Do it Now: Verifying Dependent Eligibility

Enrollment. Members. Eligibility. The traditional open enrollment season for healthcare benefits is winding down just as the holiday season comes into full swing. Hearing the pithy wisdom of Ben Franklin at this time of year always either makes me smile, or roll my eyes: “Don’t put off until tomorrow what you can do today.”

While I don’t always agree with this particular gem, I think human resource professionals, internal auditors, and chief financial officers should take heed to this timeless message as it relates to enrollment.

Did you pick up any new enrollees this year? Chances are good that you did. The Affordable Care Act requires that you enroll new members into medical coverage within 90 days.

While you may choose to buck old Ben’s advice and not enroll your new members today, you should absolutely verify their dependents’ eligibility, and do it before you finalize medical enrollment.

This inexpensive, time-tested, and fundamentally practical step provides perpetual cost avoidance. It also sends a clear signal of ERISA and public trust compliance while simultaneously educating your members about the value of their benefits.

Traditional dependent verifications focusing on existing dependents are valuable, but are often time-consuming and could create some employee abrasion.

Examining eligibility at the point of initial enrollment or when a life event occurs allows for a streamlined, often automated process that integrates into the standard onboarding process. Much of this exercise is now completed electronically. It has become so simplified, members can complete it on their smartphones.

Given the solutions available today, coupled with the pressures to control healthcare costs, there is no reason for a self-insured employer to carry an ineligible dependent on its health plan. Never put off the decision to follow through on verifying eligible member enrollment on your health plan, as even one day can make a difference. Do it now.


John Webb is managing director of employer solutions for HMS.