Healthcare Dependents Audit Work Program

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Inspecting Procedures and Policies for Healthcare Dependent Coverage

Audit, optimize and ensure compliance in your healthcare dependents process with our Healthcare Dependents Audit Work Program. The document outlines various tests and procedures that can be employed to ensure compliance with legal stipulations such as the Employee Retirement Income Security Act (ERISA), Health Insurance Portability and Accountability Act (HIPAA), and Consolidated Omnibus Budget Reconciliation Act (COBRA), among other regulations. Importantly, it also includes guidance on how to verify the effectiveness of an organization's nondiscrimination policy and diversity training program.

Additionally, it provides parameters for evaluating changes in status forms submitted by employees, conducting annual random audits of dependents' eligibility, and ensuring that all changes or updates are adequately communicated to employees. This work program is critical for organizations seeking to maintain regulatory compliance while ensuring their health plans serve the needs of their employees effectively and equitably.

Auditing procedures highlighted in this work program include:

  • Obtaining formal documentation of the employer’s group health plan
  • Obtaining evidence that the organization reviewed the plan for compliance with Employee Retirement Income Security Act (ERISA)
  • Verifying that the board of directors (BOD)/legal counsel approved the plan for compliance

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