Participant Data
During a Dependent Audit, some of the most sensitive employee data is gathered and processed. This data may include: birth certificates, divorce decrees, tax forms, marriage licenses and more. When considering a Dependent Eligibility Audit, it is important to make sure that you (or your vendor) have the proper controls and processes in place to protect your employee’s data.
A data file of your audit participants should be compiled, reviewed, and tested during the program planning process. This file should include elements that will allow you to communicate with the appropriate employees , track program responses, and report results. Consider the following data fields for inclusion in your program data file:
- Employee Name (only those with dependents)
- Unique Employee Identifier– this can be used to link employees and dependents. As this number is included on program communications for reference, the employee’s social security number should not be used.
- Employee Date of Birth
- Employee Address
- Employee Plan Type– is necessary if there are multiple plans with varying eligibility requirements and if reports by plan type will be used
- Employee Status– will identify an employee’s respective population (active, retired, COBRA)
- Plan Enrolled Indicator– will identify which products their dependents are receiving (i.e. Medical, Dental, Vision, and Life Insurance)
- Unique Dependent Identifier- this field can be helpful if multiple files are used to identify various product types to ensure that each dependent is accurately listed with the appropriate products
- Dependent Name
- Dependent Relationship
- Dependent Date of Birth
Special Considerations:
QMSCO: As your data is compiled, consider whether you have any dependents covered by a Qualified Medical Child Support Order (QMCSO) or a Qualified Domestic Relations Order (QDRO). These dependents should be referenced in communications to employees but must remain enrolled in the health benefit plans as directed by the court, regardless of the employee’s ability to provide documentation through the audit process.
Disabled Dependents: If you have an indicator for these dependents already in your data it will make identifying this particular population easier.
TIP:
Make sure your data is as organized as possible before generating your audit communications so, when you receive responses, the dependent status can be easily updated. This and allows for accuracy when determining who is an ineligible dependent.
