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Newly Diagnosed Positive & Insurance
May 29, 2001

I was just diagnosed positive thru anonymous testing. I have been on my health plan at work for two months now, and I have never received treatment or diagnosis for HIV before. I have three basic questions: can I be treated thru my insurance without fear of getting denied, i.e., can the insurance provider somehow find a loophole for "pre-existing condition"? Will anyone at work, including the benefits manager, know what I'm being treated for? (It's a small company, only 9 employees) And finally, will I be eligible for HIPAA if I leave (considering I stay for the twleve month requirement period)for another job in the future?

Response from Mr. Berg

The Health Insurance Portaability & Accountability Act (HIPAA) prohibits discrimination against any employee based on their health status. You cannot be denied coverage due to a pre-existing condition or a subsequent diagnosis. Your employer may only impose a pre-exisisting exclusion period if medical advise, diagnosis, care or treatment was received or recommended within the 6 months prior to your enrollment date. Given all the healthcare privacy legislation pending, it is unlikely that your insurance company would disclose this information for fear of a lawsuit. HIPAA allows you to receive credit for all the months health coverage you accumulate with your employer. Upon termination of this coverage (as long as you enroll into a new group plan within 63 days), this credited coverage can be used to reduce or eliminate a new 12 month pre-existing exclusion period under the new group health plan.



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