HSS is Auditing Employees Who Claim Spouses or Domestic Partners on their Health Insurance

In April, the San Francisco Health Services System (HSS) will start doing a Dependent Eligibility Verification Audit of all city employees who cover their spouse or domestic partner on the city-provided health plan.

The audit is to determine if people are improperly claiming a spouse or domestic partner on their health plan when they are no longer married or partnered to that person. HSS says that there are approximately 22,000 city employees who currently claim a spouse or partner, and they believe that approximately 5% of those claims are inappropriate.

Dependent Eligibility Verification Audits are standard operating procedures for employer health plans and insurance providers. Normally, audits are done every 3 to 5 years, but HSS has not performed one since 2010. HSS believes that cleaning up their data through this audit could save the system millions of dollars. This audit will only cover spouses and domestic partners. There is no plan to audit child dependents.

If you currently claim a spouse or domestic partner on your city-provided health plan, expect to receive a letter from HSS in early April. For employees who are currently claiming someone who is no longer their spouse or partner, there will be a one-month amnesty period for you to drop that ineligible person.

After the amnesty period ends, employees will be asked to provide documentation that verifies that the person they claim is still their spouse/partner. This could be a tax return if you have jointly filed, a joint lease or bank account, a joint utility bill, or other documents that show that you are in fact married with and/or living with the person you are claiming.

If employees fail to provide proof within the defined period, HSS will begin dropping ineligible dependents off health plans sometime in July. There will be an appeals process for anyone who is accidentally dropped.