Health Care & Benefits Division

Life & Accident Insurance

Blue Cross Blue Shield of Montana (BCBSMT) is the State Plan’s insurance provider for its fully insured Group Term Life, Accidental Death and Dismemberment (AD&D), and Long-Term Disability insurance policies. 

Evidence of Insurability  (EOI):

  • Also known as "evidence of good health", an EOI is the process that determines if a person is healthy enough to be considered eligible for the amount of insurance coverage they are requesting. 
  • Depending upon when you enroll for coverage, or the amount of coverage you are requesting, you may be required to complete EOI prior to coverage becoming effective. 

How to Submit EOI

If EOI is required for the coverage amount you requested, you may submit EOI to BCBSMT using one of the following methods:


  • Fill out the EOI form and submit to BCBSMT  
    • Insurance Group #F026969
    • Submit completed EOI PDF Forms to: BlueCross BlueShield of Montana, Attn: Medical Underwriting Department, PO Box 7072, Downers Grove, IL 60515

Note for Retirees

  • At retirement, Basic Life will be continued until age 65 or Medicare eligible.
  • If you are retiring and are eligible to port or convert some of your coverage, your rates will change. Click for information about porting or converting coverage


Life insurance and Long-Term Disability (LTD) certificates can be found on HCBD's publications page

Life & Accident Resources


Dearborn Life Insurance Company doing business as: 
Blue Cross Blue Shield of Montana


Insurance Group Number: F026969

Phone: (866) 739-4090

Submit EOI Forms To: 
BlueCross BlueShield of Montana
Attn: Medical Underwriting Department
PO Box 7072
Downers Grove, IL 60515
Fax: (855) 691-7157
For claims related questions, contact HCBD at (800) 287-8266 or


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