Dependent Eligibility Audits: Real Findings Equate to Real Savings
Business Situation
A national retailer, small manufacturer, large city government, hospital, and Fortune 500 Company were all looking to reduce their overall health care costs in a variety of different ways, yet all of them reached the same conclusion: A dependent eligibility audit performed by an experienced outside organization was the most effective way to achieve immediate measurable results while also reducing compliance risk.
Audit Findings
The findings below are taken from actual audits BMI conducts every day and are not uncommon:
An employee insured a spouse, but was never married.
Multiple employees were insuring ex-spouses from unreported divorces occurring in 1993 – 2009.
An employee enrolled a domestic partner that was married to another individual.
An employee enrolled a stepchild and then reported the dependent as a foster child, but was unable to prove the relationship.
An employee insured a spouse and two stepchildren, but was not married resulting in removal of 3 enrolled dependents.
Audit Benefits
These clients decided to terminate coverage immediately for any dependents who were identified by the audit to be ineligible. Additionally, a majority of these clients also removed coverage for those who did not respond completely prior to the audit deadline.
Based on annual enrolled per dependent costs ranging $3,000 - $4,500, most clients achieved a return on investment that exceeded 2,000%.