Glossary
Dependent Audit
A process designed to vet each employee's dependents, defined
as those who are currently receiving benefits as part of a
benefits plan. Audits are conducted to ensure that each
dependent is valid and is receiving only those benefits to
which they are entitled.
Eligibility Audit
A process that determines whether a dependent is eligible to
receive the benefits, include healthcare coverage, that are
designated under an existing corporate employee benefits
policy, or whether that dependent's benefits should be
terminated or modified.
Dependent Coverage
Defined as the degree to which an employee's dependents are
covered under an existing benefits plan, including the actual
benefits that they are entitled to receive and the terms under
which they are entitled to receive them.
Healthcare Cost Containment
This involves capping increases in or even reducing the
percentage of a company's assets that are dedicated to
providing healthcare services offered to their employees as
part of a benefits package. One of the most effective ways of
achieving this cost-cutting measure is to thoroughly audit the
existing pool of dependents to ensure that only eligible
dependents are receiving healthcare benefits at the company's
expense.
Ineligible Dependent
A dependent who is has received benefits but, according to
company policy, is no longer eligible to receive those
benefits. Examples may include an ex-spouse or child over 21
years of age not attending an institution of learning.
Dependent Fraud
This occurs when individuals collect benefits with full
knowledge that they are not in fact eligible. A case is
fraudulent only when it is a conscious act of deception.
Employee Retirement Income Security Act
(ERISA)
A federal statute passed by the United States Congress that is
designed to protect the rights of employee benefit plan
dependents and their eligible beneficiaries, and establishes
rules for cancelling or otherwise modifying said benefits
packages, including health care coverage. The actions of an
employee benefit plan's administrators, the way in which
eligibility for said plan is determined, and the access of
dependents and beneficiaries to information on policies that
affect them all fall under the purview of ERISA.
Dependent Eligibility Verification
This is the process of verifying that each individual who
receives healthcare benefits as a dependent is indeed an
eligible dependent as outlined by the company's benefits plan,
which must in turn be in accordance with ERISA.