Risk Management & Dependent Eligibility Audits
Weigh your company resources against the potential payoff of cost control and ongoing risk exposure.
WHY AUDIT? An eligibility audit is a type of voluntary compliance review that compares a plan’s eligibility rules to the dependents actually enrolled in the plan. The purpose of a dependent eligibility audit is to identify dependents that should no longer be covered. Examples include children that have met the maximum age limit, divorced spouses, or children impacted by changes in custody arrangements. Removing those ineligible dependents from the healthcare plan can translate into cost savings for employers, especially if eligibility problems are already known to exist. Additionally, by not performing an audit, employers risk non-compliance with ERISA if they fail to comply with plan eligibility rules as provided in plan documents. An audit may also reveal important tax issues.
Plan participants can be required to submit documentation verifying each dependent’s status within a designated time. Documents must establish both a dependent relationship and that the relationship still exists. Examples may include:
> Marriage certificate > Domestic partner affidavit > Tax status form > Medical documentation of disability > Adoption papers > Legal documents that establish custody, guardianship or foster care > Birth certificate