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Dependent Benefits Eligibility Audit & Amnesty Period Information

If you have a dependent enrolled in a U-M medical plan, please read on to learn about university plans for a benefits audit designed to confirm that enrolled dependents are qualified for coverage. The audit will include all faculty, staff and fellowship recipients with one or more dependent enrolled in a medical plan, and will require a response to home mailings that will begin in February 2010. However, an amnesty period is currently taking place and will continue through Dec. 18, 2009. Further details about both the audit process and the amnesty period are provided below.

Audit Information

What is an eligibility audit?

How can I determine whether a dependent is eligible for coverage in a medical plan?

Why conduct an audit?

Who will be included in the audit?

Is participation in the audit required?

How will the audit work?

Do other organizations use audits to verify the eligibility of dependents?

Amnesty Information

What is an amnesty period?

Why participate in the amnesty program?

When is the amnesty period?

How can ineligible dependents be disenrolled during the amnesty period?



Audit Information

What is an eligibility audit?
An eligibility audit is a process designed to verify that individuals enrolled in an employer’s benefit plans are qualified for the coverage being provided.


How can I determine whether a dependent is eligible for coverage in a medical plan?
You can review eligibility requirements for all categories of adult and child dependents on the Benefits Office web site www.benefits.umich.edu/eligibility. If you have questions, you can speak with a benefits representative by calling the HR Service Center at (734) 615-2000 or 5-2000 from an Ann Arbor campus phone.


Why conduct an audit?
Undertaking an audit to verify eligibility helps ensure that the University is investing benefits dollars wisely by contributing toward employees’ eligible family members. Such audits are valuable to employers for financial control and fraud prevention. The University could save money by preventing inappropriate enrollments, which can end up costing everyone more in premiums. Also, faculty and staff are better protected from incurring tax and legal liabilities from enrolling ineligible dependents.


Who will be included in the audit?
Faculty and staff members and fellowship holders who cover dependents on their medical plan will be included in the audit. Retirees and their survivors and employees on long-term disability will be excluded from the audit.


Is participation in the audit required?
Yes. All faculty, staff and fellowship holders with dependents covered by U-M medical plan must provide documentation of eligibility. The process is confidential and employees will not be required to submit the Social Security Numbers of dependents, but appropriate documents must be provided in order to continue coverage for the dependent(s).


How will the audit work?
In February 2010, faculty and staff members with one or more enrolled dependents will receive a simple audit questionnaire by home mailing requesting specific documents to verify dependent eligibility for benefits. The audit will be coordinated by an external auditing company with experience conducting confidential benefits-eligibility audits. The most common document used to verify eligibility of dependents is a copy of a current federal income tax return listing the dependent(s). Income information and Social Security Number may be redacted (blacked out to be unreadable). Several additional documentation options will be available at the time of the audit.


Do other organizations use audits to verify the eligibility of dependents?
Yes, audits are very common among large employers and are being increasingly utilized by universities to be sure benefit dollars are invested in those who qualify for coverage. Indiana University, University of Pennsylvania and Washington University in St. Louis are among those universities that have conducted similar audits.


 

Amnesty Information

What is an amnesty period?
An amnesty period is a designated time before the audit during which faculty and staff can voluntarily disenroll dependents who do not meet the eligibility requirements for coverage as a dependent in U-M benefit plans.


Why participate in the amnesty program?
Enrolling ineligible individuals is against University policy, violates the certification of eligibility each employee signs (physically or electronically) when enrolling for dependent coverage, and in some circumstances is insurance fraud. Employees who disenroll ineligible dependents during the amnesty period will avoid:

  • Disciplinary action by the University
  • Action by the University to recover premiums and claims paid on behalf of the ineligible person(s)

When is the amnesty period?
Amnesty has begun and continues through Dec. 18, 2009.


How can ineligible dependents be disenrolled during the amnesty period?
Ineligible dependents can be disenrolled anytime during the amnesty period by contacting the HR/Payroll Service Center.  Ineligible dependents can also be disenrolled through the Open Enrollment (Oct. 26-Nov. 6) process using the self-service features of Wolverine Access.