Review Evidence of Insurability (EOI) Rules for Open Enrollment

Evidence of insurability (EOI) is a process where you provide information on the condition of your own or your dependents' health to receive certain types of insurance coverage. Some benefits that require EOI have a guaranteed issue amount, which is the amount of insurance issued to an insured person without EOI. Benefits with a guaranteed issue amount and/or that require EOI, such as voluntary life, can be configured from the "EOI Rules" tab of a benefit.

EOI rules can be configured for each benefit, but not every benefit needs EOI rules configured. 

We offer a video training for this topic on Arcoro Learning.

• Expand Settings and click Benefit Management from the menu.

  

• Click the name of the new benefit package.

  

• Click the Configure Benefit Structure tab.

  

• Click the name of a non-waived benefit plan.

  

• Click the EOI Rules tab.
• The EOI rules are configured through a series of questions.

  

  • Does this benefit offer different EOI settings by event? - As many insurance providers apply different rules for different situations, you often select "Yes". 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 that 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?