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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.
More Affordable Health, Dental, Vision and Life Insurance Plans NASRO of California Recommends:
Anthem Blue Cross of California # 1
Blue Shield of California #2
Kaiser Permanente #3
In addition to our consulting experience, NASRO has an outstanding administrative unit that provides on going group services to thousands of employer groups.
Small Employer Groups
California Plan Guide
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
United HealthCare / PacifiCare
NASRO of California Members with More Affordable Health Insurance Include
- Artists & Actors
- Graphic Design Firms
- Film Makers
- 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
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
- CDA Learning Projects
- Climate Technologies
- Carando Gourmet Foods
Carriers with Health Insurance Plans in California
Anthem Blue Cross
Anthem Blue Cross Life and Health
Blue Shield of California
Need More Information?
Anthem Blue Cross of California
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
Medicare Supplement Plans J on down for People Turning 65
Level Funding Plans
$50 Co-pay Plan
$30 Co-pay Plan
$20 Co-pay Plan
$15 Co-pay Plan
$5 Co-pay Plan
Medicare Supplement Plans J on down for People Turning 65
Affordable Group Dental Insurance Plans
Anthem Blue Cross
Blue Shield of California
VSP Signature Plan
VSP Specialty Care
VSP Voluntary Plan
Life, Short Term & Long Term Disability Insurance
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.
- 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 email@example.com
Health Insurance Is Also Available In:
Health Care For All Working
or In Business
National Association of Socially Responsible Organizations
Managing Director & Founder
One Sansome Street, Suite 3500
San Francisco, CA 94104
Fax - 800-562-8588
NASRO Massachusetts Office
60 State Street, Suite 700
617-308-1525, 617- 599-6498 or 800-638-8113
NASRO New York Office
41 East 11th Street
New York, N.Y.
NASRO Washington D.C.Area Office
3 Bethesda Metro Center
Bethesda, MD 20814
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
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:
- Preventive; and
- Respiratory health.
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).
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).
Read more: http://www.californiahealthline.org/articles/2012/9/28/association-releases-list-of-top-performing-physician-groups.aspx#ixzz28RUdPAT7
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.
Read more: http://www.californiahealthline.org/articles/2012/10/2/gov-brown-signs-vetoes-health-care-reform-related-measures.aspx#ixzz28RTP8cu4
Report: Living Costs in Calif. Exceed Federal Poverty Level
The Insight Center for Community Economic Development's Self-Sufficiency Standard report found that a four-member family in California would need to earn more than $63,000 annually -- or nearly three times the federal poverty level -- to cover basic needs, such as health care, housing and food. According to the report, the pre-tax income necessary to cover basic expenses for the average family of two working, married adults with two young children ranged from $53,775 in Tulare County to $86,629 in Marin County. Although wages have remained stagnant since the center's 2008 report, there were double-digit increases in living costs throughout the state.
Read more: http://www.californiahealthline.org/articles/2011/10/4/report-living-costs-in-calif-exceed-federal-poverty-level.aspx#ixzz1Zpqm21ME
Employers Expect Rise in Health Costs; Many To Pass Costs to Workers
Large U.S. employers expect their health care costs to increase by an average of 7.2% next year, according to a according to a survey by the National Business Group on Health, Modern Healthcare reports (Daly, Modern Healthcare, 8/18).
The increase is slightly less than the 7.4% mean increase for health care costs that the companies reported for this year. However, the new figure "is on a higher base, and it still outpaces the economy's anemic growth and business conditions," according to NBGH President and CEO Helen Darling (Reichard, CQ HealthBeat, 8/18).
According to the survey, more than half of businesses plan to pass at least some of the extra costs to workers. Darling said employers are shifting away from copayments, where workers pay a fixed dollar amount for health services, and instead are charging workers a percentage of the total costs. This makes employees more aware of the total cost of health care they use, The Hill's "Healthwatch" reports.
Darling said shifting from copayments to the coinsurance model is "a more subtle way to increase what the consumer pays." She said that eventually only governments and unions likely will offer fixed copayments (Baker, "Healthwatch," The Hill, 8/18).
Darling said the federal health reform law has contributed to rising costs. She attributed one full percentage point of the increase to a provision allowing young adults to stay on their parents' insurance until age 26. She said, "I think that most employers didn't think that (the requirement) was a good idea," noting that individuals with jobs and substantial benefits can stay on their parents' insurance to avoid more cost-sharing (CQ HealthBeat, 8/18).
According to Darling, the financial strain of the ongoing increases in health care costs has created "an unsustainable model for our country" (Modern Healthcare, 8/18).
Don't Delay Emergency Care When Asthma Flare-Ups Strike
Study found waiting led to worse outcomes, including hospitalization
MONDAY, May 16 (HealthDay News) -- Asthma patients who delay seeking emergency medical care when the condition flares can suffer worse outcomes, including hospitalization.
That's the finding of a study that included 296 asthma patients in two New York City emergency departments. They were asked about the duration of their asthma symptoms and their attempts at self-management before they decided to go to the emergency department.
Two-thirds of the patients waited five days or less before they sought medical treatment and one-third waited longer than five days.
Patients who waited longer were more likely to be sicker when they arrived at the emergency department, more likely to arrive by ambulance, and more likely to be admitted to the hospital.
The study also found that patients who waited longer and those who sought treatment earlier were about equally likely to have health insurance (80 percent), to consult a physician before coming to the emergency department (23 percent and 18 percent, respectively), and to have used drugs called beta-agonists (albuterol, for example), which are typically prescribed to treat asthma flare-ups.
The study is slated to be presented Monday at the American Thoracic Society (ATS) international conference in Denver.
"An important aspect of managing asthma is for patients to realize when they can handle exacerbations with help from their regular doctors, and when they need the more intense treatment the emergency room provides," study author Dr. Carol Mancuso, an associate professor of medicine at the Hospital for Special Surgery, Weill Cornell Medical College, in New York City, said in an ATS news release.
"It is preferable to get help early from regular doctors and avoid the emergency room. However, when intense treatment is necessary, then the sooner the patients present to the emergency room the better, because then they are not as sick and are less likely to be hospitalized," she added
New Rule Ensures Students Get Health Insurance Protections of the Affordable
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
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
- 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
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.
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.
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.