Forms
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). |
Log In |
Authorization to Release Health-Related Information | Authorize The Standard to release dental and/or vision insurance information to a designated recipient. |
Download |
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. |
Download |
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) |
Download |
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. |
Download |
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). |
Log In |
Dental Claim (All states except NY) | Use this form to report a treatment plan and to initiate a dental claim. |
Download |
Dental Claim (NY) | Use this form to report a treatment plan and to initiate a dental claim. For use in New York only. |
Download |
Dental Claim (Spanish - All states except NY) | Use this form to report a treatment plan and to initiate a dental claim (Spanish). |
Download |
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. |
Download |
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. |
Download |
EFT Setup for Long Term Disability Claim Payments (NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
Eye Med Vision Out of Network Claim | Used to initiate an out of network eye care claim. |
Download |
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). |
Log In |
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). |
Log In |
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. |
Download |
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. |
Download |
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. |
Download |
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. |
Download |
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) |
Download |
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. |
Download |
PFL Bonding Leave Packet (NY) | Use this packet for file a claim for bonding leave under Paid Family Leave in New York. |
Download |
PFL Care of Family Member Packet (NY) | Use this packet for file a claim for care of family member leave under Paid Family Leave in New York. |
Download |
PFL Military Leave Packet (NY) | Use this packet for file a claim for military exigency leave under Paid Family Leave in New York. |
Download |
PFML Bonding Leave Packet (MA) | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
PFML Bonding Leave Packet (WA) | Complete this packet to apply for Washington Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
PFML Care of Family Member Packet (MA) | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
PFML Care of Family Member Packet (WA) | Complete this packet to apply for Washington Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
PFML Military Leave Packet (MA) | 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. |
Download |
PFML Military Leave Packet (WA) | 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 |
PFML Own Serious Health Condition Packet (MA) | Complete this packet to apply for Massachusetts Paid Family and Medical Leave for your own serious health condition. |
Download |
PFML Own Serious Health Condition Packet (WA) | Complete this packet to apply for Washington Paid Family and Medical Leave for your own serious health condition. |
Download |
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. |
Download |
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. |
Download |
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). |
Log In |
State Disability Claim Packet (NJ) | Use this packet to file a claim through a New Jersey State Disability plan. |
Download |
State Disability Claim Packet (NY) | Use this packet to file a claim through a New York State Disability plan. |
Download |
Vision Claim Form (All states except NY) | Use this form to initiate a vision claim. |
Download |
Vision Claim Form (NY) | Use this form to initiate a vision claim. For use in New York only. |
Download |
Vision Claim Form (Spanish - All states except NY) | Use this form to initiate a vision claim (Spanish). |
Download |
Vision Claim Form (Spanish - NY) | Use this form to initiate a vision claim (Spanish). For use in New York only. |
Download |
VSP Vision Out of Network Claim | Used to request out of network eye care expense reimbursement. |
Download |
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. |
Download |
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. |
Download |