Servicemembers' & Veterans' Group Life Insurance
VGLI Online Policy Access
Coverage and Features
-
Insurance Coverage
- SGLI
- VGLI
- Family SGLI
- SGLI Traumatic Injury Protection
Servicemembers' and Veterans' Group Life Insurance Handbook
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
1. SGLV 8283, Claim for Death Benefits (SGLI/VGLI)
2. SGLV 8283A, Claim for Family Coverage Death Benefits (SGLI)
3. SGLV 8284, Servicemember/Veteran Accelerated Benefits Option Form
4. SGLV 8284A, Servicemember Family Coverage Accelerated Benefits Option Form
5. SGLV 8285, Request for Insurance (SGLI)
6. SGLV 8285A, Request for Family Coverage for Spouse (SGLI)
7. SGLV 8286, Servicemembers' Group Life Insurance Election & Certificate*
8. SGLV 8286A, Family Coverage Election (SGLI)
9. SGLV 8700, Report of Death of Family Member
10. SGLV 8714, Application for Veterans' Group Life Insurance
11. SGLV 8721, Beneficiary Designation Form (VGLI)
12. Application for SGLI Disability Extension
13. SGLV 8600, Application for TSGLI Benefits
APPENDIX B: Addresses for Branch of Service Casualty Offices
| Active Duty | Reserves/National Guard | |
|---|---|---|
| Army | US Army Human Resources Command Casualty Operations Division Attn: AHRC-PEC 200 Stovall Street Alexandria, VA 22331 |
U.S. Army Human Resources Command ATTN: AHRC-PSP-A 9700 Page Boulevard St. Louis, MO 63132-1547 |
| Navy | Bureau of Naval Personnel Casualty Section, PERS-623 5720 Integrity Drive Millington, TN 38055-0621 |
Bureau of Naval Personnel Casualty Section, PERS-623 5720 Integrity Drive Millington, TN 38055-0621 |
| Marine Corps | Commandant, U.S. Marine Corps |
Commandant, U.S. Marine Corps |
| Air Force & Air Reserves/National Guard | Department of the Air Force Attn: AFPC/DPWCS 550 C Street West, Suite 14 Randolph Field AFB San Antonio, TX 78150-6001 |
HQ ARPC-DPSSE Entitlements & Casualty Branch 6760 East Irvington Place #4000 Denver, CO 80280-4000 |
| Coast Guard | Commandant (G-WPM-2) U.S. Coast Guard 2100 Second Street, NW Washington, DC 20593-0001 |
|
| Public Health Service | Public Health Service Attn: Division of Commissioned Personnel Parklawn Building 5600 Fishers Lane Rockville, MD 20852 |
|
| NOAA | NOAA Commissioned Personnel Division 1315 East-West Highway Room 12100 Silver Spring, MD 20910-3285 |
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
| 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 |
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.