HRAdvance Plan-Guard (Gatekeeper) Dependent Eligibility Audit

Our Plan-Guard Dependent Eligibility Audit programs help employers preserve the integrity of their benefit plan(s) and protects the results of a comprehensive audit by identifying ineligible dependents that employees attempt to enroll at the time of new hire, qualified family status events, overage students and new dependents added during the open enrollment process.  Our flexible solution ensures the verification process is designed and tailored to each organization’s specific needs, while minimizing the employer’s time commitment to the project.

Our goal with Plan-Guard is simple:  provide maximum return with minimum headaches for our clients, while ensuring that each participant is treated in a fair and helpful manner.

Plan-Guard ensures that ineligible dependents will never get on your group health plans and incur claims that are fraudulent and present a liability and fiduciary infraction on the part of the plan sponsor.

Plan-Guard Services

• Audit frequency and requirements defined by plan provisions, waiting periods, customized to each client’s needs.
• Gatekeeper services following a comprehensive dependent eligibility audit; or
  
• Audit specific populations (i.e. new hires, self-insured plans, students, etc.) 
• Document carry forward from audit to audit minimizes employee burden when spouse or student status is re-verified every 2-3 years.

 Importance of Gatekeeper Services:

• Plan-Guard eliminates the need to do a full-blown comprehensive audit every few years.  If preventive measures are not incorporated following a comprehensive dependent eligibility audit project, most employers will be back in the same situation in 2-3 years and run the risk of covering 5%-10% ineligible dependent participation.
• Avoid fiduciary exposure and liability covering ineligible dependents on the corporate health plan (ERISA Exclusive Benefit Rule, Section 125, Sarbanes Oxley)
• Everyone pays for fraud: Plan Sponsor-Employees-Carriers-Reinsurance Vendors, eliminating ineligible participants keeps you from ever paying out claim dollars for dependents that do not belong on your health plans.

Our Process