Evidence of Insurability
Follow these steps to complete an online Evidence of Insurability Application (EOI Application):
- Complete the below section by entering the Group Policy Number, your Social Security Number and whether the Application is for yourself, your spouse/partner, and/or your dependent child(ren). If you do not know the Group Policy Number or whether your spouse/partner or dependent child(ren) are eligible to submit an application, ask your employer's Benefits Administrator.
completed the above steps, you may begin the online EOI Application. The application consists of three sections: (1) Health and Personal History Questionnaire (2) Fraud Warning and (3) Signature. Make sure you answer all questions completely and accurately. You will have an opportunity to review your responses before you sign the application.
Special instructions for paper Evidence of Insurability (EOI) Applications:If you would like to complete a paper application, please print an application by clicking below for a list of forms. If you are unsure of which application to use, please contact your Benefits Administrator or the insurer at 1-800-247-6875.
- Paper EOI application
Your application(s) will not be complete until you select the SUBMIT FOR REVIEW button on the last screen of this online questionnaire. If you are inactive or away from the computer for 10 minutes, your session will time out and you will lose previously entered data.