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Employer Health Insurance Won't Cover Meds
Jul 19, 2000

I was hired by my current employer (a nonprofit health agency!) almost a year ago. Prior to this job, I've had uninterrupted group health insurance from my previous employer. The policy at my current job excludes payment for any AIDS-related treatment, including medication. I have never had this problem before. I even signed on to my husbands health plan 6 weeks ago and they have paid for ALL my meds, no questions asked! My question is twofold: 1. Can an insurer exclude one disease group? There are folks at our agency with diabetes, cancer and heart problems. They get the care they need. 2. Since my husbands policy seems to be hassle-free, I'm thinking of dropping my insurance here. My main concern is getting back payment for all the meds I have paid out of pocket. Any advice on these issues? Thanks in advance for your help.

Response from Ms. Franzoi

1. A health plan can exclude coverage for any one disease group.

2. As you stated, since your husband's plan seems to be hassle-free, you might want to consider dropping your coverage and just staying on his. I don't know of any way that you could receive reimbursement for the meds you paid for out of pocket because you weren't covered under your husband's plan at the time you received them and your plan excluded coverage.

Lynn Franzoi



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