Dependent Eligibility Verification Audit Checklist

Audit enrolled dependents against required eligibility documentation to identify ineligible dependents, confirm documentation completeness, and support plan cost control.

Audit Scope and Population

• Audit population and plan period are defined
  Verify the audit includes the correct employee group, plan year, and dependent population under review.
• Dependent types included in scope are identified
  Confirm which dependent types are being audited, such as spouse, child, stepchild, domestic partner, or other eligible dependent categories.
• Sampling method or full-population review documented
  Record whether the audit is a full census or a sample review and note the selection method used.
• Audit roster matches current enrollment file
  Confirm the list of employees and enrolled dependents matches the current benefits enrollment record.

Required Documentation Review

• Birth certificate or equivalent proof of relationship is on file for each child dependent
  Confirm a birth certificate, hospital record, adoption decree, or other acceptable proof is present for each child dependent.
• Marriage certificate or equivalent proof is on file for each spouse dependent
  Confirm a marriage certificate or other acceptable proof of spousal relationship is present for each spouse dependent.
• Adoption, guardianship, or court order documentation is on file where applicable
  Verify legal documents support eligibility for adopted children, wards, or dependents under guardianship.
• Proof of financial dependency is on file where required by plan rules
  Confirm tax return, affidavit, or other plan-approved proof of dependency is present when required for eligibility.
• Documentation is current, legible, and matches the enrolled dependent
  Check that names, dates, and relationship details on the documents match the enrolled dependent record and are readable.

Eligibility Validation

• Dependent age and relationship requirements are met
  Verify each dependent meets the plan's age, student, marital, or relationship eligibility rules as applicable.
• Dependent residency or custody requirements are met where applicable
  Confirm residency, custody, or court-ordered support requirements are satisfied when required by the plan.
• Duplicate coverage or conflicting eligibility is identified
  Check for duplicate dependent enrollment, conflicting spouse coverage, or other indicators of ineligible coverage.
• Exceptions or grandfathered cases are documented and approved
  Verify any exception to standard eligibility rules is documented with approval from HR or plan administration.

Audit Findings and Non-Conformances

• Missing documentation findings are recorded by dependent
  Document each missing or incomplete proof item and identify the affected dependent.
• Ineligible dependents are identified for removal
  List any dependents determined to be ineligible under plan rules and note the reason for removal.
• Financial impact or cost recovery estimate documented
  Capture estimated premium savings, recovery amount, or other financial impact associated with the audit findings.
• Corrective action owner and due date assigned
  Assign responsibility for follow-up, dependent removal, employee notification, or documentation correction.

Review Sign-Off

• Audit results reviewed with HR or benefits administration
  Confirm the findings were reviewed with the appropriate HR or benefits representative.
• Final disposition status recorded
  Record the final status of the audit, such as passed, passed with findings, or failed.
• Inspector signature captured
  Capture the signature of the reviewer completing the dependent eligibility audit.