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Newly Diagnosed Positive & Insurance
Jun 2, 2001

I was just diagnosed positive thru anonymous testing. I have been on my health plan at work for two months now, and I have never received treatment or diagnosis for HIV before. I have three basic questions: can I be treated thru my insurance without fear of getting denied, i.e., can the insurance provider somehow find a loophole for "pre-existing condition"? Will anyone at work, including the benefits manager, know what I'm being treated for? (It's a small company, only 9 employees) And finally, will I be eligible for HIPAA if I leave (considering I stay for the twleve month requirement period)for another job in the future?

Response from Ms. Franzoi

Since you were not diagnosed or treated prior to coverage becoming effective, you can expect to have coverage for reasonable and customary charges for procedures and medications that are covered under the plan. Even if there is a pre-existing condition clause, it would not apply to you because you did not seek treatment, have a diagnosis, etc. in the period of time (usually 3 months) that plans look at to determine if someone has a pre-existing condition. Even if you had one, the longest the plan could preclude HIV-related treatment from coverage would be 12 months (less if you have a Certificate of Creditable Coverage from your prior plan as this would count towards the pre-existing condition period unless you had gone more than 63 days without coverage). No one at work should know what you are being treated for. If the plan is self-insured, the brenefits manager or those in the Benefits Department who deal with the ehalth plan might have knowledge of this. They are prohibited from disclosing this to anyone.



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