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Health insurance audit will weed out ineligible dependents

An an Oct. 18 meeting, Houston County Attorney Tom Hall, center, and Commissioner Tom McMichael, right, listen as Personnel Director Ken Carter explains a plan to audit the dependents on the county’s health insurance.
An an Oct. 18 meeting, Houston County Attorney Tom Hall, center, and Commissioner Tom McMichael, right, listen as Personnel Director Ken Carter explains a plan to audit the dependents on the county’s health insurance. The Telegraph

For the first time, the Houston County Commission is running an audit to make sure employees do not have ineligible dependents on the health insurance plan.

The board approved a change in the personnel policy last week that could mean employees will be fired if they have falsified information to get ineligible dependents covered. It could also mean that any claims paid will have to be refunded.

But there will be a grace period during the audit for employees to remove anyone from the insurance who shouldn’t be on it.

The county is self-insured, meaning that it directly pays health claims up to $150,000. Claims higher than that are paid by Blue Cross Blue Shield, which also administers the plan. The company is raising its costs to the county by $109,000 in the coming year.

Commission Chairman Tommy Stalnaker said the effort to remove ineligible dependents from the insurance plan is a way for the county to control costs.

“Every entity that I know of that has done an audit of their insurance, there have been people on it who should not be on it for whatever reason,” he said. “I think it’s small way we can begin to try to control costs, because obviously the more people you’ve got on it, the more it’s going to cost.”

Stalnaker said about 57 percent of the people on the county’s health insurance plan are dependents.

“That is one reason we need to look at it and be sure that all of the dependents on that plan are in fact still certified to be dependents,” he said.

Ken Carter, the county’s personnel director, said it might be that employees with ineligible dependents just aren’t aware of the requirements, rather than intentionally trying to defraud the county.

One of the most common issues stems from a divorce. One spouse might be required in a divorce settlement to continue to pay health insurance for the other, but a divorced spouse cannot be on the county’s plan. The employee would have to buy separate insurance coverage for the ex-spouse.

Also, if stepchildren are involved in a divorce, then the stepchildren cannot continue to be on the county’s insurance plan, Carter said.

Of the county’s 647 employees, 356 of them have dependents on the insurance plan. All employees with dependents have been sent a letter informing them that by Dec. 2, they must provide documentation that any dependents on county insurance are eligible. If they can’t prove that, then the dependents must be removed.

“I’m optimistic that we are going to find very few” ineligible, Carter said. “But I’m also thinking there will be a few out there that may not have understood that they couldn’t carry their divorced spouse or whatever on the insurance plan.”

Wayne Crenshaw: 478-256-9725, @WayneCrenshaw1

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