Dependent eligibility verification audits.

• Author: Smith, Michael
• Position: HEALTH CARE

In its most recent analysis of medical cost trends, Pricewater-houseCoopers forecast a 9-percent jump in health-care costs for 2011--a foreboding increase that has many self-funded companies scrambling to find every possible savings opportunity amid a slow economic recovery. Ironically, one of the most effective and least burdensome cost-cutting measures may be right under their noses: Removing ineligible dependents from their plans.

While most companies are probably aware that they're covering some ineligibles, they may not realize just how much the coverage costs. Each year, ineligible dependents consume up to 6 percent of self-funded employers' total annual plan expenses, racking up millions of dollars in unnecessary medical claims.

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By identifying and removing ineligible dependents from the roster through a dependent eligibility verification audit, employer-funded health-care plans can begin to realize real cost savings without sacrificing benefits or burdening employees with additional out-of-pocket expenses--in as little as six to eight weeks. Ongoing eligibility verification ensures that disqualified/ineligible dependents are kept off the plan once the initial audit is complete.

These audits not only identify deliberate falsifications to uncover immediate cost savings, but also help companies clear up inconsistencies or areas of confusion...