EVIDENCE OF INSURABILITY: Evidence for life insurance

Evidence of insurability: Evidence for life insurance
Evidence of insurability: Evidence for life insurance

Evidence of insurability protects the employer’s group insurance program from adverse risks.  Thus, if someone has a bad medical history, he or she may not be eligible for certain insurance coverage due to the likelihood of disproportionate claims and risks associated with that person’s coverage.

Although most employer-sponsored life policies offer guaranteed coverage, EOI may be required if you are applying for coverage above the guaranteed level.  If you really need an EOI, you must complete the documentation as well as provide certain medical records so that the underwriter can further review the risks associated with enrolling you in such coverage.

What is evidence of insurability?

Evidence of insurance gives the insurance company a picture of your health at the time of application.  This information is used in the underwriting process to help the insurer decide how risky your insurance is.

If your insurer asks for proof of insurance, he will tell you the exact procedure you need to follow.  You can receive a letter in the mail with further instructions or redirect to the insurer’s website to download the required forms.

The first step is usually to fill out a medical questionnaire with basic information about you and your health.  Many times you can do this online to make the process smoother.

Where is evidence of insurability often required?

When applying for certain types of insurance in specific cases, you often need an insurance certificate, a questionnaire that documents your general health.  Frequently asked questions include whether you smoke, have you ever been treated for a disease such as cancer or high blood pressure, have you been hospitalized in the last 90 days, and so on.

How your insurability is determined

·    Your health 

likely, you will have to fill out a medical form and undergo a medical examination.  This scans you for a variety of diseases that can lead to premature death. 

This part of the EOI process usually assesses your personal and family health history to look for any signs, as well as factors such as your current medication and predisposition to high-risk behaviors such as cigarette smoking or skydiving. 

The insurance provider uses this general health check to estimate how long you will live so that they can set your premiums accordingly.

·    Your financial situation

Life insurance should help the people you leave to adjust to life without you, not enrich them overnight.  To ensure that your policy provides first, not second, a life insurance company evaluates items such as your assets and your income (or your partner’s income if you stay home) to determine a reasonable benefit from the policy for you.

Information required to fill out the EOI application

  • Your group number
  • Name / address of your employer
  • The reason for the need for EOI
  • The type and size of coverage you request
  • Your name, date of birth and social security number
  • Your height and weight
  • Your latest information on heart rate and blood pressure
  • Your latest ECG, blood test and urine test results, if any
  • History of treatment
  • The medication you are currently taking
  • Name / address of your doctor
  • Any current treatment you receive, including the name of the doctor and what the treatment is for

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Are medical recorded needed to get evidence of insurability?

Keep in mind that the insurer may request additional information after verifying your EOI, including the disclosure of your medical records.  If so, the insurer will also send a letter requesting such information from your doctor’s office. 

However, you will need to consent to the disclosure of your records before the doctor’s office provides such records to your insurer.  Keep in mind that there is an exception to this rule; in particular, if you refuse to disclose such forms, the insurer may still deny you the additional coverage you are seeking. 

The insurer may even ask you to take additional medical tests, during which you will take tests, and the office of a particular doctor will inform the insurer about the results.

  What is evidence of insurability form?

When an insurance carrier requests an Evidence of Insurability (EOI) form, the process may seem complicated and the form may seem invasive.  In this month’s Beyond Benefits newsletter, we’ll find out what form an employee needs to fill out and why they need it.

The form contains many detailed questions, and the more details will be provided in the answers, the faster the process and the better the carrier will be able to choose the coverage to suit your needs.  It is important to fill in the form completely; incomplete applications will be returned for additional information, which will delay the decision. 

Keep in mind that the completed application is also a legal document that is part of the insurance contract.  As a rule, only the form is required; however, in some cases additional requirements may be required (eg visit to a doctor, medical tests, etc.).  Any fees / costs associated with additional requirements shall be borne by the applicant.

How to download evidence of insurability form

Download the form and print it out or fill it out in Adobe Reader XI or later (not in your browser) and save.

Evidence of insurability form – M5995  | PDF 563 kb

Use this evidence of insurability form to confirm the participant’s insurance for most group plans.  The plan administrator, participant and their spouse (if any) must complete it.

What is evidence of insurability for life insurance?

The employer may offer life insurance as social assistance to employees.  Sometimes it can be just basic life insurance.  Employees usually do not need to fill out any documents for such coverage.

As basic life insurance is usually only a small amount, employers may also offer employees the opportunity to register for supplementary or supplementary life insurance.  The maximum size of the coating varies.

In many cases, when an employee decides to enroll in supplementary life insurance, he may choose to increase coverage to a certain amount or a certain increase without having to fill out proof of insurance.  If a larger amount is required, proof of insurance may be required.

What is insurable interest?

Your proof of insurance is based on what is called the insurable interest, which is, in fact, proof that someone will be financially burdened in the event of your death.  Insurers also seek financial justification or proof that your income and assets are commensurate with the amount of coverage you are requesting.

Although your insurable interest and financial justification for life insurance may set a limit on your life insurance, they do not affect the amount you pay for this coverage – instead, your premiums are determined by your health profile, family history, lifestyle and age.  You may be in good health, but due to your financial situation, you can still not claim life insurance, and vice versa.

If you receive life insurance with a certain amount of income or assets, but your financial situation deteriorates after your policy takes effect, life insurance companies cannot cancel or change your policy.

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What is evidence of insurability Metlife?

If you are registering or making changes to a group life insurance or disability plan, you may be asked to complete a health claim (SOH), also known as a medical insurance certificate (MEOI). 

In short, this is a list of questions you need to answer about your overall health (more details below).  Its implementation is the key to obtaining the necessary coverage.  Here we have answered the most common SOH questions so you can be informed.

  When do I need to fill out a health declaration?

Some situations may require you to complete an SOH.  Some examples include, but are not limited to:

  • Request for coverage exceeding the specified threshold set by your employer (MEOI levels depend on group plan and type of coverage)
  • Register after the end of the registration period, possibly because you are adding a dependent
  • Review your choice after giving up all or part of the insurance paid by the employer
  • You have been hospitalized for the last 90 days
  • An increase in salary that exceeds the MEOI level
  • You are actively working, but are not currently registered in the plan and participate in the Qualifying Life Event, you must provide a health report to register for any amount of insurance coverage
  • You have previously waived all or part of your contribution insurance with no contributions, but now you want to be insured for all or part of the amounts previously waived

Evidence of insurability FAQs

Why do insurers value evidence of insurability?

Insurers value your evidence of insurability because life insurance is not a way to enrich your family, it is a network of financial security.  If you die prematurely, it will replace the financial support you have provided.

Under what circumstances do you have to prove insurability?

You may need to provide evidence of insurability to obtain approval for certain types of insurance policies, such as in excess of the amount guaranteed by the insurance company, or if you are applying for insurance outside the established new registration period.  You may also be required to provide evidence of insurability if you add additional coverage or another person to your policy.

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