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Medicaid and Financial Award
Dec 3, 2004

I have been hiv positive since 2002 at time of diagnosis I was insured through an employer. Later that same year I was involved in an accident that left me unable to work till present time. My cobra benefits ran out and now I am on medicaid. My question is, if I am to receive a large lump sum in a judgement for my injuries how does this affect my insurance coverage. Also, if I find work I am able to perform am I still eligible to obtain private insurance through my employer regardless of my hiv status. Thanks.

Response from Ms. Franzoi

Depending on the subrogation language in your health plan, a portion of the lump sum settlement could be claimed by the health plan to reimburse the plan for medical expenses it covered that were related to your accident. If you are able to return to work and the employer offers health insurance coverage, you would be eligible for the plan regardless of your health status as long as you enroll during the enrollment period. Even if the plan has a pre-exisiting condition exclusion, as long as you don't have a break in coverage of 63 days or more, your prior coverage would have to count towards that exclusion period which can't be greater than 12 months. If you have a break in coverage that is 63 days or more and the plan has a pre-existing condition exclusion, the maximum period for this exclusion would be 12 months.

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