Dependent Verification Prevents Future Unnecessary Health Plan Expenses
Business Situation
A food distribution company approached BMI to verify the eligibility of all 2,867 dependents enrolled in the company’s health plans after continuing to see rising health care costs.
Solution
BMI customized an audit plan to meet the following objectives:
Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all employees with one or more dependents.
Examine 100% of all eligibility records to identify enrolled 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.
Securely collect and retain all verification documentation used to confirm eligibility.
Identify all dependents currently enrolled who do not meet eligibility criteria.
Report findings weekly and provide a final executive summary of results.
Audit Finding
101 dependents (3.52% of total) failed to meet plan eligibility requirements.
Reasons for ineligibility included voluntary removal, unreported divorces, or dependents eligible for coverage through their own employer.
Audit Outcome
The client terminated coverage immediately for the 101 dependents who were identified by the audit to be ineligible. Additionally, coverage was terminated for another 110 dependents who did not respond completely prior to the audit’s deadline despite multiple communications.
First Year Savings Calculations
Average Annual Cost per Dependent: $2,905 Estimated Annual Savings: $293,405 Return on Investment: 2,537%
Visit us here to learn more about dependent eligibility audits.