Evidence of Insurability (EOI) refers to the procedure where individuals submit details about their health or their dependents’ health to qualify for specific insurance plans. It’s an essential initial step in obtaining insurance coverage, aiming to address potential questions about the applicant’s health status and future care needs.
What Is Evidence of Insurability (EOI)?
Evidence of Insurability (EOI) is a key part of the employee benefits communication process. It’s the process of discovering healthcare information for employees and dependent verification in order to determine their qualifications for certain life and health insurance coverage. It is an application that will be submitted to the insurance provider for approval before any coverage can begin.
This medical history documentation will be used to decide what level of coverage is needed as well as what kind of coverage is necessary. Due to medical diagnoses or other life events, employees may seek increasing levels of healthcare, and insurers will want insights into why this is necessary.
Many insurance providers require evidence of insurability questionnaires prior to providing health coverage. For example, as a patient has smoked in the past over the history of cancer or recent hospitalizations, this will all be disclosed in the questionnaire.
Most insurance providers have a portal where you can submit your EOI online, making the process as simple as possible. Employees may also choose to submit a paper application provided by HR. Each format should include step-by-step instructions on how to fill it out and submit it. From start to finish, the process shouldn’t take more than 20 or 30 minutes.
Requirements To Show Evidence
When requesting medical history documentation, the information is fairly standardized. It will include applicant and diagnosis information as well as employer details. If the insurer requires more details, a specific request will be provided.
Any requested information must be provided in full in order for the application to be approved. It is the responsibility of the applicant to ensure all information is as accurate as possible.
Questions Normally Asked
Here is a general breakdown of common application questions.
- Group number
- Date of birth
- Height and weight
- Personal identification and contact details
- Employer info
- Date of hire
- Current coverage details
- The requested new coverage
- Existing medical conditions you have
- Date of diagnosis and treatments undergone
- Contact information for care providers
When To Complete An EOI
An EOI isn’t required all the time. There are three general scenarios that could arise for the employee or the dependent where the need arises to submit an EOI.
- In the case of a late applicant
- Non-Evidence Maximum (NEM) has been selected
- Optional coverage has been selected (AD&D, life insurance, critical illness)
Late Applicant Scenario
John lost his coverage on July 1st, so his wife Jane plans to add him to her employee benefits. She must do so by July 31st. However, Jane has been swamped and neglected to do so by the deadline. Jane must now submit an EOI form for John to have approved by her carrier before John can be added.
Non-Evidence Maximum (NEM)
The applicant chooses the option to enroll in life insurance. This option offers double the annual salary with a NEM of $100k. If the applicant earns $80,000 annually, double their salary is more than the NEM amount ($160k). An EOI must be submitted for the additional $60k.
Optional Coverage Has Been Selected
Any coverage that is more than the employer’s basic offering generally has a $0 threshold. If the applicant desires an additional $100k in life insurance coverage, an EOI application must be submitted.
Types Of Insurance That Requires EOI
An EOI is typically required for any insurance beyond the typical levels of individual health coverage. If there is an excess of the regular policy coverage, any optional coverage such as life insurance, or life-changing event coverage such as an accident or disability insurance.
When Do You Need To Submit An EOI Form?
Depending on the applicant’s employment status, there are several different timeframes that provide the opportunity to submit an EOI form.
- When enrolling in or increasing Optional Term Life coverage
- Within 31 days of a QLE
- During the standard open enrollment
- Within 31 days of retirement
- Enrolling as a dependent within 31 days of a QLE
How Evidence of Insurability (EOI) Works
Applications should be filled out as accurately as possible with the Medical History Statement (MHS), and any initial evidence required. This is then submitted via online portals or via mail or fax.
After the request is made for additional coverage and the application has been submitted, the information will be reviewed. The insurer will approve the application, deny coverage, or request additional information or evidence.
Key Takeaways About EOI
Be prepared to fill out all medical history information by having medical records or paperwork available. It may also be required to undergo additional medical exams. For any disability or life insurance policies, assume an EOI will be required. If additional information is required, the process may be delayed as the applicant collects the requested evidence.
Benefits technology may be able to help you with EOI forms. Learn more about how ebm can help.