One of Every Four Employers Conducting Health Plan Eligibility Audits

According to the nonprofit International Foundation of Employee Benefit Plans, its recent survey finds that 26 percent of U.S. employers conduct eligibility audits for their health care plans to make sure that every person covered by the health plan is an approved dependent.

“Removing ineligible dependents from the plan can ultimately save the employer hundreds of thousands of dollars and, given the current economy, I expect the percentage of employers conducting eligibility audits to grow,” says Foundation spokesperson Julie Stich. “In the past, some employers may have hesitated to conduct an audit because of the possibility of their employees’ negative reactions. With the current financial situation, however, cost-saving will likely be the employers’ main concern.”

The survey reports that employers are working to keep their health care costs in check by utilizing a number of cost-management techniques, including cost-sharing provisions such as deductibles, coinsurance and co pays (74 percent), annual and/or lifetime maximum benefits limits (56 percent) and prior authorization (55 percent). Other less popular cost-management options include health care claims/utilization analysis (39 percent), health care claims audits (26 percent) and opt-out incentives (15 percent). Predictive modeling, a strategy that uses claims data and lifestyle analytics to identify potential catastrophic claims and disease states, is used by 12 percent of the survey respondents, according to the Foundation.