Human Resources answers your questions about dependent eligibility audit Patricia Sirek June 21, 2010 Several UST employees have contacted the Human Resources Department with questions about the university’s dependent eligibility verification audit now under way. Employees who have spouses or dependents covered on their St. Thomas health insurance plans should recently have received a packet of audit materials at their homes. Here are answers to the most commonly asked questions received about the audit to date. If you have others, feel free to call Human Resources, (651) 962-6150 Why is a dependent eligibility audit necessary? There are several reasons a dependent audit at St. Thomas is necessary: First, it’s a fiscally responsible thing to do and will help the university control costs. The St. Thomas health care plan is self-insured, which means the university pays all medical claims of covered employees and dependents up to $100,000 per claim. Beyond this amount, the university’s medical Stop-Loss Insurance pays the remaining expenses. St. Thomas’ labor and benefits costs represent 70 percent of its operating budget. This percentage continues to creep each year. Ineligible dependents covered by St. Thomas’ health plan add significant, unnecessary costs to the plan each year. All plan subscribers feel the weight of these unnecessary costs through increases in their monthly premiums. Premiums are determined by the yearly and multiyear claims experience of the university’s health care plan. St. Thomas is legally obligated to ensure that all employees and dependents covered by its health care plan are eligible to receive coverage. Therefore, the goal of the audit is to verify and remove from coverage all ineligible dependents from the St. Thomas health care plan and reduce the university’s exposure to greater health care costs. What is the likelihood that the St. Thomas health care plan currently covers ineligible dependents? Industry statistics indicate that audits typically reveal between 5 to 12 percent of all covered spouses and dependents are actually ineligible for coverage. The average cost of a dependent on a typical health plan is $3,000 per year. Last year, St. Thomas provided health care coverage for 1,200 spouses and dependent children of employees, and the average annual claim was $4,100. Even if the audit reveals relatively few dependents ineligible for coverage, cost savings are likely to be significant. When will the audit be completed? The projected audit completion date is Sept. 30. I am uncomfortable providing ContinuousHealth LLC, the vendor performing the audit, with my personal information. How can I be sure my privacy will be protected? Continuous Health will preserve the privacy of employees and meet all federal privacy requirements. All interactions between you and ContinuousHealth can take place through its secure Web portal. Employees may “black out” sensitive information, e.g., Social Security numbers, tax IDs, etc., on copies of the documents that ContinuousHealth requests. What are my options if I cannot obtain one of the documents Continuous Health has requested within the timeframe allotted? Employees can contact Kelly Hudson, director of operations for ContinuousHealth, at (678) 736-6884; send a fax to (678) 397-0077 , or visit the ContinuousHealth website. Hudson or another vendor representative will assist you promptly. What happens if I don’t furnish ContinuousHealth with requested documentation during the dependent eligibility audit process? If you do not provide the required documentation to verify the eligibility of your spouse and/or dependent child(ren), they will lose their St. Thomas health care coverage on Oct. 1. If I’m notified that the health care coverage for my spouse and/or dependent child(ren) will be terminated, what are my options? If you are notified that your spouse and/or dependents are ineligible, you also will be informed of the appeal process. An employee may appeal the decision if he/she complied with the audit and provided proof of his/her spouse’s and/or dependent(s)’ eligibility by submitting the required documentation to ContinuousHealth Inc. ContinuousHealth will provide details, procedures and deadlines of the appeal process at the time of notification of ineligibility. If an employee appeals the audit finding, a spouse and/or dependents will remain eligible. If the appeal examination upholds the determination of ineligibility, the employee will be liable for all medical expenses incurred by ineligible dependents that St. Thomas paid during the appeal process. What are the options for continuing coverage for ineligible dependents? ContinuousHealth will provide an employee with information about affordable alternative insurance coverage for an ineligible spouse or dependent child(ren). Termination of an ineligible dependent who was not eligible for coverage is not considered a COBRA Qualifying Event. Please contact the Human Resources Department, (651) 962-6510, for additional information. Where can I obtain additional information about the dependent eligibility verification audit? Please begin with Human Resources, (651) 962-6510.