Argus offers an innovative, technology-driven Dependent Eligibility Management Service reducing current and long-term healthcare cost. Our program decreases legal, financial, and claim risk. It meets fiduciary and Sarbanes-Oxley obligations.


Dependent Eligibility Management Our new Dependent Eligibility Management Service initially identifies, reports, and removes spouses and children who are NOT ELIGIBLE for your organization’s medical plan. Examples may be:


  • Ex-spouses
  • Spouses covered under other plans (COB)
  • Domestic partners, common law spouses
  • Step-children, foster children, or married children
  • Students not enrolled in an accredited educational institution
  • Full-time students over a specified age


Statistics confirm that 5% to 15% of your covered dependents are not eligible for medical coverage. That coverage costs you $2,000 to $5,000 per dependent annually. And that means wasted healthcare dollars. You can solve this problem immediately, and stay on top of it in the future with our Dependent Eligibility Management Service. Here are the key reasons why our process is more effective and more efficient than other types of audit programs.


It’s an Electronic, Web-Based Process


Employees complete the audit questionnaire primarily online (supplemented by call center or paper, if necessary). They update their dependent data currently on file, and answer additional census-type questions about their family situations. They submit their information electronically into a single unified database. And you can monitor audit progress (employees finished, in-process, and ineligible) in real time.


It’s Built on Smart-Form, Rules-Based Architecture


Employees do not have to interpret rules, make decisions, or determine eligibility. They simply answer factual questions. Our proprietary questioning techniques, however, ensure the most valid, most truthful responses possible. Then, our rules-based engine, with your specific Summary Plan Description criteria built in, determines the ongoing eligibility of dependents.


It’s a Data Warehouse of Dependent Information


After the initial audit, we create a data warehouse that establishes current, baseline data for all dependents. The data is organized to support management reporting and analysis of dependent eligibility. It provides the data mining capability to uncover, forecast, and deal with issues that may affect future eligibility (like potential ineligibles, anomaly areas, demographics trends, etc).


It’s an Ongoing Eligibility Management Service


Further, we will work with you to develop an ongoing audit schedule designed to meet your specific needs for eligibility monitoring. Examples may be continuing reviews of college students, children turning 19, working spouses and Coordination of Benefits, new hires, status changes, random groups, or any other combination that best fits your organization and workforce.


Key Benefits to You


Our technology-driven ARGUS Dependent Eligibility Management Service delivers important benefits to you. It decreases your legal, financial, and claim risks. It reduces your current and future healthcare costs. And it allows you to outsource the management of dependent eligibility.