State Health Plan: Dependent audit serves members' best interests

Jun 29, 2017

From the Office of the State Treasurer

State Health Plan members who cover dependents under the age of 75 should have received a letter informing them that a Dependent Eligibility Verification Audit is currently underway.

Why an Audit is Needed

The audit is being conducted to ensure that those dependents on the plan, are actually eligible to participate. This is not only a legal requirement, but part of an effort to reduce waste, fraud and abuse. With healthcare and drug prices continuing to rise, the plan must address cost concerns in order to provide quality coverage at a reasonable rate without constantly adjusting deductibles and copays. The plan not only wants you to have benefits, but to be able to afford to use it.

This audit addresses several important issues:

  • Every dollar spent on someone receiving plan coverage who is ineligible is money out of the plan’s pocket.
  • The state has an unfunded healthcare liability of about $42 billion. Any unnecessary expenditures from ineligible dependents adds to that liability.
  • Ineligible individuals using plan coverage threaten affordable copays and deductibles and increases unnecessary spending. 
  • Freezing family premiums so younger state employees and their families can afford coverage. Right now, a starting teacher, trooper or firefighter must work five days out of every month to afford family coverage.

Correcting the Past

In 2010, the plan conducted an audit that found thousands of ineligible individuals who were receiving coverage. Their removal from the plan saved taxpayers millions of dollars. 

Unfortunately, during past audits, verification documents were collected but never saved digitally; nor were they permanently linked with each member, so subsequent audits were necessary. This time, however, state Treasurer Dale R. Folwell, CPA, is changing that. 

“There should be a way, once I tell how old my son is, for the State Health Plan to determine his eligibility,” Folwell said in a recent interview. “But right now, that isn’t always possible. So we’re doing this audit now, and getting this information digitally, so we don’t have to ask for the same document in the future.”

The plan partnered with Benefitfocus, the plan’s eligibility and enrollment vendor that conducts Open Enrollment, to ensure all uploaded documents are handled securely.

How to Comply

The letter members received explains the documentation needed for each dependent. This information must be submitted by July 31, 2017. Only members who have dependents under the age of 75 as of April 19, 2017, must comply with the audit. 

Resources Available

Visit the State Health Plan ( for more information including Frequently Asked Questions, step-by-step instructions and a video tutorial to guide you through the process. Members with questions should call the Eligibility and Enrollment Support Center at 855-859-0966, Monday through Friday, from 8 a.m. – 5 p.m.

Instructions for Active Employees:

Instructions for Retirees: