Part A: agency entries
Name of employee, date of birth, date insurance terminated, whether the employee had Option C-Family insurance on that date, and the agency certification in items 5 to 10.
SF2819
Notice of Conversion Privilege - Federal Employees' Life Insurance Program
- Agency
- GSA
- Revision
- Rev. May 1995
- Fillable fields
- 22
- Pages
- 3
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 2819 (SF 2819): Notice of Conversion Privilege (FEGLI)
Standard Form 2819 (SF 2819), Notice of Conversion Privilege, is a Federal Employees' Group Life Insurance (FEGLI) Program form. Its footer names the Office of Personnel Management (OPM) and the FEGLI Handbook for Personnel and Payroll Offices, Rev. May 1995. GSA hosts a copy in its forms library.
The form says the employing agency completes Part A whenever an employee's life insurance coverage terminates due to separation, resignation, retirement, death or end of 12 months in non-pay status, and gives the notice to the employee, any assignees, and the family of a deceased employee who had Option C-Family coverage. Part B explains converting FEGLI coverage to an individual direct-pay policy, Part C is the eligibility statement sent to the Office of Federal Employees' Group Life Insurance (OFEGLI), and Part D describes individual policies.
The form prints a 31-day window to request conversion information. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 2819
Part B: conversion information
Who may convert, the time limit, general rules for the individual policy and how to convert. The form says no medical examination is required and the government will not pay any part of the individual policy premium.
Part C: eligibility statement
Boxes to ask for conversion information for Basic, Option A-Standard or Option B-Additional, or for family members' Option C-Family insurance, then signature, date, name and address, assignment questions and SF 2821 status.
Part C item 7: eligible family members
Room for up to six family members, lines a to f, each with a birth date and relationship.
Part D: individual policies
Explains Ordinary Life policies, a variation paid up at age 95, participating and non-participating policies, and a table of sample annual premium rates per $1,000 that the form says are examples only.
Privacy Act Statement
Cites Title 5, United States Code, Chapter 87, and says OFEGLI uses the data to determine eligibility for conversion of life insurance coverage.
The form has four lettered parts and prints two copies: Part 1 for the employee, assignee or family member, and Part 2 to forward with retirement papers or file in the Official Personnel Folder.
How to complete SF 2819
- 1
The agency completes Part A
The form says that on the date insurance terminates (except by waiver), the agency gives this notice to every employee and any assignees, and to the family of each deceased employee who had Option C-Family coverage.
- 2
Read Part B
The boxes in Part C start with a statement that the person has read Part B on page 1. The form says not to apply for conversion when all FEGLI coverage is being carried into retirement.
- 3
Check the boxes in Part C
Choose the coverage to convert, answer whether the coverage was assigned, and check whether an SF 2821 is attached, not needed as a family member, or will be submitted later.
- 4
Attach the SF 2821 if there is one
The form says to attach the original (Part 1) of SF 2821, Agency Certification of Insurance Status. Retiring employees who continue Basic Life but convert one or more options send their duplicate (Part 2) instead.
- 5
Mail it to OFEGLI
Send Part C to the Office of Federal Employees' Group Life Insurance (OFEGLI), 200 Park Avenue, New York, NY 10166-0188. The form says OFEGLI then mails details and a list of eligible insurance companies.
- 6
The agency routes Part 2
For a retiring employee, the form says Part 2 (duplicate) goes to OPM with the retirement papers. Otherwise it is placed in the employee's Official Personnel Folder.
Why fill Form SF2819 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what the form says
Where it goes
The Office of Federal Employees' Group Life Insurance (OFEGLI), 200 Park Avenue, New York, NY 10166-0188.
Time limit printed on the form
The request for conversion information is mailed within 31 days of the date in item 3 of Part A, or within 31 days of receiving the notice, whichever gives more time. For a cause beyond the person's control, the form allows up to six months after the date in item 3 with a full explanation attached.
Coverage during the 31 days
The form says that under certain circumstances life insurance is payable if death occurs within 31 days after group life insurance terminates, and that extending the conversion privilege beyond 31 days does not extend coverage.
No SF 2821 yet
The form says to request a completed SF 2821 from the employing agency before the 31-day limit ends, and not to delay sending the SF 2819 while waiting for it.
The individual policy
It is issued by an insurance company chosen from OFEGLI's list. The form says it cannot be term insurance, universal life insurance or a policy with an indeterminate premium, and cannot have disability or accidental death and dismemberment benefits.
Privacy
The Privacy Act Statement says the information may be shared with national, state, local or other charitable or social security administrative agencies, or with law enforcement agencies investigating a violation of civil or criminal law.
Related forms
SF2821
Agency Certification of Insurance Status - Federal Employees' Group Life Insurance Program
67 fields, 4 pages
SF2820
Certificate of Insured Employee's Retirement Status
64 fields, 4 pages
SF2817
Life Insurance Election
37 fields, 5 pages
SF2818
Continuation of Life Insurance Coverage as an Annuitant or Compensationer (FEGLI)
30 fields, 5 pages
SF2823
Designation of Beneficiary - FEGLI
64 fields, 3 pages
SF2822
Request for Insurance - Federal Employees' Group Life Insurance (FEGLI) Program
68 fields, 4 pages
Who uses SF 2819?
The form names who completes each part and who receives the notice.
Official sources and the blank
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Questions about Form SF2819
Who issues SF 2819?
The footer names the Office of Personnel Management and the FEGLI Handbook for Personnel and Payroll Offices, Rev. May 1995. GSA hosts a copy in its forms library.
Who fills out Part A of SF 2819?
The employing agency. The form says Part A is completed whenever an employee's life insurance coverage terminates due to separation, resignation, retirement, death or end of 12 months in non-pay status.
How long is the window to ask about conversion?
The form says the request for conversion information is mailed within 31 days of the date insurance terminated or within 31 days of receiving the notice, whichever gives more time.
Is a medical exam needed to convert?
No. Part B says no medical examination is required.
Does the government pay for the individual policy?
No. The form says the government will not pay any part of the individual policy premium, and the employee or assignee pays the premium for the individual policy.
Do family members need an SF 2821?
No. The form says family members may apply by sending a completed SF 2819 to OFEGLI, 200 Park Avenue, New York, NY 10166-0188, and do not need an SF 2821.
Are the premium rates in Part D real quotes?
The form calls them sample annual premium rates per $1,000 of insurance on a participating basis and says they are examples only and not rates for any one company.