Insurance cover for HIV/AIDS patients a distant dream, expensive despite Bill

Insurance coverage for HIV/AIDS remains a distant dream despite the Bill that makes it mandatory for the central and state governments to provide treatment to HIV-positive people and penalise discrimination.

Insurers consider them risky candidates and are likely to charge high premiums, say people in the insurance industry.

The bill stipulates that insurance companies must decide the cover based on actuarial evidence. But as the disease is often transmitted sexually, there is a stigma attached to it and sufferers are often denied services including insurance in both public and private establishments.

While the Bill stipulates that a HIV-positive diagnosis cannot come in the way of employment, the reality is quite the opposite. Insurers refuse to cover HIV-positive patients as part of group insurance schemes for companies as they are considered a risk to the pool.

According to some insurers, covers cannot be mandated.

“Nowhere does the bill say that all such individuals have to be covered,” said the appointed actuary of a private life insurance company. “Each company will have an actuarial and underwriting team to ascertain whether the particular risk can be covered.”

Applicants with pre-existing diseases are not eligible for regular health insurance policies. In addition, there is a waiting period that ranges from two to three years, meaning a customer can file an insurance claim only after that period ends.

Insurance companies have for long steered clear of offering HIV/AIDS cover both in the life and general insurance sectors owing to lack of data available to price the product.

In a 2013 draft regulation, the country’s insurance regulator had directed insurers to provide cover to HIV-positive patients. However, TS Vijayan, Chairman of the Insurance Regulatory Development Authority of India, had added that the pricing would be different.

Star Health Insurance’s Star Net Plus was the first policy in India to cover HIV- positive individuals. In general, however, insurers feel introducing such policies would be unviable.

“Insurance is based on the principle or risk. If the entire pool consists of individuals who are HIV-positive, it will be a challenge to price the product,” said the head of products at a mid-sized general insurer. “Even if we do, annual premiums may touch as high as Rs 1 lakh which may be unaffordable for the masses.”