As employers roll out their 2016 benefits programs, it’s important to fully account for all of the risks inherent in the process. With a large volume of new, unverified dependents being added to plans during open enrollment, an inclusive mechanism for eligibility verification will be central to a plan’s ability to contain costs and mitigate risk. This will not only eliminate wasteful spending, but it will also protect against the nightmare scenario of a catastrophic claim being denied by your stop-loss carrier.
Post-open enrollment audits come in a variety of forms, from a limited scope verification that focuses solely on the newly added dependents, to a complete verification of all dependents on the plan. Some employers, especially those with a working spouse rule, leverage post open enrollment audits to verify the eligibility of all spouses enrolled on the plan. Given the high divorce rate, not to mention the high utilization cost of spouses, we recommend a complete spouse re-review every 18-24 months. A mechanism built into open enrollment, or an audit immediately following open enrollment, is highly encouraged and will likely yield significant risk mitigation and cost containment for employer-sponsored health plans.