HSS reports 95% compliance in 2024 dependent eligibility verification audit; estimated $417,000 annual savings

Augusto Divinci Velasquez, operations manager for SFHSS, presented the results of the 2024 dependent eligibility verification audit on Aug. 8, reporting high compliance and modest estimated savings while outlining outreach and appeals procedures.

Velasquez said the audit sampled about 985 active members with a dependent population of approximately 2,127 and achieved a reported compliance rate of 95 percent. At the data pull, 104 dependents were identified for termination as ineligible — about 5 percent of the audited dependent population — and staff estimate an annual savings of $417,000 from removing ineligible dependents.

Velasquez described a multichannel communications campaign (bright pink mailers, email reminders and an eBenefits portal), a dedicated DIVA phone queue staffed by three benefits analysts and one supervisor, and an emphasis on consistent documentation standards across dependents, spouses and domestic partners. She said 77 percent of respondents used the eBenefits portal and almost 800 audited child dependents were already compliant due to existing documentation.

HSS COO Reggien told the board the program took a nonpunitive approach: members who complied after a termination were reinstated and HSS received eight formal appeals tied mainly to tax-filing status for spouses. Commissioners asked about follow-up steps for nonresponders; Velasquez described reminder letters, email outreach and a three-month communications effort that yielded additional compliance.

Velasquez said next steps include evaluating whether future audits will be conducted internally or with external vendors and clarifying process capacity for larger samples. The board thanked staff for extensive member outreach and the high completion rate.