Sarah comes in your office with a problem; according to her dentist, she isn’t on your dental plan. She knows she enrolled last year. She shows you her pay stub, with a dental deduction. You ask accounting to pull up the dental bill and find that she isn’t on it. How could she have dropped off you ask? She was never on the bill says accounting. How can that be? Sound familiar?
What if it had been her health plan and she had been denied at the hospital? What if it was a life or disability insurance claim? Who would be liable?
To make matters worse, health plans are implementing strict retroactivity policies. No longer will they reinstate for more than a month or two. Gone are the days of six month reinstatements and paying of claims.
Today it’s more important than ever to check all the bills every month. Mistakes happen, and they cut both ways. Suppose Sarah had been terminated last year but was still on the medical bill with family coverage? Could you get a credit? Don’t bet on it.
Suppose Sarah had full family coverage, but had a payroll deduction for single coverage. Would she know? Would she bring it to your attention? Could you collect the back premium? Would you? How many Sarahs could you have? What is the cost?
Now more than ever it is a minimum responsibility of all plan sponsors to check the bills against enrollment and deduction data. Don’t have a benefits administration system to check against? That’s another problem. Mistakes happen and now they are much harder to fix and can be very expensive.