Evidence of Insurability - Chapter 8 Flashcards
Which statement is correct if an election is pending evidence of insurability?
a. All other benefits are put on hold until the status is updated to approved
b. All other benefits are put on hold until a notification email is sent through the business process
c. All benefits are enrolled with the exception of the insurance coverage
d. All benefits are enrolled including the insurance coverage, which defaults based on your configuration.
D
True or False? The manage evidence of Insurability Status report tracks all emails sent through the report
True
What is Evidence of Insurability (EOI) and how is it used?
EOI is used by insurance companies to determine eligibility for insurance coverage that exceeds the guaranteed issue amount.
How can you define EOI requirements in Workday?
By benefit groups, enrollment event, and coverage type by specifying the maximum amount of coverage workers can elect without evidence of insurability, the coverage amounts that apply to a worker whose EOI status is under review, and the coverage levels that apply when a worker’s eligibility for coverage has been approved or denied.
Does Workday provide a process outside of benefits enrollment you can use to track a worker’s EOI status, record approval or denial of EOI claims, and automatically apply the appropriate coverage level when a worker’s EOI status has been finalized.
YES
What happens when an employee elects a coverage amount that requires EOI review?
The benefits system automatically sets their EIO status to pending and tracks them on the Manage Evidence of Insurability Status page.
When an enrollment triggers EOI, the employee is obligated to complete the next step and be approved by the insurance company before the elected coverage goes into effect. What will happen in Workday?
Based on your configuration of your enrollment event rules, the employee’s coverage could default to the elected amount, the guaranteed issue amount, or their current coverage amount while pending approval.
What happens in Workday once the insurance carrier has approved or denied elected coverage?
It can either go into effect as of the original event date, or the approval/ denial date. Both the default coverage if Pending EOI rule (on enrollment event rule) and EOI takes effect on the date (located on the benefit group_ should be configured to work together.
Give an example - If the event is configured to default coverage to the guaranteed amount and EOI takes effect on the approval/ denial date, what occurs?
What if the request is declined?
Pending EOI - coverage defaults to the guaranteed issue amount.
Once the elected coverage is approved, the employees receives the elected benefit as of the approval date.
If the request is declined, then they would remain with the guaranteed issue amount.
Where could you configure notifications, or to dos routed to the EE or Benefit partner with info when EOI is triggers?
The Change Benefits for Life Event BP
What does the Manage evidence of insurability status page do?
When an employee selects a coverage amount that requires EOI review, the benefits system automatically set their EOI review status to pending and tracks them on the Manage evidence of insurability status page.
Name a few things that you can do on the Mange evidence of insurability status page.
- View EEs whose EOI status is pending and the details of the configuration.
- Update the status of employees from Pending to Approved or Denied depending on the results of the insurance providers EOI review.
- Notify employees of their EOI status through the email functionality (pending, approved, or denied).
- Apply the correct coverage amount based on the insurance provider’s final determination of an employee’s eligibility for coverage.
