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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 G: SGLI ROTC Coverage Table

 

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 8600, Application for TSGLI Benefits

SGLV 8700, Report of Death of Family Member

SGLV 8714, Application for Veterans' Group Life Insurance

SGLV 8715, Application for SGLI Disability Extension

SGLV 8721, Beneficiary Designation Form (VGLI)

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 Operations Division
1600 Spearhead Division Avenue
Fort Knox, KY  40122 
Army Reserves/National Guard US Army Human Resources Command
Casualty Operations Division
1600 Spearhead Division Avenue
Fort Knox, KY  40122 
Navy Active Duty

Commander, Navy Personnel Command
Attn:  PERS-00C  
5720 Integrity Drive
Millington, TN 38055-1300

Navy Reserves/National Guard Commander, Navy Personnel Command
Attn:  PERS-00C
5720 Integrity Drive
Millington, TN 38055-1300
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
BLDG 390  MS 68
Buckley AFB, CO 80011
Coast Guard Commander (PSC-PSD- FS Casualty)
US Coast Guard Stop 7200
2703 Martin Luther King Jr Ave SE
Washington, DC 20593-7200     
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, 2014

Amount of InsuranceAge
29 & Below
Age 30-34Age 35-39Age 40-44Age 45-49Age 50-54Age 55-59Age 60-64Age 65-69Age 70-74Age 75 & Over
$400,000 $32.00 $40.00 $52.00 $68.00 $88.00 $144.00 $268.00 $432.00 $600.00 $920.00 $1,840.00
390,000 31.20 39.00 50.70 66.30 85.80 140.40 261.30 421.20 585.00 897.00 1,794.00
380,000 30.40 38.00 49.40 64.60 83.60 136.80 254.60 410.40 570.00 874.00 1,748.00
370,000 29.60 37.00 48.10 62.90 81.40 133.20 247.90 399.60 555.00 851.00 1,702.00
360,000 28.80 36.00 46.80 61.20 79.20 129.60 241.20 388.80 540.00 828.00 1,656.00
350,000 28.00 35.00 45.50 59.50 77.00 126.00 234.50 378.00 525.00 805.00 1,610.00
340,000 27.20 34.00 44.20 57.80 74.80 122.40 227.80 367.20 510.00 782.00 1,564.00
330,000 26.40 33.00 42.90 56.10 72.60 118.80 221.10 356.40 495.00 759.00 1,518.00
320,000 25.60 32.00 41.60 54.40 70.40 115.20 214.40 345.60 480.00 736.00 1,472.00
310,000 24.80 31.00 40.30 52.70 68.20 111.60 207.70 334.80 465.00 713.00 1,426.00
300,000 24.00 30.00 39.00 51.00 66.00 108.00 201.00 324.00 450.00 690.00 1,380.00
290,000 23.20 29.00 37.70 49.30 63.80 104.40 194.30 313.20 435.00 667.00 1,334.00
280,000 22.40 28.00 36.40 47.60 61.60 100.80 187.60 302.40 420.00 644.00 1,288.00
270,000 21.60 27.00 35.10 45.90 59.40 97.20 180.90 291.60 405.00 621.00 1,242.00
260,000 20.80 26.00 33.80 44.20 57.20 93.60 174.20 280.80 390.00 598.00 1,196.00
250,000 20.00 25.00 32.50 42.50 55.00 90.00 167.50 270.00 375.00 575.00 1,150.00
240,000 19.20 24.00 31.20 40.80 52.80 86.40 160.80 259.20 360.00 552.00 1,104.00
230,000 18.40 23.00 29.90 39.10 50.60 82.80 154.10 248.40 345.00 529.00 1,058.00
220,000 17.60 22.00 28.60 37.40 48.40 79.20 147.40 237.60 330.00 506.00 1,012.00
210,000 16.80 21.00 27.30 35.70 46.20 75.60 140.70 226.80 315.00 483.00 966.00
200,000 16.00 20.00 26.00 34.00 44.00 72.00 134.00 216.00 300.00 460.00 920.00
190,000 15.20 19.00 24.70 32.30 41.80 68.40 127.30 205.20 285.00 437.00 874.00
180,000 14.40 18.00 23.40 30.60 39.60 64.80 120.60 194.40 270.00 414.00 828.00
170,000 13.60 17.00 22.10 28.90 37.40 61.20 113.90 183.60 255.00 391.00 782.00
160,000 12.80 16.00 20.80 27.20 35.20 57.60 107.20 172.80 240.00 368.00 736.00
150,000 12.00 15.00 19.50 25.50 33.00 54.00 100.50 162.00 225.00 345.00 690.00
140,000 11.20 14.00 18.20 23.80 30.80 50.40 93.80 151.20 210.00 322.00 644.00
130,000 10.40 13.00 16.90 22.10 28.60 46.80 87.10 140.40 195.00 299.00 598.00
120,000 9.60 12.00 15.60 20.40 26.40 43.20 80.40 129.60 180.00 276.00 552.00
110,000 8.80 11.00 14.30 18.70 24.20 39.60 73.70 118.80 165.00 253.00 506.00
100,000 8.00 10.00 13.00 17.00 22.00 36.00 67.00 108.00 150.00 230.00 460.00
90,000 7.20 9.00 11.70 15.30 19.80 32.40 60.30 97.20 135.00 207.00 414.00
80,000 6.40 8.00 10.40 13.60 17.60 28.80 53.60 86.40 120.00 184.00 368.00
70,000 5.60 7.00 9.10 11.90 15.40 25.20 46.90 75.60 105.00 161.00 322.00
60,000 4.80 6.00 7.80 10.20 13.20 21.60 40.20 64.80 90.00 138.00 276.00
50,000 4.00 5.00 6.50 8.50 11.00 18.00 33.50 54.00 75.00 115.00 230.00
40,000 3.20 4.00 5.20 6.80 8.80 14.40 26.80 43.20 60.00 92.00 184.00
30,000 2.40 3.00 3.90 5.10 6.60 10.80 20.10 32.40 45.00 69.00 138.00
20,000 1.60 2.00 2.60 3.40 4.40 7.20 13.40 21.60 30.00 46.00 92.00
10,000 0.80 1.00 1.30 1.70 2.20 3.60 6.70 10.80 15.00 23.00 46.00

 

APPENDIX D: Premium Rate Table for Spouse Coverage

Monthly Premium Rates - Effective July 1, 2019

Amount of InsuranceAge of Spouse
Under 3535-3940-4445-4950-5455-5960 & Over
$100,000 $4.50 $5.30 $7.00 $10.00 $17.00 $29.50 $45.00
$90,000 $4.05 $4.77 $6.30 $9.00 $15.30 $26.55 $40.50
$80,000 $3.60 $4.24 $5.60 $8.00 $13.60 $23.60 $36.00
$70,000 $3.15 $3.71 $4.90 $7.00 $11.90 $20.65 $31.50
$60,000 $2.70 $3.18 $4.20 $6.00 $10.20 $17.70 $27.00
$50,000 $2.25 $2.65 $3.50 $5.00 $8.50 $14.75 $22.50
$40,000 $1.80 $2.12 $2.80 $4.00 $6.80 $11.80 $18.00
$30,000 $1.35 $1.59 $2.10 $3.00 $5.10 $8.85 $13.50
$20,000 $0.90 $1.06 $1.40 $2.00 $3.40 $5.90 $9.00
$10,000 $0.45 $0.53 $0.70 $1.00 $1.70 $2.95 $4.50

 

APPENDIX E: Premium Rates for SGLI and Traumatic SGLI Coverage

Monthly Premium Rates - effective July 1, 2019

 

Basic SGLI

Traumatic Injury Coverage

Full-Time

$0.60 per $10,000 per month

This equates to a monthly premium of:

$3.00 for $50,000 of coverage

$6.00 for $100,000 of coverage

$9.00 for $150,000 of coverage

$12.00 for $200,000 of coverage

$15.00 for $250,000 of coverage

$18.00 for $300,000 of coverage

$21.00 for $350,000 of coverage

$24.00 for $400,000 of coverage

$1.00 per month

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

Part-Time

$0.60 per $10,000 per year

This equates to an annual premium of:

$3.00 for $50,000 of coverage

$6.00 for $100,000 of coverage

$9.00 for $150,000 of coverage

$12.00 for $200,000 of coverage

$15.00 for $250,000 of coverage

$18.00 for $300,000 of coverage

21.00 for $350,000 of coverage

$24.00 for $400,000 of coverage

Funeral Honors Duty Premium:

$.20 per $100,000

1 Day Muster Premium:
$.20 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.

APPENDIX G: SGLI ROTC Coverage Table

ROTC Member Status

Is Coverage in Effect?

When is it in Effect and for How Long?

When is Coverage Effective?

 Is Coverage Automatically at Maximum?

Is an Application for SGLI Required?

31 days or more ROTC active duty for training under 38 U.S.C. 1965(2)(C)

Full-time coverage under 38 U.S.C. 1968(a)(1)(A)

Coverage terminates 120 days following release from active duty for training

38 CFR 9.2(a) indicates effective date under 38 U.S.C. 1967

Yes, under 38 U.S.C. 1967(a)(1)(B)

Only if applying after declining/reducing SGLI under 38 U.S.C. 1967(c); would have to apply and show good health

30 days or less ROTC active duty for training under 38 U.S.C. 1965(2)(C)

Part-time coverage under 38 U.S.C. 1968(a)(2)

Coverage terminates at midnight on the last day of active duty for training*

Not covered during travel to/from duty

38 CFR 9.2(a) indicates effective date under 38 U.S.C. 1967

Yes, under 38 U.S.C. 1967(a)(1)(B)

Only if applying after declining/reducing SGLI under 38 U.S.C. 1967(c); would have to apply and show good health

Work or study performed as part of military correspondence courses

No coverage under 38 U.S.C. 1965(4)

N/A

N/A

N/A

N/A

Attendance at educational institution while not on active duty for training

No coverage under 38 U.S.C. 1965(4)

N/A

N/A

N/A

N/A

Applicant for membership in ROTC; i.e., participant in Junior ROTC unit under 10 U.S.C. 2031

No coverage under 38 U.S.C. 1965—still an “applicant” and not a member under 38 U.S.C. 1965(5)(D); see 10 U.S.C. 2104(a), (b)(3), (b)(6)(A)

N/A

N/A

N/A

N/A

National Guard members currently in Standby Reserve who participated in ROTC under 10 U.S.C. 2104 during freshman & sophomore years (not during junior or senior years)

Coverage under 38 U.S.C. 1965(5)(B) during freshman & sophomore years while attending inactive duty under 38 U.S.C. 1965(3) and under 38 U.S.C. 1965(5)(B) as are members of Ready Reserve

Coverage terminates 120 days following release from active duty for training at end of freshman and sophomore years

38 CFR 9.2(a) indicates effective date under 38 U.S.C. 1967

Yes under 38 U.S.C. 1967(a)(1)(C)

Only if applying after declining/reducing SGLI under 38 U.S.C. 1967(c); would have to apply and show good health

Army Cadet Summer Training for non-contracted Cadets

No coverage under 38 U.S.C. 1965—still an “applicant” and not a member under 38 U.S.C. 1965(5)(D); see 10 U.S.C. 2104(a), (b)(4)

N/A

N/A

N/A

N/A

Army Cadet Summer Training for contracted Cadets

Full-time coverage under 38 U.S.C. 1968(a)(1)(A); 10 U.S.C. 2104(a), (b)(4)

Coverage terminates 120 days following release from active duty for training

38 CFR 9.2(a) indicates effective date under 38 USC 1967

Yes, under 38 U.S.C. 1967(a)(1)(B)

Only if applying after declining/reducing SGLI under 38 U.S.C. 1967(c); would have to apply and show good health

Air Force ROTC Cadets attending field training under invitational orders and not on active duty for training

No coverage under 38 U.S.C. 1965—still an “applicant” and not a member under 38 U.S.C. 1965(5)(D); see 10 U.S.C. 2104(a), (b)(4)

N/A

N/A

N/A

N/A

Lieutenants pending entrance on active duty entitled to TRICARE under the provisions of TRICARE 708

No coverage under 38 U.S.C. 1965

N/A

N/A

N/A

N/A

Cadets attending professional development training (PDT) in invitational travel status

No coverage under 38 U.S.C. 1965

N/A

N/A

N/A

N/A

Cadets who paid SGLI premium for a month, but end training status before end of month

Full-time coverage under 38 U.S.C. 1968(a)(1)(A) if more 31 days

Part-time coverage under 38 U.S.C. 1968(a)(2) if for less than 30 days

If full-time, then 120 days post release

If part-time, then midnight on last day of training.  Not covered during travel to/from duty.

N/A

N/A

N/A

 

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