What Is Evidence of Insurability (EOI)?

As an HR professional, employees often turn to you with insurance questions—even after you’ve handed off responsibilities to brokers and carriers. One common topic you might encounter is Evidence of Insurability (EOI).

What Is Evidence of Insurability?

Evidence of Insurability (EOI) is the process insurance companies use to verify an applicant’s health before approving certain types of coverage. It typically applies to:

• New applicants seeking insurance beyond basic health coverage.
• Employees increasing their coverage—such as life insurance beyond the guaranteed issue amount.
• Individuals who previously declined coverage and now want to enroll.

EOI helps insurers assess risk and determine whether an applicant qualifies for additional coverage. If an applicant is deemed too high-risk, they could be denied insurance.

When Do Employees Need to Provide Evidence of Insurability?

While not all insurance plans require Evidence of Insurability (EOI), there are certain situations where employees must complete the process to qualify for coverage. Here are the most common instances when EOI is required:

An Employee Adds a Dependent to Their Insurance
If an employee gets married and wants to add their spouse to their life insurance plan, the spouse might need to complete an EOI form before being approved.

An Employee Wants More Coverage Than the Basic Plan Offers
Many employers offer life insurance as part of their benefits package. This typically includes a guaranteed issue amount, which is the highest amount of coverage an employee can get without proving they’re in good health. For example, if a company’s guaranteed issue amount is $25,000, but an employee wants $100,000 in coverage, they will likely need to complete EOI to qualify for the extra amount.

An Employee Let Their Coverage Lapse and Wants It Back

If an employee had insurance before but didn’t renew it on time or voluntarily canceled it, they may need to go through the EOI process before being approved for coverage again.
For example, an employee declined dental insurance during open enrollment last year but now wants to sign up. Since they previously opted out, the insurance company might ask for EOI before allowing them to enroll.

An Employee Was Previously Denied Coverage
An employee applied for extra disability insurance last year but was denied due to a pre-existing condition. If they reapply this year, they will likely need to submit new EOI documents.

The Evidence of Insurability Process

While the EOI process varies by insurance provider, it generally follows these steps:

1. Notification
Employees will receive a request—typically via mail or email—if they need to complete EOI.

2. Health Questionnaire
Applicants must fill out a detailed health form covering:

• Personal and family medical history
• Lifestyle habits (such as smoking or alcohol use)
• Recent hospitalizations or major illnesses
• Employment details and current insurance coverage

Providing false information can be considered insurance fraud and lead to denied coverage.

3. Medical Records & Exams (If Needed)
Insurance companies may request:

• Copies of medical records from healthcare providers
• A medical exam, which could include a blood draw

4. Underwriting Review
Insurers review all provided information to assess risk and decide on approval.

5. Approval or Denial
Once the review is complete, the applicant is notified of their acceptance or denial. If they don’t respond to information requests within the insurer’s deadline, they could be automatically denied due to lack of response.

EOI and Open Enrollment

Even though brokers and carriers manage most of the Evidence of Insurability (EOI) process, employees may still turn to HR for guidance—especially during open enrollment. By understanding what EOI is, when it’s required, and how the process works, HR professionals can provide valuable support and help employees navigate their insurance options with confidence.