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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).



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