HRAdvance: The Standard in Eligibility Solutions Dependent Eligibility Audit Dependent Eligibility Verification Plan-Smart: Dependent Eligibility Audit Verification Solutions  

Why Do a Dependent Eligibility Audit?

  1. Reduce expenses on your Medical Plan without changing plan design or employee contributions. Compelling economics: typical results indicate 10%or more ineligible dependents are enrolled on employer health plans which translates to hundreds of thousands of dollars per year in cost savings.

  2. Fiduciary responsibility to stakeholders and plan participants
    1. Exclusive Benefit Rule (ERISA)
    2. Qualified Section 125 exposure (pre-tax deductions not allowed for ineligible participants)
    3. Internal Controls

  3. Effective employee communication builds the value and workforce perception of your company health benefit plans.  Plus improving employee awareness helps set the tone from the top that company provided healthcare is a privilege, not an entitlement and fraud is not tolerated.

 

HRAdvance Clients

What Can Go Wrong and Disrupt Audit Cost Savings?

Eligibility audits performed by Human Resources or Internal Audit often fail to produce actionable results and do not overcome the three most common disruptive factors. 

Overwhelming workload can occur in manually intensive audits as the audit team is overwhelmed by the volume of paperwork. The audit team gets bogged down and is sometimes abandoned.  Inadequate resources prevent supporting employees through the process; employee pushback ensues and the project is abandoned.

Inconsistent outcomes are inevitable in the absence of a rules-based platform and often preclude actionable results.

While there is significant benefit to performing a dependent eligibility audit, watch out for the following:

  1. Delayed results caused by manual versus automated approach
  2. Lack of results because of reliance on manual versus technology-enabled solution that includes internal controls and alerts
  3. Failure to meet SLAs (Service Level Agreements) such as poor cycle times, or cost overrun for example
  4. Limited, ad-hoc reporting resulting in poor transparency without real-time access to data and results
  5. A random sampling versus a comprehensive audit
  6. And last, but not least, poor communication results from out of country call centers may result in  employee resentment.


Download the PDF: "25 Most Common Dependent Eligibility Mistakes" here.

 

Read more about Dependent Eligibility:
  ●Lowering Healthcare Costs

  ● Eligibility Quality Controls

  ● Eligibility Case Study
  

The criteria for decision making should be weighed carefully in your organization with an understanding of the impact on your workforce. 

For more information check here for Eligibility Audit Solution Case Studies



 


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