Periodic Dependent Verification = Major Savings

Business Situation & Client Profile

An organization in the banking and financial industry asked BMI to verify the eligibility for 1,181 enrolled dependents on their medical plans. Previous checks by BMI in 2016 and 2019 resulted in the removal of 71 ineligible dependents, saving over $250,000.

Solution

BMI customized a plan to meet the following objectives:

  • Communicate the purpose, deadlines, and compliance requirements to 593 employees and their enrolled dependents.

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

  • Compare eligibility requirements with documentation submitted.

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

  • Securely collect all verification documentation.

  • Report findings weekly and provide a summary of results.

Audit Findings

  • 140 dependents (11.85% of total) failed to pass the verification requirements.

  • 15% of the ineligible dependents were previously identified as a legal spouse.

  • Reasons for spousal ineligibility included divorce, unmarried legal status or voluntary removal.

Audit Outcome

Coverage was terminated for 36 dependents who were identified to be ineligible and an additional 104 dependents who failed to verify eligibility prior to the verification deadline.

First Year Savings Calculations

 Average Annual Cost per Dependent: $5,000

 Calculated Annual Savings from Dependents Removed: $700,000

 Return on Investment: 3,625%

Dependent EligibilityRobert Temples