Alyssa Lane
Group life insurance coverage is a benefit that many employers offer to their employees. It is the employer's responsibility to obtain evidence of insurability, or EOI, from their employees. This is a form that employees must submit to enrol in a group life insurance plan. If an employee fails to submit an EOI form, the employer may be liable for breach of fiduciary duty under ERISA if the insurance company denies life insurance benefits. If an employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. However, if an employee has been paying premiums for more than two years, an insurer may not be able to avoid paying life insurance benefits.
| Characteristics | Values |
|---|---|
| Definition | "Evidence of insurability" refers to the requirement that a participant meet certain health criteria set by the carrier in order to be eligible for the participant's requested amount of group life insurance coverage |
| Employee rights | If the employee submits the EOI form and the insurer has denied coverage, the employee has a right to appeal the denial |
| Employee rights | If the employee fails to meet the insurer's underwriting standards, the employee is unlikely to receive the new or added coverage |
| Employee rights | If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits |
| Employer obligations | The employer, not the insurer, is responsible for obtaining evidence of insurability |
| Employer obligations | If the employer fails to obtain an EOI form from the employee, and the insurance company denies life insurance benefits if the employee dies, the employer may be liable to the employee for breach of fiduciary duty under ERISA |
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What You'll Learn
Evidence of Insurability (EOI)
The employer, not the insurer, is responsible for obtaining evidence of insurability. If the employer fails to obtain an EOI form from the employee, and the insurance company denies life insurance benefits if the employee dies, the employer may be liable to the employee for breach of fiduciary duty under ERISA. Thus, if more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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Employee rights
Employees have a right to enrol in a group life insurance plan, but this is based on the plan's requirements. If an employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. If an employee submits an EOI form and the insurer denies coverage, the employee has the right to appeal the denial. However, if the employee fails to meet the insurer's underwriting standards, they are unlikely to receive the new or added coverage.
If an employee dies and the insurance company denies life insurance benefits, the employer may be liable to the employee for breach of fiduciary duty under ERISA if they failed to obtain an EOI form from the employee.
If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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Employer obligations
Group life insurance policies typically impose a duty on the employer to obtain an evidence of insurability (EOI) form from the employee. If the employer fails to do so, and the insurance company denies life insurance benefits if the employee dies, the employer may be liable to the employee for breach of fiduciary duty under ERISA. The employer, not the insurer, is responsible for obtaining evidence of insurability.
If an employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. If the employee submits the EOI form and the insurer has denied coverage, the employee has a right to appeal the denial. However, if the employee fails to meet the insurer's underwriting standards, they are unlikely to receive the new or added coverage.
If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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Eligibility requirements
An employee’s right to enrol in a group life insurance plan is based on the plan’s requirements. If the employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. If the employee submits the EOI form and the insurer has denied coverage, the employee has a right to appeal the denial. However, if the employee fails to meet the insurer’s underwriting standards, the employee is unlikely to receive the new or added coverage.
"Evidence of insurability" refers to the requirement that a participant meet certain health criteria set by the carrier in order to be eligible for the participant’s requested amount of group life insurance coverage. If the employee dies and the insurance company denies life insurance benefits, the employer may be liable to the employee for breach of fiduciary duty under ERISA. The employer, not the insurer, is responsible for obtaining evidence of insurability.
If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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Fiduciary duties
Evidence of insurability (EOI) is a requirement for group life insurance coverage. It refers to the need for a participant to meet certain health criteria set by the carrier to be eligible for the requested amount of coverage. If an employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. The employer, not the insurer, is responsible for obtaining evidence of insurability. If the employer fails to obtain an EOI form from the employee, and the insurance company denies life insurance benefits if the employee dies, the employer may be liable to the employee for breach of fiduciary duty under ERISA.
If an employee submits the EOI form and the insurer has denied coverage, the employee has a right to appeal the denial. However, if the employee fails to meet the insurer's underwriting standards, the employee is unlikely to receive the new or added coverage. If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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Frequently asked questions
'Evidence of insurability' refers to the requirement that a participant meet certain health criteria set by the carrier in order to be eligible for the participant’s requested amount of group life insurance coverage.
The employer, not the insurer, is responsible for obtaining evidence of insurability. If the employer fails to obtain an EOI form from the employee, and the insurance company denies life insurance benefits if the employee dies, the employer may be liable to the employee for breach of fiduciary duty under ERISA.
If the employee is a late enrollee and fails to submit evidence of insurability, additional coverage may be declined. If the employee submits the EOI form and the insurer has denied coverage, the employee has a right to appeal the denial.
If more than two years pass after evidence of insurability was required and premiums have been paid throughout, an insurer may not be able to avoid paying the life insurance benefits.
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