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Can future insurers exclude or cap HIV coverage?
Feb 26, 1998

Thanks for such a great source of information. I'm wondering about the ability to change jobs and continue my health coverage given that I'm HIV +.

My company is currently going through a "reduction of force" which is causing me great anxiety. I hope that I'm not affected, but if I am, what can happen to my medical coverage? I've been HIV + since 1987. Since I take multiple medications, I know that my insurance company is well aware of my HIV status.

I know that I can convert through COBRA for up to 18 months(paying both employee and employer costs). If I get a new job (for whatever reason) could my new insurance company refuse to cover any HIV related expenses as a "pre-existing condition"? Or could they cap the amount of money that they would be willing to pay out for HIV medications and services? I live in Texas if that makes any difference.

Thanks for your help!

Response from Ms. Franzoi

If you lose your job due to a reduction in force, you will be eligible to continue coverage for up to 18 months under COBRA. If you get a new job that offers coverage, you will be eligible for that plan. Under a new federal law, HIPAA, a plan must recognize your coverage under a prior plan towards their preexisting condition clause (if they have one). This is required as long as you did not go for a period of greater than 63 days without coverage. This means if you are laid off and find a new job, your new employer, if he offers health insurance coverage, must extend the coverage to you. If his plan has a preexisting condition clause, he must count your coverage under your current employer's plan and any COBRA coverage you have towards that preexisting condition period as long as you do not have a period of time without coverage that exceeds 63 days. Furthermore, the preexisting condition. period under his plan cannot exceed 12 months. Your prior employer will have to issue you a certificate of coverage which you will present to your new employer. This certificate will state the period of creditable coverage you had under his plan.

With respect to having limits on treatment for AIDS, plans can have such a cap.

Lynn Franzoi



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