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The late application process and Evidence of Insurability (EOI)
Note: This article is for HR Admins. If you're not an HR Admin and want to understand more about the Evidence of Insurability (EOI) form process, check out this article.
When is Evidence of Insurability (EOI) needed?
The EOI form is a comprehensive medical questionnaire that allows the insurance carrier to determine whether an employee or their dependent are eligible for benefits.
There are three reasons why an employee or their dependent might need to provide EOI:
They are a Late Applicant
They elected for coverage over the Non-Evidence Maximum
They elected for Optional coverage
What is a Late Applicant?
There are three reasons why an employee or their dependent would be considered a late applicant:
They have enrolled for benefits after the 31-day enrollment deadline.
They initially refused coverage but asked to join the plan at a later date.
They tell us about a Qualifying Life Event (QLE) more than 31 days after the effective date of the life change.
Electing coverage above the non-evidence maximum (NEM)
Non-evidence maximum (NEM) is the maximum amount of a benefit an employee can enroll for without having to provide EOI. In many cases, the benefit maximum and the NEM are equal, so employees don’t need to submit any forms. However, in some cases the maximum coverage available for a benefit is higher than the NEM. The NEM restricts the benefit amounts for the highest wage earners for benefits that are based on salary (such as Life, Long-Term Disability, and Short-Term Disability).
If the member is eligible for a benefit above the NEM (based on their salary), they are required to submit an EOI form.
Enrolling for optional benefits
Optional benefits (such as Optional Life and Optional Long-Term Disability) have very low NEMs in many cases equal to $0. This means the employee will need to submit an EOI form if they want to enroll in any optional benefit.
How do employees submit an EOI form?
Employees can download the EOI form on the League platform, under the “Documents & Forms” section. They can also request the form from League’s Customer Care team.
Once an employee receives the form, they must complete, sign, and send the paper form directly to the insurance carrier. The insurance carrier will let the employee (and League) know if their application has been accepted. League then ensures the approved benefits are activated for the employee, as of the approved date.