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September 4, 2018

Audit of Dependent and Spousal Surcharge Eligibility Achieve Combined Savings

Business Situation & Client Profile:  

A regional hospital and healthcare center with 650 employees covering 1,480 dependents contacted BMI to: 1) verify the eligibility of all dependents and 2) determine whether or not enrolled spouses should be paying a spousal surcharge per the plan. Verification was previously performed internally.

 

Solution:

BMI customized an audit plan to meet the following goals:

  • Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all employees with one or more dependents.
  • Provide a customer service department with toll-free phone lines and bilingual staff.
  • Compare plan eligibility requirements with documentation submitted.
  • Identify all dependents currently enrolled who do not meet eligibility criteria or should be paying a spousal surcharge.
  • Securely collect and retain all verification documentation.
  • Report findings weekly and provide a final executive summary of results.

 

Audit Finding:

  • 97% of audit participants completed the audit.
  • 26 dependents (1.76% of total) failed to meet plan eligibility requirements.
  • 160 dependents (10.81% of total) should be paying a spousal surcharge.

 

Audit Outcome:

The client terminated coverage for the 26 dependents who were identified by the audit to be ineligible and instituted a spousal surcharge for 160 dependents.  Additionally, coverage was terminated for another 43 dependents who did not respond completely prior to the audit’s deadline despite multiple communications.

 

First Year Savings Calculations

Average Annual Cost per Dependent:                                   $3,500
Calculated Annual Savings from Dependents Removed:                                   $241,500
Annual Spousal Surcharge per Dependent:                                   $960.00
Calculated Annual Savings from Surcharge:                                   $153,600
Return on Investment:                                   2,141%

Visit here to learn more about dependent eligibility and spousal surcharge audits.