Don’t Get Caught in a Health Insurance Eligibility Bind

Imagine after a divorce or other life-changing event owing thousands of dollars in unpaid medical bills. It happened to a Texas man after a dependent eligibility verification audit (DEVA) found him ineligible for his former wife’s group health insurance.

Businesses that offer group health benefits look for ways to save costs, and one of those ways is with a DEVA. Auditors review an employer’s group health to find ineligible dependents who are receiving coverage under the employer’s plan.

These may include dependents who are unrelated to the employee, such as a niece or an ex-spouse, non-custodial children, or young adults older than age twenty-six. As part of the audit process, employers may ask employees to furnish documentation, including marriage and birth certificates and tax returns.

Auditors typically find 2% to 15% of group plan participants are ineligible. Their health coverage is terminated, and they usually have to repay amounts for medical bills paid out when ineligible.

The Texas man didn’t learn he wasn’t covered on his ex-wife’s plan until he owed thousands of dollars in medical care costs. And many people are in the same boat. Larger employers may offer COBRA coverage, but not all employers do.

Don’t get caught in this health insurance bind. If you have a life-changing event like a separation or divorce, a job change, or a change in a custodial or a noncustodial child’s status, contact your health insurance professional.

He or she can help you decide the best, most affordable option for health care coverage.