Cover the people who qualify and stop paying for the people who do not.
Dependent eligibility is one of the quieter ways a plan loses money.
Why it matters.
Ineligible dependents cost the plan.
Claims for the Ineligible
The plan pays for people who should not be covered.
Life Changes
Divorce, age-out and other events change eligibility and are not always reported.
Premium Impact
Cost spreads across everyone in the plan.
How verification works.
A standing process, not a one-time sweep.
Clear Rules First
We confirm the plan’s definition of an eligible dependent.
Documentation
Dependents are verified against what the plan requires.
Routine Checks
Ongoing verification catches changes as they happen.
Doing it well.
Fair to employees.
Plain Communication
Employees are told what is needed and why.
A Fair Window
Time is given to provide documents before coverage is affected.
Age 26
Federal rules require plans that cover children to offer coverage until age 26.
Questions Employers Ask About This
Does verification upset employees?
It can if handled poorly. Clear notice and a fair window help.
How often should it run?
Routine and ongoing is better than a one-time sweep.
What if we find ineligible dependents?
We help you apply the plan’s rules and work through next steps with your counsel.
Related guides.
From Renewals to Results: The Broker Playbook
The full playbook.
Claims Audits That Review Every Claim, Not a Sample
Every claim, not a sample.
Group Health Claims Overpayment Recovery
Recovery, followed through.
Medical Child Support Orders and Divorce: Group Health Plan Obligations
How a medical child support order becomes qualified, the notice that arrives from a state agency.
Want this applied to your renewal?
Send us the renewal and we will run it through DATUM and show you where the number comes from.
Your renewal letter
Your census
Your current plan documents
Your renewal date
Rough answers are fine. We build the numbers from there.
Laws and rules referenced
Employee Benefit News: Renewals to Results — Opinion piece on brokers moving from plan shopping to data-driven advisory work.
42 U.S.C. § 300gg-14 — Extension of dependent coverage to age 26.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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