Get the free Evidence of Insurability Form - Coordinated Benefits Company

SUPPLEMENT TO ENROLLMENT APPLICATION EMPLOYER: We do not accept faxed forms. Submit completed enrollment applications for insurance to: Gray Hunter Stern Reliance Standard P.O. Box 7818 Philadelphia,

How to fill out evidence of insurability form

How to fill out evidence of insurability form:

1. Start by carefully reading the instructions on the form. Make sure you understand all the requirements and necessary documentation.
2. Provide personal information such as your full name, date of birth, social security number, and contact information. Double-check for accuracy, as any mistakes can delay the processing of your form.
3. Indicate the type of coverage or insurance policy for which you are applying. This could be life insurance, disability insurance, or any other type of policy requiring evidence of insurability.
4. Answer questions regarding your medical history. Be thorough and honest when providing information about any pre-existing conditions, surgeries, medications, or current health conditions. Omitting or providing false information can lead to the denial of coverage.
5. If applicable, provide details about your lifestyle choices that may affect your insurability. This could include tobacco or alcohol use, participation in hazardous activities, or recent travel to high-risk areas.
6. Attach any supporting documents required by the form. This could include medical records, recent lab results, or statements from healthcare providers.
7. Review the form once completed to ensure all sections have been filled out accurately and completely. Double-check for any errors or missing information.
8. Sign and date the form in the designated areas. Your signature indicates that the information provided is true and accurate to the best of your knowledge. It also authorizes the insurance company to access your medical records if necessary.

Who needs evidence of insurability form:

1. Individuals applying for new insurance coverage may be required to provide evidence of insurability. This is especially common for life insurance policies with higher coverage amounts, as the insurance company wants to assess the applicant's health and mortality risk.
2. Existing policyholders who wish to increase their coverage or add additional benefits may also need to submit an evidence of insurability form. This allows the insurance company to reevaluate their insurability based on any changes in health conditions or lifestyle choices.
3. Some employers offer voluntary insurance options to their employees, such as supplemental life insurance or disability coverage. In such cases, employees interested in enrolling in these additional insurance policies may need to complete an evidence of insurability form.

In summary, filling out evidence of insurability forms requires providing accurate personal and medical information, attaching any necessary supporting documents, and reviewing the form for accuracy before signing and submitting it. The form may be required for individuals applying for new insurance coverage, existing policyholders seeking additional benefits, or employees enrolling in voluntary insurance options.

For pdfFiller’s FAQs

What is evidence of insurability form?

Evidence of insurability form is a document that provides information about an individual's health condition and other relevant details to determine their eligibility for insurance coverage.

Who is required to file evidence of insurability form?

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

How to fill out evidence of insurability form?

To fill out evidence of insurability form, individuals must provide accurate and complete information about their health history, lifestyle habits, and other relevant details as requested.

What is the purpose of evidence of insurability form?

The purpose of evidence of insurability form is to help insurance companies assess the risk associated with providing coverage to an individual based on their health condition and other factors.

What information must be reported on evidence of insurability form?

Information such as medical history, current medications, lifestyle habits, and family history of illnesses may need to be reported on evidence of insurability form.

How can I send evidence of insurability form to be eSigned by others?

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