HRAdvance Plan-Guard Ongoing Dependent Eligibility Verification Outcome Data

Share Article

HRAdvance releases ongoing dependent verification audit results. Audits generate savings and preserve existing benefit levels in the face of inflationary pressures.

News Image
The message is pretty clear: employers need to stay alert. Do not rely solely on a comprehensive audit to

HRAdvance is committed to helping benefits professionals stay informed on the role of dependent eligibility verification in health plan cost containment. Ongoing eligibility verification encompasses enrollment activity from annual enrollment periods, new hires, life status changes and acquisition activity. Consistent with making our comprehensive audit outcomes available to the profession, we feel these ongoing service outcomes are also particularly relevant to benefit managers. Audits generate savings and preserve existing benefit levels in the face of inflationary pressures.

HRAdvance analyzed de-identified ongoing service data accumulated through 2009. The client data utilized in the study reflects customers utilizing ongoing verification services for an extended period of time, with at least one annual enrollment included. The twenty five (25) clients selected represent a spectrum of industries including healthcare, manufacturing, retail and telecommunications. HRAdvance provides gatekeeper services for some 50 clients with approximately 300,000 dependent covering employee lives.

Overall results reveal that 33.31% of newly enrolled dependents fail to meet plan eligibility requirements, with individual clients ranging from of 8.7% to over 50%. "Consistent with our comprehensive audit outcomes, client results are distributed in a bell curve, with a significant majority falling relatively close to the average" said Craig Firestone, President of HRAdvance.

The types of dependents being verified and found ineligible are also consistent with our comprehensive audit outcomes, namely spouses, children under 19 and college students failing to verify in similar proportions. "The highest ineligible percentages in the gatekeeper analysis are college age students, with over 60% not meeting plan specified requirements," stated Chris Heinefield, Senior Vice President of Operations for HRAdvance. He added, "This reinforces the idea that employers should re-evaluate their traditional, payor-based student screening process to remove ineligible dependents from their health plans. The traditional methods are too slow, too often initiated by claim activity, or are limited to employee attestation. The better practice is to identify these ineligible dependents more quickly, if not prevent inclusion in the eligibility rolls altogether."

The study also found that 27.8% of spouses enrolled were ineligible while 30.5% of children under 19 years of age failed to meet plan provisions. Approximately 13% of dependents in the study were previously subject to a HRAdvance comprehensive audit. A significant percentage of these, 62.5%, were once again found to be ineligible.

"Another interesting conclusion available from the data shows that outcomes are not materially different between the types of enrollment activity. For example, annual enrollment events detected 36.8% of dependents were ineligible, where new hire activity yielded 33.2% ineligible. Clearly, there is significant room for improving the effectiveness of benefit enrollment communications and related materials. We look forward to working with clients and their benefits consultants to improve the content of enrollment materials. There is room to make an impact and reduce these numbers," said Firestone.

"The message is pretty clear: employers need to stay alert. Do not rely solely on a comprehensive audit to "clean up" your eligibility and then take your eye off the ball. Comprehensive audit savings can erode more quickly than previously thought if effective controls are not put in place" concluded Firestone.

To learn more go to http://www.plan-guard.com/.

About HRAdvance:
HRAdvance was founded in 2004 with a narrow mission in mind: to provide HR and benefits professionals with best-in-class hosted solutions that can be deployed without capital expenditure or IT dependency. Its guiding principle is that employees are the most valuable asset of virtually every organization.

The company's core competency is its Plan-Smart™ and Plan-Guard™ dependent eligibility audit and verification services. With more than 170 clients that range in size from 500 to more than 100,000 employee lives, HRAdvance is the best in class dependent eligibility audit solution. Its management competencies and healthcare focus reflect over 150 years of combined experience in developing automated human resource, benefits, administrative and financial solutions for government, public and private organizations. Visit http://www.hradvance.com to learn more.

This press release was distributed through PR Web by Human Resources Marketer (HR Marketer: http://www.HRmarketer.com) on behalf of the company listed above.

###

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Braddon White
Visit website