San Francisco Health Service System Dependent Eligibility Verification Audit Begins April 2018


    Audit to Determine Eligibility of Spouses and Domestic Partners Covered by SFHSS

    In April, San Francisco Health Service System (SFHSS) will begin a Dependent Eligibility Verification Audit (DEVA). The audit will be conducted by a third party called Alight and administered by Aon, SFHSS’s actuarial consultant and trusted partner.

    Only active and retired members with spouses or domestic partners covered on their health plans will receive communications asking for verification of their currently enrolled spouse or domestic partner's eligibility to receive benefits from SFHSS. The audit is being performed in order to determine if any members are claiming an ineligible spouse or domestic partner on their health plan.

    Estimates indicate that approximately 5% of dependents covered on SFHSS plans are ineligible under SFHSS' Member Rules. Coverage for ineligible people can add up to millions of dollars in costs. The last audit conducted by SFHSS was in 2010.

    For members who have ineligible spouses or domestic partners covered, we will provide an amnesty period until April 30, when they can drop that ineligible person without penalty.

    Additionally, members who do not drop their ineligible dependents by June 15th may be required to repay the total cost of healthcare premiums and claims paid by SFHSS for the ineligible dependent. Members who have a dependent spouse or domestic partner will be asked to provide documentation to verify that the relationship is current and the dependent is eligible for benefits.

    Valid documentation is: • 2016 or 2017 tax returns or

    Proof of Cohabitation/Financial Interdependency dated within the past 12 months, such as: • joint lease/mortgage • joint bank account, • joint utility bill, or other appropriate documentation.

    Marriage Certificates or Certificates of Domestic Partnerships are not required documentation.

    Please note that if members fail to provide proof within the specified period of time, their ineligible dependents will be dropped from health plans effective July 1st. Even though the audit is only for spouses and domestic partners, it is very important to note that any child that is covered as a dependent of an ineligible spouse or domestic partner (for example, a step-child) will also be dropped from coverage effective July 1st.

    Please refer to the letters you receive for more detailed information about documentation requirements or please contact the Dependent Verification Center at (800) 725-5810 for more information. Representatives are available from 5:00am to 8:00pm PST Monday through Friday.