Missed Dependent Elidgibility Audit Deadline

[TexasJohn]

I'm in Texas.

I missed the dependent verification deadline for Dallas County Hospital District and my legitimate dependents were dropped from my health insurance plan.

I did some looking around and came across Patient Protection and Affordable Care Act Sec. 2712 which prohibits rescission of plan coverage unless an individual performs an act or practice that constitutes fraud or makes an intentional misrepresentation. The rule also references two other sections (2702C Medicare Provisions and 2712B Compliance with other Federal and State Requirements).

My employer has about 14,000 employees and many were affected just like me. The benefits administrator told me that other employees had appealed to the CEO, who would not budge on the issue.

I know that dependent eligibility audits are widely practiced and I am all for saving money where possible, however it sure doesn't look like it's legal to drop legitimate dependents.

Do I or any of the other affected employees have any recourse?

Is my employer correct to deem everyone's dependents as illegitimate unless proven otherwise and subsequently rescind their coverage?

 

[cbg]

That particular section of the PPACA does not go into effect until January of 2017. And YOUR coverage was not rescinded. YOU are the participant. Not your dependents. Medicare provision do not apply in this case and the final section you note refers to COBRA.

So there is nothing inherently illegal in what transpired.

Now, to take it a step further and determine what, if any, recourse you may have; please explain a little more about the audit. How long had your dependents been covered, what information was required, how long were you given to provide it, and why did you not?

Are the dropped dependents being offered COBRA?

Can they be re-added during your next Open Enrollment period if the missing information is provided?

 

[TexasJohn]

The audit was an email sent out to employees, to log on to a 3rd party web page, answer some questions and upload documents (such as birth certificates, marriage licenses, etc.).
The email was sent out in June and a period of about 30 days was given.
People that failed the audit or did not respond were dropped from coverage at the end of September.

My dependents have been covered since July of 2012 when I started working here. The younger ones were added as they were born and birth certificates were provided.

I did not notice the email and actually discovered the insurance was dropped when one of my children was ill and went to the doctor.

They are being offered COBRA.

My dependents are able to be re-added during open enrollment (effective Jan 1) without any documentation. The benefits manager informed me that there would be another audit around June of 2017 where I would be required to supply proof of eligibility or have them dropped again.

 

[cbg]

You said that your younger children were added as they were born and their birth certificates provided.

Were the older children's birth certificates provided at ANY time? Was your marriage certificate EVER provided?

Were the children whose birth certificates had previously be provided, dropped from coverage?

 

[TexasJohn]

The youngest child's birth certificate was sent directly to the benefits department via email after she was born.
The other 4 children's birth certificate was uploaded to the same 3rd party on 10/1/2012.
A phone call to that same 3rd party was made to verify that they had everything.

My marriage certificate was also uploaded at that time, however I am recently divorced.
I completed my divorce in June of this year (about the same time as that audit) and I provided the benefits department with my divorce decree so they could remove my ex-wife. (of course the decree says that I am still responsible to provide insurance for my children)

All five of my children have been dropped from my policy.

 

[TexasJohn]

I forgot to mention that the benefits manager told me that it is their intention to perform this audit every year, and I would be required to supply proof of eligibility each time.

 

[cbg]

Okay, it's not the way my employer would handle it, and I don't agree with the way they are dealing with it. But I can't see anything illegal in what they are doing, given that they provided COBRA, will allow reinstatement and are handling it consistently across the board.

Sorry. Watch your emails next year. That's all I can suggest.

 

[TexasJohn]

Thank you, I appreciate your time and advice. -John