When ineligible dependents are added onto a company’s healthcare policy, not only does it cost the employer, it also costs every person who benefits from the coverage. Up to 10% of an employer’s healthcare costs may be going towards people who are ineligible for medical coverage per plan rules. That’s money that could be used to maximize coverage for everyone who is supposed to be on the plan.
Benefit System Abuse: Employees may have ineligible dependents on their plan for a number of reasons. It’s estimated that approximately 1/3 of cases of ineligibility involve employees who know they’re breaking the rules, but have a loved one who requires significant, costly health care and couldn’t otherwise afford it. The remaining instances involving ineligibility often occur because employees simply aren’t aware of the eligibility rules or have experienced a change, such as a divorce, and haven’t updated their plan yet. No matter the reason, Verifi1 helps determine what’s going on in your organization so that you can correct course.
Risk Mitigation: During a typical initial dependent eligibility verification, Verifi1 finds an average of 3-8% ineligible dependents— and when conducting ongoing verification, that percentage can reach up to 17%. The cost to provide coverage for these ineligible dependents adds up quickly, especially for companies that have an experience-rated policy. One large claim from an ineligible dependent could destroy the whole company’s insurability.
Cost Containment: In conducting an initial dependent eligibility verification for a 10,000-person employer, we estimate that we’ll uncover approximately 700-800 ineligible dependents. Removing these dependents, who each cost their employer an average of $4,000 in healthcare expenses per year, will save the employer approximately $3 million yearly. How’s that for a cost containment solution?
Performance Guarantee: We’re so confident that our verification findings will save employers money that we offer a performance guarantee. If the cost of the dependent eligibility verification exceeds the amount of money that we’re able to save employers, we’ll make up the difference—no questions asked.