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3 Questions with some Background Info
Jun 1, 2001

My spouse has AIDS, and was diagnosed in 1999. Although his cd4 count has increased, (up to 338 from 7), he did have an OI, with PCP at the time of diagnosis in 1999. Therefore, I understand that "once AIDS, always AIDS", regardless of how a patient's condition improves.

My family is currently covered under a group policy through my employer, that is community rated, meaning there were no health questions involved in enrollment. However, my employer now wants to try to enroll in a new plan. The new plan requires health questions. My employer knows that there is something wrong with my spouse, but he doesn't know that he is diagnosed with AIDS. He has assured me that he would not accept an insurance plan that would exclude or limit any employee or dependent, and that if we had to stay with the same company we are with, so be it. I feel that if my employer knew the truth, he may not be so generous.

Here are my questions: 1) The health questions asks "Are you being treated for AIDS or ARC?", and makes no mention of HIV. Since the counts are up over the level defining of AIDS, could this question be answered no? (I know that is probably stretching it a bit.)

2) If we disclose all pertinent data on the application to the insurance company, would it be possible for my employer to know? (This is further complicated by the fact that my employer also employs the insurance agent that is selling us the policy), and

3) Since my employer is terminating the plan, would my spouse (alone) be able to obtain a conversion policy with our current carrier? If so, I could cover the children on my dependent coverage, and pay the premium for my spouse's conversion policy.

Any help you could provide would be greatly appreciated.

Response from Mr. Berg

First off, the federal Health Insurance Portability & Accountability Act (HIPAA) prohibits discrimination against employees and dependents based on their health status. Your husband cannot be excluded from the new plan. You can get more information on HIPAA at the following websites: www.hcfa.gov and www.dol.gov/dol/pwba (check out the publication, Questions & Answers: Recent Changes in Health Care Law).

1) I don't think you could really get away with answering no. Afterall, once the claims start coming in, they will have access to his physician's records.

2) While it's not impossible, it would subject your employer to future disclosure/privacy lawsuits if you suffered any discrimination as a result of his knowledge.

3) It may be possible. If you feel this is the best option, check with the insurance company. Usually, conversion policies are more expensive and provide less coverage so read all the fine print.



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