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FEGLI 2004 Open Season Election Form

FEGLI 2004 Open Season Election Form

Federal employees use this form for belated FEGLI 2004 Open Season elections to enroll in the FEGLI Program, or to change/increase their existing coverage. Employees must first receive a written determination from their agency human resources office that they are eligible to make a belated FEGLI 2004 Open Season election. After receiving such determination, employees have 31 days in which to elect coverage on this FE-2004.

Electronic Copies:


Paper Copies:


Download the form locally. However, if you can't access the Adobe-Acrobat PDF fillable form, contact your servicing human resources office for more information on how to obtain a copy.


Agencies can download the form locally. The form should be provided to an employee only after making a determination that he/she is eligible to make a belated Open Season election. If you are unable to download the form, agency headquarters officers may order a limited quantity of forms directly from the Office of Federal Employees' Group Life Insurance (OFEGLI). OFEGLI accepts orders by fax and mail only - no telephone orders.

The fax numbers are 315-792-6603 or 312-792-6802 - Attention: Forms Ordering Desk. The mailing address is:

Office of Federal Employees' Group Life Insurance
P.O. Box 6512, Utica
NY 13504-6512

OFEGLI will need the form number, the quantity, the shipping address and the point of contact, in case of questions.

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