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Switching insurance companies same employer
Feb 14, 2000

The company I am working for has decided to switch insurance companies (I am not changing Jobs). They are unaware of my HIV+ status. The new Insurance company has a 12 month pre-existing clause. What advice can you give me to prevent a lapse of insurance coverage for the 12 months until the new policy takes effect? I make over the limit for any State or Federal assistance. The $16,000 for my medical expenses would bankrupt me.

Response from Ms. Franzoi

If you have been covered for at least 12 consecutive months in your current employer's plan or have at least 12 months of coverage under his plan and a prior plan without a break of greater than 63 days, a pre-existing condition clause would not apply to you. This is federal law as passed under HIPAA. In addition, when an employer changes insurers, even if the new insurance policy has a pre-existing condition clause, it typically doesn't apply to employees who are currently covered but it does apply to new employees. Even if it does, HIPAA prevents a plan from applying a pre-existing condition clause for a period of greater than 12 months and the plan must recognize all prior coverage towards any pre-existing condition period, unless there has been a break in coverage of greater than 63 days.

Lynn Franzoi

HIV 10+ Years - Disability?
Returning to Work---Post-Social Security

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