Allison Loehman March 3, 2019 4 min read

Verify Eligibility, Reduce Risk: A Dependent Audit Case Study

Dependent eligibility audit case study

Employers have generally relied on the honor system for their health plan enrollment, and by doing so have unknowingly covered many non-eligible dependents such as ex-spouses, adult children and others. Unfortunately, this practice can translate directly into higher costs for the employer. In fact, as you assess your health costs after open enrollment, the most significant is often the cost of ineligible dependents.

benefitexpress has performed hundreds of dependent eligibility audits for enterprise-level clients across various industries with the main goal of helping organizations make their health dollars go further. Before taking cost-cutting measures that can negatively impact your employees, such as reducing benefits or increasing co-pays, we recommend going through the dependent eligibility verification process to identify potential dollars to put back into your budget. A carefully planned dependent eligibility audit can not only help employers uncover ineligible members and maximize health dollars, but it can improve compliance, reduce stop-loss exposure and minimize other litigation risks.

Keep reading to see how we helped a major healthcare organization reduce covered dependents by 3%, resulting in a cost savings of $2,000 per plan member per year, and a $674,000 annual savings.

Dependent eligibility audit case study

Use our infographic below to see how a major healthcare organization used the benefitexpress dependent eligibility verification process to save over $674,000, annually, in healthcare costs.


Dependent eligibility verification process

When conducting a dependent eligibility audit, our high-level process includes:

  • Notification to employee of the purpose and timing for the audit, along with the steps necessary to comply.
  • Employee online confirmation of existing dependents.
  • Employee submission of required Proof of Relationship (where paperwork is required).
  • Verification of paperwork submitted (where paperwork is required).
  • Reminder notices to employees who fail to respond.
  • Removal from coverage of any dependents where the required proof of relationship was not provided or was not sufficient.

When clients perform a dependent eligibility audit with benefitexpress we take full responsibility for the identification of the issues, provide multiple recommendations to solve the problem and fully execute the steps needed to put money back into healthcare budgets.

Are you ready to perform a dependent eligibility audit? Contact a consultant today to get started!