Please Note: Due to volume considerations, not all questions can be answered. Questions most likely to be answered will be those of general interest to a broad group of visitors to this forum. Questions pertaining to a specific case; requests for diagnosis, medical advice, or second opinion; or requests for opinions about untested alternative therapies will generally not be answered.
|
 |
 |
Clarification of Insurance Coverage
Apr 23, 2007
I am a public school teacher and have insurance through the school district which I enrolled in during open enrollment. My distric offers several different HMO/PPO plans through different companies. Can I change insurance companies during our open enrollment period with a pre-existing condition (HIV)? Further, I may decide at some point to relocate to another large city which would have similar insurance benefits (i.e. several large providers [HMO/PPO]) with open enrollment? Could I make such a move with this pre-existing condition? I like my infectious disease doctor and I don't plan to make any moves at present, but in the years to come, it may an option, and I'm wondering if it's realistic to think that I could change insurance providers in this case.
|
 |
 |
Advertisement
Response from Ms. Franzoi

Typically, at open enrollment, if an individual switches from one health plan to another, there is no new pre-existing condition limitation applied as you have been continuously covered by another plan sponsored by this employer. However, check the language in the plan summaries carefully with respect to this. Furthermore, if you have had continuous coverage for at least 12 months, even if there is a pre-existing condition clause, it cannot be greater than 12 months and the plan would have to recognize your prior period of coverage towards this period (HIPAA regulations). This is what would happen if you were to relocate and get coverage from a new employer. As long as you don't have a break in coverage of 63 days or more, the new plan would have to recognize your prior period of coverage towards any pre-existing limitation period and this period cannot be greater than 12 months.
Want to read more questions and answers on this subject? Our experts have answered many similar questions!
|
|
 |
 Please remember that this forum is designed for educational purposes only, and experts are not engaged through this
forum in rendering legal or medical advice or professional services. Experts appearing on this page are independent and are solely responsible
for editing and fact-checking their material. Neither The Body nor any sponsor is the publisher or speaker of posted visitors' questions or the experts' material.
Questions and messages posted to this forum are not statements of advice, opinion, or information of The Body, Body Health Resources Corporation or any sponsor of this
forum. While neither The Body nor Body Health Resources Corporation regularly reviews posted content, we reserve the right to delete, move, or
edit postings if we deem it appropriate under the circumstances. Visitors submitting questions remain solely responsible for the content of their
messages.
Information provided by experts is general only and should not be used for diagnosing or treating a health problem or a disease, or relied upon as
legal or other professional advice. This information is not a substitute for professional advice or care. If you have or suspect you may have a
health or legal problem, you should consult your own health care provider or your attorney.
Copyright notice.
|
|
Advertisement
|
|