Get Evidence Of Insurability Form - Myers Benefit... - Benefitsthatwork

Filling out the Evidence Of Insurability Form is a crucial step in securing your benefits. This guide will provide you with clear, step-by-step instructions to complete the form online, ensuring you include all necessary information accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Evidence Of Insurability Form. This action will allow you to open the form in your document editor.
2. Begin with Section 1: Employee Information. Here, you will need to print clearly the following details: Name of Employer, Client Number, Employer’s Address, Name of Employee, Occupation, Employee’s Address, Home Telephone, Work Telephone, Date of Birth, Place of Birth, Height, Weight, Regular Physician’s Name and Address, and Date and Reason Doctor Last Seen.
3. Move to Section 2: Applicant Questions. Answer all provided questions regarding your health and medical history. If you answer 'Yes' to any question, provide full details in Section 3. Ensure clarity and comprehensiveness in your responses.
4. In Section 3, elaborate on each 'Yes' answer by detailing the nature of the disorder, date of first occurrence, and current status and treatment. This section is important for thoroughness.
5. Review Section 4: Important Notices. Familiarize yourself with the Medical Information Bureau policies and personal information protection notice. You are acknowledging that you understand these notices.
6. Proceed to Section 5: Declaration and Authorization. Read through the statement carefully and affirm that your answers are true. Sign and date the form to complete the authorization.
7. Once you have filled out all sections, ensure to save your changes. You may also download, print, or share the form as necessary.

Complete your Evidence Of Insurability Form online today!