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Benefits of a Dependent Eligibility Audit

• Decreased overall health care costs.

• Savings of administration time and money by hiring an outside auditor

• Immediate measurable results as ineligible dependents are removed from coverage.

• Confirmation that plan participants understand eligibility requirements and definitions.

• Improved renewal processes through accurate enrollment records, documentation and communications.

• Avoidance of potential stop loss claim denials.

• Reduced compliance risk under Sarbanes-Oxley, ERISA and DOL guidelines.

Verification of eligibility will be document-based utilizing a three (3) phase mailing process supported by an in-house multi-lingual Call Center and web-based solutions. At the end of the audit, BMI will report to the Employer those employees with enrolled dependents that did not meet eligibility requirements for removal of coverage.

All mailings and follow-up correspondence inform audit participants of the options to submit requested documentation to BMI. Options include returning documentation via the included postage paid return envelope, secure digital fax or upload through the employee web portal which is a mobile optimized website.

All mailings and all follow-up correspondence will refer to BMI’s Call Center and secure web portal for additional support and guidance. Features include:

• A toll-free telephone line will be staffed during extended business hours and supported with 24/7 voice messaging,

• Spanish speaking representatives and availability of a live translation service.

• Tracking of all in-bound and out-bound messaging

• Fully-secure web portal for audit participants to upload documents, download copies of forms, view status, FAQ, or opt-in to receive future communications via email, etc.

All incoming documentation (physical and electronic) will be captured in BMI’s document management system. Documentation will be reviewed by auditors against the eligibility criteria programmed into the system during the audit setup. If BMI receives all the requested documentation, a confirming “Thank You Postcard” will be sent to the employee the same day as processed; advising that all information required to complete the audit has been received. If BMI does not receive all requested documentation, BMI will an “Incomplete Letter” the same day as processed, indicating the member-specific missing or incomplete documentation and deadline for submission. Audit status will also be mirrored on the employee web portal during this time in addition to any physical mailings.

BMI establishes the documents required to prove eligibility following a thorough review of Summary Plan Descriptions, amendments, and any other correspondence or directives prepared for the purposes of interpreting and/or clarifying plan eligibility. Documents include, but are not limited to marriage certificates/licenses, divorce decrees, domestic partner registrations, applicable affidavits or court documents, and birth certificates. In some cases, joint document collection is preferred for enhanced verification. Examples include a redacted 1040 tax form, property tax statement, mortgage, utility bill or other preferred criteria. Project Managers are well-versed in documentation and will discuss any pros and cons with the Employer to ensure optimum results.

Approximately five business days after the initial mailing, weekly reporting via email and BMI’s secure employer portal by the assigned Project Manager begins. More detailed reporting is provided after the conclusion of mailing/phase. After the 3rd and final mailing, BMI will provide a Final Summary Update and Executive Report detailing audit participants who completed the audit, were incomplete or did not respond along with their final eligibility status. Employer will have the option at this time to elect a four-week appeals period whereby employees that have already been notified of impending benefits cancellation may contact BMI to appeal any previously made eligibility decision or inaction. At the end of this optional period, BMI will report any changes in a dependent’s audit disposition and eligibility as a result.

Customized Letter-Based Employee Communications / Mailing Fulfillment, Postage and Setup / Inclusion of Multiple Eligibility Definitions and Carriers / Verification of Spousal Surcharge or Carve-out Provisions / Appeals Handling / Reminder Email and Text Blasts / Timeline Extensions / Document Replacement Copy Assistance / Joint Documentation Verification / Supplemental Audit Communication Templates.

Whether it’s BMI’s high audit participant responses rates, exceptional customer service, or inclusive features, employers like Employer, count on BMI’s expertise to deliver immediate and future return-on-investment through better benefits auditing.

What is Included in a BMI Dependent Eligibility Audit?

Available no-cost features with BMI

All-inclusive flat fee

Customized letter-based employee
communications

Mailing fulfillment, postage and audit setup

Prepaid business reply envelopes

Inclusion of multiple eligibility definitions and carriers

Verification of spousal surcharge/carve-out

Appeals handling and processing

Reminder outbound calls or text messaging

Status complete and incomplete notification

Timeline duration changes

Multi-lingual staff and translated web portal

Weekly project and dependent status reporting