Evidence of insurability (EOI) If you currently have an individual Enhanced Long-Term Disability Plan and qualify for additional coverage, the enhanced plan will increase your coverage up to a total of $7,500 a month without medical evidence of insurability. Amounts greater than $7,500 a month will require evidence of insurability up to an overall monthly maximum of $15,000. If you were previously eligible for this coverage and did not choose to enroll, all elected amounts are subject to evidence of insurability. This evidence consists of a copy of your most recent Schedule C’s and a completed medical questionnaire. In some cases, to assist in issuing a policy, an Attending Physician Statement from your primary physician may be ordered from the insurance carrier as well. If evidence is required, once your selections are received by the Farmers Agent Benefits Department, any required forms and instructions for completing these forms will be sent to you automatically. If you do not return the EOI form, you will not have coverage under the requested plan until the insurance company receives the form and approves your application for coverage. 12 The Farmers Agent Benefits Call Center can also tell you if you must complete an EOI form. Refer to the appropriate benefit sections in this booklet for more information. Note: If you qualify for the Enhanced Long-Term Disability Plan based on your Form 1099 income, you will receive a communication with enrollment instructions from the Farmers Agents Benefits Department at the next annual enrollment opportunity. Also, the Enhanced Long-Term Disability Plan is independent of the group disability plan. Converting enhanced disability The Enhanced Long-Term Disability Plan is fully portable. Once you are no longer part of the Farmers Agent Group Benefits Program, you will receive notification from Unum on your options of continuing coverage. Proprietary 8-23
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