February 26, 2008, Volume 54, No. 23
Health Aware is an ongoing series designed to help you be proactive in managing your health and healthcare by taking advantage of the many resources available to you as a Penn employee.
Preparing for Penn’s Dependent Eligibility Audit
As part of the University’s ongoing efforts to ensure good governance and keep healthcare costs affordable, Penn will conduct a dependent eligibility audit for our health plans beginning May 1, 2008. These audits are a growing trend nationwide for several reasons, including healthcare cost containment and the avoidance of potential liability under federal regulations such as ERISA.
If you’re a faculty or staff member who intends to cover dependents under Penn’s health plans when our new plan year begins on July 1, 2008, this audit will affect you in the following ways:
• You’ll need to be able to provide documentation verifying that your dependents are eligible for coverage under Penn’s plan rules.
• If you can’t produce that documentation when Penn requests it, your unverified dependents will be dropped from your coverage—and there may be additional consequences.
What is a dependent eligibility audit, and why is Penn holding one?
A dependent eligibility audit ensures the accuracy of our records by verifying the eligibility of dependents receiving healthcare benefits through Penn. It’s important that all faculty and staff have the opportunity to cover eligible dependents through the University’s plans, but enrolling ineligible dependents violates plan rules and drives up the cost of benefits for everyone. Recommended by Penn’s external financial auditors, PricewaterhouseCoopers, this audit will help the University ensure that we’re upholding our fiduciary, legal, and fiscal duties. We certainly aren’t trying to make it difficult for you and your family to access coverage—however, we need to make sure procedures are in place so that the appropriate people have access to the coverage they need.
How will the audit work?
As you may be aware, Open Enrollment is held in April of each year. During this time, you’ll make your healthcare elections for the new plan year, which begins on July 1, 2008. If you elect to cover dependents under Penn’s benefits plans for the new plan year, you’ll receive a personalized letter in May, after Open Enrollment ends. The letter will come from ADP (Penn’s benefits administrator) and will ask you to provide documentation verifying your dependents’ eligibility for coverage. You’ll need to send your personalized letter, along with the appropriate documentation, back to ADP by the end of May in order to ensure coverage for your dependents as of July 1, 2008. A full list of acceptable documents is available on the Human Resources website at www.hr.upenn.edu.
How do I know if my dependents are eligible?
There are a variety of reasons why claimed dependents may be (or may have become) ineligible to receive benefits through Penn—children may have reached the age limit, your marital or domestic partnership status may have changed, or an individual may not meet the IRS guidelines for a legal dependent, just to name a few. It’s important that you understand Penn’s requirements so you can be sure your dependents are eligible for coverage. Full details about dependent eligibility are available on the Human Resources website at www.hr.upenn.edu.
What happens if someone is covering an ineligible dependent?
Penn has designated this year’s Open Enrollment (April 7—18, 2008) as an amnesty period during which faculty and staff may remove ineligible dependents from their coverage with no penalties and no questions asked. Once the new plan year starts on July 1, anyone covering ineligible dependents will have those dependents dropped from coverage and will face financial and other consequences—so it’s important to review your dependent information carefully.
What do I need to do?
Make sure you have the legal documentation you need to verify the eligibility of your covered dependents. You’ll need to have proper documentation at hand when the audit begins in May. Please note that we cannot accept documentation prior to the start of the audit. You’ll receive full instructions in May when your personalized letter is mailed to your home.
How can I find out more information about the audit?
For more information about the upcoming dependent eligibility audit, including a list of acceptable documents to verify claimed dependents, please visit www.hr.upenn.edu or call the Penn Benefits Center at 1-888-PENN-BEN (1-888-736-6236).
Related: Last Chance to Register for a Free Health Screening