Dependent Eligibility Verification Achieves Large ROI

Business Situation & Client Profile

An electrical and telecommunication distributor contracted with BMI to verify the eligibility of their 728 enrolled dependents on the group’s health plans.

Solution

BMI customized a recurring audit plan to meet the following objectives:

  • Communicate the purpose of the audit, deadlines, and compliance requirements, to 336 employees and their 728 enrolled dependents.

  • Provide a customer service department with toll-free phone lines and bilingual staff.

  • Compare plan eligibility requirements with the submitted documentation.

  • Identify all dependents currently enrolled who do not meet eligibility criteria.

  • Securely collect and retain all verification documentation.

  • Report findings weekly and provide a final executive summary of results.

Audit Findings

  • 35 dependents (4.81% of total) failed to meet plan eligibility requirements.

  • Employees covering 22 dependents did not provide complete verification information or failed to respond.

  • Reasons for ineligibility included voluntary removal and foster children not covered by the plan.

Audit Outcome

The client terminated coverage for 35 dependents who were identified to be ineligible and 22 dependents who failed to respond or verify eligibility prior to the submission deadline; this calculates to 7.83% of the dependent population included in the verification process.

First Year Savings Calculations

  •  Average Annual Cost per Dependent: $5,000

  •  Calculated Annual Savings from Dependents Removed: $285,000

  •  Return on Investment: 2,180%

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