![]() ![]() For use in New York only.ĭental Claim (Spanish - All states except NY) ![]() Use this form to report a treatment plan and to initiate a dental claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team). Log in to file a Critical insurance claim. Use this form to designate beneficiaries for an insurance plan issued in the state of New York (Agility only). Use this form to designate beneficiaries for an insurance plan issued in all states except New York (Agility only).īeneficiary Designation Form (NY) - Agility (Spanish) For use in New York only.īeneficiary Designation Form (All states except NY) - Agility (Spanish)Īuthorization to Release Health-Related Information (Spanish - NY)Īuthorize The Standard to release dental and/or vision insurance information to a designated recipient. For use in New York only.Īuthorization to Release Health-Related Information (Spanish - All states except NY)Īuthorize The Standard to release dental and/or vision insurance information to a designated recipient. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team).Īuthorization to Release Health-Related InformationĪuthorize The Standard to release dental and/or vision insurance information to a designated recipient.Īuthorization to Release Health-Related Information (NY)Īuthorize The Standard to release dental and/or vision insurance information to a designated recipient. Log in to file an Accident insurance claim. ![]()
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