Monday - July 16, 2018
Health Plan Audits Dependents
Written by Bruce Ferrell   
Wednesday, 11 April 2018 12:40

RALEIGH --- State Treasurer Dale R. Folwell  announced that the State Health Plan has completed a year-long project to verify the eligibility of nearly 190,000 dependents on the Plan.

The goal was to collect electronic records that verify dependents’ eligibility so future audits of this scale are not required. Previous audits failed to maintain these records. The audit is part of an ongoing effort to use technology to modernize policies and procedures and improve efficiencies. Those subject to the audit who did not submit documents had their dependents terminated from the Plan.

“It is essential to the long-term sustainability of the Plan that only qualified individuals receive State Health Plan benefits,” Folwell said. “I know the process was a burden to some, but we now have a ‘living and breathing’ document that will follow an employee throughout their careers with the state. I want to thank all those who submitted documentation for their cooperation.”

The Dependent Eligibility Verification Audit was initiated in May 2017 and required all subscribers with dependents under the age of 75 to submit documents to confirm the eligibility of their dependents. Of the original audit population of 187,791 dependents, the Plan successfully confirmed the eligibility of 186,477 dependents, or 99 percent of the audit population.

Plan members were informed of the audit through letters and postcards mailed to their home, e-newsletters and phone calls. Documents were accepted via the upload feature in the Plan’s enrollment system, email, fax and mail. In addition, from August 2017 through January 2018, subscribers who had not responded, or tried to respond but submitted invalid documents, were given extra time to comply.

Ultimately, 601 dependents were terminated from the Plan. The Plan continues to work with those who have attempted to submit the correct documentation.  Going forward, the Plan is working with agency human resources departments to continue their efforts to ensure dependent verification at the time of employment or during life-changing events.

The State Health Plan for Teachers and State Employees, a division of the N.C. Department of State Treasurer, is the largest purchaser of health care in North Carolina. The plan provides coverage to nearly 730,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.

 

 
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