Eligibility Verification Before Open Enrollment Proves Beneficial

Business Situation & Client Profile

The school district realized that they do not request proof from employees to confirm dependent eligibility during enrollment, which poses a potential risk. As a result, BMI was engaged to verify the eligibility of 1,599 dependents on their medical plans before the next open enrollment.

Solution

BMI configured a plan to meet the following objectives:

  • Communicate the purpose, deadlines, and compliance requirements to 773 employees and their enrolled dependents.

  • Securely collect all verification documentation.

  • Compare eligibility requirements with the documentation submitted.

  • Identify ineligible dependents

  • Provide a customer service team with toll-free phone lines and bilingual staff.

  • Report findings weekly and provide 24/7 access to a summary of results via an online portal.

Audit Findings

  • 6.72% of dependents did not fulfill the verification requirements

  • 62 dependents (3.88%) failed to meet eligibility requirements.

  • Over 50% of the ineligible dependents were listed as a legal spouse.

  • Reasons for ineligibility included divorces, relationships not allowed by the plan or voluntary removal.

Audit Outcome

Coverage was terminated for 62 dependents identified as ineligible and an additional 43 dependents who failed to verify eligibility before the deadline.

First-Year Savings Calculations

Average Annual Cost per Dependent: $5,000

Calculated Annual Savings from Dependents Removed: $525,000

Return on Investment: 2,317%

Dependent EligibilityRobert Temples