Did you know that on the typical employer’s medical plan, 6.2% of the covered dependents are ineligible for coverage due to divorce, custody issues and a host of other reasons?

 

Under National Healthcare Reform, does your organization want to spend $63 per covered dependent for the Transitional Reinsurance Fee when, on average, 6.2% of your dependents shouldn’t be covered in the first place?

 

If your plan is self-funded, what would happen if a large claim was denied by the stop-loss provider because the dependent is ineligible?

 

Next Generation Enrollment (NGE), an eligibility management company, wants to assist your organization in ensuring that the dependents insured on your benefit plans are truly eligible for coverage based on your plan language. Typically we audit medical, dental, and vision benefit plans for fully insured and self-funded groups.  Based on NGE’s auditing experience since 2007, 6.2% of covered dependents on any given plan will not meet eligibility criteria.

 

This is a service that truly works.  Not only will your organization save money but it will ensure that you comply with plan eligibility requirements, something that is very important to your insurance carriers and/or TPAs.  The service will also help ensure compliance with federal regulations like ERISA or Sarbanes-Oxley, if applicable. NGE has an extensive list of references that will support the effectiveness of a dependent eligibility audit. In fact, every client we have ever audited serves as a reference for our company.

 

 

Why NGE Should Be Your Vendor

 

  • Experienced – NGE is not a new player with Dependent Eligibility Audits. We conducted our first audit in 2007. Since then, we have completed audits for clients across the country and from almost every sector of the economy. With each audit, we have improved our process and approach making our program among the best in the nation.
  • Full Service, Comprehensive Audits – Nearly all of our audits are comprehensive or full audits. This means employees submit hard copy documentation to help substantiate their dependent’s eligibility – not a signature only, affidavit type audit. We audit all employees – not just a random sample of group population. We manage the entire process – HR departments invest minimal time and no third party agents gather data from employees.  NGE has experience with the other approaches for conducting the audits but experience has proven that the comprehensive audit yields the best results.
  • A Better Approach and Process – NGE approaches each audit in a very positive way. We treat your employees with great care and respect. Our process offers outreach to employees up to seven times to remind them and offer support. Connecting with your employees so many times helps us achieve very high participation rates and help build employee satisfaction.
  • Structure and Flexibility – NGE has a tested and structured process in place. This ensures that each step is completed on time and as planned. At the same time, we understand each employer has unique needs, concerns and challenges. NGE’s program is easily customized.
  • Communication Strategy – Clear and repeated communication is critical to a successful audit. NGE offers you a multi-faceted communication plan to achieve the highest level of savings without alienating your employees.  NGE can help you navigate through conversations with your leadership team, unions and employees.
  • Human Resource Department Friendly – Based on post-audit client surveys, we know that HR Departments invest minimal time with our audit.  We need your help mostly with pre-planning. After the start of the audit, NGE will only need to ask for HR involvement and assistance at strategic points.
Choosing NGE for Your Next Dependent Eligibility Audit

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