Economic conditions may provoke more businesses to employ eligibility audits to weed out ex-spouses, adult children and non-family members from their health plans, a non-profit benefit plan group says.
The International Foundation of Employee Benefit Plans said its recent survey found that at present only 26 percent of U.S. employers conduct eligibility audits for their health care plans.
Julie Stich, senior information/research specialist with the foundation said, "When the audit is conducted, employers often discover many people–former spouses, adult children, non-immediate family members–who are covered under the health plan even though they do not qualify as a dependent."
"Removing ineligible dependents from the plan can ultimately save the employer hundreds of thousands of dollars and, given the current economy, I expect the percentage of employers conducting eligibility audits to grow," said Ms. Stich.
"In the past, some employers may have hesitated to conduct an audit because of the possibility of their employees' negative reactions. With the current financial situation, however, cost-saving will likely be the employers' main concern," she added.
Popular cost-management methods reported by firms with health care plans that responded include cost-sharing provisions such as deductibles, coinsurance and copays (74 percent), annual and/or lifetime maximum benefits limits (56 percent), and prior authorization (55 percent).
In addition to the 26 percent who used audits, the Foundation said that, "other less popular cost-management options" include health care claims/utilization analysis (39 percent) and opt-out incentives (15 percent).
Predictive modeling, a strategy that uses claims data and lifestyle analytics to identify potential catastrophic claims and disease states, is used by 12 percent of the survey respondents.
Another cost-saving option considered by employers, the survey found, is voluntary (employee-pay-all) benefits, which are group benefits offered at the workplace but paid for by employees.
These benefits are used to expand benefit options without increasing costs. Voluntary benefits may include coverage supplemental to the employer's current offerings or, for those employers who are unable to provide health care coverage, they may include standard health insurance.
The survey found that 39 percent of employers have voluntary health insurance, 40 percent offer voluntary dental insurance and 37 percent have voluntary vision insurance.
"Voluntary benefits can be a great option for employers with tight budgets who still want to help their employees obtain health care coverage or other types of insurance," said Ms. Stich.
She explained that, "Because group insurance premiums are typically less expensive than the premiums for an individual policy, offering voluntary benefits at the workplace can help employees who want the coverage but also need help making ends meet."
Employers are also implementing a number of cost-management techniques for prescription drugs.
The survey found the most popular technique among the respondents was using a mail-order drug service, with 85 percent of employers reporting they use this approach.
Other methods include promoting generic drugs (71 percent), the use of drug formularies (68 percent), three or more tiers for cost sharing (59 percent), and the use of a pharmacy benefit manager (50 percent).
The 157-page "Employee Benefits Survey: U.S. and Canada, 2009″ (Item #6542) costs $132 ($99 to foundation members) and can be ordered online at www.ifebp.org/books.asp?6542 or through the Foundation Bookstore at bookstore@ifebp.org or (888) 334-3327, option 4.
The International Foundation of Employee Benefit Plans is a nonprofit organization, dedicated to being a leading objective and independent global source of employee benefits, compensation, and financial literacy education and information.
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