Blank Evidence Of Insurance Template

The Evidence of Insurance form is a crucial document that verifies an individual's insurance coverage under a group plan. Completing this form ensures that employers can provide accurate information about their employees' benefits, facilitating timely processing of insurance requests. It is essential to fill out all sections to avoid any delays.

To begin, please fill out the form by clicking the button below.

Article Guide

The Evidence of Insurance form plays a crucial role in ensuring that employees can access the life insurance benefits promised by their employers. This comprehensive document is designed to gather all necessary information, filling out which is essential for processing insurance coverage requests efficiently and accurately. To begin with, employers must complete the first sections, detailing their group benefits coverage, including key elements like policy numbers and mailing addresses. Once this is done, the form is handed over to the employee, who will provide their personal details, such as their hire date and annual earnings. Additional information about life coverage, including any current or requested coverage amounts, must also be entered. This thorough process ensures that both the employer and employee are aligned on what coverage is being applied for. The form also includes a medical history section where applicants must truthfully answer questions regarding their health, past medical conditions, and treatments, facilitating the underwriting process. Understanding this form is vital as it not only propels individuals toward receiving vital financial protection but also safeguards employers from potential future liabilities. Being meticulous while completing the Evidence of Insurance form can significantly impact the approval process, making it imperative to approach it with care and thoroughness.

Form Sample

Clear Form

Employer Group Benefits Coverage Information

Thank you for choosing The Hartford. All sections of this form must be completed and received by The Hartford within 30 days of the signature date.

Employers: Please completely fill out Section 1 and Section 2 on this page and forward the entire form to the employee. Refer to your Policy and employee records for this information. These records are your property and are not on file with The Hartford. An incomplete form will result in a delay in processing your employee’s request for insurance.

Section 1: Employer Details (to be completed by Employer)	PLEASE PRINT CLEARLY
Employer Name:	Policy Number:

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

Division/Location/Subsidiary with Mailing Address (if applicable):

Benefits Contact Name (First, Last):

Benefits Contact Email Address:	Benefits Contact Phone: (	)	-

Section 2: Employee Details (to be completed by Employer)	PLEASE PRINT CLEARLY

Employee Name (First, MI, Last):	Date of Hire (mm/dd/yyyy):	/	/

Base Annual Earnings*:	Coverage Effective Date* (mm/dd/yyyy):		/	/

* As described in the contract with The Hartford

Life Insurance Coverage Requested

 Enter the dollar amount of Current Life Coverage, including Guarantee Issue (GI)*. Please include Employee Basic Life coverage even if the employee is not requesting coverage at this time

 Enter the dollar amount of Life Coverage Subject to Evidence of Insurability (EOI)

* GI is the maximum amount of coverage as defined in the contract with The Hartford that does not require EOI

	Current Life Coverage,		Life Coverage Subject to
	including GI		EOI

Employee Basic Life	$		$

Employee Supplemental or Voluntary Life	$		$
Employee Supplemental or Voluntary Life

Spouse Basic Life	$		$
Spouse Basic Life

Spouse Supplemental or Voluntary Life	$		$
Spouse Supplemental or Voluntary Life

Child Supplemental or Voluntary Life
 Check Yes if employee is requesting Child Life coverage that is subject to EOI		☐ Yes, EOI is required
 Indicate the number of children applying: __________

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries.

Page 1 of 5

EVIDENCE OF INSURABILITY

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY

One Hartford Plaza, Hartford, CT 06155

Applicant Information

●If there are more than three Applicants, please provide the information on a separate sheet of paper.

Abbreviations: Employee = EE Spouse = SP Child = CH

First Name	Last Name	Social Security						Height	Weight	Date of Birth
		Number	EE	SP	CH		Gender	(ft./in.)	(lbs.)	(mm/dd/yyyy)
									If currently
									pregnant,
									pregnant,
				(check one)					pre-
				(check one)					pregnancy
									pregnancy
									weight
							Male
							Female

							Male
							Female

							Male
							Female

EE Address:					Day Time Phone:

						Evening Phone:

						Email Address:

SP Address:					Day Time Phone:

same as EE						Evening Phone:

						Email Address:
						Email Address:

CH Address:					Day Time Phone:

						Evening Phone:
same as EE
same as EE						Email Address:
						Email Address:

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries.

Form PA-9597 (CA)

Page 2 of 5

Medical Information

Each Applicant must answer each of the following questions to the best of their knowledge and
belief. A Legal Guardian is required to answer each of the questions for minor children. If you have					EE	SP	CH
more than 1 child, specify which child(ren) the answer applies to on a separate sheet of paper.					EE	SP	CH


Within the past 5 years, have you been diagnosed with or treated by a licensed medical physician for					Yes	Yes	Yes
Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?					Yes	Yes	Yes
					No	No	No

Are you currently pregnant?					Yes	Yes	Yes
					Yes	Yes	Yes
					No	No	No

Within the past 5 years, with the exception of a past pregnancy, have you lost time from work for more than					Yes	Yes	Yes
10 consecutive work days due to a disability, injury, or sickness?					Yes	Yes	Yes
					No	No	No
					No	No	No

Within the past 5 years, have you used any controlled substances, with the exception of those taken as					Yes	Yes	Yes
prescribed by your physician, been diagnosed or treated for drug or alcohol abuse (excluding support					Yes	Yes	Yes
					No	No	No
groups), or been convicted of operating a motor vehicle while under the influence of drugs or alcohol?					No	No	No


Within the past 5 years, have you been diagnosed with or treated by a licensed member of the medical profession for:

	EE	SP	CH		EE	SP	CH
Heart Disease	Yes	Yes	Yes	Disease, injury or surgery of	Yes	Yes	Yes
(Do not check “Yes” if you only have High	Yes	Yes	Yes	Joint, Ligaments, Knee, Back,	Yes	Yes	Yes
(Do not check “Yes” if you only have High	No	No	No	Joint, Ligaments, Knee, Back,	No	No	No
Blood Pressure or a Heart Murmur)	No	No	No	or Neck (including Arthritis)	No	No	No
Blood Pressure or a Heart Murmur)				or Neck (including Arthritis)

Heart-Related Surgery or	Yes	Yes	Yes	Muscular Dystrophy	Yes	Yes	Yes
Heart Attack	No	No	No	Muscular Dystrophy	No	No	No
Heart Attack	No	No	No		No	No	No

High Blood Pressure	Yes	Yes	Yes
	No	No	No	Hepatitis (Do not check “Yes”	Yes	Yes	Yes
If you checked “Yes” to High Blood				Hepatitis (Do not check “Yes”	Yes	Yes	Yes
If you checked “Yes” to High Blood				for Hepatitis A) or Cirrhosis	No	No	No
Pressure, have you had a change in	Yes	Yes	Yes	for Hepatitis A) or Cirrhosis	No	No	No
Pressure, have you had a change in	Yes	Yes	Yes
medication within the last 6 months?	No	No	No

Blocked Arteries (Arteriosclerosis,	Yes	Yes	Yes	Amyotrophic Lateral Sclerosis	Yes	Yes	Yes
Atherosclerosis, Aneurysm, or Deep Vein	Yes	Yes	Yes	(ALS) or Multiple Sclerosis	Yes	Yes	Yes
Atherosclerosis, Aneurysm, or Deep Vein	No	No	No	(ALS) or Multiple Sclerosis	No	No	No
Blood Clot)	No	No	No	(MS)	No	No	No
Blood Clot)				(MS)

Stroke or transient ischemic attack (TIA)	Yes	Yes	Yes	Alzheimer’s or Parkinson’s	Yes	Yes	Yes
Stroke or transient ischemic attack (TIA)	No	No	No	Disease	No	No	No
	No	No	No	Disease	No	No	No

Chronic Obstructive Pulmonary Disease	Yes	Yes	Yes	Paralysis	Yes	Yes	Yes
(COPD) or Emphysema	No	No	No	Paralysis	No	No	No
(COPD) or Emphysema	No	No	No		No	No	No

Diabetes	Yes	Yes	Yes	Major Organ Transplant	Yes	Yes	Yes
Diabetes	No	No	No	Major Organ Transplant	No	No	No
	No	No	No		No	No	No

Depression	Yes	Yes	Yes	Chronic Fatigue Syndrome or	Yes	Yes	Yes
Depression	No	No	No	Fibromyalgia	No	No	No
	No	No	No	Fibromyalgia	No	No	No

Sleep Apnea	Yes	Yes	Yes	Narcolepsy	Yes	Yes	Yes
Sleep Apnea	No	No	No	Narcolepsy	No	No	No
	No	No	No		No	No	No

Cancer (Do not check “Yes” for Basal
Cell Carcinoma only)	Yes	Yes	Yes	Ulcerative Colitis or Crohn’s	Yes	Yes	Yes
	Yes	Yes	Yes	Ulcerative Colitis or Crohn’s	Yes	Yes	Yes
If “Yes”, Date of Diagnosis:	No	No	No	Disease	No	No	No
If “Yes”, Date of Diagnosis:
_______________________________
Psychotic, Psychiatric, Personality, or Bi-	Yes	Yes	Yes	Kidney Failure or Dialysis	Yes	Yes	Yes
Polar Disorder	No	No	No	Kidney Failure or Dialysis	No	No	No
Polar Disorder	No	No	No		No	No	No

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries.

Form PA-9597 (CA)

Page 3 of 5

Notice

To the best of your knowledge, you are required to notify Hartford Life and Accident Insurance Company in writing of any changes in your medical condition between the date you sign this form and the date the coverage is approved.

In order to complete the evaluation of this application, Hartford Life and Accident Insurance Company may contact you, through the mail or over the telephone:

1.to clarify any information contained on this form;

2.to obtain any information missing from this form;

3.to ask additional questions of you or your physician about the information that you have provided; or

4.to request a paramedical exam.

We may also use information about you obtained from other sources, including our claim files, evidence of insurability applications you have previously submitted to us, copies of medical records which you have authorized us to review, and information obtained from MIB, Inc. Only information that is relevant to determining Evidence of Insurability for the coverage which you are currently requesting will be considered.

Authorization

I, an undersigned applicant, authorize Hartford Life and Accident Insurance Company, together with its affiliates, (“Company”) to contact me, during the evaluation of this application, through the mail, secure e-mail, or over the telephone, at the address or telephone number identified in this application, or otherwise provided by me:

1.to clarify any information contained on this form;

2.to obtain any information missing from this form; or

3.to request a paramedical exam.

In the event that I cannot be reached via telephone, I authorize a representative of the Company to leave a voice message identifying his or her name, the Company name, and a return phone number, indicating that he or she is calling to obtain information necessary to complete my recent application for insurance. The message will also contain an underwriting ID number and the hours during which I may reach a representative of the Company by telephone.

❒Yes, you may leave a message as indicated above.

❒No, please do not leave a message.

In addition to the information that I have provided on this application, I authorize the Company to use information about me obtained from Company claim files, insurance applications and medical information I or my physician(s) have previously submitted to the Company. I further authorize my employer, any health or benefits plan, physician, medical professional, hospital, clinic, laboratory, MIB Group, Inc. (MIB, Inc), pharmacy or pharmacy benefits manager that possesses my protected personal health information (“PHI”), including copies of records concerning physical or mental illness, diagnosis, prognosis, prescription information, care or treatment provided to me (but excluding HIV and genetic testing), to furnish such protected health information to the Company or its representative. The Company may only use information disclosed under this authorization that is relevant to underwrite this or any other insurance application to the Company during the period that the Authorization is valid (as described below), at any time to aid in the detection of fraud, and for internal research purposes.

I authorize the Company to disclose the “PHI” in its files to its reinsurer(s) and affiliates, other insurance companies and their affiliates, other persons, representatives and/or organizations performing functions on behalf of the Company and their affiliates, my employer, or as required by law, including any mandated reporting to state agencies. I understand that I may request details about any of the information gathered about me that relates to this application and that such requested information and the identity of the source of the information shall be released to me or, in the case of medical information, to a licensed medical professional of my choice.

I/We authorize Hartford Life and Accident Insurance Company, or its reinsurers, to make a brief report of my/our personal health information to Medical Information Bureau.

I agree that a photocopy of this authorization is valid as the original and I understand that I or my authorized representative is entitled to receive a copy of this authorization upon request.

This authorization shall be valid for twenty-four (24) months from the date signed below. This authorization may be revoked upon written request to the Company, and will not remain valid beyond the date the revocation is received by the Company. I understand the revocation may be a basis for denying my insurance application, and that it does not alter the Company’s right to use the application for purposes of determining misrepresentation once coverage has been issued.

I have received and read a copy of the Notice of Insurance Information Practices.

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries.

Form PA-9597 (CA)

Page 4 of 5

Fraud

For your protection, California law requires the following to appear on this form: The falsity of any statement in the application for any policy shall not bar the right to recovery under the policy unless such false statement was made with the actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer.

Certification

I hereby represent that I have reviewed the above questions and that all statements and answers contained herein are full, complete, and true to the best of my knowledge and belief. For residents of Virginia only: I have read, or had read to me, the completed application, and I realize that any false statement or misrepresentation in the application may result in loss of coverage under the policy.

This application will be made a part of the Policy.


	/		/		/		/
Employee Signature		Date Signed		Spouse Signature		Date Signed

	/		/
Child Signature		Date Signed
(Parent/Legal Guardian of the Child is

required to sign when submitting

dependent Evidence of Insurability on a

minor child.)

Please mail the completed Employer Group Benefits Coverage Information page and Evidence of Insurability application to:

The Hartford

Group Medical Underwriting

P.O. Box 2999

Hartford, CT 06104-2999

If you have any questions or concerns, please call The Hartford Customer Service Department toll-free at 1-800-331-7234, Monday through

Friday, 8:00 a.m. to 6:00 p.m., Eastern Time, or email us at [email protected].

The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries.

Form PA-9597 (CA)

Page 5 of 5

⇩ PDF

Document Specifications

Fact Name	Details
Completion Requirement	All sections of the Evidence Of Insurance form must be completed and submitted within 30 days of signing.
Employer Responsibility	Employers need to fill out Section 1 and Section 2 before forwarding the form to the employee.
Property Records	Employee records and policy details are the employer’s property and are not stored with The Hartford.
Processing Delay	An incomplete form can delay the employee's insurance request.
Contact Information	Benefits contact details, including name, email, and phone number, must be provided in Section 1.
Life Coverage Request	Requests for current life coverage must include both guaranteed issue amounts and amounts subject to Evidence of Insurability.
Medical Questions	Each applicant must answer all medical questions honestly to ensure proper underwriting.
Legal Guardian Requirement	A legal guardian must complete the medical questions for minor children applying for coverage.
Authorization for Information	Applicants authorize The Hartford to access their medical and insurance history during the application process.
State-Specific Regulations	California law mandates that false statements made with intent to deceive can affect coverage. (Relevant law: Cal. Ins. Code § 359)

Steps to Filling Out Evidence Of Insurance

After completing the Evidence Of Insurance form, ensure it is submitted within 30 days of signing. Make sure all sections are filled out correctly to avoid delays in processing the insurance request.

Begin with Section 1, completing the Employer Details:

Print the Employer Name.
Input the Policy Number.
Add the Employer Mailing Address (Street, City, State, Zip Code).
Include Division/Location/Subsidiary and its Mailing Address (if applicable).
Write the Benefits Contact Name (First and Last).
Provide the Benefits Contact Email Address.
Enter the Benefits Contact Phone number.

Move to Section 2, Employee Details:

Print the Employee Name (First, MI, Last).
Fill in the Date of Hire (mm/dd/yyyy).
State the Base Annual Earnings.
Indicate the Coverage Effective Date (mm/dd/yyyy).
Enter the dollar amounts for Current Life Coverage and Life Coverage Subject to Evidence of Insurability for the employee, spouse, and children listed.
If applicable, check "Yes" for Child Life coverage subject to Evidence of Insurability and include the number of children applying.

Provide Applicant Information for each individual applying:

Fill out First Name, Last Name, Social Security, Height, Weight, Date of Birth, and Gender for each applicant.
Ensure to complete the Day Time and Evening Phone fields, as well as the Email Address for each person.

Answer the Medical Information questions for each applicant accurately and to the best of your knowledge.
Complete the Authorization section to allow the necessary parties to obtain or share health information as needed.
Sign and date the form for each applicant.
Mail the completed form to The Hartford at the provided address.

Make sure you keep a copy for your records and check for confirmation of receipt from The Hartford.

More About Evidence Of Insurance

What is the Evidence of Insurance form?

The Evidence of Insurance form is a document required by The Hartford for individuals wishing to apply for life insurance coverage. It gathers essential information from both the employer and employee, such as employer details and employee health considerations. This form must be submitted within 30 days from the date of signature to avoid delays in processing the insurance request.

Who fills out the Evidence of Insurance form?

The employer is responsible for completing the initial sections of the form, specifically Section 1, which includes employer details, and Section 2, which includes employee details. After completing these sections, the employer must forward the form to the employee for their information and signature.

What happens if the form is incomplete?

If any part of the Evidence of Insurance form is incomplete, it can lead to delays in processing the employee's insurance request. It’s crucial that the employer fills out all sections accurately and completely to ensure a smooth application process.

What information is required in Section 1?

Section 1 requires the employer to provide their name, policy number, mailing address, and contact information for the benefits representative. This information is essential for The Hartford as it helps identify the employer's specific insurance plan and the appropriate point of contact.

What medical information is necessary for the application?

Each applicant, including employees and their dependents, must answer a series of medical questions. These questions are designed to assess health conditions that may affect insurability, such as a history of serious illnesses or medical treatments. It’s important to answer these questions truthfully and thoroughly, as missing or misleading information could lead to denial of coverage.

How is the coverage effective date determined?

The coverage effective date is determined by the employer's insurance policy with The Hartford and indicated on the form. Typically, this date can align with the employee’s hire date or any specified date of eligibility outlined in the employer's insurance plan. It's essential to indicate this correctly to avoid complications in coverage activation.

What should I do if I change my medical condition after submitting the form?

Applicants are required to notify The Hartford in writing about any changes in their medical condition after submitting the Evidence of Insurance form and before coverage is approved. This ensures that the insurer has the most current and accurate information, which is crucial for the assessment of the application.

Where should I send the completed form?

The completed form should be mailed to The Hartford’s Group Medical Underwriting department at P.O. Box 2999, Hartford, CT 06104-2999. It is advisable to keep a copy of the submitted form for your records. If you have questions, you can reach The Hartford's Customer Service Department for assistance.

Common mistakes

Incomplete Sections: Failing to fill out all required sections, particularly Section 1 and Section 2, can lead to delays. Each section must be completed thoroughly.
Illegible Handwriting: Writing answers in unclear handwriting makes it difficult for reviewers to process the information. Clear, legible print is crucial.
Missing Employer Information: Providing incomplete or incorrect details about the employer, such as the employer name or policy number, can stall the application process.
Incorrect Dates: Inputting wrong dates for hire or effective coverage can create inconsistencies. Always double-check these dates for accuracy.
Omitting Medical History: Each applicant must answer medical questions honestly. Missing or incorrect information might result in coverage issues later.
Failing to Sign: Not signing the form, or forgetting to obtain necessary signatures from the spouse or legal guardian, can invalidate the application.
Not Submitting on Time: Delaying the submission beyond the 30-day window can lead to rejection of the application. Timeliness is essential.

Documents used along the form

When dealing with insurance applications, particularly those involving Evidence of Insurance, several other forms and documents often accompany the process. Understanding these documents can streamline your interactions with your insurance provider and ensure comprehensive coverage for you and your family. Below is a list of commonly used forms related to the Evidence of Insurance form.

Application for Life Insurance: This form initiates the process of obtaining life insurance coverage. It gathers essential information about the applicant's health, lifestyle, and financial needs, helping insurance companies assess the risk involved.
Beneficiary Designation form: This document allows the policyholder to specify who will receive the life insurance benefits upon their passing. Ensuring the right beneficiaries are named is crucial for providing peace of mind and ensuring financial support for loved ones.
Health Statement or Questionnaire: Often part of the application process, this form collects detailed information regarding the applicant’s medical history. The insurer uses this data to evaluate any potential risk factors that may affect coverage or premiums.
Authorization for Release of Medical Information: This form grants permission for the insurance company to access medical records. It is often necessary for the insurer to request information from healthcare providers to assess an individual's health status accurately.
Premium Payment Authorization: This document authorizes automatic deductions from a bank account or credit card for paying insurance premiums. Consistent payments help maintain coverage without interruption.
Notice of Insurance Information Practices: This notice informs applicants about how their personal information is used and protected by the insurance company. Understanding these practices is vital for privacy concerns and informed consent.
Disability Insurance Application: In some cases, individuals may seek supplementary coverage for disability. This application collects information regarding an applicant's work history and medical conditions that could affect their ability to work.
Claim Form: If a claim needs to be filed, this form provides the necessary details regarding the incident leading to the claim. It is crucial for receiving benefits in a timely manner after a loss.
Waiver of Premium Rider: This optional form can be added to life insurance policies. It allows policyholders to waive premium payments while remaining covered if they become disabled for a certain period.

Understanding these documents plays a crucial role in navigating the insurance landscape effectively. Each form serves a specific purpose, helping you secure and maintain the right insurance coverage for your needs. As you complete your Evidence of Insurance form and additional paperwork, being well-prepared ensures a smoother, more efficient process.

Similar forms

The Evidence of Insurance form has similarities with the Certificate of Insurance, which functions as a proof of insurance coverage provided to insured individuals. Like the Evidence of Insurance form, the Certificate contains essential details such as the policyholder’s name, policy number, and coverage specifics. Both documents serve the purpose of confirming that insurance is in place and outline the benefits and obligations of the policyholder.

Another document akin to the Evidence of Insurance is the Application for Life Insurance. This application gathers similar information regarding the applicant’s personal and medical history to assess insurability. An applicant must also provide consent for medical information to be released, just as is required in the Evidence of Insurance form. Both documents are essential in the underwriting process to determine eligibility for coverage.

The Enrollment Form for Insurance Benefits shares characteristics with the Evidence of Insurance form as well. The Enrollment Form records vital details such as the employee's personal information and selected benefit options. It is used to initiate coverage, much like the Evidence of Insurance form which confirms that coverage is requested and outlines medical questions that may influence acceptance.

A Summary Plan Description (SPD) closely resembles the Evidence of Insurance form by providing an overview of the insurance benefits available to employees. The SPD explains key coverage details, eligibility, and the claims process. Both documents are crucial in informing employees about their rights and responsibilities under their respective policies.

The Health Declaration Form also matches certain aspects of the Evidence of Insurance form. This document is often required before issuing health-related insurance and collects information on past medical conditions of the applicant. Like the Evidence of Insurance, it is a critical component used by the insurer to evaluate the risk and determine coverage eligibility.

The Policy Schedule shares similarities with the Evidence of Insurance form, as it outlines the specific terms of an insurance policy, including the coverage amounts and premium details. Although it is issued after acceptance of the insurance application, like the Evidence of Insurance form, it is essential in clarifying what is covered and any limitations to expect.

Lastly, the Premium Payment Receipt can also be compared to the Evidence of Insurance form in terms of its informational role. While the Evidence of Insurance confirms the request for coverage, the Premium Payment Receipt provides proof that a payment has been made towards an insurance policy. Both documents serve as confirmations of important transactional steps in the insurance process.

Dos and Don'ts

When completing the Evidence of Insurance form, it’s crucial to follow specific guidelines to ensure a smooth and successful submission process. Below are important dos and don’ts that can help enhance your experience.

Do: Fill out all sections completely, including both employer and employee details.
Do: Use clear and legible handwriting, or consider typing your answers if possible.
Do: Include all necessary documentation or information requested on the form.
Do: Ensure the signatures of all applicants are included before submitting the form.
Do: Double-check for any possible errors or omissions before sending in the form.

Don't: Leave any fields blank; incomplete forms can delay processing.
Don't: Misrepresent information, as inaccuracies can impair your insurance coverage.
Don't: Submit the form after the designated 30-day period unless instructed otherwise.
Don't: Use abbreviations or shorthand that may lead to confusion.

By adhering to these guidelines, you not only facilitate a smoother process but also better protect your rights and entitlements under the insurance policy you are applying for.

Misconceptions

Misconceptions about the Evidence of Insurance form can lead to confusion during the application process. Here are eight common misunderstandings:

It's optional to fill out all sections. Many people think they can skip sections of the form, but all parts must be completed to avoid delays.
Medical history questions are not important. Applicants sometimes underestimate the importance of answering medical questions accurately, which can affect coverage approval.
A submitted form guarantees coverage. While the form initiates the process, actual coverage is only granted after evaluation and approval from the insurer.
Evidence of insurability is the same as proof of insurance. Evidence of insurability assesses a person's health status, while proof of insurance confirms existing coverage.
Inaccuracy on the form won't matter. Providing incorrect information, whether unintentional or deliberate, can lead to denial of coverage or claims in the future.
The employer provides all necessary medical information. Employees are responsible for supplying their accurate medical history; employers only fill out employer-related sections.
Inapplicable questions can be ignored. Every applicant needs to answer all questions, even if they seem irrelevant, as they contribute to the overall evaluation.
There’s no need to update information after submission. It's crucial to notify the insurer about any changes in medical condition between form submission and coverage approval.

Key takeaways

Complete All Sections: Ensure every section of the Evidence of Insurance form is filled out completely. Incomplete forms will delay the insurance request processing.
Timely Submission: Submit the completed form to The Hartford within 30 days from the date of signature.
Employer Responsibilities: Employers must complete Section 1 and Section 2, using accurate information from company records and forward the form to the employee.
Double-Check Information: Verify all details, including names, policy numbers, and financial information, to ensure accuracy before submission.
Know Coverage Limits: Understand the coverage amounts requested, especially distinguishing between Guarantee Issue amounts and those requiring Evidence of Insurability.
Contact Information: Provide accurate contact information for the benefits contact to streamline communication with The Hartford.
Medical Information: Ensure that all medical questions are answered honestly and completely. A legal guardian must answer for minors.
Stay Informed: Be aware that changes in medical conditions before the coverage is approved must be reported to The Hartford.
Authorization Required: The applicant must authorize The Hartford to contact necessary parties for additional information or clarification regarding the application.
Keep a Copy: Retain a copy of the completed form for your records, along with any correspondence submitted to The Hartford.