How to submit a Medical History Statement for Long Term Disability and/or Additional Life Insurance for an Employee and/or Spouse/Domestic Partner

 

This site will guide you through the steps to complete and submit a Medical History Statement (MHS). The MHS form is required for your application to obtain new or enhanced insurance coverage with The Standard.

Before you proceed to the blue button below, you must apply for the coverage requested as stated in Step 1. For additional information, review this FAQ link.

Step 1 Apply for coverage. Review the FAQ and proceed to the last question on page 1 of 3 for details on how to enroll. If you have not completed this step, please return to this page once Step 1 is complete.
 
Step 2

Submit your Medical History Statement via the blue button below. To enroll for employee Long Term Disability as well as to add/or increase employee and/or spouse/domestic partner Additional Life insurance you will be asked a series of questions that will take approximately 10-20 minutes to answer. Your progress will be indicated at the top of each page.

Before you begin, please have the following information available:

  • Employee's employment details… Date of hire and Earnings
  • Types and amounts of coverage you are requesting… Long Term Disability (employee only) or Additional Life insurance (employee and/or spouse/domestic partner)
  • Coverage details…Additional Life insurance amounts currently in force and Life insurance amounts requested (in $10,000 increments). For employee requests: do not include the APS paid $10,000 Basic Life policy amount when responding to "What amount of life insurance does this applicant currently have?"
  • Personal identification…Social Security Number, Date of birth, Place of birth, Mailing address, etc.
  • Medical conditions… Diagnoses, Types of treatment and Dates for treatment
  • Physicians or clinics…Names, Addresses and Phone numbers

Note for Spouse/Domestic Partner Applicant
If this evidence of insurability submission is for a spouse/domestic partner applicant, he or she must complete the medical history statement and electronically sign this submission.

Spouse/Domestic Partner must select the Basic Family Dependent Life option (along with any Additional Spouse/Domestic Partner Life request) and complete as shown in the example below:

 
 

Note for All Applicants: Only apply once and wait for the decision before applying again.