eBenefits Access Your VA & DoDo Benefits 24-7 www.ebenefits.va.gov

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

SGLV 8283, Claim for Death Benefits (SGLI/VGLI)

SGLV 8283A, Claim for Family Coverage Death Benefits (SGLI)

SGLV 8284, Servicemember/Veteran Accelerated Benefits Option Form

SGLV 8284A, Servicemember Family Coverage Accelerated Benefits Option Form

SGLV 8286, Servicemembers' Group Life Insurance Election & Certificate*

SGLV 8286A, Family Coverage Election (SGLI)

SGLV 8700, Report of Death of Family Member

SGLV 8714, Application for Veterans' Group Life Insurance

SGLV 8721, Beneficiary Designation Form (VGLI)

Application for SGLI Disability Extension

SGLV 8600, Application for TSGLI Benefits

APPENDIX B: Addresses for Branch of Service Casualty Offices

Addresses for Branch of Service Casualty Offices

Branch of Service

Address
Army Active Duty US Army Human Resources Command
Casualty and Mortuary Affairs Operations Center
1600 Spearhead Division Avenue
Fort Knox, KY  40121 
Army Reserves/National Guard US Army Human Resources Command
Casualty and Mortuary Affairs Operations Center
1600 Spearhead Division Avenue
Fort Knox, KY  40121 
Navy Active Duty Office of the Chief of Naval Operations
Attn: OPNAV N135C 5720
Integrity Drive
Millington, TN 38055-0621 -6200
Navy Reserves/National Guard Office of the Chief of Naval Operations
Attn: OPNAV N135C 5720
Integrity Drive
Millington, TN 38055-0621 -6200
Marine Corps Active Duty

Commandant, U.S. Marine Corps
HQ, U.S. Marine Corps
Manpower and Reserve Affairs
Casualty Section (MRC)
3280 Russell Road
Quantico, VA 22134-5143

Marine Corps Reserves/National Guard

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 Active Duty Department of the Air Force
Attn: AFPC/DPWCS
550 C Street West, Suite 14
Randolph Field AFB
San Antonio, TX 78150-6001 4716        
Air Force Air Reserves/National Guard HQ ARPC/DPTTE
18420 E. Silver Creek Ave
Buckley AFB, CO 80011
Coast Guard Commander (PSC-PSD- FS Casualty)
USCG Personnel Service Center
Mail Stop 7200
4200 Wilson Blvd. Ste 1100
Arlington, VA 20598-7200
Public Health Service Public Health Service, Comp Branch
Div of Comm. Corps Support Svcs
Admin Ops Svc-Program Support Center
8455 Colesville Rd - Rm 935
Silver Spring, MD 20854-0001
NOAA

NOAA Commissioned Personnel Center
8403 Colesville Road, Suite 500
Silver Spring, Maryland 20910

APPENDIX C: Premium Rate Tables for VGLI

VGLI Premium Rate Chart
Monthly Premium Rates - effective July 1, 2008

Amount of Insurance  Age 29 & Below  Age 30-34  Age 35-39  Age 40-44  Age 45-49  Age 50-54  Age 55-59  Age 60-64  Age 65-69  Age 70-74  Age 75 & Over
$400,000 $32.00 $40.00 $52.00 $68.00 $88.00 $144.00 $268.00 $432.00 $600.00 $900.00 $1,800.00
390,000 31.20 39.00 50.70 66.30 85.80 140.40 261.30 421.20 585.00 877.50 1,755.00
380,000 30.40 38.00 49.40 64.60 83.60 136.80 254.60 410.40 570.00 855.00 1,710.00
370,000 29.60 37.00 48.10 62.90 81.40 133.20 247.90 399.60 555.00 832.50 1,665.00
360,000 28.80 36.00 46.80 61.20 79.20 129.60 241.20 388.80 540.00 810.00 1,620.00
350,000 28.00 35.00 45.50 59.50 77.00 126.00 234.50 378.00 525.00 787.50 1,575.00
340,000 27.20 34.00 44.20 57.80 74.80 122.40 227.80 367.20 510.00 765.00 1,530.00
330,000 26.40 33.00 42.90 56.10 72.60 118.80 221.10 356.40 495.00 742.50 1,485.00
320,000 25.60 32.00 41.60 54.40 70.40 115.20 214.40 345.60 480.00 720.00 1,440.00
310,000 24.80 31.00 40.30 52.70 68.20 111.60 207.70 334.80 465.00 697.50 1,395.00
300,000 24.00 30.00 39.00 51.00 66.00 108.00 201.00 324.00 450.00 675.00 1,350.00
290,000 23.20 29.00 37.70 49.30 63.80 104.40 194.30 313.20 435.00 652.50 1,305.00
280,000 22.40 28.00 36.40 47.60 61.60 100.80 187.60 302.40 420.00 630.00 1,260.00
270,000 21.60 27.00 35.10 45.90 59.40 97.20 180.90 291.60 405.00 607.50 1,215.00
260,000 20.80 26.00 33.80 44.20 57.20 93.60 174.20 280.80 390.00 585.00 1,170.00
250,000 20.00 25.00 32.50 42.50 55.00 90.00 167.50 270.00 375.00 562.50 1,125.00
240,000 19.20 24.00 31.20 40.80 52.80 86.40 160.80 259.20 360.00 540.00 1,080.00
230,000 18.40 23.00 29.90 39.10 50.60 82.80 154.10 248.40 345.00 517.50 1,035.00
220,000 17.60 22.00 28.60 37.40 48.40 79.20 147.40 237.60 330.00 495.00 990.00
210,000 16.80 21.00 27.30 35.70 46.20 75.60 140.70 226.80 315.00 472.50 945.00
200,000 16.00 20.00 26.00 34.00 44.00 72.00 134.00 216.00 300.00 450.00 900.00
190,000 15.20 19.00 24.70 32.30 41.80 68.40 127.30 205.20 285.00 427.50 855.00
180,000 14.40 18.00 23.40 30.60 39.60 64.80 120.60 194.40 270.00 405.00 810.00
170,000 13.60 17.00 22.10 28.90 37.40 61.20 113.90 183.60 255.00 382.50 765.00
160,000 12.80 16.00 20.80 27.20 35.20 57.60 107.20 172.80 240.00 360.00 720.00
150,000 12.00 15.00 19.50 25.50 33.00 54.00 100.50 162.00 225.00 337.50 675.00
140,000 11.20 14.00 18.20 23.80 30.80 50.40 93.80 151.20 210.00 315.00 630.00
130,000 10.40 13.00 16.90 22.10 28.60 46.80 87.10 140.40 195.00 292.50 585.00
120,000 9.60 12.00 15.60 20.40 26.40 43.20 80.40 129.60 180.00 270.00 540.00
110,000 8.80 11.00 14.30 18.70 24.20 39.60 73.70 118.80 165.00 247.50 495.00
100,000 8.00 10.00 13.00 17.00 22.00 36.00 67.00 108.00 150.00 225.00 450.00
90,000 7.20 9.00 11.70 15.30 19.80 32.40 60.30 97.20 135.00 202.50 405.00
80,000 6.40 8.00 10.40 13.60 17.60 28.80 53.60 86.40 120.00 180.00 360.00
70,000 5.60 7.00 9.10 11.90 15.40 25.20 46.90 75.60 105.00 157.50 315.00
60,000 4.80 6.00 7.80 10.20 13.20 21.60 40.20 64.80 90.00 135.00 270.00
50,000 4.00 5.00 6.50 8.50 11.00 18.00 33.50 54.00 75.00 112.50 225.00
40,000 3.20 4.00 5.20 6.80 8.80 14.40 26.80 43.20 60.00 90.00 180.00
30,000 2.40 3.00 3.90 5.10 6.60 10.80 20.10 32.40 45.00 67.50 135.00
20,000 1.60 2.00 2.60 3.40 4.40 7.20 13.40 21.60 30.00 45.00 90.00
10,000 0.80 1.00 1.30 1.70 2.20 3.60 6.70 10.80 15.00 22.50 45.00

 

APPENDIX D: Premium Rate Table for Spousal Coverage

Monthly Premium Rates - Effective July 1, 2010 

Amount of Insurance Age of Spouse
Under 35 35-39 40-44 45-49 50-54 55-59 60 & Over
$100,000 $ 5.00 $ 6.50 $ 8.50 $ 13.00 $ 25.00 $ 37.00 $ 50.00
$90,000 $ 4.50 $ 5.85 $ 7.65 $ 11.70 $ 22.50 $ 33.30 $ 45.00
$80,000 $ 4.00 $ 5.20 $ 6.80 $ 10.40 $ 20.00 $ 29.60 $ 40.00
$70,000 $ 3.50 $ 4.55 $ 5.95 $ 9.10 $ 17.50 $ 25.90 $ 35.00
$60,000 $ 3.00 $ 3.90 $ 5.10 $ 7.80 $ 15.00 $ 22.20 $ 30.00
$50,000 $ 2.50 $ 3.25 $ 4.25 $ 6.50 $ 12.50 $ 18.50 $ 25.00
$40,000 $ 2.00 $ 2.60 $ 3.40 $ 5.20 $ 10.00 $ 14.80 $ 20.00
$30,000 $ 1.50 $ 1.95 $ 2.55 $ 3.90 $ 7.50 $ 11.10 $ 15.00
$20,000 $ 1.00 $ 1.30 $ 1.70 $ 2.60 $ 5.00 $ 7.40 $ 10.00
$10,000 $ 0.50 $ 0.65 $ 0.85 $ 1.30 $ 2.50 $ 3.70 $ 5.00

APPENDIX E: Premium Rates for SGLI and Traumatic SGLI Coverage

Monthly Premium Rates - effective July 1, 2008 – June 30, 2014

  Basic SGLI Traumatic Injury Coverage
Full-Time

$.065 per $10,000 per month

This equates to a monthly premium of:

$3.25 for $50,000 of coverage

$6.50 for $100,000 of coverage

$9.75 for $150,000 of coverage

$13.00 for $200,000 of coverage

$16.25 for $250,000 of coverage

$19.50 for $300,000 of coverage

$22.75 for $350,000 of coverage

$26.00 for $400,000 of coverage

$1.00 per month

You must have Basic SGLI coverage to obtain Traumatic Injury coverage.

Part-Time

$.065 per $10,000 per year

This equates to an annual premium of:

$3.25 for $50,000 of coverage

$6.50 for $100,000 of coverage

$9.75 for $150,000 of coverage

$13.00 for $200,000 of coverage

$16.25 for $250,000 of coverage

$19.50 for $300,000 of coverage

$22.75 for $350,000 of coverage

$26.00 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

Premium Rates for SGLI and Traumatic SGLI Coverage

Monthly Premium Rates - effective July 1, 2014

Basic SGLI

Traumatic Injury Coverage

Full-Time

$0.70 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

$0.70 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.

Return to Table of Contents

« Previous Chapter