PEIA to conduct eligibility audits

Published: December 25, 2009 10:00 AM
By By Alison Knezevich

December 25, 2009

PEIA conducting eligibility audits

By Alison Knezevich

Staff writer

CHARLESTON, W.Va. -- Public employees and retirees will need to dig up documents to prove that their kids, spouses and other dependents qualify for coverage offered by West Virginia's Public Employees Insurance Agency.

If they don't, their dependents' coverage could be canceled.

PEIA is conducting its first full-scale dependent eligibility audit of all policyholders who have dependents, said state Department of Administration spokeswoman Diane Holley-Brown.

"This is very common with businesses and other government organizations," Holley-Brown said. "The goal is to make sure that we're covering employees that are truly covered under PEIA and that their dependents" also qualify.

The state wants to make sure that policyholders aren't claiming as dependents people who don't qualify -- such as ex-spouses or children ages 19 and older who aren't enrolled full-time in school.

The reviews are part of a two-step project that began with agency heads analyzing payroll data to verify that employees qualify for PEIA coverage, Holley-Brown said.

Dependent-eligibility audits are becoming increasingly popular as employers look to keep health-care costs in check.

Watson Wyatt, a global benefits consulting company, surveyed large U.S. companies in 2009 and found that more than 60 percent conducted such reviews in 2009 -- up from fewer than 50 percent in 2007.

PEIA has contracted with Healthcare Data Management Inc. to conduct its eligibility review, Holley-Brown said.

Once policyholders get their letters from HDM, they have 30 days to fill out the forms and submit documentation -- such as proof of school enrollment for older children and copies of marriage and birth certificates -- to prove that their dependents qualify.

If people miss the deadline, their dependents' coverage will be canceled, according to a letter the company sent to policyholders.

Holley-Brown said that if people have trouble finding the needed documents, they should contact HDM.

The company is notifying policyholders in four rounds, Holley-Brown said. Some employees and retirees have already received their audit materials. The first mailing went out in early November.

The next round of policyholders should receive their letters by Jan. 4, Holley-Brown said.

If a person knows that a dependent is now ineligible for life or health insurance coverage, they don't need to submit documentation to prove that, Holley-Brown said. If someone has no dependents, they will not receive the dependent eligibility verification letter.

PEIA officials hope to finish the project by April.