RSA Health Insurance Census Information
Progress: 
 
The RSA has begun research, as requested at the Strategic Planning Meeting, to create a health insurance plan for RSA members ages 65+. The law currently allows for interstate purchasing of group insurance for ages 65+, however, it does not allow for insurance purchasing for 64 and under.   
 
This survey, which we ask all members to complete, is to gauge their interest on such a plan. This data will be important in order for the RSA to procure an organization willing to underwrite the program.

The information collected on this form will be kept confidential. The RSA will only use the information to create a census to find affordable Medicare and health insurance options for our RSA members.

Census can include part time, full time, retired employees and employee spouses and dependents and also includes RSM members and their employees and spouses and judges, coaches and their spouses.

If you are your employees are 60 or over, please complete this survey as insurance companies will want to see how many potential clients will be aging into the Medicare system over the next five years.  
 
1.

RSA Membership ID

 

50 characters left.
Medicare Health Insurance
Individuals 65 and over, plus includes anyone on disability. 
 
2.

Name of Owner or Operator 65 and Over

 

50 characters left.
3.

Birth date with Month/Day/Year

 

50 characters left.
4.
Gender 
Male
Female
5.
Name of Spouse
 

50 characters left.
6.
Spouse's Birth Date with Month/Day/Year
 

50 characters left.
7.

Gender

Male
Female
8.
Best Number to Reach You (Home/Cell)
 

50 characters left.
9.

Personal Email

 

50 characters left.
10.

Home Address

 

50 characters left.
11.

City

 

50 characters left.
12.

State

 

50 characters left.
13.

Zip

 

50 characters left.
14.

County

 

50 characters left.