Member Dependent Verification Saves Labor Union over $350k

Business Situation & Client Profile

To ensure only eligible members were enrolled for health benefits and to avoid denials of stop loss claims, trustees of this labor union engaged BMI to verify the eligibility of 1,047 total enrolled dependents on their health plans.

Solution

BMI customized a plan to meet the following objectives:

  • Communicate the purpose, deadlines, and compliance requirements to all members 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 and provide a summary of results.

Audit Findings

  • 23 dependents (2.2% of total) failed to meet eligibility requirements.

  • Reasons for ineligibility included unreported divorces and voluntary removal.

Audit Outcome

The audit identified 51 dependents (4.9% of verified dependents) who failed to meet eligibility requirements. Coverage was terminated for 23 dependents who were identified as ineligible and an additional 28 dependents who failed to verify eligibility prior to the verification deadline.

First Year Savings Calculations

Average Annual Cost per Dependent: $7,000

Calculated Annual Savings from Dependents Removed: $357,000

Return on Investment: 2,356%

Dependent EligibilityRobert Temples