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Health Insurance Accessibility for Employees of Small Groups

July 1999

While access to health insurance in the U.S. is not universal, accessibility to group insurance for employees with medical problems has improved in recent years.

Examples of improved access include the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law, and a California law still called by its bill number, AB1672.

HIPAA prohibits refusing employer-based health insurance because of a person's health history or medical condition, provided the person is otherwise eligible for employee benefits. That's great news for anyone who works for an employer that offers health insurance to its employees. Employees are now able to get the insurance, regardless of HIV status, medications being taken, past hospitalizations or other factors.

The California law is similar. There is one major exception: If the employer has between two and 50 employees, the insurance company can adjust the group's rates up to 10 percent above or 10 percent below their standard rates based on the health of the employees to be insured.

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On the surface, this doesn't seem so bad. At least all the eligible employees will still get the insurance and the group's rates can't be increased more than 10 percent because of someone's health condition.


Invasion of privacy

Insurance companies have the right, however, to include a health questionnaire in the enrollment form. And, as in other insurance applications, one must be truthful on that application.

Unfortunately, insurance agents do not come around and personally ask each employee for his or her enrollment form. Each employee is expected to turn in the completed form to the employer. The employer, the administrator, the supervisor, and anyone else who sees the enrollment form are able to read the answers to the health questions. And those answers are not usually something a person dealing with HIV will want others at the workplace to see.

Even if there are no questions on HIV status, which is prohibited under California law, the form may require medications to be listed, prior hospitalizations to be detailed, and ask the employee to disclose the name and address of his or her current physician, including the "reason for the last visit."

Talk about being stuck between a rock and a hard place. Under these terms, health insurance is guaranteed, but the price is that the other employees may learn of the HIV treatment.


Beating the system

There may be ways around this problem, however.

Blue Cross of California writes a large share of the small group policies in California. They understand the desire of people to keep their health issues private from co-workers, not just those with HIV but also people with a lot of different medical/psychological issues.

So in 1997, they developed a new enrollment form that allows each employee to seal the health questions portion of the application.

If Blue Cross is the carrier, then there is no problem then, right? Sorry, it's not so easy. Many employers have supplies of enrollment forms from before 1997 that do not seal.

If your employer is one of those, call any small group office of Blue Cross, tell them the situation and ask for enrollment form number IS 70 11. If they hesitate or don't understand the request, contact the Benefits office at AIDS Project Los Angeles and ask for a form. You can explain to the employer you lost their form and got one directly from Blue Cross.


Some success seen

If the employer is with an insurance company that is not with Blue Cross, it's a little more difficult. APLA's Benefits Program has had some success with this rather complicated process.

First, get a second enrollment form from the employer claiming "I messed up the first one" or "my dog ate it." Then call the underwriting department of the insurance company and explain the situation. Usually, an individual will agree to let you send the form directly them.

Then you fill out a dummy form, lie on the health statements and turn it in to the employer. The person in underwriting then switches the dummy form for the honest one you have sent in directly.

It's complicated, but taking these steps does work. As always, if you require assistance, APLA's Benefits Program will be glad to help.

The bottom line is that no one who is eligible for group insurance from an employer can be turned down because of his or her health condition. While this falls short of universal access, it is an improvement.

Jacques Chambers manages AIDS Project Los Angeles' Benefits Department. He can be reached by calling (323) 993-1473 or by e-mail at jchambers@APLA.org.


This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).


  
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This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.
 
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