Health Insurance Portability and Accountability

The Health Insurance Portability and Accountability Act (HIPAA), passed in 1996, attempts to address a number of issues for people with pre-existing conditions, including those with HIV/AIDS. The law prohibits group health plans, insurers, and managed care organizations from denying coverage because of pre-existing conditions if the person had been insured for an uninterrupted 12 month period prior to the application. In addition, the law

  • limits to 12 months the time a person can be subject to a pre-existing medical condition exclusion if they had no previous health care coverage;
  • guarantees the availability of individual health insurance policies for those who leave jobs and maintain previous coverage;
  • prohibits denial of coverage in group plans to persons in poor health; and
  • requires insurers to sell plans to small employers and guarantees renewal for both small group and individual coverage.

The law did not specify what benefits a health plan must include and did not guarantee that health insurance coverage would provide adequate care or be affordable. In addition, there are a number of issues involving AIDS and private insurance coverage that remain unresolved at this time. These include questions about whether health plans can exclude from coverage individuals who have received a diagnosis of HIV infection before coverage; whether an employer can restructure a health plan to reduce benefits for a specific type of illness after a claim has been filed; and whether specific services will be considered "medically necessary" and, therefore covered under insurance plans.

Americans with Disabilities Act

The Americans with Disabilities Act (ADA) of 1990 protects against discrimination in the workplace, housing, and public accommodations for people with disabilities, including people living with HIV/AIDS. On June 25, 1998 the decision by the U.S. Supreme Court has important implications for anti-discrimination protections for individuals with asymptomatic HIV disease in employment, insurance, and services offered by business and government (AIDS Action Council, 1998a). The ruling determined that "HIV infection satisfies the statutory and regulatory definition of physical impairment during every stage of the disease." This means that persons with asymptomatic HIV cannot be excluded under the ADA and should have access to non-discriminatory and high quality health care. The decision also determined that reproduction was a major life activity for the purposes of the ADA and that HIV infection limits the ability to reproduce.



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