Spouse and Dependent Audit
The South Dakota State Employee Health Plan is partnering with Dialog Direct to conduct a spouse and dependent eligibility audit in the fall of FY19. This means employees will be required to certify spouses and dependents enrolled in the health plan, and/or flexible benefits, are eligible for coverage. As a reminder, employees may cover spouses and dependent children up to age 26 or up to age 29 if the child is a full-time student.
The first page of the eligibility worksheet sent to employees as part of the Spouse and Dependent Verification Audit has an error. A dependent child either needs to be under age 26 or between ages 26-29 and a full-time student, not both. The corrected version of this section is below.
If you cover a spouse or dependents on the health plan and/or flexible benefits, it is recommended you review the eligibility requirements. Employees are not able to cover adult dependents if the adult dependent is also a state employee.
If you have questions, please call the Dialog Direct Dependent Eligibility Verification Service Center at 800.899.9685 between 9 a.m. and 6 p.m. CT, Monday-Friday for more information.
Members should receive their first informational packet from Dialog Direct by mail with more details the week of September 10.
IMPORTANT INFORMATION (9/17/18):
The initial mailing for the Dependent Verification Audit was sent on September 7 by Dialog Direct. Although the packets were sent as pre-sorted first class mail and expected to arrive last week, we understand very few employees have received the information thus far.
Therefore, we will need to extend the deadline for submitting the verification documents past the original November 9, 2018 deadline. We will provide the revised deadline as soon as we can establish the initial letters have been delivered.
In the meantime, if you would like to begin the process of gathering your verification documents, please call the Dialog Direct Dependent Eligibility Verification Service Center toll-free number at 800.899.9685 between 9 a.m. and 6 p.m. CT, Monday-Friday to determine the documents you will need to validate your dependents.
- Have questions? Contact the State of South Dakota Spouse and Dependent Eligibility Verification Service Center, administered by Dialog Direct at 800.899.9685. The Service Center is available from 9 a.m. to 6 p.m. CT, Monday through Friday.
Frequently Asked Questions
Q: Is a birth certificate all I need to verify my dependent child?
A: If a mother is or has been married, a birth certificate for their dependent child from South Dakota or another state that only shows the mother's maiden name may not be enough to prove the relationship. Additional proof of relationship will be required in addition to birth certificates, such as a marriage certificate that shows a married name, or a redacted tax return that lists parents and dependents.
Q: If two state employees are married but one covers the other on a flex benefits program, like dental insurance, will the employee who covers the spouse be required to verify eligibility?
Q: If two state employees are married and each cover children on different parts of the benefits program, do both employees need to submit documentation?
Q: I turned these materials in years ago. Why do I have to do it again?
A: More than eight years ago, the South Dakota State Employee Health Plan required employees who added a spouse or dependent through a Family Status Change form to provide eligibility of documentation. Documentation was never collected when a spouse and/or dependents were added to the health plan when an employee first enrolled or were added during annual enrollment.
The practice of collecting proof of eligibility was discontinued and previous documents are no longer available.
Q: If dependents are found to be ineligible for coverage by the benefits program, will they be eligible for COBRA?
Q: Do status letters get sent only after the November 9 deadline?
A: No. Each time an employee submits documentation, he or she will receive a status letter from Dialog Direct within 7-10 days of receipt.
Q: Can employees use their work scanner and computer to submit documents to Dialog Direct?
Q: I lost my original letters. How do I submit my documents?
A: An employee who has lost his or her original notification of the dependent eligibility audit must contact Dialog Direct. The letters include individualized barcodes, which must accompany document submissions.
Q: Will an employee found to be covering an ineligible spouse or dependent be penalized?
A: No. There will be no effort to recover claims paid for an ineligible spouse or dependent or penalties to the employee.
Q: Are we going to have to do this every so many years now?
A: No, this is the first step in an on-going verification process. From this point forward, documentation will be required to add a spouse and/or dependents to the health plan or flexible benefits program. Employees who add a dependent during annual enrollment or by submitting a Family Status Change form will be contacted by Dialog Direct to submit the required verification documents.
Q: If an employee uses his or her HSA to pay expenses for a spouse and/or dependents but does not cover these individuals through the benefits program is verification required?
A: No. The IRS permits the use of HSA funds to pay for eligible expenses for any immediate family member, regardless if they are covered on the same insurance plan.