SYMPOSIUM ON HIV AND
HUMAN RIGHTS IN THE
CARIBBEAN
13 – 14 SEPTEMBER, 2010
BRIDGETOWN, BARBADOS
SESSION 4
PANEL DISCUSSION
HIV EMPLOYMENT AND
INSURANCE ISSUES
HIV AND INSURANCE – STEVE R. STOUTE
Overview
• The impression is given that the life and health insurance
industry is less tolerant of persons infected with HIV
compared to persons with other medical impairments.
• I will examine this perspective in this presentation.
Selection Process
• Applicants for insurance are screened /underwritten
before being provided with insurance.
• This process is necessary to prevent people from
acquiring insurance when they are sick and to eliminate
“anti-selection”.
• The underwriter reviews specific medical data to
determine the morbidity and mortality of an applicant.
• A decision is either made to provide coverage at normal
rates, at an increased cost or to deny coverage.
• Depending on the size of the policy, various medical
requirements are routinely requested.
Insurers Reaction To HIV/AIDS
• The first diagnosis in the early 1980’s caused great
concern within the insurance industry.
• Actuaries and underwriters were worried that this
disease could greatly impact the overall profitability of
the life and health insurance industry.
• Companies worldwide took immediate steps to protect
from adverse mortality and morbidity from HIV.
• The HIV screening test was added to the list of routine
underwriting requirements mentioned above.
Insurers Reaction To HIV/AIDS
• Some insurers attempted to affix AIDS Exclusions to their policies
but this was disallowed by regulators in most jurisdictions.
• In the Caribbean, there are no policy exclusions for non-payment of
benefits for individuals suffering from HIV/AIDS.
• In most Caribbean jurisdictions, Governments objected strongly to
insurers introducing the routine HIV blood test. It was argued that
this could motivate panic and was not an effective detection device.
• In negotiations with governmental agencies, insurers argued that
they tested for diabetes, cholesterol, cancer, kidney disease and
other impairments on a routine basis. The HIV test would not be
discriminating against a specific group.
• Governments conceded subject to special rules and regulations.
Insurers Experience with HIV/AIDS
• Ten years after the first diagnosis, the impact of HIV/AIDS on the
insurance industry was minimal. There were 3 reasons for this:
– The HIV screening test was successful more from what insurers
termed the sentinel effect than as a detection device. The
sentinel phenomenon meant that high risk individuals were not
motivated to apply for insurance out of fear of testing positive.
– HIV/AIDS, especially within the Caribbean region seemed to be
prevalent in the lower social strata.
– In the health insurance employee benefit discipline, persons
suffering from the disease were not motivated to make claims
due to the stigma attached to the disease.
Insurers Experience with HIV/AIDS
• At this point in time, an HIV positive individual is unable
to obtain individual life or individual medical insurance.
• Persons who have in force life and health insurance
become HIV positive remain fully covered.
• HIV positive persons who are recruited by companies
with large group health employee benefit programmes
can receive full coverage under these policies even
though infected by HIV.
• There is strong adverse criticism of the insurance
fraternity for not being more liberal towards HIV-infected
persons.
The Insurer’s Dilemma
• Regional insurers operate in a vacuum with respect to
salient mortality and morbidity data on HIV/AIDS.
• In Barbados, although the insurer pays for the routine
HIV test, the results of a positive test are not revealed to
the insurer, who must guess that an applicant is HIV
positive when an application is not proceeded with.
• Medical practitioners seldom, if ever, mention HIV/AIDS
on a death certificate. Insurers must, therefore, guess
whether a death claim has resulted from an HIV/AIDS
infection.
The Insurer’s Dilemma
• Insurers provide life insurance to persons suffering from
diabetes, hypertension, a history of cancer and other
impairments as salient data is available to allow for
assessment of these diseases.
• This is not the case for HIV/AIDS.
The Way Forward
• The medical fraternity and the insurance industry needs to work
together to find remedies for this situation.
• In South Africa, where data is readily available, some insurance
companies have started providing policies specifically designed for
HIV-positive individuals. In assessing these lives, viral load and
other factors are taken into consideration.
• The same way that the medical fraternity has worked with insurers
on diabetes, hypertension, obesity etc with preventative and other
programmes a similar example should be followed for HIV/AIDS.
It will always be difficult to provide individual health insurance for
HIV, diabetics, etc. but with closer co-operation, life insurance
products could be available.
Summary
• Traditionally, the insurance sector and the medical sector have
worked closely. Routine insurance tests have revealed uncontrolled
hypertension, diabetes and other diseases and such early detection
have prolonged the lives of many people.
• The famous basket-ball player, Marvin ‘Magic’ Johnson was found to
be HIV positive through a routine insurance test which prolonged his
life and perhaps saved the lives of others.
• In the United States and other countries, the oral HIV test has been
added to the profile of other tests required for insurance. This is a
day-to-day and routine happening in that environment. It is my
belief that the medical profession currently motivates the paranoia
and stigma attached to HIV instead of treating same as any other
chronic non-communicable disease.
CONCLUSION
• In order to protect their policyholders, their shareholders
and indeed the financial future of many employees,
insurance companies have to discriminate against
certain categories of risk. There is no specific policy to
single out HIV and AIDS sufferers. However, closer cooperation and understanding from all salient parties
would work to the advantage of all players, especially
those persons suffering from HIV/AIDS.
CONCLUSION
• Thanks.
• Comments/Questions.