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Standard 2823 Form: What You Should Know

Section 1. Purpose: To determine whether this beneficiary is covered by the Federal Employees Group LIFE Insurance Program (FELL) on the day this form is signed, including the applicable requirements and limitations applicable to the beneficiary. Section 2. Information to be Collected: For Federal Employees: • The beneficiary's Social Security number. • The beneficiary's date of birth. • If the beneficiary is an employee or agency of the Federal Government, the beneficiary's title and employer for the most recent year in which the beneficiary had a gross annual compensation of 20,000 or more (80,000 for married individuals). Section 3. Statement of Policy. (a) Federal Employees' Group Life Insurance Plan Benefits. The Federal Employees' Group Life Insurance Program (FELL) provides benefits to all covered Federal employees during the period covered by the plan in accordance with this form and procedures that may be provided by the Secretary of the Treasury with respect to the FELL Program. • Effective March 6, 2013, no beneficiary is eligible to receive these benefits if a plan member dies during the period between the date of enrollment in the FELL plan and the date of the plan member's death. • Effective March 6, 2013, any beneficiary who died during the period between March 6, 2013, and December 31, 2014, may be covered under the FELL plan if the beneficiary's plan member died before March 6, 2013. The benefit may be paid to the beneficiary's estate by the Secretary if the beneficiary had been eligible for the benefit under the FELL plan (see the Notice of Change of Policy dated April 19, 2024 ( )). (b) FELL Termination Procedures.  • If a plan member dies during the period between the date of enrollment in the FELL plan and the date of death, the plan terminates with respect to that member. • The beneficiary's plan must be reauthorized with respect to such deceased plan member by the beneficiary's Social Security Administration. 3. Effective Dates. Effective March 6, 2013, and effective March 6, 2014, the following changes to the FELL Program are made in order to conform with revised Social Security administration regulations and the Social Security Amendments of 1983, published on September 28, 1983, as amended.

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