Article Structure
The Aa8596 form, issued by American-Amicable Life Insurance Company of Texas, serves as a vital tool in the process of determining an individual's insurability through testing for the presence of human immunodeficiency virus (HIV) antibodies or antigens. This form outlines the circumstances under which testing will occur, emphasizing that consent must be given by the proposed insured, which may include an individual or their authorized representative. The form highlights the importance of understanding the implications of an HIV test and suggests options for obtaining pre-testing information and counseling. It clarifies that a positive test result indicates an increased risk of developing immune system issues, while not being a definitive diagnosis of AIDS. Key aspects covered in the form include procedures for notification of test results, confidentiality protocols regarding both positive and negative results, and resources available for individuals who test positive. Moreover, the document stresses the necessity of informed consent, ensuring that individuals are fully aware of their rights and the potential impact of their test results on obtaining insurance coverage. Overall, it aims to provide clear guidance and support for individuals navigating the complexities of HIV testing within the insurance context.
Aa8596 Example
P.O. BOX 2549 • WACO, TEXAS
WISCONSIN NOTICE AND CONSENT FOR HUMAN IMMUNODEFICIENCY TESTING
To evaulate your insurability,
PRETESTlNG CONSIDERATION
Many public health organizations recommend that, if you have any reason to believe you may have been exposed to HIV, you become informed about the implications of the test before being tested. You may obtain information about HIV and counseling from a private health care provider, a public health clinic, or one of the AIDS service organizations on the attached list. You may also wish to obtain an HlV test from an anonymous counseling and testing site before signing this consent form. The Insurer is prohibited from asking you whether you have been tested at an anonymous counseling and testing site and from obtaining the results of such a test. For further information on these options, contact the Wisconsin AlDSline at
MEANING OF POSITIVE TEST RESULTS
This is not a test for AIDS. It is a test for HlV and shows whether you have been infected by the virus. A positive test result may have an effect on your ability to obtain insurance. A positive test result does not mean that you have AIDS, but it does mean that you are at a seriously increased risk of developing problems with your immune system. HlV tests are very sensitive and specific. Errors are rare but they can occur. If your test result is positive, you may wish to consider further independent testing from your physician, a public health clinic, or an anonymous HIV counseling and testing site. HIV testing may be arranged by calling the
Wisconsin AlDSline at
NOTIFICATION OF TEST RESULTS
If your HlV test result is negative, no routine notification will be sent to you. If your HIV test result is other than normal, the Insurer will contact you and ask for the name of a physician or other health care provider to whom you may authorize disclosure and with whom you may wish to discuss the test results.
DISCLOSURE OF TEST RESULTS
All test results will be treated confidentially. The laboratory that does the testing will report the result to the Insurer. If necessary to process your application, the Insurer may disclose your test result to another entity such as a contractor, affiliate, or reinsurer. If your HlV test is positive, the Insurer may report it to the Medical Information Bureau (MIB, Inc.), as described in the notice given to you at the time of application. If your HIV test is negative, no report about it will be made to the MlB, Inc. The organizations described in this paragraph may maintain the test results in a file or data bank. These organizations may not disclose the fact that the test has been done or the results of the test except as permitted by law or authorized in writing by you.
CONSENT
I have read and l understand this notice and consent for HIV testing. I voluntarily consent to this testing , and the disclosure of the test result as described above. A photocopy or facsimile of this form will be as valid as the original.
_____________________________________________/___________________
Signature of Proposed Insured or Parent, Guardian, |
Date |
or Health Care Agent |
|
_________________________________________________________________________________
Name of Proposed Insured(Print)
_________________________________________________________________________________
Date of Birth
_________________________________________________________________________________
Address |
City, State, and ZIP Code |
Form No. AA8596 (Rev. 1/00) |
(SEND TO HOME OFFICE) |
RESOURCES FOR PERSONS WITH A POSITIVE HIV TEST
The Wisconsin AlDSline provides accurate, timely information on AIDS/HIV to people throughout Wisconsin. It offers confidential answers to your questions on the implications of a positive HlV antibody test. The Wisconsin AlDSIine also provides a comprehensive listing of
AIDS Resource Centers of Wisconsin provide direct support services to people living with AIDS and HlV infection. Ser- vices include medical referral, financial assistance, legal counsel, emotional support, referral for pastoral care, assis- tance with daily living needs, support groups, and comprehensive care management. Call, visit, or write the AIDS Re- source Center near you:
Appleton |
AIDS Resource Center of Wisconsin |
Counties served: Calumet, Fond du Lac, |
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120 North Morrison St., Ste. 201 |
Green Lake, Marquette, Oconto, Outagamie, |
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Appleton, WI 54911 |
Sheboygan, Waupaca, Waushara, Winnebago |
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(920) |
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Fax: (920) |
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Eau Claire |
AIDS Resource Center of Wisconsin |
Counties served: Barron, Buffalo, Burnett, |
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505 Dewey St. South, Ste. 107 |
Chippewa, Clark, Dunn, Eau Claire, Pepin, |
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Eau Claire, WI 54701 |
Pierce, Polk, Rusk, St. Croix, Washburn |
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or |
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P.O. Box 11 |
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Eau Claire, WI |
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(715) |
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Fax: (715) |
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Green Bay |
AIDS Resource Center of Wisconsin |
Counties served: Brown, Door, Kewaunee, |
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824 South Broadway |
Manitowoc, Marinette, Menominee, Shawano |
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Green Bay, WI 54304 |
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or |
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P.O. Box 2040 |
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Green Bay, WI |
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(920) |
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Fax: (920) |
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Kenosha |
AIDS Resource Center of Wisconsin |
Counties served: Jefferson, Kenosha, Racine, |
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1212 57th St. |
Walworth |
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Kenosha, WI 53140 |
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or |
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P.O. Box 0173 |
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Kenosha, WI |
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(414) |
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Fax: (414) |
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La Crosse |
AIDS Resource Center of Wisconsin |
Counties served: Jackson, La Crosse, Monroe, |
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Grandview Center |
Trempealeau, Vernon |
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1707 Main St., Ste. 420 |
|
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LaCrosse, WI 54601 |
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(608) |
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Fax: (608) |
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Milwaukee |
AIDS Resource Center of Wisconsin |
Counties served: Milwaukee, Ozaukee, |
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820 North Plankinton Road |
Washington, Waukesha |
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Milwaukee, WI 53203 |
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or |
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P.O. Box 92487 |
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Milwaukee, WI |
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(414) |
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Fax: (414) |
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(GIVE TO APPLICANT)
Rhinelander |
AIDS Resource Center of Wisconsin |
COUNTIES SERVED: Florence, Forest, |
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Oneida County Health Department |
Oneida, Price, Vilas |
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P.O. Box 400, Courthouse |
|
|
Rhinelander, WI 54501 |
|
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(715) |
|
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Fax: (715) |
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Superior |
Information to be announced. |
Counties served: Ashland, Bayfield, Douglas, |
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Contact Eau Claire office until then. |
Iron, Sawyer |
Wausau |
AIDS Resource Center of Wisconsin |
Counties served: Langlade, Lincoln, Marathon, |
|
1105 Grand Avenue, Ste. 3 |
Portage, Taylor, Wood |
|
Schofield, WI 54476 |
|
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(715) |
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Fax: (715) |
|
Additional |
Dennis C. Hill |
|
Resources: |
Harm Reduction Center |
|
` |
AODA Outpatient Clinic |
|
|
4311 West Vliet St. |
|
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(414) |
|
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Fax: (414) |
|
Survival/Revival Resale
Milwaukee's Best Resale Shop
246 East Chicago St.
Milwaukee, WI 53202
(414)
Wisconsin AIDS Research Consortium
820 North Plankinton Ave.
Milwaukee, WI 53202
or
P.O. Box 92487
Milwaukee, WI
(414)
Fax: (414)
THE IMPLICATIONS OF TESTING POSITIVE FOR HIV
A positive test result is not a diagnosis of AIDS. A positive test means that you have HlV infection. Like people with other chronic medical problems, people with HlV infection have a spectrum of conditions, rang- ing from no symptoms to very serious ones. Over time, most people with HlV infection progress along the spectrum toward more serious symptoms. However, both improved medical management and many options for
It is extremely important to find a knowledgeable, experienced, and supportive health care provider to work with you in evaluating and managing your HlV infection. If you do not know whom to see, consult your local AIDS Resource Center for a recommendation or call the Wisconsin AIDSline to obtain a referral. In
Wisconsin, call
Your health care provider can perform periodic examinations and arrange for appropriate tests to help you decide what treatments and interventions you may want to use. Many people with HlV infection are being successfully treated with
You may also want to utilize some
A positive test result may mean that you have to make changes in certain areas of your life. It is much easier to make these adjustments with the help and support of others. There are support groups and counselors at most AIDS service organizations. You might seek support from your partner or trusted friends, family, clergy, or health professionals.
Counseling can help you put things in perspective. Some people who test positive find that counseling assists them in handling social and intimate relationships, dealing with fear, and promoting
You have a responsibility to yourself and to others to avoid transmitting the virus. Counselors can help you sort out your feelings about intimate relationships and help you learn about HlV
Being HIV positive means taking the right steps to maintain your health. Dealing with the fear is healthier than avoiding the knowledge of HlV infection.
For more information on HlV antibody testing and HlV related services, contact the Wisconsin AlDSIine at
Based on information contained in the brochure The HlV Antibody Test, produced by the American College Health Association.
(GIVE TO APPLICANT)
Form Characteristics
| Fact Name | Fact Description |
|---|---|
| Purpose | The Aa8596 form is used by the American-Amicable Life Insurance Company of Texas to request HIV testing for assessing an individual's insurability. |
| Testing Requirement | By signing the form, the individual agrees to undergo testing for the presence of HIV antibodies or antigens, which helps in underwriting decisions. |
| Governance | The testing is governed by Wisconsin law, specifically approved by the Wisconsin Commissioner of Insurance. |
| Confidentiality | All test results are treated confidentially. They are reported to the insurer, but sharing with other entities is limited and follows legal guidelines. |
| Notification Process | If the test result is negative, no notification is sent. However, if the result is abnormal, the insurer will contact the individual to discuss options. |
| Resources Available | The form provides contact information for the Wisconsin AIDSline, which offers support and referrals for individuals with a positive HIV test. |
| Consent and Acknowledgment | By signing the Aa8596 form, the proposed insured confirms that they have read and understood the notice about testing and consented to it voluntarily. |
Guidelines on Utilizing Aa8596
Filling out the Aa8596 form is a straightforward process that requires attention to detail. It is designed to collect necessary consent and identification information in a clear manner. The following steps will guide you through completing the form correctly.
- Read the form carefully to understand the purpose and implications of the HIV testing. Make sure you're comfortable with what the form states.
- Sign and date the form at the indicated section, ensuring that you have the correct date.
- Print your name in the space designated for the name of the proposed insured. Ensure that the name matches the identification documents.
- Provide your date of birth in the space provided. Double-check to ensure it's accurate.
- Fill out your address completely, including city, state, and ZIP code. Ensure all information is current and correctly formatted.
- Review the completed form for any errors or missing information before submission. It's crucial that all parts are filled out accurately.
- Submit the form to the appropriate address as instructed, ensuring you have a copy for your records.
Once you've completed these steps, your form will be sent to the home office for processing. Be sure to keep track of any follow-up communications regarding the results of your HIV test and any next steps that may be necessary.
What You Should Know About This Form
What is the purpose of the Aa8596 form?
The Aa8596 form is used by the American-Amicable Life Insurance Company of Texas to obtain consent for testing for the human immunodeficiency virus (HIV) as part of the underwriting process. By signing this form, you agree to undergo testing to evaluate your insurability based on the results.
What should I consider before taking the HIV test?
It is recommended that individuals who believe they may have been exposed to HIV educate themselves about the test and its implications before testing. This can involve speaking to a healthcare provider, a public health clinic, or accessing resources from AIDS service organizations. You can also consider testing at an anonymous site before signing the form for results that remain confidential.
What does a positive HIV test result mean?
A positive test result indicates that you have been infected with HIV. It is important to note that this test does not diagnose AIDS. A positive result suggests a significantly increased risk of immune system complications, which emphasizes the necessity of further medical evaluation.
Will I be notified about my HIV test results?
If your HIV test result is negative, you will not receive routine notification. If the results are other than normal, the insurance company will contact you to discuss the findings and request the name of a healthcare provider you authorize to receive the details of your test results.
How are my test results kept confidential?
Your test results will be managed with strict confidentiality. While a licensed laboratory reports the results to the insurance company, they are legally restricted from disclosing any information about the testing or results without your written consent, unless authorized by law.
What happens if I test positive for HIV?
A positive result will not only impact your ability to secure insurance but may also result in the insurance company reporting it to the Medical Information Bureau (MIB, Inc.) for risk assessment. It's vital to engage with healthcare providers who are experienced in managing HIV infection for ongoing support and treatment options.
Are there resources available if I receive a positive test result?
Yes, numerous resources exist for individuals who test positive for HIV. The Wisconsin AIDSline offers confidential support and information about available medical and social services, including counseling, support groups, and healthcare assistance. They can be reached at 1-800-334-2437 for more information.
Can I revoke my consent for testing after signing the Aa8596 form?
Once you have signed the Aa8596 form, your consent for testing is generally considered binding. However, it is advisable to speak with the insurance company or your healthcare provider about any concerns or changes to your decision, as policies may differ regarding the revocation of consent.
Common mistakes
Filling out the AA8596 form can be an essential step in the insurance application process, but there are common mistakes that many people make. These errors can lead to delays or even denials of coverage. Understanding what to watch for can help you submit your form correctly the first time.
One significant mistake is not reading the entire form carefully. This form requests consent for HIV testing, and every section contains important information regarding the process. Skimming through could lead to misunderstandings about the implications of the test. Take the time to read and comprehend the details, especially the sections on possible outcomes and the disclosure of results.
Another frequent error occurs when individuals forget to sign or date the form. Without a signature and the date, the form is incomplete and will likely be rejected. Always double-check that you have filled in all required fields before submission, especially your consent and acknowledgment of understanding.
People often struggle with providing accurate personal information, such as their date of birth and address. Mismatches can cause delays in processing your application. Ensure that all information matches official documents like your driver's license or ID. Take a moment to verify everything is correct and clear before submitting.
Additionally, some individuals neglect to provide the name of their healthcare provider when asked. This step is crucial, particularly if the test results are anything but normal. The insurer will need this information to discuss results with your provider. Make sure you include this information to prevent any unnecessary delays.
Lastly, many applicants overlook the option to ask questions or seek clarification about any part of the form or the testing process. If something is unclear, reaching out for help can prevent missteps. Know that assistance is available, whether through your insurance agent or health care provider.
Documents used along the form
The AA8596 form is an important document for individuals undergoing HIV testing as part of the life insurance application process. It serves as a notice and consent form essential for ensuring that applicants are informed about the implications of the test and give their permission for testing and potential disclosures. Along with this form, several other documents are frequently utilized. Below is a list of these forms and documents, each accompanied by a brief description.
- Medical Information Bureau (MIB) Authorization Form: This form grants permission for the insurance company to access health information from the MIB, which collects and maintains medical information for insurers. This helps companies make informed decisions about risk assessment and policy approval.
- Application for Life Insurance: This primary application outlines personal information, health history, and the amount of coverage sought. It serves as the foundation for the insurance company's underwriting process, affecting the overall evaluation of the application.
- Supplemental Health Questionnaire: When more information is required, this additional questionnaire is used. It helps gather detailed information about an applicant's medical history, lifestyle, and any potential risk factors that weren’t addressed in the initial application.
- Authorization for Release of Medical Records: This document allows the insurer to obtain specific medical records and information from healthcare providers. It helps ensure that the insurer has access to all necessary health data to make accurate underwriting decisions.
- Disclosure Notice: This document outlines the rights of the applicant regarding the use of their health information, including how it will be protected and disclosed. It aims to ensure transparency in how personal health information is handled during the insurance underwriting process.
These forms and documents together create a comprehensive framework for processing an insurance application accurately and efficiently. Understanding each component ensures that applicants are aware of their rights and responsibilities throughout the testing and underwriting processes.
Similar forms
- HIV Testing Consent Form: This document serves a similar purpose by obtaining consent from an individual for HIV testing and explaining the implications of the results.
- Health Insurance Portability and Accountability Act (HIPAA) Release Form: Both documents address issues of confidentiality and the sharing of medical information, including test results.
- Medical Release Form: This form grants permission for healthcare providers to disclose medical records, akin to how the AA8596 allows for sharing of HIV test results under consent.
- Life Insurance Application: Life insurance applications typically include health questions and may involve similar consent for medical testing to evaluate risk factors.
- Pre-Employment Health Questionnaire: This document often requires individuals to disclose health information for employment screening, paralleling the consent requirements for HIV testing.
- Disclosure Authorization Form: This type of form allows an individual to authorize the release of personal health information to third parties, resembling the consent given in the AA8596.
- Informed Consent for Medical Procedures: Similar in nature, this form ensures that individuals understand and agree to the procedures being performed, including tests, like those for HIV.
- Blood Donation Consent Form: When donating blood, individuals must consent to testing for infectious diseases, similar to the consent provided for HIV testing on the AA8596.
- Medical History Questionnaire: This document gathers comprehensive health information and may address infectious disease history, related to the context of HIV testing.
- Acknowledgment of Privacy Practices Form: Both forms include statements regarding how personal health information will be handled and the individual's rights regarding that information.
Dos and Don'ts
When filling out the AA8596 form, there are essential actions to keep in mind to ensure a smooth and accurate process.
- Read the entire document carefully. Understanding the implications of HIV testing is crucial before consenting.
- Provide accurate personal information. Double-check that your name, address, and date of birth are correctly filled out.
- Sign and date the form appropriately. Ensure that you provide your signature in the specified area.
- Consult a healthcare professional if you have concerns. If uncertainties arise regarding your health or the testing process, seek advice.
Conversely, there are actions you should avoid while filling out the AA8596 form.
- Do not rush through the form. Take your time to ensure you understand each section.
- Avoid providing false information. Submitting incorrect data may lead to complications during the insurance process.
- Do not skip the consent section. Ensure that you fully understand and agree to the consent terms before proceeding.
- Refrain from submitting the form incomplete. Confirm that all necessary sections have been filled out to avoid delays.
Misconceptions
Misconception 1: Testing positive for HIV means you have AIDS.
This is one of the most common misunderstandings. A positive result from the Aa8596 form indicates HIV infection, not AIDS. It’s essential to remember that while a person with HIV is at risk of developing AIDS, the two conditions are not synonymous.
Misconception 2: You must know your HIV status before applying for insurance.
Many believe they need to have prior knowledge of their HIV status before completing the form. However, the purpose of the Aa8596 form is to evaluate your insurability after the testing process.
Misconception 3: The results will be shared with anyone without my consent.
The confidentiality of your test results is paramount. The law protects your privacy, and only authorized entities will receive your results. Disclosures are limited to necessary situations involving underwriting your application.
Misconception 4: A negative HIV test result will always be communicated.
It's understandable to expect notification of negative results, but according to the Aa8596 form, routine notifications are not sent unless there is a concerning result.
Misconception 5: You can’t seek counseling before testing.
In fact, the form encourages individuals to seek counseling or additional information before undergoing the test. This proactive step can provide vital support and clarity regarding the implications of the results.
Misconception 6: Only high-risk populations should be tested.
This form emphasizes that anyone considering insurance should be aware of their HIV status, regardless of perceived risk. Testing encourages responsible health management for everyone.
Misconception 7: Once I receive a positive result, I have no options.
Contrary to this belief, testing positive for HIV opens a pathway to options including medical support, counseling, and community resources. It’s crucial to focus on health management and remain informed about available treatments.
Key takeaways
- Purpose of the Form: The AA8596 form is essential for individuals seeking insurance with American-Amicable Life Insurance Company of Texas, as it enables testing for the presence of HIV antibodies or antigens.
- Pre-Testing Considerations: Prior to testing, individuals are encouraged to be informed about HIV implications. Resources, including private health care providers and public health clinics, are available for counseling.
- Understanding Results: A positive test does not indicate AIDS but signifies a higher risk of developing immune system issues. Further testing is advisable if results are positive.
- Result Notification: You will not receive a notification if your HIV test result is negative. However, if the result is anything other than normal, the insurer will contact you to discuss it with a designated healthcare provider.
- Confidentiality of Results: All test results will be kept confidential. The insurer may share results only with necessary entities for application processing and only as permitted by law or authorized by you.
- Support Resources: The Wisconsin AIDSline and other local AIDS resource centers provide information and support services for individuals who test positive, assisting with medical referrals, counseling, and community services.
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