TSS - Evidence of Insurability

Evidence of Insurability

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First Published  :Mon Nov 02 21:12:45 GMT 2015
Last Modified  :Tue Apr 18 04:00:51 GMT 2017
Last Published  :Tue Apr 18 04:00:51 GMT 2017
Summary :  Cases where employees may need to complete an Evidence of Insurability document


Primary Information

    There may be instances where an employee must complete an Evidence of Insurability document.  These instances include enrollment in these benefits:

    New Hires:
    *  Supplemental Employee Life Insurance –  Amounts in excess of the lesser of 3 times your annual base salary or $750,000 require Evidence of Insurability as a New Hire
    Open Enrollment:
    *  Supplemental Employee and Dependent Life Insurance and/or Long Term Disability - 
    All applications to become newly enrolled or change to increase the amount of Supplemental Employee, Dependent Life or LTD insurance will require an Evidence of Insurability/Short Form Health Statement form and approval from the insurance company. The form should be submitted to Prudential by December 31st.  Prudential will then advise if the request has been approved. You do not need to take any further action, as Prudential will also update the Benefits group. Note the process has changed in 2016 for 2017 Open Enrollment. Instead of completing the Request form and sending to TSS/Benefits who forwards to Prudential, the Request form with attached Short Form Health statement should be returned directly to Prudential- fax to (617) 587-5998 or mail to: The Prudential Insurance Company of America, Attention: Melissa O’Brien, 800 Boylston Street, 14th Floor, Boston, MA 02199 

    *Note if you apply for additional Supplemental Life of either 4x or 5x salary, but is not approved, he/she will NOT get a lower Supplemental Life. Only NEW HIRES who have enrolled in 3x Supplemental Life  and also apply for higher Supplemental life during the New Hire period will be enrolled with the minimum of 3X if their application for  4x or 5x is denied. The below applies only to NEW HIRES and NOT during Open Enrollment:
     Note: As a new hire or newly Benefit Eligible Employee, you can elect up to 3 times your base annual salary (to a maximum of $750,000) without EOI. If applying for coverage for 4 or 5 times your salary, it is required that you elect coverage equal to 3 times your salary on eServe in conjunction with submitting this request. This will insure that regardless of the decision by Prudential, you will be enrolled for at least 3 times your salary.


Related Information



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