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Health insurance caps for HIV/AIDS
Dec 12, 1997

I have HIV and my husband's self-insured company has covered my health care expenses since 1989. This year they are setting a $50,000 life-time cap on HIV/AIDS. This will give me only 4-5 more years of health insurance coverage at my current rate. The companies plan administrator suggested the HIV/AIDS cap to help the company reduce its costs. It is a small enough company that I may be the only HIV+ person currently covered. Is it legal to cap one disease, but not others?

Response from Ms. Franzoi

HIV caps are generally illegal if they provide coverage that is different from other illness coverage. Your company cannot simply cap your HIV treatment benefits without limiting all health benefits for all illnesses and for all employees. You should explain this to your employer. The Americans with Disabilities Act prevents your employer from discriminating against you by setting a unilateral HIV treatment cap on your health benefits.

-- Lynn Franzoi



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