Business Situation & Client Profile:
This city and county government approached BMI to help confirm if health care plan dollars were being spent appropriately by verifying the eligibility of 7,596 enrolled dependents.
BMI customized a dependent eligibility verification plan to meet the following goals:
- Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all 3,347 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.
- 98% of audit participants responded to the audit.
- 386 total dependents (5.08% of total) failed to meet plan eligibility requirements.
- Reasons for ineligibility included voluntary withdrawal, unreported divorces or dependents eligible for medical coverage through their own employer.
Coverage was terminated for the 386 dependents who were identified by the audit to be ineligible. Additionally, coverage was terminated for another 287 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 673 Dependents Removed:||$2,355,500|
|Return on Investment:||3,822%|
Find out how much your group could save here.