Evidence of Insurability

Evidence of Insurability (EOI) provides information on the condition of your health or a dependent’s health in order to be qualified for certain life insurance coverage. The application itself requires approval from your insurance provider or carrier before the coverage will take effect. It is essentially a statement of medical history, which can be used to determine what kind of coverage, as well as what level of coverage, is applicable. Therefore, if an employee is requesting coverage or increasing coverage significantly, the insurer will want to know the reasons as to why there is a sudden increase in coverage. While there are many legitimate reasons for such a request, i.e. having children, etc., others may seek an increase if he or she suddenly falls ill and has a drastically decreased life expectancy.

EOI protects an employer’s group insurance program from otherwise adverse risks. Therefore, if someone has a poor medical history, he or she may not be approved for certain insurance coverage due to the likelihood of disproportionate claims and risk associated with covering that individual.

While most employer sponsored life policies offer guaranteed coverage, EOI may be required if you apply for a level of coverage higher than the guaranteed rate. If the EOI is in fact required, then you must fill out the documentation entirely while also providing certain medical documents so that the underwriter can further review the risks associated with enrolling you in such coverage.

When Is It Required?

  • When an employee applies for contributory coverage more than 31 days after first becoming eligible to apply for such coverage.
  • When an employee applies for contributory dependent coverage more than 31 days after first becoming eligible.
  • When an employee enrolls in or increases optional term life coverage due to qualifying events, i.e. sickness of oneself or an immediate family member
  • For insurance coverage requests in excess of the group’s guaranteed coverage limit. For example, if the employer provides the each employee will be guaranteed life insurance coverage in an amount that is 2 times his or her base salary, and the employee requests additional insurance coverage exceeding that amount, an EOI will likely be required.
  • The insurance carrier can actually request an EOI under any circumstances, provided that the carrier has a reason for requesting such documentation. For example, if an employee is 55 years or older, then the insurance carrier can request that an EOI be filled out for each employee in this age bracket. Further, if the insurance carrier has reason to believe that the employee is trying to utilize the system due to a recent sickness or injury, then the insurance carrier will request an EOI before offering an increased coverage amount.

If an individual does in fact request additional coverage after 31 days of becoming eligible, the insurance carrier will want to know the reason for the request. For example, if someone just found out that he or she is sick with a disease that will drastically reduce his or her lifespan, the insurance carrier may not increase the employee’s insurance coverage for that reason.

How to Submit an EOI

You can submit your EOI online, which may be an easier and quicker process for you. However, if you choose to submit a printable EOI application, you can request the application from your employer’s HR department. The application provides step-by-step instructions on how to fill it out. The entire application generally takes 15-30 minutes. It is important that you have all required information to fill out the application, which includes:

  • Your group number
  • Your employer’s name/address
  • The reason the EOI is required
  • The type and amount of coverage you are requesting
  • You name/DOB/Social Security Number
  • Your height and weight
  • Your most recent pulse and blood pressure information
  • Your most recent EKG, blood test, and urinalysis results, if applicable
  • Medical treatment history
  • Medications you are currently taking
  • Your physician’s name/address
  • Any ongoing treatment you are receiving, including the name of the treatment provider and what the treatment is for

Keep in mind that the insurer may request additional information after reviewing your EOI, including the disclosure of your medical records. If this is the case, the insurer will also send a letter requesting such information from your physician’s office. However, you will need to consent to the release of your records before the physician’s office will provide such records to your insurer. Be mindful that there is an exception to this rule; particularly, if you deny the disclosure of such forms, the insurer can still deny you the additional coverage you are seeking. The insurer may even request that you take additional medical tests, in which you will take the tests and that specific physician’s office will report the results to the insurer. If you are ultimately denied additional coverage from the insurer, you can appeal the decision in writing, providing an explanation as to the reason your request should not have been denied. You may also provide your insurer with additional medical records to assist them in making a more favorable decision.

If you would like to learn more about the EOI form, or what is required of you, you can post your legal need on UpCounsel’s marketplace. UpCounsel accepts only the top 5 percent of lawyers to its site. Lawyers on UpCounsel come from law schools such as Harvard Law and Yale Law and average 14 years of legal experience, including work with or on behalf of companies like Google, Stripe, and Twilio.