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Insurance companies may now provide insurance coverage to PLHIVs

In what may be considered a long, LONG overdue move, insurance companies may now provide insurance coverage to PLHIVs. The Philippines has a law that – at least in idea – promotes non-discrimination of people living with HIV (PLHIVs). But there are HMOs (health maintenance organizations, including insurance companies) that refuse to cover PLHIVs. The guidelines, nonetheless, state that applications of PLHIVs with co-morbidities, medical conditions or other risk factors may still be postponed or denied by an insurance company.

In what may be considered a long, LONG overdue move, insurance companies may now provide insurance coverage to PLHIVs.

The Insurance Commission (IC) issued new underwriting guidelines in the assessment of risks of persons with actual, perceived or suspected to be with HIV. These guidelines determine “the parameters to be considered for life insurance risk classifications and other underwriting purposes in cases of life insurance applications of persons with actual, perceived or suspected to be with HIV.”

According to IC commissioner Dennis Funa, “the issue of HIV requires a comprehensive approach in prevention, treatment and impact alleviation. Despite free antiretroviral treatment, the lack of life insurance cover for persons with HIV continue to be a source of economic strain to them and their families. Thus, there is a need to provide insurance protection to these individuals.”

The Philippines has a law that – at least in idea – promotes non-discrimination of people living with HIV (PLHIVs).

Section 26 of Republic Act 8504 (AIDS Prevention and Control Act, the AIDS Law), which deals with insurance for persons with HIV, states that “the Secretary of Health, in cooperation with the Commissioner of the Insurance Commission and other public and private insurance agencies, shall conduct a study on the feasibility and viability of setting up a package of insurance benefits and, should such study warrant it, implement an insurance coverage program for persons with HIV. The study shall be guided by the principle that access to health insurance is part of an individual’s right to health and is the responsibility of the State and of society as a whole.”

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In practice, however, there are HMOs (health maintenance organizations, including insurance companies) that refuse to cover PLHIVs.

The new guidelines, though well-intentioned, may still be seen as half-baked.

Under the new guidelines, insurance companies may require applicants to voluntarily undergo HIV testing, pursuant to the existing law. The somewhat tricky part is the determination of whether or not HIV testing is necessary, as this depends on profiling, based on certain parameters like “age, occupation or lifestyle of the applicant”.

HIV-positive applicants will be reported to the Medical Information Database (MID), with the applicants’ agreement and in compliance with provisions of the Data Privacy Act of 2012.

Under the guidelines, insurance companies still have the option to choose to provide insurance coverage to PLHIVs, based on:

  1. Whether the applicant is undergoing proper medical treatment;
  2. If the applicant has a “favorable risk profile”; and
  3. The results of the medical examinations required by insurance companies are within normal limits.

In case of newly-discovered HIV-positive individuals, “insurance companies can postpone the issuance of a life insurance policy for a period of not more than a year from the seat of ART.” This period is supposed to be “necessary for the purpose of evaluation of compliance with and efficacy of the ART.”

Applications of PLHIVs with co-morbidities, medical conditions or other risk factors may still be postponed or denied by an insurance company.

For the new guidelines, IC worked with the Home Office Life Underwriters Associations of the Philippines, Philippine Society of Insurance Medicine, and Philippine Life Insurance Associations-Medical Information Database.

Insurance companies may now provide insurance coverage to PLHIVs
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