When Does Group Life Insurance Require Evidence of Insurability?
Group life insurance is often praised for skipping medical questions altogether, but that’s usually only true up to a certain coverage amount.
The short answer
Evidence of insurability is a health questionnaire, and sometimes additional medical information, that a group life insurance plan can require once an employee’s coverage amount goes above a set threshold known as the guaranteed issue amount. Below that threshold, coverage is generally available automatically; above it, the insurer wants more information about the applicant’s health before agreeing to the additional amount.
Why group plans set a threshold at all
Group life insurance is typically priced and underwritten based on the group as a whole rather than each individual, which is part of what makes it available without health questions for most participants. But insurers still need to manage risk, so plans commonly cap the coverage available without any health screening at a specific level — the guaranteed issue amount — and require evidence of insurability for anything requested above that amount. This balances broad, simple access to a base level of coverage against the insurer’s need for more information on larger amounts.
When evidence of insurability typically gets triggered
A few common situations tend to bring this requirement into play.
- Electing coverage above the guaranteed issue limit. Requesting more than the automatic threshold generally requires completing a health questionnaire, and sometimes a medical exam, similar in concept to what’s involved in life insurance underwriting generally.
- Enrolling outside the initial eligibility window. Employees who don’t sign up for supplemental group coverage when first eligible, and try to add it later, are often asked for evidence of insurability even for amounts that would have been guaranteed issue during that initial window.
- Increasing coverage during open enrollment. Adding coverage in a later enrollment period, rather than at initial hire, can also trigger the requirement depending on the plan’s specific rules.
What the process generally involves
Evidence of insurability usually starts with a written questionnaire covering health history, medications, and sometimes family health history, and can sometimes extend to a medical exam or additional records depending on the amount requested and the insurer’s specific rules. The insurer then reviews the submission and can approve the requested amount, approve a reduced amount, or decline the additional coverage.
What this means for planning coverage
Because the guaranteed issue amount is generally only available without health questions during specific enrollment windows, waiting to request supplemental coverage can mean facing underwriting that wouldn’t have applied earlier. This is one of several reasons timing matters with group benefits, in the same way that portability windows matter when leaving a job — enrollment periods and their rules are set by the specific plan and don’t reopen on demand.
The takeaway
Evidence of insurability exists to let group plans offer a base level of coverage broadly and quickly while still managing risk on larger amounts. Understanding where a specific plan’s guaranteed issue threshold sits, and when enrollment windows apply, makes it easier to know in advance whether requesting more coverage will mean a straightforward addition or a health-based review.