Client Case Study

Benefit Cost Control

$1.5 million saved

• Profile: Manufacturing Company
  • 7,000 Dependents
  • $35 Million in health & welfare premiums
  • 14 Carriers
  • Funding Type: Self-funded
• Challenges
  • Explaining the lax enforcement in the past
  • Merger and acquisition activity caused inconsistent protocol of dependent eligibility verification
  • No amnesty period was provided
• Strategy
  • Align Plan Documents with administrative procedures
  • Realize cost savings by removing ineligible dependents from plans
  • Address Sarbanes-Oxley concerns
  • Increase accuracy of enrollment data
  • Implement protocol for future enforcement
  • Develop and distribute communication documents requesting proof of eligibility such as: full-time student status, domestic partner, Incapacitated child
  • Establish a help desk to address employee questions pertaining to the instructions audit instructions
  • Communicated ineligible records to carriers and employees
• Results
  • Process supported by required audit controls
  • Updated current enrollment data
  • Savings of $1.5 million
  • Eliminated future financial exposure
  • Established proactive and ongoing protocols to proactively manage and enforce dependent eligibility rules outlined in an “Enrollment and Administration Workflow”