Dependent Eligibility Audit Achieves 1,200% ROI Ratio
Business Situation
A small city government was referred to BMI by their employee benefits consultant regarding their needs for a dependent eligibility audit. The purpose of the audit was to confirm that benefit dollars were only being spent on eligible participants while meeting the following objectives:
Identify all dependents currently enrolled who do not meet eligibility criteria.
Examine 100% of all eligibility records to identify covered employees with one or more dependents.
Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all employees with one or more dependents
Provide a dependent eligibility customer service department with toll-free phone lines, bilingual staff during normal business hours.
Securely collect and retain all verification documentation used to confirm eligibility.
Compare plan eligibility requirements with documentation submitted.
Report findings periodically and an executive level overview to analyze potential savings.
Client Profile
Small city government
239 employees covering 542 total dependents
Audit Finding
34 dependents (6.27% of total) failed to satisfy the plan’s eligibility criteria. Many of those who failed were spouses who were legally divorced, but had not reported the divorce to the eligibility vendor.
Audit Benefits
The client terminated coverage for 34 dependents (6.27 % of total). Given that the employer’s average dependent costs the plan about $3,000 per year; our client obtained a minimum first year savings amount of more than $100,000 for a return of investment ratio of 1,200% while meeting all the audit objectives.
Learn more at http://www.bmiaudit.com/dependent-eligibility-audit.html