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Switching Ins Co at work place.
Jul 19, 2012

HI.. I am HIV + and I am under my Employer's health Ins Coverage. Because of the incrising premiums my employer decided to switch Insurance Companys. 1-Do I have to disclosed the medications I am taking to the new Insurance co and/or my employer? We were given new forms to fill out where they ask all these health questions and I have to give them back to my office manager. I am freaking out and do not know what to do. I do not want to disclose my status nor the medications i am taking to my employer, but i am afraid that the new Ins Co may think I am lying and therefore deny coverage. 2-Can the new Ins co deny me?

Response from Mr. Chambers

First, because this is employer-provided group health insurance, the new carrier cannot refuse you coverage. That is federal law under HIPAA.

Some states do permit insurance companies to ask health questions, usually just for small groups. The point of this is not to deny you coverage, they can't do that, but to adjust the group's rate based on the "health" of the group.

While that is not a coverage problem since you will get the coverage, the drawback is that you must turn this into your employer who can see your health issues. And, assuming this is a small group, that information is not what you want circulating among your co-workers.

Based on your comfort level, your choices are:

1. If known, call the agent or the new insurance company. You will need to know the company name your employer uses on contracts, and, ideally, you will know the policy number because you really have to pin down what group you are calling about. Tell them that you would rather not have your medical information available to the employer. Ask if there is an individual you can send your enrollment form to directly. Then, just tell your employer you misunderstood and sent it directly to the insurance company.

2. An alternative to #1 is to contact the insurance company and let them know you are giving the employer an incorrect enrollment form and want to send the accurate form directly to the carrier. Be sure you identify whom you are sending it to so it can be traced if lost. You can then turn in an "inaccurate" enrollment form with false health information and the carrier can replace it with the real one. Get a name and number so you can make sure the switch was made.

3. One alternative is to tell your employer that your enrollment form has information you would rather not be known to your co-workers and ask for assistance in getting it to the insurance company without anyone at the company seeing it. Drawback here is that just makes the employer more curious and they may insist on you turning in to him/her. If so, consider adding choice #4.

4. Based on your relationship with the employer and you are valued as an employee, you can take the form directly to the employer and turn it in to him/her, even bypassing a clerk assigned to collect the forms. show the form to the employer; assure him/her that your condition has absolutely no effect on your ability to do your job. Politely remind your employer that this information is confidential medical information and telling that to anyone but the insurance company is a violation of federal law. You probably want to also present a letter (and keep a copy) summarizing your concern about the illegal release of that information.

This is a tough situation to be in and I wish I had better solutions, but you must be truthful in the application that the insurance company uses, whether it goes through your employer or directly to the carrier.

A note of caution about dealing with the agent/broker. They are probably independent and not part of the insurance company. Also, the broker's client is the employer not you so he/she may feel some obligation to tell the employer if you choose to give your enrollment form to him/her.

Good luck, Jacques



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