TSGLI

1. TSGLI TRAUMATIC INJURY PROTECTION UNDER SERVICEMENS GROUP LIFE INSURANCE LCDR HOWARD AUPKE BUMED / M312

2. TSGLI WHAT IS TSGLI? Traumatic Servicemembers’ Group Life Insurance (TSGLI) is a traumatic injury protection rider under Servicemembers’ Group Life Insurance (SGLI) that provides for payment to any member of the uniformed services covered by SGLI who sustains a traumatic injury that results in certain severe losses.

3. TSGLI “Retroactive” (7 Oct 2001-30 Nov 2005) • Injury incurred during OIF/OEF (member deployed outside U.S. on orders in support of OIF or OEF OR served in a geographic location that qualifies the member for Combat Zone Tax exclusion) • SGLI enrollment not required Current (Beginning 01 Dec 2005) • SGLI enrollment required • Automatic $1.00/mo SGLI premium increase (1 Dec 05) • 24/7/365 worldwide coverage

4. TSGLI Eligibility Requirements For Payment Under TSGLI? • Member must meet all of the following requirements: • Insured by SGLI when the traumatic injury is sustained. • Incurred a scheduled loss and that loss must be a direct result of a traumatic injury. • Suffered the traumatic injury prior to midnight of the day they are separated from the uniformed services. • Suffered a scheduled loss within 365 days of the traumatic injury. • Survived for a period of not less than seven full days from the date of the traumatic injury. (The 7-day period begins at the date and time of the traumatic injury as measured by GMT and ends 168 full hours later).

5. TSGLI Claim Amount • TSGLI coverage will pay a benefit of between $25,000 and $100,000 based on the schedule of injuries. TSGLI Coverage • TSGLI coverage is automatic for those insured under basic SGLI and cannot be declined. The only way to decline TSGLI is to decline basic SGLI coverage.

6. TSGLI MULTIPLE CLAIMS • For losses such as coma or traumatic brain injury, the TSGLI benefit is payable in $25,000 increments on the 15th, 30th, 60th, and 90th consecutive days. A separate claim for TSGLI must be filed at each time interval. • If the member files a claim for a loss and then subsequently incurs another loss as a result of the same traumatic event, a new claim must be filed for the subsequent loss.

7. TSGLI BUMED POLICY LETTER – 12 DEC 2005 • Initiate processes that immediately identify hospitalized members with qualifying traumatic injuries and expedite submission of the claim form. • Appoint MTF TSGLI Program Coordinator. • Ensure MTF and service liaison staffs are aware of TSGLI program in order to immediately identify eligible service members. • Provide necessary training to ensure accurate completion of the medical certification section of the claim form. • Establish a centralized medical and administrative process to review all claim forms for completion and appropriate medical documentation. • Expedite submission of the completed medical section (Part B), along with Part A, of the claim form to the appropriate service's program office.

8. TSGLI NAVY MILITARY TREATMENT FACILITY • Train medical professionals to identify TSGLI eligible patients and complete claim form. • An appropriate attending medical professional must fill out Part B of the TSGLI form. The term attending medical professional means a licensed physician, optometrist, nurse practitioner, registered nurse, or physician assistant • Provide easy access to VA Website and Procedures guide. http://www.insurance.va.gov/sgliSite/legislation/TSGLIFacts.htm • Develop processes within the framework of your MTF to administratively process, review and submit claim forms.

9. TSGLI ACTIVITIES OF DAILY LIVING (ADLs) (Eating, Dressing, Toileting, Transferring, Bathing, Continence) • Most common problem in claim certification process. • Injury must affect at least 2 of 6 ADLs for greater than 30 days. • ADL affected must be consistent with type and severity of injury.

10. TSGLI APPEALS PROCESS • A service member may appeal if denied TSGLI. • If the service member is appealing a decision based on eligibility criteria such as their loss or the circumstances surrounding the traumatic injury causing the loss, the service member should contact the appropriate service department point of contact. • If the service member is appealing a decision based on whether they had TSGLI coverage at the time of the traumatic injury, the service member should contact the Office of Servicemembers’ Group Life Insurance at 1-800-419-1473 to file an appeal. • All appeals must be in writing and must be filed within one year of the date of the denial.

11. TSGLI PROGRAM OFFICES • U.S. Navy Comm:(901)874-4311 DSN:882-4311 Toll Free: 1(800)368-3202 FAX: (901)874-6654 E-Mail: MILL_TSGLI@NAVY.MIL • U.S. Marine Corps Comm: (703)432-9277 DSN: 378-9277 Toll Free: 1(877)216-0825 FAX: 1(888)858-2315 E-Mail: T-SGLI@USMC.MIL