Dependent Eligibility Audit

Who's Included in Audit?

If you are an active employee or retiree of the City of Boston, the Boston Public Health Commission or the Boston Water & Sewer Commission and have a dependent (spouse, ex-spouse or child) covered under a City of Boston health insurance plan, or if you are the surviving spouse of a former employee/retiree of the City of Boston, Boston Public Health Commission or Boston Water & Sewer Commission, and are receiving health insurance coverage from the City of Boston, please carefully read the notice below. If you receive health insurance from the City of Boston, but you are not covering a dependent, then this notice does not pertain to you.

Audit to Comply With New Legislation

“An Act Relative to Municipal Health Insurance” became law on July 12, 2011 (Chapter 69 Acts of 2011). In order to comply with this law the City of Boston will begin an audit of all dependents this September. This means that active employees and retirees who are covering dependents under their health plan will be required to provide certain documentation to verify their dependents’ eligibility. Surviving spouses will also be contacted and will need to provide certain documentation. There is no change in the eligibility requirement for dependents. This audit is just confirming that all dependents meet the already existing requirements.

City Hires Independent Auditor

The City has hired an independent auditor, HMS Employer Solutions, to conduct this audit. When you receive the letter from HMS in September, it will list the dependents you are currently covering under your health plan and it will state what documents you will need to submit to continue coverage for your dependents. These documents may include marriage certificates to cover a spouse, birth certificates/adoption paperwork to cover a dependent child, etc.

Please carefully read any correspondence you receive from HMS Employer Solutions because there are specific instructions and timelines outlined in the letter. Failure to follow the instructions could result in loss of coverage for your dependents. Detailed eligibility information, as well as a toll-free customer service phone number, fax number and customized web address will be included in the upcoming correspondence from HMS Employer Solutions. Feel free to contact them if you have any questions or need additional information.

Frequently Asked Questions

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Why are we doing the audit?
Who is getting audited?
Who is an eligible dependent?
What types of documentation will employees be required to submit?
What is the timeline for this audit?