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).
Use this form to request and authorize an agreement for prearranged payments via Automated Clearing House. For use in New York only.
Use this form to request and authorize an agreement for prearranged payments via Automated Clearing House.
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.
Complete this packet to apply for Colorado Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.
Complete this packet to apply for Colorado Paid Family and Medical Leave to care for a family member with a serious health condition.
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.
Complete this packet to apply for Colorado Paid Family and Medical Leave for your own serious health condition.
Used to attest the need for Safe Leave, as defined on the form, when submitting a request for CO PFML Safe Leave benefits.
Complete this packet to apply for Colorado Paid Family and Medical Leave Safe Leave benefits.
Complete this packet to apply for Connecticut Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.
Complete this packet to apply for Connecticut Paid Family and Medical Leave to care for a family member with a serious health condition.
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.
Complete this packet to apply for Connecticut Paid Family and Medical Leave for your own serious health condition.
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).
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.
Use this Electronic Funds Transfer form to request and authorize a bank payment plan. For use in New York only.
Use this Electronic Funds Transfer form to request and authorize a bank payment plan.
Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments.
Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments.
Used to initiate an out of network eye care claim.
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 to file a Hospital Indemnity claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).
Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York.
Use this packet to file a claim for a Long Term Disability plan issued in the state of New York.
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 packet for file a claim for bonding leave under Paid Family Leave in New York.
Use this packet for file a claim for care of family member leave under Paid Family Leave in New York.
Use this packet for file a claim for military exigency leave under Paid Family Leave in New York.
Complete this packet to apply for Oregon Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child.
Complete this packet to apply for Oregon Paid Family and Medical Leave to care for a family member with a serious health condition.
Complete this packet to apply for Oregon Paid Family and Medical Leave for your own serious health condition.
Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York.
Use this packet to file a claim for a Short Term Disability plan issued in the state of New York.
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).
Use this packet to file a claim through a New Jersey State Disability plan.
Use this packet to file a claim through a New York State Disability plan.
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.
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.
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.
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.