SF 2819
May 1995
Use:
Agencies give this form to employees and assignees when the employee's life insurance coverage ends due to separation, resignation, retirement, death, or the end of 12 months in non-pay status. The form notifies employees or assignees of their rights to convert to an individual insurance policy.
Electronic Copies:
PDF Fillable Version 
[76 KB]
NOTICE: The address given on this form for submission of the completed form is no longer correct. The form should be sent to:
Office of Federal Employees' Group Life Insurance
P.O. Box 8149
Long Island City, NY 11101-8149.
For overnight deliveries only (such as express mail): OFEGLI, FEGLI Conversion Team, 5th Floor, 27-01 Queens Plaza North, Queens, NY 11101.
Paper Copies:
Employees:
Will receive a copy from their servicing Human Resources Office when their life insurance coverage ends, except by voluntary cancellation.
Agencies:
Use your internal agency procedures for ordering Standard Forms. Paper copies of this form are NOT available from OPM.