An employee reviews their benefits during open enrollment, keeps the same medical plan, and carries forward the dependents already in the system. Their elections are complete. But one of those dependents is a former spouse who no longer qualifies under the plan.
Nobody flagged it, because nothing in the process asks. In a passive enrollment, existing elections roll forward unless the employee changes them, so the record moves into the next plan year with everyone else’s.
By the time OE opens, the employer has already settled plan design, carriers, and contributions. What’s left is enrollment, which confirms what employees want to elect. It doesn’t confirm whether the people they’re covering qualify.
How records go stale
A spouse is added years ago, and the divorce never gets reported. A parent isn’t sure whether a stepchild or an adult child still qualifies. None of this requires bad intent. An outdated record or a wrong assumption is enough.
What it costs
Every ineligible dependent is a premium the employer pays for someone outside the plan, plus any claims that follow. That cost repeats each year the record goes unchecked. At renewal, employers and brokers weigh higher contributions, deductible changes, and plan adjustments. Ineligible coverage belongs in that same conversation, because removing it is spending reduced without shifting cost onto employees.
Keep conducting dependent audits after OE
A full audit covers the dependents enrolled on a given day. New hires and qualifying life events keep adding more. Verify new dependents when they’re added, and give employees a clear way to report changes that affect existing ones, so the audited population stays current.
How ebm helps
ebm offers dependent audits and ongoing verification for newly added dependents. Employees upload documentation through a secure portal, and HR can see verification status in real time.
If you’re reviewing healthcare costs for the next plan year, schedule a discovery call to talk through timing, process, and potential savings for your organization or your clients.
