How to Enroll for Long Term Disability and Short Term Disability Insurance

If you are electing an amount of coverage above the Guarantee Issue Limit of $2,000, you will need to complete a Medical History Statement. Follow the simple steps below to apply.

1. Complete the Physician Enrollment Form to apply for coverage.
2. Complete a Medical History Statement for coverage to become effective.

Follow the steps below to complete a Medical History Statement.

• Select your state of residence. Select the View Form button to open the form. Complete the form online.
• Print using either the Print button at the end of the form or the print icon located on the Adobe toolbar.
• Sign and date the form, then make a copy for your records.
• Mail the completed form to the address noted at the top of the form.

Please contact SMA Services, Inc., with questions about coverage options and Evidence of Insurability requirements.