Insurance Commission allows HMOs to limit coverage of HIV patients

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Metro Manila (CNN Philippines, July 1) — The Insurance Commission (IC) is allowing private health insurers to limit coverage of people living with the Human Immunodeficiency Virus (HIV), even if a recently-signed law prohibits the denial of health insurance coverage on the basis of a person’s HIV status.

Under Circular Letter 2019-30, the insurance regulator allows health maintenance organizations (HMOs) to temporarily suspend or decline the application of an HIV patient when the patient has other medical conditions or other risk factors which would have also resulted in the suspension or denial of the application even if not HIV positive.

These include kidney, liver or cardiovascular diseases, hepatitis B or C, pulmonary tuberculosis, signs of infections brought on by a weakened immune system, smoking, and injection of illegal drugs.

People living with HIV sometimes also have Hepatitis B and C, and tuberculosis. In fact, tuberculosis is one of the leading causes of death among people with HIV worldwide.

HMOs are also allowed to set limits of acceptance for people with HIV depending on their age, payment terms or amount of coverage, upon approval of the IC.

While private health insurers can deny coverage to HIV positive Filipinos on the basis of these risks, the IC stresses that they “cannot decline an application … on the sole basis of his or her HIV status.”

The IC said an HMO may provide coverage to people with HIV if they are undergoing proper medical treatment, if they have a “favorable risk profile,” and if the results of their medical examinations are within normal limits.

HMOs can also temporarily suspend the acceptance of newly-discovered HIV positive individuals for up to one year from the start of continuous anti-retroviral treatment in order to evaluate their compliance and the efficacy of the treatment.

HMOs may also require applicants to undergo HIV testing depending on their age, total amount at risk and their occupation or lifestyle, as long as they would consent to getting tested.

The IC also allows HMOs to charge people with HIV additional fees for “special underwriting requirements relative to his or her application.”

This order is a reiteration of guidelines issued February 2017 which created special underwriting standards for insurance policies of people with HIV.

Republic Act No. 11166 or the HIV and AIDS Policy Act, signed in January, states, “No [person living with HIV] shall be denied or deprived of private health insurance under an HMO and private life insurance coverage under a life insurance company on the basis of the person’s HIV status.”