Dependent Eligibility Audit Provides “Clean Slate” Prior to Open Enrollment
Business Situation
This group health plan sponsor wished to conduct a dependent eligibility audit of all enrolled dependents prior to open enrollment to ensure there was a “clean slate” going forward.
Client Profile
County Government
1,035 Employees Covering 2,277 Dependents
Audit Finding
The client achieved a 99% response rate to BMI’s verification mailing campaign which identified:
37 dependents (1.62% of total) as ineligible.
Reasons for ineligibility included overage dependents, voluntary removal, unreported divorces and employees or their spouses who did not have legal custody of the enrolled dependent child.
Audit Benefits
The client terminated coverage immediately for the 37 ineligible dependents who failed to meet eligibility requirements.
First Year Savings Calculations
Average annual cost per dependent:
$4,254
Annual savings for dependents removed:
$157,398
Return on Investment:
586%