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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).



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