Evidence of Insurability

What Is Evidence Of Insurability (EOI)?

The process of obtaining healthcare information for workers and dependent verification in order to assess their eligibility for a particular life and health insurance coverage is known as "evidence of insurability" (EOI). Before any coverage may begin, an application will be sent to the insurance company for approval.

Individual health data is provided by life insurance plan members to the insurance carrier as Evidence of Insurability (EOI). This is frequently accomplished via written documentation, like a medical questionnaire.

Why Is EOI Used?

The information provided in this medical history paperwork will be utilized to determine the kind and degree of coverage that is required. Insurance companies will want to know why an employee needs a higher degree of care as a result of a medical diagnosis or other life circumstances.

Before offering health coverage, several insurance companies demand proof of insurability through questionnaires. For instance, the questionnaire will ask if the patient has ever smoked and if they have a history of cancer or recent hospitalizations.

When To Complete An EOI

A request for proof of insurability from a person by an insurance provider often arises in one of three situations.

To Claim Coverage For An Amount More Than The Non-Evidence Maximum

The Non-Evidence Maximum is the highest level of protection an employee may receive without submitting proof of insurability. Any benefit that is salary-based will also have a Non-Evidence Maximum (NEM) cap. An EOI form must be filled out if an employee qualifies for more money than the NEM amount.

Requesting Optional Benefits

Optional benefits like optional life, optional AD&D, and optional critical illness are covered by several group benefit plans (for both employees and their spouses and children in some cases). These benefits are optional, as their name implies, but if an employee decides to apply for them, an EOI form must be filled out.

If A Dependent Or Employee Is Classified As A Late Applicant

The advantage of a group benefits plan is that if someone enrolls within 31 days of the plan's effective date, they are not needed to present documentation proving that they are in good enough condition to be insured. However, the employee will be regarded as a late application if the 31-day grace period is not met.

The majority of the time, an EOI is needed for insurance that goes beyond the normal individual health coverage, such as extra coverage beyond what is typically covered by the policy or more specialized insurance like accident or disability insurance.

What Insurance Types Require EOI?

Not all policies demand this extra supporting information. However, it can be necessary for applications for life and disability insurance.

How EOI Works

Depending on the insurer and the kind of insurance, different EOI procedures apply. Regardless of the specifics, applicants will be informed by insurers—often by letter or email—if they must start the EOI procedure.

EOI nearly usually asks candidates to submit a thorough health questionnaire, which may include questions about recent hospitalizations, smoking or drinking habits, and personal and family medical histories. Additionally, the questionnaire could request information about work, insurance status, and healthcare providers' contact information. Giving false information on EOI paperwork may be considered insurance fraud.

Underwriters from the insurance company will often analyze the questionnaire as the next step to assess if the applicant is insurable or whether more information is required. A physical examination, including a blood test and/or copies of medical records, might be requested by the insurer.

An applicant may be refused coverage owing to a lack of information if they do not reply to the insurance company's request for further information within a specific amount of time.

The insurer will tell the applicant of approval or refusal as soon as they have adequate data to assess insurability.

Conclusion

A medical questionnaire called an EOI form, often called a health statement, is used to gather data about a person's medical history.

It is crucial to thoroughly fill out this questionnaire since applications that are not complete will be returned for more details, delaying the decision-making process. Remember that the filled-out application serves as a legal document that is a component of the insurance contract.