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Frequently Asked Questions

NASRO's Group Health, Dental, Vision, Life, STD, LTD, Flexible Spending Accounts, Payroll, 401-K Plans

A two year rate guarantee is now being offered for employer groups starting new coverage in the fourth quarter of 2012, under certain conditions. Call us at 800-638-8113 to find out more.

California Employer Groups From Technology Companies, to Main Street Businesses, to Social Service Agencies Are Calling NASRO for Help with the Newest and Most Innovative Plan Designs from Blue Shield, Health Net, Anthem Blue Cross, Kaiser and Aetna.

Adults applying for individual coverage still have to go through individual medical underwriting in California and can be turned down for coverage for having pre-existing medical conditions. Some plans will accept people with certain pre-existing conditions and charge higher rates. Coverage is available through NASRO for adults under 65 who have pre-existing conditions and are eligible for coverage under the HIPPA law. If you need to know your HIPPA rates contact NASRO. Within 63 days of group health insurance ending HIPPA eligibility ends and the only other option is the state of California high risk pool, where the rates are even higher and enrollment not always open.

What We Offer To California Employers Is Aggressive and Innovative Cost Controls Combined with Tangible and Measurable Service

• Multiple Dual Option Plans from Different Carriers
• Flexible Spending Accounts
• Payroll Services

• Organization of a Large Multi-Employer Co-op
• Coverage for Out of State Employees in 50 States
• HIPPA Plan Enrollment
• Benefits Administration of Open Enrollment
• Assistance Filling Out Enrollment Forms
• Administration of New Hire Enrollment
• COBRA and California COBRA Administration
• Employee Advice on California Medical System
• Claims Analysis
• Health Insurance Company Appeals
• Coverage for 1099 Employees
• Advice on Compliance with State & Federal Laws
• Coordination with California Government Agencies

The National Association of Socially Responsible Organizations (NASRO) of California is also a health insurance and reinsurance administrator for employer groups Founded by health care consumer advocate Robert Gaw, it is working hard for you and is able to recommend, as a free service, the best individual health insurance, Medicare supplement insurance, small group health insurance and large group self funding arrangements that are available in California at a more affordable rate.

Veteran Health Care Consultant & Consumer Advocate for Universal Health Care, Robert Gerard Sullivan Gaw, NASRO Managing Director & Founder

If you are preparing for your annual California health insurance or reinsurance renewal, starting a new business, are currently on an expensive COBRA plan from a previous job, expanding operations in California, or just need to lower your monthly health insurance costs then you need to know more about NASRO. We have worked hard for decades to help establish a more humane health care system in California. NASRO has made important achievements at developing health insurance exchange models the government is now starting to use that begin to set controls on the health care industry.

In addition to our consulting experience, NASRO has an outstanding administrative unit that provides on going group services to thousands of employer groups.

Aetna

Small Employer Groups

California Plan Guide

Individuals

MC Open Access 3500

MC Open Access 5000

MC Open Access 5000 with Limited Rx

MC Open Access 7500 with unlimited primary care and dental

To Apply On Line Click On Box Above

Anthem Blue Cross

Anthem Premier & Smart Sense Plan Brochure

Blue Shield of California

California Choice

CIGNA

Health Net

HMO 15

HMO 40

Kaiser Permanente

United HealthCare / PacifiCare

NASRO of California Members with More Affordable Health Insurance Include

• Artists & Actors
• Studios
• Graphic Design Firms
• Film Makers
• Programmers
• Web Developers
• Medical Providers
• Biotech Firms
• Technology Start Ups
• Computer Software Developers
• Construction Companies
• Builders and Special Trades
• Internet Marketers
• Social Service Organizations
• Religious Organizations
• Robotics Specialists
• Advertising Companies
• Business Consultants
• Automotive Businesses
• Social Workers
• Photographers

Short Cuts for California Individuals and Families

For Individuals and Families paying for their own health insurance in California it is important not to wait until you have a medical condition before you purchase health insurance. Once you have a medical condition, even a minor one, as inhuman as it seems, the health insurance companies can turn you down and refuse to provide any coverage.

If you recently have had California group coverage from a previous employer, you have 63 days after the end of your group plan to pick up an individual plan and not be subject to medical underwriting. If you have a pre-existing medical condition and are applying for individual health insurance coverage there is an excellent chance all the health insurers will turn you down for coverage. HIPPA the federal law we have worked with since 1996 protects individuals from being turned down for health insurance coverage, under certain conditions. Call our office for more information 415-732-9440 or 800-638-8113

Since age rating is the only option, the younger you are the more affordable the health plans are. The older you are the more the premium costs go up. Young families may actually be able to afford more coverage to protect their children and older individuals who are healthy can find plans that provide good access to routine physicals, unlimited sick visits and prescription drug coverage and carry a larger deductible for the less likely to occur inpatient admissions.

Children's Individual Health Insurance Guidelines for Guaranteed Coverage

• A child's open enrollment period applies to each individual child during the Month of the child's birth date.
• Applications should include proof of birth date such as a copy of the birth certificate, passport or driver's license.
• If child had prior coverage within the 90 day period prior to the date of the application, include a copy of the Certificate of Creditable Coverage or the premium billing statement showing coverage for the applicant.
• A child may be assessed a 20%surcharge for a period not greater than 12 months if the applicant has not had prior coverage within the 90 day period prior to the date of the child's application and is note a late enrollee.

For more enrollment information call NASRO.

Frequently Asked Questions About California Health Insurance

What are my options if I lose my group health insurance coverage at work and I am not eligible for COBRA?

If you have been covered for 18 months by a previous group plan you earn HIPPA rights that allow you to qualify for a plan with carriers such as Anthem Blue Cross, Blue Shield, Kaiser, Health Net and Aetna where you are guaranteed acceptance by the federal government, regardless of your pre-existing medical conditions and your height/weight ratio. NASRO can help walk you through the process, make sure that you qualify and have access to the health insurance you have a right to.

If you do not have pre-existing conditions and finding a good affordable plan is your goal, NASRO can help provide you with focused options at no additional cost to you.

What can I do if I can not balance the rising cost of health insurance premiums with the lower income I am earning as a result of the recession?

First you should know that this sad state of affairs is pushing the federal government to very soon enact major changes to how the health insurance industry is run this year. While waiting for that new day we suggest that you review your benefit plans once again to make sure that the plan you currently have is allowing you to have access to the health care benefits you actually use. NASRO can help you with that process.

Blue Shield of California Individual Rates

Anthem Blue Cross Individual Rates

The Immoral Practice of Pre-Existing Conditions Underwriting and Individual Health Insurance in California - If Turned Down for Coverage and Have Been Previously Been Covered by a Group Plan for the Previous 18 Months, or If You Have Been Without Health insurance for Six Months Call NASRO for Rates, Benefits and an Enrollment Form

NASRO helps people find the best health insurance available and is right now developing a non-profit health insurance co-op. We believe strongly that the fast growing number of self employed and individuals who need affordable health insurance in California should be allowed to band together and have the right to buy the same health insurance plans for the same price, as anyone else, with their own money. We believe it is a sin for health insurance companies to " play God " with the lives of people. Turning down people with any form of illness large or small is severely limiting their economic lives.

Help with some COBRA premium costs provided in the recent "stimulus bill ", is great for people who work for large employers, but most people do not work for large employers. Unemployment could rise reach 15% in California by the end of 2009 and prudent financial planning needs to be made now.

NASRO does not yet have a group plan in California that will accept individuals that have been turned down for coverage. We are working for a new National Health Care law to accomplish this mission. In the meantime, we will assist any self employed person in California that needs to know how to qualify for group coverage right now.

NASRO Administrators Personal Service in California From Our Offices in Los Angeles and San Francisco

What People Are Saying About Us!

" I have nothing but praise for the good folks at NASRO ( National Association of Socially Responsible Organizations ). If you've ever dealt with insurance providers, you know that the usual goal of the person who answers the phone is to say " no " and hang up as quickly as possible. My experience with Barbara Gibson at NASRO Co-op could not have been more different.

She actually did the math on whether it would be better for me to stick with COBRA for 18 months before switching to the NASRO plan. The one time I actually had a problem with coverage for a medical condition, she not only straightened it out, but remembered to ask me if I was feeling better after the procedure.

Deborah Elizabeth Finn

Information Technology Management Consultant

P. S. Full disclosure. NASRO does not compensate me in any way for praising it immoderately. I am just a fan."

NASRO Non Profit, Co-op and Business Members Include

• Community Builders Worker Cooperative
• International Physicians for the Prevention of Nuclear War
• International HIV/AIDS Alliance
• Jobs with Justice
• Act Blue
• Women In Film and Video
• Alliance to Defend Health Care
• Health Care For All
• National Pancreas Foundation
• Working Assets
• Forum on Democracy and Trade
• A1 Auto Body
• Blue Sky Dogs
• AFC Mentoring
• Gnaristas
• CDA Learning Projects
• Climate Technologies
• Carando Gourmet Foods

Carriers with Health Insurance Plans in California

Anthem Blue Cross of California

Anthem Blue Cross Life and Health

Blue Shield of California

CIGNA

Kaiser Permanente

Healthnet

PacifiCare

Need More Information?

Anthem Blue Cross of California

• Basic PPO Plan
• Saver PPO Plan
• PPO $40 Co-pay Plan
• PPO $35 Co-pay Generic Rx Plan
• PPO $30 Co-pay Plan
• PPO $45 Co-pay Generic Rx Plan
• Advantage PPO $25 Co-pay Plan
• Premier PPO $20 Co-pay Plan
• Premier PPO $10 Co-pay Plan
• Power Health Fund 750 Plan
• Power Health Fund 500 Plan
• Power Select HMO Plan
• Power $35 Select HMO Plan
• HMO 100% Plan
• HMO $25 100% Plan
• Classic HMO Plan
• Classic $35 HMO Plan
• Saver HMO Plan
• Saver$30 HMO Plan
• Lumenos 1500 HSA Plan

Medicare Supplement Plans J on down for People Turning 65

Blue Shield of California

For People Coming Off COBRA

Blue Shield HIPPA Access HMO Plan

Blue Shield HIPPA Savings 4000 HSA Plan

Blue Shield HIPPA Shield Spectrum PPO 5000

Blue Shield HIPPA Spectrum PPO 5500

to enroll call 800-638-8113

For Small Employer Groups

Group Dental

Medicare Supplement Plans J on down for People Turning 65

CIGNA

Level Funding Plans

Kaiser Permanente

Copayment Plans

$50 Co-pay Plan

$30 Co-pay Plan

$20 Co-pay Plan

$15 Co-pay Plan

$5 Co-pay Plan

Group Dental

Health Net

Group Dental

Medicare Supplement Plans J on down for People Turning 65

PacifiCare

Aetna

United Healthcare

Affordable Group Dental Insurance Plans

Delta Dental

Anthem Blue Cross

Blue Shield of California

PacifiCare

Vision Plans

VSP Signature Plan

VSP Specialty Care

VSP Voluntary Plan

Life, Short Term & Long Term Disability Insurance

Dearborn National

UNUM Life Insurance Company

West Coast Life Insurance Company

See through the mist and confusion surrounding finding affordable health insurance with the help of a recognized non-profit like NASRO.

Enrollment Tips

• We are able to immediately process individual applications on line
• If you are having trouble filling out the enrollment form just fax it to NASRO at 800-562-8588 or email it to bgibson@nasro-co-op.org

Health Insurance Is Also Available In:

Washington

Oregon

Massachusetts

Maryland

Washington D.C.

Virginia

New York

New Jersey

Georgia

North Carolina

Texas

New Mexico

Illinois

Health Care For All Working

or In Business

National Association of Socially Responsible Organizations

Robert Gaw

Managing Director & Founder

NASRO

One Sansome Street, Suite 3500

San Francisco, CA 94104

415-732-9440

800-638-8113

Fax - 800-562-8588

NASRO Massachusetts Office

60 State Street, Suite 700

Boston, Massachusetts

02109

617-308-1525, 617- 599-6498 or 800-638-8113

NASRO New York Office

41 East 11th Street

11th Floor

New York, N.Y.

10003

917-474-1218

NASRO Washington D.C.Area Office

3 Bethesda Metro Center

Suite 700

Bethesda, MD 20814

800-638-8113

NASRO of California Health Care Reform News

Health Care Reform is coming to California in little more than nine months. NASRO is ready to assist anyone in California that needs help. There are many new rules and many new benefits. Price increases have been down and Anthem Blue Cross is even agreeing to give two year rate guarantees to certain groups during the fourth quarter of 2012. We place this under the category of every little bit helps and attribute it to hearing footsteps.

Right now a new long form for people qualifying for expanded Medi Cal coverage has been released. As soon as more information about benefit plans, rates and forms are available we will publish them. NASRO and many other organizations that have long supported universal health care are working as partners with the U.S. Department of Health and Human Services to make sure that this program is one that is known and understood by the American people.

Where are NASRO offices located in California?

One Sansome Street, Suite 3500

San Francisco, CA 94104

415-732-9404

800-638-8113

Association Releases List of Top-Performing Physician Groups

The Integrated Healthcare Association has released a list of the top-performing and most-improved physician groups in California as part of a pay-for-performance initiative, Payers & Providers reports.

IHA included a total of 47 medical groups on the list, or about 25% of groups that participate in the initiative.

Under the pay-for-performance initiative, physician groups are eligible for incentive payments from seven participating health insurers. According to IHA, incentive payments this year are expected to reach about $40 million.

About the List

IHA selected the physician groups based on criteria for meaningful use of health information technology and patients' overall care experience.

It also assessed clinical quality measures for various topics, including:

• Cardiovascular;
• Diabetes;
• Musculoskeletal;
• Preventive; and
• Respiratory health.

Top Performers

The list includes several physician groups that have been cited as top performers by IHA in previous years, such as:

• Brown & Toland Physicians;
• Cedars-Sinai Medical Group;
• Palo Alto Medical Foundation;
• Sharp Rees-Stealy Medical Group; and
• Sutter Medical Group.

Groups cited by IHA this year that are new to the list include:

• MemorialCare Medical Group;
• Monarch Healthcare; and
• Primary Care Associates Medical Group (Payers & Providers, 9/27).

Most-Improved Performers

IHA selected eight groups as the most-improved physician groups:

• Arch Health Partners;
• Cedars-Sinai Health Associates;
• Central Valley Medical Group;
• Children’s Physicians Medical Group;
• Southern California Permanente Medical Group;
• St. Joseph Heritage Medical Group;
• The Permanente Medical Group; and
• Woodland Healthcare (IHA release, 9/20).

Gov. Brown Signs, Vetoes Health Care Reform-Related Measures

Recently, Gov. Jerry Brown (D) signed several bills into law that implement health care reform in California, the Sacramento Business Journal reports.

Bills Signed by Brown

The bills include:

• AB 1083, which implements new insurance rules for small businesses, including a rule that small business owners cannot be subject to additional premium hikes based on their employees' health;
• AB 1453 and SB 951, which require insurers to cover a minimum set of benefits in their health plans (Robertson, Sacramento Business Journal, 10/1);
• AB 1526, which allows the Managed Risk Medical Insurance Board to subsidize premiums for program members at no less than 100% of comparable rates for the individual insurance market and prohibits the amount of subsidies from affecting the calculation of premiums (AB 1526 bill text, 9/30);
• AB 1761, which prohibits individuals or entities from falsely representing themselves as the California Health Benefit Exchange;
• AB 174, which provides funding for the Office of System Integration to establish data sharing between the Employment Development Department, the Franchise Tax Board, specified health agencies, and county departments and agencies to verify eligibility for state health programs;
• AB 1580, which requires transportation planning to include health criteria to help facilitate healthier communities;
• AB 792, which requires that consumers be given information about their coverage options under the insurance exchange when they file a job change, separation, divorce, adoption or other life changes; and
• SB 1410, which clarifies the process under which consumers appeal denial-of-care decisions.

Report: Living Costs in Calif. Exceed Federal Poverty Level

News Release

Employers Expect Rise in Health Costs; Many To Pass Costs to Workers

New Rule Ensures Students Get Health Insurance Protections of the Affordable Care Act

A new proposed regulation announced today by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act.  Students enrolled in college plans would have the freedom from worrying about losing their insurance, or having it capped unexpectedly if they are in an accident or become sick.

“Thanks to the Affordable Care Act, college students will have more control over their health care,” said Secretary Sebelius. “This rule would ensure that these plans remain a viable, affordable option for students while guaranteeing that they are regulated consistently and offer transparent benefits to students.”

Student health plans are often purchased when family coverage is not available, or is unaffordable.  Approximately 1,500-2,000 institutions of higher education across the country offer some type of health coverage; however, what benefits are covered by these plans, as well as how they’re regulated vary widely.  The proposed regulation would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act by clarifying that these plans will be defined as “individual health insurance coverage.”  Under the proposed rules, some of the new health insurance protections include:

• No Lifetime Limits on Coverage: Insurance companies would no longer be able to impose lifetime dollar limits on the amount they spend on health benefits in student health plans.
• No Arbitrary Rescissions of Insurance Coverage: Insurance companies can no longer drop coverage when student health plan enrollees get sick because of an unintentional mistake on an application.
• No Pre-Existing Condition Exclusions for Students Under Age 19:  Insurance companies cannot deny or exclude coverage for students under age 19 because of a pre-existing condition.

Today, some student health plans, only offer limited benefits with low annual dollar limits on health care, or have limited networks of doctors, and other health care providers. For many students, these health plans are their only health insurance option.

The Affordable Care Act allows HHS to take steps to preserve market stability while ensuring student health plans remain affordable until all Americans have new coverage options through the state-based Exchanges that will be established in 2014. Under the proposed rule announced today, student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012.  Student health plans with policy years beginning after that date must fully comply with the Affordable Care Act’s annual limit restrictions.

The proposed rules would also require insurance companies to clearly tell students enrolled in student health plans whether or not their plan meets the new requirements laid out under the Affordable Care Act—bringing transparency to this marketplace and enabling students to understand the value and quality of the coverage they have.

As a part of the new proposed rule, HHS also is requesting comments on how other Affordable Care Act protections might apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules.

To find the new proposed rule, visit www.ofr.gov/inspection.aspx.  For a fact sheet on the new proposed rule, visit www.HealthCare.gov/news/factsheets/students02092011a.html .  For more information about the new patient protections created under the Affordable Care Act, visit www.HealthCare.gov.

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New Study Shows Universal Access to Health Care a Step Not a Solution to Ending  Health Care Inequality

Insurance Association Files Suit Over New Anti-Rescission Rules

This week, the Association of California Life and Health Insurance Companies filed a lawsuit seeking to nullify new state regulations designed to make it more difficult for insurers to rescind members' health insurance coverage, the AP/San Francisco Chronicle reports.

Regulation Details

The California Department of Insurance's new rules -- which took effect Wednesday -- require insurers to investigate individual policyholders' medical backgrounds prior to accepting any premiums (Mohajer, AP/San Francisco Chronicle, 8/19).

The rules also require insurers to:

• Limit application questions about health conditions and histories to only those required for medical underwriting;
• Require that all questions on an insurance application be clear, specific and easy to understand;
• Offer applicants the option to indicate that they are unsure or cannot remember the answer to a health history question;
• Provide policyholders with a copy of their application to allow them to check for possible errors; and
• Allow members the opportunity to respond during investigations that could lead to a policy rescission

The Highly Profitable Student Group Health Plan Business May Leave Your Student Without Proper Medical Coverage

A trip to the student health center has the right geograghy but many times students need more treatment. Students are better off having their own individual health insurance plan if they are in good health and can be approved. Prices are based on age and are low, with the benefits higher than many parents plans.

Most student health plans have low maximum benefit limits and do not cover even small pre-existing conditions that an individual health insurance plan will cover.

This adds up to great stress for the student if a health problem arises and massive financial exposure to the parents if the student needs hospital care or surgery.

The key factor to keep in mind is that the loss ratios of the student health plans are very low because fewer claims are being paid than with individual health insurance plans.

New Federally Financed California High Risk Pools Only Available to People With Pre-Existing Medical Conditions Who Have been Without Health Insurance Coverage For Six Months or Longe

Stand Alone Dental Now Available For Both Employer Groups and Individuals Through NASRO in California

Click on the link above for more information.