SF 2817 Life Insurance Election Form

This form is due 31 days from your entrance on duty.

Federal Employee Group Life Insurance (FEGLI) Basic Coverage is term insurance with 1/3 of the cost paid for by the Federal Government. All eligible employees are automatically enrolled in the Basic Coverage from the date of entrance on duty unless coverage is waived as indicated in the general instructions.

You have up to 31 days from your first day of employment to elect or waive basic coverage or choose further options. If you wish to elect coverage, refer to the booklet RI 76-21 for the various options available.

If you do not want life insurance coverage you must complete the form and sign the waiver. If the form with signed waiver is received in the Human Resources Department within the first pay period of your employment any deductions that may be taken from your first paycheck will be refunded to you.