Business Situation & Client Profile:
To ease the burden of rising health care costs and reduce risk, this manufacturer enlisted BMI’s assistance with dependent verification of 1,020 enrolled dependents on the health plan.
BMI customized a dependent eligibility audit plan to meet the following goals:
- Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all 484 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.
- Securely collect and retain all verification documentation.
- Identify all dependents currently enrolled who do not meet eligibility criteria.
- Report findings weekly and provide a final executive summary of results.
- 99% of audit participants responded to the audit.
- 41 total dependents (4.02% of total) failed to meet plan eligibility requirements.
- Reasons for ineligibility included voluntary removal, unreported divorces or enrolled spouses who were not actually married to the employee.
The client terminated coverage for the 41 dependents who were identified by the audit to be ineligible. Additionally, coverage was terminated for another 28 dependents who did not prove eligibility prior to the audit’s deadline despite multiple communications.
First Year Savings Calculations
|Average Annual Cost per Dependent:||$3,500|
|Calculated Annual Savings from 69 Dependents Removed:||$241,500|
|Return on Investment:||1,662%|
Visit here to learn more and see how much your organization could save.