Dependent Eligibility Verification Audit Status
(All Members)

As previously advised, the State Health Plan has continued to reach out to subscribers who did not submit dependent eligibility verification documentation by the end of the Dependent Eligibility Verification Audit.  To date we have approximately 1,300 subscribers who have yet to respond.  We also have about 1,000 subscribers who submitted documents that were invalid.

The Plan continues to reach out to both populations to obtain the appropriate documentation.  We also plan to audit the outstanding subscribers with their Open Enrollment elections to determine if any of their dependents have been dropped for January 1, 2018. If they have been dropped, we will cease any efforts to obtain those documents.  We are still targeting to send a final termination notice in December to subscribers who have not complied with the audit and therefore should be terminated. The termination date for these dependents will be February 1, 2018.

As a reminder, please do not click "verify" for any employees with Missing Dependent Verification tasks for dependents included in the Dependent Eligibility Verification Audit, which includes all dependents under the age of 75 as of April 19, 2017. The Plan continues to identify employees who have had dependents verified by the HBR.  This is resulting in additional work to remove the “verified” status on the dependents.

Ongoing Dependent Eligibility and Qualifying Life Event Verification

The Plan is pleased to see that some employing units have incorporated the eEnroll document center into their ongoing efforts to collect dependent eligibility verification and qualifying life event (QLE) documentation.  Unfortunately, through our own audits on these events we are finding that many employing units still do not have a process in place to collect this information. It is imperative that the appropriate documents are obtained for these transactions and we strongly recommend usage of the document upload functionality within eEnroll. Once the documents are uploaded and verified, no further action is required.

As reminder, as legislated in North Carolina General Statute 135-48.1 (16), HBRs are responsible for ensuring that employees and dependents meet the Plan’s eligibility requirements. This includes validating that a status change meets the requirements of a qualifying life event and verifying the eligibility of any new dependent that is added to the Plan.

The Plan will continue to audit QLEs and newly added dependents (whether the dependents are added as part of the new hire enrollment, through Open Enrollment or through a QLE). If the appropriate documentation has not been provided, we will allow two weeks for the member or HBR to produce the documents. If the documents are not successfully uploaded or sent to us, the Plan will have the transaction reversed with a future effective date.

  • Step 1 – Review Employee’s eEnroll Record: The Plan will review the document center for valid documentation.  If a valid document is uploaded to the employee’s eEnroll record, the audit for this member ends.
  • Step 2 – Notification:
    • Employee - If there is no document uploaded or the uploaded document is invalid, the Plan will send a message directly to the employee requesting the documentation. The message will include instructions on how to upload the documents and a deadline for providing the documents.  We will also include instructions about how to send the documents to us if uploading is not an option.
    • Employing Unit – The Plan will email the HBR to notify them that the employee has been targeted for audit.  If the HBR has the documents, they can either upload them to the document center or send them to the Plan for verification and upload.
  • Step 3 – Documents Received:
    • Valid Documents - If documents are approved, the employees will receive a confirmation email.
    • Invalid Documents - If submitted documents are not valid, employee will receive a follow-up email requesting new documents and a timeline for submission.
  • Step 4 – Documents Not Received - If appropriate documents are not received by the deadline, the employee’s transaction will be reversed. The employee and HBR will be notified.

We recognize that some employees do not have a valid email in eEnroll.  In those instances, we will reach out to the HBR to obtain the correct email address.

Dependent Audit Hotline: 866-416-4476
Fax: 919-855-5819
Email Address:

Members are now able to submit documents via mail to:

State Health Plan
Attention: Dependent Audit
3200 Atlantic Ave.
Raleigh, NC 27604