Following directions from the Delhi High Court last September to provide health insurance to people living with HIV/AIDS (PLHA), the Insurance Regulatory and Development Authority (Irda) has released the draft norms on covering the health of PLHA.
All life and non-life insurance companies will have to put an underwriting policy on insuring the health of people suffering from HIV and people vulnerable to HIV/AIDS under their health insurance policies, Irda said while releasing the draft norms for such policies.
Speaking about the kind of products that could be offered to people who are HIV negative, the regulator said that the risk could be covered through a critical illness policy, through a rider policy that would provide a lump-sum incase the insured contracts the disease, by giving him a life time pension if he contracts the diseases during the tenure of the policy, by including Aids death as an insured event in a health policy, or could even cover HIV/AIDS under group schemes.
Insurance companies will have to specifically address people who are yet not showing Aids symptoms but are in Stage I and II of HIV infection, are in compliance with treatment protocols of the medication, have CD4 count in excess of 350, have CD4 percentage greater than 23 per cent, to be P24 antigenemia negative, said the insurance regulator in the draft norms.
The health insurance cover should tell potential customers the eligibility criteria, and if, the PLHA meets the criteria, he should not be denied a health cover, said Irda. 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 and different loadings for different stages of the disease. Insurance companies have been asked to file the loadings with regulator in the next months and seek its approval.
Irda has also instructed that proposal form of the insurance company should capture necessary information to underwrite the proposal in accordance with the underwriting policy. Insurers have been asked not to reject claims of persons who are HIV-negative at the outset, and subsequently found to be HIV positive.
The regulator has asked companies to charge a suitable premium and load, accordingly.
P Nandagopal, MD and CEO of India First Life Insurance, said, “HIV is not the only dreadful disease. People with different levels of mortality buy life insurance. However, the pricing should be proportionate to the risk we take. We will be happy to cater to this segment with appropriate pricing and various safeguards.â€
Standalone health insurer, Star Health and Allied Insurance, is the only 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.â€
The insurance regulator has asked for feedback in a month’s time, after which, the guidelines will be made effective from October 1.
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By Falaknaaz Syed Feb 03 2012 , Mumbai
http://www.mydigitalfc.com/insurance/irda-issues-draft-norms-insure-hivaids-infected-852
