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  • Standard Insurance Company Medical History Statement Medical ... - Per Lacity

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Tion Practices Notice(s) on page 3. A separate form must be submitted for each applicant (Employee/Member, Spouse and/or Child) when Evidence Of Insurability or Proof of Good Health is required to apply for coverage. Complete all items, date and sign in the space at the bottom of page 2. Keep a copy for your records, and send the original to Standard Insurance Company at the address given above. MEMBER/EMPLOYEE INFORMATION Name of Group Group Number Check who is Applying (One per form) Member.

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Personal identification - social security number, date of birth, mailing address, etc. Medical conditions – diagnoses, types of treatment and dates for treatment • Physicians or clinics – names, addresses and phone numbers Once you have the required information, you are ready to begin the process.

To determine your insurability, most insurance providers look at things like: Your projected longevity. They'll evaluate how long they expect you to live based on things like your personal health history, your family health history, and even your gender, since women are stastically more likely to live longer than men.

What is Evidence of Insurability (EOI)? EOI is an application process through which you provide information on the condition of your health or your dependent's health in order to be considered for certain types of insurance coverage. EOI is required for any life and/or disability insurance elections.

Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.

How to Submit an EOI Your group number. Your employer's name/address. The reason the EOI is required. The type and amount of coverage you are requesting. Your name, date of birth, and Social Security number. Your height and weight. Your most recent pulse and blood pressure information.

Evidence of Insurability (EOI) is documented proof of good health. An applicant begins the EOI/medical underwriting process by submitting a Medical History Statement (MHS), which along with other information obtained during the underwriting evaluation is used by The Standard to make the underwriting determination.

Medical history details, including medical conditions, dates of diagnoses, treatments and medications. Names and addresses of current and past physicians who provided treatment.

After you submit your life insurance application, the underwriter begins the verification process. They assess the findings from your underwriting medical exam (if you took one) or health questionnaire, review your medical records and may even conduct personal interviews with friends and relatives.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232