Evidence of Insurability (EOI), also known as a statement of health, is an application process in which you provide an insurance carrier with details about your health (or your dependent’s health). In simple terms, you can think of it as proof of good health.
An EOI application requires review and approval by the carrier before certain life and/or disability insurance policies become effective.
When is it needed?
Evidence of Insurability (EOI) comes into play in two scenarios:
- You want coverage higher than the “guaranteed issue”—this is the amount of insurance available to an employee regardless of health status.
- You missed your one-time* opportunity for the guaranteed issue, and you’re now required to complete the EOI process for coverage (even for coverage that is at or below the guaranteed issue amount).
*Guaranteed Issue is a one-time opportunity (almost always).
The guaranteed issue is available the first time you’re offered the benefit as an employee (you don't get the chance again at subsequent open enrollments or when you have a qualifying life event). Either you just became eligible for benefits, or this is the first time your employer is offering the benefit.
In rare instances, there may be another guaranteed issue opportunity: if your employer changes insurance carriers (and it's the first time you're being offered the benefit through this carrier) or if your employer has negotiated an exemption.
Qualifying Life Events don't provide a second chance for the guaranteed issue.
For example, let’s say you didn’t enroll in life insurance when it first became available to you, but you just got married and you’ve changed your mind. Let’s also say you want coverage that is at the guaranteed issue amount.
You’ll be required to provide EOI. Your spouse won’t need to provide EOI; however, dependent coverage is contingent on the employee having insurance. This means your EOI will need to be approved.
Why is it needed?
The insurance carrier uses EOI information to determine whether you (or your dependent) have any health issues or pre-existing conditions that might disqualify you from coverage. It can also affect how much your premiums cost.
What does it ask about?
The EOI form asks for basic information, such as:
- Date of birth
- Health history
- Primary care physician's contact information
Be thorough when completing your EOI. Leaving out important information is considered insurance fraud.
If the insurance carrier needs more information to make a decision, you may be asked to undergo a physician’s examination and/or blood tests. If so, this will be done at the expense of the carrier, not you.
What if I have a pre-existing condition?
If you have a pre-existing condition, then you may not qualify for additional coverage. However, a pre-existing condition doesn’t prevent you from getting a policy for the guaranteed issue amount.