SOLUTIONS PORTFOLIO

For benefits administrators, the message is clear: You should closely evaluate the cost-benefit relationship of your current enrollment processes. An audit is an effective cost- measurement technique. The cost side of the equation varies by employer but represents a risk to the preservation of plan assets and may needlessly reduce the plan sponsor's operating results. Many employers should also consider fiduciary liability and the tax implications of pre-tax premiums attributable to ineligible dependents:

>> ERISA/Exclusive Benefit Rule: health plan dollars must be used for eligible expenses. The primary responsibility of fiduciaries is to run the plan solely in the interest of participants and eligible beneficiaries and for the exclusive purpose of providing benefits and paying plan expenses for those eligible individuals. There can be personal liability issues for a benefit’s supervisor who knowingly pays claims for ineligible dependents.

 

>> Section 125 Pre-Tax Contributions: The IRS allows pre-tax treatment for employee contributions for qualified cafeteria plans and beneficiaries, only. Allowing pre-tax deductions for unqualified dependents/beneficiaries could set-up a liability.

 

>> Sarbanes-Oxley Compliance (Public Companies): A company’s management must assess and report the effectiveness of its internal controls over financial reporting. An external auditor must also attest to the accuracy of the company’s assertions and shortcomings must be reported. When ineligible dependents are covered on the corporate health plan and claims are paid under a benefit plan, a shortcoming exists. Management must report it and the financial burden caused by the ineligible dependents.

Benefits professionals are struggling to contain costs in today's labor market, and fiduciaries face a new kind of challenge. It's also important to note that employee feedback is encouraging. Most realize a greater appreciation of their health benefits as a result of the audit process. Not unlike popular consumer-directed initiatives, an audit is a means by which employees come to understand a fiscally sound health plan in today's labor market. As our clients' most valuable assets, their employees need a supportive and informative process. A well-designed eligibility audit is a very effective technique to achieve these objectives.

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Superior Service to Every Client

• >> Plan-Smart™ technology enables our staff to answer questions and respond to issues more expediently and efficiently than our competitors.
• >> Web-based client home page provides real-time views into status of project, upcoming tasks and outcomes to date.
• >> Participative process projects the employers intended message and culture
• >> HRAdvance ownership of the entire employee support process minimizes stress and workload on the Benefits and HR department.

Superior Support for your Employees

• >> Call Center staffed with supportive, bilingual representatives.
• >> Unmatched levels of support, including referrals to document sources through Plan-Smart’s exclusive database of issuing authorities.
• >> Online status and email capabilities ensure employee convenience.
• >> HRAdvance ownership of the entire employee support process assures consistency for every employee.

Service Based Architecture and Process Design

• >> Plan-Smart™ technology affords comprehensive service through a single interface
• >> Collaborative solution promotes the client’s culture and sponsorship as well as employee investment in fiscal wellness of the health plan.
• >> Access to real-time reports 24/7 empowers HR / Benefits staff
• >> Collaborative approach assures each client can project their culture throughout the process

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Communication:

1. Our process begins with a positive, customized introduction to the audit process and solicitation of necessary documentation.
2. Our solution is designed with the flexibility to match your company culture.
3. Each client controls timelines, customized letter content, FAQs and response deadlines

Service:

1. Our Culture of outstanding service is most evident in our employee focused customer service representatives.
2. Transparent technology solutions ensure you can see everything we do throughout a manageable process.
3. Our goal is to deliver the best possible experience and outcome for your company and each of your employees.

Technology:

1. The provisions of your SPD(s) control the evaluation of your dependent eligibility audit.
2. Business driven rules ensure the process, required documentation, and escalation rules.
3. Verification documents are scanned and entered into Plan-Smart's system, this process ensures a consistent and objective assessment.

Reporting:

1. Each client has access to a web-based utility to design and monitor the audit process over the life of the program.
2. Your employees will have access to a custom designed web portal, which allows them access to their audit status, ability to ask questions or request information and update personal data.
3. You have complete control from beginning to end without the burden of clerical tasks.

Plan-Smart examines 100% of your entire enrolled dependent population. Questionnaires, surveys and sampling tactics produce only a modest fraction of the possible results, and subject the plan to discrimination allegations. Only a complete audit, as compared to a statistical sampling, can ensure maximum return on investment while treating all employees equitably.

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Our goal with Plan-Guard™ is simple: provide maximum return with minimum headaches for our clients, while ensuring that each participant is treated in a fair and helpful manner.

Plan-Guard™ ensures that ineligible dependents will never get on your group health plans and incur claims that are fraudulent and present a liability and fiduciary infraction on the part of the plan sponsor.

Plan-Guard™ Services

• >> Audit frequency and requirements defined by plan provisions, waiting periods, customized to each client’s needs.
• >> Gatekeeper services following a comprehensive dependent eligibility audit; or
• >> Audit specific populations (i.e. new hires, self-insured plans, students, etc.)
• >> Document carry forward from audit to audit minimizes employee burden when spouse or student status is re-verified every 2-3 years.

Importance of Gatekeeper Services:

• >> Plan-Guard™ eliminates the need to do a full-blown comprehensive audit every few years. If preventive measures are not incorporated following a comprehensive dependent eligibility audit project, most employers will be back in the same situation in 2-3 years and run the risk of covering 5%-10% ineligible dependent participation.
• >> Avoid fiduciary exposure and liability covering ineligible dependents on the corporate health plan
  (ERISA Exclusive Benefit Rule, Section 125, Sarbanes-Oxley)
• >> Everyone pays for fraud: Plan Sponsor-Employees-Carriers-Reinsurance Vendors, eliminating ineligible participants keeps you from ever paying out claim dollars for dependents that do not belong on your health plans.
  

Our Process

The Plan-Smart™ implementation and project process is designed to create a tailored solution without requiring our clients to invest much of their own time. We collect your information, including desired timelines, plan designs, and overall project tone to create a solution that will maximize your benefits while reflecting your internal company culture.

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Employer health costs continue to rise and today’s market conditions demand that organizations and their health plans identify and realize every cost containment opportunity available. Health insurance expenses are the fastest growing cost component that employers face. Statistics have shown that companies today are providing coverage to 5% - 15% of their dependent population who are ineligible. A dependent eligibility audit provides a compelling economic story and helps preserve the integrity of your corporate health plans.

Use the ROI Calculator to determine how much your company may be spending to cover ineligible dependents and what your potential and immediate savings are. Contact us today for a custom quote and savings analysis tailored to meet your specific needs. There is no charge to review your current plan participation and expenditures to see if a dependent eligibility audit is right for your company.

Dependent Eligibility ROI Calculator Plan-Smart ROI Calculator

How much are you spending to cover ineligible dependents? HRAdvance has hundreds of clients that have utilized our dependent eligibility audit services and our average project results yield 11% ineligible, which has saved our clients more than $125M in first year savings.

Try HRAdvance's Plan-Smart™ ROI calculator and determine how much you can start saving today.