Dependent Eligibility Controls Playbook

Dependent eligibility leakage happens quietly:

• ineligible dependents remain enrolled
• terminations and life events are not processed quickly
• documentation is inconsistent
• no one owns the control as a recurring process

This playbook installs an eligibility control you can run repeatedly without chaos.

Not legal advice.

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What you will install

1. Eligibility rules in plain English
2. A quarterly or semiannual eligibility check cadence
3. Documentation and exception handling workflow
4. A clean appeals process
5. Ongoing controls to prevent recurrence

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Step-by-step playbook

Step 1: Define eligibility rules simply

Write the rules like you are explaining them to a new hire:

• who qualifies as a dependent
• what documentation is acceptable
• what happens if documentation is missing
• timelines for response and termination

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Step 2: Choose a cadence you can sustain

Beginner-safe:

• quarterly checks for high-change populations
• semiannual for stable populations

Consistency matters more than perfection.

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Step 3: Run an eligibility check workflow

Workflow stages:

1. notify employees
2. collect documentation or attestation
3. review and resolve exceptions
4. confirm removals and effective dates
5. document outcomes

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Step 4: Handle appeals without breaking the system

Appeals should be:

• time-bound
• documented
• resolved by a defined owner

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Step 5: Install ongoing controls

Prevention controls:

• termination feed from HRIS to benefits admin
• life event changes require documentation
• periodic roster reconciliation
• simple dashboard: dependent counts and change rates

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Templates

A) Eligibility policy statement (copy/paste)

Copyable template (TEXT)
Copy
Dependent Eligibility Policy (Plain English)

Only eligible dependents may be enrolled.

Employees must provide documentation when requested.
If documentation is not provided by the deadline, the dependent may be removed from coverage.

Appeals may be submitted within the appeal window and must include supporting documentation.

This policy is intended to keep coverage accurate and prevent incorrect premiums.

B) Employee notification email (copy/paste)

Copyable template (TEXT)
Copy
Subject: Dependent Eligibility Verification for Benefits Coverage

We are conducting a dependent eligibility verification to ensure benefits coverage remains accurate.

What you need to do:
- If you have dependents enrolled, you may be asked to confirm eligibility and provide documentation.
- Please respond by the deadline to avoid disruption.

Why we are doing this:
- To keep coverage accurate and manage costs fairly.

Deadline:
Support:

C) Eligibility audit tracker (copy/paste)

Copyable template (TEXT)
Copy
Eligibility Verification Tracker

Employee:
Dependent:
Status: pending / verified / needs-docs / removed / appealed
Docs received:
Deadline:
Outcome date:
Notes: