Step 1 : Select Coverage
* required

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

If you do not know your Group ID/Plan Number, please contact your plan administrator.