Dependent Eligibility Audit Program
Introduction
Employer healthcare costs are increasing rapidly, which has many searching for creative ways to reduce these costs. Most companies are unnecessarily losing significant dollars due to ineligible dependents receiving healthcare benefits. A recent Wall Street Journal article estimated that 10% to 15% of enrolled dependents do not qualify for coverage and the employer cost for each of these ineligible dependents averages over $2,400 per year.
Opportunity
One solution is easy….a Dependent Eligibility Audit. TMDG LLC has developed a comprehensive audit program to ensure that dependents of enrolled employees meet your plan's defined eligibility rules. Utilizing the unique experience of our management, audit team and call center staff, a TMDG engagement includes the following:
- In-house Call Center for inbound and outbound phone calls
- In-house Mail Center which includes fax and web based services
- In-house IT Department and data storage capabilities
- Proprietary software to manage the entire audit process with documentation
- HIPPA compliant and fully secure systems and processes
- Business continuity and back-up support in case of electrical or catastrophic incident
Audit Process Overview
TMDG's audits are customized to meet the specific needs of our clients.
A) Audit Planning Process
TMDG dependent eligibility experts will conduct an on-site meeting with
representatives of your organization to decide on all aspects of the engagement.
B) Implementation
TMDG staff will validate that the employee dependents, who are enrolled in the organization's health, prescription drug, dental and vision plans, meet the plans' eligibility criteria by reviewing independently received documentation supporting the dependent's eligibility status.
This process will include four separate phases:
I) Initial Employee & Dependent Communication
II) Amnesty Period
III) Validation Process:
- Request for Documentation
a. First Mailing
b. Second and Final Mailing
- Confirmation of Dependent Eligibility Status
- Request for Additional Documentation
IV) Termination of Benefits & Related Communication Reporting
Types of Findings
- Children over the age of 26 who do not have medical eligibility status
- Employees who are divorced but continue to carry their former spouses on the plan
- Children listed as dependents that have no legal relationship to the employee
- Employees who enroll a "spouse" on the plan when they are not legally married
Client Benefits
- Immediate savings by removing ineligible dependents from the company plan
- Total verification of all dependents eligible for benefits
- Increased knowledge of your current dependent eligibility processes/verifications
- Minimal employee noise and disruption
- Minimal time and resources needed from your Human Resource and Employee Benefits staff.
- Fully HIPPA & ERISA compliant
