Two Objectives Completed Using One Dependent Eligibility Audit
Business Situation
This group health plan sponsor wished to 1) conduct a dependent eligibility audit of all enrolled dependents and 2) verify whether or not working spouses are eligible to be covered under plans sponsored by their own employer (spousal carve-out).
Client Profile
Regional heath care provider with multiple facilities
1,238 employees covering 2, 851 dependents for a total of 4,089 members
Audit Finding
In addition to requesting copies of documentation from all enrolled dependents to provide eligibility, enrolled spouses were asked to confirm and have their employers certify whether or not they were eligible for employer-sponsored coverage.
59 dependents or a little over 2% of total dependents were determined to be ineligible for coverage.
An additional 18 spouses were determined to be eligible for other coverage through their employer.
Audit Benefits
Coverage was terminated immediately for 59 ineligible dependents and a $1,200 annual surcharge was added for each of the 18 enrolled spouses. Inaccurate eligibility language among different plans was also identified and corrected through the audit process setup.
Average annual cost per dependent: $3,466
Annual savings for ineligible dependents removed: $204,494
Return on Investment: $769%