Small Business Owner and HIV+
May 31, 2001
Within the past year I started a small business that covers myself and employees with a group health plan. I also recently found out I'm HIV+, but still healthy. I also have creditable coverage (12 years) with my former job. What are the risks of any claims I might start making for HIV treatment under my companies health plan, in regards to cancellation or coverage? I think I'm covered squarely by HIPAA but not sure since I'm owner of the company. Any help or direction would be greatly appreciated.
Response from Mr. Berg
Once a pattern of claims is established on a new plan or policy, the insurance company usually starts a pre-existing investigation and can suspend payment of claims. Given that you didn't have a pre-existing conditon in the 6 months prior to the coverage effective date and you have enough creditable prior coverage to eliminate an exclusion period, you should be ok. I don't believe the fact that you are the owner makes any difference as members of the group plan are protected by HIPAA. You can get more information on HIPAA at: www.hcfa.gov and www.dol.gov/dol/pwba (check out the publication, Questions & Answers: Recent Changes in Health Care Law).
Get Email Notifications When This Forum Updates or Subscribe With RSS
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.