Dependent audits and plan caseload

Conventional wisdom says dependent audits are the only way to manage your plan’s caseload. It also says they’re not worth the headache.

Neither is true.

Caseload is the number of people on your plan. It’s the variable most employers aren’t managing. Every dependent who shouldn’t be on the plan, every spouse who has access to coverage elsewhere, every employee who’d rather take cash — they’re all driving your E=CUP cost equation in the wrong direction.

Three tools that actually move the number:

Dependent eligibility audits. On average, 3-7% of dependents on a plan are ineligible. That’s not a rounding error. That’s claims you’re paying for people who shouldn’t be there.

Spousal incentive HRAs. If a spouse has access to coverage through their own employer, you can offer them an HRA to use that coverage instead. They get help with their out of pocket expenses under the other plan. You get them off your plan. Both sides win.

Opt-out incentives. Employees who have other coverage through another employer’s plan, such as a spouse’s plan, can be offered a cash incentive to waive enrollment. Done correctly, the incentive costs less than the per-member cost of keeping them on the plan.

None of these are aggressive. They’re math.

The compliance pieces matter. Spousal HRAs and opt-out incentives each have rules around how they’re structured. But none of them are out of reach for a well-advised plan sponsor.

If your last renewal conversation didn’t include at least one of these, it’s worth asking why.