Instructions for Employees
Two pages of questions and answers: when to complete the form, what a waiver is, what Basic and Options A, B and C are, when coverage is effective, approvals, denials and where to get more information.
SF2822
Request for Insurance - Federal Employees' Group Life Insurance (FEGLI) Program
- Agency
- GSA
- Revision
- Revised December 2013
- Fillable fields
- 68
- Pages
- 4
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 2822 (SF 2822): Request for Insurance (FEGLI)
Standard Form 2822 (SF 2822), Request for Insurance, is a Federal Employees' Group Life Insurance (FEGLI) Program form. Its footer names the U.S. Office of Personnel Management (OPM) and the FEGLI Handbook, Revised December 2013. GSA hosts a copy in its forms library.
The instructions say an employee completes it when they are in a position that makes them eligible for FEGLI coverage and at least one year has passed since the effective date of their most recent waiver of Basic, Option A and/or Option B life insurance. The employing agency completes Part A, the employee completes Part C, the examining physician or other healthcare provider completes Part D and mails the form, and the Office of Federal Employees' Group Life Insurance (OFEGLI) approves or denies the request in Part B.
The form says it can lead to Basic, Option A and Option B if OFEGLI approves the physical, but not Option C. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 2822
Part A: Employing Agency
Employee's name, date of birth, Social Security number, department, work location and phone, whether more than 1 year has passed since the last waiver, any absence of 3 weeks or more for sickness or injury, and the certifying official's details.
Part B: OFEGLI
Approve or deny boxes addressed to the employing agency, the OFEGLI reviewer and the date.
Part C: Employee
Address, daytime phone, changes in health and medical advice in the past 5 years, any denied or higher-rated insurance, a checklist of conditions with details in 5a, and the signature.
Part D: Examining Physician or Other Healthcare Provider
Name, gender, date of birth, height, weight, two sitting blood pressure readings, pulse, any abnormalities found, the provider's certification and their name, address and phone.
Instructions for Agencies and Privacy Act Statement
What the agency does after an approval or a denial, and a Privacy Act Statement citing Chapter 87, title 5, U.S. Code, and Public Law 104-134 (April 26, 1996).
How to complete SF 2822
- 1
Ask HR to complete Part A
The instructions say to ask the human resources office to complete Part A. It can add an email address or fax number for OFEGLI's decision.
- 2
Answer Part C
The form says to answer all of the questions or mark N/A, and not to leave an answer blank. A blank sheet can be used if more room is needed.
- 3
Take it to the physical
Bring the form to a physician or other healthcare provider. The form says OFEGLI cannot accept a previous physical and has to receive the form within 60 days of the date of the physical.
- 4
Sign in front of the provider
Sign item 6 of Part C in the presence of the examining physician or other healthcare provider.
- 5
The provider mails it to OFEGLI
The provider completes Part D and mails the form to the Office of Federal Employees' Group Life Insurance, P.O. Box 6080, Scranton, PA 18505-6080.
- 6
After OFEGLI decides
Human resources passes on the decision. The form says Basic starts automatically on the first day in pay and duty status on or after approval, and Option A or Option B needs an SF 2817 that HR receives within 60 days after approval.
Why fill Form SF2822 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
Office of Federal Employees' Group Life Insurance, P.O. Box 6080, Scranton, PA 18505-6080, mailed by the examining physician or other healthcare provider.
Fee for the physical
The form says the employee pays any fee for the physical, and the agency or OFEGLI cannot pay for it.
60-day limits
The form says that if the employee is not in a pay and duty status within 60 days after approval, there is no Basic insurance (unless already held), and without an SF 2817 within those 60 days, Option A or Option B cannot be elected.
When the decision arrives
The agency instructions say the decision should arrive within 2 weeks after OFEGLI receives the form, by email, fax or regular mail depending on what the agency gives in blocks 14 and 15. OFEGLI's number is 1-800-633-4542.
Denials
The form says OFEGLI's decision is final and there are no formal appeal procedures. The employee or provider may call OFEGLI at 1-800-633-4542 to ask why, and may be able to submit additional medical evidence.
Related forms
SF2817
Life Insurance Election
37 fields, 5 pages
SF2823
Designation of Beneficiary - FEGLI
64 fields, 3 pages
SF2818
Continuation of Life Insurance Coverage as an Annuitant or Compensationer (FEGLI)
30 fields, 5 pages
SF2821
Agency Certification of Insurance Status - Federal Employees' Group Life Insurance Program
67 fields, 4 pages
SF2819
Notice of Conversion Privilege - Federal Employees' Life Insurance Program
22 fields, 3 pages
Who fills out SF 2822?
Four parties each complete or act on their own part of the form.
Official sources and the blank
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Questions about Form SF2822
Who issues SF 2822?
The footer names the U.S. Office of Personnel Management and the FEGLI Handbook, Revised December 2013. GSA hosts a copy in its forms library.
Can SF 2822 be used to get Option C?
No. The form says Option C cannot be elected with this form, only during an open enrollment period or after a life event when the employee already has Basic.
Who pays for the physical?
The form says the employee pays any fee for the physical, and the agency or OFEGLI cannot pay for it.
Can an earlier physical be used?
No. The form says OFEGLI cannot accept a previous physical. The provider performs the physical for this request, and OFEGLI has to receive the form within 60 days of the date of the physical.
How does the form describe Basic insurance?
As life insurance based on annual salary, rounded up to the nearest thousand dollars if not already an even thousand, plus $2,000, including accidental death and dismemberment coverage and an Extra Benefit for those under age 45.
What if OFEGLI denies the request?
The form says OFEGLI's decision is final and there are no formal appeal procedures. The employee or provider may call OFEGLI at 1-800-633-4542, and depending on the reason more medical evidence may be submitted.
How long does a decision take?
The agency instructions say the agency should receive OFEGLI's decision within 2 weeks after OFEGLI receives the form from the physician or other healthcare provider.