Savings Continue with Ongoing Dependent Eligibility Audits

Business Situation & Client Profile

This healthcare organization relied on BMI for ongoing dependent eligibility audits to help manage eligibility and spousal surcharge verification in circumstances such as life events or new hires. This independent expert verification can prevent ineligible dependents from continuing to enroll in the plan while reducing an employer’s administrative burden. 

An initial audit by BMI led to the removal of over 1,000 dependents and annual savings of over 4 million dollars.

Ongoing Solution

Following an initial audit, BMI provided an ongoing audit plan to meet the following goals:

  • On an ongoing basis, communicate the purpose of the audit, deadlines, requirements, etc. to all employees with recently enrolled dependents.

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

  • Compare plan eligibility requirements with documentation submitted.

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

  • Securely collect and retain all verification documentation.

  • Report findings periodically and provide a final summary of results.

Ongoing Findings

  • Ineligible relationships

  • Dependents eligible for other coverage

  • Unreported divorces

  • Voluntary requests for removal

Audit Outcomes

First Year Savings Calculations

Average Annual Cost per Dependent: $4,789

Annual Savings from 16 Dependents Removed: $76,624

Average Spousal Surcharge per Dependent Spouse: $1,623

Annual Savings from 7 Spousal Surcharges: $11,361

Return on Investment: 415%

Calculate your savings estimate here.


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