Outsourcing a Dependent Eligibility Audit Proves to be Successful
Business Situation
This client provides comprehensive benefits to employees and their families, but acknowledged that they failed to consistently verify eligibility of new dependents due to limited resources. To help keep costs down and to free up resources, BMI was hired to conduct an audit of all enrolled dependents.
Client Profile
Manufacturing and Distribution
3,194 Employees Covering 6,907 Dependents
Audit Finding
The client achieved a 97% employee response rate to the dependent verification process which resulted in:
671 dependents (9.71% of total) failing to meet plan eligibility requirements.
Reasons for ineligibility included unreported divorces, failure to prove an eligible relationship to the employee and availability for insurance coverage through other employment.
Audit Outcome
The client terminated coverage immediately for the 671 dependents who were identified by the audit to be ineligible. Coverage was also terminated for an additional 206 dependents who did not respond completely prior to the audit deadline despite multiple reminders. Immediately following the audit BMI was engaged by the client to perform dependent eligibility audits for new enrollees and new hires on a quarterly basis.
First Year Savings Calculations
Average Annual Cost per Dependent: $3,500 Estimated Annual Savings: $3,069,500 Return on Investment: 4,555%