Introduction

If your broker manages your company’s pending benefit coverages through Evidence of Insurability, congratulations – you can move on to other topics!

In your role as an administrator, you may be responsible for approving or denying employees’ pending coverages that are over a given benefit’s Guarantee Issue. To approve or deny these pending coverages, go to the Evidence of Insurability link under the Employee Administration icon on your Administrator Menu. This link has been marked on the image below for the purposes of this article.

Don’t See the Link?

Note that the Evidence of Insurability link, along with the number of pending coverages and Evidence of Insurability Reminders link, will only appear when there is at least one pending EOI to manage. Otherwise, both links will be hidden.

Evidence of Insurability Page

The Evidence of Insurability Page provides information about your employees’ pending coverages. The image below is an example of what the Evidence of Insurability page looks like. You can click each of the hotspot icons on the image () to learn more about what is being shown on this page.

You can also use the button in the top right corner of the image to open it in fullscreen. Press the Escape key on your keyboard to exit fullscreen.

The Approval/Denial Process

Once you have received EOI forms from your employees, use the Evidence of Insurability page to locate the employee and benefit in question, then follow the steps below to approve, partially approve, or deny coverage.

Approving All Elected Coverage

1. Enter the date you received/are approving the EOI form into the Date Received field.
2. Enter the coverage effective date into the Date Effective field.
3. Press the tab key on your keyboard or select the Approved Coverage field. This will automatically populate the full Elected Coverage value into the Approved Coverage field.
4. Click the Save button (after completing all necessary EOI management) to save and complete the approval.

Example

Let’s say that Alice Admin received Benny HUBster’s EOI for his Long Term Disability election on 12/14/24. The EOI meets approval, so this means:

• The coverage can go into effect on the plan effective date of 1/1/25.
• The full elected amounts for that line of coverage will automatically populate into the Approved Coverage field.

Approving Partial Coverage and Denying All Additional Coverage

1. Enter the date you received/are denying the EOI form into the Date Received field.
2. Enter the coverage effective date into the Date Effective field.
3. Press the tab key on your keyboard or select the Approved Coverage field. This will automatically populate the full Elected Coverage value into the Approved Coverage field.
4. Edit the Approved Coverage amount.
   • If you are denying all additional coverage, enter the Current Coverage amount into the Approved Coverage field.
   • If a partial additional coverage is being approved, enter the approved amount into the Approved Coverage field.
5. Check the Deny Unapproved Coverage Checkbox.
6. Enter the reason for denial into the Reason field, for future reference purposes.
7. Click the Save button (after completing all necessary EOI management) to save and complete the denial.

Example

Let’s say that Benny HUBster’s spouse, Tracy, was only approved for part of her election.

• The Approved Coverage for Taylor has been edited from the elected $50,000 to the amount of $25,000.
• Reasons have been added for the spouse’s line of coverage.

Denying Coverage With a $0 Current Coverage/Guarantee Issue

If coverage is denied for a benefit with a $0 Guarantee Issue, there are some extra steps to the denial process. Let’s look at an example of this before walking through those steps.

Example

In the example below, Benny’s son Trent has been denied his elected coverage with a $0 Guarantee Issue.

• The Date Received, Date Effective, Approved Coverage, and Deny Unapproved Coverage/Reason fields have been completed following the 7 steps listed above.

As Trent has no coverage in this benefit, the benefit will need to be terminated as if it never existed. This is done by waiving enrollment in the benefit.

Waiving Enrollment Steps

1. After saving the Evidence of Insurability, search for the given employee using the Edit Employee link under the Employee Administration icon.
2. From the employee’s Employee Menu, navigate to the Benefit Plan Enrollment link under the Benefit Plan Information icon.
3. Under the Eligible Plan Types on the right side, click the link for the given benefit (Employee Life in the example above).
4. At the bottom of the Benefit Election page, select the radio button next to “Employee waives enrollment in all available Employee Life plans”.
   • If this is happening outside of the Open Enrollment window, this will make a pop-up appear prompting you to submit a Qualifying Event. Click OK to go to the Qualifying Event page.
   • On the Qualifying Event page, enter a Benefits Administrator Correction in the Qualifying Event drop-down menu, and today’s date in the Qualifying Date. Click Continue to return to the Benefit Election page.
   • On the Benefit Election page, select to waive the plan once more.
5. The termination date will automatically appear in the Termination Date field. Ensure this date is prior to the Effective Date listed on the Benefit Election page.
6. Click Save to complete the election termination.

Evidence of Insurability Reminders

If you have employees with pending coverage who have not yet turned in their EOI paperwork, you can use the Evidence of Insurability Reminders link under the Employee Administration icon on your Administrator Menu to send a reminder email to them. This link has been marked in red on the image below for the purposes of this article.

Remember that the Evidence of Insurability Reminders link will ONLY appear when there is at least one pending EOI to manage. Otherwise, both EOI links will be hidden.

The Evidence of Insurability Reminders page lists all of the employees from the pending EOI screen who have an email address included in their employee record.

The image below shows an example of what the Evidence of Insurability Reminders page may look like. You can click each of the hotspot icons on the image () to learn more about what is being shown on this page.

You can also use the button in the top right corner of the image to open it in fullscreen. Press the Escape key on your keyboard to exit fullscreen.