Benefits
& Insurance
Private Insurance FAQ
Table of Contents
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.
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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.
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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.
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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.
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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.
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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.
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If you have questions
about APLA, becoming a client or about
any of the services we offer, call
us at 213.201.1600 during normal business
hours or send
an e-mail. We are happy
to help.
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