We’re here to help
Health benefits plans are human. User error, forgotten forms. Our dependent eligibility and compliance solutions are easy to execute and integrate with your cloud-based benefits admin platform to stay on top of regulations you’re required to support — even as things change.
Here’s the Challenge
Benefits keep changing
Here’s how we solve it
Stay ahead of twists and turns
More of what’s possible with Eligibility and Compliance
Eligibility
We’ve spent years finding savings for you, auditing more than 12 million dependents from one-time audits and verifying over a million dependents each year for hundreds of our ongoing verification clients.
Benefits
- Reduce your spend and increase net profitability
- Demonstrate fiduciary responsibility and reduce risk
- Deliver user-friendly experience and support
Compliance
We get in the weeds, so you don’t have to. That means minimized legal risk, less admin stress and compliance that’s finally under control
Benefits
- Support on Form 5500 administration
- Support on POA / QDRO / QMCSO administration
- Support processing claims and appeals
Frequently asked questions
Have a particular question about Dependent Eligibility Services? We've answered some of the most commonly asked questions.
What is a dependent verification audit?
A dependent verification audit is a process used by organizations to confirm that all dependents enrolled in a group benefit plan are eligible for coverage. Dependent verification audits require employees to provide documentation to validate the relationship between the employee and the dependent. This confirms the dependent is eligible for coverage based on the plan’s rules. Dependent verification audits are a best practice among employers and helps manage both regulatory compliance and rising health insurance costs. Dependent verification audits are predominantly used for health plan management, but can be applied to any group benefit plan that offers dependent coverage.
What is the difference between a dependent verification audit and a dependent eligibility audit?
There is no difference between these terms – they are used interchangeably.
Why perform dependent verification?
Employees often do not know or misunderstand the plan’s dependent eligibility rules and will unintentionally enroll ineligible dependents in the company health plan. Covering ineligible dependents costs both employers and employees significant dollars. Dependent verification protects the health plan from ineligible dependents, helping plan sponsors ensure their health plan is compliant and that benefit dollars are only being spent on participants who are eligible, keeping health care costs down for everyone.
Why are ineligible dependents enrolled?
Most plan participants who enroll an ineligible dependent are unaware of what they are doing and don’t know or understand their plan’s dependent eligibility rules. It’s rare for plan participants to intentionally enroll an ineligible dependent.
Who is an ineligible dependent?
Eligibility for a group benefit plan will differ from plan to plan. However, the most common ineligible dependents on health benefit plans include: ex-spouses and ex-domestic partners, ex-step children, boyfriends and girlfriends, relatives that do not qualify as a dependent (such as parents or siblings) and personal staff (such as nannies or housekeepers).
What types of dependent verification are there?
There are two main ways to do dependent verification:
1. A one-time, comprehensive dependent eligibility audit of enrolled dependents ensures that all dependents enrolled at the end of the audit are eligible.
2. Ongoing verification for new dependents confirms eligibility of new dependents at the point of enrollment, ensuring only eligible dependents can enroll in benefits coverage. Performing a comprehensive, one-time dependent eligibility audit followed by ongoing dependent verification is the best practice.
What documentation is required in a dependent verification audit?
Documentation requirements will vary, but typically acceptable documentation is a legal document that validates the dependent’s relationship to the plan participant. For example, for a biological child, the child’s birth certificate, listing the child’s name and date of birth and listing the employee as the parent, is acceptable.
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