Eligibility Verification Services

Our dependent eligibility audit services help employers meet their fiduciary responsibility and compliance obligations to cover only eligible individuals.
The Importance of Dependent Eligibility Audits

Statistics show that as many as 15% of spouses and dependents covered under employers’ health plans are ineligible for that coverage. These individuals cost employers millions of dollars each year and contribute significantly to the rising costs of health insurance.

Employers need help identifying ineligible individuals for removal from the employer’s health plan – that’s where our eligibility verification services come in.

Also known as "dependent eligibility audits," our eligibility verification services make it easy for employers to meet their fiduciary responsibilities and compliance obligations:

  • The Employee Retirement Income Security Act (ERISA) contains an “exclusive benefit” rule that stipulates only eligible individuals may receive benefits. Corporate officers and senior management can be held personally liable for failures to comply with this rule.
  • The Sarbanes-Oxley Act prohibits the “unauthorized disposition” of company resources, which includes providing coverage for ineligible individuals.

Allowing ineligible individuals to remain covered under the employer’s health plan is not just a compliance concern – it can be a huge financial issue as well, resulting in increased costs both now and in the future. That’s because the employer is contributing to the cost of coverage for these individuals now, and their collective claims experience contributes to rising premiums in the future.

Performing eligibility audits can help put an end to covering ineligible individuals while saving the employer significant money. Depending on how much an employer contributes towards the cost of coverage for dependents, an eligibility audit can result in savings as high as 8% of total plan expenses. For some employers, that means savings of hundreds of thousands - or even millions - of dollars.

"We engaged UnifyHR for their eligibility verification services. From the beginning, they were very thorough with the project timeline and expectations. We always felt well informed about what was going on with the project and what was being communicated to our employees when they contacted UnifyHR customer service. They provided guidance and client access to reports that allowed us to complete our verification with full confidence that all documentation was reviewed correctly."

We're Leading the Change in Eligibility Verification Services

CUSTOMIZABLE ATTRIBUTES

Our proprietary application gives us the flexibility to support client-specific audit parameters and verification sets so we can meet even the most complicated business requirements.

RESPONSIVE DESIGN

We optimized our website for viewing on all devices, including computers, phones, and tablets. Web pages automatically resize and reflow to accommodate an employee’s chosen device, improving ease of use and increasing engagement.

EVENT-BASED VERIFICATION WINDOWS

We can proactively trigger single, multiple, or concurrent audits based on events like new hires and life status changes, or based on client defined rules such as full or partial populations or division-specific audits, etc.

PROVEN SOLUTION

As one of the originators of dependent eligibility audit services, our deep experience helps employers save money while meeting their compliance obligations.

EMPLOYEE FOCUSED

Our engagement strategy and fully customizable employee communications help minimize employee disruption and turns employees into advocates for protecting your health plan.

MANAGEMENT DASHBOARDS

Real-time audit results, including individual employee status, provide complete transparency throughout the project.

Service Features

STRATEGY AND PLANNING

Define desired results
Identify cultural requirements
Develop project plan
Review plan documents and SPDs
Configure audit business rules

COMMUNICATIONS

Clear and concise strategy
Fully customizable communications
Crafted to match company culture
Six standard letters to employees
Optimized release schedule

EMPLOYEE TOOLS AND SUPPORT

Simplified document submission
Mobile device uploads
Customer care support
Online account access

EMPLOYER REPORTING

Summary and detail reporting
Eligibility determination and change report
Returned mail communication
Vendor eligibility updates
Document disposal

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