Hertz sample Initial Letter.pdf - ConSova
Hertz sample Initial Letter.pdf - ConSova
Hertz sample Initial Letter.pdf - ConSova
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Si quisiera recibir una copia de esta carta en español<br />
por favor comuníquese con <strong>ConSova</strong> 866-964-1315<br />
Month Day, Year<br />
John Smith<br />
123 ABC Way<br />
Anywhere, USA 99999<br />
- IMMEDIATE ACTION IS REQUIRED -<br />
IF YOU DO NOT RESPOND TO THE ENCLOSED VERIFICATION REQUEST, BENEFIT COVERAGE<br />
FOR YOUR DEPENDENT(S) WILL BE CANCELLED.<br />
Dear John Smith:<br />
As part of <strong>Hertz</strong>’ ongoing efforts to manage the cost of our health coverage under the <strong>Hertz</strong> Custom<br />
Benefit Program, we want to ensure that only eligible dependents are enrolled. To assist us in this effort,<br />
we have retained <strong>ConSova</strong>, a benefits audit firm specializing in the verification of dependent eligibility.<br />
<strong>ConSova</strong> is contacting every employee who has one or more dependents enrolled in a <strong>Hertz</strong> health care<br />
plan and is asking for verification of eligibility. The verification process, and what is expected from you, is<br />
explained in detail in the attached letter from <strong>ConSova</strong>. For general information about the verification<br />
process, please review the enclosed Frequently Asked Questions.<br />
If you have one or more dependents enrolled in a company-sponsored medical insurance plan you will<br />
need to submit supporting documentation to verify their eligibility. The attached verification request from<br />
<strong>ConSova</strong> provides you with:<br />
identification of the dependent(s) you currently have enrolled in a <strong>Hertz</strong>-sponsored benefit plan<br />
the plan eligibility requirements as set forth in the Summary Plan Description (SPD)<br />
Please be assured the information you provide is kept secure and confidential. <strong>ConSova</strong>, a named<br />
Business Associate of <strong>Hertz</strong> as defined under the Health Insurance Portability and Accountability Act of<br />
1996 (HIPAA), complies with all provisions of the law.<br />
If you have any questions about dependent eligibility or the verification process, please contact <strong>ConSova</strong>’s<br />
Dependent Eligibility Assistance Center at 1-866-964-1315. <strong>ConSova</strong> Associates are available Monday<br />
through Friday, 9:00 a.m. – 5:00 p.m. Central Time.<br />
Thank you for your cooperation.<br />
Corporate Employee Benefits Department
Frequently Asked Questions<br />
Why is <strong>Hertz</strong> conducting this audit?<br />
The cost of providing health care benefits to employees continues to rise at an alarming pace. At <strong>Hertz</strong>,<br />
we want to ensure that we are doing everything we can to manage those costs for employees who are<br />
covering eligible dependents. Employers across the nation are conducting such audits and are discovering<br />
an alarming number of ineligible dependents covered under their plans. The costs associated with<br />
covering ineligible dependents can be millions of dollars for an employer the size of <strong>Hertz</strong>.<br />
Where did <strong>ConSova</strong> get my personal information?<br />
<strong>ConSova</strong> initially receives your basic personal information from your employer prior to the start of an<br />
audit. During the audit we receive personal information from you.<br />
Who is <strong>ConSova</strong>?<br />
<strong>ConSova</strong> is a human resources firm that specializes in the dependent eligibility verification process and<br />
has conducted many dependent verification audits for Fortune 500 companies and governmental<br />
organizations.<br />
What guarantee do we have that our personal documents will be kept secure?<br />
<strong>ConSova</strong> considers security and confidentiality a very serious matter. They utilize encryption technology<br />
to transact sensitive data. The server that maintains Dependent Eligibility Verification systems and<br />
scanned images is only accessible on <strong>ConSova</strong>’s Local Area Network located in Lakewood, Colorado. This<br />
Local Area Network is a closed system that is not accessible via Virtual Private Network or any other<br />
interactive connection.<br />
<strong>ConSova</strong> Associates have audited over 1.5 million dependents in the past eight years, and they have<br />
never been accused or alleged to have not protected the private personal information of its clients’<br />
employees.<br />
<strong>Hertz</strong> realizes and understands that employees may have concerns about releasing this information to a<br />
third party. We assure you that every precaution has been taken to ensure your information is kept<br />
confidential. As we do with our other benefits service providers, <strong>Hertz</strong> and <strong>ConSova</strong> have entered into a<br />
privacy and security agreement (Business Associates Agreement) which is governed by federal privacy<br />
laws. You can help protect your own privacy by following the instructions included with the enclosed letter<br />
from <strong>ConSova</strong>.<br />
Will the submitted documents be retained by <strong>ConSova</strong>? If so, for how long?<br />
Documentation received from <strong>Hertz</strong> employees will be batched and maintained in a secure location<br />
monitored only by <strong>ConSova</strong> employees. 30 days after the dependent verification is completed, <strong>ConSova</strong><br />
will shred all documentation and wipe all hard drives containing protected health information.<br />
Can I black out my financial information and Social Security number on these documents?<br />
On any document you provide, you may cross out all financial information and the first five digits of your<br />
Social Security number.<br />
Can I submit my documents to my local Human Resources Department instead of <strong>ConSova</strong>?<br />
No. All documents must be provided directly to <strong>ConSova</strong> for review.<br />
If I am unable to supply documentation by the deadline for my eligible dependent, will <strong>Hertz</strong><br />
terminate my dependent from the plan?<br />
If you are experiencing any difficulties in gathering the requested documents, as long as you continue to<br />
keep <strong>ConSova</strong> updated as to the status of your gathering the appropriate documents, your dependent(s)<br />
will not be automatically terminated if you do not meet the submission deadline. Eventually, <strong>Hertz</strong> will<br />
terminate a dependent if it is determined that you are unable to provide documentation that verifies<br />
eligibility. <strong>ConSova</strong> is willing to assist you through this process, including helping you contact agencies to<br />
locate the documents you need.
Month Day, Year<br />
Dear John Smith:<br />
Dependent Eligibility Verification<br />
As part of an operational excellence initiative to increase efficiencies and reduce costs, <strong>Hertz</strong> has retained the<br />
services of <strong>ConSova</strong> Corporation to collect documentation to review and verify eligibility for dependents in the<br />
company’s medical programs.<br />
Dependent(s) you have included on <strong>Hertz</strong> sponsored medical plan are listed below:<br />
Dependent Name Relationship Year of Birth<br />
Michelle Smith Spouse 1956<br />
Jane Smith Child 1990<br />
Your Action Items<br />
Review your list of dependents above and the detailed explanation of the documentation you will need to<br />
provide to verify eligibility for dependent(s) on the following pages.<br />
<br />
<br />
Complete and sign the enclosed Dependent Verification Form. If any of your dependents listed above are no<br />
longer eligible for medical coverage, please provide their names and the reason for ineligibility on this form.<br />
Coverage for ineligible dependents will end as soon as reasonably possible after this has been reported to<br />
<strong>Hertz</strong>.<br />
Upload documentation by logging into www.consova.com/hertz or mail documentation in the enclosed<br />
postage-paid envelope with a postmark on or before Month Day, Year. You will need your PIN number to<br />
log in to the website; your PIN number is located at the bottom left hand corner of this letter.<br />
Please note: This is not a passive verification process. Non-response or incomplete documentation will result<br />
in the termination of insurance coverage for your dependents. Once your submitted documentation has been<br />
reviewed, <strong>ConSova</strong> will mail a letter to you regarding the updated status and if any additional information is<br />
required.<br />
If you have any questions about this process or need assistance, please call <strong>ConSova</strong>’s Dependent Eligibility<br />
Verification Assistance Center at (866) 964-1315 Monday through Friday, 9:00 a.m. – 5:00 p.m. Central<br />
Time.<br />
Thank you for your cooperation during this important initiative.<br />
Sincerely,<br />
<strong>ConSova</strong> Corporation
Dependent Verification Form<br />
Please mail this completed and signed form and the requested verification documentation, in the enclosed<br />
postage-paid envelope by Month Day, Year to ensure that coverage continues for your eligible<br />
dependents.<br />
Please check the appropriate box:<br />
I have enclosed the requested documentation to verify the eligibility of my dependent(s).<br />
I have an ineligible dependent(s) and have noted the reason below. I understand that their coverage<br />
will end as soon as reasonably possible after this has been reported to <strong>Hertz</strong>.<br />
Ineligible Dependent(s)<br />
If any of your dependent(s) are no longer eligible for medical or dental coverage, please provide his/her<br />
name(s) and the reason for ineligibility below. Coverage for ineligible dependents will end as soon as<br />
reasonably possible after this has been reported to <strong>Hertz</strong>.<br />
Ineligible Dependent Name<br />
Ineligibility Reason<br />
Signature of Employee:<br />
Date:<br />
By signing above, I certify and warrant to <strong>Hertz</strong> that all information on this Dependent Verification Form is true, correct and current<br />
as of the date signed. I further understand that if I knowingly submit false information I may be subject to disciplinary action up to<br />
and including termination of employment. I authorize <strong>Hertz</strong> and <strong>ConSova</strong> Corporation to contact any institution or organization to<br />
verify any and all documents provided for eligibility verification.<br />
Please mail this completed and signed form along with the requested<br />
verification documentation.
Dependent<br />
Relationship<br />
Spouse<br />
Your legally married<br />
spouse<br />
(legally separated or<br />
divorced spouses are not<br />
eligible for coverage)<br />
Dependent Documentation Request<br />
What You Need to Submit to <strong>ConSova</strong><br />
Copy of marriage certificate<br />
AND<br />
Documents Required<br />
A copy of your tax return from the most recent tax season (front page through line 6 of<br />
Form 1040); please black out the first five digits of your SSN and all financial<br />
information. Note: if your spouse files married separately, head of household or single,<br />
you will also need to submit their Form 1040 from the most recent tax season (front<br />
page through line 6 of Form 1040). Please black out any financial information and social<br />
security numbers. We only need the last 4 digits of the employee's SSN.<br />
Domestic Partner<br />
Your eligible, unrelated<br />
domestic partner<br />
*The attached Benefit Verification and Information Release Authorization Form.<br />
Copy of Attached Domestic Partnership Affidavit or a copy of Domestic Partner<br />
Registration through any governmental Domestic Partner Registry<br />
AND<br />
Proof of dependency as evidenced by a copy of one of the following documents:<br />
• Proof of shared residence via joint mortgage statement or rental agreement<br />
• Automobile title or registration showing joint ownership of vehicle<br />
• Joint checking, bank or investment account statement<br />
• Joint credit account statement<br />
• A will and/or life insurance policy which designates the other as primary beneficiary<br />
AND<br />
• The attached Benefit Verification and Information Release Authorization Form.<br />
Child under age 26<br />
• Your natural child,<br />
children of your<br />
domestic partner,<br />
legally adopted child, or<br />
child in the process of<br />
being adopted;<br />
• Your stepchild;<br />
• Your foster child who<br />
lives in your home and<br />
who qualifies as a<br />
dependent for federal<br />
income tax purposes;<br />
• A child whom you have<br />
legal guardianship of<br />
appointed by a court;<br />
or<br />
• A child who is the<br />
subject of a Qualified<br />
Medical Child Support<br />
Order (QMCSO) issued<br />
to you.<br />
Please note: Proof of dependency documents need to be dated within 60 days prior to<br />
the date of this letter and insurance and medical-related documents will not be accepted<br />
as a proof of dependency.<br />
A copy of the following documents (varies by the relationship of the child to the<br />
Employee):<br />
• Natural child or legally adopted child: State or county issued birth certificate<br />
showing employee’s name or signed court order<br />
• Stepchild: State or county issued birth certificate showing parents’ names, copy of<br />
your Marriage Certificate, and copy of your joint federal tax return from the most<br />
recent tax season (front page only).<br />
• Foster child: Signed letter from social service agent confirming child has been<br />
placed under your care and your federal tax return from the most recent tax season<br />
claiming the child as a dependent.<br />
• Child whom you have legal guardianship: Signed Court Order and federal tax<br />
return from the most recent tax season claiming the child as a dependent. Please be<br />
sure to leave the last four digits of the dependent’s SSN visible.<br />
• Child who is the subject of a Qualified Medical Child Support Order: Signed<br />
Court Order<br />
If unable to provide any of the documents requested, the employee will need to contact <strong>ConSova</strong> for alternative documents if<br />
applicable.<br />
Don’t Forget! Your response is required by Month Day, Year.