Considerations for Defining Eligibility
A thorough understanding of dependent types and eligibility guidelines as explained in your healthcare Summary Plan Description (SPD) is necessary to begin the dependent verification process. To insure consistency and accuracy in the validation of plan participant dependents, relationship types and eligibility guidelines must be explained clearly to your audit population. The SPD will outline those dependents eligible for coverage by your company’s plan.
In defining eligibility, you will also need to consider whether any of your plans are fully insured, as these plans must be administered in accordance with specific state and/or federal regulations as they apply to common law marriage, domestic partnerships, and student eligibility.
According to the Congressional Budget Office (CBO), roughly 150 million people are covered by employer-based health care coverage. This means, you will also need to decide how your company will address the new Healthcare Reform within your employee population.
