Dependent Eligibility Audit
#1 reason for stop-loss claims denial is ineligible dependents, impacting the plan's bottom line.
An employer spends an average of $4,500 to $7,000 per dependent on their health benefits per year. Our audit helps employers save that much per ineligible dependent per year. Our best-in-class technology meets your employees where they are, employees can complete their dependent eligibility audit requirements through their smartphones, tablets, computers, or our call center in under 5 minutes. It’s that easy!
Your Challenge
Handling eligibility for your dependents can be a taxing and time-intensive process. Errors or inefficiencies can further strain already busy HR teams. Retaining ineligible dependents on your plan not only poses compliance issues but can also result in elevated premium costs for you and your members.
Our Solution
Our Dependent Eligibility Audit is a meticulous examination of the eligibility within the summary plan description designed to ensure that enrolled spouses and children are truly eligible for continuing coverage.
We offer three types of dependent eligibility audits to identify ineligible dependents, helping you stay compliant with not only the plan’s requirements but also federal and state regulations.
Our mobile-enhanced collection with text confirmation makes it easier for members to complete an audit. That means a shorter timeline and improved savings potential.
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The online affidavit can be completed in less than 5 minutes, right from the member’s phone.
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Personal verification document requirements are instantly viewable.
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Text confirmation alerts notify of missing or completed verifications.
Why Choose Us?
We deliver more informed eligibility rulings, analytics for better HR decisions, the most truthful employee responses, the highest dependent information accuracy, and the best overall financial results. You win because we are significantly different than other dependent eligibility audit firms. Our audits are more than simply an “identify and report” dependent eligibility verification system. It improves the effectiveness of your eligibility policies, risk management processes, health plan controls, and more. The outcome of our program for you is a tight, clean, consistent, disciplined eligibility operation – the hallmark of a well-run, high-quality health plan.
Key differentiators of Our Dependent Eligibility Audits:
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Built-in rules engine for SPD criteria
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Data integrity and validation process
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Empathetic, directive communications
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Easy-to-use online affidavit
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Electronic data capture system
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Information matching (affidavit vs. documents)
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Status notifications and alerts
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Employee progress displays.
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High-tech, high-touch call center
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Employee experience and engagement
Let our audit experts handle the process from start to finish, letting you maintain focus on your core competencies while achieving the overall best results - with no delays, no mistakes, no surprises, and no hassles.
Leverage Our Expertise Today!
Transform your benefits strategy. Empower your clients. Amplify your results. Discover tailored solutions for Brokers and TPAs in the self-funded arena.
Amwins Health & Employee Benefits Consulting has the solutions to help you gain and retain clients.
