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SFHSS audit finds about 808 dependents ineligible, estimates ~$2.9 million in 2018 premium savings

San Francisco Health Service System Board · January 10, 2019
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Summary

HSS reported results of a full dependent verification audit covering 26,319 members: 25,511 dependents verified, 808 dependents were not verified and removed from coverage; the audit produced a conservative estimate of roughly $2.9 million in 2018 premium savings and revealed communications challenges with third‑party mailings.

Mitchell Griggs, chief operating officer of the San Francisco Health Service System, told the board that a dependent eligibility verification audit begun in April 2018 covered 26,319 employees and retirees who had an enrolled spouse or domestic partner. "Our audit began in April 2018, and included, just over 26,000 employees and retirees who have an enrolled legal spouse or domestic partner," Griggs said.

Griggs said 25,511 dependents were verified and kept on coverage; about 808 dependents were not verified and were dropped from eligibility under the system's member rules. "When the verification was complete, the dependents that were not verified and moving forward they did not have eligibility was about…

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