Dependent Eligibility Audit

Eligibility Rules for Dependents

While each company determines who is eligible for coverage under its health plan, mistakes happen with regularity. Eligibility rules can be confusing, particularly when it comes to children. Even employers who consider themselves diligent record keepers can find errors in their documentation in this arena.

We have found ineligible dependents usually fall into one of the following categories:

• Ex-spouses with court-ordered health coverage
• Common-law spouses
• Step-children, foster children or married children
• Students not enrolled in an accredited educational institution
• Full-time students older than the maximum age allowed in health plan eligibility requirements
• Friends or other relatives
• Domestic partners (when they are not covered by a health plan)

In addition, we want to ensure that your health plan is not the primary payer for employees’ spouses who are covered under another health plan.