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Life Insurance

CHAPTER 11. Traumatic Injury Protection Under SGLI

11.01 General Information
11.02 Persons Eligible to be Insured
11.03 Effective Date of Insurance
11.04 Cost of Insurance
11.05 Termination of Insurance
11.06 Claims
11.07 Payment of Proceeds
11.08 Legislative History

 11.01 General Information

a. The Traumatic Injury Protection under Servicemembers' Group Life Insurance program (TSGLI) provides coverage to any Servicemember insured under SGLI who sustains a serious traumatic injury that results in certain prescribed losses. TSGLI provides between $25,000 and $100,000 of coverage depending on the loss incurred.

b. TSGLI coverage is automatic for those Servicemembers insured under SGLI. The member cannot decline TSGLI coverage unless he or she also declines SGLI.

c. TSGLI coverage is a "rider" provided under a group life insurance policy purchased from a commercial life insurance company by VA. TSGLI is administered by OSGLI (see paragraph 1.01b for address) and is supervised by VA.

d. TSGLI has no cash, loan, paid-up or extended insurance values and does not pay dividends.

e. TSGLI is the Servicemember's benefit and the member is the automatic beneficiary of the policy.

f. Certain injuries and conditions are excluded from coverage. See appendix F for more information on these exclusions.

 11.02 Persons Eligible to be Insured

a. Effective December 1, 2005, every member who has SGLI (See section 1.03, Persons Eligible To Be Insured) will also have TSGLI. This includes active duty members, reservists, National Guard members, funeral honors duty and one-day muster duty.

b. Also eligible is any Servicemember who experienced a traumatic injury between October 7, 2001 through and including November 30, 2005 if the member sustained a loss as a direct result of a traumatic injury, regardless of whether the member elected to be insured by SGLI.

  • while deployed outside the United States on orders in support of Operation Enduring Freedom or Operation Iraqi Freedom, OR
  • while serving in a geographic location that qualified the Servicemember for the Combat Zone Tax Exclusion under 26 U.S.C. 211.

 11.03 Effective Date of Insurance

a. With the exception of those eligible for retroactive coverage, the earliest effective date of TSGLI coverage is December 1, 2005.

b. For those individuals insured under SGLI prior to December 1, the effective date of TSGLI coverage is December 1, as long as the member's SGLI remains in effect on that date.

c. For those members who enter service after December 1, 2005 or elect SGLI coverage after December 1, 2005, the effective date of coverage is the date the member enters service or the date the member elects coverage, respectively.

d. For members who previously declined SGLI coverage and therefore do not have TSGLI, the effective date of TSGLI coverage is the date an application electing SGLI coverage is received by the member's branch of service. If it is necessary for such application to be forwarded to the OSGLI for review, the effective date of coverage will be the date the application for SGLI coverage is approved.

11.04 Cost of Insurance

a. The cost of TSGLI is shared by the member and the Government. The member pays the premium, which is intended to cover only the civilian incidence of such injuries, and the Government pays the cost of all traumatic injury claims in excess of the level of traumatic injury claims that would result from civilian experience.

b. For all members entitled to TSGLI coverage, the necessary amount will be deducted from the member's service pay or otherwise collected from the member by the uniformed service.

c. The table below outlines the rates for various categories of SGLI coverage.

Duty Status

Premium

Active duty members

$1.00 per month

Reservists or National Guard members w/full time coverage

$1.00 per month

Reservists or National Guard members w/part time coverage

$1.00 per year

Funeral honors duty

no charge

1 day muster duty

no charge

Note: Premiums effective December 1, 2005. These rates are determined by VA and are subject to change based on claims experience.

d. The law, Title 38 of the United States Code, section 1969, requires the uniformed services to remit amounts equal to the deduction which should have been made for members who are provided full-time or part-time coverage and who are not receiving pay. DoD is responsible for seeking reimbursement from the member for the cost of coverage provided to those not receiving pay.

 11.05 Termination of Insurance

a. TSGLI coverage terminates at midnight of the last day of the month that the member is no longer covered under SGLI or at midnight of the date of the member's separation from service, whichever occurs first.

b. TSGLI coverage is not in effect during the 120-day post-separation period or during a 2-year SGLI disability extension.

c. TSGLI cannot be converted to Veterans' Group Life Insurance or to commercial coverage.

 11.06 Claims

a. To file a claim, SGLV 8600, Application for TSGLI Benefits, must be completed in its entirety and submitted to the member's branch of service TSGLI Processing Office. The form consists of two parts:

  1. The member or the member's guardian, power of attorney or military trustee must complete the first part (Part A) of the form to provide basic identifying information, select how they would like to receive payment, and authorize the release of medical information to the branch of service and OSGLI. Medical documentation should be submitted by the member along with the completed application.
  2. A medical professional must complete the second part (Part B) of the form, indicating whether the member sustained a traumatic injury or injuries and a scheduled loss as a direct result of the injury or injuries that would make the member eligible for the TSGLI benefit.

b. The branch of service must certify that the member is covered and that the injury qualifies the member for payment under TSGLI. All claims for traumatic injury benefits must then be submitted to OSGLI, 80 Livingston Avenue, Roseland, New Jersey 07068-1733. The TSGLI Certification worksheet is provided for the purpose of certifying the claim.

c. When OSGLI receives the fully completed TSGLI application indicating that the member is entitled to payment, OSGLI will pay to the member, the member's guardian, power of attorney, military trustee or the member's SGLI beneficiary, if applicable, the amount that corresponds to the scheduled loss that results from the traumatic injury.

d. If a member suffers more than one scheduled loss (as a result of a single traumatic event),on Part 1 of the TSGLI Schedule of Losses, the payment amounts for each loss will be added together, but the total of these losses will not exceed the maximum amount of TSGLI, $100,000. If a member suffers more than one of the losses listed on Part II of the TSGLI Schedule of Losses as a result of a single traumatic event, payment will be made for the scheduled loss with the highest benefit amount.

e. In the case of multiple traumatic events occurring within a seven-day period, the member will receive the benefit under the schedule for the multiple losses up to $100,000, the maximum amount payable for a single traumatic event.

e. If a member suffers more than one scheduled loss from separate traumatic events occurring more than seven full days apart, the scheduled losses will be considered separately and a benefit will be paid for each loss up to the maximum amount according to the schedule.

Note: If SGLV 8600 is not furnished to the member, one may be obtained from OSGLI or from this web site at the forms page.

 11.07 Payment of Proceeds

a. The member will receive the insurance proceeds by designating either:

  • Payment Option 1 - Prudential's Alliance Account®*,
  • Payment Option 2 -Electronic Funds Transfer (EFT), or
  • Payment Option 3 - Check, under Payment Options, Part A, Section 4 of SGLV 8600, Servicemembers Group Life Insurance Traumatic Injury Protection Program (TSGLI) - Application for TSGLI Benefits

*An Alliance Account is an interest bearing draft account established in the beneficiary's(ies') name(s) with a draft book.  The beneficiary can write drafts ("checks") for any amount up to the full amount of the proceeds. There are no monthly service fees or per check charges and additional checks can be ordered at no cost, but fees apply for some special services including returned checks, stop payment orders and copies of statements/checks.

The funds in an Alliance Account begin earning interest immediately and will continue to earn interest until all funds are withdrawn. Interest is accrued daily, compounded daily and credited every month. The interest rate may change and will vary over time subject to a minimum rate that will not change more than once every 90 days. You will be advised in advance of any change to the minimum interest rate via your quarterly Alliance Account statement or by calling Customer Support at (877) 255-4262.

Open Solutions Inc. is the Service Provider of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance Company of America, located at 751 Broad Street, Newark, NJ 07102-3777. Draft clearing and processing support is provided by UMB Bank, N.A. Alliance Account balances are not insured by the Federal Deposit Insurance Corporation (FDIC). Open Solutions Inc. and UMB Bank, N.A. are not Prudential Financial companies.

b. TSGLI claimants can take advantage of no cost professional financial advice through the Beneficiary Financial Counseling service. You can find more information about BFCS in Chapter 9 of this handbook.

c. In the event the member is legally incapacitated, the member's guardian, power of attorney or military trustee will be paid the benefit on behalf of the member.

d. In the event the member dies before receiving payment of the TSGLI benefit, the payment will be made to the member's SGLI beneficiary via the Alliance Account.

11.08 Legislative History

a. Public Law 109-13, signed into law May 11, 2005, established Traumatic Injury Protection for members of the uniformed services who are insured by SGLI. This law provides automatic traumatic injury protection in an amount between $25,000 and $100,000 to Servicemembers insured through Servicemembers' Group Life Insurance under section 1967(a)(1) of title 38.

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