January 20, 2011

 

Pilot Dependent Eligibility Audit to Be Conducted

In today's challenging economy, employers of all sizes are striving to curb the rising cost of providing health insurance for their employees. For this reason, it is critically important that the premiums your small group clients pay and the dollars EmblemHealth spends on benefits are for those who are eligible to receive them, as defined by EmblemHealth's benefits plans' guidelines and contract.

The small group community-rated contract allows for EmblemHealth to obtain and verify proof of eligibility. To this end, we are conducting a pilot dependent eligibility audit in partnership with HR Best Practices that focuses on GHI-underwritten, small group, community-rated products. Subscribers selected for review began receiving letters the first week of January 2011. Subscribers are responsible to confirm the eligibility of their dependents, such as spouses and children, currently insured under their coverage. These subscribers are being requested to provide documentation of their enrolled dependents by completing the following steps:

  1. Completing and signing the Dependent Confirmation Form included with the mailing, removing any ineligible dependents.
  2. Collecting unaltered copies of official documents that support proof of dependency for each listed dependent.
  3. Completing the Proof Checklist Form included with the mailing.
  4. Mailing all of the above to the following address:
    HR Best Practices
    c/o EmblemHealth Dependent Audit
    601 Hamburg Turnpike - Suite 303
    Wayne, NJ 07470

Alternatively, subscribers may respond via secure fax to 1-877-687-8712 or by e-mail to DepAudit@HRBestPractices.com.

Click here to see samples of the letter and forms we are sending to subscribers.

By conducting this pilot audit and potentially removing ineligible dependents, we hope to reduce the incidence of dollars spent on medical care for ineligible recipients and, in the process, help control small group health insurance costs.

We look forward to continuing to work closely with you to best serve our customers and your clients. If you have questions, please contact your EmblemHealth representative.

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