Dependent Eligibility Review - Monday, June 30, 2008
The County of Riverside will be conducting a review of eligibility for dependents enrolled in County sponsored Medical, Dental and Vision insurance plans. This audit is being conducted to meet our fiduciary responsibility as a plan sponsor and to control costs for all county employees. The audit will verify that coverage is provided, and claims are paid for, only those individuals who meet our eligibility rules.
This audit benefits all County employees by assuring that our financial resources are spent appropriately. Claims paid on behalf of ineligible dependents are factored into our rates and create higher costs for everyone.
If you are selected to participate in the audit, you will receive a personalized Dependent Eligibility Verification Affidavit identifying those individuals who our records show you have enrolled in a County sponsored health plan as your dependent. You will be asked to review the affidavit for accuracy, complete the form, and return it with the required documentation to certify that each dependent remains eligible for coverage. It is important that you respond within the required timelines described in the audit letter you receive; if you fail to return a completed and signed Affidavit before the deadline, coverage for your enrolled dependent(s) will be terminated
Following are some Questions and Answers developed to help you understand the reason for the audit and what to expect in the future:
Q. Is it Mandatory that I respond to this request?
A. Yes, if you are selected for the audit and we do not receive a response from you within the timelines provided in the notice, your dependent’s coverage will be terminated.
Q. What happens if you discover that my enrolled dependent is not eligible during the audit?
A. It is against County policy to enroll ineligible individuals into a County sponsored health plan. To knowingly do so is fraud. Fraudulent actions will result in disciplinary action and cause you to become responsible for all costs incurred by the ineligible dependent.
Q. What happens if I fail to complete the Dependent Eligibility Verification Affidavit during the audit?
A. The County will make every effort to ensure that you complete this Affidavit; however, if it is not received within the timelines described in the notice, your dependents coverage will be terminated.
Q. What are the options for continuing coverage for ineligible dependents?
A. Terminated ineligible dependents may be eligible for COBRA continuation coverage if a qualifying event occurred within the last 60 days. Termination of an ineligible individual THAT WAS NEVER ELIGIBLE is not considered a qualifying event and these individuals will not be offered continuation of coverage.
Q. If I’m not selected for the upcoming audit will additional audits occur in the future?
A. Yes, all new employees enrolling in the plan(s) will be required to certify their dependents at the time of enrollment. Employees will be required to certify their dependents at each open enrollment period thereafter and periodic audits will be conducted to recertify dependent eligibility.
Q. What if I have additional questions about this process?
A. You may contact the Benefits Information Line at 951 955-4981, Monday - Friday from 8 am – 5 pm.