Dependent Eligibility Audit

Each year it is possible that your health care plan may unknowingly be subsidizing the cost of health care benefits for ineligible dependents. If you currently do not have an effective eligibility verification process in place, your organization could be spending millions every year on completely unnecessary health care expenses.

ConSova has performed over 500 audits for some of the world’s largest and most respected companies, including Bertelsmann, Bristol-MyersSquibb, CDW, Covenant Health, Dollar/Thrifty/Automotive Group, Gwinnett County, Hertz, Humana, Kaiser Permanente, Nissan, Nokia, Providence Health, St. Lukes Hospital, Sony, Sprint, Tyco International, and many more.  

Costs Will be Removed Entirely

With ConSova, it is possible to reduce your health care spending without shifting your costs to your employees. ConSova knows that the costs to offer employee benefits only continue to rise. This means that employers are increasingly faced with the challenge of identifying alternative means of controlling costs and exposure to adverse risks. ConSova can help.

Thanks to our Dependent Eligibility Audit services, we can help our clients reduce their total health care spend by 3-5%. Note that unlike other cost containment measures, eligibility verification does not shift costs onto employees; instead, it works to remove costs from the system entirely.

Going Beyond the Honor System

It is a simple fact that virtually every employer is carrying dependents on its plan that ultimately fail to meet the plan’s eligibility rules. In the past, employers have largely relied on the “honor system” to verify dependent eligibility. Even when combined with an employee affidavit, the honor system still effectively subjects employers to unnecessary liability. Whether attributed to a lack of understanding regarding eligibility rules by the employee or outright fraud, the simple fact remains that ineligible dependents are enrolling on health care plans because proper preventative measures are not being taken. However with ConSova’s Dependent Eligibility Audit, the necessary preventative measures can be put into place.

A Proven System that Works

Through our Dependent Eligibility Audit and ongoing services, you will have a proven mechanism through which to identify and remove ineligible dependents from an employer health plan. On average, ConSova identifies 5-8% of enrolled dependents as ineligible. This translates into an annual health care costs ranging from $3,000 to $5,000 savings per ineligible enrolled dependent, with cost savings potentially reaching into the millions every year.

In addition to this highly compelling economic incentive, ConSova’s eligibility verification services help fulfill your fiduciary responsibility to manage the plan for the exclusive benefit of eligible participants and beneficiaries. The systematic verification of dependent eligibility demonstrates your commitment to running the plan in a fiscally responsible manner.

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