Possibilities of life insurance expanded for HIV positive people

According to new notification from the Verbond van Verzekeraars (Dutch Association of Insurers), HIV positive people who are not yet taking combination therapy can now be insured. Moreover, the association now regards HIV as a chronic illness. This notification is a step forward, but it still excludes a group of perfectly healthy HIV positive people.

The Verbond van Verzekeraars published a new report in June 2009 on life insurance for HIV positive people entitled 'Verzekerbaarheid hiv verder uitgebreid' (HIV insurability expanded). (This title is a little curious. It's not the HIV virus that can be insured, but the people with HIV.) In 2005, the association published a report entitled 'Verzekerbaarheid hiv dichterbij' (HIV insurability closer). Since then it has been possible for certain HIV positive people to take out life insurance. According to the association, these possibilities should be expanded, although it is ultimately the insurers themselves who decide on the matter. 

Receiving treatment
HIV positive people who began combination therapy after 1997 and who had a CD4 count higher than 200 within 24 weeks after treatment, who do not inject drugs and do not have AIDS can essentially qualify for insurance. The amount of the premium depends on the CD4 count 24 weeks after beginning treatment and the degree of risk aversion by the insurer. How high the premium will be is up to the insurer. It pays to compare insurers.
This HIV positive group has qualified for insurance coverage since 2005. The premium has changed, the longer you've been treated, the lower the premium. This might sound strange, but it isn't. When you had a CD4 count of 300 after 24 weeks of treatment, then after 1 year, your CD4 count will be higher, and after 5 years even higher. Having an even higher CD4 count will calculate less risk.

Not yet receiving treatment
What is new about this report is that now HIV positive people who are not yet being treated can take out an insurance policy. It is true that this could be the case in the past, if insurers understood that when you are too healthy to receive treatment, you are also healthy enough to be insured. But now this group has been included in the report and insurance for them can be calculated. Basic conditions: a CD4 count of more than 200; 24 weeks after the positive test result; no AIDS diagnosis and no IV drug use. In addition, the current CD4 count must be higher than 200 and the viral load less than a million. The increase of the premium is also dependent on the insurer and on the CD4 count after 24 weeks.

HIV as a chronic infection
The association uses the report to tackle another question. In the health declaration of the application for a life insurance policy there are questions about a number of chronic illnesses. No questions about HIV infection are included. This means that having an HIV infection is considered as having a first-order infection. The association advises inclusion of HIV infection in the questions about other chronic illnesses. Thus the association regards HIV infection as a normal chronic infection.

Acceptance and feasibility
The report also showed that in the first year after publication of the first report, more applications were denied than in the second year: 59% against 26%. The old report was also reassessed. It appeared that HIV positive people who meet the above mentioned conditions were indeed insurable. Thus, the association had not made an error.

Improvement, but not yet perfect
We should be happy with this new advice, as it is an improvement over previous advice. A premium based on the CD4 count some 24 weeks after beginning treatment could however be crippling for some HIV positive people. You could not take out an insurance policy if you started treatment before 1997 or if you had a CD4 count of 150 some 24 weeks after beginning the treatment. Reason: people who at that time had that amount of CD4 cells ran the increased risk of illness and death. In spite of this risk, if you are now 10 years older, you certainly have a much lower risk. Yet you can't get insured.
If 10 years ago, your CD4 count was 210 some 24 weeks after starting treatment, you would pay a higher premium. Reason: having a CD4 count of 210 means that you run a relatively high risk of illness and death. Even if any of this did not happen to you, you still pay a higher premium because your fellow-sufferers who started treatment 10 years ago are, by now, deceased. A curious principle. In this situation the higher premium is offset by the fact that you've been successfully using combination therapy for a long time. This is rather laborious.

Now, not back then
What is decisive about risk of illness and death is not the question of how you were doing in the past, but how you're doing right now. This, however, is difficult for insurers to put into a model. If you look at the number of CD4 cells now, the future remains an unknown. Insurers cannot make a calculation based on that.
It is advantageous to come up with solution for this problem. In other words a model that does more justice to the present situation and relies less on the way it was in the past, but which enables insurers to estimate risks. If this can be accomplished, a number of obvious injustices can be eliminated from life insurance. Life insurance policies can certainly be further improved.

The situation in other countries
In most other developed countries HIV positive people cannot qualify for a life insurance policy. Switzerland is an example of this. In 2008/2009 AIDS-Hilfe Schweiz (AHS) analysed the situation in other countries. Besides the Netherlands, life insurance was only possible in France, Norway and South Africa. This had already been possible in France since 1991. Since 2007, the maximum insured amount has been € 300,000. One insurer insures up to € 750,000.
In South Africa, HIV positive people can be insured up to € 262,000. It is also possible in Norway, but AHS could not obtain the conditions.




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