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Pre-Existing Condition Times 2
Nov 20, 2000

Complicated situation. Work for a company that initally provided medical benefits through Insurance Company A (pre HIV+). Was covered by them for 4 mos. Company then switched to a new insurance carrier Insurance Company B. One month on that plan and Diganosed HIV+. I was clearly covered by the plan of the second Insurance company at the time I tested poz and began treatment and monitoring with a doctor. Well... Insurance Company 2 is trying to excercise the 'pre-existing' condition clause though I don't see how they can do it. IT was not an existing condition at all till i was covered by that plan. Can they do this?? They are currently bent on creating a paperwork nightmare for me. To make matters worse, my company has now switched to yet another 3rd insurance company (yes..all in less than a year! don't get me started!) and i'm concered that the new Insurance company is going to excercise their "Pre-Existing" condition muscle since we were covered by Ins. Co. B for less than 12 mos. So...Can Insurance Company 2 claim pre-existing ? and then can Insurance company 3 claim pre-existing ? I have a headache...great... HELP!

Response from Ms. Franzoi

I think this is being administered incorrectly. Typically, when a company changes insurance providers, everyone who was covered under the prior plan without a pre-existing condition limitation becomes covered under the new plan on the same basis.

This should also apply with respect to the new and third company. However, with the third one, federal law is on your side. Under HIPAA:

1. a plan cannot impose a pre-existing exclusion of greater than 6 months; and

2 if it has such a clause, it must recognize coverage under a prior plan(s) (unless there was a break in coverage of greater than 63 days) towards its pre-existing condition limitation period.

For you, this means that as long as you have had continuous coverage for at least 12 months (under the prior two plans), the new plan (third one) cannot impose a pre-existing condition period on you.

Lynn L. Franzoi

Denied Salary
Some workplace HIV transmission questions

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