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May 9, 2016

Dependent Eligibility Audits: Real Findings Equate to Real Savings

Business Situations:
A national retailer, small manufacturer, large city government, hospital, and Fortune 500 Company were all looking to reduce their overall health care costs in a variety of different ways, yet all of them reached the same conclusion: A dependent eligibility audit performed by an experienced outside organization was the most effective way to achieve immediate measureable results while also reducing compliance risk.

Audit Findings:
The findings below are taken from actual audits BMI conducts every day and are not uncommon:
  • An employee insured a spouse, but was never married.
  • Multiple employees were insuring ex-spouses from unreported divorces occurring in 1993 – 2009.
  • An employee enrolled a domestic partner that was married to another individual.
  • An employee enrolled a stepchild and then reported the dependent as a foster child, but was unable to prove the relationship.
  • An employee insured a spouse and two stepchildren, but was not married resulting in removal of 3 enrolled dependents.

Audit Benefits:
These clients decided to terminate coverage immediately for any dependents who were identified by the audit to be ineligible.  Additionally, a majority of these clients also removed coverage for those who did not respond completely prior to the audit deadline.
 
Based on annual enrolled per dependent costs ranging $3,000 – $4,500, most clients achieved a return on investment that exceeded 2,000%.