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Changing Jobs and HIPPA

Aug 1, 2000

I've read the previous questions and still am not clear on a few items. I'm in the process of relocating from Oregon to Texas and have been covered by my employer's group health plan for over 2 years and was recently diagnosed as HIV+. In my reading of HIPPA, my new employer's health insurance provider would not be able to exclude covering treatment related to HIV for more than 12 months. Could the new provider exclude covering HIV treatment all together, or could coverage be excluded only for a maximum of 12 months?

Response from Ms. Franzoi

If your new employer's plan has a pre-existing condition clause and you do not have a break in coverage of greater than 63 days, your new employer's plan would have to recognize your period of coverage under your prior plan (referred to as creditable coverage). There would be no pre-existing condition exclusion applied to you because the maximum period that a plan can have is 12 months but the plan must recognize prior creditable coverage. However, you should review the terms of your new employer's plan for any exclusions or maximum benefit limitations on certain illnesses, such as AIDS.


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