Aetna EOI Form PDF Details

The Aetna EOI form is the primary insurance document for applicants requesting life or disability coverage above the guaranteed-issue limit. It is divided into two parts: Part A for the plan sponsor and Part B for the employee. These sections capture health history, requested coverage amounts, and employment details that Aetna uses to determine coverage eligibility. The form is 8 pages long and typically takes about 20 minutes to complete.

What the EOI form collects

Part A, completed by the plan sponsor or employer, includes the account number, employee Social Security number, and the plan sponsor name and mailing address. Part B, completed by the employee, covers the requested coverage types and amounts. Applicants must specify coverage for basic life, supplemental life, spouse life, children's life, and short-term or long-term disability. The health questionnaire in Part B asks about current diagnoses, prescription medications, recent surgeries, and any conditions diagnosed within the past 10 years. All entries must be complete and accurate.

When you need to submit an EOI

Employees must submit this form when they apply for coverage amounts that exceed the guaranteed-issue (GI) limit. The GI limit is typically one to two times annual salary for life coverage. Additional submission triggers include:

Some employer plans require EOI for all supplemental coverage requests, regardless of amount. Check your benefits guide or contact your HR department to confirm whether your request requires an EOI submission.

Legal implications of submitting the form

Submitting an EOI form is a legal declaration. By signing, you certify that all health information is accurate and complete. Providing false or incomplete information is grounds for policy rescission. A rescinded policy means Aetna can cancel your coverage from the effective date and deny pending claims. Aetna reserves the right to request additional medical records, an independent medical examination, or written statements from treating physicians before issuing a coverage decision. All information is reviewed against third-party medical databases and records from the past 10 years.

Common mistakes to avoid

The most frequent errors on this evidence of insurability form include:

If you have a pre-existing condition, disclose it fully. Any condition discovered during underwriting that was not disclosed may result in coverage denial or premium adjustment.

What to expect after submitting

After you submit the completed form, the underwriting team reviews it within 3 to 8 weeks. Aetna may contact you to request additional medical records, a physical examination, or clarification on specific health disclosures. Once the review is complete, Aetna sends a written approval or denial letter. Approved coverage becomes effective from the date specified in the letter. If denied, you may submit an appeal or apply for a lower coverage tier within the guaranteed-issue limit without requiring additional EOI approval.

EOI thresholds by coverage type

The guaranteed-issue limit varies by coverage category and employer plan. Basic life insurance plans typically set the GI limit at one to two times your annual salary. Supplemental life coverage requires EOI for amounts above the plan's non-medical maximum, which often ranges from $100,000 to $300,000. Spouse life coverage triggers an EOI requirement when the requested benefit exceeds $25,000 to $50,000. Short-term and long-term disability plans require EOI when the monthly benefit exceeds 60 percent of your pre-disability earnings or the plan's non-medical maximum. Review your Summary Plan Description for the specific threshold that applies to your enrollment. Contact your HR representative if you are unsure whether your request falls above or below the GI limit.

Preparing your health records before you start

Gathering documentation before you begin reduces errors and speeds up the underwriting review. Collect the following before you open the form:

Aetna may contact your physicians directly to verify the information you provide. Having accurate records reduces the chance of a discrepancy that delays your underwriting review.

How Aetna communicates its coverage decision

All coverage decisions are delivered in writing. An approval letter specifies the effective date, the approved coverage amount, and any exclusions or riders attached to the policy. A denial letter explains the reason for the decision and lists the appeal rights available under your plan. Keep the decision letter with a copy of your EOI submission for your personal records. If you receive a partial approval, you may accept the approved amount or file an appeal to request reconsideration of the original amount.

For related Aetna forms, the Aetna Appeal Form is available if your coverage application is denied. The Aetna Attending Physician Statement allows your treating physician to provide supporting medical documentation for underwriting. For similar coverage through another carrier, the MetLife Evidence of Insurability form follows a comparable process.

QuestionAnswer
Form NameAetna EOI Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesaetna life insurance company claimant's statement form, eoi form, aetna insurability life, mortgage disability scotialife employers statement sunlife forms

How to Edit Aetna Eoi Form Online for Free

Use our online PDF editor to complete this evidence of insurability form in about 10 minutes. No software installation is required. Work directly in your browser and download the completed form when you are finished.

Step 1: Open the form editor

Click the Get Form Here button at the top of this page. The PDF editor opens in your browser and loads the form automatically. You can type, select, and sign directly in the editor without downloading any additional software.

stage 1 to filling out evidence of insurability

Step 2: Complete Part A (plan sponsor information)

Part A is typically completed by your employer or HR representative. If you are completing this section yourself, enter the following details accurately:

  • Plan sponsor name and full mailing address
  • ATTN contact name at the plan sponsor
  • Employee or member full legal name
  • Employee Social Security number
  • Account number and ATTN field
  • City, state, and ZIP code for both the sponsor and the employee

The plan sponsor signature and date are required in this section before the completed form can be submitted to Aetna.

evidence of insurability EmployeeMember Basic Life  a, Reason for Requested Coverage, EmployeeMember Supplemental, Spouse Life, Children Life, Salary Increase Change in Multiple, Late Applicant, Change in Increments Other Please, Life EventStatus Change, Disability Coverages, Short Term Disability Long Term, Current Amount  Current Amount, or or, Requested Amount  Requested Amount, and or or fields to fill out

Step 3: Enter your coverage request (Part B)

Part B is completed by the employee applying for coverage. Enter your coverage request details for each applicable category:

  • Basic life coverage amount requested
  • Supplemental life coverage for yourself, spouse, or children
  • Short-term and long-term disability coverage amounts
  • Current coverage amount and the new requested amount
  • Reason for the request: new hire, late applicant, salary increase, life event, or other

Record both the current and requested amounts for each coverage type you are changing or adding.

evidence of insurability EmployeeMember Basic Life  a, Reason for Requested Coverage, EmployeeMember Supplemental, Spouse Life, Children Life, Salary Increase Change in Multiple, Late Applicant, Change in Increments Other Please, Life EventStatus Change, Disability Coverages, Short Term Disability Long Term, Current Amount  Current Amount, or or, Requested Amount  Requested Amount, and or or fields to fill out

Step 4: Complete the health questionnaire

The health questionnaire is in Part B. Answer every question honestly and fully. Do not leave any question blank. Write "None" or "N/A" for questions that do not apply to you. The questionnaire asks about:

  • Current pregnancies and expected due dates
  • Planned or recent surgeries or outpatient procedures
  • All prescription medications, dosages, and how often you take them
  • Diagnoses within the past 5 to 10 years, including cancer, arthritis, AIDS or HIV, immune system disorders, and nervous system conditions
  • Any hospitalizations or specialist consultations in the past 5 years

Aetna reviews submitted health data against third-party medical records during underwriting. Any omission discovered during this review may result in coverage denial.

evidence of insurability B EmployeeMember Complete this, Statement of Health for, If any of the following questions, EmployeeMember Social Security, Is any individual pregnant If Yes, Date Due, Any complications or problems If, If Yes Who, Are any inpatient or outpatient, Individual Reason for procedure In, Name of procedure, When, When, Is any individuals currently, and Name of Individual blanks to fill out

Step 5: Review and finalize

Before submitting the form, review all sections to confirm that every required field is complete. Pay special attention to the medications section and the list of past diagnoses. Make sure all individual names, diagnosis dates, and details are entered correctly. Sign and date all required signature fields. Click Done to download the completed PDF to your device. Store a copy for your personal records before sending it to your plan sponsor or to Aetna.

Completing evidence of insurability step 5

Frequently asked questions about the Aetna EOI form

How long does Aetna take to process an EOI form?
Aetna typically completes the review in 3 to 8 weeks. The timeline depends on the completeness of your submission and whether Aetna requests additional medical documentation. You will receive a written approval or denial letter once the review is finished. Complex applications or incomplete submissions may extend the review period beyond 8 weeks.

Can I complete and submit the EOI form online?
You can complete and download the form using our online PDF editor. The completed form must then be submitted to Aetna or your plan sponsor using the method specified in your enrollment materials. Most employers accept submissions by mail, fax, or through a secure HR portal. Confirm the preferred submission method with your HR department before sending.

What happens if Aetna denies my EOI application?
If Aetna denies your coverage request, you can submit an Aetna Appeal Form along with supporting medical evidence to request a reconsideration. You may also apply for a lower coverage tier that falls within the guaranteed-issue limit, which does not require EOI approval. Review the denial letter carefully, as it specifies the appeal deadline and the documentation required.

What is the guaranteed-issue limit for Aetna coverage?
The guaranteed-issue limit varies by employer plan but typically ranges from one to two times annual salary for life coverage. Amounts above this threshold require EOI approval. Disability coverage has separate thresholds based on monthly benefit amounts and salary percentage. Check your employee benefits guide or contact your HR department for the specific GI amount that applies to your plan.

Do I need to see a doctor before submitting the EOI form?
You do not need a doctor visit to submit the form. However, Aetna may request an independent medical examination after reviewing your submission if additional health information is needed. Providing documentation from your treating physician upfront can help speed up the review process. The Aetna Attending Physician Statement is a standard supporting document for this purpose.

Can I submit an EOI form for a spouse or dependent?
Yes. Part B of the form includes sections for spouse life and children's life coverage. If the requested benefit for a spouse or dependent exceeds the plan's guaranteed-issue limit, you must complete the health questionnaire on their behalf. The plan sponsor must still sign Part A before the form is submitted. Contact your HR department to confirm the GI limit that applies to dependent coverage under your plan.

What if I leave a question blank on the health questionnaire?
Leaving any health question blank may cause Aetna to return the form for completion, which delays your underwriting review. Write "None" or "N/A" for any question that does not apply to you. Blank responses are treated differently from a documented "None" answer and may flag the submission as incomplete during the initial review.

Can my employer see my health information on the EOI form?
Your employer's HR department typically handles routing the form to Aetna, but health information disclosed in Part B is kept confidential under HIPAA and is not shared with your employer for employment purposes. Aetna uses your health disclosures only to determine coverage eligibility. If you have concerns about confidentiality, contact Aetna directly to ask about their privacy practices for EOI submissions.

How do I find out what my guaranteed-issue limit is?
Your guaranteed-issue limit is listed in your employee benefits guide or Summary Plan Description (SPD). You can also contact your HR representative or benefits administrator for the specific amount. The Aetna benefits enrollment portal, if available through your employer, may display GI limits alongside your coverage options during open enrollment.

Related insurance forms

If you are applying for similar coverage through another insurer, the MetLife Evidence of Insurability form follows a comparable process with different plan-specific requirements. Employees managing life insurance details may also need the life insurance beneficiary form to designate or update beneficiaries. For disability-related processes, see the disability claim form for filing a claim once coverage is approved.

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