ETC Eligibility Audits

Get your healthcare plan in to compliance.  Only insure eligible members.

Eligibility Audits

Plan sponsors have a fiduciary duty to administer their health plan in the interest of eligible participants and their eligible dependents. If an employer is providing health plan coverage for non-qualified participants, the employer not only is wasting money but also is at risk of violating federal requirements and the Internal Revenue Code. Organizations can avoid such negative outcomes by carefully managing dependent eligibility.

A typical dependent audit can find 6 to 12 percent of dependents who do not meet eligibility criteria.  Removing ineligible persons from the plan can ultimately save the employer and the plan substantial sums and reduce the exposure to unnecessary risk.

So for both employee and employer, this review of compliance is a healthy move for the future of healthcare.