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Eligibility Audits for Employer-Sponsored Health Plans: Potential Benefits and Best Practices


June 19, 2018
Recorded Online

Fully insured health plans may be required to offer coverage to all or some of an employee’s dependents. Coverage of ineligible employees or dependents increases health plan costs and raises important legal issues under the Affordable Care Act (ACA), ERISA, COBRA, and HIPAA. Those considerations make periodic eligibility audits advisable to determine whether eligibility provisions are being properly administered and whether the eligibility provisions accurately reflect the employer’s goals. However, auditing and possibly dropping individuals from health plan coverage can raise significant legal and employee-relations issues that should be considered in determining whether to undertake an audit and how to manage an audit.

Please join Christine Williams, founder of Health Plan Plain Talk, as she reviews eligibility compliance issues and the potential benefits of eligibility audits.

This webinar will cover:

  • Data on whether an eligibility audit can reduce plan costs
  • Reviewing and evaluating eligibility provisions as reflected in summary plan descriptions
  • Differences between spouses and other dependents for eligibility purposes
  • How the ACA applies to dependent eligibility and potential penalties for noncompliance
  • The circumstances under which an ineligible employee or dependent may be removed from plan coverage and whether COBRA must be offered
  • How the HIPAA privacy rules apply to eligibility audits and what action may be taken against an employee who enrolls ineligibility individuals
  • Acceptable documentation to provide evidence of eligibility
  • Best practices for conducting an eligibility audit
  • Important communication and coordination tasks for eligibility audits
  • And much more!

Continue by clicking on the following link:

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