Page images
PDF
EPUB

Armed Forces performed by Reserves for training purposes;

(2) Full-time duty for training purposes performed as a commissioned officer of the Reserve Corps of the Public Health Service;

(3) Full-time duty as a member, cadet, or midshipman of the Reserve Officers Training Corps while attending field training or practice cruises; and

(4) In the case of members of the Army National Guard or Air National Guard of any State, full-time duty under sections 316, 502, 503, 504, or 505 of title 32, United States Code.

(e) The term "inactive duty training" means (1) Duty (other than full-time duty) prescribed or authorized for Reserves (including commissioned officers of the Reserve Corps of the Public Health Service) which duty is scheduled in advance by competent authority to begin at a specific time and place; and

(2) In the case of a member of the Army National Guard or Air National Guard of any State, such term means duty (other than full-time duty) which is scheduled in advance by competent authority to begin at a specific time and place under sections 316, 502, 503, 504, or 505 of title 32, United States Code.

(f) The terms "active duty for training" and "inactive duty training" do not include duty performed as a temporary member of the Coast Guard Reserve, and the term, "inactive duty training" does not include (1) work or study performed in connection with correspondence courses, or (2) attendance at an educational institution in an inactive status. (g) The term "uniformed services" means the Army, Navy, Air Force, Marine Corps, Coast Guard, including in each instance the corresponding Reserve and Reserve Officers Training Corps, if any, and in the case of the Army, including the Army National Guard and in the case of the Air Force, the Air National Guard. Also included are the commissioned corps of the Public Health Service and its Reserve Corps and the commissioned corps of the National Oceanic and Atmospheric Administration.

(h) The term "policy" means Group Policy No. G-32000, effective September 29, 1965, purchased pursuant to subchapter III of chapter 19, title 38, United States Code, from the insurer, which was executed and attested on December 30, 1965, and amended on June 25, 1970.

(1) The term "insurer" means the commercial life insurance company or

companies selected under 38 U.S.C. 766 to provide insurance coverage specified in the policy.

(j) The term "office" means the Office of Servicemen's Group Life Insurance located at 212 Washington Street, Newark, NJ 07102, which is the administrative office established pursuant to 38 U.S.C. 766(b) by the insurer.

(k) The term "reinsurer" means any life insurance company, meeting established criteria as set forth in § 9.28 which reinsures a portion of the total amount of insurance covered by the policy and issues individual life insurance policies in accordance with § 9.26.

(1) The term "converter" means any life insurance company, meeting criteria set forth in § 9.28 which issues individual life insurance policies in accordance with § 9.26.

(m) The term "coverage" means Servicemen's Group Life Insurance payable upon death occurring while the member is insured under the policy.

(n) The term "termination of duty" means: (1) In the case of active duty or active duty for training being performed under a call or order that does not specify a period of less than 31 days-discharge, release or separation from such duty.

(2) In the case of other duty-the member's release from his obligation to perform any duty in his uniformed service (active duty, or active duty for training or inactive duty training) whether arising from limitations included in a contract of enlistment or similar form of obligation or arising from resignation, retirement or other voluntary or involuntary action by which the obligation to perform such duty ceases.

(0) The term "waive" or "waiver" means an election in writing signed by a member and received by the uniformed service not to be insured under the policy.

(p) The term "break in service" means the situation(s) in which: (1) A member terminates duty or obligation to perform duty in one service and enters on duty or assumes the obligation to perform duty in another uniformed service, regardless of the length of time intervening.

(2) A member reenters on duty or resumes an obligation to perform duty as a Reserve in the same uniformed service and 1 calendar day or more has elapsed following termination of the prior period of duty or obligation to perform duty.

(q) The term "disability” means any type of injury or disease whether mental or physical.

(r) The term "total disability" means any impairment of mind or body which continuously renders it impossible for the insured to follow any substantially gainful occupation. Without prejudice to any other cause of disability, the permanent loss of the use of both feet, of both hands, or of both eyes, or of one foot and one hand, or of one foot and one eye, or of one hand and one eye, or the total loss of hearing of both ears, or the organic loss of speech shall be deemed to be total disability. Organic loss of speech will mean the loss of the ability to express oneself, both by voice and whisper, through the normal organs of speech if such loss is caused by organic changes in such organs. Where such loss exists, the fact that some speech can be produced through the use of an artificial appliance or other organs of the body will be disregarded.

(s) The term "basic coverage" refers to the coverage of members called or ordered to active duty or active duty for training under calls or orders that do not specify a period of less than 31 days.

(t) The term "reservist coverage" refers to the coverage of members performing active duty or active duty for training under calls or orders to duty that specify a period of less than 31 days and the coverage of members performing inactive duty training scheduled in advance by competent authority to begin at a specific time and place.

(u) The following definitions of the terms widow, widower, child, and parent for Servicemen's Group Life Insurance purposes apply only to such insurance on the life of an insured member who dies on or after December 15, 1971.

(1) The term "widow" or "widower" means a person who is the lawful spouse of the insured member at the time of his death.

(2) The term "child" means a legitimate child, a legally adopted child, an illegitimate child as to the mother, or an illegitimate child as to the alleged father, only if (1) he acknowledged the child in writing signed by him; or (ii) he has been Judicially ordered to contribute to the child's support; or (iii) he has been, before his death, judicially decreed to be the father of such child; or (iv) proof of paternity is established by a certified copy of the public record of birth or church record of baptism show

ing that the insured was the informant and was named as father of the child, or (v) proof of paternity is established from service department or other public records, such as school or welfare agencies, which show that with his knowledge the insured was named as the father of the child.

(3) The term "parent" means a father of a legitimate child, mother of a legitimate child, father through adoption, mother through adoption, mother of an illegitimate child, and father of an illegitimate child but only if (i) he acknowledged paternity of the child in writing signed by him before the child's death; or (ii) he has been judicially ordered to contribute to the child's support; or (iii) he has been judicially decreed to be the father of such child; or (iv) proof of paternity is established by a certified copy of the public record of birth or church record of baptism showing that the claimant was the informant and was named as father of the child; or (v) proof of paternity is established from service department or other public records, such as school or welfare agencies, which show that with his knowledge the claimant was named as father of the child. No person who abandoned or willfully failed to support a child during his minority, or consented to his adoption may be recognized as a parent for the purpose of the Servicemen's Group Life Insurance program. However, the immediately preceding sentence shall not be applied so as to require duplicate payments in any case in which insurance benefits have been paid prior to receipt by the Office of Servicemen's Group Life Insurance of sufficient evidence to clearly establish that the person so paid could not qualify as a parent solely by reason of such sentence. [36 FR 3808, Feb. 27, 1971, as amended at 37 FR 4194, Feb. 29, 1972; 37 FR 19359, Sept. 20, 1972]

[blocks in formation]

§ 9.4 Amount of insurance.

Each member on duty on or after June 25, 1970, is automatically insured against death in the amount of $15,000 unless the member elects in writing (a) not to be insured or (b) to be insured in the amount of $10,000 or $5,000 as provided for in § 9.6 (a), (b), and (c). § 9.5 Coverage.

(a) Basic coverage. For a member performing active duty or active duty for training under a call or order which does not specify a period of less than 31 days, coverage is effective during the period of such duty and without further deductions from pay for 120 days following separation or release from such duty; and, if the member is totally disabled at time of separation or release, coverage may be extended up to 1 year under § 9.7(a).

(b) Reservist coverage. (1) For a member performing active duty or active duty for training under a call or order that specifies a period of less than 31 days, coverage is in effect from the first day of such duty through midnight local time of the last day of such duty; and, if the member is disabled, coverage may be extended for 90 days under § 9.7(b).

(2) For a member performing inactive duty training, coverage is in effect from the beginning of the scheduled training period through the end of the scheduled training period; and, if the member is disabled, coverage may be extended for 90 days under § 9.7(b).

(3) A member who, when authorized or required by competent authority, assumes an obligation to perform (for less than 31 days) active duty, or active duty for training, or inactive duty training scheduled in advance by competent authority and who is rendered uninsurable at standard premium rates according to good health standards approved by the Administrator, or dies within 90 days thereafter, from a disability, or aggravation of a preexisting disability, incurred by him while proceeding directly to or returning directly from such active duty, active duty for training, or inactive duty training, as the case may be, shall be deemed to have been on active duty, active duty for training, or inactive duty training, as the case may be; and to have been insured at the time such disability was incurred or aggravated; and if death occurs within 90 days thereafter as a result of such disability, to have been insured at the time of death. In determining whether or not such individual

was so authorized or required to perform such duty and whether or not he was rendered uninsurable or died within 90 days thereafter from a disability so incurred or aggravated, there shall be taken into account the call or order to duty, the orders and authorizations of competent authority, the hour on which the member began to so proceed or to return, the hour on which he was scheduled to arrive for, or on which he ceased to perform such duty, the method of travel employed, his itinerary, the manner in which the travel was performed, and the immediate cause of disability or death. Whenever any claim is filed alleging that the claimant is entitled to benefits by reason of 38 U.S.C. 767(b), the burden of proof shall be on the claimant.

(c) Arrest or confinement. Arrest or confinement of a member covered under paragraph (a) of this section by military or civil authority does not terminate coverage, except as specified in § 9.24(a).

(d) Members in missing status. With respect to an individual carried in a missing status by a uniformed Service and found to have died while in such missing status, the date of the member's death for purposes of coverage and the amount thereof shall be established as follows:

(1) If the member was in a missing status on September 29, 1965, and is determined to have died by the Uniformed Service prior to June 25, 1970, the date of death shall be that date determined by the Secretary concerned for ending the crediting of pay and allowances as provided in 37 U.S.C. 555.

(2) If a member was in a missing status on June 25, 1970, and is determined to have died, the date of death shall be that date determined by the Secretary concerned for ending the crediting of pay and allowances as provided in 37 U.S.C. 555.

(3) Insurance in force on the date of death as determined under subparagraphs (1) and (2) of this paragraph shall not be payable to a beneficiary who as a result of the member's death received a gratuity payment under Public Law 89-214 (79 Stat. 880) unless such beneficiary agrees to refund the amount of the gratuity received.

[36 FR 3808, Feb. 27, 1971, as amended at 37 FR 25041, Nov. 25, 1972]

§ 9.6 Waiver or reduction of coverage.

(a) A member may waive his right to group coverage or elect to reduce the

amount of insurance from $15,000 to $10,000 or $5,000 by filing a written notice with his uniformed service. In any case where a member's uniformed service receives a waiver or reduction prior to the date any group coverage would become effective, no insurance shall be placed in effect on the lives of those members who waive coverage and those who elect reduced coverage shall be insured for only $10,000 or $5,000, as the case may be, from the date coverage becomes effective.

(b) Basic coverage, § 9.5(a), in effect before a waiver or reduction is filed will terminate or be reduced at midnight of the last day of the month such notice is received by a member's uniformed service. Where a waiver or reduction is filed for basic coverage, it is effective for the entire period of active duty or active duty for training and for any period of time after termination of duty during which the coverage is or would be extended. If, following termination of duty, the member reenters duty (in the same or another uniformed service) the waiver or reduction will not apply to the subsequent period of duty. (c) Reservist coverage, § 9.5(b) or (2), will terminate or be reduced at the end of the last day of the period of duty then being performed if the member is on active duty or active duty for training when the waiver or reduction is filed; at the end of the period of inactive duty training then being performed if the member is on inactive duty training when the waiver or reduction is filed; or on the date the waiver or reduction is received by his uniformed service if the member is not on active duty, active duty for training, or inactive duty training on the date the waiver or reduction is filed.

(1)

(1) When a member insured under reservist coverage, § 9.5(b) (1) or (2), waives his right to group coverage or elects a reduced amount of insurance, such waiver or election, unless changed, is effective throughout the period of the member's continuous reserve obligation in the same uniformed service. If, following termination of duty, the member reenters duty or resumes the obligation to perform duty (in the same or another uniformed service), the waiver or reduction will not apply to the subsequent period of duty or obligation.

(2) If a reservist insured under reservist coverage, § 9.5 (b) (1) or (2), is called or ordered to active duty or active duty for training under a call or order

that does not specify a period of less than 31 days and is separated or released from such duty and then resumes his reserve obligation, any waiver or election of reduced coverage made while eligible for reservist coverage, unless changed, shall be effective throughout the entire period of reservist coverage, the active duty or active duty for training period and 120 days thereafter and the period of immediately resumed reserve obligation providing the period of active duty or active duty for training is 1 year or less.

(3) If a reservist having coverage performs continuous active duty or active duty for training for more than 1 year, any waiver or election of reduced coverage made during such period of active duty or active duty for training or the prior period of reservist duty shall cease to be effective at the end of 120 days following termination of such active duty or active duty for training, except that if such member's coverage is continued beyond 120 days following termination of duty under § 9.7 (a), such waiver or election shall cease to be effective at the termination of such coverage.

(4) If a member, other than a member referred to in subparagraph (2) or (3) of this paragraph, upon termination of duty qualifying him for basic coverage under § 9.5(a) assumes an obligation to perform duty as a reservist, any waiver or election previously made by him shall not apply to coverage arising from his reservist obligation. Furthermore, during the 120 days following termination of such duty the basic coverage shall not be reduced by any waiver or election made by a member as a reservist.

(d) Members reentering on duty under paragraph (b) of this section or resuming a previously terminated obligation to perform duty under paragraph (c) (1) of this section or assuming an obligation to perform duty under paragraph (c) (4) of this section begin a new period of automatic coverage for $15,000 unless on or before the date of reentrance, resumption or assumption the member waives his right to automatic coverage or elects to be covered for only $10,000 or $5,000 for the new period of duty or obligation. Members having a continuing obligation to perform duty under the circumstances in paragraph (c) (3) of this section begin a new period of automatic coverage for $15,000 on the 121st day following separation or release from continuous active duty or active duty for training of more than 1

year unless on or before such 121st day the member waives his right to automatic coverage or elects to be covered for only $10,000 or $5,000 commencing on such 121st day. Coverage automatically provided or elected in a reduced amount in the situations referred to replaces any coverage in the same or a lesser amount in effect on the day before the first day of the new period of duty or obligation in paragraphs (b) and (c) (1) and (4) of this section or on the 120th day following separation or release in paragraph (c)(3) of this section. In no event will there be coverage for more than $15,000.

§ 9.7 Extension of coverage based on disability.

(a) Coverage of any member of the uniformed services on active duty or active duty for training on or after June 25, 1970, under a call or order to duty that does not specify a period of less than 31 days who is totally disabled at separation or release from such duty shall continue for 1 year after the date of separation or release from such duty, or until and including the date the insured ceases to be totally disabled, whichever is the earlier date, without further premium payments, but in no event shall such coverage cease prior to the expiration of 120 days after such separation or release. If a member insured under the provisions of law in effect prior to June 25, 1970, was separated or released from duty on or after February 25, 1970, but before June 25, 1970, and was totally disabled on the date of separation or release from such duty and such total disability continues beyond the 120-day period after separation or release the amount of coverage in effect at the time of separation or release from duty continues for 1 year after the date of separation or release from duty or until and including the date he ceases to be totally disabled, whichever is earlier.

(1) If a member whose coverage is extended under paragraph (a) of this section converts his group insurance (§ 9.26) to an individual policy which is effective before he ceases to be totally disabled or before the end of 1 year following termination of duty, whichever is earlier, and dies while group insurance would be in effect, except for such conversion, the group insurance will be payable, provided the individual policy is surrendered for a return of premiums and without further claim. When there

is no such surrender, any amount of group insurance in excess of the amount of the individual policy will be payable. (b) Coverage of any member on active duty, or active duty for training under a call or order to duty that specifies a period of less than 31 days, or on inactive duty training on or after June 25, 1970, who, while so covered incurs a disability or aggravation of a preexisting disability, is extended to death if the member dies within 90 days thereafter as the result of such disability, or for 90 days following the end of the duty period during which the disability was incurred or aggravated if such disability renders him uninsurable at standard premium rates under good health standards referred to in § 9.27.

§ 9.8 Restoration of coverage.

(a) Coverage is automatically restored without evidence of good health when subsequent to termination of all duty in his uniformed service, a member reenters on duty (in the same or another uniformed service) even when there is no break in service.

(b) Coverage that has been terminated under § 9.24 because of (1) absence without leave, (2) confinement by civil authorities under a sentence adjudged by a civilian court, or (3) confinement by military authorities under a courtmartial sentence involving total forfeiture of pay and allowance shall be automatically revived, together with any beneficiary designation for such insurance as of the date the member is restored to active duty with pay or to active duty for training with pay.

(c) Subject to approval by the insurer, coverage is restored in the amount applied for ($15,000, $10,000, or $5,000) effective the date of receipt of application with evidence of good health by the uniformed service:

(1) For a member who previously waived the right to be covered or elected to be covered for only $10,000 or $5,000;

or

(2) For a member who forfeited the right to be covered for one of the offenses listed in § 9.34 but who was restored to duty under conditions which, in effect, result in a remission of sentence. § 9.10 Deductions from pay.

(a) During any period in which a member, on active duty or active duty for training under a call or order to such duty that does not specify a period of

« PreviousContinue »