This site will guide you through the steps to complete and submit a Medical History Statement to The Standard. The Medical History Statement may be specific to your state of residence.
Completing the form will take approximately 15 minutes. Your progress will be indicated at the top of the page. After each set of questions, click the "continue" button. You will need to have the following information available before you begin:
If a Medical History Statement is required for spouse/domestic partner coverage, please provide them access to this site. The Medical History Statement must reflect that individual's health status and be completed and signed by the spouse/domestic partner.
For your protection, this application session will time out after 30 minutes of inactivity.
Please contact your Agency with questions about coverage options, spouse/domestic partner eligibility and Evidence of Insurability requirements.