• Life Insurance (Basic) Beneficiary Designation/Change form (for laid-off employees) (SI 11210-645571)
  The Standard Insurance Company's fillable beneficiary form for exempt employees. Can be completed on-line, printed, signed, then mailed to The Standard Insurance Company at the address on the form.

• Life Insurance (Basic) Continuation Form (ADM 4302) (for laid-off employees)

• Life Insurance (Supplemental) Conversion Privilege form (for exempt employees)
  Exempt employees may use this form to convert their supplemental (employee-paid) term insurance to whole life insurance upon leaving active state employment.

• Life Insurance (supplemental) Enrollment and Beneficiary Designation Form (for exempt employees)
  Union-represented employees should consult the Union Benefits Trust at 800-228-5088 for information. Click here for detailed information about using this form.

• Life Insurance, The Standard Insurance Claim Form (for Exempt Employees)
  This form should be used by beneficiaries to apply for benefits upon the death of a covered exempt State employee.

• Life Insurance, The Standard Insurance Dismemberment Claim Form (for Exempt Employees)
  This form should be used by exempt employees to file a work-related claim for loss of a limb, hearing or sight.

• Life Insurance, The Standard Accelerated Benefit Application (for Exempt Employees)
  This form may be used by exempt employees to apply for an advancement of benefits if diagnosed with a terminal illness.

• Life Insurance, The Standard Insurance Application for Portability (for Exempt Employees)
  This form should be used by exempt employees to apply for a continuation of their life insurance after leaving State employment
  
  
  

PLEASE NOTE: The free Adobe Acrobat Reader software is required in order to display and print these forms. Following the Adobe Acrobat Reader link above will take you to the Adobe Systems Web site, where you can download the latest version of Acrobat Reader. Follow the directions on the Adobe Systems Web page.

If you are unsure of which category your form falls into, click here for an alphabetized list of all available forms.