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Title Purpose Action
Accident Benefit Claim Form

Log in to file an Accident insurance claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).

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ACH for Dental & Vision Customers Based in NY

Use this form to request and authorize an agreement for prearranged payments via Automated Clearing House. For use in New York only.

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ACH for Dental & Vision Customers Based Outside NY

Use this form to request and authorize an agreement for prearranged payments via Automated Clearing House.

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Authorization to Release Health-Related Information

Authorize The Standard to release dental and/or vision insurance information to a designated recipient.

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Authorization to Release Health-Related Information (NY)

Authorize The Standard to release dental and/or vision insurance information to a designated recipient. For use in New York only.

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Authorization to Release Health-Related Information (Spanish - All states except NY)

Authorize The Standard to release dental and/or vision insurance information to a designated recipient. (Spanish)

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Authorization to Release Health-Related Information (Spanish - NY)

Authorize The Standard to release dental and/or vision insurance information to a designated recipient. (Spanish) For use in New York only.

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Colorado Paid Family and Medical Leave Bonding Packet

Complete this packet to apply for Colorado Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.

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Colorado Paid Family and Medical Leave Care of Family Member Packet

Complete this packet to apply for Colorado Paid Family and Medical Leave to care for a family member with a serious health condition.

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Colorado Paid Family and Medical Leave Military Leave Packet

Complete this packet to apply for Colorado Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad.

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Colorado Paid Family and Medical Leave Own Serious Health Condition Packet

Complete this packet to apply for Colorado Paid Family and Medical Leave for your own serious health condition.

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Connecticut Paid Family and Medical Leave Bonding Packet

Complete this packet to apply for Connecticut Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.

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Connecticut Paid Family and Medical Leave Care of Family Member Packet

Complete this packet to apply for Connecticut Paid Family and Medical Leave to care for a family member with a serious health condition.

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Connecticut Paid Family and Medical Leave Military Leave Packet

Complete this packet to apply for Connecticut Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad.

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Connecticut Paid Family and Medical Leave Own Serious Health Condition Packet

Complete this packet to apply for Connecticut Paid Family and Medical Leave for your own serious health condition.

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Critical Illness Benefit Claim Form

Log in to file a Critical insurance claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).

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Dental Claim (All states except NY)

Use this form to report a treatment plan and to initiate a dental claim.

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Dental Claim (NY)

Use this form to report a treatment plan and to initiate a dental claim. For use in New York only.

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Dental Claim (Spanish - All states except NY)

Use this form to report a treatment plan and to initiate a dental claim (Spanish).

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Dental Claim (Spanish - NY)

Use this form to report a treatment plan and to initiate a dental claim (Spanish). For use in New York only.

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EFT for Dental & Vision Customers Based in NY

Use this Electronic Funds Transfer form to request and authorize a bank payment plan. For use in New York only.

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EFT for Dental & Vision Customers Based Outside NY

Use this Electronic Funds Transfer form to request and authorize a bank payment plan.

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EFT Setup for Long Term Disability Claim Payments (All states except NY)

Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments.

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EFT Setup for Long Term Disability Claim Payments (NY)

Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments.

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Eye Med Vision Out of Network Claim

Used to initiate an out of network eye care claim.

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Health Maintenance Screening Benefit Claim Form

Log in to file a Health Maintenance Screening claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).

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Hospital Indemnity Benefit Claim Form

Log in to file a Hospital Indemnity claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).

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Long Term Disability Claim Packet (All states except NY)

Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York.

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Long Term Disability Claim Packet (NY)

Use this packet to file a claim for a Long Term Disability plan issued in the state of New York.

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Massachusetts Paid Family and Medical Leave Bonding Leave Packet

Complete this packet to apply for Massachusetts Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.

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Massachusetts Paid Family and Medical Leave Care of Family Member Packet

Complete this packet to apply for Massachusetts Paid Family and Medical Leave to care for a family member with a serious health condition.

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Massachusetts Paid Family and Medical Leave Military Leave Packet

Complete this packet to apply for Massachusetts Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad.

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Massachusetts Paid Family and Medical Leave Own Serious Health Condition Packet

Complete this packet to apply for Massachusetts Paid Family and Medical Leave for your own serious health condition.

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Maternity Dental Benefit Authorization to Obtain and Release Information (All states except NY)

Authorize the release of medical information to The Standard for review for the Maternity Dental Benefit.

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Maternity Dental Benefit Authorization to Obtain and Release Information (NY only)

Authorize the release of medical information to The Standard for review for the Maternity Dental Benefit. For use in New York only.

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Maternity Dental Benefit Authorization to Obtain and Release Information (Spanish - All states except NY)

Authorize the release of medical information to The Standard for review for the Maternity Dental Benefit. (Spanish)

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Maternity Dental Benefit Authorization to Obtain and Release Information (Spanish - NY only)

Authorize the release of medical information to The Standard for review for the Maternity Dental Benefit. (Spanish) For use in New York only.

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New York Paid Family Leave Bonding Leave Packet

Use this packet for file a claim for bonding leave under Paid Family Leave in New York.

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New York Paid Family Leave Care of Family Member Packet

Use this packet for file a claim for care of family member leave under Paid Family Leave in New York.

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New York Paid Family Leave Military Leave Packet

Use this packet for file a claim for military exigency leave under Paid Family Leave in New York.

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Oregon Paid Family and Medical Leave Bonding Packet

Complete this packet to apply for Oregon Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.

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Oregon Paid Family and Medical Leave Care of Family Member Packet

Complete this packet to apply for Oregon Paid Family and Medical Leave to care for a family member with a serious health condition.

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Oregon Paid Family and Medical Leave Own Serious Health Condition Packet

Complete this packet to apply for Oregon Paid Family and Medical Leave for your own serious health condition.

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Short Term Disability Claim Packet (All states except NY)

Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York.

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Short Term Disability Claim Packet (NY)

Use this packet to file a claim for a Short Term Disability plan issued in the state of New York.

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Specified Disease Benefit Claim Form

Log in to file a Specified Disease claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).

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State Disability Claim Packet (NJ)

Use this packet to file a claim through a New Jersey State Disability plan.

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State Disability Claim Packet (NY)

Use this packet to file a claim through a New York State Disability plan.

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Vision Claim Form (All states except NY)

Use this form to initiate a vision claim.

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Vision Claim Form (NY)

Use this form to initiate a vision claim. For use in New York only.

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Vision Claim Form (Spanish - All states except NY)

Use this form to initiate a vision claim (Spanish).

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Vision Claim Form (Spanish - NY)

Use this form to initiate a vision claim (Spanish). For use in New York only.

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VSP Vision Out of Network Claim

Used to request out of network eye care expense reimbursement.

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Waiver of Premium Claim Packet (All states except NY)

If you have a life insurance policy issued outside of New York that includes the Waiver of Premium benefit, you can use this packet to request the waiver.

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Waiver of Premium Claim Packet (NY)

If you have a life insurance policy issued in New York that includes the Waiver of Premium benefit, you can use this packet to request the waiver.

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Washington Paid Family and Medical Leave Bonding Leave Packet

Complete this packet to apply for Washington Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.

Download
Washington Paid Family and Medical Leave Care of Family Member Packet

Complete this packet to apply for Washington Paid Family and Medical Leave to care for a family member with a serious health condition.

Download
Washington Paid Family and Medical Leave Military Leave Packet

Complete this packet to apply for Washington Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad.

Download
Washington Paid Family and Medical Leave Own Serious Health Condition Packet

Complete this packet to apply for Washington Paid Family and Medical Leave for your own serious health condition.

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