Evidence of Insurability

HR Glossary for HR Professionals

Glossary of the most common HR terms and acronyms to assist professionals navigating the ever-growing and ever-changing world of HR terminology.

Evidence of Insurability

What Is Evidence of Insurability?

Evidence of Insurability (EOI) refers to:

  1. The process of verifying an individual’s good health to qualify for insurance
  2. The documentation required as part of that process

Not all insurance requires EOI as part of the overall application process, but it is more common for disability and life insurance. Insurance carriers use EOI for the underwriting process to calculate how risky an applicant is to insure.

When Is Evidence of Insurability Needed?

EOI is most often required for insurance beyond typical individual health coverage—such as an amount in excess of the regular policy coverage or additional, specific coverage like accident or disability insurance.

EOI may be required if a beneficiary adds a dependent not covered under a previous policy, if there’s been a lapse in coverage, or if an applicant is seeking coverage after being previously declined.

Finally, life insurance policies over the guaranteed issue amount will require EOI for approval. Each particular company has its own guaranteed issue threshold—usually around $25,000—and by definition, approval for the guaranteed issue amount or less is not conditional based on EOI.

What Is the Process for Evidence of Insurability?

EOI typically requires applicants to complete a detailed health questionnaire—which may ask for such information as personal and family medical history, smoking or drinking habits, or any recent hospitalization. The questionnaire may also ask for employment details, current insurance coverage, and contact information for healthcare providers. Providing misleading information on EOI documentation could be grounds for insurance fraud.

The next step often involves underwriters from the insurance carrier reviewing the questionnaire to determine insurability or whether further information is needed. The insurer could request copies of medical records and an examination with a blood draw.

Suppose an applicant does not respond to the insurance company’s request for more information within a limited window of time. In that case, the applicant could be denied coverage due to a lack of information.

Once the insurer has enough information to determine insurability, they will notify the applicant of approval or denial.

Related Terms: Health Insurance

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