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A Thank You and a few insurance questions
Jan 24, 2004

I'd would like to say thank you for all your thorough responses and especially for your positive and encouraging comments regarding those with HIV. I feel it is a strange parodox to be labeled as having a condition that somehow makes me less "healthy." The fact of the matter is that my overall health has greatly improved since the diagnosis and as a result of that information I have taken great strides in maintaining my health to a greater degree than ever before. Also, with the advent of HAART, most all experts would agree that the future looks extremely bright for the vast majority of HIV individuals.

For myself, I have been on HAART for less than 2 yrs., having started in acute phase and have fortunately never had any serious side effects and quickly went to an undectable VL and have maintained very good CD4s. My diet is much, much improved and in the last year and a half have not missed a week of almost daily exercise. My body has never looked better (I'm in my mid-40s), having muscles now where none existed before. The bottom line is even though no one knows for sure what the future holds, the experts on this website concur that the majority of HIV+ individuals will have at least a near-full-life expectancy. Pretty good odds considering the hazards inherent in today's society! It seems odd that the insurance companies seem so sadly behind the times in evaluating HIV+ individuals. Also, they don't seem to take into account the length of one's diagnosis, success with treatment, etc.

On to my questions: I am currently on my last two months of COBRA and want to explore my options for continuous coverage. I have Kaiser in So. Ca. and think it would be best to continue with them once COBRA is over as a matter of convenience and to stay with my doctor, etc. I gather from my status that there is no way I could get a Personal Advantage plan with them? Otherwise, my options as I see them are either HIPAA or Major Risk Medical. The HIPAA coverage is about 150 more per month than the Personal Advantage plan, whereas the Major Risk is about 50 per month more than the Personal Advantage. The plans are fairly similar in coverage, though the biggest difference I can see is the yearly maximum. The HIPAA coverage does not appear to have a yearly maximum, whereas the Major Medical has a 75000 yearly maximum, obviously a problem if one were unfortunately hospitalized.

I am wondering if there are other differences between HIPAA and Major Risk here in California that I'm not aware of? Am I "labeling" myself badly by being on either coverage for when I hopefully go back to work full-time? The cost is an issue to me since I'm currently unempolyed and will have difficulty with premium payments. Do you see an advantage to one plan over the other? In other words, is it better to have HIPAA or Major Risk? Would the extra 100 per month be worth the HIPAA coverage? I know that I don't want to be without any coverage, so I'll need to get something. Do I have any options as a low income individual as well? I made less than 10,000 last year. I would like to get back to working in a good paying full-time job again later this year, but in the meantime will need to stay covered and pay for my meds.

Thank you for all your advice and again thanks for the support for making us not feel disabled and unhealthy.

Response from Ms. Breuer

What an encouraging letter to read! Congratulations on your improved health and taking charge of your own situation. You could give lessons!

My colleague Lynn Franzoi is the expert on plan comparisons. My two cents, before I refer your question to her, is that Kaiser Permanente of Southern California gives excellent HIV care, especially to patients who are full participants in their own health care, as you are. There are good reasons to stay with them, including how your meds are dispensed and their general reputation for well-informed in HIV.

And now to Lynn...

Response from Ms. Franzoi

You are correct. Based on your status, your choices would be a HIPAA policy from Kaiser or coverage under the California Major Risk Insurance Plan, of which Kaiser is one of the insurers offering coverage. There are other differences between the HIPAA policy and the Major Risk policy besides the $75,000 annual benefit maximum that you should consider:

1. The Major Risk policy has a maximum enrollment. Once this is reached, individuals who apply for coverage are put on a waiting list on a first come, first served basis. The Major Risk coverage is a 36-month program. This means that after an individual has been covered for 36 month, he rolls off the plan and someone on the waiting list becomes eligible for the coverage.

2. The Major Risk policy has a 90-day pre-existing condition clause in it; the HIPAA policy does not. However, the exclusion period is waived if you are on the waiting list for longer than 6 months.

Clarification re: pre-existing exclusion

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