance benefits cannot be paid to a minor. The age of adulthood for the FEGLI Program is 18, unless the state in which the minor lives has established a lower age of adulthood. In that case, the lower age applies.
When a minor is entitled to payment of benefits, OFEGLI will:
- Pay the court-appointed guardian of the minor child's estate;
- Pay the parent(s) of the minor child, if the proceeds are $10,000 or less; or
- Hold the proceeds on deposit until the minor child reaches adulthood.
Payment to a Guardian
A parent does not automatically qualify as a guardian of the child's estate. He/she must apply to be the guardian. A court must appoint a guardian and grant to the guardian the authority to collect money on behalf of the child. The guardian then can submit a claim to OFEGLI with proof of the guardianship, and OFEGLI will pay benefits to the guardian on behalf of the minor.
Payment to the Minor's Parents
When the benefits payable to a minor do not exceed $10,000, OFEGLI will release the funds to the minor's parent(s), provided that the parent(s) agree(s) in writing to meet all of the following conditions:
- The parent(s) will hold such amount for the sole use and benefit of the minor until the minor reaches adulthood;
- The parent(s) will account to the minor for such amount when the minor reaches adulthood; and
- The parent(s) will hold OFEGLI harmless in the event the minor, when he/she reaches adulthood, brings any legal action challenging OFEGLI's payment of such amount to the minor's parent(s).
Held on Deposit
If there is no guardian and there are no plans to appoint one, and the proceeds are greater than $10,000, OFEGLI will hold the funds in the minor's name in an interest-bearing account. OFEGLI will pay the funds, plus interest, to the minor when he/she reaches adulthood.
Designations In Trust For A Minor
When a designation of beneficiary calls for payment to be made in trust for a minor, OFEGLI will determine whether a trust has been established and whether payment can be made in accordance with the designation and trust. If not, then OFEGLI will request that a guardian be appointed by a court. If no guardian is appointed, then payment will be made either to the parent if the proceeds are less than $10,000, or held on deposit until the minor reaches adulthood.
QUESTIONS REGARDING CLAIMS
If a claimant has a question regarding the status of a claim, he/she must contact OFEGLI at 1-800-633-4542. Overseas beneficiaries should call 212-578-2975.
The following information should be available:
- The name of the insured employee/retiree/compensationer
- The insured's social security number
- The name of the deceased (if different than above), and
- The date of death of the deceased
If a claimant thinks OFEGLI made an error in paying benefits, he/she must contact OFEGLI.
If a claimant thinks he/she is due money from FEGLI benefits and that legal action is necessary to get the money, the claimant must take action in Federal court against the company that OPM contracts with, not against OPM.
U.S. Office of Personnel Management 1900 E Street NW, Washington, DC 20415 | (202) 606-1800 | TTY (202) 606-2532