Comprehensive Verification Audits

One of the major factors affecting benefit plan sponsors’ benefit payments is the enrollment of ineligible dependents under their participants’ plans. For this reason, more and more plan sponsors are conducting dependent eligibility verification audits. Workforce’s Dependent Eligibility Verification Audit (DEVA) is a process for certifying the eligibility of enrolled dependents and capturing lost dollars through the termination of coverage for dependents who do not meet eligibility requirements under current benefit plans. Through positive messaging and round the clock participant support, response is maximized and non-eligible dependents are quickly identified, eliminating unnecessary payments and administrative costs and improving the renewal process by ensuring that accurate demographic data is used to determine plan pricing. Why Should a Dependent Eligibility Verification Audit Be Performed?

  • Realize Immediate Savings Most clients experience a 3% – 8% reduction of enrolled dependents, translating into multi-million dollar benefit cost reductions that begins to accrue in as little as 3 months. (Multi-employer fund ineligible rates may be higher.)
  • Provide Compliance With Plan Rules Workforce’s Dependent Eligibility Verification Audit process works to ensure that participants adhere to eligibility guidelines for enrolling dependents.
  • Meet Plan Fiduciary Obligations Workforce’s Dependent Eligibility Verification Audits help manage fiduciary responsibilities as a plan administrator.

What customer support philosophy does Workforce use to yield the greatest cost savings? Workforce delivers custom solutions focused on education, communications, and participant advocacy to ensure a positive experience for participants while simultaneously delivering exceptional results. It is our job to be aware of trends and regulations impacting eligibility so we can assist clients stay ahead of the curve throughout the data verification stage all the way down to the termination and coordination of non-eligible dependents.
After completing the initial Dependent Eligibility Verification Audit, Workforce’s Ongoing Dependent Eligibility Verification program is the next step in managing qualifying events and new hires that result in additional dependent enrollments.

Ongoing Dependent Eligibility Verification

Conducting an initial Dependent Eligibility Verification Audit is a necessary first step in protecting an organization’s entire benefit structure, including medical, dental and vision plans. Statistics show that ineligible dependents migrate back onto their health plan at a rate of 2-3% per year following an audit. Our own analyses have demonstrated that without ongoing dependent eligibility verification the number of ineligible dependents will revert to its pre-audit level in three to five years. To generate ongoing hard dollar savings and help preserve existing benefit levels for participants, protect initial investment through Ongoing Dependent Eligibility Management. Why Protect Plans through Ongoing Dependent Eligibility Management?

  • Manage new hires and qualifying events systematically and consistently require documentation for new-hires and qualifying events.
  • Prevent post-audit migration at scheduled intervals, require documentation, and recertify all enrolled dependents based on prior audit results.
  • Free up operational dollars, decrease plan reserve funding, and prevent claims payments or plan sponsor contributions made on behalf of ineligible dependents.

What Dependent Eligibility Verification process does Workforce use to produce quantifiable and measurable results? Workforce delivers custom solutions focused on education, communications, and participant advocacy to ensure a positive experience for participants while simultaneously delivering results. Maintaining high-quality, affordable health care is vitally important to Workforce, which is why many organizations need a partner who recognizes and aligns with these priorities.

In support of delivering ongoing dependent eligibility management services, Workforce’s solutions feature the following components:

  • Requesting, collecting, auditing, and maintaining eligibility verification documentation from benefit participants newly enrolling dependents in applicable benefit plans
  • Recertifying verification documentation on a scheduled basis to ensure current eligibility
  • Providing a secure data file detailing eligibility status on a regular basis
  • Providing call center, online, mail, and fax participant advocacy services to benefit participants to certify eligibility documentation
  • Providing approved benefit administrators secure online access to Workforce’s Dependent Eligibility Management System to view and manage eligibility verification documentation