Health Insurance eligibility audit

Typically, between 6% and 8% of dependents enrolled in a health insuance plan are not truly eligible for health coverage, but some employers have reported much higher percentages when conducting audits, according to Watson Wyatt Worldwide.

With more companies shifting to electronic enrollments in health plans, employees haven't had to provide documentation to prove who was eligible and who wasn't.

But as health insurance premiums rise, employers are paying closer attention to the people their employees report as dependents.

In some cases, employees really don't know they've signed up someone who is ineligible.

If you don't want any trouble, review the dependent eligibility rules for your plan. The list of who is covered varies by health insurance plan, but most often includes your spouse in a marriage legally recognized in your state, and your eligible children.

Children under age 19 are usually covered as long as the child is unmarried and counts on you for financial support. Disabled dependents over age 18 may be covered. In many cases children from age 19 to 25 are eligible if enrolled as full-time college students.

At the same time, don't assume automatically that an adult child isn't covered under your health plan. To combat the growing number of uninsured, many states have expanded the definition of a dependent, according to a report by the National Conference of State Legislatures.

Some plans now allow employees to enroll same-sex partners for benefits. Other plans might allow same-sex and opposite-sex partners. In either case, the partner may need to meet certain eligibility requirements specific to that plan or the state -- or both. To receive benefits, many employers require domestic partners to have lived together as a couple for at least six consecutive months.

Covered employees in domestic partnerships typically have to document the relationship. Such documentation varies by employers, but often requires proof of some financial relationship such as a joint lease or mortgage or copies of tax returns showing financial interdependence, according to the Employee Benefit Research Institute.