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Dependent Eligibility Audit Guide
10 Reasons Why Leading Employers Verify Dependents to Reduce Cost and Eliminate Risk
Wednesday, November 29, 2017 at 2:00 pm ET (11:00 am PT)
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Today’s
Speakers
Bradley Taylor
Executive Vice President,
Business Development
PlanSource
Emma Fromholz
Benefits and Compensation
Manager
Bethany Christian Services
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About Bethany Christian Services
3
Bethany has a heart for children and we equip families to
be the answer for children in need.
Bringing & Keeping Families Together
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Better Technology for a Better Benefits and HR Experience
PlanSource provides flexible and intuitive benefits administration software and services to nearly
10,000 employers and 3.5 million consumers.
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Software + Services =
Best Benefits Experience
PlanSource offers a full suite
of professional services that
ensures that you get the most
out of your benefits
technology investment.
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What is a Dependent Eligibility Audit?
Top 10 Reasons to Conduct an Audit
Q&A
Agenda
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What is a Dependent Eligibility Audit?
A one-time or ongoing audit that verifies the
relationship and eligibility status of all dependents
enrolled on a medical plan. The audit could also
incorporate other benefit plans such as dental
and/or vision insurance.
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Top 10 Reasons to Conduct an Audit
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Quick to Set Up
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Dependent Eligibility Audit Process
Weeks 3-10
Audits
Weeks 11-12
Appeals
Weeks 1-2
Planning
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Dependent Eligibility Audit Process
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PlanningAudits
Appeals
Employee
Outreach
PlanSource reaches out
to employees via email,
phone, email and could
even use text
messaging
Documentation
Submission
Employees submit
documentation to
validate dependent
relationships
Coverage
Cancellations
PlanSource reaches out
to employees via email
or mail
Audits
Weeks 11-12
AppealsPlanning
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Easy to Conduct
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Ways to Conduct an Audit
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Full audit - captures documentation on all dependents
Affidavit-style audit - requires just a signature from employees
Targeted audit - only audits a specific groups of employees
Mixed audit - full documentation needed for some employees, affidavit needed for others
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Full Audits Yields the Best Results!
It’s consistent among employees & requires
employees to actively read the communications
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Easy to Outsource
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Outsourcing Takes the Pressure off HR
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Let someone else handle the communications and follow up
Ensures objectivity
Eases communication to employees
Reduces risk of objections from unions and other groups
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Makes HR a Hero
From cost center to strategic partner
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Keys to Positioning an Audit Internally
Be prepared for overcoming the objections
Consider amnesty for removed dependents
Involve all levels of management, union reps, etc.
Develop a detailed timeline and process –
the best time to conduct an audit is outside open enrollment
Communicate, Communicate, Communicate!
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Communication is Key!
Use multiple communications channels: email,
snail mail, posters, video, carrier pigeons, etc.
Include calls-to-action and deadlines in all comms
Keep emails short and sweet and make them scannable
Use attention-getting subject lines
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Furthers Compliance
with ERISA and other laws
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Its considered an ERISA violation if a self-funded medical plan
uses employee contributions to fund the claim payments of ineligible
dependents
Sarbanes Oxley requires stringent fiduciary oversight of publically-
traded companies, including the administration of benefits spending
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Reduce Stop-loss Exposure
for self-funded plans
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When Do Dependents Lose Coverage?
Typically
Date employee self-reports an ineligible dependent
End date of the audit for individuals that were never
documented
Note: Consider how to handle COBRA
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Generates Sizable Savings
No more Ex’s in the ER!
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6.2%of audited dependents
are typically foundas ineligible
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Average Savings from Dependent Eligibility Audits
Company
Type
Employees
Audited
Dependent
Count
% Found
Ineligible
Projected 1st Year
Savings
Hospital 1,602 3,617 7.2% $813,000
College 1,202 2,295 10.1% $722,000
Energy Supplier 146 325 5.2% $27,000
Hospital 251 523 11.4% $216,000
Fabricator 935 2,180 15.3% $1,016,000
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Allows Employers to
Verify Surcharges
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Many organizations apply surcharges for
spouses who can receive coverage
elsewhere, but have no way of checking
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Easy to Integrate
With ongoing benefits programs
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Ongoing Strategies Post Initial Audit
Determine when dependents can re-enroll
Plan how you will keep up with ongoing auditing
Use outsourcing partner to manage ongoing auditing
throughout the year
Do a full audit every 3-5 years
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Funds Other Strategic Initiatives
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Just a Few of the Ways to Apply Savings
Maintain medical plan contributions
Fund an FMLA administration service
Purchase more support for your benefits administration
Add executive benefits
Create a year-round employee communication strategy
Investigate employee engagement software platforms
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Special Dependent Verification Offer
Sign by January 1, 2018 | Start your audit by March 1, 2017
15% Discount
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Get in touch with us
www.plansource.com/getintouch
877-735-0468
Q&A
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Dependent Eligibility Audit Guide
10 Reasons Why Leading Employers Verify Dependents to Reduce Cost and Eliminate Risk
Wednesday, October 29, 2017 at 2:00 pm ET (11:00 am PT)