Dependent and Surcharge Verification Achieves High ROI
Business Situation & Client Profile
A healthcare organization with 4,908 employees engaged BMI to verify whether any of the 10,006 enrolled dependents met the plan’s eligibility and spousal surcharge criteria.
Solution
BMI customized an audit plan to meet the following goals:
Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all employees with one or more dependents.
Provide a customer service department with toll-free phone lines and bilingual staff.
Compare plan eligibility requirements with documentation submitted.
Identify all dependents currently enrolled who do not meet eligibility criteria and spouses who should have been subject to paying a surcharge.
Securely collect and retain all verification documentation.
Report findings weekly and provide a final executive summary of results.
Audit Findings
40 dependents failed to meet plan eligibility requirements.
120 dependents were identified as requiring a spousal surcharge.
957 dependents did not respond completely prior to the verification deadline despite multiple outreaches.
Audit Outcome
The client terminated coverage for all dependents who were identified by the audit to be ineligible and those who did not respond completely prior to the audit’s deadline. A spousal surcharge was applied to the 120 dependents who were not paying previously.
First Year Savings Calculations
Average Annual Cost per Dependent: $4,789
Calculated Annual Savings from Dependents Removed: $4,774,633
Average Spousal Surcharge per Dependent Spouse: $1,623
Calculated Annual Savings from Spousal Surcharge: $194,760
Return on Investment: 5,878%