Policy_Document_-_STD_B_Amendment_6_OE.pdf

This is a group policy amendment issued by Standard Insurance Company to the County of Dane, Wisconsin, relating to short-term and long-term disability insurance services. Amendment No. 6 to Group Policy 163054-B became effective May 1, 2022, and modifies the evidence of insurability requirements for members seeking contributory insurance coverage. The amendment establishes an open enrollment period running from February 21, 2022, through March 18, 2022, during which employees may apply for contributory insurance without submitting evidence of insurability, provided they have not previously had health evidence rejected by the insurer or prior plan carriers.

The amendment specifies the conditions under which evidence of insurability remains required, including late applications for contributory insurance, coverage for members eligible for more than 31 days who were not insured under the prior plan, and certain reinstatements. When evidence of insurability is required, applicants must complete a medical history statement, authorize the insurer to obtain health information, undergo a physical examination if requested, and provide additional insurability information as reasonably required by the insurer. The amendment applies to the County of Dane's employee disability benefits program and outlines the underwriting standards necessary to process insurance applications and determine coverage eligibility.