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LTD, LTC &  Life Forms for Download:  All forms in Acrobat .pdf format unless otherwise noted.

The Standard LTD Policy #:       146481
Unum LTC Policy #:                    220185

Contact Info for UNUM:                           Contact Info for The Standard:

 500 West Monroe                                   Life Claims 800-628-8600 
 Suite 3400                                        
Life Benefits Department
 Chicago, IL 60661                            PO Box 2800
  (800)-633-7479                                                Portland OR  97208 


                                                           Long Term Disability Claims
                                                           Ph:   800-368-1135
                                                           Fax: 971-321-8400
                                                           Employee Benefits Department
                                                           PO Box 2800
                                                           Portland OR 97208
                      

The Standard  Long Term Disability Forms and Info: 
  1.     Standard Enrollement & Change Form
  2.     Standard Group Life Ins. Summary Plan Description
  3.     Standard Group LTD Cert and Summary Plan Desc
  4.     Standard Life Insurance Benefits Claim Form
  5.     Standard LTD Claim Form
  6.     Standard AD&D Claim Form
  7.     Standard Survivor Income Application
  8.     Standard Waiver of Life Premium Form
Other Unum provided services  
  1. Worldwide Emergency Travel Assistance
  2. Work Life Balance Program

 

         Long Term Care Forms and Info: 
  1. Long Term Care Employee enrollment form
  2. Long Term Care Family enrollment form
  3. Long Term Care Benefit Highlight Sheet
  4. Long Term Care Rate Sheet
  5. Long Term Care Certificate Booklet
  6. Long Term Care Conversion Form – Use this form when LTC coverage is terminating.

Each employee at Nagle Hartray Danker Kagan McKay Penney 
has a life and accidental death and dismemberment benefit. 
 Please see Human Resources to determine the amount of coverage available.

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