Presentation on theme: "Employee Insurance Program Dependent Audit May 1, 2011 Laura Caldwell, Benefits Administrator."— Presentation transcript:
Employee Insurance Program Dependent Audit May 1, 2011 Laura Caldwell, Benefits Administrator
Dependents are anyone you have listed on your insurance coverage. Your spouse and children who are covered by health, dental, vision, or life coverage are your dependents.
In an effort to control costs, the Employee Insurance Program, (EIP) will begin verifying eligibility of all dependents by requiring documentation for all covered dependents. When an audit was performed last fall, it was found that out of 529 students, 189 were not eligible for coverage. The state saved 1.2 million dollars by not paying claims on these students.
With more than 187,000 covered dependents on state coverage, EIP expects to find somewhere around 7% of dependents do not actually qualify for coverage. Saving an estimated $19 to $20 million dollars per year. The initial audit cycle began mid-April and is expected to take 18 to 24 months to complete.
At some point during the audit cycle, all subscribers, who cover dependents, will receive a letter from EIP asking them to submit documentation to verify the eligibility of each of their covered dependents. If the subscriber does not provide documentation within 60 days from the date of the audit request, his dependents will be dropped from whatever coverage they have, health, dental, vision or life insurance.
Spouse Verification Requirements
Legal Spouse: 1.A copy of your marriage license and a copy of page 1 of your current federal tax return. If married filing separately, submit page 1 of both federal tax returns. To protect your privacy, please black out all financial information. 2.If not married long enough to file a joint tax return, a copy of your marriage license only. Former or Separated Spouse: 1.Photocopy of divorce decree ordering the subscriber to cover the former spouse. 2.If separated, a copy of the separation agreement.
Common Law Spouse (provide both 1 and 2): 1) One of the following to prove that you and your spouse live at the same residence (submit one for yourself and one for your spouse): Lease or mortgage Auto registration Drivers licenseUtility bill Pay stub (with your address listed) Current tax return 2) PLUS one proof of current financial interdependency: Joint ownership of your home Joint lease/rental agreement Joint homeowner/renters insurance policy Joint bank account statement or a voided check Joint credit card statement Account numbers and account balances may be blacked out. NOTE: If you have not already submitted a signed, notarized Common Law Marriage Affidavit, you should do so at this time.
Child Verification Requirements
Natural Child - Birth Certificate (long form) showing the subscriber as the parent. Step-child - Birth Certificate (long form) showing name of natural parent plus proof natural parent and subscriber are married (see spouse above). Adopted Child - Court documentation verifying completed adoption or a letter of placement from an adoption agency, an attorney or the SC Department of Social Services, verifying the adoption is in progress.
Foster Child - Court order or other legal documentation placing the child with the subscriber, who is a licensed foster parent. Other Children - For all other children for whom a subscriber has legal custody, a court order or other legal document granting custody of the child to the subscriber. Documentation must verify the subscriber has guardianship responsibility for child, not just financial responsibility.
If you have children on your health, dental, vision or life insurance coverage, you will be required to provide a “long form” birth certificate that lists both of the parents. If your child was born in South Carolina, the only place to obtain this certificate is at SCDHEC, located in Columbia. Local SCDHEC offices will only issue the short form (blue card) birth certificates and the short form does not list the parents. You can obtain the form to request the long form birth certificate from SCDHEC at
To Obtain Long Form Birth Certificates by Mail 1. Complete the application found on the SCDHEC website 2. Enclose $12 per original certificate requested by certified check or money order; personal checks will not be accepted. 3. Send a photocopy of a valid picture ID of the applicant. (person requesting the certificate) Any United States’ Department of Motor Vehicles office- issued picture identification, i.e. driver’s license, identification card, learner’s permit (unexpired) Current school or employer picture identification card Military card (unexpired – active duty or retired member) Passport – US or Foreign (unexpired)
Remember: Do not wait until the last minute to request this information…. Average processing time at SCDHEC is 2-4 weeks (standard), 3-5 business days (expedited) for an additional fee. Mailing address: SCDHEC, 2600 Bull St., Columbia, SC You may also “walk-in” to the SCDHEC, 2600 Bull St., Columbia, SC 29201, but you will still need the completed application, photo ID and $12 search fee to obtain the birth certificate the same day.
To complete your audit prior to receiving the letter from EIP, gather the needed information and complete the Dependent Verification Form found on the Employee Insurance Program website at After you get to the website, select Forms, then select Dependent Verification Form.www.eip.sc.gov Make sure your address is correct with EIP so that you will receive your audit letter in a timely manner. This is your responsibility. You can check your address by going to then scroll down to MyBenefits listed on the left hand side of the screen. After you sign into MyBenefits, you can review your contact information and make changes if necessary.
NOTICE As of May 1, 2011, specific documentation will be required to enroll a dependent at any time such as Open Enrollment in October 2011 or a Special Eligibility Situation. A Special Eligibility Situation is loss of insurance due to loss of job, marriage, or birth, etc. when insurance coverage can be added within 31 days of event.