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TEXAS ASSOCIATION OF COUNTIES FORT DEARBORN LIFE INSURANCE COMPANY (Please print) PART 1: TO BE COMPLETED BY POLICYHOLDER EMPLOYEE Declined EVIDENCE OF INSURABILITY FOR FDP USE ONLY Approved SPOUSE

How to fill out evidence of insurability

How to fill out evidence of insurability:

1. Contact your insurance provider: Begin by reaching out to your insurance provider to understand their specific requirements and to request the necessary forms for evidence of insurability.
2. Gather necessary information: Collect all the relevant personal and medical information required for the application. This may include details like your name, address, date of birth, social security number, current health conditions, medical history, and any recent medical procedures or treatments.
3. Complete the application: Fill out the application form accurately and thoroughly. Make sure to provide all the requested information as incomplete or incorrect details could delay the processing of your application.
4. Attach supporting documents: Depending on the insurance provider's requirements, you may need to provide additional documents to support your application. These might include medical records, lab results, or any other relevant paperwork requested.
5. Submit the application: Once you have filled out the application and gathered all necessary documents, submit them to your insurance provider according to their instructions. This can typically be done either online, through mail, or in person.
6. Follow up and provide any additional information: After submitting your application, stay in touch with your insurance provider to ensure all your documents have been received and to address any possible questions or requests for further information.

Who needs evidence of insurability?

1. Individuals applying for life insurance: When you apply for a life insurance policy, especially for a higher coverage amount, the insurance company may require evidence of insurability to assess your overall health and determine the appropriate premium rates.
2. Group insurance participants: In some cases, group insurance plans offered through employers or organizations may require evidence of insurability when an individual joins the plan or applies for additional coverage beyond the group's standard limits.
3. Those seeking disability insurance: Disability insurance providers may request evidence of insurability to evaluate an individual's medical history and current health conditions, ensuring they are eligible for coverage against potential disabilities.
4. Individuals seeking critical illness coverage: Some insurance policies that protect against critical illnesses may require evidence of insurability to assess the applicant's health status and determine whether they qualify for specific coverage options related to certain illnesses.

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What is evidence of insurability?

Evidence of insurability is documentation or proof provided by an individual to show their eligibility for insurance coverage.

Who is required to file evidence of insurability?

Individuals who are applying for insurance coverage or making changes to their existing coverage may be required to file evidence of insurability.

How to fill out evidence of insurability?

Evidence of insurability can be filled out by providing information about one's medical history, lifestyle choices, and other relevant factors that may impact insurance coverage.

What is the purpose of evidence of insurability?

The purpose of evidence of insurability is to assess the risk associated with providing insurance coverage to an individual and to determine the premium rates.

What information must be reported on evidence of insurability?

Information such as medical history, current health status, family medical history, lifestyle choices, and any other relevant factors that may affect insurance coverage must be reported on evidence of insurability.