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 or Evidence of Insurability.

A Statement of Health or Evidence of Insurability contains a series of 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 send a request to MetLife for the coverage level you selected. The request status will be “Unprocessed” until it is sent to MetLife and “Pending” after it is sent to MetLife until MetLife approves or denies your coverage request. You cannot make changes while it is pending.

MetLife will send instructions for completing a Statement of Health to your Wells Fargo email address, if you have one, or by letter to your home address on file with Wells Fargo within 7 to 10 business days of either the end of your enrollment period for elections made through the Your Benefits tool, or the date you made your election through Employee Care.

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. Wells Fargo will notify you and ask you to view your updated Benefits Confirmation Statement, which will display updated coverage 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) or during 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 applicable chapter in the Benefits Book.