Private Insurance FAQ

Are there companies that are still buying the life insurance polices of people with HIV/AIDS?

Yes, there are still some out there, however, not as many as there were a year ago. The success of the new treatments has caused the companies to lose confidence in their ability to estimate a person's life expectancy accurately, which is the key to investing in these policies. That, coupled with their overly generous predictions to investors on expected rate of return, has caused a sharp reduction in the dollars available to buy polices.

However, if there are still serious medical problems, including lack of success with the new drugs, there are companies out there willing to bid, but, because the market is softer, it's even more important to put it out to bids with several companies to receive the highest bid.

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Can I buy insurance if I am HIV-positive?

That depends on the laws and the practices of insurance companies in the state where you live. In most states, a company may require an HIV antibody test as part of the application procedure and will reject anyone who is positive. Because of the cost of the testing, however, many insurance companies will not go to the expense in areas where they believe the presence of HIV positive persons is very low. Most states will prohibit them from limiting testing to certain groups, single men living in certain ZIP codes for example.

In California, companies are prohibited from asking about HIV or from testing for HIV for health insurance, although it is permitted for life and disability insurance. Just because a company doesn't require testing doesn't mean that getting health insurance is easy. Any medical history of symptoms, any medication, including prophylactic treatment, will be enough for the carrier to refuse coverage. Also, check with a local AIDS service organization. Some states have open enrollment periods, fund high risk medical policies, or provide some other means for the HIV positive person to get health insurance.

I have private health insurance, but the premiums are a burden to me trying to live on Social Security alone.

Most state Medicaid programs offer a program to assist with the payment of health insurance premiums for persons who are disabled. The logic is that it is a lot cheaper for Medicaid to pay the private insurance premiums than to pay the large medical bills. Check with an AIDS service organization in your state for details on what your state's Medicaid program offers.

In California, Medi-Cal has the Health Insurance Premium Payment (HIPP) program which may be accessed through a local AIDS service srganization or by calling 800.952.5294. California also has the CARE/HIPP program, which will temporarily pay health insurance premiums for person not yet eligible for Medi-Cal and its HIPP program. It may be access through a local AIDS service organization.

Is the money I get from my employer's disability policy taxable income?

We are not tax advisors and can't give you a formal ruling. Generally the IRS will tax either the premium that paid for the coverage or the benefits, but not both. If your employer gave you the coverage, then the benefits are probably taxable, because the employer took a tax deduction for the premiums paid.

However, if you paid the premiums through payroll deduction from your regular salary, which means those deducted premiums were part of your W-2 earnings and therefore taxed, then the benefits will be received income tax free. This is a guide only. Please check with a tax advisor for verification.

I'm about to be hired by a company that says I have to take a pre-employment physical. If they discover my HIV status, will I not be hired? Should I lie?

Because of the Americans with Disabilities Act and other labor legislation, an employer cannot require a prospective employee to take a physical exam until a job offer has been made. This means that you cannot be denied the position unless the physical exam reveals something that would prevent you from doing your job. And chances are being HIV-positive will not interfere with work performance.

Because most of the health history questionnaires contain a statement to the effect that "lying on this form are grounds for termination", it is better to either tell the truth or mark the question with "I will discuss with the physician". In either case, don't lie to the physician. However, when it comes up, there's nothing wrong with emphasizing, "But it does not impair my ability to do my job." Many people use this method and get hired.

Is it true I won't get good treatment if I am part of an HMO?

Many clients who are quite happy with the care they receive from their HMO. The hardest part seems to be finding an HIV-experienced physician within the HMO system. For obvious reasons, medical groups and HMOs aren't going to be making a big issue of how great their HIV treatment is.

There is no broad specialty of "HIV Specialist" that would allow listing such doctors. Not all infectious disease specialists know HIV well, while many of the best known "HIV specialists" are internists or family practice physicians. It usually takes a lot of networking with friends and support group members, and calling to medical groups to track down an HIV-knowledgeable physician.

Studies show that, generally, the more HIV patients a physician has, the better those patients fare. If a physician has over 50 HIV patients, chances are that doctor is staying abreast of current treatments and has experience at seeing early symptoms in time to treat them successfully. If, however, a physician has fewer than five HIV patients, consider another doctor.

When I started with my doctor, he said that he would accept the 80 percent that the insurance company paid as payment in full. Now, a year later he is threatening me with collection for my 20 percent. Can he do that?

You are really raising a debtor-creditor issue and I encourage you to seek some legal advice on your particular situation.

Doctors and other providers who make such statements are walking a thin line. If they truly intend to accept the insurance payment as payment in full, the insurance companies will frown, to say the least, on the practice. At the least, they will insist that if 80 percent is payment in full, they have a right to cut their payment to 80 percent of 80 percent and on and on. At worst, they have threatened legal action to providers who are doing it openly.

On the other hand, insurance companies cannot complain if the physician just happens to be bad at collecting debts and has all this 20 percent money owed from the patients that they just never seem to get around to collecting. If a physician agrees to that, be aware that the practice is somewhat off the straight and narrow.