A dependent eligibility audit is a comprehensive process that involves reviewing and verifying 100% of dependents associated with a company’s group health plan to ensure all dependents are eligible to receive benefits. The process requires all health plan participants with dependents to provide documentation for review, which could include birth certificates, marriage licenses, court documents, etc. On average, 4%-8% of dependents on a company group health plan are not eligible to receive coverage.

What is the dependent audit process?

The process is simple. The PlanSource verification procedure is broken into three key steps: planning and communication, documentation and verification, appeals and cancellations.

 Planning and Communication

During weeks 1-3, PlanSource will work with your HR department to better understand your unique needs and develop a comprehensive action plan for your custom audit.

Documentation and Verification

During weeks 4-10, your employees will submit the required documentation to PlanSource for review. We provide an ample window for the verification communication and document submission process to allow employees to fully understand the procedure. PlanSource will review all of the documentation and verify 100% of your group health plan’s dependents.

Appeals and Cancellations

In most cases, ineligible dependents will be identified through the audit. Weeks 11-12 will cover communication with employees about changes to their dependent status as well as any appeals to the audit. Finally, PlanSource will work to cancel all ineligible dependents from coverage under your company’s group health plan.

The typical timeline takes about 12 weeks from start to finish – it’s that easy! You are just 3 short months away from savings.

Why do I need a dependent eligibility audit?

Do you like saving money? If so, you need a dependent eligibility audit. On average, 4%-8% of dependents on a company group health plan are not actually eligible to receive coverage. We’ve said that a few times already, but it warrants repeating. Simply put, your company could be wasting thousands, or even millions, of dollars each year by covering dependents that are not eligible to receive benefits. Controlling costs will not only help save your company money on benefits but also allow you to pass those savings on to your employees. By weeding out ineligible dependents, you will be able to continue to offer affordable health care packages without reducing coverage or increasing co-pays.

10 Reasons To Complete Dependent Verification

How will a dependent verification audit help maintain compliance?

There are several organizations that closely monitor employer health care programs and maintaining compliance should be a top concern. For self-funded medical plans, using employee contributions to fund the claim payment of ineligible dependents is a major ERISA violation. Furthermore, ineligible dependents can put self-funded plans at risk for stop-loss exposure. For publically traded companies, Sarbanes Oxley requires stringent fiduciary oversight of benefits spending. Identifying and eliminating ineligible dependents from your group health plan will ensure that you are fully compliant with current health care regulations.

How much money will a dependent eligibility audit save my company?

A lot. Though the number will vary greatly depending on your current benefits offerings and the size of your organization, auditing and verifying dependents will likely save your company thousands each year, if not more. Though there are too many variables to throw out a blanket estimate, we do have a handy tool to help you estimate savings.

To get a better idea of how much you can really save with a dependent eligibility audit, check out our case study below on Grand Rapids Public Schools. We partnered with the district to complete an audit and saved them over $800,000 annually in health care costs! View the Case Study

How much does a dependent eligibility audit cost?

As you’ve probably already guessed, pricing will vary based on your company’s unique needs. We offer custom pricing to ensure we complete a thorough audit that leaves no stone unturned and no dependent unverified. Please contact us for your free quote.

Completing a dependent eligibility audit is a surefire way to ensure that every single person on your company group health plan is eligible to receive benefits. This will save your company substantial money over time and ensure that you remain compliant with current health care regulations.

Are You Ready To Start Saving?

Contact us below for a complimentary discovery session and audit evaluation. We can help you determine the best course of action for verifying dependents, saving money, and maintaining compliance.