January / December #11 : Health Insured - by Catherine Hanssens

POZ - Health, Life and HIV
Subscribe to:
POZ magazine
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join

Back to home » Archives » POZ Magazine issues

Table of Contents

Network News

1995 POZ Honors

1995 POZ Honors: It's An Ad World

1995 POZ Honors: Role Models

1995 POZ Honors: Pope Innocent He's Not

1995 POZ Honors: Arts

1995 POZ Honors: Foreign Affairs

1995 POZ Honors: Hollywood

1995 POZ Honors: Law

1995 POZ Honors: Media

1995 POZ Honors: Movies

1995 POZ Honors: Politics

1995 POZ Honors: Research

1995 POZ Honors: Eating Your Young

Baseball, Hotdogs, Apple Pie and HIV

Hollywood Shuffles AIDS

The Newest AIDS Treatment Is Not a Drug

Banned in the U.S.A.

Mind Over Health Matters

Party Planner

Industrial Strength

Prosper, and Live Long

Worse Things He Could Do

Get Bothered

Health Insured?

See Span


Health Insured

Rhymes and Reason, Too

X-ray Visions

A Little Personal Attention

Symptoms? Persist!

See Span

Butter's Not All Bad

Pas de Deux

C'mon and Celebrate

Most Popular Lessons

The HIV Life Cycle


Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

email print

January / December 1996

Health Insured

by Catherine Hanssens

The ADA offers new hope of preserving coverage

If there is one issue people with HIC are virtually guaranteed to encounter, it is the issue of health care insurance and access. HIV can be a severe barrier to getting and maintaining health coverage, a problem that typically worsens with the advancement of the disease. The volatility of the issue recently was illustrated when New Jersey announced its plan to adopt regulations allowing insurers to test new applicants for HIV and to deny coverage to those who test positive or who refuse the test. The move provoked an uproar among state medical experts and consumer advocates, causing the insurance commissioner to extend her study of the regulations and delay possible implementation.
    There are a number of hotly contested legal issues which can arise for a person with HIV who is seeking, or trying to keep, private insurance. However, an important development in changes to HIV-specific benefit exclusions is currently being battled out in the courts, with employers and insurance companies seeking to limit the Americans With Disabilities Act’s (ADA) protections against insurance-related discrimination.
Before the ADA, advocates failed in their attempts to attack one of the more egregious examples of discrimination—the capping or exclusion of benefits for persons with AIDS who had been covered under an employee benefit plan for years, but found themselves without coverage after submitting an AIDS-related claim. A well-known and horrifying example of this is McGann v. H&H Music. In that case, Houston’s H&H Music replaced its group health insurance plan offering $1,000,000 lifetime benefits after a long-time employee, Jack McGann, submitted AIDS-related treatment claims. H&H changed to a plan which maintained this level of benefits for everyone except those with AIDS-related claims, which had a $5,000 lifetime limit under the new plan. The federal appeals court decided that the cap on AIDS benefits did not violate ERISA, the applicable federal law which at least in theory prohibits discrimination intended to deprive a plan beneficiary of benefits.
The ADA may prove to be an antidote for the McGann brand of insurance discrimination against people with HIV. The ADA’s provisions on disability-related employment discrimination, and the Equal Employment Opportunity Commission’s (EEOC) guidelines, seem clear that employer-provided health benefits are among the “terms, conditions and privileges of employment” in which employers cannot single out people with HIV for different treatment. A little over two years ago a New York City federal trial judge, in Mason Tenders District Council Welfare Fund v. Donaghey, concluded that a union health plan’s exclusion of AIDS-related claims violates the ADA. Since the ADA’s adoption, the EEOC has pursued, and successfully settled, a number of cases attacking employer-provided health benefits plans with AIDS caps. These settlements, however, leave a shortage of law defining the extent of the ADA’s application.
The ADA also allows advocated to argue that plans which exclude benefits only for AIDS care violate the ADA’s protection against discrimination in public accommodations. The heart of the battle here is whether the “public accommodations” access governed by the ADA is limited to actual physical structures, or whether it also forbids interference with a disabled individual’s equal enjoyment of goods and services when the individual’s purchase or inquiry occurs outside the place of business. A federal appeals court in New England decided late last year that the ADA’s public accommodations protections are not limited to actual physical structures, a conclusion echoed by an Illinois federal court in late September, 1995 in Baker v. Hartford Life Insurance Co.. In the past year, however, federal courts in Ohio and Tennessee have come to the opposite conclusion.

Scroll down to comment on this story.


(will display; 2-50 characters)


(will NOT display)


(will display; optional)

Comment (500 characters left):

(Note: The POZ team reviews all comments before they are posted. Please do not include either ":" or "@" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)

Comments require captcha.
Please enter this number for verification:

| Posting Rules

Hide comments

Previous Comments:


[Go to top]

Facebook Twitter Google+ MySpace YouTube Tumblr Flickr Instagram
Quick Links
Current Issue

HIV Testing
Safer Sex
Find a Date
Newly Diagnosed
HIV 101
Disclosing Your Status
Starting Treatment
Help Paying for Meds
Search for the Cure
POZ Stories
POZ Opinion
POZ Exclusives
Read the Blogs
Visit the Forums
Job Listings
Events Calendar
POZ on Twitter

Ask POZ Pharmacist

Talk to Us
Did you participate in an event for National Black HIV/AIDS Awareness Day 2016?


more surveys
Contact Us
We welcome your comments!
[ about Smart + Strong | about POZ | POZ advisory board | partner links | advertising policy | advertise/contact us | site map]
© 2016 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.