Insurance
Insurance is a very important issue for people living with HIV. You should attempt to maintain any coverage that you may have. This section deals mostly with health, life, and disability insurance. Your local AIDS Service Organization or an attorney can help you to deal with insurance issues (see the Resources chapter forphone numbers).
Can I be asked if I am HIV-positive on an application for health insurance?
The answer depends on whether the insurance plan is a "group", "individual" or "self-funded"policy. Usually, private health insurance is either a group or self-insured policy providedby your employer, or an individual policy that you bought on your own. Group Policy: Under a groupinsurance policy, an insurer may not ask you if you have been tested for HIV. An insurer can,however, ask you whether you have been treated by a medical professional for AIDS or AIDSRelated Complex (ARC).
Individual Policy: Under an individual insurance policy, an insurer may require informationabout your HIV/AIDS status. Individual policies may cover single persons or families.
Self-funded Policy: Some insurance plans are self-funded or funded and managed by anemployer -- not an insurance company. Self-funded plans are not subject to the same state andfederal laws as regular plans and you may be asked your HIV/AIDS status under these plans.
Can an insurer require that I be tested for HIV or deny me coverage because I have HIV disease?
If you are applying for coverage under an individual or self-funded policy, the insurer may requireyour written consent to be tested for HIV and may deny you coverage if you test positive forHIV. If you are applying for coverage under a group policy, the insurer may NOT requirethat you be tested for HIV, and may not deny you coverage based on your HIV/AIDS status or HIV test results.
What is a pre-existing condition and how may it affect my insurance coverage?
A pre-existing condition is an illness or medical condition that already exists before you applyfor health insurance. Insurance claims relating to a pre-existing condition that arise within acertain time period, or waiting period, may be denied. Individual and Self-FundedPolicies. If you have not been insured in the last two months, an insurance company may denyyou insurance for a pre-existing condition if it was first treated within the last six months beforethe date that your insurance coverage began.
If you have been insured within the last two months, the timeperiod for excluding coverage for pre-existing conditions is limited to a maximum of twelve months.Group Policies. A group insurer cannnot deny insurance coverage to you for a pre-existing condition without denying coverage to the whole group. There is no pre-existing condition exclusion for group coverage.
What if I lie about my HIV/AIDS status on the insurance application?
Intentionally providing incorrect answers on your insurance application may be considered fraud.The insurance company can use the fraud as a basis to cancel your policy from the date of application.The insurance company, however, is allowed to cancel for fraud only within the first two years the policy is in effect.
If an insurer discovers you lied on your application, the insurer has 60 days (from when it learnedif your lie) to cancel your policyand refund all premium payments to you. If you cash the refundcheck, you are accepting the insurer's finding of fraud and decision to cancel your policy. Youmay want to consult an attorney before cashing any such check.
Will I be able to keep my health insurance coverage after I leave my job or if I reduce my work-hours to part-time?
Federal law requires employers with 20 or more employees to provide continuing health insurance coverage for up to 18 months after an employee leaves the job. This law is known as COBRA. This law also applies ifyou leave your job or reduce your work hours for health reasons.
You have 60 days after your jobends to inform your employer that you are choosing this coverage. You are responsible for monthly premium payments for the health insurance. Your employer must inform you of your right to continuing coverage,and will be able to put you in touch with the insurance company to determine your monthly premium cost.
You may eligible for up to 29 months of insurance coverage, instead of 18 months. To get thisextra coverage, the Social Security Administration must determine that you are disabledduring the first 60 days of continuing COBRA coverage. You must also inform your employer of your disability status within 60 days of the Social Security determination.
If I leave my job or reduce my work hours to part-time, can I get help to pay my monthly premiums for continuation health insurance (COBRA)?
The Wisconsin AIDS/HIV Health Insurance Premium Subsidy Program may be able to pay your premiums for up to 29months after you leave your job. See the end of the Public Benefits chapter for more information on this and other programs that may help you.
If I stop working, can I keep my employer-provided life insurance?
Yes. You have 31 days from your last day of work to convert your employee group life insurance to an individual policy. Once con-verted,you will be responsible for the premium payments.
Can I sell my life insurance policy?
Yes, if you are the owner and the "insured" person on the life insurance policy. One way to sell your policy is to have a companycalled a "viatical company" purchase the policy. The company will then be the owner of the policy and may designate a newbeneficiary. You remain the "insured," but are no longer the owner. Purchase prices vary significantly, so it is best to contactseveral different viatical companies for price quotes. There is no state or federal tax on the sale of your life insurancepolicy when the viatical company is licensed in Wisconsin. However, you should consult a financial expert or attorneybefore you sell your policy to avoid other tax consequences and changes in public benefits that you may be counting on.The money you receive in the sale of your life insurance policy can drastically affect your eligibilityto get benefits. A local AIDS service organization, attorney or financial expert may advise you.
Can I collect on my employer's disability insurance if I am HIV-positive?
Maybe. If you are diagnosed with HIV while you are enrolled in an employer disability insurance plan, you may be able to collectmonthly payments from this plan. If you apply for these benefits from the disability insurance company and are denied,you should consult an attorney. Not all employers have disability insurance.
Last updated: January 1999 | 
