Confirm your preferred approach for auditing/verifying dependent eligibility.

For plan(s) to be audited.

Confirm if dependent eligibility is currently being verified upon enrollment.

Confirm HRIS system currently being used, if applicable.

Describe any concerns that you may have about dependent eligibility.

Confirm the date in which you would like the audit/verification to begin.

Confirm yes/no if the plan(s) to be audited apply a spousal surcharge or carve-out.

Confirm if the plan(s) to be audited are fully or self-insured.

Total # of employees with 1+ dependent enrolled in the Medical/Rx plan.

Total # of dependents currently enrolled in the Medical/Rx plan.

Estimated # of new households enrolled per year.

Estimated # of QLEs per year.

If yes, total # of employees with 1+ dependent enrolled in the Dental plan ONLY.

If yes, total # of dependents enrolled in the Dental plan ONLY.

If yes, total # of employees with 1+ dependent enrolled in the Vision plan ONLY.

If yes, total # of dependents enrolled in the Dental plan ONLY.