These questions and answers are for general information purposes only. This information does not create an employment contract between the employee and the agency. This information does not create any contractual rights or entitlements. The agency reserves the right to revise the content of this information, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment. This information does not constitute tax or legal advice.
Dependent Eligibility Audit
Q. Why is PEBA Insurance Benefits conducting this verification audit?
A. Your employer-sponsored health insurance is a valuable benefit, but it is also a costly one. It becomes more costly to you and your employer when ineligible dependents are covered. The audit is to ensure that only eligible dependents are covered under your state benefits. This will help us control costs and ensure enrollment files are accurate.
Q. Why am I being required to submit verification of my family members but my coworker is not?
A. The dependent eligibility audit is an ongoing process. PEBA Insurance Benefits anticipates it will take 18 to 24 months to complete. If your coworkers are covering any dependents, they will be required to submit verification before the audit is completed.
Q. What types of dependents are being verified/audited?
A. Any family member covered under one or more benefits offered by PEBA Insurance Benefits is subject to verification.
Q. What happens if I do not respond to the verification request?
A. If you do not respond, your dependents will be removed from your coverage.
Q. What can I do if an eligible dependent is removed?
A. You have 90 days from the date your dependent’s coverage is canceled to appeal the decision. Include the required documentation to support eligibility with your request. Instructions on how to appeal will be included in the termination notification.
Q. Why aren't my dependents being offered COBRA?
A. Termination of a dependent who was not eligible for coverage is not a COBRA Qualifying Event. Therefore, the dependent is not eligible for COBRA coverage.
Q. What type of documentation will I be required to submit?
A. A complete list of acceptable documents will be included on the verification worksheet. The most common documents will be a birth certificate, marriage license and/or the front page of your most recent tax return.
Q. Should I send originals?
A. No. Send copies only. After the documents have been electronically added to your file, the paper documentation will be destroyed. Be sure that the copies you send are legible.
Q. My child’s birth certificate says “Do not copy.”
A. For the purpose of this verification audit, a copy will be acceptable.
Q. My child’s birth certificate does not show the name of the parents.
A. Most states (including South Carolina) offer both a short and a long form of a child’s birth certificate. The long form includes the parents’ names and is the only birth certificate that will be accepted.
Q. My child's birth certificate has my previous last name and not my current last name. Will PEBA Insurance Benefits require any additional documentation to verify our relationship?
A. Not at this time. PEBA Insurance Benefits will review the documentation submitted, and will contact you within 10 business days if additional information is needed.
Q. Where can I get a copy of my child’s birth certificate?
A. The South Carolina Department of Health and Environmental Control (DHEC) office can assist you with this. Be sure to ask for the “Long Form,” which includes the parents’ names. The long form is not available through the county DHEC offices. For more information about obtaining birth certificates, visit: www.scdhec.gov/administration/vr/birth.htm. If your child was not born in South Carolina, you can find information on how to request his birth certificate here.
If you would like to request a birth certificate online, most states refer citizens to VitalCheck. VitalCheck, a private company, is not affiliated with the State of South Carolina, and additional fees are charged as well as any applicable state fees. Phone and online orders: Call 877-284-1008 (toll-free) or visit Vitalchek 7 days a week, 24 hours a day. Average processing time is 5-7 business days.
Q. I have been audited and cannot find the birth certificate for one of my three children. I have requested a copy, but it will not arrive before the deadline. I have documentation for the other two children. What should I do?
A. PEBA Insurance Benefits would prefer that all documents be submitted at the same time; however, we understand there may be times when that is not possible. If you are unable to obtain documentation for one of your dependents before the deadline, you should submit the Dependent Verification Form and documentation for the remaining dependents to ensure their coverage will continue. Only the dependent without documentation will be dropped from coverage.
You have 90 days from the date of termination to submit the required documentation for the terminated dependent. If you receive the documentation within 90 days, you may submit documentation along with a letter of appeal to: PEBA Insurance Benefits Appeals Committee, PO Box 11661, Columbia, South Carolina 29211. If the documentation is acceptable, the dependent will be reinstated without a break in coverage.
Q. My child was born in another country. What documentation will you accept?
A. PEBA Insurance Benefits will review birth records from other countries. If the documents you submit are not sufficient, PEBA Insurance Benefits will contact you for additional information before the child is terminated from coverage.
Q. My dependent documentation was issued in a foreign country and is not in English. Do I need to provide a copy of the document translated into English for it to be acceptable?
A. Yes. Any document provided as proof of eligibility that is in a foreign language (such as marriage certificate or birth certificate) must be completely translated into English and should be certified with a letter of accuracy from the translator.
If you do not have a translation and you wish to submit a copy of the foreign document, PEBA Insurance Benefits will try to provide a translation, but depending upon the language (or symbol language), if PEBA Insurance Benefits cannot adequately translate the document, you will be mailed a letter advising that you are responsible for providing an acceptable English translation.
Q. Where can I get a copy of my marriage license?
A. You can find information on how to get a copy of your marriage license here.
Q. Where can I get a copy of my latest tax return?
A. If you need a copy of your tax return, you may request it from the IRS. For instructions, visit www.irs.gov. Under "Tools," click on "Order a Return or Account Transcript."
Q. I am recently married and my spouse isn’t listed on my tax return. How do I show we are married?
A. If you have been married for less than one year, PEBA Insurance Benefits will accept a marriage license as verification, and you do not need to submit a tax return.
Q. I have been married for many years. Why can’t you accept a copy of my marriage license?
A. The purpose of the audit is to ensure that only eligible dependents are covered by the plan. A marriage license, along with a copy of page 1 of your most recent tax return, ensures that you are covering a current spouse and not a former spouse. Former spouses are only eligible if the divorce decree mandates coverage.
You should black out all financial information from your tax return before sending it.
Q. My spouse and I file our taxes separately. What should I send?
A. A copy of both your and your spouse’s most recent tax return, with all financial information blacked out.
Q. I missed the deadline to submit the required documentation. What should I do?
A. Submit it as soon as possible. If your dependents have not already been removed from coverage, the documentation will be accepted. If you have already been notified that your dependents have been removed, you may appeal the decision. Include the required documentation to support eligibility with your request. Instructions on how to appeal will be included in the termination notification.
Q. I have submitted the requested documents. What should I do next?
A. You do not need to do anything at this time. Your documentation will be reviewed to determine your dependents’ eligibility. If all dependents on your coverage are eligible, your coverage will not change. If any dependent on your coverage is deemed ineligible, you will receive a letter to notify you of the termination and explaining your right to appeal.
To check the audit status of your dependents, please wait seven business days from the day you mail your documentation, then go to MyBenefits and select “Review Benefits” from the dropdown menu. There is a field next to each dependent for audit status.
Q. Can I provide documentation for my dependents before I am audited?
A. You are permitted to provide documentation before you are audited. Submit the Dependent Verification Form along with the required documentation for each of your covered dependents. You must submit documentation for all dependents at the same time. If you file in advance, coverage for any dependent who is not documented will be terminated by PEBA Insurance Benefits.
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