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Pre-Existing Condition Waiting Period
May 27, 2013

I was on Cobra until Aug 31, 2012, then was without insurance until May 8, 2013, when I accepted a job with an employer that provides guaranteed acceptance insurance through United Healthcare (over 8 months gap in coverage; during those 8 months I relied on Ryan White services to maintain my med routine). Now, my employer is switching to Cigna as of July 1, 2013; Cigna's policy is NOT a guaranteed issuance policy and they are asking for a health questionnaire. I indicated I have HIV on my health application. Can Cigna impose a waiting period or deny coverage of my HIV related medical costs due to my prior gap in insurance before United Healthcare? Or, since I was accepted by United Healthcare, and since there will NOT be a gap between United Healthcare and Cigna coverage, Cigna is precluded from imposing a waiting period? Thanks.

Response from Mr. Chambers

My first question is whether the CIGNA coverage is truly employer provided coverage or is the employer simply letting CIGNA sell individual health policies to eligible employees. A few employers with a very small number of employees attempt to use individual policies, but that is quite rare.

If it is truly employer provided group health insurance, CIGNA cannot, by federal law (HIPAA), refuse to accept you for coverage. Some carriers, depending on what state you live in and the size of the employer, are permitted to ask health questions, but can only use the information to set the rates for the group, not deny coverage and is sometimes used to assign case managers to persons with serious or chronic conditions.

Regarding a pre-existing conditions waiting period, it appears you have been on United Healthcare's health plan for less than twelve months. Under federal law again, a new carrier (CIGNA) must count the time you were under the prior carrier towards any waiting period for pre-existing conditions. By law it can't exceed twelve months, so depending on how long you were covered under United Healthcare, you may only have few months more to wait IF there is such a waiting period.

HMOs do not have such waiting periods and some states permit shorter limits on them. The answer for these would be no waiting period.

Check your plan document from CIGNA once you receive it. Hopefully, you will be OK.

Good luck, Jacques

FMLA, disability

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