EIP Audit Information

8/6/2019 EIP Audit Information

1/17

Employee InsuranceEmployee Insurance

ProgramProgramDependent AuditDependent Audit

May 1, 2011Donna Lazar, Benefits Administrator


2/17

yDependents are anyone

you have listed on yourinsurance coverage.

yYour spouse and childrenwho are covered by health,

dental, vision, or lifecoverage are yourdependents.


3/17

y In an effort to control costs,

the Employee Insurance Program,(EIP) will begin verifying

eligibility of all dependents by

requiring documentation for all

covered dependents.

y When an audit was performed last fall, itwas found that out of 529 students, 189

were not eligible for coverage. The statesaved 1.2 million dollars by not payingclaims on these students.


4/17

y With more than 187,000 covered

dependents on state coverage, EIPexpects to find somewhere around 7% of

dependents do not actually qualify forcoverage. Saving an estimated $19 to

$20 million dollars per year.

y The initial audit cycle beganmid-April and is expected to

take 18 to 24 months tocomplete.


5/17

y At some point during the audit cycle, all

subscribers, who cover dependents, willreceive a letter from EIP asking themto submit documentation toverify the eligibility of eachof their covered dependents.

y If the subscriber does notprovide documentationwithin 60 days from the dateof the audit request, his dependents

will be dropped from whatever coveragethey have, health, dental, vision or lifeinsurance.


6/17

SpouseSpouseVerificationVerification

RequirementsRequirements


7/17

y Legal Spouse:1. A copy of your marriage license and a copy of

page 1 of your current federal tax return. Ifmarried filing separately, submit page 1 of bothfederal tax returns. To protect your privacy, pleaseblack out all financial information.

2. If not married long enough to file a joint taxreturn, a copy of your marriage license only.

y Former or Separated Spouse:1. Photocopy of divorce decree ordering the

subscriber to cover the former spouse.

2. If separated, a copy of the separation agreement.


8/17

y Common Law Spouse (provide both 1 and 2):

1) One of the following to prove that you and your spouse live at

the same residence (submit one for yourself and one for yourspouse):Lease or mortgage Auto registrationDrivers license Utility billPay stub (with your address listed) Current tax return

2) PLUSone proof of current financial interdependency:Joint ownership of your homeJoint lease/rental agreementJoint homeowner/renters insurance policyJoint bank account statement or a voided checkJoint credit card statementAccount numbers and account balances may be blacked out.

y NOTE: If you have not already submitted a signed,notarized Common Law Marriage Affidavit, you shoulddo so at this time.


9/17

ChildChildVerificationVerificationRequirementsRequirements


10/17

y Natural Child - Birth Certificate (long form)showing the subscriber as the parent.

y Step-child - Birth Certificate (long form)showing name of natural parent plus proofnatural parent and subscriber are married

(see spouse above).

y Adopted Child - Court documentationverifying completed adoption or a letter ofplacement from an adoption agency, an

attorney or the SC Department of SocialServices, verifying the adoption is inprogress.


11/17

y Foster Child - Court order or other legaldocumentation placing the child with thesubscriber, who is a licensed foster parent.

y Other Children - For all other children forwhom a subscriber has legal custody, a courtorder or other legal document grantingcustody of the child to the subscriber.Documentation must verify the subscriber hasguardianship responsibility for child, not just

financial responsibility.


12/17

y If you have children on your health, dental,vision or life insurance coverage, you will be

required to provide a long form birthcertificate that lists both of the parents.

y If your child was born in South Carolina, theonly place to obtain this certificate is at

SCDHEC, located in Columbia. LocalSCDHEC offices will only issue the shortform (blue card) birth certificates and theshort form does not list the parents.

y You can obtain the form to request the longform birth certificate from SCDHEC at

www.scdhec.gov.


13/17

To Obtain Long Form Birth Certificates by Mail

1. Complete the application found on the SCDHECwebsite

2. Enclose $12 per original certificate requested bycertified check or money order; personal checks

will not be accepted.3. Send a photocopy of a valid picture ID of the

applicant. (person requesting the certificate)x Any United States Department of Motor Vehicles office-

issued picture identification, i.e. drivers license,

identification card, learners permit (unexpired)x Current school or employer picture identification cardx Military card (unexpired active duty or retired member)x Passport US or Foreign (unexpired)


14/17

y Remember: Do not wait until the last minute torequest this information.

y Average processing time at SCDHECis 2-4 weeks (standard), 3-5 businessdays (expedited) for an additional fee.

y Mailing address: SCDHEC, 2600 Bull St.,Columbia, SC 29201

y You may also walk-in to the SCDHEC, 2600 BullSt., Columbia, SC 29201, but you will still needthe completed application, photo ID and $12search fee to obtain the birth certificate thesame day.


15/17

y To complete your audit prior to receiving theletter from EIP, gather the needed information

and complete the Dependent Verification Formfound on the Employee Insurance Programwebsite at www.eip.sc.gov. After you get to thewebsite, select Forms, then select DependentVerification Form.

y Make sure your address is correct with EIP so thatyou will receive your audit letter in a timelymanner. This is your responsibility.

y You can check your address by going to

www.eip.sc.gov then scroll down toMyBenefits listed on the left hand sideof the screen. After you sign into MyBenefits,you can review your contact information and makechanges if necessary.


16/17

NOTICE

As of May 1, 2011, specificdocumentation will be required to

enroll a dependent at any time such

as Open Enrollment in October 2011or a Special Eligibility Situation.

A Special Eligibility Situation is loss

of insurance due to loss of job,marriage, or birth, etc. wheninsurance coverage can be added

within 31 days of event.


17/17

Please Dont Shoot the

Messenger

EIP Audit Information

Documents

Transcript of EIP Audit Information