Non-Evidence Maximum

216 views March 19, 2018 August 27, 2018 ghclienthelp 6

Your benefit plan may be set up with a Non-Evidence Maximum for the Basic Life, AD&D, ASI and Disability benefits. The Non-Evidence Maximum is the maximum amount of insurance a member may have under the plan without providing any medical information to the Insurer. A member may become eligible for a higher benefit level based on changes to their reported earnings.

If the amount of insurance exceeds the Non-Evidence Maximum, then the portion of the increase in excess of the Non-Evidence Maximum will be subject to the submission and approval of Evidence of Insurability. GroupHEALTH will automatically generate a “Non-Evidence Maximum Notification” with your Billing Statement for any member whose earnings make them eligible for benefits exceeding the Non-Evidence Maximum. This report shows the member’s current coverage and premium, as well as the additional coverage which the member is eligible and the corresponding premium. (This notification will only appear one time.)

  • You must offer the member any additional benefit amount for which they are eligible.
  • If the member wishes to waive the additional coverage, have the member complete a Waiver of Excess Coverage and return it to GroupHEALTH.
  • If the member wishes to apply for the additional coverage, have them complete and sign the appropriate form for Evidence of Insurability.
  • Return the completed form to GroupHEALTH for underwriting. The Insurer will review the information and provide an answer in writing to the member.
  • As the Plan Administrator, you will receive a letter from GroupHEALTH advising whether the additional coverage is approved or declined. If approved, the higher benefit volume and increased premiums amount will appear on your next Billing Statement.

If a member has been approved for excess insurance amounts, and later receives a subsequent salary increase, the additional amounts are automatically approved up to 15%. If a member’s earnings place them over the Non-Evidence Maximum and the reported salary increase is 15% or more over current reported earnings, completion of Evidence of Insurability forms will be required again.


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