A healthcare plan audit program
to safeguard your plan assets
is a Best Practice

Statistics and Benefits of a Dependent Eligibility Audit


The Statistics

  • Studies show that on average 3{9f449642cc71d911bc0e73d66adeb5f70c1d0d8124487245c9d145ae7d5813d1} – 12{9f449642cc71d911bc0e73d66adeb5f70c1d0d8124487245c9d145ae7d5813d1} of plan participants are ineligible for coverage
  • On average, it costs a self-insured employer $6,500 per year to provide group health coverage to an employee. About half of that cost is attributable to spouses and children.
  • Eliminating ineligible participants results in significant cost savings through a reduction in annual premium and a reduction in claims expenses.
  • Example: a 5{9f449642cc71d911bc0e73d66adeb5f70c1d0d8124487245c9d145ae7d5813d1} elimination of participants in a 5,000 member group could yield over $625,000 in annual savings.


The Benefits

  • Reduce health care costs
  • Maintain the integrity of the plan
  • Reduce the risk of non-compliance
    Average savings of $2,500 – $5,000 per plan participant
  • By identifying and removing ineligible plan participants, Dependent Eligibility Audits save administrative costs, prevent filing of erroneous claims, prevent denials of large dollar claims, and improves the renewal process by ensuring that accurate demographic data is used to determine plan pricing.