HIV/AIDS Guide
Table of Contents
- Introduction
- What You Need to Know About Health Insurance
- Other Health Insurance Options
- What if I lose my coverage?
- Other Types of Insurance
- In Summary
Introduction
Since the first diagnosed case of HIV/AIDS over forty years ago, there have been many remarkable advances in treating the disease. The life expectancy for many people living with HIV/AIDS has increased dramatically since the advent of antiretroviral drug therapies. The continuing hope is that medical science will find a cure for HIV/AIDS.
While public attitudes regarding HIV/AIDS have changed for the better because of education and exposure, many of the concerns surrounding HIV/AIDS diagnosis and treatment remain the same. The cost of life-saving drugs and treatment regimens are still very expensive. Also, people living with HIV/AIDS often face discrimination because of ignorance about the disease.
The California Department of Insurance (CDI) believes that it is crucial for people living with HIV/AIDS to know their insurance rights. Being informed of your insurance rights can help you take charge of your future and allow you to effectively manage HIV/AIDS.
What You Need to Know About Health Insurance
Enrolling in Health Insurance
It is important to know that a health insurance company cannot refuse an application for health insurance coverage on the basis of an applicant's race, color, religion, national origin, ancestry, sexual orientation, gender identity, health status, medical condition, claim experience, receipt of health care, medical history, disability, genetic information, claims history or preexisting conditions, nor can they charge higher premiums based on these criteria.
This means that a health insurer cannot ask you to disclose your HIV/AIDS status, or require you to take an HIV test as part of the application process. In addition, health insurers cannot ask you questions about your HIV status, whether you received medical treatment for AIDS, AIDS-related complex (ARC), an immune system disorder other than HIV/AIDS, or whether you have taken HIV/AIDS medications.
If your application for health insurance is declined due to a health status-related factor, you can file a complaint with CDI.
Coverage of HIV Prevention and Treatment
Most health insurance covers HIV prevention and treatment, including antiretroviral drug therapy. Additionally, if you don’t have HIV, but are at increased risk, most health insurance covers HIV prevention medications for pre-exposure prophylaxis, or PrEP, without any out-of-pocket cost to you. Coverage of HIV PrEP without any cost includes health care services that are needed to take PrEP, such as HIV tests and screening for other sexually transmitted infections. If you are unsure whether your health insurance covers PrEP without any out-of-pocket cost, or if you have had to pay for health care related to HIV PrEP, you can contact CDI for assistance.
Other Health Insurance Options
Consumers Guide to Health Insurance
Covered California
Covered California connects Californians with brand-name health coverage under the Affordable Care Act. Depending upon your income, you may qualify for a discount on a health plan through Covered California or receive help covering out-of-pocket costs. You can enroll in a plan through Covered California either during the annual open enrollment period, which goes from November 1 through January 31, or if you are eligible for a special enrollment period due to certain qualifying events, which includes losing your coverage.
Covered California
Phone: 800-300-1506
Website: https://www.coveredca.com/
Medi-Cal
The California Department of Health Care Services (DHCS) oversees the Medi-Cal program. Medi-Cal is California's Medicaid health care program and is supported by federal and state tax dollars. This program pays for a variety of medical services for people with limited income and resources, regardless of immigration status. If you are eligible, you can receive Medi-Cal benefits as long as you continue to meet the eligibility requirements.
Department of Health Care Services (Medi-Cal)
Phone: 916-552-8990
Website: https://www.dhcs.ca.gov/
Office of AIDS and the AIDS Drug Assistance Program (ADAP)
The California Department of Public Health (CDPH) operates the Office of AIDS. The Office of AIDS collaborates with state and federal agencies, local health jurisdictions, universities, and community-based organizations to ensure efforts to combat the HIV/AIDS epidemic are targeted and effective. Their efforts target publicly-funded HIV/AIDS care and treatment programs and critical prevention strategies aimed to interrupt HIV/AIDS transmission.
The California AIDS Drug Assistance Program (ADAP) Branch administers ADAP for people living with HIV/AIDS in California. ADAP was established in 1987 to help provide HIV/AIDS drug therapy access to individuals who are uninsured or underinsured of low-to-moderate income levels. ADAP is a state prescription drug program that is jointly funded by Ryan White CARE legislation and state funds. The goal of the ADAP is to make available drug treatments that can reliably be expected to increase the duration and quality of life for those living with HIV/AIDS. Individuals enrolled in ADAP may also be eligible for additional programs offered through the Office of AIDS.
The ADAP Branch also runs the Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) to prevent HIV in HIV negative individuals living in California. For eligible individuals, PrEP-AP covers the cost of HIV prevention medication (for both HIV PrEP and post-exposure prophylaxis, or PEP) and health care that is needed for taking PrEP and PEP, such as health care provider visits and screening for HIV and other sexually transmitted infections.
Office of AIDS
Center for Infectious Diseases
California Department of Public Health
MS 7700 P.O. Box 997426
Sacramento, CA 95899-7426
Phone: 916-449-5900
Email: OfficeofAIDS@cdph.ca.gov
Website: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAmain.aspx
AIDS Drug Assistance Program (ADAP) Branch
Phone: 844-421-7050.
Website: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAadap.aspx
Private Clinics and HIV/AIDS Related Organizations
Since the onset of HIV/AIDS, many private clinics and support organizations have been created that provide services to people living with HIV/AIDS. These clinics and organizations can be an excellent source of information on a variety of HIV/AIDS related issues, including access to health care. Some private clinics provide basic health care services to HIV/AIDS patients and care to prevent HIV. These organizations include APLA Health, Los Angeles LGBT Center, Minority AIDS Project, and the San Francisco AIDS Foundation.
APLA Health
611 S. Kingsley Drive
Los Angeles, CA 90005
Phone: 213-201-1600
Website: www.apla.org
Los Angeles LGBT Center
1118 N. McCadden Pl.
Los Angeles, CA 90038
Phone: (323) 993-7400
Website: https://lalgbtcenter.org/
Minority AIDS Project (MAP)
5149 West Jefferson Blvd.
Los Angeles, CA 90016
Phone: 323-936-4949
Website: https://minorityaidsproject.org/
San Francisco AIDS Foundation
940 Howard Street
San Francisco, CA 94103
Phone: 415-487-3000
TDD: 415-864-6606
Email: Info@SFAF.org
Website: www.sfaf.org
What if I lose my health coverage?
Generally, if you change jobs or lose your health coverage, you are entitled to a special enrollment period to enroll in health insurance. If you lose your coverage through work, you and your dependents may be able to keep your existing health coverage temporarily. These options are called continuation coverage. If you lose your coverage, your employer must provide you with information on your options for continuing your existing coverage. You may see options with names like COBRA, Cal-COBRA, Conversion or HIPAA. Enrolling in these options may be particularly important if you are going through a current course of treatment with a network provider.
When you are covered under a group health insurance policy from your employer, you have certain rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA is a federal law that extends your current group health insurance when you experience a qualifying event such as termination of employment or reduction of hours to part-time status. By electing COBRA, you extend your current group coverage and maintain continuity of care, which can be very crucial when undergoing treatment for HIV/AIDS. The extension period for COBRA is 18 months and some people with special qualifying events may be eligible for a longer extension.
To be eligible for COBRA, your group policy must be in force with 20 or more employees covered on more than 50 percent of its typical business days in the previous calendar year. PPOs, HMOs, and self-insured health plans are eligible for COBRA extension; however, federal government employee plans and church plans are exempt from COBRA.
Cal-COBRA is a California law that has similar provisions to federal COBRA. With Cal-COBRA, the group policy must be in force with 2-19 employees covered on at least 50 percent of its working days during
- the preceding calendar year, or,
- the preceding calendar quarter, if the employer was not in business during any part of the preceding calendar year.
Eligibility for Cal-COBRA extends only to health insurance policies that are regulated by the state. Self-insured plans are not eligible. Unlike COBRA, church plans are eligible under Cal-COBRA. The extension period for Cal-COBRA is 36 months. California Insurance Code section 10128.59 provides a similar extension under Cal-COBRA for those who have exhausted their 18 months on federal COBRA (or longer in special circumstances) for a total extension that cannot exceed 36 months for COBRA and Cal-COBRA combined. For Cal-COBRA to apply, the employer's master policy must be issued in California. If the group master policy is not issued in California, then the employer must employ 51% or more of its employees in California and have its principal place of business in California.
It is important to note that healthcare jurisdiction in California is divided between both state and federal agencies. COBRA is regulated by the U.S. Department of Labor, Employee Benefits Security Administration (DOL-EBSA) and Cal-COBRA is jointly regulated by the CDI and the California Department of Managed Health Care (DMHC) depending upon what type of group coverage you have. These agencies can provide further information on the time frames employers and insurance companies/health plans must follow to offer COBRA or Cal-COBRA extension coverage for eligible employees and their dependents.
You can also buy health insurance directly from a health insurance company, or through Covered California. Covered California helps pay the premium for those with qualifying incomes. Losing your job-based coverage is a qualifying event for special enrollment that allows you to enroll in this type of coverage.
If you have questions or problems with COBRA or Cal-COBRA, you can reach the appropriate state of federal agency by referencing the contact information below. Also, you may wish to review the "Consumers Guide to Health Insurance" for a more detailed explanation of indemnity health insurance, HMOs, PPOs, and self-insured health plans.
U.S. Department of Labor
Employee Benefits Security Administration (DOL-EBSA)
Northern California
90 7th St. Suite 11-300
San Francisco, CA 94103-2050
Phone: 415-975-4600 or 415-625-2481
Southern California
1055 E. Colorado Blvd., Suite 200
Pasadena, CA 91106-2341
Phone: 626-229-1000
Toll Free Number: 866-275-7922
Website: https://www.dol.gov/agencies/ebsa
Department of Managed Health Care (DMHC)
980 Ninth Street, Suite 500
Sacramento, CA 95814
Phone: 888-466-2219
Website: www.dmhc.ca.gov
Other Types of Insurance
Unlike health insurance, your HIV/AIDS status may be used for other types of insurance, such as life and disability income insurance.
What You Need to Know About Life and Disability Income Insurance
When you apply for a life or disability income insurance policy, an insurance company can request a physical examination, which may include an HIV antibody test. Effective January 1, 2023, Insurance Code section 799.02 prohibits an insurer from declining an application or enrollment request for life insurance or disability income insurance based solely on the results of a positive HIV test. This applies regardless of when, or at whose direction, the test was performed. However, disability income and life insurers are not required to charge the same rates, offer the same coverage, or offer coverage to an applicant who is HIV positive, if certain requirements are met. In addition, nothing in section 799.02 prohibits an insurer from transferring an applicant from a simplified, expedited, accelerated, or algorithmic underwriting process to a traditional medical underwriting process based solely on the results of a positive HIV test.
Further questions on life and disability income insurance concerning HIV/AIDS related topics can be addressed by contacting the CDI at its toll-free hotline number. Also, for general information on life insurance, including product descriptions and glossary, review the Life Insurance and Annuities guide.
Viatical Settlement and Life Insurance
Viatical settlement purchasers buy life insurance policies that are based on the lives of people with catastrophic or life-threatening illnesses or conditions. If the policyholder has heart disease, for example, the settlement may be considered a viatical settlement. Selling your life insurance policy provides you with a cash settlement that can be used in any way you see fit. Even though a settlement is called a "life settlement," or other names, it may still be considered a "viatical settlement" under California law.
If you are considering selling your life insurance policy to a viatical settlement purchaser, you should contact your life insurance company directly to determine if they offer an accelerated benefit, a living death benefit, a loan, or cash value for the policy. The terms and conditions offered by the insurance company for these types of similar benefits may be better than those offered by a viatical settlement purchaser. By comparing, you may be able to receive a larger amount of money for your life insurance policy.
People who "enter into" or "solicit" viatical settlements from policyholders must be licensed by the CDI. For example, a person who assists an insured or policyholder in selling their policy, a purchaser of the policy, and a person soliciting investments in a viatical settlement transaction must all be licensed by the CDI. Consumers should check the license status of the parties involved with the CDI.
In Summary
Health, life, and disability income insurance can play a major role for people living with HIV/AIDS. Knowing your insurance rights and being able to properly utilize the coverage you have can assist you in staying healthy and in maintaining the quality of your life. CDI is dedicated to people living with HIV/AIDS and is available to answer any HIV/AIDS questions relating to insurance. Please feel free to contact us by calling the CDI toll free number (800) 927-HELP (4357).
