Evidence of Insurability (EOI) is an application process in which you provide information on the condition of your health or your dependent's health to get certain types of insurance coverage. Many times, benefits that require EOI have a Guarantee Issue Amount, which is the amount of insurance that will be issued to an insured person without evidence of insurability. Benefits that have Guarantee Issue amounts and/or require Evidence of Insurability, such as Voluntary Life, can be configured on the EOI Rules tab for each Plan.

The configuration within this tab deals with change events and the ability for employees to view and elect amounts over a guaranteed issue, where evidence of insurability is needed.

The configuration of your EOI Rules is completed with a series of questions, where some options will only appear depending on your response to a previous question.

As you progress through the setup of your EOI Rules, you will be prompted with options for the format of the Guaranteed Issue.

• Does this benefit offer different EOI settings by event? - When answering this question, consider situations such as, but not limited to:
  • What are the EOI rules for a new hire enrolling in benefits?
  • Are they different during open enrollment?
• Does this benefit offer different GI amounts based on age? - Guaranteed Issue (GI) is the amount of coverage an employee can elect without needing to provide evidence of insurability.
  • If your benefit plan applies GI limits based on age, select "Yes".
  • If the benefit offers the same guaranteed issue amount, regardless of age, select "No". 
• Please Complete the process below for your New Hire Event - Select the appropriate format for GI - Select the appropriate GI format for employees during a new hire event.
  • Coverage Amount - This option is typically used for benefits with a guaranteed issue set at a specific coverage amount, such as for voluntary life or critical illness benefits. 
  • Coverage Level - Level Rank Field - This option is typically used for benefits where an administrator will configure multiple ranks for which an employee will receive guaranteed issue amounts, such as for long-term/short-term disability benefits. Waived coverage is the exception to this, where it is recommended to have a coverage level of 0, regardless of display order. 
  • Multiple of Compensation - This option is typically used when employees receive guaranteed issue amounts dependent on a multiple of their compensation, and any coverage over that amount will require evidence of insurability. If the amount were to exceed the maximum, evidence of insurability would need to be submitted and approved by the carrier. If compensation rounding was used in the "Premium / Benefit Amt Rules" tab, be aware of rounding rules and values. 
• Please Complete the process below for your Open Enrollment Event - Select the appropriate format for GI - Select the appropriate GI format for employees during an open enrollment event, if applicable. Typically, if an employee had waived a benefit during their new hire event and wants to enroll during open enrollment, they would need to provide evidence of insurability to enroll.
  • Coverage Amount - This option is typically used for benefits with a guaranteed issue set at a specific coverage amount, such as for voluntary life or critical illness benefits. 
  • Coverage Level - Level Rank Field - Allowing level rank increase will allow employees to increase their rank, up to 2 ranks, without needing to provide evidence of insurability. 
  • Multiple of Compensation - This option is typically used when employees receive guaranteed issue amounts dependent on a multiple of their compensation, and any coverage over that amount will require evidence of insurability. If the amount were to exceed the maximum, evidence of insurability would need to be submitted and approved by the carrier. If compensation rounding was used in the "Premium / Benefit Amt Rules" tab, be aware of rounding rules and values. 
• Does the allowed increase amount change if the employee is enrolled below GI? - This option allows an employee to adjust their rank if they are already enrolled in a benefit, without needing to provide evidence of insurability, as some carriers allow limited coverage increases during open enrollment without needing evidence of insurability, even though they do not offer a full guaranteed issue amount. If an employee is enrolled below the GI amount, specify how much an employee is allowed to increase their coverage and by how much. If the employee is at or above the GI amount, specify if any increase is allowed. 
• If the employee previously waived coverage, is EOI required on all levels of coverage? - Typically not used for new hire events, as any default coverage should be set to waived and set to "Yes" for all other events. For benefits that have a guaranteed issue or EOI, the "waive" option should have a level rank of 0, so selecting "Waive" is not interpreted as increasing level rank. For example, if the "Waive" option is level rank 51 and the employee is currently level rank 25, selecting the "Waive" option at level rank 51 may be seen as increasing coverage.
• Would you like to apply these settings to any other event?
• Would you like to configure settings for any other event?

FAQs

What is Level Rank?

A field that is configured as part of the Benefit Option Name (coverage level). Typically, the Level Rank will be he same as the Display Order for the Benefit Option Name. The exception to this is for Waive coverage, where Waive is recommended to have a Level Rank of 0, regardless of the Display Order assigned.

How does Level Rank effect EOI?

Level Rank is what the system uses to determine if the elected coverage level requires EOI. The system compares the Level Rank for the current coverage to the Level Rank of the elected coverage.

My Waive Coverage does not have a Level Rank of 0, will that be a problem?

It is recommended that for benefits that have Guarantee Issue/EOI that the Waive option have a Level Rank of 0. This is so that the Waive option will never be seen as an increase in coverage. For example of there are 50 coverage options, plus Waive, and Waive has a Level Rank of 51 instead of 0, an employee moving to the Waive option from a coverage option with a Level Rank of 25, could be seen as an increase and therefore have an EOI action incorrectly associated with it.

Why does the Waive option require EOI?

See question #2 above.