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When Coverage Is Dependent

Properly communicated, eligibility audits can save money and boost morale.
 
 
By Michael Smith
 
 
In the wake of healthcare reform amid ongoing economic pressures, many companies are looking to tighten up spending on the cost of providing healthcare coverage for their employees.
 
 
For many self-insured employers, dependent eligibility verification (DEV) audits have proven to be a much more effective—and employee-friendly—alternative to cost-shifting measures for achieving significant, immediate healthcare cost savings. Instead of shifting the burden of higher out-of-pocket expenses to employees, DEV audits not only save more money over the long haul, but also help to avoid the negative impact cost shifting. Increased benefits costs to employees will have an impact with incumbent employee attitude and loyalty, as well as recruitment efforts for new employees as employers want to attract talented employees.
 
 
In addition to DEV audits, employers are also implementing other areas of verification, including other insurance verification to maximize participation with working spouse rules and ongoing eligibility verification. When successfully implemented in concert, these measures enable managers to balance the needs of both management and employees to create immediate and long-term cost savings.
 
 
Effective communication surrounding a DEV program is crucial. It’s basic human nature that most are afraid of the unknown, and given the negative connotation commonly associated with the term “audit,” a DEV audit can rattle nerves. Employees might fear being challenged on the eligibility of their dependents, and when audits are performed in-house, managers might cringe at having to question colleagues on the validity of their qualifying relationships. Outsourcing the audit to an experienced, qualified DEV auditing firm can overcome both of these challenges.
 
 
Emphasizing clear and consistent communications throughout the audit can literally make or break the project. Money is on the line, but so is employee morale. So a DEV audit must be clearly equitable and transparent. Edicts do little to encourage participation in the process and can create a tense environment.
 
 
With a proven, multichannel system that is respectful and easily understood, employers can implement an audit that not only saves money but also supports and preserves its most vital asset—the employees. Here are the keys:
Personalized communications. To best support employees and
encourage participation, communications must be customized. Communications that are designed specifically for each dependent situation can dramatically enhance participation and eliminate confusion surrounding verification requirements.
Co-branded communications. When using a third-party DEV
service provider, practitioners need to maintain their corporate culture, tone, and messaging. Employees need to know the company and its leadership are on board, rather than having just outsourced and washed their hands of the process. Letters should be distributed on company letterhead and signed by management; phone calls should be conducted by individuals who identify themselves as representing the company.
Explain the mutual benefit. In addition to helping the company
reduce costs, DEV audits can also help employees save money, either by eliminating the need for cost-shifting measures or preventing the risk of out-of-pocket premium increases. Employees simply shouldn’t be paying to cover ineligible dependents, and a DEV process can ensure this doesn’t happen. Communicating employee benefits can achieve a significantly higher participation rate than those that focus only on company benefits.
Eliminate confusion. The audit process should be clear, concise,
and transparent. Actively making the benefits and participation requirements of the audit clear to the employees up front significantly reduces employee frustration. It also reduces the amount of complaints and questions coming to the HR department.
Provide multiple channels for participation. No two employees are the same, and employers must factor in environment and diversity of the workforce when designing touch points for participation. The process must be as accessible as possible for every participant. This means not only making multilingual documentation and support available as required, but also providing multiple channels based on unique situations.
 
 
For example, remote offices, international locations, and field operations can make it difficult, if not impossible, for some employees to participate in a timely manner via standard mail. Maximize the use of appropriate channels, including web, print, and telephone.
 
 
While conducting a DEV audit might seem a tall order for many companies, it actually can be an extremely efficient process. By leveraging the experience of a firm dedicated to this business, companies can achieve much greater efficiency, significantly higher participation rates, and overall better employee satisfaction with the process.
 

Michael Smith is president and co-founder of ConSova Corporation, a leading provider of healthcare cost containment solutions. For more information on ConSova please visitwww.consova.com.
 

Tags: Benefits, Contributors, Engaged Workforce

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