Medical History Statement

Purpose

• If you'd like to enroll in or add to your existing optional life insurance coverage, you must apply to the Standard Insurance Company by completing and submitting a Medical History Statement Form, below, as evidence of insurability (EOI).
• Classified Staff applying for long-term disability coverage will also complete and submit a Medical History Statement Form.
• 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.

  Complete the Medical History Statement

Last updated: 6/2023