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