1. Educators Health Alliance
Dependent Eligibility Verification
Group Leader Orientation

2. Dependent Eligibility Verification (DEV)
What is DEV?
With the help of the workforce, Dependent Eligibility Verification is a process that reviews and confirms the eligible status of EHA’s family members
A standard, consistent & defendable
process that removes dependents
from the medical and dental
plan who do NOT
meet the Plans
guidelines for
eligibility
Educators Health Alliance Board of Directors has retained Xerox HR Solutions (Xerox) to execute this project
DEV
an EHA
driven project...
It is a shared pledge
NOT
just
Educators Health Alliance Board of Directors launched this initiative to ensure effective compliance of qualified employees and their dependents

3. Who will be included in the verification?
Populations to be reviewed
Actives
Direct Bill Retirees
Plans included in the review
Medical
Dental
Dependents to be verified
Spouse
Dependent Children
November 12, 2018

4. Required Documentation
Dependents to be verified
Spouse
Dependent Children
Married
Most Recent (documentation from Xerox will advise tax year accepted) Federal Tax Return
(pages 1 and 2)
Mark out all financial information OR
Either State Issued Marriage Certificate (issued after marriage date) or Common Law Affidavit AND
Proof of Joint Ownership
(shows both names)
Mortgage Statement
Bank Statement
Utility Bill
Current lease or rental agreement
(within 120 days of initial correspondence mailed date)
Marriage Certificate
Legally Separated or Divorced
Court Documents
Biological
Birth Certificate
Adopted
Court Documents; Modified Birth Certificate
Stepchild
Stepchild (Spouse not on the plan)
Birth Certificate showing spouse as parent
AND
Will also need to provide spouse documentation (see left-hand columns)
Foster child; Legal Guardianship
Court Documents
November 12, 2018

5. What support is available to participants?
Xerox HR Solutions Service Center Highlights
100% dedicated to Dependent Eligibility Verification
Spanish speaking agents available
Trained, experienced Service Center team members
Standard training: HIPAA, ERISA, State and Federal regulatory guidelines (common law marriage etc.)
EHA specific training: SPD Guidelines, documentation requirements, etc.
Employee calls tracked using proprietary software (DADE)
Detailed notes logged for all employee calls
Recording of calls for dispute and appeal purposes
Hours: Monday–Friday 8 a.m. to 8 p.m. and Saturday 9 a.m. to 2 p.m. ET.
Helpline Number
November 12, 2018

6. Example of An Audit Timeline
*Members will receive similar time frames to complete audits – example below highlights dates that may apply to dependents
added to coverage January-March
Dependent Eligibility Verification
May
June
July
August
Employee Correspondence
5/3
Pre-Announcement Postcard (Home Mailing)
6/24
Postmark Date for POE Materials
7/5
Removal Notices
(Term Date will be 6/30)
for Non-Responders (Home Mailing)
8/23
Appeals Process Ends
(Approximately 60 days for appeals 6/24-8/23)
5/ POE (Proof of Eligibility) Initial Notice – Dependent and Spouse Verification (Home Mailing)
*Please note that dependents will not actually be termed from coverage until appeals period is exhausted, however, the termination date will be retroactive (in this example back to 6/30)
5/31
POE Reminder Notice (Home Mailing)
*Participation Complete or Incomplete Response notice sent within 3-5 days of member response
November 12, 2018

7. Additional FAQs
Audits are performed on-going on a quarterly basis; eligibility files are sent to Xerox from BCBSNE which include dependents added to coverage January-March, April-June, July-September, & October-December
If a dependent was missed on a previous audit, they may be picked up on a future audit – Example: Baby born on 3/31 and was not added to policy in time to be sent to Xerox on January-March file will be picked up on the next audit
Xerox advises BCBSNE of which dependents did not complete their audit prior to appeal process. BCBSNE currently sends Group Leaders communication about which dependents will be termed. It is at the Group Leader’s discretion to reach out to affected individuals as a reminder
Common causes of audit denials: State issued marriage certificate with issue date after marriage is required versus the marriage license which is issued pre-ceremony; Birth certificate is required versus hospital issued birth record
BCBSNE Members Services & BCBSNE Group Account Teams are unable to view documentation received by Xerox so questions about a specific audit should be directed to Xerox HR Solutions Service Center at for further assistance
November 12, 2018

8. Example of Audit Correspondence Envelope
P.O. BOX 980 Maumee, OH
Eha_110612_Eg_#10 Mailing Envelope
9.25
Open Immediately — Dependent Eligibility Verification Information
BARCODE AREA
November 12, 2018