Medical History Statement: For classified staff


If you'd like to enroll in or add to your existing optional life insurance coverage or enroll in Long Term Disability, you must apply to the Standard Insurance Company by completing and submitting a Medical History Statement Form, below, as evidence of insurability. If you are approved, Standard will notify CU, and you will be enrolled in the approved amount on the first of the month following the date of your approval, or on July 1, 2019—whichever is later.

Last updated: 4/2012

Download this form below.