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Not totally honest on initial insurance application
Jan 5, 2007

My question is this:

When I was first diagnosed I was on a group health plan with a church and was totally freaked out about being "outed" so I never used the insurance for anything related to my HIV. I then left the church and set up a small group health plan with just my wife and 8 kids with my wife and I being the only two employees. We have had this policy in effect for three years and I have never used it in connection with my HIV. So effectively, there is no record of me having HIV. We now are in the position of having to use the insurance because I am going to have to use the insurance for a hernia surgery that I am sure will notate that I am HIV positive. Are they going to want the records from the time I was diagnosed. I have been on meds for 5 years. I am concerned if they all of a sudden see this HIV come up they are going to want additional information. The doctors chart will show It goes back 5 years therefore being a preexisting condition which I was not upfront about. I did switch from a group policy to this small group policy. Does the preexisting condition even come into play?

My other question is about changing jobs. How private is my health status? If I am employed at a small church with about 10 members in the plan and one of the employees handles the insurance, will the insurance company really jump the rates of the church because of my diagnosis? I don't want to hurt the churches situation. I also do not want them to find out about my status. Do you think there is a pretty good likelyhood of them finding out in a "company" this small? Are insurance companies really that reliable not to tell employers?

Response from Ms. Franzoi

This is not a pre-existing condition situation. However, the fact that you procured the coverage based on false answers to the medical questionnaire is insurance fraud. Your insurer could take action based on this, including cancellation of coverage, request for reimbursement for all claims paid, etc.

If you were to take a job at a church that offers a health plan to its employees, your health information would be confidential, between you and the insurance copmapy. In a plan with only 10 employees, it is often insured on a community basis so individual claims might or might not drive the cost up. The cost won't be based on diagnosis but on actual claims costs.



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