How to Get Evidence of Insurability

Evidence of Insurability (EOI) is a process where individuals provide personal and health-related details to an insurance provider. This allows the insurer to evaluate the risk associated with extending coverage, determine eligibility for specific plans, and set appropriate premium rates.

Understanding Evidence of Insurability

EOI is a procedure where individuals provide health and lifestyle information to an insurance company. This allows the insurer to assess risk and confirm eligibility for specific plans. The information gathered helps the insurer make informed decisions regarding the terms of a policy.
Insurers request information including health history (past illnesses, surgeries, current medical conditions, medications) and lifestyle habits (tobacco or alcohol use, high-risk activities). This data helps the insurer understand the applicant’s health profile.

When Evidence of Insurability is Needed

EOI is required in several situations:
Applying for certain types of insurance for the first time, such as life insurance or long-term disability coverage.
Increasing existing insurance coverage amounts beyond a “guaranteed issue” limit. Many employer-sponsored group plans offer base coverage without EOI, but additional voluntary coverage or higher benefit amounts require this health review to ensure the increased coverage aligns with the individual’s health status.
Reinstating an insurance policy that has lapsed due to non-payment or voluntary cancellation.
Enrolling in employer-sponsored group benefits outside an initial enrollment period (as a “late applicant”).
Adding a new dependent to specific plans, especially if outside a designated enrollment window or for higher coverage levels.

Preparing Your Evidence of Insurability Application

Preparing an EOI application involves gathering information and potentially undergoing assessments.

Required Information

Collect personal details like your name, address, contact information, date of birth, height, and weight. Compile health information, including past diagnoses, surgeries, current medications, medical treatments, and family health history.

Health Questionnaire

The EOI application includes a health questionnaire. This form asks about your medical background, current health conditions, and lifestyle habits. Provide accurate and complete answers, using medical records or your doctor’s contact information if needed. Misrepresenting or omitting information on this questionnaire can lead to future issues, including the denial of claims.

Medical Examination

A medical examination may be required, depending on the coverage type and amount. This can be a paramedical exam conducted by a medical professional, or specific tests like blood work, urine samples, or an electrocardiogram (EKG). Follow any insurer instructions, such as fasting or avoiding certain medications, before the appointment.

Consent Forms

Sign consent and authorization forms. These forms permit the insurance company to obtain your medical records directly from your healthcare providers. This step allows the insurer to verify the information provided in your application and health questionnaire.

Obtaining and Submitting Forms

Obtain EOI forms from your employer’s human resources department, the insurance provider’s website, or an insurance agent. Fill out all required fields accurately. This preparation phase can take a few days to several weeks, depending on your health history and insurer requirements.

Submitting and Awaiting a Decision

After preparing your EOI application, submit it through an online portal, by mail, or via your employer’s HR department or an insurance agent. Online submission is often the most efficient.

Underwriting Review

The application then undergoes an underwriting review by the insurance company. Underwriters are professionals who evaluate the risk associated with insuring an individual by carefully reviewing all the provided EOI documentation. Their assessment considers health history, lifestyle factors, and other relevant information to determine if you meet coverage criteria.
The insurer may request additional information or clarification. You will be contacted directly for these requests. Promptly providing follow-up information helps prevent delays.

Decision and Timeline

The decision on your application is communicated, usually by letter. Outcomes include:
Approval
Approval with modifications (e.g., adjusted coverage amounts or premiums)
Denial of coverage
The typical timeframe for a decision ranges from three to eight weeks, but may extend during peak enrollment periods or if extensive additional information is needed.
Upon approval, coverage becomes effective on the date outlined by the insurer. Final premiums are confirmed based on the underwriting assessment.