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How to Manage Evidence of Insurability (EOI)

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How to Manage Evidence of Insurability (EOI)

Contents

Overview

Admin users will also find the platform contains a tool to manage employee requested benefit amounts that are over the Guaranteed Issue Amount (GI) and are pending awaiting carrier underwriting approval. This tool can be used for both Life and Disability products.

To manage Evidence of Insurability (EOI) form and Guaranteed Issue (GI) Amount, go to: Tools → Manage EOI.

All employees and dependents who elect amounts over the GI during enrollment and have pending requested amounts should display here. Once carrier reviews EOI form and approves or denies request, admin users can manage here.

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Admin users will have 4 options for managing pending requested benefit amounts:

  1. Approved → Carrier approved the entire requested benefit amount
  2. Denied → Carrier denied the requested amount over the GI, but employee/dependent is still approved for an amount up to the GI
  3. Rejected → Carrier rejected the entire requested benefit amount (including the amount up to the GI -- employee/dependent benefit = $0)
  4. Withdrawn → Employee never completed EOI form for employee/dependent coverage, so the requested amount over the GI is withdrawn and employee/dependent is only approved for an amount up to the GI

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If an employee elects employee and dependent coverage and all are pending approval:

  • Each requested amount (employee, spouse, children) is handled separately. A carrier may approve employee and dependents for different dates, and may also approve employee but deny dependents
    • Example: If carrier only approves employee requested amount effective 2/1/19 (spouse and child not approved yet), then only the employee benefit and cost will be updated to reflect the new full approved benefit amount and total cost. The spouse and child benefits will remain in a pending status and calculations will still only be for approved benefit amount/cost. If the dependents are approved 3/1/19, then the dependent calculations should be updated as of 3/1.
  • If an employee elects Child coverage for more than one child and any portion of the requested amount is pending approval, then all children are listed together on the table and MUST be handled as a single unit. User is not allowed to approve a pending amount for one child but not the other
    • Example: Employee elects child coverage so his 2 eligible children are auto enrolled, but a portion of the requested amount is pending EOI approval. Both children should reflect the same approved / pending calculations. When managing the pending requests via the Manage EOI tool, if User approves the pending amount, BOTH children will be approved.
  • You can only process an action (approve, deny, reject etc.) one time for pending employee requests. Once an action has been taken on a pending enrollment, you are not allowed to make changes again.
  • If a plan does not allow dependents to enroll without employee, and employee GI is $0 (no approved employee benefit yet), then dependent rows on this table are disabled until employee’s benefit is approved.

 

Approve

Carrier may approve full requested amount, or partial. Value entered for Approved amount will be employee’s new benefit amount and cost as of the date entered for Effective Date.

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Deny

Amount over the GI is denied, but employee can still keep amount up to GI.

  • Example 1: Employee requested $500k for 1/1/19 enrollment effective date. GI is $100k. Employee’s enrollment record should be approved $100k and cost. Carrier denied amount over $100k. Current enrollment should remain the same, since no additional amount was approved
  • Example 2: Employee requested $150k for 1/1/19 enrollment effective date. GI is $0. Admin denies. Employee’s enrollment record should be retro corrected back to 1/1/19 to reflect a $0 benefit and $0 cost and pushed to prior. Enrollment start date should be 2/1/19 and end date should be 1/31/19.

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Reject

Carrier rejected entire requested amount -- including the initial amount that was approved up to the GI. Employee should have $0 benefit back to original effective date.

  • Example: Employee requested $150k for 1/1/19 enrollment effective date. GI is $100k. Carrier rejected application on 2/1/19. Employee’s enrollment record should be retro corrected back to 1/1/19 to reflect a $0 benefit and $0 cost and pushed to prior. Enrollment start date should be 2/1/19 and end date should be 1/31/19.

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Withdraw

When an employee elects over the GI, but never submits EOI form, Admin User can withdraw the request for any amounts over the GI. Employee will keep GI amount

  • Example: Employee requested $500k for 1/1/19 enrollment effective date. GI is $100k. Employee’s enrollment record should be approved $100k and cost. Employee never submitted EOI form. Current enrollment should remain the same, since no additional amount was approved
  • Example 2: Employee requested $150k for 1/1/19 enrollment effective date. GI is $0. Admin withdraws election. Employee’s enrollment record should be retro corrected back to 1/1/19 to reflect a $0 benefit and $0 cost and pushed to prior. Enrollment start date should be 2/1/19 and end date should be 1/31/19.

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