The Body: The Complete HIV/AIDS Resource
Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol
Ask the Experts About

Workplace and Insurance IssuesWorkplace and Insurance Issues
Rollover images to visit our other forums!
  • Email Email
  • Glossary Glossary

New insurance and pre-existing conditions
Dec 18, 2006

In 2004, I moved to Los Angeles and began using ADAP to cover my HIV-related expenses (labs, doctor visits, etc.). Recently, I started a new job with full health insurance coverage under Blue Cross/Blue Shield. I joined without informing them of my HIV status. I recently renewed my ADAP for another year but I will likely make over $ 40,000 at my new job by next year. And I would eventually like to take advantage of the new insurance. I am concerned about their preexisting condition clause. Will I end up with not coverage for my HIV related expenses? I have been positive since October of 2003 and before moving to Los Angeles, I was fully covered through Blue Cross/Blue Shield in another state.

Response from Ms. Franzoi

Under HIPAA, a federal law, health plans that have a pre-existing condition clause must recognize prior periods of coverage (called Creditable Coverage) unless there was a break in coverage of 63 days or more. Since your prior BC/BS coverage was in 2004, that won't count as Creditable Coverage. However, ADAP might as I know Medicaid does. Contact ADAP and ask for a letter of Creditable Coverage. If they can provide this, your ADAP coverage would apply towards any pre-exisitng condtion clause (which cannot be for longer than 12 months, 18 months if you are a late enrollee). However, even if ADAP coverage doesn't count, as stated above, the longest a pre-existing condition clause could apply to you would be 12 months (18 months if you are a late enrollee).

Company changing group insurance
Health Insurance While on LTD

  • Email Email
  • Glossary Glossary



This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.

Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.

Review our complete terms of use and copyright notice.

Powered by ExpertViewpoint