Public Employee Press

Health benefits audit
Court asks 22,000 policyholders for more documentation to verify dependents' eligibility

The city has notified 22,000 municipal employees and retirees that they must submit further documentation to verify that their dependents are eligible to be included in their health-care coverage.

Earlier this year, the city launched an audit of more than 300,000 members and retirees with family health-care plans.

The city asked the policyholders to submit documentation, such as marriage and birth certificates, to prove that their dependents are eligible for coverage. If the audit finds that the dependents aren't eligible, the city will convert the policyholder's family plan into an individual plan and their reported dependents will lose coverage.

Before the city initiated the audit, city unions worked out an agreement to protect the privacy of members and retirees; established an amnesty for policyholders with ineligible dependents, and set up a three-step appeals process for individuals who, according to the outside auditor, submitted inadequate documentation.

The city's mailing to the 22,000 policyholders in November has triggered the first step in the appeals process. To avoid having their dependents lose insurance coverage, recipients of the mailing must fill out an affidavit and submit additional documentation to the outside auditor, Aon Hewitt.

The tentative deadline for the step 1 appeal is Dec. 20.

In the second and third steps of the appeals process, union members and retirees will be able to count on representation from the Municipal Labor Committee. In the step 2 appeal process, a city technical representative and an MLC technical representative will review the documents. Arbitrators will handle step 3 appeals. The deadlines for the step 2 and step 3 appeals are not set yet.

Anyone with questions or concerns about the verification process should call Aon at 855-594-7454.