Insurance Commission orders HMOs not to discriminate vs HIV

MANILA, Philippines — The Insurance Commission (IC) has ordered Health Maintenance Organizations (HMOs) not to discriminate against individuals with the human immunodeficiency virus, or HIV, in providing and underwriting health coverage.

Insurance Commissioner Dennis Funa issued IC Circular Letter No. 2019-30, dated June 21, 2019, prescribing the guidelines on the provision of HMO coverage for persons with actual, perceived or suspected HIV.

He said this is pursuant to Republic Act 11166, or the Philippine HIV and AIDS Policy Act, which says that no person living with HIV shall be denied or deprived of private health insurance on the basis of their HIV status.

“The issue on HIV requires a comprehensive approach in prevention, treatment and impact alleviation. Despite free anti-retro viral treatment, the lack of HMO coverage for persons with HIV continues to be a source of economic strain to them and their families,” Funa said.

“Thus, 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,” he added.

Under the IC circular, an HMO cannot decline an application of a Person Living with HIV (PLHIV) on the sole basis of his or her HIV status.

The guidelines provide that an HMO may provide coverage to a PLHIV if the applicant is undergoing proper medical treatment, has a favorable risk profile and if the results of medical examinations required by insurance companies are within normal limits.

To allow HMOs to evaluate the application, Funa said they may temporarily suspend the acceptance of newly discovered HIV-positive individuals for a period of not more than one year from the start of their continuous Anti-Retro Viral Treatment (ART).

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

The IC chief said HMOs may temporarily suspend or decline an application of a PLHIV only if it is presented with co-morbidities, medical condition or other risk factors that would lead to the suspension or denial of the application without taking into account the applicant’s HIV status.

These include diseases outside the scope of an AIDS-defining illness, such as diabetes mellitus, cardiovascular disease, respiratory diseases and hepatic diseases.

Meanwhile, the circular also states that HMOs may require applicants to undergo HIV testing provided that the applicant voluntarily consents to such testing pursuant to Article IV of RA 11166.

“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.

Under the circular, HMOs must also seek approval of the IC before it may set the limits of acceptance for PLHIVs with regard to age, payment terms and amount of HMO coverage, provided that such limits “are reasonable and not discriminatory.”

Citing data from the Department of Health, the IC said the Philippines has been reported as having one of the fastest growing incidences of HIV/AIDS worldwide, with a reported 56,275 cases since 1984.