Dependent Verification
Take charge of who you are covering on your health plan.
What is dependent verification?
Dependent eligibility verification is a process that uses common documents to verify if the relationship between dependents and the employee or member aligns with the eligibility rules defined by the plan. For example, a valid birth certificate would confirm if a child is an eligible dependent of the member.
At BMI, we help you ensure that only eligible dependents remain covered under your plan - protecting resources, keeping costs sustainable, and showing fiduciary responsibility. Our verification process minimizes administrative burden while providing clear communication and support to your members, so you can focus on managing your benefits program with confidence.
Dependent Eligibility Savings Calculator
Savings that are easy to see
Use our dependent eligibility savings calculator to find out how much you could save.
On average, 9.5%* of enrolled dependents are ineligible for coverage.
*Based on BMI audits conducted in 2022-2024, results will vary. See ineligible rates by industry.
What’s at stake?
Avoiding these risks is crucial and easy with BMI Audit Services.
Average Ineligible Rate
Nearly 1 out of every 10 dependents are receiving benefits that they are not entitled to.
Compliance Risk
Providing benefits to ineligible members violates ERISA, Sarbanes-Oxley, and other regulations.
Annual Spend Per Dependent
On average, plans are losing an extra $7,000 on each ineligible dependent every year.
Medical Bankruptcy
Covering ineligible dependents exposes members and employees to the risk of medical bankruptcy.
Return on Investment (ROI)
Failing to conduct dependent verification results in a missed ROI averaging 2,573%.
Stop Loss Denials
Stop-loss carriers will deny claims for ineligible dependents, putting the plan and members at risk.
Dependent verification helps with regulatory compliance (ERISA audit), reduces waste, and protects your organization from costly fines. By eliminating unnecessary expenses, it lowers costs and frees up resources for valuable benefit enhancements.
“Our team has unofficially deemed BMI as our Vendor of the Year! ... We could not have asked for a better experience.”
It’s easy to work with us
How does it work?
We make it easy.
Our dependent eligibility verification process is designed to be simple and stress-free, making it easy for participants to verify their dependents. With BMI’s user-friendly system, members know what to do and when to do it. The process provides a quick and efficient experience with live in-house support if needed.
Because we do the hard work, you can be as hands-off or involved as you want. Our clients report they spend an average of one hour per week on project-related activities. Here’s what to expect:
1. Planning + Setup
Planning a dependent verification audit starts with defining which dependents need to be verified and what documents are required. BMI then helps to establish a timeline, communication plan, and secure ways for members to submit documents. Systems and processes are put in place to ensure a smooth and efficient audit.
what you do
Share eligibility rules
Participate in a kick-off call with BMI experts
Approve communication templates
Announce the verification internally to members
Send enrollment file to BMI
What we do
Assign a project manager to be your designated consultant and guide throughout the project
Analyze eligibility rules
Create a timeline using key dates received from client
Conduct a kick-off call with the plan sponsor and/or the broker consultant to review project timing, communication plan and confirm document requirements
Configure BMI’s software according to client eligibility criteria
Verify enrollment file for accuracy and completeness
Import and process the enrollment file in accordance with the project requirements
Tailor communications to the specifics of the campaign
Train BMI call center and document processing teams on specific eligibility rules and documents being requested
Grant access to and provide a demo of BMI’s Verification Portal and dashboard reporting
2. Communicate + Verify
Once the dependent verification effort has been communicated to members, BMI collects and reviews documentation submitted by members for authenticity and compliance with the plan’s eligibility rules. If more information is needed, members receive follow-up communications with additional instructions.
What you do
Monitor progress and review updates
Refer member questions to BMI
Provide updated addresses for returned communications
Give feedback to BMI on unique member scenarios
Participate in a status call with the BMI team
What we do
Send the audit notification to all members included in the enrollment file with instructions on how to complete the verification process and what documents are needed
Provide live human support to members needing assistance through our US-based, multilingual in-house call center, or by email
Give each member access to BMI Verify to submit documents, view their current status in the process, and complete the verification form
Review each document received from members to verify accuracy and ensure it meets your eligibility requirements
Request additional information from members who:
submit partial responses
have not responded
Conduct a status call with the plan sponsor and/or the broker consultant to review progress, explain reporting, and discuss what to expect for the remainder of the project
3. Reporting + Results
BMI keeps you informed throughout the verification process, making it easy to see who is eligible and ineligible. The insights gained from the dependent audit help organizations improve benefits administration, control costs, and establish guidelines for future ongoing verification.
What you do
Participate in a wrap-up call with BMI experts
Send termination letters using a template provided by BMI
Remove ineligible dependents from coverage
What we do
Provide clients with 24/7 access to progress reports through our online dashboard. The dashboard will be available throughout the entire project and includes information such as:
Progress towards completion
Family and dependent status
Ineligible and incomplete reasons
Alerts
Compile verified results, flag ineligible dependents, and provide a final detailed report to the employer for action
Conduct a wrap-up call to review the final results and consult with the client on how to move forward with next steps for the removal of ineligible dependents
Deliver an Executive Report including statistics and summarization of the final results, return on investment, and recommendations for future verification
Types of Eligibility Verification
There are two main types of dependent verification: comprehensive and ongoing. Implementing both comprehensive and ongoing dependent verification identifies and removes current ineligible dependents from the plan and helps prevent any additional ineligible dependents from being added in the future. Both types can include a working spouse rule.
Comprehensive Verification
A one-time review of all dependents currently enrolled in the healthcare plans.
Ongoing
Verification
A recurring review of newly added dependents from new hires, life events, mergers, and acquisitions.
An alternative verification method is the spousal-only approach, which focuses exclusively on types of spousal relationships. BMI can also accommodate an affidavit-only verification, but strongly recommends collecting documents to verify eligibility.