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Fill Out Your Met Life Evidence Of Insurability Form

The Met Life Evidence Of Insurability form is an essential document used to assess an individual’s eligibility for insurance coverage. This form collects vital health information from the proposed insured, which may include the employee’s spouse or child, to help determine the risk and ultimately, the insurance decision. Completing this form accurately and thoroughly is crucial for ensuring a smooth application process.

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Fill Out Your Met Life Evidence Of Insurability Form

Article Structure

The Met Life Evidence of Insurability form plays a vital role in the insurance application process, ensuring that accurate health information is collected for individuals seeking group insurance coverage. This detailed form guides both employees and those being insured—be it a spouse, domestic partner, or child—through the necessary steps required to validate health status. Initially, employees must fill out specific group customer and employee information, including their name and Social Security number. Then, the next phase involves the proposed insured, who must complete their section carefully. Each proposed insured is required to fill out a separate Statement of Health form. A comprehensive health evaluation is undertaken, where various medical history questions must be answered honestly, as this information is used by MetLife to assess insurability. Should additional medical details become necessary after MetLife reviews the form, applicants may be requested to take further action, including potential physical examinations. With strict guidelines in place, it is crucial for all parties involved to ensure that no section of the form is overlooked, as incomplete submissions will only lead to delays in the application process. Moreover, understanding the importance of compliance, accuracy, and timely submission can significantly influence the outcome of one's insurance request.

Met Life Evidence Of Insurability Example

INSTRUCTIONS

FOR THE STATEMENT OF HEALTH FORM AND THE AUTHORIZATION FORM THAT FOLLOW THIS SECTION

INSTRUCTIONS TO THE EMPLOYEE

1.Fill in the Group Customer Information and Insurance Information on the Statement of Health form.

2.Fill in your name and Social Security # on the Statement of Health form. The Employee's Name and the Employee’s Social Security # must appear on the form.

3.Give the forms to the Proposed Insured to complete and send to MetLife.

INSTRUCTIONS TO THE PROPOSED INSURED (The Proposed Insured is the person for whom insurance is being requested. The Proposed Insured may be the Employee, the Employee’s Spouse/Domestic Partner or the Employee’s Child.) A separate Statement of Health form must be completed by each Proposed Insured. Based on the enrollment form submitted by the Employee, a Statement of Health form is required to complete the employee’s request for group insurance coverage for you, the Proposed Insured.

		Metropolitan Life Insurance Company
1.	Complete the Statement of Health form and sign where indicated by an arrow.		Statement of Health Unit
1.			P.O. Box 14069
2.	Sign the Authorization form where indicated by an arrow.		Lexington, KY 40512-4069
3.	After completion, make a copy of both completed forms for your records and FAX, MAIL or EMAIL the original		FAX: 1-859-225-7909
3.			To Submit Completed Forms Email:
	forms to the address at the right. Emailed forms must be printed and signed before they are scanned and

	submitted.		SOHSubmissions@metlife.com
	submitted.		SOHSubmissions@metlife.com

For questions, call MetLife at 1-800-638-6420, prompt 1 (Statement of Health Unit) or email us at			For Questions Email:
eoi@metlifeservice.com.			eoi@metlifeservice.com

Note: Additional medical information may be required after MetLife’s initial review of a completed Statement of Health form. The additional information requested may be a physical examination, paramedical exam, or an Attending Physician Report. Correspondence will be sent within ten days by MetLife or our approved vendor. Incomplete forms will be returned to you for completion.

Some services in connection with your Statement of Health form may be performed by our affiliate, MetLife Global Operations Support Center Private Limited. This service arrangement in no way alters Metropolitan Life Insurance Company's obligations to you. Services will not be performed by our affiliate if prohibited by state or local law or by mutual agreement with the Group Customer .

STATEMENT OF HEALTH FORM

Metropolitan Life Insurance Company, New York, NY 10166

GROUP CUSTOMER INFORMATION (To be Completed by the Recordkeeper)

Name of Group Customer/Employer/Association

Street Address

City

Group Customer #

State

Reporting Location #

Zip Code

EMPLOYEE INFORMATION (To be Completed by the Employee)

Name of Employee (First, Middle, Last)

Social Security # of Employee

YOUR INFORMATION (To be Completed by the Proposed Insured)
YOUR INFORMATION (To be Completed by the Proposed Insured)
Name (First, Middle, Last)				Relationship to Employee			Child	Male
				Self	Spouse/Domestic Partner		Child	Female
Street Address			City			State	Zip Code

Date of Birth (MM/DD/YYYY)	Daytime Phone #	Home Phone	#	Email Address

GEF02-1

ADM

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF02-1

ADM applies to residents of Connecticut, North Dakota and Utah)

Please complete all sections of this form. Incomplete forms will be returned to you.

Page 1 of 5

SOH-BR400M-NY (06/17)

Metropolitan Life Insurance Company, New York, NY 10166

HEALTH INFORMATION

SECTION 1

Please complete all questions below. Omitted inf ormation will cause delays. In this section, “you” and “your” refers to the person for whom insurance is being requested. Health Information is required for the Proposed Insured only. For questions 5 through 11u, for “yes” answers, please provide full de tails in Section 2.

Your name

Employee’s Name

inches Your weight

Employee’s Social Security/Identification #

Your height

feet

pounds

Yes

Are you now on a diet prescribed by a physician or other health care provider? If “yes” indicate type

Are you now pregnant? If “yes,” what is your due date (month/day/year)?

If “yes”, provide Physician’s name

Telephone:

Are you now, or have you in the past 2 years, used tobacco in any form?

In the past 5 years, have you received medical treatment or counseling by a physician or other health care provider for, or been

advised by a physician or other health care provider to discontinue, the use of alcohol or prescribed or non-prescribed drugs?

In the past 5 years, have you been convicted of driving while intoxicated or under the influence of alcohol and/or any drug?

If “yes”, specify ”date(s) of conviction(s) (month/day/year)

Have you had any application for life, accidental death and

dismemberment or disability insurance

declined

postponed

withdrawn

rated

modified or

issued other than as applied for?

Indicate reason

Are you now receiving or applying for any disability benefits, including workers’ compensation?

9.Have you been Hospitalized as defined below (not including well-baby delivery) in the past 90 days?

Hospitalized means admission for inpatient care in a hospital; receipt of care in a hospice facility, intermediate care facility, or long term care facility; or receipt of the following treatment wherever performed: chemotherapy, radiation therapy, or dialysis.

10.For residents of all states except CT, please answer the following question: Have you ever been diagnosed or treated by a physician or other health care provider for Acquired Immunodeficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?

For CT residents, please answer the following question: To the best of your knowledge and belief, have you ever been diagnosed or treated by a physician or other health care provider for Acquired Immunodeficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?

11. Have you ever been diagnosed, treated or given medical advice by a physician or other health care provider for: a. cardiac or cardiovascular disorder? Indicate type

b. stroke or circulatory disorder? Indicate type c. high blood pressure?

d. cancer, Hodgkin's disease, lymphoma or tumors? Indicate type e. anemia, leukemia or other blood disorder? Indicate type

f. diabetes? Your age at diagnosis?Check if insulin treated g. asthma, COPD, emphysema or other lung disease? Indicate type

h. ulcers, stomach, hepatitis or other liver disorder? Indicate type

i. colitis, Crohn’s, diverticulitis or other intestinal disorder? Indicate type j. memory loss? Indicate type

k.epilepsy, paralysis, seizures, dizziness or other neurological disorder?

Specify date of last seizure (month/year) Indicate type

Epstein-Barr, chronic fatigue syndrome or fibromyalgia? Indicate type

multiple sclerosis, ALS or muscular dystrophy? Indicate type

lupus, scleroderma, auto immune disease or connective tissue

disorder?

arthritis?

osteoarthritis

rheumatoid

other/type

back, neck,

knee, spinal, joint or other musculoskeletal disorder? Indicate type

carpal tunnel syndrome?

kidney, urinary tract or prostate disorder? Indicate type

thyroid or other gland disorder? Indicate type

mental, anxiety, depression, attempted suicide

or nervous disorder? Indicate type

sleep apnea? Indicate type

After completing the Personal Physician and Prescription Information on the next page, please provide full details in Section 2 for “yes” answers to questions 5 through 11u.

GEF09-1

HEA

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF09-1

HEA applies to residents of Connecticut, North Dakota and Utah)

Please complete all sections of this form. Incomplete forms will be returned to you.

Page 2 of 5

SOH-BR400M-NY (06/17)

Metropolitan Life Insurance Company, New York, NY 10166

Personal Physician Information

Personal Physician’s Name:

Address (Street, City, State, Zip Code):

Telephone:

Date of last visit (MM/DD/YYYY):

Reason for visit:

Prescription Information

Are you currently taking any prescribed medications?

Yes

If yes, list the medications.

Medication:

Condition/Diagnosis:

Prescribing Physician’s Name:

Telephone:

Address (Street, City, State, Zip Code):

Medication:

Condition/Diagnosis:

Prescribing Physician’s Name:

Telephone:

Address (Street, City, State, Zip Code):

Check here if you are attaching another sheet for any additional medications.

SECTION 2

Please provide full details-below for each “Yes” answer to questions 5 through 11u in Section 1. If you need more space to provide full details,

attach a separate sheet with the information and sign and date it. Delays in processing your application may occur if complete details are not provided.

MetLife may contact you for additional or missing information.

Check here if you are attaching another sheet.

Your name

Employee’s Name

Your Date of Birth

Question Number

Condition/Diagnosis

Please list any medication prescribed that you did not already identify in

the Prescription Information above.

Date of Diagnosis (Month/Year)

Date of Last Treatment (Month/Year)

Type of Treatment

Treating Health Professional

Physician’s Name:

Date of last visit:

Reason for visit:

Address

Street

City

State

Zip Code

Telephone:

Question Number

Condition/Diagnosis

Please list any medication prescribed that you did not already identify in

the Prescription Information above.

Date of Diagnosis (Month/Year)

Date of Last Treatment (Month/Year)

Type of Treatment

Treating Health Professional

Physician’s Name:

Date of last visit:

Reason for visit:

Address

Street

City

State

Zip Code

Telephone:

GEF09-1

HEA

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF09-1

HEA applies to residents of Connecticut, North Dakota and Utah)

Please complete all sections of this form. Incomplete forms will be returned to you.

Page 3 of 5

SOH-BR400M-NY (06/17)

Metropolitan Life Insurance Company, New York, NY 10166

Question Number

Condition/Diagnosis

Please list any medication prescribed that you did not already identify in

the Prescription Information above.

Date of Diagnosis (Month/Year)

Date of Last Treatment (Month/Year)

Type of Treatment

Treating Health Professional

Physician’s Name:

Date of last visit:

Reason for visit:

Address

Telephone:

Street

City

State

Zip Code

GEF09-1

HEA

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF09-1

HEA applies to residents of Connecticut, North Dakota and Utah)

FRAUD WARNINGS

Before signing this Statement of Health form, please read the warning for the state where you reside and for the state where the contract under which you are applying for coverage was issued.

Alabama, Arkansas, District of Columbia, Louisiana, Massachusetts, New Mexico, Ohio, Rhode Island and West Virginia : Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Colorado: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

Florida: Any person who knowingly and with intent to injure, defraud or deceive any insurance company files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree.

Kansas and Oregon: Any person who knowingly presents a materially false statement in an application for insurance may be guilty of a criminal offense and may be subject to penalties under state law.

Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

Maine, Tennessee and Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

Maryland: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

New Jersey: Any person who files an application containing any false or misleading information is subject to criminal and civil penalties.

New York (only applies to Accident and Health Benefits): Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

Puerto Rico: Any person who knowingly and with the intention to defraud includes false information in an application for insurance or files, assists or abets in the filing of a fraudulent claim to obtain payment of a loss or other benefit, or files more than one claim for the same loss or damage, commits a felony and if found guilty shall be punished for each violation with a fine of no less than five thousand dollars ($5,000), not to exceed ten thousand dollars ($10,000); or imprisoned for a fixed term of three (3) years, or both. If aggravating circumstances exist, the fixed jail term may be increased to a maximum of five (5) years; and if mitigating circumstances are present, the jail term may be reduced to a minimum of two (2) years.

Vermont: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

Virginia: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated the state law.

Pennsylvania and all other states: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

GEF09-1

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF09-1

FW applies to residents of Connecticut, North Dakota and Utah)

Please complete all sections of this form. Incomplete forms will be returned to you.

Page 4 of 5

SOH-BR400M-NY (06/17)

Metropolitan Life Insurance Company, New York, NY 10166

DECLARATIONS AND SIGNATURES

By signing below, I acknowledge:

1.I have read this Statement of Health form and declare that all information I have given, including any health information, is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.I have read the applicable Fraud Warning(s) provided in this Statement of Health form.

Sign

Here

Signature of Proposed Insured

Print Name

Date Signed (MM/DD/YYYY)

If a child proposed for insurance is age 18 or over, the child must sign this Statement of Health. If the child is under age 18, a Personal Representative for the child must sign, and indicate the legal relationship between the Personal Representative and the proposed insured. A Personal Representative for the child is a person who has the right to control the child’s health care, usually a parent, legal guardian, or a person appointed by a court.

Sign Here

Signature of Personal Representative

Print Name

Date Signed (MM/DD/YYYY)

Relationship of Personal Representative

GEF09-1

DEC

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana; and

GEF09-1

DEC applies to residents of Connecticut, North Dakota and Utah)

Please complete all sections of this form. Incomplete forms will be returned to you.

Page 5 of 5

SOH-BR400M-NY (06/17)

AUTHORIZATION

This Authorization is in connection with an enrollment in group insurance and information required for underwriting and claim purposes for the proposed insured(s) ("employee", spouse, and /or any other person(s) named below). Underwriting means classification of individuals for determination of insurability and / or rates, based upon physician health reports, prescription drug history, laboratory test results, and other factors. Notwithstanding any prior restriction placed on information, records or data by a proposed insured, each proposed insured hereby authorizes :

•Any medical practitioner, facility or related entity; any insurer; MIB Group, Inc (“MIB”); any employer; any group policyholder, contract holder or benefit plan administrator; any pharmacy or pharmacy related service organization; any consumer reporting agency; or any government agency to give Metropolitan Life Insurance Company (“MetLife”) or any third party acting on MetLife's behalf in this regard:

•personal information and data about the proposed insured including employment and occupational information; medical information, records and data about the proposed insured including information, records and data about drugs prescribed, medical test results and sexually transmitted diseases;

•information, records and data about the proposed insured related to alcohol and drug abuse and treatment, including information and data records and data related to alcohol and drug abuse protected by Federal Regulations 42 CFR part 2;

•information, records and data about the proposed insured relating to Acquired Immunodeficiency Syndrome (AIDS) or AIDS related conditions including, where permitted by applicable law, Human Immunodeficiency Virus (HIV) test results;

•information, records and data about the proposed insured relating to mental illness, except psychotherapy notes; and motor vehicle reports.

Note to All Health Care Providers: The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA
Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To
comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. ‘Genetic
information’ as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that
an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an
individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
Expiration, Revocation and Refusal to Sign: This authorization will expire 24 months from the date on this form or sooner if prescribed by law. The
proposed insured may revoke this authorization at any time. To revoke the authorization, the proposed insured must write to MetLife at P.O. Box 14069,
Lexington, KY 40512-4069, and inform MetLife that this Authorization is revoked. Any action taken before MetLife receives the proposed insured's
revocation will be valid. Revocation may be the basis for denying coverage or benefits. If the proposed insured does not sign this Authorization, that
person's enrollment for group insurance cannot be processed.
By signing below, each proposed insured acknowledges his or her understanding that:
•	All or part of the information, records and data that MetLife receives pursuant to this authorization may be disclosed to MIB. Such information may also
	be disclosed to and used by any reinsurer, employee, affiliate or independent contractor who performs a business service for MetLife on the insurance
•	applied for or on existing insurance with MetLife, or disclosed as otherwise required or permitted by applicable laws.
	Medical information, records and data that may have been subject to federal and state laws or regulations, including federal rules issued by Health and
	Human Services, setting forth standards for the use, maintenance and disclosure of such information by health care providers and health plans and
	records and data related to alcohol and drug abuse protected by Federal Regulations 42 CFR part 2, once disclosed to MetLife or upon redisclosure by
•	MetLife, may no longer be covered by those laws or regulations.
	Information relating to HIV test results will only be disclosed as permitted by applicable law.
•	Information obtained pursuant to this authorization about a proposed insured may be used, to the extent permitted by applicable law, to determine the
•	insurability of other family members.
	A photocopy of this form is as valid as the original form. Each proposed insured (or his/her authorized representative) has a right to receive a copy of
•	this form.
	I authorize MetLife, or its reinsurers, to make a brief report of my personal health information to MIB.

Sign Here

Signature of Proposed Insured		Date Signed (MM/DD/YYYY)
Print Name	State of Birth	Country of Birth

If a child proposed for insurance is age 18 or over, the child must sign this Authorization form. If the child is under age 18, a Personal Representative for the child must sign, and indicate the legal relationship between the Personal Representative and the proposed insured. A Personal Representative for the child is a person who has the right to control the child’s health care, usually a parent, legal guardian, or a person appointed by a court.

Sign Here

Signature of Personal Representative

Print Name

Date Signed (MM/DD/YYYY)

Relationship of Personal Representative

AUTH-XDP110M-NW (06/17)

Get Met Life Evidence Of Insurability PDF Form

Form Characteristics

Fact Name	Details
Purpose of the Form	The Met Life Evidence of Insurability form is used to assess an individual’s health when applying for group insurance coverage, ensuring eligibility based on health conditions and history.
Who Must Complete It	The form must be filled out by the employee, along with any proposed insureds, which may include the employee's spouse, domestic partner, or child.
Required Information	Completing the form requires personal information, including the name and Social Security number of the employee and the proposed insured, along with detailed health history.
Submission Process	After completing the form, it can be submitted via fax, mail, or email. Originals must be signed before emailing. Making a copy for personal records is recommended.
State-Specific Forms	Form number GEF09-1 applies to residents of Montana, while GEF02-1 ADM is for Connecticut, North Dakota, and Utah, reflecting state-specific requirements.
Potential Follow-Up	After an initial review, MetLife may request additional medical information, such as a physical examination or Attending Physician Report, which is important for final approval.

Guidelines on Utilizing Met Life Evidence Of Insurability

After gathering all required information, the next step involves completing the Met Life Evidence of Insurability form. Ensure all sections of the form are filled accurately before submitting it to MetLife. Be mindful that incomplete or improperly filled forms may delay the application process.

Start by filling in the Group Customer Information and Insurance Information on the Statement of Health form.
Provide your name and Social Security Number on the Statement of Health form. Ensure that the Employee's Name and Social Security Number are clearly labeled.
Pass the forms to the Proposed Insured. They need to complete their sections of the form.
The Proposed Insured should complete the Statement of Health form. They must sign where indicated.
Also, the Proposed Insured must sign the Authorization form, where indicated.
Make a copy of both completed forms for personal records.
Submit the original forms via FAX, MAIL, or EMAIL to MetLife.

Investigate additional medical information that may be necessary after the initial review of the completed form. Responses or requests for further information typically arrive within ten days of submission.

What You Should Know About This Form

What is the Met Life Evidence of Insurability form?

The Met Life Evidence of Insurability form is a required document used by Metropolitan Life Insurance Company to assess an individual's eligibility for group insurance coverage. This form collects detailed information about the proposed insured's health status and medical history, allowing Met Life to evaluate the risk associated with the insurance application.

Who needs to complete the Evidence of Insurability form?

The form must be completed by the proposed insured, who may be the employee, their spouse or domestic partner, or their child. Each proposed insured needs to fill out a separate Statement of Health form to ensure accurate information is provided for every person being insured.

What information is required on the form?

The form requires various types of information including personal details such as name, Social Security number, relationship to the employee, health information, and medical history. Specific questions cover topics like use of tobacco, pregnancy, hospitalization, and existing medical conditions.

How should the completed form be submitted?

Once the form is completed, the proposed insured must sign it and send it to Met Life. This can be done via mail, fax, or email. It is essential that the original, signed forms are submitted, as emailed forms must be printed and signed before scanning.

What happens if the form is incomplete?

If any section of the form is incomplete, Met Life will return it for the necessary information. This can delay the review process, and it is crucial to fill out all sections accurately to avoid such setbacks.

How long does it take to receive a decision after submitting the form?

After the completion and submission of the Statement of Health form, Met Life generally sends correspondence regarding the decision within ten days. In some cases, additional medical information may be requested, which could prolong the process further.

Is there a possibility of needing to provide more medical information?

Yes, after the initial review of the form, Met Life may request additional medical information. This could include a physical examination, paramedical exam, or an Attending Physician Report to clarify any health conditions disclosed in the form.

What do I do if I have questions about the form or the process?

If you have any questions while completing the Evidence of Insurability form, you can contact Met Life directly at 1-800-638-6420, prompt 1. Alternatively, you can email their support team at eoi@metlifeservice.com for assistance.

What are the consequences of providing false information on the form?

Providing false or misleading information on the Evidence of Insurability form can lead to serious consequences, including potential criminal charges. Different states have various laws regarding the submission of fraudulent information, resulting in fines or penalties. It is essential to be truthful and accurate to ensure compliance and maintain coverage.

What is the importance of knowing the Fraud Warnings?

Before signing the Statement of Health form, it is vital to read the applicable Fraud Warnings. These warnings outline the legal implications of submitting false information and inform the proposed insured of their responsibilities. Understanding these warnings helps ensure that all information provided is complete and accurate, thereby protecting both the insured and Met Life.

Common mistakes

Filling out the Met Life Evidence of Insurability form can seem straightforward, but there are common mistakes that can lead to delays or complications. One frequent error is not providing the full Group Customer Information. This section is vital, and missing even a single piece can result in the form being returned for correction.

Another common mistake is failing to appropriately fill in personal details. Many people forget to include their Social Security number or misspell their names. These details are critical for identification and processing, so take an extra moment to double-check them.

It's also essential to read through the instructions clearly. Several individuals skip the section that indicates who should complete the form. Remember that each proposed insured must fill out a separate Statement of Health form if applying for coverage. If this is overlooked, it can add unnecessary time to the process.

Furthermore, providing incomplete health information can be a significant setback. People may leave questions unanswered or fail to elaborate on "yes" responses. Incomplete answers may delay approvals or even result in the rejection of the application altogether.

Another mistake involves the lack of a signature. Omitting a signature where indicated is another common error that can halt the processing of the form. Ensure that all relevant parties sign the document to avoid this problem.

Giving in to the temptation to abbreviate answers can also lead to issues. When answering health questions, it’s essential to provide complete details, especially for questions with "yes" responses. Inadequate explanations can lead to complications later in the review process.

Lastly, neglecting to keep a copy of the submitted documents can be a regrettable oversight. Always make a copy for your records before sending the forms off, whether by fax, mail, or email. This practice helps if any issues arise during the processing stage.

By avoiding these common pitfalls, you can help ensure a smoother experience when filling out the Met Life Evidence of Insurability form. Take your time, read the instructions carefully, and pay attention to detail to avoid delays in obtaining your insurance coverage.

Documents used along the form

When completing the Met Life Evidence of Insurability form, you may also need to submit various other documents to support your application. Each of these documents serves a specific purpose and helps ensure that your application is processed smoothly and efficiently.

Enrollment Form: This document provides essential information on your insurance coverage selections and confirms your intention to apply for group insurance.
Authorization Form: This form allows Met Life to access your medical records as needed. It includes your consent for them to obtain necessary health information.
Attending Physician Report (APR): If additional medical information is needed, an APR may be requested. This document is completed by your physician and provides detailed health information.
Personal Physician Information Form: This form includes details about your primary care physician, including their contact information and details of your last visit, which can be relevant for your application.
Prescription Information Sheet: This document lists any medications you are currently taking, along with the prescribing physician’s details, to give Met Life a complete picture of your health history.
Medical Examination Report: In some cases, a physical or paramedical exam may be necessary to assess your health status more comprehensively before insurance coverage is approved.

Submitting these additional forms along with the Met Life Evidence of Insurability form can streamline your application process. Ensure that all documents are filled out completely and accurately, as incomplete submissions might delay your coverage. If you have further questions, don't hesitate to reach out for assistance.

Similar forms

Medical History Questionnaire: Like the Met Life Evidence of Insurability form, this document gathers comprehensive information about an individual's past and current health conditions. Both forms require the insured to disclose medical treatments, medications, and any ongoing health issues.
Life Insurance Application: Similar to the Evidence of Insurability, a life insurance application requests personal details and health history. It assesses eligibility and risk factors before processing insurance coverage.
Health Insurance Application: This form, like the Evidence of Insurability, evaluates an applicant’s health status to determine coverage. Both forms aim to identify any potential risks for the insurance provider based on the applicant's health.
Worker’s Compensation Claim Form: This document collects health and injury information much like the Evidence of Insurability form. It ensures the applicant’s eligibility based on prior health conditions and the nature of their claim.
Disability Insurance Application: This application closely resembles the Evidence of Insurability form as it aims to gather specific health information. Both documents help in determining claims for insurance based on health status and medical history.
Health Declaration Form: Similar to the Evidence of Insurability form, this document requires individuals to declare their current health status. Both forms are used to assess risk and eligibility for insurance coverage.
Patient Medical History Form: This form gathers detailed health records, similar in function to the Evidence of Insurability. Both documents require patients to disclose conditions and treatments, enabling insurers to evaluate risk accurately.
Authorization for Release of Medical Information: Like the Evidence of Insurability, this document ensures that health information can be shared with insurers. Both forms facilitate the review of an applicant's health status for coverage decisions.

Dos and Don'ts

When completing the Met Life Evidence of Insurability form, consider the following guidelines to ensure a smooth process:

Do fill in all required sections accurately to prevent any delays.
Do provide your name and Social Security number where indicated.
Do ensure the Proposed Insured completes their section thoroughly.
Do make a copy of the completed forms for your records before sending.
Do sign the Authorization form where marked.
Do contact MetLife for any questions or clarifications needed.

Don't leave any fields blank; incomplete forms will be returned.
Don't forget to attach any additional information if required.
Don't submit the forms without checking for accuracy.
Don't include false or misleading information.
Don't neglect to send the completed forms within the designated timeline.
Don't sign the form without fully understanding the contents and implications.

Misconceptions

Misconception 1: Everyone must fill out the Evidence of Insurability form. Not every employee or proposed insured needs to submit this form. It is only necessary if the employer's enrollment process requires it for group insurance coverage.

Misconception 2: Only the employee needs to complete the form. The form must be filled out by the employee and may also require information from the proposed insured, such as a spouse or child, depending on who is applying for coverage.

Misconception 3: Submitting the form guarantees approval. Completing the Evidence of Insurability form does not guarantee insurance approval. MetLife will review the information provided and may request additional medical data before making a decision.

Misconception 4: Incomplete forms can be submitted. All sections of the form must be completed. Any blanks or missing information will result in the form being returned for completion, causing delays in the application process.

Misconception 5: I can submit the form without signing it. Proper submission includes signing the form where indicated. An unsigned form will not be processed.

Misconception 6: Faxing the completed form is the only way to submit it. There are multiple submission methods available, including faxing, mailing, or emailing the forms. Choose the one that suits you best.

Misconception 7: I can skip disclosing health issues. Omitting health information may lead to delays. Full disclosure is needed to ensure accurate evaluation and consideration for coverage.

Misconception 8: The proposed insured can complete the form without the employee's input. The employee must provide necessary details and submit the form on behalf of the proposed insured. Communication between the two parties is essential.

Misconception 9: Fraud warnings don’t apply to me. All applicants must pay attention to the fraud warnings included. Filing false information can result in serious legal consequences.

Key takeaways

Accurate completion of the Met Life Evidence of Insurability form is essential. Ensure that the Group Customer Information, Employee Information, and Proposed Insured Information are filled out correctly.
Each Proposed Insured must complete their own Statement of Health form. This includes spouses, domestic partners, and children of the Employee seeking insurance coverage.
Make copies of the completed forms for personal records. Original forms should be submitted to MetLife via fax, mail, or email after they are filled out and signed.
In case of incomplete forms, they will be returned for necessary completion. Additional medical information may also be required, which MetLife will communicate within ten days after the initial review.

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