ETC Eligibility Audits

Purge your health plan of ineligible dependents.

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 so removing ineligible persons from the plan can ultimately save the employer substantial sums–but finding even one ineligible dependent during an audit can save the employer money and exposure to unnecessary risk.