Forms

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

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

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

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

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

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

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

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

Used to initiate an out of network eye care claim.

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

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

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.

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

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

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

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

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

Use this form to initiate a vision claim.

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

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

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

Used to request out of network eye care expense reimbursement.

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

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

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.

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