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Dependant audits elicit growls from protective mama bear

By Kelley M Butler
March 1, 2008

I fully admit, my "mama bear" instinct is running pretty high these days. Just weeks away from giving birth to my second child, I am feeling extremely protective of not only my children, but all children.

So perhaps that's why Associate Editor Chris Silva's article, "Removing children from the rolls: Dependant audits increase as employers seek to control costs," struck such an emotional chord, and seems to speak to what's wrong with our health care system.

"Audits have taken off in the last 18 months as health care costs have gone up and as boutique firms have come into business specializing in this," Susan Johnson, senior consultant with Watson Wyatt, told Silva. She estimates that employers remove an average of 8% to 12% of dependants after conducting an audit, of which 60% to 70% are children.

The growth understandably is being fueled by cash-strapped employers, trying everything they can think of to stem the tidal wave of rising health care costs. Mark Rucci, senior vice president with Gallagher Benefit Services in Princeton, N.J., estimates that one dependant costs an employer $2,500 a year, so an audit that removes between 8% and 12% of ineligible dependants could yield significant savings.

While I understand there are some workers who are genuinely cheating the system and can empathize with employers' financial plight, it just doesn't seem right to ask equally cash-strapped employees - most of whom are only trying to provide health coverage for their families amid rising costs - to prove their children exist and/or somehow certify their eligibility for care.

I can recall a situation with a close friend who opted to take a break from attending college full-time to get treatment for depression. Once she was no longer a full-time student, however, her health benefits ceased - right when she needed them most.

When I graduated college, I knew I needed to hurry up and find a job because, similarly, the health benefits I had through my mother ran out shortly after I walked across the stage. Although I was able to find work quickly, my benefits did not kick in for three months, leaving me uninsured for 90 nerve-wracking days.

It isn't just older children affected by insurance eligibility issues. When my son was born almost three years ago, my husband and I were told our son's hospitalization, several newborn exams and other birth expenses were not covered - even though we both had health insurance.

Turns out, each of our insurance companies thought the other should cover our son, and as a result he was covered by neither. It was months before the issue was successfully straightened out.

While I don't mean to demonize employers, I wonder if it makes moral sense to join health insurers in removing children and other dependants from insurance rolls. I know it makes perfect financial sense.

I'm interested in hearing from you on this topic, particularly those who have undergone such an audit.

Did you waver at all on whether it was the right thing to do? How did employees react at having to document their children? How did you respond to them? How much did you save, and was it worth the price you paid - in dollars and employee goodwill?

If you haven't opted to conduct a dependant audit, is the chance to save $2,500 per ineligible dependant found enough to sway you?

Please let me know what you think. I promise to keep my mama bear instinct in check and hear you out. Make comments online at ebn.benefitnews.com, or send them to kelley.butler@sourcemedia.com.

To hear more discussion on this topic, download a "Five Minutes With ..." podcast with Mark Rucci of Gallagher Benefit Services, available at http://ebn.podhoster.com. As always, send queries, letters and story ideas to Editor-in-Chief Kelley Butler at kelley.butler@sourcemedia.com.

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