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Is HIV considered as preexisting condition
May 8, 2012

I am switching jobs and wondering is HIV considered as preexisting condition for the purpose of insurance before I resign

Response from Mr. Chambers

Pre-Existing Condition has a general definition and a contractual one. Yes, anything that you have had previously is considered pre-existing in the general definition.

However, when used in a health insurance contract, pre-existing condition has a special meaning and is always specifically defined in the contract. A typical definition of a pre-existing condition in an insurance contract is: "A condition for which you received medical treatment in the three months immediately prior to the effective date of your insurance coverage." With that definition HIV is not a pre-existing condition unless you had treatment for it less than three months before your coverage started.

The federal law HIPAA, however, creates an exception to any insurance plan's pre-existing conditions limitations provision. If you move from one insurance plan to another (i.e. change jobs), the new carrier can not impose a pre-existing conditions waiting period if there is no gap in coverage of more than 63 days between your old coverage and the new plan, not counting any probation period you must wait at the new job before insurance begins.

During that probation period you would probably want to take COBRA from your old employer anyway until the new coverage starts.

The only exception to that would be if you were covered under the old plan only briefly. For example, if you were covered under the old plan for three months and the new plan has a six month pre-existing waiting period, then you would have to wait three more months to get coverage for HIV under the new plan.

Not simple, but that's government legislation for you.


ADAP Ryan White and PCIP
afraid for job

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