Dependent Eligibility Audit
Eligibility Auditors report that the typical dependent eligibility audit removes 5%-12% of ineligible dependents from a health plan, resulting in substantial plan savings while creating a fair environment for all employees and their eligible dependents.
With the cost of healthcare steadily increasing, it is important for Health Plans to consider use of their plan services.
Although Health Plans have criteria that define eligible dependents, experience shows that there are ineligible dependents taking advantage of the Health Plan benefits. Many plans have complicated eligibility definitions and your employees may not even be aware that their dependents are no longer eligible. Ineligible dependents increase administration costs, claims costs and liability. These claims are not eligible for stop loss reimbursements. These factors combined can be a costly oversight.
Employers have a responsibility under ERISA to ensure that plan funds are used for the sole benefit of employees and their eligible dependents.
Your dependent eligibility audit should be handled by professionals that treat the task with the sensitivity that it deserves.
ENV will communicate with your employees to collect the necessary, required documentation for dependent eligibility verification. When the responses are received by ENV, the documents are reviewed and verified to ensure each member individually meets your Health Plan's eligibility requirements. If required, eligibility changes will occur in a compliant method. All participants' audit responses are stored electronically for reference.
For more information on Dependent Eligibility Audits, please contact your representative at ENV.