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Dependent Audits

 

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Dependent Audits

Basic_LogoThe first step in controlling your benefit plan cost is ensuring that you are only providing benefits to intended dependents.
There is also a reduction in risk and expenses, considering regulatory issues, outcomes, processes, reporting and methods required by HIPAA, ERISA, COBRA and other regulations.
Industry trends - Covered Employees and Dependents
  • 5-15% of dependents are ineligible for coverage
    • Examples include legally separated or divorced
  • The 2007 Kaiser Family Foundation Survey found that each dependent cost $2,400/yr. (employer cost). A "Dependent Eligibility Audit" will identify ineligible dependents so they can be removed from your plan. 
Primary Objective of a Dependent Verification Audit: Controlling benefit plan cost by ensuring that Group health benefits are being provided to intended dependents only.
Other Impacts: Reduced administration time/expense meeting HIPAA, ERISA, COBRA and other regulatory requirements affecting dependent coverage.
 
Dependent Verification Audit Process
 
  1. Detailed Planning Phase
  2. No Consequences Amnesty Phase.
  3. Validation Phase"
    1. Requires specific documentation proving eligibility.
    2. Process all received documents
  4. Closure Phase
    1. Review Results (0utcomes)
  5. Implement procedural changes to insure future compliance
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