Online Evidence of Insurability

Welcome to Online Evidence of Insurability

To complete this process, you may need to provide:

• Group ID/Plan Number
• Coverage(s) being requested
• Health history/Doctor information
• Current insured amount
• Additional amount being requested

If applying for dependent coverage, you may need to provide their:

• Date of Birth
• Height
• Weight
• Health history/Doctor information
• Current insured amount
• Additional amount being requested

To help you understand the Online Evidence of Insurability process, please read our FAQ's. haga clic aquí para 'preguntas más frecuentes' en español

To complete a paper version of the Evidence of Insurability Form, please select this link to obtain the proper form. y seleccione este enlace para obtener una guía de instrucción en español para ayudarle

If your employer is located in New York or New Hampshire; your group is not eligible for Online Evidence of Insurability. Please complete a paper version of the Evidence of Insurability Form.

Before you can begin the Online Evidence of Insurability Process, you must indicate that you have read the Disclosure Statement below.

Yes, I have read and agree to the Disclosure Statement.

To get started, we need some information