Huge ROI Following Dependent Eligibility Verification

Business Situation & Client Profile

To ensure only eligible dependents were enrolled for health benefits, this manufacturer engaged BMI to verify whether any of the 809 dependents were eligible according to plan eligibility requirements.  

Solution

BMI customized an audit plan to meet the following objectives:

  • Communicate the purpose of the audit, deadlines, compliance requirements, etc. to 376 employees with 270 enrolled spouses and 539 dependent children.

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

  • Compare plan eligibility requirements with documentation submitted.

  • Identify all dependents currently enrolled who do not meet eligibility criteria.

  • Securely collect and retain all verification documentation.

  • Report findings weekly and provide a final executive summary of results.

Audit Findings

  • 47 dependents (5.81% of total) failed to meet plan eligibility requirements.

  • 28 of the 47 dependents (60% of total) were eligible for coverage through their own employer but did not enroll.

  • 77 dependents did not provide complete verification information or failed to respond.

Audit Outcome

The client terminated coverage for 124 dependents who were identified by the audit to be ineligible or who failed to respond or verify eligibility prior to the audit’s submission deadline. The client subsequently engaged BMI to conduct ongoing dependent eligibility verification.

First Year Savings Calculations

 Average Annual Cost per Dependent: $5,000

 Calculated Annual Savings from Dependents Removed: $620,000

 Return on Investment: 4,950%

Spousal Carve-out, Dependent EligibilityRobert Temples