IC sets rules for PLHIV applications

THE INSURANCE Commission (IC) has issued guidelines on the underwriting of applicants with actual, perceived or suspected human immunodeficiency (HIV) status.

In a circular addressed to health maintenance organizations (HMO), the IC said an HMO cannot decline an application of a person living with HIV (PLHIV) on the sole basis of his or her status.

IC said HMOs may provide coverage to a PLHIV if the applicant is undergoing proper medical treatment, has a favorable risk profile, and has a medical examination result required by HMOs within normal limits.

However, the regulated organizations may temporarily suspend an application of newly-discovered HIV-positive individuals for a period of not more than a year from the start of their anti-retroviral treatment (ART).

“The one-year period is necessary for the purpose of evaluation of compliance with and efficacy of the ART,” the IC said.

HMOs may also hold or suspend an application of a PLHIV when presented with “co-morbidities, medical conditions or other risk factors” that can be decided on even without taking into account the applicant’s HIV status.

Risk profiles that may cause suspension or decline of application include individuals with hepatitis B or C, pulmonary tuberculosis, co-morbidities such as kidney, liver or cardiovascular diseases, and other declinable medical conditions like chronic kidney failure and uncontrolled diabetes or hypertension.

It can be noted that tuberculosis as well as hepatitis B and C are common among PLHIVs given their weakened immune systems.

HMOs may also require applicants to voluntarily undergo HIV testing.

“The determination on whether or not HIV testing is necessary depends on certain parameters such as the age, occupation or lifestyle of the applicant,” the IC said.

The regulated firms must also seek the approval of IC before setting limits of acceptance for PLHIVs in terms of age, payment terms or amount of HMO coverage, provided that such limits are reasonable and not discriminatory.

“The issue on HIV requires a comprehensive approach in prevention, treatment, and impact alleviation,” Mr. Funa said. “There is a need to provide clear guidelines in the underwriting of applicants with actual, perceived or suspected HIV status to ensure that they are not deprived of HMO coverage.

The commissioner added that the IC issued the guidelines in the interest of the implementation of Republic Act No. 11166 or the Philippine HIV and AIDS (acquired immune deficiency syndrome) Policy Act.

The law says no PLHIV shall be denied or deprived or private health insurance under an HMO under the basis of a person’s HIV status.

HIV is a virus that attacks a person’s immune system. This can develop into a more advanced stage called AIDS if left untreated.

Based on the latest data from the Department of Health, there were 66,303 reported cases of HIV as of April. There were 840 confirmed HIV cases in April alone, although lower than the 1,172 reported in March and the 924 tallied in the same month in 2018. — Karl Angelo N. Vidal