Evidence of Insurability (EOI)

What is Evidence of Insurability (EOI)?

Evidence of Insurability (EOI), also known as medical underwriting, EOI or evidence of insurability is documentation of (good) health used by insurers to determine whether or not an individual is insurable.

You answer some simple health questions and provide information on basic details like gender, height and weight, physical condition, and tobacco status (if applicable). Once this is done, a medical underwriter will review your application to determine whether you meet the acceptance standards for the requested insurance amount.

Here are a few things to keep in mind:

• In case of initial benefits enrollment, new employees must apply for coverage within 31 days after commencement of their employment.
• The EOI form should be submitted within 15 days following the application.
• In future annual enrollment periods, employees should apply for coverage before the end of the period and submit their EOI forms within 15 days.

Why is Evidence of Insurability (EOI) required?

To understand why you need Evidence of Insurability or EOI insurance, consider evaluating the insurance underwriting process and the factors affecting issuance policies. Insurance companies follow a standard process of assessing risks associated with insuring an individual.

This process applies to all types of insurance whether it’s life insurance, health insurance or other types of coverage. This is where evidence of insurability comes into play.

Insurance companies need evidence of insurability to assess these risks. Below are key reasons to help you understand the importance of an EOI insurance form:

• Assessment of risk: EOI forms enable insurers to assess an applicant’s health state, medical history, and lifestyle habits to determine their risk level. This information is particularly useful in determining appropriate rates and coverage limitations.
• Preventing adverse selection: EOI forms allow insurers to avoid adverse selection, which occurs when people with higher health risks are more likely to apply for insurance. This helps to balance risk pools while ensuring the financial stability of the insurance plan.
• Customized coverage: Evidence of insurability allows insurers to adapt insurance coverage to an applicant’s unique needs and medical conditions. This allows insurers to guarantee that the policy offers enough coverage without over- or under-insuring an individual.
• Compliance and verification: The EOI serves as a verification method for applicants’ information and data, which is necessary to meet regulatory criteria and avoid false claims.
• Ensuring fair premium pricing: EOI allows insurers to determine if the standard premium rates apply or if adjustments are needed due to higher health risks. This keeps the pricing model sustainable across all policyholders.
• Preventing fraudulent claims: By verifying the applicant’s health history and personal disclosures upfront, EOI minimizes the chances of false or misleading information being used to claim benefits later.

When is an Evidence of Insurability (EOI) required?

An EOI form is usually required for:

• Covering excess of any applicable guaranteed issue amount
• Late entrants and reinstatements (if required)
• Eligible members and dependents not insured under the prior plan
• Individuals previously declined for coverage
• Coverage due to life events (marriage, birth of a child, etc.)

What are the types of Evidence of Insurability?

Typically, different types of evidence are used to establish the insurability of an individual. Insurers get a clearer picture of an applicant’s health and other risk factors.

Below are the common types of evidence of insurability:

1. Health Questionnaire

The most common form of EOI is a written health questionnaire. It includes questions about:

• Medical history (e.g., chronic illnesses, surgeries, hospitalizations)
• Current medications
• Lifestyle habits (e.g., smoking, alcohol consumption, exercise)
• Family medical history

2. Medical Exam

Some insurers require a physical examination, usually conducted by a licensed medical professional. It may include:

• Height and weight measurements
• Blood pressure and heart rate
• Blood and urine tests (for cholesterol, glucose, nicotine, etc.)

3. Attending Physician’s Statement (APS)

If the insurer needs more detailed or specialized information, they may request a statement from your primary care doctor or specialist. The APS typically includes:

• Diagnosis and treatment history
• Prognosis
• Medication records and compliance

4. Lab Tests and Diagnostics

In some cases, additional tests may be required to assess specific conditions, such as:

• Electrocardiogram (EKG/ECG)
• Chest X-rays
• Imaging scans (if relevant to disclosed health conditions)

5. Medical Records Authorization

You may be asked to sign a HIPAA-compliant form authorizing the insurer to access your medical records directly from hospitals, clinics, or physicians.

6. Telephonic or Virtual Interview

Some carriers conduct phone or video interviews with underwriters or nurse consultants to verify the information provided in questionnaires and clarify ambiguities.

7. Pharmacy Data and Prescription History

Insurers may use third-party databases to review your prescription history to identify any medications that indicate undisclosed medical conditions.

8. Lifestyle and Occupational Information

In high-risk policies (like for critical illness or accidental death), insurers may also request:

• Travel history
• Dangerous hobbies (e.g., skydiving, scuba diving)
• Occupation details (especially if hazardous)

This is all about the importance and varieties of evidence of insurability. Now, let’s look into the components of a typical EOI form.

What does the EOI form include?

Here are the basic components of an EOI form:

1. Personal information

• Full name, date of birth, gender, and contact details
• Employment information (if applying through an employer-sponsored plan)

2. Health history

• Detailed medical history of past and current conditions
• Information about hospitalizations, surgeries, or treatments
• Family medical history of hereditary or chronic diseases

3. Lifestyle information

• Smoking, alcohol, and drug use habits (if any)
• Participation in high-risk activities such as extreme sports, aviation

4. Current medications

• List of prescribed and OTC (over-the-counter) medications
• Duration and purpose of medication intake

5. Physician information

• Names and contact details of primary care physicians and specialists
• Date and purpose of recent consultation(s)

6. Previous insurance details

• Details of prior insurance coverage (if any)

7. Authorization and Consent

• A legal statement authorizing the insurance company to access medical records from doctors, hospitals, and third-party data sources (like pharmacy benefit managers)
• Consent to use personal and health information for underwriting purposes
• HIPAA compliance statements (in the U.S.)

8. Declaration and Attestation

• A section where the applicant certifies that all information provided is accurate and complete to the best of their knowledge
• Acknowledgment that providing false or incomplete information may result in denial of coverage or cancellation of the policy

9. Coverage Details Being Requested

• Type of insurance (e.g., life, disability, supplemental health)
• Amount of coverage requested (especially if above guaranteed issue limits)
• Whether the coverage is for the applicant only or includes dependents (spouse, children)

10. Dependent Information (if applicable)

• Personal and health details of spouse or children included in the coverage
• Separate health declarations for each covered individual

11. Employer or Plan Sponsor Section (for group coverage)

• Employer’s name, group policy number, and plan type
• HR or benefits administrator signature (sometimes required for employer-sponsored plans)

12. Signature and Date

• Signature of the applicant (and spouse if joint coverage or spousal consent is needed)
• Date of completion to validate the timeliness of the information

[For a detailed overview, you can also check these EOI form instructions issued by Washington State Healthcare Authority.]

What questions are asked for evidence of insurability?

You can anticipate the below questions related to an EOI form:

1. Personal and Demographic Information

• What is your full name, date of birth, and gender?
• What is your marital status and do you have any dependents?
• What is your contact information (address, phone number, email)?

2. Physical and Health Attributes

• What is your height and weight (BMI)?
• Do you have any physical disabilities or impairments?
• What is your age (used to assess age-related health risks)?

3. Employment and Financial Information

• Who is your employer and what is your job title?
• How long have you been employed with your current employer?
• What is your annual income (if relevant for coverage eligibility)?

4. Insurance and Coverage Details

• What type and amount of insurance coverage are you applying for?
• Is this application for yourself only or are dependents included?
• Is the coverage request above the guaranteed issue amount?
• What is your reason for applying or increasing coverage?
• Have you ever had insurance declined, modified, or canceled?

5. Medical Conditions and History

• Do you have any chronic or pre-existing medical conditions?
• Have you had surgeries, hospitalizations, or serious illnesses?
• Are you currently undergoing treatment for any condition?
• What is your family medical history (e.g., heart disease, cancer, diabetes)?
• Have you been diagnosed or treated for mental health conditions (e.g., depression, anxiety)?

6. Current and Past Medications

• Are you currently taking any prescribed or over-the-counter medications?
• What is the name, dosage, and purpose of each medication?
• How long have you been taking each medication?
• Physician and Treatment Information
• Who is your primary care physician and what are their contact details?
• Have you seen any specialists recently?
• What were the reasons for recent consultations or tests?
• Are you scheduled for any upcoming exams, procedures, or tests?

7. Lifestyle and Behavior

• Do you currently or have you recently used tobacco or nicotine products?
• Do you consume alcohol? If so, how frequently?
• Do you use recreational or illicit drugs?
• Have you ever received counseling or treatment for substance use or addiction?
• High-Risk Activities and Travel
• Do you participate in high-risk activities such as skydiving, scuba diving, racing, or mountaineering?
• Do you pilot aircraft or plan to in the near future?
• Do you plan to travel to high-risk countries or regions?

8. Disability and Functional Limitations

• Do you have any condition that limits your ability to work or perform daily tasks?
• Are you currently receiving or have you applied for disability benefits?

9. Reproductive Health (for female applicants)

• Are you currently pregnant or planning pregnancy?
• Have you had any complications in previous pregnancies?

How to fill out evidence of insurability form?

1) Provide personal and demographic information

Enter your full legal name, date of birth, gender, marital status, and contact details such as address, phone number, and email. If the application is for employer-sponsored insurance, include your employer’s name and job title.

2) Specify coverage details

Indicate the type of insurance coverage you are applying for (e.g., life, disability, supplemental) and the amount requested. Mention if this request exceeds the guaranteed issue amount or includes dependents.

3) Complete health history

Disclose any current or past medical conditions, chronic illnesses, surgeries, or hospitalizations. Be accurate and thorough—missing information can delay approval or result in denial.

4) List current and past medications

Provide a list of all medications you are currently taking or have taken recently. Include prescription and over-the-counter drugs, dosages, duration, and the condition being treated.

5) Share physician and treatment information

List the names and contact information of your primary care physician and any specialists you’ve consulted. Include the date and purpose of recent visits or treatments.

6) Answer lifestyle and behavioral questions

Indicate whether you currently or have ever used tobacco, alcohol, or recreational drugs. Disclose your use history and any treatments or counseling received for substance use.

7) Report high-risk activities and travel

Note if you participate in extreme or hazardous activities like scuba diving, aviation, or rock climbing. Also mention any recent or planned travel to high-risk regions.

8) Disclose family medical history

Provide details of hereditary conditions in your immediate family such as heart disease, cancer, or diabetes. This helps insurers assess genetic risk factors.

9) Declare any pending or scheduled procedures

State whether you are awaiting results or scheduled for medical tests, surgeries, or specialist visits. Insurers use this to evaluate ongoing or emerging health risks.

10) Include prior insurance history

Mention if you have ever been declined coverage, issued a policy with exclusions, or had a policy canceled or modified due to health reasons.

11) Complete authorization and declarations

Read and sign the authorization section to permit the insurer to access your medical records. Review all declarations and sign/date the form to affirm the accuracy of the information.

How to submit evidence of insurability?

Step-1. Check the requirements properly.

Properly review the specific requirements from your insurance provider. This can also include filling questionnaires about your medical attributes or treatment history.

You can download the EOI forms from the links below:

• Evidence of Insurability (ND)
• Long Term Disability (LTD) Evidence of Insurability Form
• Evidence of Insurability Application

Step-2. Check processes for your preferred type of submissions.

For online submission:

• Log in to the insurance portal of your insurance provider.
• Navigate to the section for EOI and fill out the required information (personal details, medical history, and current health status).

For paper submission:

• Obtain the form. You can request a paper form from your HR department or insurance provider)
• Complete the form with accurate information (health information, details about your employment).
• Once completed, submit the form either online through the portal. You can also mail it to the address provided by your insurance provider.

Step-3. Follow up after submission.

After submission, you may need to provide additional information if requested by the insurer. Keep an eye on any communications from your insurance provider.