Part 1: Personnel Systems & Procedures

Chapter 10: Retirement, Insurance, Income Protection, and Other Employee Services

Section 2: Life Insurance

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing directive?
3. What references were used when writing this section?
4. What are the procedures for completing life insurance forms?

1. What is the purpose of this section? This section establishes procedures relating to the Federal Employees Group Life Insurance (FEGLI) Program for the Federal Highway Administration (FHWA). This section is to be used in conjunction with the FEGLI Program Handbook.

2. Does this directive cancel an existing directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Chapter 87.

   2. Title 5, Code of Federal Regulations (CFR), Part 870, Federal Employees Group Life Insurance Program.

   3. FEGLI Program Handbook.

4. What are the procedures for completing life insurance forms? The procedures for completing the four most frequently used life insurance forms are as follows:

   1. Standard Form (SF)-2817, Life Insurance Election

      1. The SF-2817 is completed by the employee either to indicate waiver of all insurance or to indicate his/her choice of Basic Life, Standard (Option A), Additional (Option B), and Family (Option C) insurance. If a newly appointed employee does not complete the SF-2817 within 31 days, he/she automatically acquires basic life insurance.

      2. It is essential that the first administrative office that receives the SF-2817 immediately date and initial the form in the space marked "To be completed by Agency." In the division offices, the administrative manager or designee should date and initial the form. In the Resource Center locations, the servicing human resources officer or designee should date and initial the form. In Washington Headquarters, the Human Resources Services Group (HAHR-20) will initiate the SF-50, Notification of Personnel Action, to reflect the change in coverage. Forms SF-2817 received in the field from employees whose official personnel folders (OPFs) are maintained in the Washington Headquarters office should be dated and initialed by the receiving office and forwarded to HAHR-20.

   2. SF-2823, Designation of Beneficiary

      1. This form is to be completed at any time by an employee to indicate the individual(s) to receive payment under the FEGLI Program upon the employee's death. This form is necessary only if the employee wishes to deviate from the order of precedence specified on the back of the SF-2823. The employee should carefully read all of the information provided on the back of the form before submitting the form.

      2. It is essential that the first administrative office that receives the SF-2823 immediately date and initial the form in the space marked "This Space Reserved for Receiving Agency".

   3. SF-2822, Request for Insurance

      1. This form is to be used by an employee to cancel a waiver of basic life insurance or a declination of optional insurance under the FEGLI Program, if the employee meets certain requirements specified in the FEGLI Program Handbook. This form is completed by the employing Agency, the employee, and the employee's examining physician.

      2. It is essential that the employee sign the SF-2822 in the presence of the "authorized agency official" who completes Part A, 1 through 8. For most FHWA employees, the "authorized agency official" is an individual designated by the personnel officer in the servicing human resources office. For field office employees, the administrative manager or a designee will serve as the "authorized agency official". Part B of SF-2822 is to be completed by the employee and must be signed in the presence of the examining physician. The examining physician must mail the SF-2822 to the Office of Federal Employees' Group Life Insurance.

   4. SF-2821, Agency Certification of Insurance Status

      1. The SF-2821 is used whenever an employee's FEGLI coverage terminates or when an employee continues FEGLI coverage into retirement.

      2. The servicing human resources office completes this form. Item 7 on the SF-2821 should reflect the actual annual basic pay including locality pay.