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Accident Benefit Claim Form |
Use this form to file an Accident insurance claim. |
17502 |
|
Authorization to Release Health-Related Information |
Authorize The Standard to release dental and/or vision insurance information to a designated recipient. |
11702 |
|
Balanced Care Vision Plan III Claim |
Use this form to initiate an eye care claim. |
SI 14068 |
|
Critical Illness Benefit Claim Form (Not in NY) |
Use this form to file a Critical Illness insurance claim. |
17503 |
|
Dental Claim |
Use this form to report a treatment plan and to initiate a dental claim. |
SI 3943 |
|
Dental Claim (NY Only) |
Use this form to report a treatment plan and to initiate a dental claim. For use in New York only. |
SNY 3943 |
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EFT Setup for Long Term Disability Claim Payments |
Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
SI 9571 |
|
EFT Setup for Long Term Disability Claim Payments (NY Only) |
Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
SNY 9571 |
|
Eye Med Vision Out of Network Claim |
Used to initiate an out of network eye care claim. |
SI 14070 |
|
Health Maintenance Screening Benefit Claim Form |
Use this form if you have the Health Maintenance Screening Benefit through your employer. |
17430 |
|
Hospital Indemnity Benefit Claim Form (Not in NY) |
Use this form to file a Hospital Indemnity insurance claim. |
17504 |
|
Long Term Disability Claim Packet (Not in NY) |
Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York. |
SI 3379 |
|
Long Term Disability Claim Packet (NY Only) |
Use this packet to file a claim for a Long Term Disability plan issued in the state of New York. |
SNY 3379 |
|
New Jersey State Disability Claim Packet |
Use this packet to file a claim through a New Jersey State Disability plan. |
SI 9426-RCO |
|
New York State Disability Claim Packet |
Use this packet to file a claim through a New York State Disability plan. |
SNY 9457 |
|
PFL Bonding Leave Packet (NY Only) |
Use this packet for file a claim for bonding leave under Paid Family Leave in New York. |
SNY 19378 |
|
PFL Care of Family Member Packet (NY Only) |
Use this packet for file a claim for care of family member leave under Paid Family Leave in New York. |
SNY 19379 |
|
PFL Military Leave Packet (NY Only) |
Use this packet for file a claim for military exigency leave under Paid Family Leave in New York. |
SNY 19380 |
|
Short Term Disability Claim Packet (Not in NY) |
Use this packet to file a claim for a Short Term Disability plan issued outside of the state of New York. |
SI 2047 |
|
Short Term Disability Claim Packet (NY Only) |
Use this packet to file a claim for a Short Term Disability plan issued in the state of New York. |
SNY 2047 |
|
Specified Disease Benefit Claim Form (NY Only) |
Use this form to file a Specified Disease insurance claim. |
SNY 17503 |
|
Specified Disease Benefit Claim Form (Vermont Only) |
Use this form to file a Specified Disease insurance claim. |
17503 VT |
|
Vision Claim Form |
Use this form to initiate a vision claim. |
SI 14068 |
|
Vision Claim Form (NY Only) |
Use this form to initiate a vision claim. For use in New York only. |
SNY 14069 |
|
Vision Claim Form (Spanish - NY Only) |
Use this form to initiate a vision claim (Spanish). For use in New York only. |
SNY 14069 SPU |
|
Vision Claim Form (Spanish) |
Use this form to initiate a vision claim (Spanish). |
SI 14068 SPU |
|
VSP Vision Out of Network Claim |
Used to request out of network eye care expense reimbursement. |
SI 14071 |
|
Waiver of Premium Claim Packet (Not in 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. |
SI 1284 |
|
Waiver of Premium Claim Packet (NY Only) |
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. |
SNY 1284 |