Ineligible Dependents Found Across Multiple Coverages
Business Situation
Because covering ineligible dependents drives up the costs of health care for all participants, this client came to us to identify any enrollees in medical, dental and vision who did not meet eligibility criteria while also complying with ERISA requirements.
Client Profile
Manufacturer within the technology and communications sector
1,041 employees covering 2,528 dependents for a total of 3,569 members
Audit Finding
98% of the employee population completed the audit following the communications campaign.
129 dependents or 5% of total dependents were determined to be ineligible for coverage.
The most common reasons for ineligibility included failure to maintain full-time student status (dental), dependent marriage (dental and vision) and spouses legally divorce or separated, but not reported (medical).
Audit Benefits
Coverage was terminated immediately for 129 ineligible dependents across medical, dental and vision plans.
First Year Savings Calculation
Avg. Annual Cost Per Dependent Across All Coverage: $1,450
Annual Savings From Ineligible Dependents Removed: $187,050
Return on Investment: 916%