A healthcare plan audit program
to safeguard your plan assets
is a Best Practice

 

Why Perform a Dependent Eligibility Audit?

A Dependent Eligibility Audit manages risk going forward

 

  • Definition of “standard family” has changed drastically
    • Increased complexity and regulations have made this a difficult issue for Human Resources
    • Does your SPD clearly define rules for this level of complexity?
    • Do you know when an employee gets a divorce?
    • Do your employees step children meet your plan’s requirements?
  • Most employers are under the impression that their TPA/Carrier is verifying plan member eligibility for them; therefore they do not verify the dependents that employees add to the plan.
  • Plan Sponsors need to enforce their rules
    • The exposure of having ineligible participants on the plan can represent a Sarbanes-Oxley risk to public companies and/or personal liability exposure to the Plan Fiduciary under ERISA and the Exclusive Benefit Rule.
    • If an ineligible participant has a claim, that claim must be denied.
    • Ineligible plan participants increase the cost for all plan participants