Sglv 8286 Form PDF Details

Navigating the complexities of military benefits can be daunting, and the SGLV 8286 form, or the Servicemembers' Group Life Insurance Election and Certificate, plays a crucial role for those in service who wish to manage their life insurance coverage effectively. This form allows servicemembers to make important elections concerning their insurance, such as naming or updating beneficiaries, changing the amount of coverage, and deciding on the payment options in the event of their death. It serves as the primary document for servicemembers to declare their intentions regarding their life insurance, replacing all prior designations. The form is comprehensive, asking for personal information, coverage details, beneficiary information—including the distribution and payment options—and health-related questions if coverage is being increased. It emphasizes the significance of making informed decisions regarding beneficiary designations, as these determinations directly affect how and to whom insurance benefits will be distributed. The instructions detailed on the SGLV 8286 form guide servicemembers through updating their coverage in response to life changes such as marriage, the birth of a child, or other significant events, ensuring their life insurance benefits align with their current life situation and future aspirations. Furthermore, the form handles the delicate matter of coverage changes, underscoring potential repercussions on family coverage and post-separation benefits, thereby mandating a careful review and understanding by the servicemember before making any alterations to their insurance plan.

QuestionAnswer
Form NameSglv 8286 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namessglv 8286, sglv8286, sglv army, fillable sglv 8286 form

Form Preview Example

Servicemembers’ Group Life Insurance

Election and Certificate

Office of Servicemembers'

Group Life Insurance

1. About You

Print Name (First, Middle, Last)

 

Rank, title or grade

Social Security Number

 

 

 

 

 

 

 

 

 

 

Duty Location

 

Branch of Service

Current Amount of SGLI

2. About Your Coverage (This form replaces all prior designations)

I am completing this form to: (Check all that apply)

Name or update my SGLI beneficiary. You must complete sections 3 & 5.

Increase or restore my SGLI coverage to $

 

 

. You must complete sections 3, 4, & 5.

(Increasing SGLI does not automatically increase FSGLI, if FSGLI was < $100,000.)

Reduce my SGLI coverage to $

 

 

. You must complete sections 3 & 5.

Decline or cancel SGLI coverage. Write below I do not want insurance at this time.” You must complete section 5 only.

 

.

Coverage is available in increments of $50,000 up to

amaximum of $400,000

3.About Your Beneficiaries (Please always complete this section unless you are declining coverage. If you do not specifically name beneficiaries, your insurance will be paid by law. Please read the information on page 3 before selecting your beneficiaries.)

 

 

 

Share to each (% or $

 

 

 

 

amounts. The sum of the

 

 

 

 

shares must equal 100% or

Payment Option

Primary

 

 

the full dollar amount of your

(Lump sum* or

Social Security Number

Relationship

insurance.) (Each share must

36 equal monthly

Name and Address

(If available)

to you

be greater than $0.00 or 0%)

payments)

 

 

 

 

 

1.

2.

3.

4.

Secondary

1.

2.

3.

4.

Have more beneficiaries? Check this box if 1.) you have additional beneficiaries and are completing the Supplemental SGLI Beneficiary Form, SGLV 8286S or, 2.) You are attaching additional documentation to complete your beneficiary designation noted above.

*If the insured member elects a lump sum payment, the beneficiary(ies) will be given the option of receiving the lump sum payment through the Prudential Alliance Account®, by check, or Electronic Funds Transfer (EFT). Alliance Account is not available for payments less than $5,000, payments to individuals residing outside the United States and its territories, and certain other payments. These will be paid by check.

The Bank of New York Mellon is the Administrator of the Prudential Alliance Account Settlement Option, a contractual obligation of The Prudential Insurance Company of America, located at 751 Broad Street, Newark, NJ 07102-3777. Draft clearing and processing support is provided by The Bank of New York Mellon. Alliance Account balances are not insured by the Federal Deposit Insurance Corporation (FDIC). The Bank of New York Mellon is not a Prudential Financial company.

GL.2010.094 Ed. 2/2015

SGLV 8286

Page 1 of 4

4.About Your Health Complete this section ONLY if you are restoring or increasing coverage.

Your gender

Your date of birth (MM, DD, YYYY)

Your weight

Your height

Female Male

Have you had, been treated for, or

 

 

had known indications of:

Yes

No

a. A heart condition?

b. High blood pressure?

c. A neurological disorder? d. Diabetes?

e. Cancer or tumors?

f. Have you ever been diagnosed as having a disease of the immune system?

g. Do you have any known physical impairments, deformities, or ill health not covered above?

Did you answer “YES” to any question? If so, reference the question by letter and list date, duration and details below. Please attach additional documentation if necessary.

If you answered “yes” to any question above, a request to increase coverage does not take effect until approved by the Office of Servicemembers’ Group Life Insurance (OSGLI). If you answered “no” to all the questions above, your request for increased coverage takes effect immediately.

5.Your Signature You must complete this section.

I have read the information on page 3 and instructions on page 4 and understand that:

This form replaces any prior beneficiary or payment instructions.

I can have SGLI and Veterans’ Group Life Insurance (VGLI) coverage at the same time, but the combined amount cannot be more than $400,000.

Reducing or declining SGLI coverage can affect the amount of my family coverage, traumatic injury coverage and post-separation coverage (see instructions on page 4).

Please take note:

If my spouse is…

and…

then…

 

 

 

also a member of the

we married on or after January 2, 2013

spouse SGLI coverage is not automatic, but I may apply for spouse coverage by

uniform services

 

completing SGLV 8286A.

 

 

 

not a member of the

I am married, or get married after completing

spouse SGLI automatically covers my spouse. I must register my spouse in DEERS so

uniformed services

this form, and have not declined SGLI,

my branch of service can deduct premiums from my pay. Failure to do so will result in a

 

 

debt for unpaid premiums. I can decline spouse coverage by completing SGLV 8286A.

 

 

 

I am free to name anyone I want as my beneficiary. I understand if I am married and have designated someone other than my spouse or child as my beneficiary, the person I have named is the person I intend to receive my insurance proceeds. I also understand that my spouse may be notified that he/she (or my child) is not my designated beneficiary.

I certify that, to the best of my knowledge and belief, the above statements are complete and true. Any deception or false statement, either by reference, omission, or otherwise can result in loss of coverage or denial of a claim for benefits.

Service Member Signature

Social Security Number

Date (MM, DD, YYYY)

 

 

 

 

 

 

Address

Submit this form to your Unit Personnel Clerk.

For Branch of Service Use Only

Name of Personnel Clerk

For OSGLI Use Only

Representative

Rank, title or grade

Approve

Contact telephone/email

Disapprove

Date

Date

Address

GL.2010.094 Ed. 2/2015

SGLV 8286

Page 2 of 4

Information for the Service Member

About your SGLI Coverage

Servicemembers’ Group Life Insurance (SGLI) is granted under title 38, United States Code, and is subject to the provisions of that title and its amendments, and title 38 Code of Federal Regulations.

The following charts provide information you should review before naming a beneficiary or selecting a payment option.

Naming Beneficiaries who will receive the insurance

 

If you…

Then…

 

 

 

are married and decline coverage upon

your spouse will be notified that you declined coverage.

 

 

 

entry into service

 

 

 

 

 

 

 

 

 

are married and designate any person

your spouse will be notified in writing, by the Branch of Service that he/she or your child is not the named beneficiary,

 

other than your spouse or child for any

unless:

 

 

 

amount of insurance

– your spouse has been previously notified, OR

 

 

 

 

– your spouse is not designated as beneficiary for any amount of insurance prior to the new election.

 

 

 

 

 

 

 

 

 

are married and your spouse is designated

your spouse will be notified in writing of your election to decline or reduce coverage.

 

 

 

as beneficiary and you decline coverage

 

 

 

 

 

or elect less than maximum coverage, and

 

 

 

 

 

that election reduces your coverage from

 

 

 

 

 

the automatic maximum or from a

 

 

 

 

 

previously elected amount of coverage

 

 

 

 

 

have any life event such as marriage, divorce,

you should complete a new beneficiary form. Beneficiaries are not automatically changed by life events.

 

 

 

or children after completing this form

 

 

 

 

 

 

 

 

 

 

 

name more than one beneficiary

the sum of the shares must equal 100% or the full dollar amount of your insurance.

 

 

 

 

 

 

 

want to name more than four primary or

you must complete the SGLI Supplemental Beneficiary Form, SGLV 8286S or attach additional documentation to

 

secondary beneficiaries

complete your beneficiary designation.

 

 

 

 

 

 

 

name minors as beneficiaries

 

OSGLI will pay the insurance benefit to the court-appointed guardian of the minor’s estate if the beneficiary is a

 

 

 

minor at time of claim; or

 

 

 

 

 

you can establish a trust for the benefit of the minor and name the trustee of the trust as beneficiary.

 

 

 

 

 

naming a trust as a beneficiary on this form does NOT create a trust.

 

 

 

 

 

 

 

 

 

name more than one primary beneficiary

OSGLI will pay the shares equally among the remaining primary beneficiaries.

 

 

 

and one or more of them predeceases you

 

 

 

 

 

want to name a Trust as a beneficiary

you must create a trust. Please consult with a military attorney, professional financial planner, or estate planner to

 

 

help you create Trust documents. (Please note: Do not send Trust documents to OSGLI until the time of claim).

 

 

 

 

 

 

 

have no surviving primary beneficiaries

OSGLI will pay the insurance benefit to the secondary beneficiaries, if any.

 

 

 

 

 

 

 

 

 

do not name a beneficiary or

OSGLI will pay the insurance benefit in the following order:

 

 

 

there are no surviving primary

1. Widow or widower

 

 

 

 

 

 

 

or secondary beneficiaries

2. Children in equal shares (the share of any deceased child will be distributed equally among the

 

 

 

OR

 

 

 

 

descendants of that child)

 

 

 

indicate that payment should be made

 

 

 

 

3. Parent(s) in equal shares or all to surviving parent

 

 

 

by law

 

 

 

4. A duly appointed executor or administrator of your estate

 

 

 

 

 

 

 

 

5. Other next of kin

 

 

 

 

 

 

 

 

 

Payment Options

 

 

 

 

 

 

 

 

 

 

 

If you want the beneficiary to…

Then…

 

 

 

receive the insurance proceeds in one

write the phrase “lump sum” under Payment Options. If you elect a lump sum payment, your beneficiary(ies)

will

 

lump sum

be given the option of receiving the lump sum payment through the Prudential Alliance Account®*, by check,

or

 

 

Electronic Funds Transfer (EFT).

 

 

 

 

* Alliance Account is not available for payments less than $5,000, payments to individuals residing outside the

 

 

 

 

 

United States and its territories, and certain other payments. These will be paid by check.

 

 

 

receive the insurance proceeds in 36

 

write “36” under the Payment Option.

 

 

 

 

 

 

 

equal monthly payments

 

your beneficiary cannot change this payment option.

 

 

 

 

 

 

 

 

have a choice

write the phrase “lump sum” under Payment Option or leave blank.

 

 

 

 

 

 

 

GL.2010.094 Ed. 2/2015

 

SGLV 8286

Page 3 of 4

Instructions for Personnel Clerk and the Service Member

1.A representative of the Uniformed Services must complete the “For Branch of Service Official Use Only” section to indicate receipt of the form from the member after reviewing the following table:

 

 

The Personnel Clerk should inform

 

 

 

 

 

If the service member…

 

the service member…

 

Then the Personnel Clerk should…

has just entered the service

 

he or she is automatically insured for $400,000 SGLI, unless the

 

have the service member designate beneficiaries by

 

 

service member declines or reduces coverage.

 

completing SGLV 8286.

 

 

 

 

 

 

 

 

 

is increasing or restoring SGLI

 

he or she must complete Section 4, About Your Health.

 

 

 

 

approve form if the responses to questions 4a through

 

 

 

 

 

 

 

 

 

 

 

4g are “No” and forward the form to payroll to change

 

 

 

 

 

 

 

 

SGLI premium deductions.

 

 

 

 

 

 

 

 

send form to OSGLI if any answer to questions 4a through

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4g are “Yes.” Only inform payroll when approved by OSGLI.

 

 

 

 

 

 

 

 

 

Reduces, declines,

 

 

an application with health questions is required to increase,

 

 

 

 

forward the form to payroll to change SGLI premium

 

 

 

 

 

or cancels SGLI

 

 

elect, or restore coverage at a later date.

 

 

 

 

deductions.

 

 

 

of the following:

 

 

 

 

if canceling SGLI, have the service member complete

 

 

 

 

 

 

 

 

 

– the purpose and role of life insurance in financial planning.

 

 

 

 

SGLV 8286A to end payment of Family SGLI premiums.

 

 

 

– the difference between term life insurance and whole life insurance.

 

 

 

 

No form is required to end TSGLI premium deductions.

 

 

 

– the availability of commercial life insurance.

 

 

 

 

if the member is married and reduces, declines, or

 

 

 

 

 

 

 

 

 

– the relationship between SGLI and VGLI.

 

 

 

 

cancels SGLI, inform the member that his her spouse

 

 

 

– declining or canceling SGLI will also cancel Family SGLI— both

 

 

 

 

may be notified in writing, by the Branch of Service, of

 

 

 

 

 

 

 

the member’s election based on Title 38, USC 1967 (f).

 

 

 

spouse and dependent child coverage— and Traumatic Injury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Protection (TSGLI).

 

 

 

 

 

 

 

 

 

 

 

 

 

gets married to another member of

 

spouse SGLI coverage is not automatic and the member may

 

if member wants spouse SGLI coverage, provide the

the uniformed services on or after

 

apply for spouse SGLI coverage by completing SGLV 8286A.

 

member with SGLV 8286A, Spouse Coverage Election and

January 2, 2013

 

 

 

 

Certificate, and follow the instructions therein.

 

 

 

 

 

 

 

 

is married or gets married after

 

 

spouse SGLI automatically covers spouse.

 

if applicable, forward the form to payroll to begin

 

 

 

completing this form and is not

 

 

he or she must register their spouse in DEERS for

 

premium deductions for the spouse coverage.

 

 

 

 

 

 

 

 

 

 

 

married to another member of the

 

 

payroll to deduct premiums.

 

 

 

 

 

 

 

 

 

 

 

 

 

uniformed services

 

 

If the member wants to decline coverage or take a lesser amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of spouse coverage, the member must complete SGLV 8286A.

 

 

 

 

 

 

 

 

 

 

 

 

has questions about this form

 

the advice of a military attorney is available at no expense.

 

direct them to the appropriate resource.

 

 

 

 

 

 

 

wants to designate more

 

he or she must complete the Supplemental SGLI Beneficiary Form

 

attach the Supplemental Beneficiary Form to the SGLV

beneficiaries than the form allows

 

SGLV 8286S or attach additional documentation to complete your

 

8286 or attach additional documentation to complete your

 

 

beneficiary designation.

 

beneficiary designation.

designates any person other than

 

 

while the member is free to designate anyone he or she

 

have the member sign SGLV 8286 to certify that he/she

 

 

 

his/her spouse or child for any

 

 

chooses as beneficiary, the member must certify that he

 

understands that:

amount of insurance

 

 

or she is designating someone other than a spouse or

 

 

 

 

he/she is free to name anyone as beneficiary.

 

 

 

child and the person named will receive the benefit.

 

 

 

 

 

 

 

 

 

 

 

if he/she designated someone other than his/her

 

 

 

if the member is married, the member’s spouse will be

 

 

 

 

 

 

 

 

 

 

 

spouse or child as beneficiary, the person the member

 

 

 

 

 

 

 

 

 

 

notified in writing by the Branch of Service, that he/she or

 

 

 

 

 

 

 

 

 

 

 

has named is the person he/she intends to receive the

 

 

 

the member’s child is not the named beneficiary, unless:

 

 

 

 

 

 

 

 

 

 

 

insurance proceeds.

 

 

 

– the spouse has been previously notified, OR

 

 

 

 

 

 

 

 

 

 

 

if married, the spouse will be notified that he/she

 

 

 

– the spouse is not designated as beneficiary for any

 

 

 

 

 

 

 

 

 

 

 

(or any child) is not the designated beneficiary.

 

 

 

amount of insurance prior to the new election.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.After the form is completed, Personnel Clerk should:

File a copy in the member’s official personnel file

Provide a copy to the service member

Provide a copy of the form to the payroll office for the member’s unit

Submit the form to OSGLI ONLY if the member is increasing or restoring SGLI coverage and answered “Yes” to one or more of the health questions

OSGLI

PO Box 41618

Philadelphia, PA 19176-9913

If a member is making a Beneficiary change only, the form DOES NOT have to be forwarded to OSGLI.

GL.2010.094 Ed. 2/2015

146202-09142

SGLV 8286

Page 4 of 4

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3. Your next part is generally simple - fill out all of the blanks in About Your Health Complete this, Your date of birth MM DD YYYY, Your weight, Your height, Your gender, Female Male, Have you had been treated for or, a A heart condition, b High blood pressure, c A neurological disorder, d Diabetes, e Cancer or tumors, Yes, Did you answer YES to any question, and f Have you ever been diagnosed as in order to finish this segment.

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4. This fourth part comes next with these form blanks to fill out: I certify that to the best of my, Service Member Signature, Social Security Number, Date MM DD YYYY, Address Submit this form to your, For Branch of Service Use Only, Name of Personnel Clerk, Rank title or grade, Contact telephoneemail, Date, Address, For OSGLI Use Only, Representative, Approve, and Disapprove.

Date MM DD YYYY, Address, and I certify that to the best of my inside sglv print

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