Stop Loss Claim Nightmare

Busy Jill – She Had 18 Children In Less Than 10 Years

Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….

There are many dependent audit companies in the market ready to help plan sponsors identify those members who are ineligible for health insurance benefits. We did a quick search on the internet and the first one to pop up was Everything Benefits:

SOURCE: www.everythingbenefits.com/

According to benefits experts, as many as 12% of enrolled dependents may not be eligible to receive benefits. Our automated solution makes the auditing process seamless and secure. We handle every detail, from employee notifications, to securely collecting and reviewing the information and keeping you informed with real-time status updates.

Our Dependent Eligibility Audit

Solution

  • Our automated solution keeps you compliant, eliminates liability and reduces benefits expenses by as much as 3-10%
  • Fully automated and configurable workflows that ensure a fair and equitable process for all participants on your plan
  • Secure document upload functionality ensures sensitive documents such as marriage or birth certificates and other legal documents are protected at all times
  • Notification templates make communications simple and clear during every stage of the audit
  • Gives you access to industry experts and compliance specialists in the U.S.

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