SECURE – Dependent Eligibility Audit

Is Your Company's Health Plan paying for more than its share?

With the cost of healthcare increasing dramatically year after year it is vital for Health Plans to consider various containment options.

WHAT

Although Health Plans have criteria that define eligible dependents, experience shows that there are ineligible dependents taking advantage of the Health Plan benefits. Ineligible dependents drive up administration costs, claims costs, liability, and worst of all these claims are not eligible for stop loss reimbursements! These factors combined can be a costly oversight. Don't let your Health Plan spending spiral out of control, take the necessary steps to reduce your risk and keep costs down.

WHY

Statistics and experience show that employer sponsored Health Plans, have on average anywhere from 3% to 12% of populations that are not eligible for Health Plan benefits. The potential plan savings far out weigh the cost.

According to ERISA, the employer is the fiduciary in charge of verifying that all premiums are being spent on only those who are eligible. HealthComp can assure compliance with State and Federal regulations and can deliver important benefits to you.

  • Decrease your legal, financial, and claim risks

  • Reduce your current and future healthcare costs

  • Create a system for ongoing dependent eligibility auditing

WHO

HealthComp has the experience and information to audit dependent eligibility with minimal involvement from the employer group and no outsourcing. The audit is conducted completely by HealthComp Audit Board. Good participant relations are essential to conducting a smooth transaction for all involved during a dependent audit. As the Third Party Administrator for Your Company's Health Plan, HealthComp is already known and trusted by your participants.

HOW

HealthComp will interface with your employees to collect the necessary documentation for dependent eligibility verification. Once the responses are received by HealthComp, the documents are reviewed and verified, individually in a secure environment by our staff of experts. Not only will we collect the necessary information, review it individually for meeting the Health Plan's eligibility requirements; we will take immediate action by administering eligibility changes in a compliant method. All participants audit responses received by HealthComp are scanned and stored electronically for reference.

  • PLANNING - Addresses the Health Plan design to customize the audit to fit the group culture and assure compliance with State and Federal regulations. The tempo of the process should be to educate, document, and make corrections.

  • AMNESTY - Offers a "no-consequences" disenrollment packet to participants for removing ineligible dependents from the Health Plan.

  • CLOSURE

    1. Results will be summarized, documented, and will show annual savings with ROI established.

    2. Implement process and requirements for "New-Hire" and subscriber/dependent eligibility change requests.

    3. Continuation - Repeat verification on a partial or random basis for maintenance purposes.

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