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Long Term Care/Pre-existing
Nov 22, 2005

Hello! And thank you very much for taking the time to answer my question. As an employee of my large company, I may purchase additional Long Term Care coverage during the enrollment period without having to fill out a medical questionnaire as long as I dont exceed the Guarantee issue limits. (Currently the company pays for my Long Term Care coverage, which has a $2,000 benefit for 3 years at no cost to me. With the new options on the table I can increase my coverage to $7,000 per month for 3 years). The new coverage being offered states that Benefits may be subject to a pre-existing condition exclusion. Their definition of Pre-existing is as follows:

Pre-existing condition is a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, during the six months period right before coverage begins.

It goes on to say:

The policy will cover Pre-existing conditions that are disclosed on the application no later than six months following the effective date of the coverage, regardless of the date the loss or confinement begins.

Just so you know a little bit about my background and employment history. Im a 36 year old male that has been HIV positive close to fourteen years and Im not on Meds as of yet. I have been with the same company a little over 10 years and was diagnosed during this same time frame.

The extra premium wouldnt be a burden whatsoever. However I would only want to pursue the extra coverage if it were not to exclude my pre-existing condition. By the language I used above what would your advice be on my eligibility?

Many Thanks!

Response from Ms. Franzoi

Based on how you describe your plan and the buy up option, if you haven't taken any meds or sought medical treatment or seen a physisian for anything related to your HIV status in the 6 months prior to the effective date of the coverage, you would not have to disclose your HIV status. For example, if you tested positive 3 years ago but are not currently on meds or seeing a doctor for HIV and haven't done so in the prior 6 months, your HIV status would not be a pre-exisiting condition as defined in the plan.



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