Earlier this year, the Division of State Group Insurance (DSGI) began requesting a random sample of employees’ documents as part of a quality assurance review to confirm that employees’ dependents, both newly added and existing, are eligible for insurance coverage. Effective Dec. 1, a Dependent Eligibility Verification Audit will include all employees with dependents enrolled in state plans.
Employees receiving requests for dependent documentation must respond promptly and submit appropriate documentation as noted in the request. Failure to submit legible copies of required documents can result in termination of insurance coverage for the dependents in question.
Please note: You may remove ineligible dependents by calling People First at 866-663-4735 at any time, but you must still respond to any requests for information from the company conducting the audit (Health Management Systems Inc.). If you have questions regarding dependent eligibility or required documentation that are not addressed below, please call DSGI at 850-921-4600.
Learn more in the FAQ.
Why is this audit occurring?
During the 2017 Legislative Session, the Florida Legislature directed the Department of Management Services’ Division of State Group Insurance (DSGI) to conduct a dependent eligibility verification audit to ensure accuracy in the State Group Health Insurance Program.
When will the audit begin?
The audit will begin later this month and applies to nearly 93,000 enrollees, with approximately 193,000 actively enrolled dependents. Initial requests for documents will go out in three separate batches starting at the end of December 2017. The last requests will be sent in early March 2018.
Who is conducting the audit?
Health Management Systems Inc. (HMS), an independent third-party cost containment company, has been contracted by the State of Florida to verify the eligibility of dependents covered under its health benefit plans. HMS specializes in verifying health plan eligibility and has reviewed verification documentation for millions of dependents for some of the largest employers in the U.S.
Will members be notified of the audit?
Yes. The first communication was a postcard mailed in August 2017 to all enrollees, which specified those dependents that are eligible. Beginning in December 2017, multiple communications will be sent to enrollees with email addresses listed in People First. HMS will also send out email and mail communications throughout the process. Please make sure your contact information in People First and the myUFL system is correct. To check or update your address in People First, log onto the site and select “Contact Information” in the My Quick Links section. To update your address in myUFL, view these instructions.
What will be required for enrollees under this audit?
Enrollees will be required to respond to any requests for documentation to verify the eligibility of their dependent(s). If enrollees do not send legible documents to HMS within the timeframe requested, or if their documents do not prove dependent eligibility, the insurance coverage for those particular dependents will be terminated.
The documentation required contains sensitive information. Is this process secure?
Protecting personal information is a priority to the State of Florida and HMS. In compliance with applicable federal and state regulations, information and documentation submitted to HMS for this audit will be stored, processed and protected by physical, electronic and procedural safeguards. When submitting your tax documentation, only the top portion, which includes the names of the employee, spouse and any dependent child(ren) is required. Please mark out Social Security Numbers and any income information.
All documents are securely stored for six months following completion of the verification audit. Upon expiration of the retention period, all documents and electronic files will be securely destroyed by HMS, and a Certificate of Destruction will be supplied to the State of Florida. Documents provided will NOT be returned. Only HMS employees directly involved in the State of Florida dependent verification audit will have access to these documents.
What documentation is needed to verify my dependent’s eligibility?
Please visit this State of Florida website to learn what documents are required for which dependents.
What type of tax transcript do I need to supply?
You can request a tax transcript online at www.irs.gov. Select the “return transcript” for the most recent year filed.
I would like to submit documentation before I receive a letter from HMS. What should I do?
Do not send documentation before you receive a letter from HMS. HMS will not accept documentation until a letter has been sent out.
How do I submit documentation to HMS?
Instructions on how to submit documentation will be contained in the letter sent by HMS.
What happens if I do not submit all required documents by the verification deadline?
If you do not submit complete documentation for your dependents by the deadline, or if you knowingly submit false information for enrolled dependents, one or all of the following actions may occur:
The State of Florida is ultimately responsible for determining how best to handle each individual case.
May I provide my documents to UFHR?
No. UFHR will not be able to forward your documents to HMS or provide employees with copies of previously submitted documents. The only way to ensure that all documents are logged appropriately and that eligibility of your dependents is verified is to submit your supporting documentation to HMS. The State of Florida, People First and UFHR will not be able to answer questions or provide assistance with the verification audit, as this is an independent review conducted by HMS. All inquiries should be directed to HMS.
Where can I go for more information?