What is a Dependent Eligibility Audit?

With the healthcare costs steadily on the rise, companies are turning to various cost containing methods to ensure they are providing proper benefits coverage. One such cost containment strategy is the execution of a Dependent Eligibility Audit.

For self-funded health plans, a Dependent Eligibility Verification Audit is a great way of reducing your healthcare spend by 3-5%. A comprehensive Dependent Eligibility Audit will review 100% of the dependents enrolled on the plan to ensure that each dependent meets your defined eligibility rules. On average, a quality Dependent Eligibility Verification Audit will identify 5-8% of dependents. In some cases we see ineligible rates reach 20% or more.

 Reasons why you should conduct a Dependent Verification Audit:

• Identify benefit cost savings; conducting a DEV can reduce your total healthcare spend by 3-5%
• Fulfill your fiduciary responsibility under ERISA
• Preserve the integrity and better manage the costs of your benefit plans for your employees
• Establish ongoing eligibility verification standards

Every employer carries dependents on their plans that fail to meet their eligibility rules. In any given plan, 5-8% of enrolled dependents are identified as ineligible. With benefit costs that range from $3,000 to $5,000 per dependent, this could represent millions of dollars in savings opportunity for your company each year.