5-15% of covered dependents are
typically found to be ineligible.

The average client has seen over $170,000
in projected annual savings after an
audit by Next Generation Enrollment.

Next Generation Enrollment wants to assist your organization in ensuring that the dependents covered on your medical plan are truly eligible per the wording in your plan documentation.

A simple, cost cutting solution that does not require plan changes or increased employee payroll deductions, is a Dependent Eligibility Audit. A Dependent Eligibility Audit allows for the verification of covered dependants and the removal of those that do not satisfy the eligibility definition in the medical plan summary description.

To read more about Next Generation Enrollment's CEO Bradley Taylor and NGE's focus on Dependent Eligibilty Audits, please click here to download a PDF.

Why Do a Dependent Eligibility Audit?

1. Reduce expenses on your Medical Plan without changing the plan design or employee contributions

2. Adhere to ERISA Fiduciary requirements, Sarbanes-Oxley, and Stop Loss Contracts

From the Mercer 2005 US National Employer-Sponsored Health Plans Survey study, it was determined that the average cost for a dependent covered under a medical plan is $1,584 per year. This statistic was calculated by surveying over 3,000 employer groups. It has also been determined that anywhere from 5% to 15% of a plan’s covered dependents are not eligible. By removing these dependents, a significant cost savings will be created.

Along with ERISA violations, there may be Sarbanes-Oxley concerns due to the financial significance of health plan costs. Paying benefits to ineligibles could increase your organization’s exposure. Stop Loss providers will audit large claims and if the claim pertains to an ineligible dependent, they will reject those claim payments.

If your company agrees that a Dependent Eligibility Audit and the ongoing tracking of employee enrollment information is critical to protecting the integrity and costs associated with your medical plan, Next Generation Enrollment presents a no-risk solution. We would love to assist your company by partnering to perform this audit.

Dependant Audit Case Study 1
• Metro Detroit Hospital
• Over 1,100 employees with 1,400 covered dependents
• 50 dependents removed at the end of the audit
• Total projected one year savings from removing these dependents was over $150,000

Dependant Audit Case Study 2
• Mid-Size Metropolitan Detroit School District
• Approximately 600 dependents
• 42 dependents eligible to be removed from the medical plan at the end of the audit
• Total projected one year savings from removing these dependents was over $150,000

Dependant Audit
Case Study 3
• Manufacturing Company
• Over 700 employees with 800 covered dependents
• 86 dependents eligible to be removed at the end of the audit
• Total projected one year savings from removing these dependents was over $250,000

For more information, please download PDFs of our Dependent Eligibility Audit Brochure.

Participant and Payroll Deduction Audit
Let us help you verify that the participants showing on your invoices should be covered and the payroll deduction amounts in your system accurately reflect the participant’s coverages for all benefit plans.

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