Evidence of Insurability (EOI) Secure Link Request

Complete the Medical History Statement online

You can apply to enroll or increase coverage for additional life or dependents life insurance using the Standard's secure online form. Please carefully read all the information on this form and then fully complete the information, below. Once we have all of the information (including the Tennessen acknowledgement, we will provide you with the link.


Approval process

After you submit the online form, The Standard will review the Medical History Statement. You may be contacted by The Standard to provide additional information. You will receive notification to your home address regarding whether your request for additional coverage has been approved or denied by The Standard.


Deductions from Payroll

After you are approved, you will receive a letter from HR-Benefits requesting that you contact HR-Benefits using CityLife to indicate if you would like your deductions for that coverage to be taken pre-tax or after-tax. For assistance contact 612-673-2282 ext 2.

If HR-Benefits does not hear from you, your additional life and/or dependents life insurance will be deducted pre-tax. You will be able to change your election the following open enrollment.


Tennessen

The data requested allows The Standard to determine eligibility for you and your dependent(s) in the City sponsored life insurance plan(s) and allows The Standard and the City the ability to establish an enrollment record for you and your dependent(s). You are not required to provide this information, however, failure to do so may result in ineligibility and non-enrollment. This form may be available to the City's and The Standard's employees or agents for purposes related to the insurance you may have or for which you apply, to The Standard's affiliates who provide insurance or financial products and services to you, to those with whom The Standard has a joint marketing agreement, or to others through the subpoena or as permitted or required by Federal or State law. For further details, please see The Standard's Privacy Notice at www.stancorpfinancial.com.

 
 
 
 

Please provide the email address you would like this for sent to. Please type carefully.

 

Please provide a phone number we can use to reach you should we have questions about your request.

 

I acknowledge that I have read and understand the Tennessen provided above.