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nN TRUCTIONS TO EMPLOYING AGEN‘ ( Who must file.—A}] employees iit excluded by law or regulation from insurance coverage, including those who have previously waived coverage, are required to com- plete and file Standard Form 176-T. Employees who are m the service onFebruary 14, 1968, as well as those who are appointed after that date but before April 14, 1968, must file the form. . Automatic cancellation of previously filed waiv- ers.—-All “Waivers of Life Insurance Coverage” (SF 53) on file are automatically canceled as of the first day of the first pay period beginning on or after February 14, 1968. Payroll offices are to begin regular insurance deductions on the automatic cancellation date for employees who do not file a new waiver, i.e., those who do not check box € of SF 176-T, on or before that date. . Employees failing to file.—If an employee does not return a completed SF 176—T, contact him and urge him to do so even if he does not want optional insurance (he will, of course, be autornatically covered for regular in- surance). If he still fails to file SF 176-T by April 14, 1968, or at days after appe pointment, whichever ts lat file one for him as of that date: mark box B, and note in the space provided for his signature “employee con- tacted—failed to elect optional insurance.” See note 2 below. . Review of completed forma.—(a} Review both copies of the SF 176-T for legibility, completeness, and con- sistency. Reconcile with the employee any obvious major “I discrepancy such as a mark in more than one box (b) If the employee marked box A or box ©, make sur. the Statistical Stub is complete. Then detach and mail stubs, in a bundle, weekly to: Office of Federal Employees’ Group Life Insurance (Statistical Study} 4 East 24th Street New York, New York 10017 {c) If the employee marked box 8 detach and destro. the stub, . Date of receipt and effective date.—(a) Scamp datc of receipt by employing office in the space provided fc- this purpose on both the Original and the Duplicate. {b) The effective date is determined from the table be- low. . Disposition of forms.—(a) File the Original SF 176- T in the official personnel folder in all cases. (b) Any necessary payroll change, with effective date, may be posted in the space reserved on the Duplicatc for [i ‘mploy! Ang office (c) The Duplicate may be destroves’. 'f no payroll actio : is required, or after the requirements of the agency - payroll system have been met. . Use of SF 176-T.—SF 176-T “Election, Declinatio: or Waiver of Life Insurance Coverage” should not he used after the initial filing period ‘after April 14, 1968 A revised edition will be available fur use after that date TABLE OF EFFECTIVE DATES DATE SF 176-T } RECEIVED BY EMPLOYING OFFICE On or before February 14, 1968 EMPLOYEE'S DECISION Elects optional (ins addition to regu- fer) (box A). Declines om (but not régular) Waives regular (90 ineligible for optional) (box €). a ia “Coverage effective February 14, 1968. Dectination effective Fetiruary -14, 1 Waiver effective last day of pay peri- od in which February 14, 1968 EFFECTIVE DATE (IF NO WAIVER, SF 53, IN EFFECT; GF DEDUCTIONS | | pede moe eee ee OF DECISION Deductions begin lst day of 1st pay period beginning on or after February 14, 1968 968. Deductions <'.> jasi gav of pay period in which Februar- 14. 1968 falls. | falls, Elects optional (in addition te regu- ler) (box A). i Declines optional (but not regular) | (box 8). After february 14 but not later than Aprit 14, 1968. Cancels previously elected optional (but net regular) (box &). Waives regular (s0 ineligible for op- tional} (box €). NOTES: 1. Because regula: inaurance coverage end deductions are automatic uniess waived (by checking bor €), A and B eiections do net affect regula: a t Coverage effective on date of receipt. Deductions begin Ist day of Ist pay period beginning on or afte: date of receipt. Declination effective on date of re- caipt, but employee loses auto- matic optional protection on Feb. ruary 14, 1968. Cancellation effective iast day of pay period in which received. Warver cffective last day of pay peri od in which received. Deductions for optionar stop :-t day of pay pericd in whic > ceived Deduction: s'-5 fast day of pay pe. riod in wh.on received, aia eecrre oy 2. An employeaiochem tha agency files SF 176-T because he failed to fie is deemed to have declined optional, but not reguiar, inuurence. —_ 3. An employes with an uncenceled waiver (SF 53) an file cannet be insured eny eartier than the first dey he is in duty and pay status «- m pey perio’ be orning en or after February 14. 1968; filing of an SF 176—T before that date will not cancel en SF 53 any earlier. Geduction: begin the day he becomes insure 4. Tre affective date of reguiar (and optional) insurance coverage tor on employee whe has been on leave without pey for more than ! year pay and duty statu: Deduction: are affective the seme day Pt tae Ce ee a 2 she firet day vec oh