Important Documents and Forms
- Employee Enrollment Application
- Board Member Enrollment Application
- Schedule A for Beneficiary Designation
- Schedule B for Birth Registration
- Schedule C for Marriage Registration
- Beneficiary Questions & Answers
- Change Card
- Affidavit for Domestic Partner
- Termination of Domestic Partner
-
Retiree life Insurance Application
(under age 65) -
Options for Continuing Life Insurance
Due to Retirement - Release of Health Information
- Sample Loss of Coverage Form
- Part Time Resolution Template
- Employers' First Report of Injury/Illness
- Notice of Accident
- LTD Claim Packet
- Life Claim Packet
Applying for Life and LTD Coverage
For Additional Life or Long Term Disability that is declined or if the employee chooses to enroll AFTER the 31 day enrollment deadline, to add these coverages the emlpoyee needs:
- 1. A Change Card
- 2. Evidence of Insurability (Medical History Statement)
- 3. Approval by The Standard
What is evidence of insurability?
EOI is a statement or proof of a person's physical condition that is required to obtain certain types of insurance.
This applies to requests for LTD coverage or Additional Life for the employee and Dependent Life coverage for spouse.
Step 1
Complete the attached NMPSIA
Employee Change Card
Step 2
Complete the attached Standard
Medical History Statement
Step 3
Submit both forms to your
employer's Benefits Office. They will send to the NMPSIA administrator who will expedite to The
Standard for review.
If you do not want to send the Medical History Statement to your employer's Benefits Office, you may mail it to the address on the form. You MUST submit the NMPSIA Employee Change Card to your employer's Benefits Office before you mail the Medical History Statement to The Standard.
Note: The late enrollment process is available anytime, but for faster decision turnaround, apply between January and August. The annual Fall Open/Switch Enrollment is not the ideal time to apply.