Dependent Eligibility Audits

 

 

The Dependent Eligibility Audit — A Service that Truly Works. Save your company money and reduce your liability simply by making sure 100% of your covered dependents are truly eligible!

 

Click here to skip the overview and fast-forward to the case studies below showing the good stuff!

 

At our core, we are an eligibility management company. With that comes a strong desire to assist your organization in ensuring that the dependents insured on your benefit plans are truly eligible for coverage based on plan language.

 

Typically we are auditing medical, dental, and vision benefit plans for fully insured and self-funded groups. 

 

Based on NGE’s auditing experience since 2007, 6.2% of covered dependents on any given plan will not meet eligibility criteria. This statistic is unchanged following the adoption of Healthcare Reform.

 

This is a service that truly works. Not only will your organization save money but you will comply with plan eligibility requirements, something that is very important to your insurance carriers and/or TPAs. The service will also help with compliance with federal regulations like ERISA or Sarbanes-Oxley, if applicable.

 

Who are we finding as ineligible you ask? NGE will routinely find divorced spouses, step children, mothers, grandkids, girlfriends, boyfriends, common law or domestic partners who can’t substantiate the relationship. You name it, we’ve seen it. Through the simple exercise of gathering documentation, NGE will root out these issues and ensure you are spending money on the right dependents. 

 

With flexibility to charge on a Percentage of Savings basis or on a Flat Fee, our service is a fit for any organization. NGE has an extensive list of references that will support the effectiveness of a dependent eligibility audit.

 

When Healthcare Reform was enacted, we weren’t sure what to expect. The good news for NGE and for this service, and frankly, the not-so-good news for Employers, is that we are still finding 6.2% of audited dependents to be ineligible. Here are some recent results and also, some client comments and feedback on our service.

 

 

Post Healthcare Reform Case Studies

Case Study 1

  • 3256 employees with 7673 dependents were audited
  • 4.9% of dependents were found as ineligible (379 dependents removed)
  • Projected annual savings: $1,165,166.00
  • Industry - Hospital

 

Case Study 2

  • 1923 employees with 3,574 total dependents were audited
  • 6.2% of dependents were found as ineligible (223 dependents removed)
  • Projected annual savings: $371,573
  • Industry - Community College

 

Case Study 3

  • 655 employees with 1,474 total dependents were audited
  • 5.9% of dependents were found as ineligible (88 dependents removed)
  • Projected annual savings: $113,607
  • Industry - Food/Beverage Bottler

 

Case Study 4

  • 429 employees with 815 total dependents were audited
  • 7.6% of dependents were found as ineligible (62 dependents removed)
  • Projected annual savings: $205,307
  • Industry - Property Management Company

 

Case Study 5

  • 173 employees with 405 total dependents were audited
  • 6.1% of dependents were found as ineligible (25 dependents removed)
  • Projected annual savings: $55,822
  • Industry - Manufacturing

 

 

Testimonials

Testimonial from a client that calculated the claims paid on dependents identified as ineligible:
“I thought you may like to use this as part of your testimonials for the ROI on the dependent eligibility process. Together we projected $113, 607 in annual claims incurred by the dependents found as ineligible when in reality, we incurred $418,021.98 in medical claims on the individuals who were determined ineligible, just within the past 12 months — no telling how long they were ineligible, so we used 12 months as a baseline.”

 

Client comments from past audits:

  • “Great support, easy access to management team and professional execution.”
  • “Excellent service. Very, very responsive. Better than I could have imagined!”
  • “It was handled in a very professional manner with the least stress possible on the HR Team.”
  • “Very professional and on schedule. They provided what they promised.”
  • “Very helpful, efficient. Great follow through.”
  • “Your employees are knowledgeable.”

 

Please click here to download a brochure of NGE's Dependent Eligibility Audit options.

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