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Recently positive, need to start treatment ,on COBRA, what next?
Feb 26, 1998

Hi there! Thank you for this very valuable resource. I am computer programming professional living and working in New York. I am recently HIV positive, and it has been determined that it is time to begin drug therapy. I have a comprehensive indemnity healthcare insurance package through a major insurer that I maintain through COBRA (with 10 of the 18 months of coverage remaining) from my last employer. My current employer, a small start-up co., does not offer a healthcare plan, thus I am paying over $300/monthly for my insurance. My questions are these: 1.) Is this legal -- not offering health insurance? 2.)When I begin treatment and start claiming the expenses against my policy, can they drop me? Does the COBRA arrangement complicate things? 3.) And when my COBRA expires, how will I get new insurance when the potential insurer sees I am HIV positive on antiretroviral therapy = a great cost to them? Isn't there some sort of pre-exisitng condition clause? And even in a new insurer takes me on, won't they charge me absurd amounts in premiums? 4.)What about programs like ADAP in New York State (AIDS Drug Assistance Program)? Is there an income cap to qualify? I am making a good living (about $80K annually), but not enough to to pay for my drugs myself. I am concerned and confused. Thank you for your assistance regarding this matter.

Response from Ms. Breuer

1. Yes it is legal. There is no legal obligation for an employer to offer his employees medical benefits.

2. As long as you can continue to pay your COBRA premiums, they cannot drop you. The COBRA arrangement does not complicate things. The plan is administered in the same way for COBRA participants as it is for active employees.

3. When COBRA expires, you have some options. If the plan under which you are offered COBRA has a conversion provision, you will be eligible to convert the coverage to an individual policy. I would examine this option carefully. Conversion policies typically offer lower levels of coverage at high costs.

With the Health Insurance Portability and Accountability Act (HIPAA) being effective 1/1/98, you would be able to purchase an individual policy without a preexisting condition clause and without evidence. HIPAA guarantees availability of individual health insurance to individuals with prior group coverage. An insurance company that providers health insurance in the individual market cannot refuse to offer coverage or deny enrollment under policies it markets in the individual market. The insurer may not impose any preexisting condition exclusion. The cost of the policies and the actual policies offered will vary by carrier and by statel, if the state in which the insurer is implements an acceptable alternative to the federal provisions. But all insurers in the individual market must offer policies with guaranteed availability and renewability to individuals with prior group coverage.

4. With respect to ADAP in New York, you would have to contact the agency directly to obtain information on eligibility for benefits.



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