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San Jose Mercury News Examines Obstacles HIV/AIDS Patients Face Obtaining Life Insurance

April 28, 2004

The San Jose Mercury News on Tuesday examined the obstacles some HIV/AIDS patients face in obtaining life insurance policies because insurance companies have not "kept pace" with what is becoming a "chronic, controllable" disease. Although people living with HIV/AIDS cannot be denied group life insurance policies through employers or associations, they are "routinely denied" individual policies that require a medical review, according to the Mercury News. Some HIV-positive people can obtain "guaranteed issue" life insurance policies that do not require a medical review, but the policies are expensive and provide limited coverage, the Mercury News reports. Currently, only one U.S. company -- Guarantee Trust Life Insurance -- provides "significant" individual coverage to HIV-positive people; however, the company does not provide policies to people living with AIDS, according to the Mercury News. Guarantee Trust Life Medical Director Calvin Scott said that the company requires HIV-positive applicants to have certain levels of CD4+ T cells and viral loads in order to qualify for a life insurance policy, the Mercury News reports. The company, which began offering policies to HIV-positive people in 1997, also does not provide policies for HIV-positive people who contracted the disease through injection drug use or blood transfusions and only offers coverage to people between the ages of 20 and 49. Guarantee Trust Life Vice President of Underwriting Dean Zivkovic said that about 50% of HIV-positive people who have sought coverage have been denied, according to the Mercury News.

Cost, Stigma, Actuarial Data
One barrier for some HIV-positive people seeking life insurance policies is the high cost, the Mercury News reports. For a $250,000 policy, a 35-year-old HIV-positive man who does not smoke would pay $1,631 a month, compared with a non-smoking man of the same age with cancer, who would pay $635 month, according to Zivkovic. Another issue is the stigma associated with the disease, the Mercury News reports. Zivkovic said, "It's how the person got the disease, what that implies about lifestyle. Not a lot of people want to take that to their CEO." Another issue could be actuarial data that does not reflect true life expectancy of HIV/AIDS patients, according to the Mercury News. Guarantee Trust Life estimates life expectancies for people living with HIV as an average of 12 to 15 years from diagnosis, Scott said, according to the Mercury News. A study published in the September 2003 issue of the Lancet demonstrated that death rates among thousands of HIV-positive people in Switzerland -- who were being treated with antiretrovirals and did not have hepatitis C -- were similar to the death rates among people with cancer (Feder Ostrov, San Jose Mercury News, 4/27). The researchers compared death rates of the HIV-positive people in the study to the death rates of the overall Swiss population. Dr. Bernard Hirschel of the Geneva University Hospital, a co-author of the study, said, "Successfully treated HIV-positive and hepatitis C-negative patients have a short-term mortality as low as, or lower than that of, patients with cancer who have been successfully treated -- a group that is able to obtain life insurance." The researchers defined successful treatment as having a CD4+ T cell count greater than 250 cells/mm3 at least six months after starting treatment. They predicted that the mortality rate among these patients is likely to remain low over the next several years. The researchers concluded that the study "provides preliminary evidence that life coverage could be considered under specific conditions" (Kaiser Daily HIV/AIDS Report, 9/12/03).

What Next?
American Council of Life Insurers spokesperson Jack Dolan said that the Swiss study offers "very exciting information," adding, "Life insurance companies want to provide coverage and they want to provide it to as many people as possible. We really want to see more data." Actuary Rick Bergstrom of the actuarial consulting firm Milliman said that the industry "has not yet attempted to tackle" AIDS-related death rates as an underwriting issue, according to the Mercury News. He added that actuaries have tried to develop life expectancy predictions, but the "rapidly mutating nature" of HIV/AIDS and patients' development of resistance to antiretroviral treatment has "stymied their efforts," the Mercury News reports. Currently, there is "little if any" consensus among life insurance companies about how to underwrite people living with HIV/AIDS, Bergstrom said, according to the Mercury News. He added, "If the industry would want to take a serious look at it, we could in theory price a product for someone who is HIV-positive. But it's not on anyone's front burner, to my knowledge. We just don't have enough information to make a fair assessment of the risk to do it right" (San Jose Mercury News, 4/27).

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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.




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