Dependent eligibility audits are commonly used by employer-sponsored health plans to verify that employees have enrolled only eligible dependents. Identifying ineligible dependents and removing them from coverage, either retroactively or prospectively, can reduce health plan costs and provide evidence of good plan management. In addition, employers that perform services for governmental agencies are often subject to expense audits that include review of health plan costs. If the employer cannot provide proof of dependent eligibility to the government auditors, the employer may find itself with a reduction in its reimbursement or subject to penalties for inaccurate claims.
There are no hard and fast rules for dependent eligibility audits, and employers and insurers can design an eligibility audit program in many ways—for example, audits can be done on a regular schedule or randomly; employees may or may not be given an amnesty period to remove ineligible dependents voluntarily; ineligible dependents can be removed from coverage prospectively as of a date set by the health plan or retroactively to the date of enrollment. But the health care reform law placed new limits on retroactive cancellation of coverage, which the law refers to as "rescission," and employers need to understand the new rescission rules in order to avoid triggering penalties. The new rules apply to grandfathered and non-grandfathered health plans, insured and self-funded plans, and impose notice and external review requirements. In addition, plans should review and many will need to revise their eligibility language to state eligibility rules as clearly as possible and to advise employees that enrolling ineligible dependents is prohibited and constitutes fraud or misrepresentation of material facts.
This program will address common dependent eligibility audit design issues and provide detail on the new health care reform limitations on retroactive cancellation of coverage.
Who Should Participate
Any HR or Benefits Professional with responsibility for health plan design, management, compliance, or cost control.
What You Will Learn
• Common designs for health plan eligibility audits, including documentation requirements, amnesty periods, timing, and coordination with insurance carriers or claims administrators
• What requirements the health care reform law imposes on retroactive cancellation of health plan coverage
• What plan language should be reviewed and how it should be revised to support retroactive cancellation of coverage
Do you have any comments that you would like to share about the value of this session?
Please help others considering viewing the archive understand the value of the session. How would you rate this presentation?
Are you becoming an industry expert? Each One Hour Webcast on HR.com is reviewed and can qualify for an Institute for Human Resources credit. The Institute for Human Resources Certification Program provides HR Professionals with an opportunity to specialize in one vertical or domain, making them an Industry Expert. Each of HR.com’s webcasts are reviewed and evaluated against the verticals/domains criteria, and one credit hour can be applied to the appropriate vertical or domain.
For more information regarding the IHR Certification Program, please click here or visit: http://www.hr.com/en/ihr_certifications/
Did you know that each one-hour webcast is submitted to qualify for HR Certification Institute recertification credits? The archive of the webcast also qualifies recertification credits, for one (in some cases two) year(s) after the original broadcast. You can get your PHR, SPHR, GPHR and credits all without ever leaving your desk. We know how busy today's successful HR professionals are, which is why we're committed to delivering the best education to you in an easy and entertaining format. For more information about certification or recertification, please visit the HR Certification Institute homepage at www.hrci.org "The use of this seal is not an endorsement by HR Certification Institute of the quality of the program. It means that this program has met HR Certification Institute’s criteria to be pre-approved for recertification credit."
WorldatWork Society of Certified Professionals. Recertification credit for this event applies to the Certified Compensation
Professional (CCP®), Certified Benefits Professional® (CBP), Global
Remuneration Professional (GRP®), Work-Life Certified Professional (WLCP®),
Certified Executive Compensation Professional (CECP™) and Certified Sales
Compensation Professional (CSCP™) designations granted by WorldatWork
Society of Certified Professionals.
Recertification credit for this event can be taken by entering it into your online
WorldatWork Society recertification application and entering the program date,
title and length. Please note that the CECP and CSCP designations require
a minimum number of credits from executive and sales compensation-related
activities. For more information on recertification, visit the WorldatWork Society
recertification webpage at www.worldatworksociety.org/recertification.