Dependent Eligibility Audits

Protect the Value and Integrity of Your Health Plan

Dependent populations are always in a state of change. Marriage, divorce, childbirth, adoption and regulatory changes cause 5% to 15% of employees to have dependents enrolled who no longer comply with the eligibility definition in your health plan summary description.

Dependent eligibility audits identify ineligible dependents and removes them from your benefit plan, creating a significant reduction in future claim costs. At an average per dependent cost of $2,500 per year, an organization with 500 employees could easily realize a savings of $125,000 within one year of an audit.

Dependent eligibility audit process consists of three phases designed to educate employees about your plan’s eligibility rules and helps prevent simple enrollment errors.

1) Planning – This includes a review of your plan and eligibility documentation, your requirements for proof of eligibility and preparing a timeline for the audit process.

2) Communication – During this phase, we distribute customized materials to all employees, receive their response and follow up to obtain the information we need.

3) Verification – Once the first two phases are complete, we track all responses, verify that your eligibility requirements have been met and handle any appeals.