Ideon Blog

Managing Evidence of Insurability (EOI) data has become a critical—and challenging—priority for group benefits carriers. Traditional EOI processes often result in errors that expose carriers to significant risks, from Department of Labor (DOL) fines to reputational harm and poor member experiences.

This guide dives into the risks hiding within routine EOI data processing. We’ll examine why carriers struggle to identify missing EOI before it’s too late, and reveal how advanced EOI data auditing prevents errors, mitigates risk, and helps carriers stay ahead in a competitive market.

The Status Quo: Challenges in Identifying Incomplete EOI

Most carriers can’t effectively detect and resolve instances where a member has enrolled in coverage that requires EOI but hasn’t completed the EOI process. This problem is more common than many realize and has far-reaching implications.

The Problem: EOI errors are difficult to detect

• • • Enrollment With Incomplete EOI: Members often select life or disability coverage that exceeds guaranteed issue amounts, triggering the need for EOI. However, due to gaps in enrollment data exchange, complex plan eligibility rules, the BenAdmin misconfiguring plans in its system, or miscommunication, the member may not complete the required EOI process.
    • Invisible Discrepancies: These incomplete EOI cases frequently go unnoticed because carriers rely on manual checks or systems that can’t flag these discrepancies.
    • Delayed Detection at Claims Time: The failure to identify these issues means that carriers often discover them only when a claim is filed. At this point, it’s too late to rectify the oversight without causing delays and member dissatisfaction.

The Impact: What happens when EOI errors go unnoticed

• • • Financial Risk: Carriers can face lawsuits and fines from the Department of Labor (DOL) if claims are denied due to missing EOI, especially if the member was paying a premium for supplemental coverage. In just the last two years, several large carriers have reached settlements with the DOL over their EOI practices.
    • Poor Claims Experience: Mistakes in EOI collection lead to negative member experiences, especially at claims time—when a slow process or wrongly denied claim can be disastrous for the member and their family. And, these negative experiences could result in brokers and employers taking their business elsewhere.
    • Reputational Damage: Brokers increasingly prioritize carriers with automated, advanced EOI capabilities. Those who don’t meet this expectation may find themselves losing out on key business opportunities and RFPs

Simply put, the status quo is no longer sustainable for carriers looking to remain competitive and compliant in the modern benefits landscape.

Making EOI Data Management a Strategic Priority

The consequences of mishandling EOI are extensive. But there’s light at the end of the tunnel — carriers, with the right auditing technology, can solve EOI data challenges and mitigate risk. Here’s why it should be a top priority:

• • • Rising Demand for Automation: Brokers and employers expect streamlined, automated EOI processes to enhance the member experience, speed up enrollment, and reduce errors. Some RFPs even request information about EOI automation, including API capabilities.
    • Revenue Growth Opportunities: Carriers that simplify EOI processes see higher adoption rates for supplemental benefits like life and disability coverage—opening new revenue streams.
    • Mounting Regulatory Pressure: With increased scrutiny from the DOL, carriers face a higher risk of costly fines and reputational damage if EOI data errors aren’t addressed proactively.

EOI Audit by Ideon: An Industry-First Solution to De-Risk EOI Data

Better technology is the only way to minimize the financial and reputational risk of EOI errors.

Ideon’s EOI Audit solution offers a unique, automated approach to solving this industry-wide challenge. It addresses two key areas: data auditing and decision return. Here’s how it works:

• • • Identifies Members Requiring EOI: Ideon’s system pinpoints members whose elections require EOI.
    • Audits Groups for Missing EOI: The audit function flags members who require EOI but didn’t complete it. Errors and discrepancies include why someone needs EOI, based on the carrier’s plan eligibility rules, decisions already in the carrier’s system, and group enrollment data.
    • Error Resolution: All discrepancies are surfaced through automated reports and dashboards. Each issue has a clear, actionable resolution path, allowing carriers to avoid downstream problems.
    • Decision synching: EOI statuses and decisions are synched between carriers and BenAdmin platforms, ensuring up-to-date, accurate data across all systems.

This process not only improves data accuracy but also prevents costly errors that lead to DOL fines and poor member outcomes.

Results with EOI Audit

By implementing Ideon’s EOI Audit solution, carriers not only improve compliance and enhance claims experiences, but also strengthen their competitive position by offering a more reliable EOI process. Here are the key benefits they can expect:

• • • Risk Mitigation: Proactively address EOI discrepancies to avoid DOL fines, reputational harm, and operational disruptions.
    • Faster Resolution: Early detection and actionable insights mean carriers resolve EOI discrepancies quickly, avoid downstream problems, and process claims accurately.
    • Stronger Market Position: Showcase advanced EOI capabilities to stand out in RFPs, win more business, and build stronger broker relationships.

Success in Action: How Prudential is Using Ideon’s EOI Audit Solution

Carriers like Prudential are already seeing positive results with Ideon’s EOI Audit solution. As Sherri Bycroft, Director of Benefit Technology Partnerships at Prudential, shared in a recent Ideon Insights interview:

“We’re really excited about the fact that it’s going to flush out issues much earlier on,” she said. “We can have full confidence that we have the right information about the members in our system, and at the time of claim, be able to pay that without delays.”

Get a Demo of EOI Audit by Ideon

See how Ideon’s EOI Audit solution can help you reduce risk, identify missing EOI, and provide a better claims experience. Schedule a demo below.