PLAN-GUARD™ SOLUTION OVERVIEW

Plan-Guard™ ensures that ineligible dependents will not get on your group health plans and incur claims that are fraudulent and present a liability and fiduciary infraction on the part of the plan sponsor.

Plan-Guard™ Services

• Tailored and adaptive to the clients plans, culture
• Automated process that provides consistent, objective, and defensible results
• Audit frequency and requirements defined by plan provisions, waiting periods, customized to each client’s needs.
• Ongoing verification services following a comprehensive dependent eligibility audit; or
• Audit specific populations (i.e. new hires, self-insured plans, students, etc.)
• Integrated with comprehensive audit project that provides document carry forward from audit to audit minimizes employee burden when spouse or student status is re-verified every 2-3 years.

Importance of Plan-Guard™ Ongoing Verification Services:

• Plan-Guard™ prevents duplicate work by your employees to stay “verified”. It eliminates the need to repeat a comprehensive audit every few years. If preventive measures are not incorporated following a comprehensive dependent eligibility audit project, most employers will be back in the same situation in 2-3 years and run the risk of covering 5%-10% ineligible dependent participation.
• Meet and maintain fiduciary compliance and avoid exposure and liability covering ineligible dependents on the corporate health plan
  (ERISA Exclusive Benefit Rule, Section 125, Sarbanes-Oxley)
• Who ultimately pays for fraud: you – the employer and the enrolled employees. Eliminating ineligible participants keeps you from ever paying out claim dollars for dependents that do not belong on your health plans.
• As a sign of the times, the Department of Defense now requires contractors to verify dependent eligibility.

Our Process

The Plan-Guard™ implementation and project process is designed to create a tailored solution without requiring our clients to invest much of their own time. We collect your information, including desired timelines, plan designs, and overall project tone to create a solution that will maximize your benefits while reflecting your internal company culture. Contact us today to discuss this process in detail.