Hertz sample Initial Letter.pdf - ConSova

Si quisiera recibir una copia de esta carta en español
por favor comuníquese con ConSova 866-964-1315
Month Day, Year
John Smith
123 ABC Way
Anywhere, USA 99999
- IMMEDIATE ACTION IS REQUIRED -
IF YOU DO NOT RESPOND TO THE ENCLOSED VERIFICATION REQUEST, BENEFIT COVERAGE
FOR YOUR DEPENDENT(S) WILL BE CANCELLED.
Dear John Smith:
As part of Hertz’ ongoing efforts to manage the cost of our health coverage under the Hertz Custom
Benefit Program, we want to ensure that only eligible dependents are enrolled. To assist us in this effort,
we have retained ConSova, a benefits audit firm specializing in the verification of dependent eligibility.
ConSova is contacting every employee who has one or more dependents enrolled in a Hertz health care
plan and is asking for verification of eligibility. The verification process, and what is expected from you, is
explained in detail in the attached letter from ConSova. For general information about the verification
process, please review the enclosed Frequently Asked Questions.
If you have one or more dependents enrolled in a company-sponsored medical insurance plan you will
need to submit supporting documentation to verify their eligibility. The attached verification request from
ConSova provides you with:
identification of the dependent(s) you currently have enrolled in a Hertz-sponsored benefit plan
the plan eligibility requirements as set forth in the Summary Plan Description (SPD)
Please be assured the information you provide is kept secure and confidential. ConSova, a named
Business Associate of Hertz as defined under the Health Insurance Portability and Accountability Act of
1996 (HIPAA), complies with all provisions of the law.
If you have any questions about dependent eligibility or the verification process, please contact ConSova’s
Dependent Eligibility Assistance Center at 1-866-964-1315. ConSova Associates are available Monday
through Friday, 9:00 a.m. – 5:00 p.m. Central Time.
Thank you for your cooperation.
Corporate Employee Benefits Department

Frequently Asked Questions
Why is Hertz conducting this audit?
The cost of providing health care benefits to employees continues to rise at an alarming pace. At Hertz,
we want to ensure that we are doing everything we can to manage those costs for employees who are
covering eligible dependents. Employers across the nation are conducting such audits and are discovering
an alarming number of ineligible dependents covered under their plans. The costs associated with
covering ineligible dependents can be millions of dollars for an employer the size of Hertz.
Where did ConSova get my personal information?
ConSova initially receives your basic personal information from your employer prior to the start of an
audit. During the audit we receive personal information from you.
Who is ConSova?
ConSova is a human resources firm that specializes in the dependent eligibility verification process and
has conducted many dependent verification audits for Fortune 500 companies and governmental
organizations.
What guarantee do we have that our personal documents will be kept secure?
ConSova considers security and confidentiality a very serious matter. They utilize encryption technology
to transact sensitive data. The server that maintains Dependent Eligibility Verification systems and
scanned images is only accessible on ConSova’s Local Area Network located in Lakewood, Colorado. This
Local Area Network is a closed system that is not accessible via Virtual Private Network or any other
interactive connection.
ConSova Associates have audited over 1.5 million dependents in the past eight years, and they have
never been accused or alleged to have not protected the private personal information of its clients’
employees.
Hertz realizes and understands that employees may have concerns about releasing this information to a
third party. We assure you that every precaution has been taken to ensure your information is kept
confidential. As we do with our other benefits service providers, Hertz and ConSova have entered into a
privacy and security agreement (Business Associates Agreement) which is governed by federal privacy
laws. You can help protect your own privacy by following the instructions included with the enclosed letter
from ConSova.
Will the submitted documents be retained by ConSova? If so, for how long?
Documentation received from Hertz employees will be batched and maintained in a secure location
monitored only by ConSova employees. 30 days after the dependent verification is completed, ConSova
will shred all documentation and wipe all hard drives containing protected health information.
Can I black out my financial information and Social Security number on these documents?
On any document you provide, you may cross out all financial information and the first five digits of your
Social Security number.
Can I submit my documents to my local Human Resources Department instead of ConSova?
No. All documents must be provided directly to ConSova for review.
If I am unable to supply documentation by the deadline for my eligible dependent, will Hertz
terminate my dependent from the plan?
If you are experiencing any difficulties in gathering the requested documents, as long as you continue to
keep ConSova updated as to the status of your gathering the appropriate documents, your dependent(s)
will not be automatically terminated if you do not meet the submission deadline. Eventually, Hertz will
terminate a dependent if it is determined that you are unable to provide documentation that verifies
eligibility. ConSova is willing to assist you through this process, including helping you contact agencies to
locate the documents you need.

Month Day, Year
Dear John Smith:
Dependent Eligibility Verification
As part of an operational excellence initiative to increase efficiencies and reduce costs, Hertz has retained the
services of ConSova Corporation to collect documentation to review and verify eligibility for dependents in the
company’s medical programs.
Dependent(s) you have included on Hertz sponsored medical plan are listed below:
Dependent Name Relationship Year of Birth
Michelle Smith Spouse 1956
Jane Smith Child 1990
Your Action Items
Review your list of dependents above and the detailed explanation of the documentation you will need to
provide to verify eligibility for dependent(s) on the following pages.
Complete and sign the enclosed Dependent Verification Form. If any of your dependents listed above are no
longer eligible for medical coverage, please provide their names and the reason for ineligibility on this form.
Coverage for ineligible dependents will end as soon as reasonably possible after this has been reported to
Hertz.
Upload documentation by logging into www.consova.com/hertz or mail documentation in the enclosed
postage-paid envelope with a postmark on or before Month Day, Year. You will need your PIN number to
log in to the website; your PIN number is located at the bottom left hand corner of this letter.
Please note: This is not a passive verification process. Non-response or incomplete documentation will result
in the termination of insurance coverage for your dependents. Once your submitted documentation has been
reviewed, ConSova will mail a letter to you regarding the updated status and if any additional information is
required.
If you have any questions about this process or need assistance, please call ConSova’s Dependent Eligibility
Verification Assistance Center at (866) 964-1315 Monday through Friday, 9:00 a.m. – 5:00 p.m. Central
Time.
Thank you for your cooperation during this important initiative.
Sincerely,
ConSova Corporation

Dependent Verification Form
Please mail this completed and signed form and the requested verification documentation, in the enclosed
postage-paid envelope by Month Day, Year to ensure that coverage continues for your eligible
dependents.
Please check the appropriate box:
I have enclosed the requested documentation to verify the eligibility of my dependent(s).
I have an ineligible dependent(s) and have noted the reason below. I understand that their coverage
will end as soon as reasonably possible after this has been reported to Hertz.
Ineligible Dependent(s)
If any of your dependent(s) are no longer eligible for medical or dental coverage, please provide his/her
name(s) and the reason for ineligibility below. Coverage for ineligible dependents will end as soon as
reasonably possible after this has been reported to Hertz.
Ineligible Dependent Name
Ineligibility Reason
Signature of Employee:
Date:
By signing above, I certify and warrant to Hertz that all information on this Dependent Verification Form is true, correct and current
as of the date signed. I further understand that if I knowingly submit false information I may be subject to disciplinary action up to
and including termination of employment. I authorize Hertz and ConSova Corporation to contact any institution or organization to
verify any and all documents provided for eligibility verification.
Please mail this completed and signed form along with the requested
verification documentation.

Dependent
Relationship
Spouse
Your legally married
spouse
(legally separated or
divorced spouses are not
eligible for coverage)
Dependent Documentation Request
What You Need to Submit to ConSova
Copy of marriage certificate
AND
Documents Required
A copy of your tax return from the most recent tax season (front page through line 6 of
Form 1040); please black out the first five digits of your SSN and all financial
information. Note: if your spouse files married separately, head of household or single,
you will also need to submit their Form 1040 from the most recent tax season (front
page through line 6 of Form 1040). Please black out any financial information and social
security numbers. We only need the last 4 digits of the employee's SSN.
Domestic Partner
Your eligible, unrelated
domestic partner
*The attached Benefit Verification and Information Release Authorization Form.
Copy of Attached Domestic Partnership Affidavit or a copy of Domestic Partner
Registration through any governmental Domestic Partner Registry
AND
Proof of dependency as evidenced by a copy of one of the following documents:
• Proof of shared residence via joint mortgage statement or rental agreement
• Automobile title or registration showing joint ownership of vehicle
• Joint checking, bank or investment account statement
• Joint credit account statement
• A will and/or life insurance policy which designates the other as primary beneficiary
AND
• The attached Benefit Verification and Information Release Authorization Form.
Child under age 26
• Your natural child,
children of your
domestic partner,
legally adopted child, or
child in the process of
being adopted;
• Your stepchild;
• Your foster child who
lives in your home and
who qualifies as a
dependent for federal
income tax purposes;
• A child whom you have
legal guardianship of
appointed by a court;
or
• A child who is the
subject of a Qualified
Medical Child Support
Order (QMCSO) issued
to you.
Please note: Proof of dependency documents need to be dated within 60 days prior to
the date of this letter and insurance and medical-related documents will not be accepted
as a proof of dependency.
A copy of the following documents (varies by the relationship of the child to the
Employee):
• Natural child or legally adopted child: State or county issued birth certificate
showing employee’s name or signed court order
• Stepchild: State or county issued birth certificate showing parents’ names, copy of
your Marriage Certificate, and copy of your joint federal tax return from the most
recent tax season (front page only).
• Foster child: Signed letter from social service agent confirming child has been
placed under your care and your federal tax return from the most recent tax season
claiming the child as a dependent.
• Child whom you have legal guardianship: Signed Court Order and federal tax
return from the most recent tax season claiming the child as a dependent. Please be
sure to leave the last four digits of the dependent’s SSN visible.
• Child who is the subject of a Qualified Medical Child Support Order: Signed
Court Order
If unable to provide any of the documents requested, the employee will need to contact ConSova for alternative documents if
applicable.
Don’t Forget! Your response is required by Month Day, Year.