Review Evidence of Insurability (EOI) Rules for LTD/STD Benefits 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. 

For our examples below, we will focus on setting up typical EOI rules for long-term and short-term disability. 

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. For example, a plan may allow employees under the age of 70 a certain GI amount, while employees above 70 will receive a lower amount. Any coverage above that amount would require EOI. 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 Level - Level Rank Field - Level rank is typically used with LTD/STD, as it can be a simple elected or waived benefit, with a level 0 waived rank and a level 1 enrolled rank. When enrolling during their new hire event, they typically do not need to provide EOI.
  • 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.
    • Coverage Level - Level Rank Field - Level rank is typically used with LTD/STD, as it can be a simple elected or waived benefit, with a level 0 waived rank and a level 1 enrolled rank, and is typically set to 0. If an employee waives the benefit during their new hire event and wants to enroll during open enrollment or a qualifying life event, they will typically need to provide EOI. There is no GI allowance for these benefits.
  • Does the allowed increase amount change if the employee is enrolled below GI? - This is typically set to "No" as there are only two level rank fields, waived or enrolled. Allowed coverage level rank increases are "0" as no level rank changes are allowed without underwriting approval to enforce typical carrier rules for disability benefits during open enrollment. 
  • If the employee previously waived coverage, is EOI required on all levels of coverage? - This is typically set to "Yes" for LTD/STD benefits as employees are generally required to provide EOI during open enrollment. 
  • Would you like to apply these settings to any other event? - You can apply these EOI rule settings to other events, as it is common for only the new hire event to not require EOI, while all other events do, such as open enrollment, qualifying life event, etc. to require EOI for coverage. For our example, we have selected all available events.