Dependent Eligibility Audits

Protect the Value and Integrity of Your Health Plan

Dependent populations are always in a state of change. Marriage, divorce, childbirth, adoption and regulatory changes cause 5% to 15% of employees to have dependents enrolled who no longer comply with the eligibility definition in your health plan summary description.

ACS dependent eligibility audits identify ineligible dependents and removes them from your benefit plan, creating a significant reduction in future claim costs. At an average per dependent cost of $2,500 per year, an organization with 500 employees could easily realize a savings of $125,000 within one year of an audit.

Our Dependent Eligibility Audit Approach

Our dependent eligibility audit process consists of 3 phases designed to educate employees about your plan’s eligibility rules, help prevent simple enrollment errors and stem future fraud and abuse.

Planning – This includes a review of your plan and eligibility documentation, your requirements for proof of eligibility and preparing a timeline for the audit process.

Communication – During this phase, we distribute customized audit materials to all employees, gain their response and follow up to obtain the information we need.

Verification – Once the first two phases are complete, we track all responses, verify that your eligibility requirements have been met and handle any appeals.

Protect the Integrity of Your Health Plan

After the verification process is completed and all appeals have been settled, we provide management with a summary including termination statistics, estimated cost savings, projected annual cost savings and projected annual claim savings.

With results of audits conducted finding that 8 to 10 percent of dependent enrollees do not meet the dependent eligibility definition, a reduction in covered dependents could mean significant savings for your organization and its employees.

For more information regarding Dependent Eligibility Audits, click to Contact ACS.