Insurance for HIV/AIDS patients to be a reality soon on Naco push

Pricing issues that were holding back insurance companies from covering HIV/AIDS patients, may soon be removed with the National Aids Control Organisation (Naco) setting up a working group to collect data that will help in pricing an insurance product covering HIV/AIDS.

A working group was formulated under the aegis of additional secretary of Naco last month with representatives from ministry of finance, Insurance Regulatory and Development Authority (IRDA), Life Insurance Council, General Insurance Council, United Nations Development Programme (UNDP) and People Living with HIV (PLHIV) representatives, a senior official of Naco said.

The draft study protocol is under consideration with our research unit in Naco that will be presented to the working group for fine tuning and commissioning of the study for designing an insurance product by month-end. Apart from the anti retroviral therapy (ART), the study protocols will look into how frequently PLHIV get opportunistic infections, the medical requirements and the periodicity of it from the point of view of insurance, the official added.

Once the analysis is complete, the insurance regulator will come out with different options of insuring HIV/AIDS, said the Naco official.

In September last year, the Delhi High Court had directed IRDA to provide health insurance to PLHIV/AIDS. The insurance regulator in February had released the draft norms asking for feedback and stating that the final guidelines for covering PLHIV/AIDS would be out by October 2012. However, in absence of data to price such products, the final guidelines could not be released.

J Hari Narayan, chairman of IRDA, said, Before we issue the final guidelines for covering HIV/AIDS people, insurers need to prepare the underwriting guidelines that will include how they will calculate the premium for the product et cetera. The General Insurance Council pointed to us that the data on HIV/AIDS needs to be strengthened as they don’t have very good data. So, Naco and the government formed a working group to analyse the data that will help in pricing. Once the data is analysed, insurers will be able to issue the underwriting guidelines.

According to the draft norms released by IRDA in February, persons who are HIV/AIDS negative at inception can be covered against HIV/AIDS in critical illness cover, by providing a lump sum amount that can be offered as annuity for lifetime in case he contracts the disease during the policy term, death due to Aids besides the product could also cover HIV/AIDS under a group insurance cover for various segments of the population.

All life and non-life insurers will have to put an underwriting policy on insuring the health of people suffering from HIV and vulnerable to HIV/AIDS under their health insurance policies, IRDA had said in the draft norms for such policies.

It is estimated that 2.4 million people live with HIV in India. While countries such as South Africa with high adult HIV prevalence of over 15 per cent, have taken measures to mainstream HIV through commercial insurance cover, with a low prevalence of 0.31 per cent, insurance sector in India still perceive HIV as a non-insurable risk. HIV remains as an exclusion in almost all health and life insurance products in India.

At present, standalone health insurance company Star Health and Allied Insurance is the only insurance company that has a product exclusively covering HIV/AIDS called Star Net Plus.

V Jagannathan, CMD of Star Health and Allied Insurance, said, “It is a profitable product for us. The policy offers cash compensation of Rs 30,000-50,000 if HIV becomes a full-blown Aids. The medical cover too, continues, but would not cover opportunistic infections like tuberculosis and stomach infections.

KG Krishnamoorthy Rao, MD and CEO at Future Generali India Insurance, said, There is no data for pricing a cover for HIV. Most HIV affected people do not disclose about the disease while taking an insurance policy. Also, if someone has contracted HIV, he may not come to know of it (initially). So, we cannot asses the risk properly. Also, people who are likely to avail the product may not be large in numbers.

The underwriting policy should provide clear guidelines on all the possible risks that can be considered for underwriting, all those risks that will not be covered, different loadings for different stages of the disease, said the draft norms.

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