Concept: Evidence of Insurability Processes

The EOI review and approval process is triggered automatically when an employee elects an amount or level of coverage over the guaranteed issue amount. The guaranteed issue amount is the maximum amount an employee can elect without evidence of insurability.

When the Benefits Administrator finalizes an enrollment event, Workday:

Identifies:

Employees that have elected coverage that is greater than the

Guaranteed Issue Amount

Guaranteed Issue Multiplier

Employees that had no insurance coverage before but have elected coverage that is greater than the

Guaranteed Levels Without EOI

Employees that had insurance coverage before but have elected coverage that is greater than the

Maximum Levels of Change Allowed Without EOI

Maximum Amount of Change Allowed Without EOI

If an employee elects an amount or level of coverage that requires evidence of insurability, the EOI process automatically sets the employee's EOI status to Pending
.

Use the

Manage Evidence of Insurability Status

task to search for employees with a status of Pending
. You can also use this task to send an email notification that contains a link to the EOI form. The enrollment form Insurance section instructional text can also include a link to the EOI form.

When the status is Pending
, Workday updates the employee’s coverage during the EOI review period to:

a. The elected coverage, if the

Default Coverage if Pending EOI

value is Elected Coverage Amount
. The effective date of coverage is determined by the

EOI Takes Effect on Date

for the benefit group.

b. The guaranteed issue amount, if the

Default Coverage Pending EOI

value is Guaranteed Issue Amount
. The effective date of coverage is determined by the

EOI Takes Effect on Date

for the benefit group.

When the insurance carrier approves or denies the employee's EOI claim, the Benefits Administrator enters the employee's status (Approved
or Denied
) on the

Manage Evidence of Insurability Status

task.

You can use the

Manage Evidence of Insurability Status

task to send an email notification informing the employee of their new status.

If the status is Approved
, the employee's benefit coverage is updated to the elected coverage.

If the status is Denied
, Workday updates the employee's coverage to:

a. The guaranteed issue amount, if the guaranteed issue amount does not equal zero. The effective date of coverage is determined by the

EOI Takes Effect on Date

for the benefit group.

b. The previous coverage, but only when the employee is changing plans.

c. Waived, if the guaranteed issue amount equals zero.

Benefits Administrators can finalize open enrollment and other benefit change events while the EOI process is pending. This is because Workday tracks evidence of insurability outside of the enrollment process.