POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: Niceguy2013 on June 16, 2014, 11:38:32 am
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During open enrollment for insurance through my employer I decided to elect to add a long term disability policy. Two weeks later I received a notice that I would have to complete an Evidence of Insurability form before it would be effective.
The form has a section that asks if you have had a diagnosis of AIDS or ARC (AIDS related complex.)
My first question: Is this the same as HIV positive or only if you had an AIDS diagnosis?
Second: Will I be automatically denied LTD insurance if I answer yes?
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If this is group insurance, you can't be excluded for a preexisting condition, so either way you answer it shouldn't cause you to be denied. But since they specified AIDS or ARC, and not HIV, if you have never been diagnosed with AIDS or ARC, then you can truthfully answer 'no'.
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Good to know. I wonder if they would fight later if I was disabled due to hiv related illness.
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JR,
I don't understand this. If Niceguy can't be excluded from LTD insurance for a preexisting condition, why would the company have him complete an Evidence of Insurability form?
I do remember that when I was working, all employees could purchase life insurance up to 2.5 times their annual salary without evidence of insurability. However, if you wanted insurance above that amount you had to provide evidence of insurability. Is it possible that this LTD insurance falls into the same category as excess life insurance?
My experience dates back to the early 1990s, so I'm not sure if things have changed since then.
Allan
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If this is group insurance, you can't be excluded for a preexisting condition, so either way you answer it shouldn't cause you to be denied. But since they specified AIDS or ARC, and not HIV, if you have never been diagnosed with AIDS or ARC, then you can truthfully answer 'no'.
This doesn't sound right to me -- but you are more of an expert than I. My understanding is that if you sign up when you are first employed (or when this benefit is first offered to anyone) you don't need EOI. However, if you pass it over and then go for it, you do hit the EOI -- and that would be pre-existing conditions -- otherwise, why do an EOI at all??
This past year, my company allowed same-sex spouses to be covered by dependent Life Insurance for the first time -- so, while if I had a wife and hadn't picked up this benefit for the 14 yrs I've been with this company, an EOI would have been needed, but because I have a husband, he did not need the EOI (of course, he'd have passed anyway).
Mike
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If this is group insurance, you can't be excluded for a preexisting condition, so either way you answer it shouldn't cause you to be denied. But since they specified AIDS or ARC, and not HIV, if you have never been diagnosed with AIDS or ARC, then you can truthfully answer 'no'.
Not true. Only health insurance can't discriminate. He'll also probably be in the MIB database and lying could present issues, the question is outdated, but he shouldn't lie.
Also, as Bocker mentioned, if niceguy signed up when he first started, he probably wouldn't have needed to do the eligibility questions. He does now and will be denied. Otherwise it leaves it open to situations like never getting LTD until after you get cancer etc. then take advantage of the policy once you need it and haven't paid fair premiums into the pool.
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JR,
I don't understand this. If Niceguy can't be excluded from LTD insurance for a preexisting condition, why would the company have him complete an Evidence of Insurability form?
Allan,
My understanding is that they gather this information so that they can project their potential future costs, and to adjust their rates accordingly. They spread that cost over the entire group. The information they collect has HIPPA protection. They can't disclose it. And if it is group insurance, it can't be used to exclude someone from the group.
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Not true. Only health insurance can't discriminate. He'll also probably be in the MIB database and lying could present issues, the question is outdated, but he shouldn't lie.
Also, as Bocker mentioned, if niceguy signed up when he first started, he probably wouldn't have needed to do the eligibility questions. He does now and will be denied. Otherwise it leaves it open to situations like never getting LTD until after you get cancer etc. then take advantage of the policy once you need it and haven't paid fair premiums into the pool.
Since the questionnaire asked about an AIDS or ARC diagnosis, he's OK answering in the negative if he hasn't had the diagnosis. If they had asked about HIV, different story. But they didn't.
One question for niceguy. Does the form say that the information you provide will be used for underwriting? Or do they say they are collecting demographic information?
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We're certainly not encouraging anyone here to lie in filling out forms. There are legal remifications about that. And also it can backfire and result in disqualification if and when it is uncovered.
But you don't have to give information that you are not specifically asked about. Just answer the specific question and don't add anything.
Just saying...
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Since the questionnaire asked about an AIDS or ARC diagnosis, he's OK answering in the negative if he hasn't had the diagnosis. If they had asked about HIV, different story. But they didn't.
One question for niceguy. Does the form say that the information you provide will be used for underwriting? Or do they say they are collecting demographic information?
So, I get this distinction, but it makes me uncomfortable because these insurance companies have large legal departments and I can't believe that they haven't thought through this distinction.
The cynic in me worries that they want folks to go forward with the "HIV is not AIDS or ARC" premise, then, after paying premiums for however long, you need file a claim and BAM, they fight based on misrepresentation. They might lose over the semantics, or they might win over a "reasonable person" sort of line -- but most likely, they get someone who can not or will not fight. Thus - they get your money, and you don't get your insurance.
When you most need insurance is a point that you are probably, financially, mentally and/or physically least able to mount anything like a strong fight against a deep pocketed company that can keep this in limbo for a long time and wait you out.
While, legally, perhaps there is a distinction -- practically, I think it is dangerous and could cost in the end. I would not, personally, pick that nit.......
Mike
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This is how its worded.
- Do you currently have any disorder, condition (including pregnancy), or disease or are you currently taking medication prescribed or provided by a medical or other practitioner for any disorder, condition (including pregnancy), or disease other than a cold, cough, or allergies?
During the last five years, have you been in a hospital or other institution for observation, rest, diagnosis, or treatment?
During the last five years, have you had life, disability, or health insurance declined, postponed, changed, rated-up, cancelled, or withdrawn by an insurer?
Within the last five years, have you been treated for or had any trouble with any of the following: heart; chest pain; high blood pressure; cancer or tumors; diabetes; lungs; kidneys; liver; alcoholism; mental, or nervous disorder or have you been diagnosed with, or treated by a member of the medical profession for, Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?
It further says that they may request more information if you answer yes to any questions. The document is forwarded to the underwriting department.
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This is how its worded.
- Do you currently have any disorder, condition (including pregnancy), or disease or are you currently taking medication prescribed or provided by a medical or other practitioner for any disorder, condition (including pregnancy), or disease other than a cold, cough, or allergies?
During the last five years, have you been in a hospital or other institution for observation, rest, diagnosis, or treatment?
During the last five years, have you had life, disability, or health insurance declined, postponed, changed, rated-up, cancelled, or withdrawn by an insurer?
Within the last five years, have you been treated for or had any trouble with any of the following: heart; chest pain; high blood pressure; cancer or tumors; diabetes; lungs; kidneys; liver; alcoholism; mental, or nervous disorder or have you been diagnosed with, or treated by a member of the medical profession for, Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?
It further says that they may request more information if you answer yes to any questions. The document is forwarded to the underwriting department.
If it were me -- I'd focus on the first line rather than the last. I would hate to pay for something that I simply might not get, if/when needed.
Is this additional LTD Insurance? Do you already have a lower amount through your employer? At my company, we all get LTD at 50% of salary, paid for by the company and no EOI needed -- I could purchase additional, to bring to 75%. The additional would be paid by me and require EOI -- unless chosen at initial benefits sign up.
Mike
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Well I'm sure there is no harm in filling it out. We do not get long term unless we opt in at approximately $2.50 per paycheck. As of now it says coverage is waived pending proof of good health. If they deny it, which I suspect they will, then no harm no foul.
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The first line asks if you have a disease !
YOU HAVE A DISEASE ! HIV !!!!
Not a good idea to lie on insurance forms , just saying ....
Carl
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1.I never said I would lie.
2. It's not life insurance.
I know that I have a disease. The question was specifically related to the difference between being HIV positive and an AIDS diagnosis.
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- Do you currently have any disorder, condition (including pregnancy), or disease or are you currently taking medication prescribed or provided by a medical or other practitioner for any disorder, condition (including pregnancy), or disease other than a cold, cough, or allergies?
[...] or have you been diagnosed with, or treated by a member of the medical profession for, Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?
It further says that they may request more information if you answer yes to any questions. The document is forwarded to the underwriting department.
That's a lot of 'or's. The way it's worded, I have to say that you need to disclose your HIV status, even though 'HIV' isn't listed. The worst that could happen is it gets denied. But it might not, if you're otherwise in pretty good health. Remember, this only pays off IF you get sick, so they might be willing to insure you if they think you're likely to retire before you become disabled from HIV.
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I'm more worried about long term disability from an injury or something else than complications from hiv. I'm in great health and have responded to treatment extremely well.