Dependent Eligibility Verification: Optimize Your Benefits, Control Costs

We recognize the challenges associated with delivering high-quality benefits programs in a financially sustainable manner. It is important to note that significant cost savings can be achieved through effective member eligibility practices. By conducting a Dependent Eligibility Verification (DEV) Audit, along with ongoing maintenance, organizations can realize these savings, thereby reducing overall expenses while continuing to offer competitive benefits that support talent attraction and retention.

What is a Dependent Eligibility Verification (DEV) Audit?

A DEV audit is a systematic review of all dependents on your employer-sponsored or Taft-Hartley benefits plan.

• Purpose: To confirm each dependent meets eligibility requirements, ensuring only qualified individuals receive coverage.
• Benefit: Prevents unnecessary plan and claims expenses by removing ineligible dependents (e.g., ex-spouses, over-age children, non-qualifying relationships).

Key Benefits for Your Organization

• Significant Cost Savings: On average, organizations recover 3% to 10% of total healthcare spending.
• Enhanced Compliance: Meet ERISA and other regulatory requirements.
• Reduced Fraud & Waste: Identify and eliminate coverage for ineligible individuals.
• Fairness for Employees: Prevents higher premiums for eligible participants due to others' ineligibility.
• Sustainable Benefits: Promotes the long-term viability and affordability of your plan.

Common Reasons Dependents Become Ineligible

Understanding why dependents may no longer qualify is crucial. Common scenarios include:

• Divorce or Separation: Ex-spouses may remain on plans after coverage should have ended.
• Employment Changes: Spouses who gain their own employer-sponsored benefits may no longer qualify under your plan's spousal carve-out rules.
• Non-Qualifying Relationships: Employees might mistakenly enroll individuals who do not meet the plan’s definition of an eligible dependent (e.g., nieces, nephews, other relatives).
• Lack of Documentation: Necessary legal documents (like marriage or birth certificates) may be missing or insufficient to prove dependent status.
• Aging Out: Most plans cease coverage for children after age 26, unless otherwise qualified.

Recommended Audit Frequency

• Regular Audits: Conduct a comprehensive audit every three to five years.
• Continuous Monitoring: Implement ongoing verification processes to maintain accurate records.

The AP Advantage: How We Make It Easy

As part of our commitment to bring new ideas and cost-saving employee benefits solutions to our clients, we align ourselves with highly specialized, strategic partners. Our commitment to your long-term success is our top priority and as part of this service you can expect proven results, expert management, employee-centric approaches, and transparent reporting.
Is It Time For Your Audit?

If your organization has never conducted a dependent audit, or if it's been more than three years since your last one, now is the time to secure your plan and realize significant savings.

Contact your AssuredPartners account team for more information on dependent audit verifications or to learn more about our Part D Advisor partners at Accretive.