Managed Care


Employers Focus On Just Who Should Be Covered

MANAGED CARE November 2006. © MediMedia USA
News and Commentary

Employers Focus On Just Who Should Be Covered

MANAGED CARE November 2006. ©MediMedia USA

Here are two interesting recent moves by employers. There are reports that more businesses have begun conducting audits of workers to ensure that all the dependents listed on a health benefits policy are really dependents. Also, some companies are charging higher premiums to workers whose spouses could have obtained insurance from their own employers, but choose not to.

First, about those audits. It is not a new idea, but it appears that it is getting more attention. Sara Taylor, a benefit expert at Hewitt Associates, tells the Baltimore Sun that audits find that 2 percent to 15 percent of listed dependents are, in fact, not eligible. That anecdotal evidence? Well, there's this parenthetical in the article: "The Tribune Co., which owns the Sun, will launch an audit next year." Talk about news that hits close to the cubicle.

Meanwhile, the Los Angeles Times reports that more and more companies are penalizing workers who double up on coverage. The Times cites a Mercer study that says that 6 percent of businesses charged higher premiums for spouses of employees who could have obtained coverage from their own employers. "On average, the additional premium was $178 a month — or $2,136 a year," the paper reports.

Barry Barnett, a principal at PricewaterhouseCoopers, tells the Times that "In the old days, if you both worked, spouses would be covered under both plans and you'd get 100 percent coverage.

But in the last two years, we've seen employers looking at whether the spouse has coverage under another plan. If they do, the company will charge more."


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