Presentation on theme: "Future Compliance How do you maintain accuracy of eligible dependents as an ongoing process?"— Presentation transcript:
Future Compliance How do you maintain accuracy of eligible dependents as an ongoing process?
Congratulations! You’ve just completed your dependent audit verification. Now what? Critical Step : The ongoing management of dependents’ eligibility! WHY? Ongoing verification of dependent eligibility saves insurance costs BEFORE they are incurred!
WHAT and HOW? Obtain required documentation during activities that add dependents. New hires Employees adding new dependents Qualifying events Open enrollment
Communication New Hire Orientation New Hire Orientation: Focus part of discussion on “dependent eligibility.” SPDs SPDs: Verify language within your benefit summary plan documents that clearly defines “dependent eligibility” requirements. Internal News Updates Internal News Updates: Periodic reminders on enrollment rules, when and how dependents are added. Open Enrollment Open Enrollment: Define eligibility and requirements.
Ongoing Procedures New Hires New Hires: Orientation includes discussion on definition of “eligible dependent.” Make request for required documentation to verify eligibility of new hire’s dependents. Employee adding new dependents Employee adding new dependents: When new dependents added (marriage, birth, adoption or qualifying event), documentation required to verify dependent’s eligibility. Other documents: Qualified Medical Child Support Orders, child disability, student status.
Ongoing Procedures Open Enrollment Period Open Enrollment Period: Define requirements and expectations in your open enrollment communications. Identify key areas most often misunderstood and emphasize during open enrollment. At conclusion of open enrollment, review report of newly added dependents. Request required documentation to verify “new” dependents.
Best Practice: Consistent and well communicated dependent eligibility procedures. Process & Procedures to verify dependent eligibility = Prevention of any payment for ineligible costs