Finding Ineligible Dependents is Not Limited to Certain Industries
Business Situation
While providing comprehensive medical benefits packages to employees with single and family coverage options, this client wished to avoid payment of healthcare claims for ineligible dependents under the plan.
The client outlined specifically in their audit objectives that the goal of the audit was not to maximize the number of dependents removed, but rather ensure covered dependents do in fact meet the eligibility guidelines specified in the plan.
Client Profile
Institution of higher education
3,597 employees covering 7,872 dependents
Audit Finding
The client achieved a 99% response rate which revealed the following:
226 dependents (2.87% of total) were determined to be ineligible.
Audit Benefits
All audit objectives were achieved. Coverage was terminated immediately for 226 ineligible dependents, thus avoiding future payment of healthcare claims for ineligible dependents under the plan.
First Year Savings Calculation
Average annual cost per dependent:
$3,300
Total annual savings for ineligible dependents:
$745,800
Return on Investment:
1,410%