MEET PENNY - BENEFITS MANAGER
HER BIGGEST FEAR CAME TRUE!
$243,568 IN CLAIMS FOR AN INELIGIBLE SPOUSE
PENNY’S STORY
As Benefits Manager for a large technology company, Penny had all the bases covered when it came to managing dependent eligibility.
She published the rules. She issued newsletter reminders. She asked employees to verify their relationships during open enrollment. She was on top of it.
But something was nagging at her. Was she missing anything important? To find out, Penny asked us to conduct a dependent audit using our Expert Audit system.
PENNY’S BIG SURPRISE!
On day one of our audit, Robert, a 25-year employee, completed his online affidavit, and selected his current marital status from our menu of 10 potential categories. We called Penny immediately to tell her that Robert came up “ineligible” because he had a common law spouse. There was a long silence. Then we heard her typing furiously. “OH NO!!” she gasped. “His spouse has had $243,568 in claims over the years, and we’ve never covered common law spouses!! How did we miss that?”
HE THOUGHT HE WAS ALL GOOD!
When she questioned Robert about it, he said, “Well, every year, you just asked me if I was single or married. I told you I was married. I didn’t know common law spouses were not eligible!” But Robert was NOT trying to cheat the plan at all. He just didn’t know the rules. And he wasn’t asked the drill-down questions that would uncover his exact marital relationship. Until the Expert Audit.Robert was caught in the wide Expert Audit net, and his common law wife was immediately removed from the plan.
PENNY’S EXPERIENCE WITH EXPERT AUDIT
“Everyone appreciates the financial rewards of a successful dependent eligibility audit,” Penny declared. “Significant plan savings. Reduced health costs. Outstanding ROI. But there’s more…”
“With Expert Audit, I didn’t have to worry about missing something important. They put our plan under the eligibility microscope—and delivered a deep-dive service that was meticulous and all-encompassing. That 'Robert' situation won’t happen to me again. What a relief!”
