Case Histories

The argument for eligibility verification

A dependent eligibility verification remains one of the fastest and most compelling strategies to obtain immediate savings and protect your health plan from unnecessary and fraudulent claim expenditures.

We've conducted more than 475 dependent eligibility audits with more than 3.8 million dependents verified. Our results to date have produced an average ROI of 2,400 percent and an average ineligible result of nearly 7 percent.

Case Study Assumptions

Pre-Health Care Reform results are based on our own audit results.
Cost per dependent spouse and dependent child is based on an average annual cost per employee at $5,124 per year. We assumed the same employee-only cost for the spouse and the cost-per-dependent-child at $2,050 per year, which is 40% of the employee-only figures. For post-Health Care reform we assumed health care costs increased by 10%.
For post-Health Care Reform, we assume all dependents over age 19 will be eligible under the new laws. This is a highly conservative figure, as we know not all dependents over age 19 would be eligible, even under the PPACA regulations.

Retail Company—63,000 Enrollees

Pre-Heath Care Reform		Post-Heath Care Reform
30,778	Employees Covering Dependents Subject to Audit	30,778
60,712	Dependents Subject to Audit	60,712
$2,849	Cost Per Dependent Per Year	$3,133
6,627	Ineligible Dependents	5,103
1,524	Ineligible Dependents Over Age 19	0
10.92%	Percentage of Dependents Found Ineligible	8.41%
$18,880,323	First-Year Savings	$14,538,447
2489%	First-Year Return on Investment	2061%

Health Care Organization—9,600 Enrollees

Pre-Heath Care Reform		Post-Heath Care Reform
5,572	Employees Covering Dependents Subject to Audit	5,572
11,800	Dependents Subject to Audit	11,800
$3,614	Cost Per Dependent Per Year	$3,975
1,323	Ineligible Dependents	1,173
150	Ineligible Dependents Over Age 19	0
11.21%	Percentage of Dependents Found Ineligible	9.94%
$4,781,322	First-Year Savings	$4,239,222
2378%	First-Year Return on Investment	2219%

County Government—3,814 Enrollees

Pre-Heath Care Reform		Post-Heath Care Reform
2,054	Employees Covering Dependents Subject to Audit	2,054
4,481	Dependents Subject to Audit	4,481
$3,160	Cost Per Dependent Per Year	$3,476
681	Ineligible Dependents	574
107	Ineligible Dependents Over Age 19	0
15.20%	Percentage of Dependents Found Ineligible	12.81%
$2,151,960	First-Year Savings	$1,813,840
2734%	First-Year Return on Investment	2446%