As healthcare costs continue to escalate, HDM's Dependent Eligibility Audit is a valuable method for which self-insured employers can effectively qualify the eligibility and benefits of employee dependents. By identifying and removing ineligible dependents with this auditing process, the Dependent Eligibility Audit saves employers administrative costs, prevents filing of erroneous claims, and improves the renewal process by ensuring that accurate demographic data is utilized to determine correct dependent eligibility.

When conducted, the Dependent Eligibility Audit reviews an employer's entire dependent population or targets a specific high-risk group, such as different last names, common law spouses, domestic partners, full-time students, and others. Our Dependent Eligibility Audits typically uncovers significant numbers of ineligible dependents, usually aged-out college students or divorced spouses, which oftentimes produce in a considerable savings for employers in annual premium costs.

The stages of HDM's Dependent Eligibility Audit include the following:

Stage 1: Amnesty Period
An amnesty period is a very important tool for effectively identifying and removing ineligible dependents from an employer's self-funded health plan. An amnesty period, as part of a dependent eligibility audit, involves a time period in which employees are requested to self-report any dependents that are enrolled in their employer's health plan who are not meeting the plan's eligibility requirements. This voluntary self-reporting of ineligible dependents typically involves a time period in which there will be no financial consequences for employees who self-report their ineligible dependents relative to past paid claims.

Stage 2: Data Collection and Electronic Analysis
HDM requests and obtains an employee/dependent eligibility data file containing detailed enrollment records of all employees who currently have dependents enrolled. HDM imports and analyzes eligibility using customized applications developed by HDM. HDM manipulates the data and categorizes dependents based on various parameters in order to tailor document request letters. We send document requests to all employees with enrolled dependents or a subset of employees. We then share detailed information regarding the outcome of the analysis in order to provide a sense of possible audit outcomes and to quantify potential candidates for focused analysis.

Stage 3: Documentation Collection and Eligibility Confirmation
HDM pepares the document request letters that are sent to employees. Employee responses and all related documents will be sent from each employee to HDM. We then monitor responses, send a follow-up letter to non-respondents, and review all submitted documents in order to identify those not meeting the plan's requirements and to confirm those who are truly eligible.

Click here to request a Dependent Eligibility Audit Brochure.

To learn more about our cost containment solutions for self-insured employers, contact HDM today at 800.859.5119 or request information with our online form. You may also send an email to: info@HDMinc.com.