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Fillable Printable SF 2818

Fillable Printable SF 2818

SF 2818

SF 2818

Continuation of Life Insurance Coverage
As an Annuitant or Compensationer
Federal Employees'
Group Life Insurance
Federal Employees' Group Life Insurance (FEGLI) Program
Instructions for Completing this SF 2818
yRead these instructions carefully. yDetach and keep these instructions for your records.
yComplete this form: yReturn both copies of the completed form to your human resources
When you retire, or
office (HRO). Your HRO will return a copy to you.
When you are receiving compensation payments from the
yPremium information can be found at www.opm.gov/insure/life.
Office of Workers' Compensation Programs (Department of
y"You" means the insured employee. "We" and "us" mean the Office
Labor) and your FEGLI coverage as an employee ends.
of Personnel Management (OPM) or your retirement system, if
OPM is not your retirement system.
yBe sure to sign at the bottom of the election page and return the
entire form.
y
Terms of coverage as applicable at retirement described below also
yYour coverage, based on your eligibility and the elections you
apply to coverage in effect at the end of 12 months nonpay status,
make, is effective at retirement and may continue for life.
whichever occurs first.
1. Basic Insurance
What is Basic insurance?
That is the coverage equal to your annual basic pay, rounded up to the
next $1,000, plus $2,000 (or a minimum of $10,000).
Will I have Basic insurance in retirement?
If you are eligible and want to carry Basic insurance in retirement, you
must mark "Yes" in Item 7. If you mark "No" in Item 7, you will not
have any insurance in retirement. Please sign in item 14 and return to your
Human Resources office.
You cannot newly elect or increase existing life insurance as an
annuitant now or after you retire.
Who is eligible?
You are eligible to have Basic insurance in retirement if: (1) you retire
on an immediate annuity; (2) you were enrolled in Basic insurance for
the five years of service immediately before your annuity began or for all
opportunities during which it was available to you, if enrolled less than
five years; (3) you or the assignee(s), if applicable, do not cancel the
coverage; (4) you, the assignee(s), or a power of attorney acting on your
behalf, do not convert it to an individual policy; and (5) you did not
receive a full Living Benefit. See page 3 for information on
compensationers, assignments and Living Benefits.
How much Basic insurance will I have?
The amount of your Basic insurance will depend on your final annual
basic pay, your age, your choice of reduction in Item 8, and whether you
elected a Living Benefit. See page 3 for information on Living Benefits.
Your Basic insurance in retirement is equal to your final annual basic
pay, rounded up to the next $1,000, plus $2,000 (or a minimum of
$10,000). This amount continues until you reach age 65. If you are under
age 45, you have an Extra Benefit (see below). Your Basic insurance will
reduce after you retire and turn age 65, unless you elect No Reduction in
Item 8.
What is the Extra Benefit?
The Extra Benefit doubles the amount of Basic insurance payable if you
die at age 35 or younger. Beginning on your 36th birthday, the Extra
Benefit decreases by 10% each year. If you die at age 45 or older, there
is no Extra Benefit. You do not pay for the Extra Benefit.
What if I don't want Basic insurance in retirement?
If you don't want to have Basic insurance in retirement and you have not
assigned your coverage, mark "No" in Item 7 and sign in Item 14. Do
not file a Life Insurance Election (SF 2817). You will not have any life
insurance in retirement, but you will be insured for 31 days after your
life insurance coverage as an employee stops. You can convert to private
coverage.
Will my Basic insurance reduce?
It depends. If you are eligible and choose to have Basic insurance in
retirement, you can choose either 75% Reduction, 50% Reduction, or
No Reduction in Item 8.
yWhat is 75% Reduction?
This means that your Basic insurance will reduce by a fixed
amount each month, equal to 2% of the amount of Basic insurance
you carried into retirement. Your Basic insurance will continue to
reduce until 25% of the original amount remains. You do not pay an
extra premium for this choice.
yWhat is 50% Reduction?
This means that your Basic insurance will reduce by a fixed
amount each month, equal to 1% of the amount of Basic insurance
you carried into retirement. Your Basic insurance will continue to
reduce until 50% of the original amount remains. You pay an extra
premium for this choice.
yWhat is No Reduction?
This means that your Basic insurance will not reduce. You pay an
extra premium for this choice.
When do reductions begin?
If you elect 75% Reduction or 50% Reduction in Item 8, your Basic
insurance begins to reduce on the first day of the second month after you
reach age 65 or on the first day of the second month after you retire,
whichever is later.
What do I pay?
As an annuitant, you will pay the same regular Basic premium, on a
monthly basis that active employees pay, until you reach age 65. You
probably paid a biweekly premium as an employee. You stop paying the
regular premium on the first day of the month after you reach age 65.
If you retire after turning 65, you will never pay the regular premium in
retirement. If you choose 50% Reduction or No Reduction, you must pay
an extra premium. You continue to pay the extra premium for life or
until you cancel the coverage or change to 75% Reduction. See
www.opm.gov/insure/life for information on current rates.
What if I want to change my reduction election?
You have 30 days from the date you receive your first regular monthly
annuity check to change your reduction election. Write to us and tell us
what you want to change. After that time you or the assignee(s), if
applicable, mayonly change to 75% Reduction and not to 50%
Reduction or NoReduction. If you or the assignee(s), if applicable,
change to 75%Reduction, we will compute the amount of your Basic
as if you hadoriginally elected 75% Reduction. Premiums will stop and
you will not receive a refund of premiums you already paid.
Will I have accidental death and dismemberment
coverage in retirement?
No. Accidental death and dismemberment coverage stops when your life
insurance as an employee stops.
SF 2818 Instructions (page 1 of 3)
Previous editions are not usable. Revised February 2012
2. Optional Insurance
SF 2818 Instructions (page 2 of 3)
Revised February 2012
What is Optional insurance?
There are three types of Optional insurance. Option A (Standard) equals
$10,000. Option B (Additional) equals 1 to 5 multiples of your annual
basic pay, after rounding your pay up to the next $1,000. Option C
(Family) is 1 to 5 multiples of coverage for your spouse and eligible
children. Each Option C multiple equals $5,000 for your spouse and
$2,500 for each of your eligible children.
What is No Reduction?
This means that for the multiple(s) you elect, your coverage will not
reduce. You will continue to pay premiums for the rest of your life,
or until you cancel the insurance or change to Full Reduction.
y
Will I have accidental death and dismemberment
coverage for Option A in retirement?
No, you will not. Accidental death and dismemberment coverage stops
when your life insurance as an employee stops.
What do I pay for Option A?
As an annuitant you will pay the same premium, monthly, that active
employees pay, based on your age. You probably paid a biweekly
premium as an employee.
Option A is free starting on the first day of the month after you reach age
65 or starting at retirement if you retire after turning age 65. Premium
information can be found at www.opm.gov/insure/life.
Will my Option A reduce?
Yes. You do not have a choice. Option A reduces on the first day of the
second month after you reach age 65 or the first day of the second month
after you retire, whichever is later. Each month the amount reduces by
another $200. Reductions stop when Option A reaches $2,500.
What if I want to change my reduction election after I
retire?
You can write to us at any time and change from No Reduction to Full
Reduction or cancel your coverage, (unless you assigned your
coverage, in which case only the assignee(s) can change to Full
Reduction). However, neither you or an assignee can change from
Full Reduction to No Reduction later in retirement.
Will I have Optional insurance in retirement?
If you are eligible and want to carry Option A and/or Option B and/or
Option C in retirement, you must mark "Yes" and sign for that coverage
in items 9, 10, and 12. If you mark "No", you will not have that
coverage in retirement.
You cannot newly elect or increase existing life insurance as an
annuitant now or after you retire.
Who is eligible?
You are eligible to have Optional insurance in retirement if:
(1) you continue your Basic insurance in retirement (employees who
received a full Living Benefit are exempt from this requirement), (2) you
were enrolled in the option for the five years of service immediately
before your annuity began or for all opportunities during which it was
available to you, if enrolled less than five years; (3) you, the assignee(s),
or a power of attorney acting on your behalf, if applicable, do not convert
it to an individual policy; and (4) you or the assignee(s), if applicable, do
not cancel it. See page 3 for information on compensationers. If you
cancel your Basic insurance, you cannot continue your Optional
insurance.
How much Option A will I have?
If you are eligible to have Option A in retirement and choose "Yes" in
Item 9, you will have $10,000 of Option A coverage.
How much Option B will I have?
If you are eligible to have Option B in retirement and choose "Yes" in
Item 10, your Option B will equal your annual basic pay at retirement,
rounded up to the next higher $1,000, multiplied by either the lower of
(1) the number of multiples you are eligible to continue; or (2) the
number of multiples you elect to continue in Item 11.
How much Option C will I have?
If you are eligible to have Option C in retirement and choose "Yes" in
Item 12, your Option C will be the lower of either (1) the number of
multiples you are eligible to continue; or (2) the number of multiples you
elect to continue in Item 13; multiplied by $5,000 (for your spouse) and
$2,500 (for each of your eligible children).
How many multiples of Option B and/or Option C can I
have?
You may have up to the number of multiples you had during:
the 5 years of service immediately before your annuity began, ora.
all service during which those multiples were available to you, if
enrolled less than 5 years.
b.
You have 30 days from the date you receive your first regular
monthly annuity payment to change your reduction election. After
that time, you can only reduce or cancel coverage.
Will my Option B and/or Option C reduce?
It depends on what you choose now in Item 11 and Item 13. You may
choose Full Reduction or No Reduction. You can mix and match
multiples - you can choose either Full Reduction or No Reduction for
some or all multiples of the same option. You can also choose
something different for Option B than for Option C.
What is Full Reduction?
This means that for the multiple(s) you elect, your coverage will
reduce by a fixed amount each month, equal to 2 percent of the
original amount, for 50 months, at which time coverage will end.
Reductions start on the first day of the second month after you reach
age 65 or the first day of the second month after you retire, if later.
Coverage is free starting on the first day of the month after you turn
age 65.
y
What if I don't want Optional insurance in retirement?
If you don't want to have Optional insurance in retirement, and you have
not assigned your coverage, mark "No" in Item 9 for Option A, Item 10
for Option B and/or Item 12 for Option C. Do not file a Life Insurance
Election (SF 2817). You will not have that option in retirement, but you
will have it for 31 days after your life insurance coverage as an employee
stops. You can convert to private coverage. Your human resources office
will provide you with SF 2819 "Notice of Conversion Privilege" so you
can convert your coverage to a non-FEGLI policy.
What if I elect to have more multiples of Option B
and/or Option C than I'm eligible to have?
You will have whichever number is lower - the number you elect to
continue or the number you are eligible to continue.
Can I elect to have both "No Reduction" and "Full
Reduction" multiples?
Yes. You may elect to have both reduced and unreduced multiples of
Option B and/or Option C. After retirement, you may change your "No
Reduction" multiples to "Full Reduction", but you will not be able to
change your multiples from "Full Reduction" to "No Reduction".
What do I pay for Options B and C?
As an annuitant, you will pay the same premium, on a monthly basis,
that active employees pay, based on your age and the number of
multiples you have in retirement. You probably paid a biweekly
premium as an employee.
For Full Reduction multiples, coverage is free to you starting on the first
day of the month after you reach age 65 or starting at retirement if you
retire after turning age 65. For No Reduction multiples, you will
continue to pay premiums for the rest of your life, or until you cancel
the insurance or change to Full Reduction.
3. General Information
Who can sign this form?
Only you, the insured employee, may sign this form in item 14. The
signature of an assignee, a guardian, conservator or other fiduciary
(including, but not limited to, those acting according to a Power of
Attorney or a Durable Power of Attorney) is not acceptable. Even if your
power of attorney previously applied for a living benefit on your behalf,
only you can sign the form.
When does my life insurance coverage as an employee
stop?
It stops on the earliest of the date you resign, separate for retirement, or
end 12 months in nonpay status.
What if I don't make a choice for one or more
coverages or I don't file this form at all?
Then, if you are eligible to continue the insurance in retirement, you
will have the default selection(s). For Basic insurance, that means 75%
Reduction. For Option A, that means having it in retirement (it reduces
automatically). For Options B and C, that means Full Reduction for all
multiples you are eligible to have in retirement.
To avoid confusion, please complete the entire form, as applicable, and
return it to your human resources office.
What if I want to change my reduction election?
You have 30 days from the date you receive your first regular monthly
annuity payment to change your reduction election. Write to us and tell
us what you want to change. After that time, you or your assignee(s) can
only change from No Reduction to Full Reduction, or cancel coverage.
Premiums will stop and you will not receive a refund of premiums you
already paid.
Can I stop my FEGLI insurance later?
After you file this form, you (or the assignee(s), if applicable) can
cancel any or all life insurance coverage at any time, by writing to us.
If you cancel Basic insurance, you will cancel all Optional insurance too.
The cancellation will be effective at the end of the month in which OPM
receives your letter. You will not be entitled to a refund of premiums
paid through the end of the month in which we receive your request, and
you cannot get the coverage back. You cannot convert the cancelled
coverage.
What if I am receiving Workers' Compensation
benefits?
During your first 12 months in nonpay status while in receipt of
compensation, your life insurance coverage is still treated as if you are
an employee. At the end of 12 months, to be eligible to have life
insurance coverage as a compensationer, you must meet the 5-year/all
opportunity requirement as of the date you became eligible for
compensation. The Office of Workers' Compensation Programs will
withhold applicable premiums from your compensation benefits.
The amounts of Option A and Option C for compensationers are the
same as for retiring employees. The amount of your Basic insurance and
Option B is based on your annual basic pay at the time your insurance as
an employee ended (at separation or the end of 12 months of nonpay
status, whichever came first).
If you are eligible to continue coverage as a compensationer, you have
the same choices for reduction as if you were retiring.
If the Department of Labor finds you are capable of returning to work,
your life insurance coverage as a compensationer will stop. This is still
true even if you don't return to work and even if you receive partial
compensation payments. If you return to work in a position eligible for
FEGLI coverage, you will get life insurance coverage as an employee.
Basic premiums will be deducted from your salary (and for Option A and
Option C, if enrolled). Your coverage is treated the same as if you are a
reemployed annuitant. You are covered for the higher of your Basic
insurance, either the Basic you had as a compensationer or the
reemployment-acquired Basic.
For Option B, you must choose which coverage to have, either the
Option B you have as a compensationer or the reemployment-acquired
Option B. Premiums will be withheld according to which Option B
coverage you choose.
We cannot reinstate any insurance you cancel while receiving
compensation.
What if I assigned my coverage?
Assignment means giving a person, firm or trust the ownership and
control of your life insurance coverage (except Option C), generally by
using an RI 76-10 Assignment form.
You complete this form (SF 2818). Assignees do not.
If you assigned your life insurance coverage, you cannot stop your
Basic, Option A or Option B by marking "No" in items 7, 9, or 10.
You must choose "Yes".
If you assigned your life insurance coverage, you elect the Basic
insurance reduction (75%, 50% or No Reduction) and the Option B
and Option C reduction (Full Reduction or No Reduction). However,
only the assignee(s) can later change the Basic reduction to 75%, change
the Option B reduction to Full Reduction, or cancel coverage.
What if I received a Living Benefit?
If you received a full Living Benefit, you no longer have any Basic
insurance benefits. There is no Basic insurance to continue into
retirement. Check "I received a full Living Benefit" in Item 7. Leave
Item 8 blank. You may still continue Optional insurance.
If you received a partial Living Benefit, your Basic insurance remains
the same as it was after your Living Benefit election. If you want to have
Basic in retirement, you must check "No Reduction" in Item 8.
Privacy Act Statement
Chapter 87, title 5, U.S. Code, Federal Employees' Group Life Insurance,
It may also be shared and verified, as noted above, with law enforcement
authorizes the solicitation of this information. The Office of Personnel
agencies when they are investigating a violation or potential violation of civil or
Management will use the data you furnish to determine the amount of life
criminal law. Public Law 104-134 (April 26, 1996) requires that any person
insurance coverage you will have in retirement or as a compensationer. This
doing business with the Federal government furnish a Social Security number or
information may be shared and is subject to verification, via paper, electronic
tax identification number. This is an amendment to title 31, Section 7701. If you
media, or through the use of computer matching programs, with national, state,
don't furnish the requested information, you may not have the level of insurance
local or other charitable or social security administrative agencies in order to
protection you want.
determine benefits under their programs or to obtain information necessary for
determination or continuation of benefits under this program.
SF 2818 Instructions (page 3 of 3)
Revised February 2012
Continuation of Life Insurance Coverage
Federal Employees
As an Annuitant or Compensationer
Important:
Group Life Insurance
Read instructions on pages 1 - 3
Federal Employees' Group Life Insurance (FEGLI) Program
before completing this form.
Identifying Information
1.Employee's name (last, first, middle)
2.
Date of birth (mm/dd/yyyy) 3.Social Security number
4.Employing department/agency 5.Work location (city, state, ZIP 6.Compensation claim number
code) (if applicable)
Basic Life Insurance
7.Do you want to have Basic Life insurance in retirement/compensation if you are eligible?
I received a full Living Benefit.
No
Yes (If yes, complete item 8.)
(skip to Item 9)
8.What level of Basic do you want in retirement/compensation? Check only one box. If you received a partial Living Benefit, you must check No
Reduction.
75% Reduction 50% Reduction No Reduction
Option A — Standard Optional Insurance
9.
Do you want to have Option A in retirement/compensation if you are eligible? To continue Option A, you must also continue Basic.
(Check "yes" only if you currently have as an employee)
No I don't have Option A.
Yes
Option B — Additional Optional Insurance
10.
Do
you want to have Option B in retirement/compensation if you are eligible? To continue Option B, you must also continue Basic.
(Check "yes" only if you currently have as an employee)
Yes (If yes, complete item 11.) No I don't have Option B.
11.How many multiples of Option B do you want to have in retirement/compensation? You can elect up to the number of multiples you are eligible to
continue in retirement. Put a number on each line to indicate how many multiples you want for NO REDUCTION and FULL REDUCTION. If the
number is "zero", "0" should be written on that line. The total of both No and Full Reduction multiples cannot exceed 5. See the instructions.
______________ (number of NO REDUCTION multiples) ______________ (number of FULL REDUCTION multiples)
Option C — Family Optional Insurance
12.
Do you want to have Option C in retirement/compensation if you are eligible? To continue Option C, you must also continue Basic.
(Check "yes" only if you currently have as an employee.)
Yes (If yes, complete item 13.) No I don't have Option C.
13.How many multiples of Option C do you want to have in retirement/compensation? You can elect up to the number of multiples you are eligible to
continue in retirement. Put a number on each line to indicate how many multiples you want for NO REDUCTION and FULL REDUCTION. If the
number is "zero","0" should be written on that line. The total of both No and Full Reduction multiples cannot exceed 5. See the instructions.
______________
(number of NO REDUCTION multiples) ______________ (number of FULL REDUCTION multiples)
Signature
14.Signature (Do not print.) Only the insured may sign. Signatures by guardians, conservators, or through a power Date (mm/dd/yyyy)
of attorney are not acceptable.
U.S. Office of Personnel Management SF 2818
FEGLI Handbook (RI 76-26) Previous editions are not usable. Revised February 2012
PRINT
SAVE
CLEAR
Part 1 - Agency Use
Instructions for Human Resources Offices
Give this form to each employee who is enrolled in the FEGLI Program and is either:
(1)Retiring; or
(2) Receiving compensation payments from the Department of Labor and is either
a. Separating from the agency; or
b. Ending 12 months in nonpay status period.
If you have already completed the Agency Certification of Insurance Status (SF 2821), give the employee his/her
copy of the SF 2821 so s/he can complete this SF 2818 correctly.
After the employee completes and returns this form, review it to make sure the employee filled it out correctly and
completely. If correct and complete, give Copy 2 to the employee. Attach this original to the original of the Agency
Certification of Insurance Status (SF 2821).
Completing this form accurately helps OPM process the employee's retirement more quickly and avoid unnecessary
delays.
Important
Inform the employee that rates may change in the future.
Rates can be found at www.opm.gov/insure/life.
Back of Copy 1
SF 2818
Revised February 2012
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