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Recently diagnosed and confused about insurance issues
Nov 20, 2000

I'm a 23 year old male in my first job out of college. I have also recently been diagnosed with HIV, which I did not actually contract until after my employment (and coverage) began. If I begin treatments, or file any of the medical bills with my insurance, can this make it a pre-existing condition if I change employers and try to get that companies health plan. Also, I was diagnosed at a clinic, do I have to disclose that I have HIV? (I know that this is ethically and morally wrong to not tell them, but there is no way I can even come close to being able to afford the expense of having HIV without insurance). I know next to nothing about insurance to begin with.

Response from Ms. Franzoi

If you change employers and your new employer's plan has a pre-existing condition clause in it, federal law provides that:

1. A pre-existing condition clause cannot apply for more than 12 months.

2. The plan cannot use a look-back of more than 6 months to determine if the employee has a pre-existing condition. A 6-month look-back means that if the employee saw a doctor or took medication in the 6 months prior to coverage beginning, that illness would be considered a pre-existing condition.

3. If the employee had other coverage and did not go more than 63 days without coverage, his period of coverage under the prior plan would have to count towards any pre-existing condition period under the new plan

More simply stated: If you are covered under your current plan for at least 12 months and you transfer to a new company and therefore a new plan, as long as you don't go more than 63 days without coverage, your 12 months of coverage under the prior plan would count towards the pre-existing condition exclusion period under the new plan. Since a plan cannot impose a pre-existing exclusion greater than 12 months, you wouldn't be subject to a pre-existing condition clause.

Lynn L. Franzoi



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