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OHBEN1125 - Define Evidence of Insurability Conditions

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For certain levels of coverage, employees may be required to provide evidence of their insurability. In this step, you define evidence of insurability (EOI) requirements in accordance with the policies of the plans that you offer.

You can perform the following activities in this step:

• Specify which plan options/dependent coverages require employees to present EOI in order to be enrolled.

• Define the changes in election that require EOI.

• Determine the action the system should take if EOI is not provided at the time of enrollment.

• Specify grace periods within which the employee must provide EOI.

The Standard Health plan requires EOI to be provided within 1 month of participation in Option II, regardless of whether it is a change in election or a new enrollment in the plan. Option II is therefore defined as an option requiring EOI.

A pending record is to be created if Option II is selected, and a grace period of 1 month from the participation start date is set.

1. Choose Options requiring EOI to enter the dependent coverages and plan options that require EOI.

• If all coverages within an option require EOI, enter the option only.

• If EOI is only required on initial enrollment, set the InitEnrol. indicator.

1. Choose Changes requiring EOI to specify the jumps in option and/or coverage that require EOI.
   

You can specify that a jump from one option to another or a change in option within a plan requires EOI.

1. In the Action field, choose the appropriate procedure for creating infotype records in cases where EOI is required but not yet provided.
2. If required, enter the grace period, within which employees must provide EOI, and specify whether the grace period starts on with enrollment participation.

If you enter an option as requiring EOI, you do not need to enter all jumps to this option as changes requiring EOI. The fact that the option is defined as requiring proof is sufficient to ensure that any employee changing to this option is required to provide EOI.

In the event of EOI not being provided at enrollment, the system can create infotype records in either of the following ways:

1 - Create an active record for the chosen option

2 - Create a pending record for the chosen option

The action that you choose determines how the infotype records created during enrollment are attributed.

Action	Locked	EOI reqd	EOI provided
EOI provided	n/a		x	x
EOI not provided	1		x
2	x	x

These attributes are read by the EOI Monitor, which displays the status of EOI provision and indicates whether enrollments are pending or active. Pending enrollments are those for which the infotype record is locked.

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