Eligibility Audits

Why Perform Eligibility Audits?

With the high cost of health care, most employers are struggling to provide competitive health benefits for eligible plan members – let alone ineligible ones. Family dynamics are changing – the traditional family unit is becoming less common and single-parent and “blended” families are more prevalent. Whether intentional or not, employees often enroll plan members that are not eligible.

An Eligibility Audit will provide a method to identify dependents and spouses that should not be covered under your health care plan. By removing these ineligible dependents, clients save thousands of dollars each year. Additionally, it’s a company’s fiduciary responsibility to administer the plan according to plan documents and only provide benefits for those who are eligible.

Why Us?

We provide an employer with experienced representatives who will ensure that a professional, thorough and complete audit is performed. We pride ourselves in working with employers to create a tailored audit that will clearly be respectful of employees. Your audit will be professionally and efficiently managed in all phases of the project — planning, execution and results. Our representatives provide superior customer service and are supported by a comprehensive guide that provides uniformity in verifying documentation and determining the eligibility of dependents and spouses.

All communications are recorded on our proprietary tracking system, which assures consistency and accuracy in working with employees, generates daily status reports and summarizes end-of-project information. We also offer the unique service of outbound calling to those who provide incomplete information or do not respond to mailed requests, improving the participation number and ensuring a more complete audit.

With integrated consulting throughout the process, we offer a smooth Eligibility Audit that values our client’s time and employee relations.

>>> Dependent Eligibility Audit – Frequently Asked Questions