MANILA, Philippines – The Insurance Commission (IC) issued guidelines for health maintenance organizations (HMOs) regarding the assessment of risks of individuals with the human immunodeficiency virus (HIV) to ensure that these persons are not deprived of health coverage.
“Despite free antiretroviral treatment, the lack of HMO coverage for persons with HIV continues to be a source of economic strain to them and their families,” said Insurance Commissioner Dennis Funa. (READ: [OPINION] I’m complicit in the rise of the HIV epidemic – and so are you)
Under the guidelines, an HMO may provide coverage to people living with HIV if:
- The applicant is undergoing proper medical treatment.
- The applicant has a favorable risk profile.
- The results of the medical examinations required by insurance companies are within normal limits.
The guidelines cover people with HIV, and even those with perceived or suspected HIV-positive status.
In the case of newly discovered HIV-positive individuals, HMOs may temporarily suspend acceptance of an applicant not more than one year from the start of continuous antiretroviral treatment (ART). (WATCH: What can you do to encourage HIV testing?)
“The one-year period is necessary for the purpose of evaluation of compliance with and efficacy of the ART,” the IC said.
However, HMOs can temporarily suspend or decline an application if the individual has comorbidity or another medical condition, or other risk factors. This provision does not take into account the applicant’s HIV status.
The IC defines comorbidity in HIV as diseases outside the scope of an acquired immunodeficiency syndrome (AIDS)-defining illness.
The common comorbidities among HIV-positive individuals are diabetes as well as cardiovascular, respiratory, and hepatic diseases.
The IC specified in the guidelines that HMOs may only require applicants to undergo HIV testing if they voluntarily consent to such.
As to the benefits and terms, the IC said HMOs must seek its approval before setting limits such as age, payment terms, and amount of the coverage.
The Department of Health said the Philippines has one of the fastest growing HIV/AIDS rates in the world, with 56,275 cumulative cases since 1984.
The guidelines were issued in line with the implementation of Republic Act No. 11166 or the Philippine HIV and AIDS Policy Act signed by President Rodrigo Duterte in December 2018. – Rappler.com