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Evidence of Insurability

Evidence of insurability (EOI) is the information an insurance company requires to assess your health and determine whether you qualify for coverage. It typically includes details about your medical history, lifestyle habits, and current health status. The insurer uses this information to evaluate risk and decide whether to approve your application, exclude specific conditions, or adjust your premium rate.

EOI is often required when applying for individual health, life, or disability insurance, or when an employee in a group plan requests optional or additional coverage beyond the guaranteed amount. The process may involve completing a medical questionnaire, providing medical records, or undergoing a paramedical exam such as bloodwork or blood pressure testing. Once reviewed, the insurer determines whether coverage can be issued and under what terms.

Example:

If your group life insurance automatically includes $50,000 in coverage but you want to increase it to $200,000, you must complete an evidence of insurability form. The insurer reviews your health information before approving the additional amount.

What to Watch For:

Respond honestly and completely when providing medical information. Any misrepresentation could lead to denied claims or cancellation of coverage. Submit EOI forms promptly, as coverage for optional benefits does not take effect until the insurer has reviewed and approved your application. Keep a copy of your submission and confirmation of approval for your records.

Related Terms

Effective Date

The effective date is the day your insurance coverage officially begins. From this date forward, you are eligible to receive benefits for covered health, dental, life, or disability expenses under the terms of your policy. The effective date is established once your application has been approved, all requirements are met, and the first premium payment has been received, unless otherwise specified in the policy.

Eligibility Period

The eligibility period is the window of time during which an individual can apply for or enroll in an insurance plan after first becoming eligible. It ensures that applicants join coverage within a reasonable timeframe, helping insurers manage risk and prevent people from waiting until they need care to apply. Eligibility periods are common in both group and individual insurance and are especially important for guaranteed issue or conversion options.

Eligibility Window (Guaranteed Issue)

An eligibility window in a guaranteed issue (GI) plan is the period after losing group benefits during which you can enroll in personal health coverage without completing medical questions. This window is typically 60 to 90 days. Applying within it ensures uninterrupted protection for prescription drugs, dental care, and health services that were previously employer-sponsored.

Eligible Expenses

An eligible expense is any medical or dental service, product, or treatment that qualifies for reimbursement under the terms of your insurance plan. To be eligible, the service must meet several criteria: it must be medically necessary, performed by a licensed or approved provider, and fall within the plan’s specific limits and exclusions.

Elimination Period

The elimination period is the waiting time that must pass after an illness or injury occurs before disability insurance benefits begin to be paid. It functions like a deductible measured in days rather than dollars. During this period, you are responsible for your own income replacement through savings, sick leave, or other sources.

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