$100,000 Saved Following Ineligible Dependent Removal

Business Situation & Client Profile

After merging two companies into one benefit plan offering, this food and beverage company engaged BMI to verify whether 329 enrolled dependents were eligible for the company’s health plans.

Solution

BMI customized an audit plan to meet the following objectives:

  • Communicate the purpose of the audit, deadlines, compliance requirements, etc. to all employees with one or more dependents.

  • Provide a customer service department with toll-free phone lines and bilingual staff.

  • Compare plan eligibility requirements with documentation submitted.

  • Identify all dependents currently enrolled who do not meet eligibility criteria.

  • Securely collect and retain all verification documentation.

  • Report findings weekly and provide a final executive summary of results.

Audit Findings

  • 15 dependents (4.56% of total) failed to meet plan eligibility requirements.

  • Reasons for ineligibility included eligibility for coverage through the dependent’s own employer but did not enroll and voluntary removal upon receipt of existing eligibility information.

Audit Outcome

The client terminated coverage for 15 dependents who were identified by the audit to be ineligible.  Coverage was also terminated for 10 additional dependents who failed to provide information despite multiple communications prior to the deadline.

First Year Savings Calculations

Average Annual Cost per Dependent: $4,000

Calculated Annual Savings from Dependents Removed: $100,000

Return on Investment: 1,046%

Calculate your potential savings with our dependent eligibility savings calculator.

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