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HIV/HBV pre-existing condition?
Nov 20, 2000

Thank you for your service. Our son is HIV+ and is carrying hepatitis B, but has not "come down" with it. He is getting gov't help with his drugs for HIV. He recently took a job with insurance that doesn't cover pre-existing conditions. If he were to actually come down with Hep B would that be a pre-existing condition since he was already carrying it? He has done very well on his drugs and so far (for a year) and hasn't been ill.

Response from Ms. Franzoi

I need some more information. How does the plan define a pre-existing condition? Since a plan cannot use a look-back of more than 6 months, if your son neither took medication nor saw a doctor for Hep B in the 6 months prior to coverage, Hep B would not be a pre-existing condition. However, you should check the definition in the plan as it might be less restrictive than this.

Did your son have health coverage before he took this job? If so, provided he had not gone more than 63 days without coverage, his period of coverage under his prior plan would count towards the pre-existing condition period under the new plan. The new plan cannot impose a pre-existing condition period of greater than 12 months.

Lynn L. Franzoi



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