What are the terms of coverage provided under the Aetna Health Maintenance Organization (HMO) plan? Is it possible for insurance companies to end the policy of people with serious illnesses?
Insurance coverage for HIV-positive patients varies depending on the plan. If your Aetna HMO plan has a pre-existing condition clause related to HIV, you will have to wait for six months before being covered. By then, you will have met the requirements to get continuous coverage under the plan. An Aetna HMO plan usually offers normal coverage for HIV-positive patients. For example, a non-Medicare 20-year-old HIV-positive patient who got an Aetna HMO plan prior to acquiring HIV will still get normal benefits under the plan. He/she will get a benefit percentage that is the same for any other kinds of treatment in terms of copays and the like. It is unlikely however, that the plan will cover medical expenses for treatments that are considered experimental such as brand new drug or therapy recommendations by a doctor. As a general rule, you must disclose all the necessary information related to your past health conditions and medical history in your original insurance application. Lying or omission of past health conditions, unrelated to HIV or conditions as minor as sinus infections may constitute fraud and may jeopardize coverage and benefits that you receive under the plan. Answer by general public — June 17, 2009 @ 9:38 am No CommentsNo comments yet. Leave a comment |
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It is generally against the law to drop someone from a health plan including cases where the insured is later infected with HIV. So if you become infected with HIV, for example, your Aetna HMO plan will not be able to suspend coverage and benefits for you. You will be given continuous coverage under the plan unless you fail to settle your premiums, you have committed fraud against the insurance company or if there is a pre-existing condition clause in your plan that allows or prevents coverage for HIV+ patients.
