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FEGLI Life Insurance Election Form


Monday, September 21, 2020

FEGLI SF2817

By law, unless you waive all coverage or are ineligible, you are automatically covered for Basic life insurance as an employee. When you first become eligible for FEGLI, you may: 

  1. Do nothing and have Basic automatically,
  2. Elect Basic and any or all of the options, or
  3. Waive all life insurance coverage.

Please use this form to make one of those selections.

For Federal Employees' Group Life Insurance (FEGLI) Program members only.

You can send the completed form and any required attachments by fax to (202) 566 -5001 or by mailing your documents to:

DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001

If you have further questions, please contact the DCRB Member Services Center by clicking on the Ask Member Services link, or by phone at (202) 343-3272 Monday – Friday from 8:30 am to 5:00 pm.