Updated: January 21, 2022
We will continue to accept the Confirmation of Illness form for STD claims submitted for COVID-19 or symptoms of COVID 19. This form is for COVID Short-Term Disability (STD) claims with a maximum duration of 10 days. The form has been updated.* Please be sure to access and submit the most recent version.
If a plan member is still not able to work after 10 days, they will need to submit an Attending Physician Form.
We reinstated our standard requirement for a completed Attending Physician Statement as part of a new claim submission, effective November 1, 2021. The Attending Physician Statement must be completed by a Physician or Nurse Practitioner.
* Fillable web forms may not work in certain internet browsers such as Google Chrome. If this occurs, you can try: Right clicking on the form and select “Save link as” to your desktop. The saved PDF on your desktop should open.