The insurance eligibility guide is a questionnaire that documents your general health status and is often required when applying for certain types of insurance under specific circumstances.
Definition of the Insurance Eligibility Guide
The insurance eligibility guide is a questionnaire that documents your general health status and is often required when applying for certain types of insurance under specific circumstances. In most cases, the questions include whether you are a smoker, whether you have been treated for a medical condition such as cancer or high blood pressure, or whether you have been hospitalized in the past 90 days, etc.
To get approved for certain types of insurance policies, particularly if the amount of insurance exceeds the guaranteed amount by the insurer or if you are applying for coverage outside of the designated open enrollment period assigned to you, you may need to provide the insurance eligibility guide. You may also be required to provide the insurance eligibility guide if you are adding additional coverage or another person to your policy.
The specific documentation required for EOI varies from one insurance company to another. The type of insurance you are applying for may also dictate the type of information you need to provide.
During the EOI process, you may be asked to provide some or all of the following:
- Medical questionnaire
- Your personal medical history
- Questionnaires about your spouse’s health and your dependents
- Medical examination with blood draw
These elements give the insurance company a more detailed picture of your overall health. The insurer uses this information during the underwriting process as a factor in deciding whether to approve your policy.
Some other scenarios in which you may need to provide the insurance eligibility guide include if you are:
- Applying for insurance after the initial deadline
- Applying for insurance after being previously denied
- Restoring insurance coverage after it has lapsed
- Reapplying for coverage that was previously denied
Note: If your insurance company requests an EOI, your coverage will not begin until you provide all required information, and it is approved by the insurer. There may be a time limit, so be sure to complete the process in a timely manner. Otherwise, your application may be closed due to missing information.
How the Insurance Eligibility Guide Works
The insurance eligibility guide provides the insurer with a picture of your health status at the time you submit your application. This information is used in the underwriting process to help the insurance company assess the risk you pose for coverage.
If your insurance company requests the insurance eligibility guide, they will inform you of the exact process you need to follow. You may receive a letter by mail with additional instructions, or you are directed to the insurance company’s website to download the forms you need.
The first step is usually to complete a medical questionnaire that includes basic information about you and your health. Often, you can complete this questionnaire online to help the process run more smoothly.
You may be asked in the questionnaire for the following:
- General application information (date of birth, height, weight)
- Personal identification and contact information
- Employment details including the date of hire
- Current insurance coverage
- Coverage you are applying for
- Details about any medical conditions you have, including diagnosis dates and treatments you have tried
- Contact information for doctors and clinics you have used
Answer the questions as thoroughly as possible. If you do not answer completely, the insurer may ask for more information. While filling out the form, be sure to be honest. Providing misleading information on these forms is considered insurance fraud in most states, so always be truthful.
Note:
If you are applying for coverage for your spouse, you may need to provide evidence of insurability for them. If that is the case, you will need to fill out a separate questionnaire using their details.
After submitting your questionnaire, the insurance company reviews your answers. They will then approve or deny your insurance policy, or request additional information.
If the insurance company requests additional information, you may need to provide copies of your medical records or further details about your health, or undergo a medical examination, which will gather your current and past medical information. This way, the insurance company gets the information it needs to make a decision about your coverage.
Source: https://www.thebalancemoney.com/what-is-evidence-of-insurability-5211062
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