The ROI of Dependent Verification: How One Employer Achieved 5,463% Return
Healthcare costs aren’t just rising, they’re accelerating. What many plan sponsors don’t realize is that a significant portion of their annual spend is consumed by dependents who don’t meet plan eligibility requirements.
Dependent Eligibility Verification is one of the most effective ways to uncover these hidden costs, strengthen enrollment accuracy, and reinforce compliance with plan rules. Yet it’s also one of the most overlooked strategies.
This case study shows how a healthcare employer partnered with BMI Audit Services to validate its dependent enrollment and uncover millions in potential savings.
Business Situation:
A healthcare employer with 2,633 employee families and 5,619 dependents partnered with BMI Audit Services to conduct Comprehensive Dependent Eligibility Verification.
Like many employers, the organization recognized the need for a comprehensive review to ensure:
Only eligible dependents were enrolled
Documentation aligned with Summary Plan Descriptions (SPDs)
Plan assets were being used appropriately
The goal was simple: reduce unnecessary healthcare spending and enhance compliance by validating that all dependents meet plan eligibility criteria.
The Solution: A Comprehensive Dependent Eligibility Verification Audit
To achieve these goals, BMI deployed a structured and customized dependent verification process guided by SPD criteria. The solution included:
100% audit of all dependents, comparing documentation directly to SPD rules
Secure, centralized review of birth certificates, marriage certificates, and legal documents
Bilingual call center support available throughout the review
Multiphase communication campaigns across initial, reminder, and final notice cycles
Ongoing weekly reporting via a secure, password-protected web portal
Documentation retention & audit trails to support plan governance
This approach ensured high engagement, clear communication, and a smooth experience for both the employer and employees
Audit Findings:
The audit affirmed high compliance rates but also revealed risks that carried significant financial impact.
Overall Dependent Outcomes
91.51% passed verification
6.34% deemed ineligible
2.15% were suspended from further review
Confirmed Ineligible Dependents (37 Total)
Reasons included:
75.68% voluntarily removed by members
18.92% spouses did not meet marital criteria
2.7% lack legal guardian documentation
2.7% identified as divorced spouses
Unverified Dependents (319 Total)
Due to missing documents or non-response, unverified dependents are at high risk for ineligibility.
These findings underscore a common reality in healthcare plans, even a small percentage of ineligible dependents drive substantial financial waste.
The Results: $2.49M in First-Year Savings = 5,463% ROI
Using the industry-standard estimated annual cost of $7,000 per dependent, BMI identified significant savings tied to the removal of ineligible and unverified dependents.
Estimated First-Year Savings:
Confirmed Ineligible Dependents: $259,000
Incomplete & No-Response Dependents: $2,233,000
Total Potential Savings: $2,492,000
ROI: 5,463.50%
Beyond the immediate financial impact, the audit strengthened internal controls, increased data accuracy, and positioned the employer for more compliant benefit administration moving forward.
Conclusion:
In an era of rising medical costs, Dependent Eligibility Verification is more than a compliance step, it’s a strategic decision.
This healthcare employer’s results highlight the power of:
ongoing verification strategies
stronger new-hire document collection
spousal-only verifications
periodic full audits every 2–3 years
These results demonstrate how dependent verification is one of the most effective tools available for controlling costs and protecting plan assets.
Whether your organization is conducting verification for the first time or revisiting it , a structured, data-driven audit delivers immediate and long-lasting value.
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