Traumatic Injury Protection Under SGLI

Traumatic Injury Protection Under SGLI

Orlando, FloridaMay 22, 2008

Training for Patient AdministratorsTraining for Patient Administrators

TSGLI BasicsTSGLI 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?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?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?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

DressingBathingEatingToileting TransferringContinence

What Losses are Covered by TSGLI?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?Can Losses Be Combined?

Example: Loss of ADL of dressing and bathing due to shrapnel injuries to torso requiring surgeries to reconstruct digestive system.

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

ExamplesExamples

Excluded LossesExcluded 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 MisconceptionsCommon 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 ProcessTSGLI Claims Process

Service MemberCompletes Part

A

Medical Professional

Completes Part B

NAVY TSGLI Office

Adjudicates and Certifies Claim

OSGLIBeneficiaries

Methods of PaymentMethods of Payment

• Electronic Funds Transfer

• Alliance Account

• Paper Check

Beneficiary Financial Counseling Service (BFCS)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 ContactNavy Points of Contact

Phone: (800) 368-3202

Email: MILL_TSGLI@navy.mil (MILL_TSGLI@navy.mil)www.npc.navy.mil/CommandSupport/CasualtyAssistance/TSGLI/

• Navy claims: 168 paid for $10.3 million

• Average amount paid: $61,310

TSGLI - TSGLI - Program Status for Program Status for NAVYNAVY

TSGLI - TSGLI - Program Status for Program Status for NAVYNAVY