Evidence Of Insurability (EOI) Request: Instructions

What You Will Need Before You Begin

  • Your group number.
  • Employer or sponsor name and address.
  • Reason EOI is required.
  • Coverage type and amount of current coverage or amount of requested coverage. (Your employer should provide you with this information and help determine your benefits elections that require EOI.)
  • Social Security Number of all applicants requiring EOI (you and/or your dependents). This will be used as the eSignature and, when applicable, as the eSignature of your spouse and any dependent child(ren) age 18 or over.
  • Height, Weight, and State of Birth of all applicants requiring EOI (you and/or your dependents).
  • Treatment history and medication(s) for any health condition(s); name and address of any physician, hospital or other practitioner that provided medical care, consultation or treatment.

Submission Instructions

  1. To submit this EOI Application and receive a response from us, you will need a computer capable of running an internet browser and a connection to the internet for that computer. This EOI Application can be fully completed online in approximately 20 minutes and electronically submitted, depending on the health information required. If you decide to exit the site before submitting this EOI Application, any information that you have entered will not be saved. If you would prefer to complete a paper copy of this EOI Application and receive written confirmation, click Group Benefits Forms to access the correct EOI application for your state.
  2. Your application is complete when you click the green "Submit Online EOI Application" button on the "Review" screen. We will confirm that your application has been received and is Pending. Your EOI Application will then be processed by our Individual Medical Underwriting Department. Subsequent correspondence to you will be by mail.