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Statement of Health Forms

Also known as Evidence of Insurability

Some insurance plans are available for open enrollment only during your initial enrollment period or within 60 days of experiencing certain Qualified Events. However, some insurance plans allow you to request enrollment or increased coverage at any time (whether during the Annual Benefits Enrollment period or not) by completing the appropriate Statement of Health (also known as Evidence of Insurability).

A Statement of Health contains questions about the applicant’s overall health and is used by the insurance company to determine if the applicant meets the company’s insurability guidelines, based on the company’s underwriting rules.

For Term Life Insurance

Optional Term Life and Spouse/Partner Optional Term Life require you to complete a Statement of Health for coverage amounts that exceed the guarantee level, for increases in coverage after initial enrollment (without a Qualified Event), and for late enrollments.

Note: If you are on a leave of absence, elections for Optional Term Life, Spouse/Partner Optional Term Life, and Dependent Term Life (excluding newborns) can be made up to 60 days after your return date.

If your enrollment or increase in term life coverage requires a Statement of Health, Wells Fargo will immediately notify MetLife of your request for coverage and send you a Workday Inbox message with the Statement of Health link. For enrollments that occur during Annual Benefits Enrollment, you will receive your Workday inbox message after the enrollment period ends. Note: Any amounts requiring a Statement of Health will be pended and will not display as Calculated Coverage on your Workday Benefits page until after your coverage is approved by MetLife.

You will have 60 days to complete and submit the Statement of Health Form using the link in the Workday Inbox message. If the form is not completed and submitted within 60 days, the request will be closed and you will have to start the enrollment process over in Workday if you still want the requested coverage amount.

After you submit the Statement of Health, you can check the status by logging into MetLife and clicking the Statement of Health link. MetLife will either approve or deny your request. If your request is approved, you’ll be enrolled at the coverage level you selected, effective on the first day of the month after MetLife’s approval, subject to the actively-at-work requirement for Optional Term Life and Spouse/Partner Optional Term Life as well as the nonconfinement clause for Spouse/Partner Optional Term Life. You can view your coverage on the Benefits page in Workday, which will display updated calculated coverage amounts after the effective date. If your request is denied, you’ll retain your current amount or waived coverage.

For Optional Long-Term Disability

During your initial enrollment period (when you first become eligible for benefits), certain qualified events, or Annual Benefits Enrollment, you can enroll in Optional Long-Term Disability (LTD) with no evidence of insurability. However, if you want to enroll in Optional LTD at any other time during the year, complete the Evidence of Insurability for Long-Term Disability (PDF)* and submit the completed form directly to the plan’s insurance provider as instructed on the form. Pre-existing condition limitations may apply. For details, see the Benefits Book.