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 health care 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 health care 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 health care benefits at the company's expense.
Ineligible Dependent
A dependent who has received benefits but, according to company policy, is no longer eligible to receive those benefits. Examples may include an ex-spouse or child older than 25 years of age.
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 health care 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.
