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Medical, Dental, and Vision Plans Dependent Audit
A dependent audit of PWCS medical, dental and vision plans will be done starting June 2012 to confirm that all insured dependents on PWCS plans meet the eligibility criteria.  Employees will begin to receive information soon about the audit, including details on how the program will take place and when dependent documentation will need to be provided.  Any employee who wishes to maintain medical, dental and/or vision insurance coverage for his/her dependents from July 1, 2012, and going forward will need to provide documentation demonstrating his/her dependents are eligible for coverage (confirmation of the relationship of the employee to dependents receiving coverage).  Before the audit begins, employees should ensure they have copies of appropriate legal documents (such as marriage certificates, birth certificates, adoption decrees, and/or court orders) to supply when needed. 

Dependent Eligibility Definitions
AON Hewitt FAQs 
Dependent Audit FAQs
 

What is a Dependent Audit?
A dependent audit is a formal check of benefit enrollees’ dependents to make sure that dependents are still eligible for coverage under plan guidelines.


Why is PWCS conducting a Dependent Audit of the medical, dental and vision plans?
The dependent audit is being conducted in an effort to help contain rising healthcare costs by ensuring that only eligible dependents are covered by the PWCS medical, dental and vision plans.


What cost savings does PWCS expect from the July Dependent Audit?
The costs savings are not only for the system, but also for the plan participants since premiums are shared costs. Estimates for dependent fraud in the health insurance marketplace are  5-12 percent. We currently cover more than 10,000 dependents on our plans. Given the nature of our organization, we assume the fraud level to be less than in some other organizations, yet the audit savings are anticipated to be several million dollars annually.  


When will the audit be conducted?
The audit will be conducted from July 1, 2012 to September 30, 2012.

How will the audit be done?
PWCS with Aon Hewitt, an outside vendor, in order to be as efficient as possible with the resources available. Using the external vendor, the audit can be run during an optimal time of year with experienced audit staff who can ensure compliant, confidential document retention.


Why isn’t PWCS conducting the dependent audit internally? 
We decided to have an external vendor perform our audit for several reasons.  We have neither sufficient numbers of staff nor the technical resources to perform an equitable and timely dependent audit with accessible and secure documentation storage; but Aon Consulting does. Aon is already familiar with our programs and was able to commit to providing expert services during a time of year that worked for a majority of employees.


Who are considered eligible dependents under the PWCS medical, dental and vision plans?
The following dependents are eligible for coverage under the PWCS medical, dental and vision plans:
  • Your spouse, as defined by U.S. Federal tax law.
  • All dependent children under age 26 who are not eligible for group healthcare through their own employer.
Dependent children, regardless of student status, are defined as:
  • A biological child or stepchild of a current marriage
  • A legally adopted child, a child who has been placed with you for adoption, or one for whom you have legal guardianship or legal custody
A child who meets the definitions above and who has been certified by your carrier as being disabled is eligible to remain on your policy, regardless of age, as long as he/she is considered disabled and that disability occurred prior to age 26.


I’ve had a PWCS medical and dental plan for 20 years, and I’ve never had to do this before; why now?
At the initial request for insurance coverage, most employers require that employees provide documentation that proves their dependents are eligible for coverage.  In reviewing our business practices in light of our budget constraints, we identified that this is another way to keep medical and dental plan costs down. The definition of eligible dependents is not changing. The medical and dental plan costs will be less, and that cost savings can be passed on to plan participants.


It is an inconvenience for me to have to provide documentation to support information that I provided when I was hired.     
While we recognize this request may be inconvenient for some participants, the potential cost savings for PWCS and its participating employees is the driving factor for the dependent audit. Many participants have ready access to the requested documents and we have provided information on how to acquire missing or misplaced documentation (see FAQ below). 


Will original documents be required?
No, photocopies are acceptable.

Can I just send my documents ahead of time to the Office of Benefits and Retirement Services?
No, the Office of Benefits and Retirement Services does not have the resources or space to accept the documentation ahead of the audit. However, during the audit, PWCS will be partnering with Aon Hewitt to collect the required documents. Documentation will be accepted beginning in June through scanned e-mail, fax, and U.S. Mail. In future communications, you will receive detailed instructions about the options available to you for submission of your documents.


I will be adding my 24-year-old child back on to my policy. Do I have to provide his birth certificate?
Yes, you will have to provide documentation for all dependents, regardless of age.


I already submitted my marriage certificate when I got married last year and enrolled my spouse on my coverage; do I have to resubmit my documents?
Yes, because PWCS will be partnering with Aon Hewitt to collect the required documents to verify that all dependents are eligible to be covered by a PWCS plan.


I have a birth registration card that lists my child’s information, but not the name of the parents.  Will that work?
No. Birth certificates are requested so that we can verify the parents of the child. Unfortunately, the birth registration card does not list the parents and, therefore, cannot be used to verify the child’s eligibility for coverage.


My name is not on the birth certificate for my stepchild. Is this going to be a problem?
No, as long as we have a copy of your marriage certificate and the child’s birth certificate that lists you or your spouse as the parent of the child.


 My 30-year-old child is disabled and incapable of self-support. How do I ensure he remains covered by the plan?
This dependent audit is only verifying the child’s eligibility as a dependent. Your carrier determines the disability status of the child, and this process is unaffected by the dependent audit.


I have misplaced my child’s birth certificate and my marriage certificate. What should I do?
To obtain a copy of a birth or marriage certificate, please contact the vital records department of the state in which the event took place. You may also request copies of these documents by going to www.vitalchek.com or www.vitalrec.com. Please note that fees may be incurred when requesting additional copies of certificates or licenses from local governments and that VitalChek charges for its services as well.


My documents are not attainable (destroyed, lost, etc.). What should I do?
Once the audit starts in June 2012, you may contact Aon Hewitt for guidance and review of your individual situation. They will give you options to help resolve your particular challenge. 


This is my private information, and I do not want to share it with others.
To ensure confidentiality of your information, PWCS will be partnering with Aon Hewitt to collect the required documents. Your documents will be imaged and stored as electronic records. Hard copies will not be stored post audit by the outside vendor; the documents are destroyed following imaging. We also suggest you remove all financial information and SSNs with the exception of the last four digits from the top page of your tax return document before you submit it.  


I am concerned about identity theft and sharing my personal information with a third party, Aon Hewitt. 
We understand and share your concern for the security of personal information.  PWCS complies with federal and state mandates regarding data security and our vendors are held to the same standard. All health-related vendors are held accountable in their contract with PWCS to protect the privacy and security of Protected Health Information (PHI) disclosed to them and to comply with the Health Insurance Portability and Accountability Act (HIPAA) as amended.   
I did not keep a copy of my 2010 or 2011 tax return. What should I do?
If you do not currently have a copy of your 2010 or 2011 tax return, please visit
www.irs.gov/taxtopics/tc156.html and follow the instructions to request a copy from the Internal Revenue Service (IRS). You may also contact the IRS at (800) 829-1040.


To prove my spouse’s eligibility for coverage, why do you require a copy of my tax return and a copy of my marriage certificate?
Since a marriage takes place in history, the only way to verify the current status of the legal union is to have updated documentation. A marriage certificate provides proof of a legally recognized marriage. A tax return provides proof of an existing marriage.

My financial information is private and I do not want it provided.  
PWCS has no interest in your financial records.  As noted in the question above, the purpose for requesting the top page of your tax return is to provide proof of an existing marriage.   We suggest you remove all financial information and SSNs with the exception of the last four digits from the document before you submit it.   


What happens if I do nothing?
Dependents not certified during the audit will be ineligible for coverage following the audit and will be dropped from coverage.


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