Eligibility Audits

Auditing the eligibility status of the dependents of your benefit plan participants is an often-overlooked opportunity to reduce health care costs.

A convergence of several reasons has lead to an increase of ineligible dependents being enrolled in various benefits, especially health care plans. One reason is the sheer cost to an individual of buying benefits outside an employer-sponsored plan. When an employer subsidy is removed, health care for many individuals is simply unaffordable. Another reason is that individual health care policies are medically underwritten. This means many cannot get coverage at any cost.

The result: Ineligible dependents often are enrolled, causing unnecessary cost to the employer. The potential savings of removing these ineligible dependents can be significant.

An important service provided by your BeneSource® team is conducting periodic dependent audits. One of the ways we do this is by requiring (and carefully reviewing for authenticity) the following types of dependent documentation:

• Spouse – Marriage Certificate
  
  
• Domestic Partner – Domestic Partner Certification or Affidavit of Domestic Partner Relationship
  
  
• Addition of Children - Birth Certificate or Adoption Documentation
  
  
• Over-Aged Dependents – Full-Time Student Verification or Disabled Dependent Certification

Our goal: To see the terms and conditions of your benefit plan are followed; that only eligible individuals are covered under your plans and that all who should be covered - are.