In Maxwell, evidence of insurability is pending when:
- An employee or spouse chooses a coverage amount that is over the guaranteed issue amount. This can also apply to children if that setting has been applied.
- An employee or spouse chooses to enroll in any amount of coverage when they declined coverage in the past (late entry rule). This can also apply to children if that setting has been applied.
- An employee or spouse chooses to increase their existing coverage by any amount (late entry rule). This can also apply to children if that setting has been applied.
Here’s what happens in Maxwell if an employee, spouse, or child (if applicable) elects coverage in a plan that requires EOI based on the above rules:
- Employee enrolls in the benefit
They’ll see their pre-approved amount and the total amount they've selected represented once they enter a coverage amount over their guaranteed issue:
If you’re ever electing coverage on behalf of the employee in Maxwell, you should add the entire coverage amount that the employee would like to elect on the voluntary plan. The system will automatically let you know what coverage is pre-approved and what coverage is pending EOI.
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You review the enrollment
As the Administrator, if you view the event details on the employee’s profile, you’ll see that the employee has elected the voluntary plan and that the coverage is pending EOI. You can also tell the reason that EOI was needed—either the coverage amount was over the guaranteed issue, or if the plan participant is a late entrant into the plan.
If the employee is in OE and you want to see if an election they’ve made requires EOI before you’ve ended the event, go to the employee’s profile and click Actions > View Event Details on the banner. You can then see if the election they made is pending EOI by going to the “Benefits” section.
Whether it’s an open enrollment event, a new hire event, or a life event, you’ll approve the pre-approved amounts by approving and ending the event. You can then view the pre-approved coverage and the total amount requested on the employee’s “Benefits” tab:
For plans that are pending EOI due to late entry with a pre-approved amount is $0, the cost will be hidden, and the effective date will be listed as “Pending EOI Decision.”
Note for clients of the Maxwell + Sun Life solution: You will not see the "Process EOI Request" button on the employee's Sun Life benefit because the decision will be processed on your behalf. See more below.
For an annual Open Enrollment, you can also download a report that will list all the enrollments that were part of the OE and include coverage that’s pending EOI. This report will be available right on the screen after you end the OE. - Employee completes the EOI application
At this point, the employee will need to fill out the carrier's EOI application. How this is done depends on the carrier, so you'll want to look up the process on the carrier's website, or ask your Advisor for guidance.- If you have EOI forms set up in your portal: Maxwell will immediately send the employee an EOI form to complete when they submit their enrollment. Learn more about auto-sending forms here >
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Note for clients of the Maxwell + Sun Life solution: Within two business days of submitting their enrollment, any employee with a pending EOI amount will receive an email asking them to complete their EOI application online in their Sun Life portal. These employees will also receive reminder emails 30 days and 60 days after the first email is sent if they still haven't completed the application.
- You send the elections over to the carrier
- If you have an EDI connection with the carrier, this will happen automatically. Please note that the election may send over to the carrier before you approve the event.
- If you're using forms, you should send the completed EOI forms over to the carrier.
- If you're using Maxwell reports, you'll want to run the “Pending Elections Report” which will always display the full requested coverage amount, even if the pre-approved amounts have already been approved (by ending the event). The pre-approved amounts that have been processed will display on the “Coverage Report.” Similarly, the “Pending Elections Cost Report” will show cost information based on the full requested coverage amount, even if the pre-approved amounts have already been processed. The cost of the pre-approved amounts will display on the “Enrolled Cost Report.”
Clients of the Maxwell + Sun Life solution: You do not need to take this step for your Sun Life benefits as Sun Life will have the coverage information right away. You do not need to approve the EOI request in Sun Life Connect to start the application review process. - The carrier reviews the elections and the employee's application
How long this step takes varies by carrier.
Clients of the Maxwell + Sun Life solution: You can track the EOI application status within Sun Life Connect. - The carrier notifies you that the additional coverage amounts are approved or denied
At this point, you should approve or deny those amounts in Maxwell. Learn how to close out EOI here >
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Clients of the Maxwell + Sun Life solution: |
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Do I need to configure evidence of insurability or late entry rules?
Evidence of insurability and standard late entry rules described above are automatically applied to employees and spouses for every voluntary life and most voluntary critical illness products, as they’re common rules across these lines of coverage.
For any voluntary products where the coverage amount is equal to the guaranteed issue amount, you’ll indicate in Tempo (or on the EIF, for Maxwell + Sun Life clients) that the late entry penalty exists on the product. This is because it varies as to whether or not late entry rules apply to these products. Please note that for Maxwell Marketplace products, the Implementation Team set these rules up on your behalf, both on a going-forward basis and for your existing portals.
If late entry should apply to children, you can set that up in Tempo (or on the EIF, for Maxwell + Sun Life clients).
Can I set up special rules to increase participation during my client’s annual open enrollment?
In an effort to increase participation, some carriers may offer different evidence of insurability requirements during your company’s annual open enrollment. While a carrier will always require evidence of insurability for employees who are offered the product for the first time and choose to elect over the guaranteed issue, they may allow some flexibility when it comes to those who were previously offered coverage or want to increase their coverage at this point.
Maxwell offers the flexibility to run an open enrollment that allows every employee and spouse to be treated as a first-time enrollee with access to the guaranteed issue, regardless of their past interactions with the product (sometimes called a “true open enrollment” or “one-off special open enrollment”). You’ll indicate this on the product configuration in Tempo (or on the EIF, if implementing a Maxwell + Sun Life client):

Maxwell also offers the ability to enable employees to increase their inforce coverage by an additional amount without requiring evidence of insurability as long as the total requested amount is not above the guaranteed issue (sometimes called “additional purchase guarantee” or “one-off provision”). This is a less common scenario, but you also have the ability to enable employees with inforce coverage above the guaranteed issue to increase their inforce coverage by an additional amount without requiring evidence of insurability. You’ll indicate this on the product configuration in Tempo (or on the EIF, for Maxwell + Sun Life clients):


- Some carriers may allow late entrants to enroll in the lowest increment without requiring evidence of insurability throughout the year. This is an available configuration in Tempo (or on the EIF for Maxwell + Sun Life clients) on any plan that has late entry rules, as long as the plan allows employees to choose their increment amounts.
- Some carriers may also allow late entrants to enroll up to the guaranteed issue amount without requiring evidence of insurability for certain life events that result in a family status change, including: Birth or Adoption of a Child, Change in Domestic Partnership Status, Change to Spouse Coverage, Family and Medical Leave Act, Marriage, Divorce, Death of Spouse or Dependent, Part-time to Full-time, Full-time to Part-time, Spouse Loss/ Gain Insurance Eligibility. This is an available configuration in Tempo (or on the EIF for Maxwell + Sun Life clients) on any plan that has late entry rules.
- Note: If this rule is not set up, EOI will be required during any life event for the employee or spouse (other than Marriage and Change in Domestic Partnership Status for the spouse).
- In Maxwell, evidence of insurability can be set up on all voluntary lines of coverage (life, critical illness, disability) except for voluntary cancer and voluntary accident plans. EOI is not commonly covered for these types of plans.
- If the employee's salary increases so much as to require EOI for basic life plans, the Administrator will need to manually reduce the coverage amount on the enrollment until the full requested amount is approved by the carrier.
- If the employee's salary increases so much as to require EOI for basic life plans, the Administrator will need to manually reduce the coverage amount on the enrollment until the full requested amount is approved by the carrier.
- Maxwell does not support giving late entrants access to a guaranteed issue amount above $0.
- Maxwell does not support one guaranteed issue amount across a basic plan and a voluntary plan (for example, a shared GI amount across Basic Life and Voluntary Life).
- At times, carriers allow rehires not to be subject to EOI based on late entry rules if it’s been an extended period of time since they left the company and were previously enrolled in or offered coverage. Currently, Maxwell does not allow for this scenario and ensures late entry rules are applied to all rehires, regardless of how long it’s been since they were previously employed by the company. (Of course, this requires that the employee was listed in the Maxwell system during their previous employment). While this may cause a voluntary product to pend EOI when it’s not necessary, the Administrator can always manually approve the full amount in Maxwell without having the individual complete a form.
- One of the late entry rules mentioned above is if an employee declines coverage, they will be subject to evidence of insurability the next time they’re offered coverage. Please note that in the Maxwell platform, the employee does not need to actively waive or even log in to be considered as “declining” coverage. They only need to have been offered the product at a point in time.
- For voluntary critical illness products, some carriers do not use a form and instead have the employee answer health questions right in the Maxwell shopping experience after they elect a coverage amount that requires EOI. For those products, Maxwell does not currently support late entry rules and only requires EOI if the employee elects over the guaranteed issue. The HR administrator can manually administer late entry for these products by following these steps.