What is EOI?

Insurance providers offer a valuable service, but in order to be a successful business, they need to ensure that customers are good candidates to insure. Evidence of insurability describes the process, formula, or qualifications the provider uses to determine a person’s eligibility for certain insurance policies they offer.

Purpose and Requirements of EOI

Evidence of insurability is a necessary element for insurance providers. Without any standards in place, insurance providers would destroy their bottom line by offering policies to individuals who wind up costing the company way more than they pay into it. The meaning of EOI is also taken to another level when you consider the impacts on everyone when bad actors get insured. When one person exhausts an insurance company’s resources, everyone else who is paying into their policy loses out because benefits may not be available when they need them. What’s more, all the ‘good’ policyholders will wind up paying more overall when they haven’t actually used any of the policy’s benefits.

That said, the main purpose of EOI is to ensure that insurance companies stay afloat and maintain profits.

Different insurance companies have different EOI requirements. If you are applying for medical insurance, then you’ll almost certainly need to provide some form of medical history documentation. Once you do, insurance adjusters can review your specific circumstances to make an appropriate coverage level determination. All that said, different insurers have different requirements. Some providers may simply ask you to fill out a survey and trust your word, while others may want to see specific, official records.

The EOI Process

The EOI process differs from provider to provider, but in general, you’ll first be asked to fill out a simple EOI form where you can self-report any significant health information, like if you smoke or you’ve been diagnosed with a serious condition. You should be as honest as possible on your EOI forms since the coverage available to you will be dependent on the accuracy of information you provide. Most employers now offer the option to apply via an online EOI submission, which streamlines the whole process.

Depending on your specific health details submission, you might be asked to provide further evidence regarding medical conditions or diagnosis information.

Once the information is received, your employer will analyze it and determine your coverage options based on your details. They’ll let you know what plans you’re eligible to apply for.

Common Scenarios Requiring EOI

An EOI form is fairly standard in certain situations, but you may not need to fill one out at all if you’re seeking out standard health coverage and you’re an average citizen with average health. The main purpose of insurability questionnaires is to identify potential customers who will (or likely will in the future) require excessive coverage. The most common scenarios that require an EOI include:

  • When you’re a late applicant or apply outside of the general enrollment period.
  • You selected non-evidence maximum as an option for your insurance coverage.
  • You selected additional insurance coverage options.

In general, you should expect to fill out an EOI anytime you’re looking for coverage outside of the standard level. Excess coverage requires additional information, so your insurer will want to know more about your situation.

You will also be expected to fill out an EOI form if you recently experienced an accident or a life-changing event.

Impact of EOI on Insurance Coverage

What does EOI mean in insurance terms and how it will impact your overall coverage? Your EOI will have a direct impact on your insurance qualification and the level of insurance coverage available to you. Sometimes, the information on your EOI will disqualify you from certain plans or coverage. Most of the time, though, you’ll simply need to provide further details about specific health conditions. In some situations, you may be asked to submit to medical exams.

Tips for Completing EOI Forms

As you complete your EOI forms, the best tip to follow is to be as accurate and honest as possible.

So, how do you get evidence of insurability? Depending on your specific situation, an EOI may not necessarily be required for you to get coverage. Some insurers only require an EOI when you opt for additional coverage or you’ve selected non-evidence maximum as a policy option.

To get evidence about your health, you can request a medical history statement. A medical history statement (MHS) comes from your doctor, hospital, or insurance company. It goes over all the significant details about your past treatment. This can help you fully complete your EOI as accurately as possible.

Non-evidence maximum (NEM) describes the maximum amount an insurer will pay an employee if they suffer a future critical illness or disability and the employee doesn’t provide proof. It also defines the maximum amount they’ll pay for an employee’s life or beneficiary claim without medical evidence.

Glossary References



Ray Kermani
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