Presentation on theme: "Traumatic Injury Protection Under SGLI Orlando, Florida May 22, 2008 Training for Patient Administrators."— Presentation transcript:
Traumatic Injury Protection Under SGLI Orlando, Florida May 22, 2008 Training for Patient Administrators
TSGLI Basics Effective December 1, 2005 $25,000 - $100,000 benefit Payable to service members who suffer a qualifying loss due to a traumatic event Provides a short-term financial assistance to members and their families to help with the expenses of recovery from severe injuries
Who Is Covered by TSGLI? All SGLI insured –TSGLI coverage is automatic with SGLI Coverage is 24/7 for all full-time SGLI insureds Retroactive coverage for those injured from 10/7/01 – 11/30/05 in OEF/OEF or combat zone tax exclusion areas
Who Qualifies for a TSGLI Payment? You must be insured by SGLI. You must incur a scheduled loss and that loss must be a direct result of a traumatic event. You must have experienced the traumatic event prior to midnight of the day that you separate from the uniformed services. You must suffer a scheduled loss within 2 years (730 days) of the traumatic event. You must survive for a period of not less than seven full days from the date of the traumatic event.
What Losses are Covered by TSGLI? Limb Amputations/Salvage Amputations of thumb, big toe, 4 fingers, or 4 toes Loss of sight, hearing, speech Paralysis of one or more limbs Burns
Facial Reconstruction Coma Loss of two of six activities of daily living due to traumatic brain injury or other injuries not already specifically listed as covered –For periods of 15, 30, 60, 90 days for TBI –For periods of 30, 60, 90, 120 days for other injuries –Continuous 15-day inpatient hospitalization can be substituted for initial 15 or 30 day ADL period Dressing Bathing Eating Toileting Transferring Continence What Losses are Covered by TSGLI?
Losses can be combined up to the maximum $100K benefit, with the exception of: Loss of two of six ADL due to injuries not specifically listed on the schedule Can Losses Be Combined? Example: Loss of ADL of dressing and bathing due to shrapnel injuries to torso requiring surgeries to reconstruct digestive system.
One leg amputated = $50,000 + Loss of hearing in one ear = $25,000 $75,000 Loss of sight in one eye = $50,000 + TBI with loss of ADL for 15 days = $25,000 $75,000 Loss of sight in one eye = $50,000 + Loss of ADL for 30 days from torso injury = $25,000 $50,000 Hospitalization for 15 days = $25,000 + Amputation of one arm = $50,000 $50,000 Examples
Excluded Losses TSGLI Intentionally self-inflicted injuries or attempts to inflict such an injury Use of an illegal or controlled substance that was not administered or consumed on the advice of a medical doctor Medical or surgical treatment of an illness or disease A traumatic injury sustained while committing or attempting to commit a felony A physical or mental illness or disease
Common Misconceptions NOT just a combat benefit NOT just for active duty service members NOT a compensation program NOT for minor or moderate injuries DOES NOT reduce the SGLI benefit
TSGLI Claims Process Service Member Completes Part A Medical Professional Completes Part B NAVY TSGLI Office Adjudicates and Certifies Claim OSGLI Beneficiaries
Methods of Payment Electronic Funds Transfer Alliance Account Paper Check
Beneficiary Financial Counseling Service (BFCS) Available to TSGLI beneficiaries Provides free, personalized financial counseling Beneficiary can ask questions or receive detailed financial plan Toll-free access to a financial counselor for 1 year
Navy Points of Contact Phone: (800) sistance/TSGLI
Navy claims: 168 paid for $10.3 million Average amount paid: $61,310 TSGLI - Program Status for NAVY