Health Decisions, Inc. has over twenty five years of experience helping employers manage and reduce their health plan costs. Since 1985, Health Decisions, Inc.
is a privately owned, Michigan Corporation founded in 1985. The firm specializes in post payment and enrollment data auditing services to group health benefit clients throughout the country. The firm’s founders, Si Nahra and Judy Mardigian, understood early on that effective administration of group health benefits requires: the intelligent use of highly advanced and constantly changing technology;
a comprehensive understanding of the forces that affect health care; and the willingness to focus accurately on the difficult-to-document eligibility information that has major financial implications. has successfully served hundreds of clients, including self-funded employers, HMOs, insurers including Blue Cross/Shield plans, and TPAs. The firm successfully processes annually more than one billion dollars of paid claims data submitted in dozens of different formats; and also processes special surveys for over one quarter-million covered members. distinguishes itself with its service philosophy:
Respect for existing procedures;
Emphasis on customization; and
Focus on solutions. The company is organized into three divisions along service lines and employs an extensive staff of benefit review specialists, system programmers and maintenance staff, data managers, and claim collection staff.
Do you have control of your plan data? Prudence is back this week to discuss months 1-4 of the fiduciary plan year. See what she has to say about it!
In this video, Prudence discusses the "Ready" phase of the fiduciary plan year, or, months 1-4 of the year. Give Prudence a call! 1-855-PRU-SAYS (1-855-778-7...
Our latest video discusses a year in the life of a fiduciary. Check it out!
In this video, Prudence gives you an overview of the Fiduciary year, splitting the year into three parts. (Ready...Aim...Fire!)
While not garnering the headlines of the “repeal-and-replace” debate, in his "MyHealthGuide” Newsletter Ernie Clevenger shares reporting on a significant development – bi-partisan Congressional action! The House passed a bill, (HR 1304) “The Self-Insurance Protection Act,” with Republican AND Democratic support. The bill is now in the Senate.
The bill reinforces the role of stop-loss coverage in self-funding and explicitly exempts self-funding from state regulation.
If you follow developments in the self-funded community you probably know about the weekly “MyHealthGuide.” If you don’t, check it out by subscribing for free: https://app.e2ma.net/app2/audience/signup/28858/17135/?v=a
The Self-Insurance Protection Act, which protects medical stop-loss, passed this week with a 400-16 vote.
Is your health plan a separate legal entity? We have a new video that explains why it should be!
Have you set up your health plan as its own legal entity? Prudence thinks it's wise to do so. In this video she'll walk you through a comparison between a pl...
Our comment on the latest in the "Repeal and Replace" saga.
Here is our 30,000-foot view of what is happening, from the employer perspective.
Check out the latest episode in our "Prudence Says" video series!
Prudence is back! This time she has a series of questions you should ask before jumping into the fiduciary role of a self-funded health plan. Pull up a fiduc...
It’s looking more and more likely that the Affordable Care Act – and its compliance requirements – aren’t going to be repealed any time soon. Regardless of what happens, it is prudent for employers to remain prepared for future IRS reporting.
Regardless of what happens, it is prudent for employers to remain prepared for future IRS reporting.
Check out our first "Prudence Says" video! Practical advice for plan fiduciaries from our 30-plus years of experience.
Health Decisions, Inc. is happy to introduce Prudence, your guide to fiduciary responsibilities in relation to self-funded group health plans. As a fiduciary...
Repeal and Replace: Until regulations are finalized, employers should continue compliance efforts. http://conta.cc/2kdKtfg
Contrary to the dates on the photo we just posted, we have indeed been in business for 30 years; Health Decisions incorporated in 1986.
2016 was an interesting year for health plan fiduciaries. 2017 is likely to follow suit.
This is sage advice. Health Decisions' experience is that for most of our clients filing is simple. However, for self-funded plans with complicated work forces, the extension is not only welcomed but needed. To avoid the need for extensions next year, employers should adopt monthly ACA monitoring. Also, you can expect the IRS to amend and alter the form. ACA compliance is not a once-a-year event but, like COBRA, a year-round responsibility. Don't wait until January of 2017 to start your 2016 filing. IRS extensions are not likely next year; but the uncapped IRS penalties will remain.
Those employers truly dodged a bullet. There are a couple advantages for starting this late in the game.
This article humanizes the very real complexity introduced by Affordable Care Act (ACA) employer reporting. The author is correct in noting that, despite their promises, payroll companies cannot handle ACA reporting requirements. You need to combine payroll and enrollment facts. Heath Decisions has 20+ years of experience combining these files; they never match. One of the positive side effects from the ACA will be having employers recognize and reconcile these differences. The new dimensions ACA introduces into coordination-of-benefits are also very real. Add to that witches brew the opt-out incentives (and their effects on affordability). We will all be sorting out the changes ACA introduces for some time.
How many employees understand the need to share Form 1095 with other family members, especially adult children?
ACA Extensions Make for a Happier New Year
If you haven't already, please take two minutes to share your story regarding ACA IRS forms!
It's not too late! Register for today's webinar: ACA Compliance - Lessons Learned from 2015
It's not too late to register! Webinar TOMORROW: ACA Compliance - Lessons Learned from 2015
It's great to see Dependent Audits getting wide recognition. Health Decisions has been doing these audits since the 1980s. Our decades of experience taught us that successful Dependent Eligibility Audits focus on response rates above all. Low response rates are how deliberate ineligibles hide. Low response also causes correctly enrolled to be labelled ineligible -- leaving HR staff to deal with time-consuming appeals. If you use outside support, be sure to confirm their response rate guarantees and their track record on appeals. Health Decisions averages 97% response with zero appeals.
Anywhere from 4% to 8% of dependents enrolled in group employee health insurance are not eligible to be in the plan. How it happens and what you can do about it.
Something for Everyone: Top Trends in Healthcare Reviews
Webinar TOMORROW: Payroll Vendors and ACA Compliance: Competition or Opportunity for Brokers? http://conta.cc/1FvvSCC
Webinar Thursday: Payroll Vendors and ACA Compliance - Competition or Opportunity for Brokers? http://conta.cc/1KosFok
Webinar MONDAY on ACA IRS Reporting: Who Reports What? http://conta.cc/1Mbj9cN
Webinar next Monday: Who Reports What? http://conta.cc/1Ikss4D
Monika Blazeski is Health Decisions' own Certified Healthcare Reform Specialist. Ms. Blazeski has been with Health Decisions since 2012 and has a bachelor's degree from the University of Michigan.
Webinar TOMORROW: 100% Data Security - Is it Possible? http://conta.cc/1EjIhEG
Webinar next Tuesday: 100% Data Security - Is It Possible? http://conta.cc/19c04Ge
This article reinforces what we at Health Decisions have been seeing at the jails we have worked with. Jails need to be seen as part of the continuum of care. The Affordable Care Act took some positive steps in this direction, but more needs to be done.
The study found that a majority of those in local and county jails are there for minor violations, and have been jailed for longer periods over the past 30 years because they are unable to pay court-imposed costs.
Webinar TOMORROW: Getting the Most Out of Your Audit http://conta.cc/1yMRQOc
Enough ACA Already! http://conta.cc/1E3fXLm
You're Done with Open Enrollment. (Phew!) NOW what? http://conta.cc/1vkzkar
Open enrollment is a hassle you survive. Or at least that's the view of most benefits staff. However, a growing number of savvy benefits professionals see open enrollment as the beginning of a management process to control health benefit costs where they start - with the people you cover.
Webinar TOMORROW: ACA Compliance Checklist -- Are You Ready for 2015? http://conta.cc/1qTuWNM
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