Aetna Health Insurance
Nov 28, 2012
I am currently on a state program Adap, my Husband just got a job at Cotsco , a very big company ,they will provide health insurance in 60 days with Aetna , my question is : Will they accept me with my Pre-existing condition HIV ? my health is very good ,my cd4 count is over 800 and no detectable , Is there a possibility the employer find out about my condition? please help ,I do not want to sign up until I'm sure about all this. Thank you !
Response from Mr. Chambers
I'm glad for your husband but this does raise some sticky issues for you and your medical care.
First, Costco is so large, it's more than likely self-insured and has hired a third party administrator or insurance company to process and pay the claims. Technically, Costco owns all that paperwork which theoretically means they would have access to your claims. HOWEVER, smart employers (and Costco is smart to be as big as they are) understand the legal problems involved with knowing about your medical condition under many federal and state laws, so most employers create strong barriers to make sure they do not get details of employees' health conditions as it can cost them dearly if there is a suspected connection between your health and their personnel decisions. It would be very rare for and employer of that size to become aware of your medical condition. The information they get is usually bundled without names of actual people attached to their medical bills.
The pre-existing conditions question depends two issues. First, if the plan Costco offers in an HMO, they typically do not have any waiting period on pre-existing conditions so all would be covered once you become covered.
If the plan does have a pre-existing conditions waiting period it is only imposed if you have not had other health insurance coverage in the 63 days just prior to your effective date of coverage. If you have had coverage within that period, they will count whatever time you were in that plan toward the pre-existing conditions waiting period in the Costco plan.
If you have not had coverage in that period, you will have to go through the waiting period which is usually six months before they will cover HIV related charges.
By the way, being on ADAP does not count as prior coverage, but Medicare, Medicaid, and regular health insurance plans are considered "creditable" coverage.
Good luck, Jacques
Get Email Notifications When This Forum Updates or Subscribe With RSS
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 TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.