Lessons learned from underwriting HIV/Aids

02 April 2012 Dalene Allen, Altrisk

Although HIV/Aids mortality is in decline neither the medical nor insurance professions can rest easy. Dalene Allen, underwriting expert and co-founder of specialist long-term risk cover provider, Altrisk, looks at some of the lessons learned as the industry underwrites and insures this chronic condition.

The most recent research shows that there are 5.6 million people infected with HIV in South Africa. Approximately 1.3 million of these sufferers receive treatment as government pushes ahead with the largest antiretroviral treatment (ART) rollout anywhere in the world. As a result the number of HIV/AIDS deaths has contracted by around 25% in the latest period.

At war with HIV

Since the discovery of HIV in the early 1980s, massive funding has gone into researching and understanding the disease. Global pharmaceutical companies have committed untold resources to finding treatments to manage the diseases’ progression.

While there is currently no cure for HIV/Aids, enormous progress has been made in antiretroviral therapy programmes, helping to turn the tide on AIDS deaths and new HIV infections in many parts of the world. What this means is that thousands of HIV positive people are living longer and better lives than scientists imagined possible in the 1980s.

Ongoing improvements in the management of the disease have forced life insurers to rethink their position on underwriting. Currently there are only two insurers in the country offering cover for HIV positive clients.

Chronic condition versus death sentence

HIV is a chronic illness and not a life-threatening disease. Insurers now view HIV/Aids in a similar light to other chronic disease such as diabetes or cancer. When Altrisk started providing life insurance cover for HIV applicants in 1999, we only offered 10 year policies, having limited research or data upon which to base our underwriting decisions.

But over the past 13 years, we have received only two HIV claims, a trend that most likely repeats across the limited pool of insurers who offer this type of cover and echoes the research studies conducted by re-insurers. The evidence supports that an HIV positive client who is diligently managing their condition need not have any time limitations or exclusions on their cover.

Compliance is critical

The underwriter’s primary consideration when assessing an HIV positive applicant for cover is strict compliance with the ART programme. Medication must be taken every day, at the same time in strict adherence to dosing instructions.

Compliance with the treatment regime is the single biggest factor in ensuring that the HIV sufferer does not become drug-resistant and run the risk of progressing to Aids. Private medial aid schemes currently cover up to four antiretroviral treatment regimes, while State plans cover two...

An underwriter will look at the applicant’s blood test results to assess CD4 counts and viral loads. These measurements provide strong indicators – assuming ART compliance – as to whether the applicant is, or is at risk of, becoming drug resistant. This test also provides an overview of how the disease is progressing.

ARV Treatment risk

The modern statistics show that many HIV sufferers have been living with the disease for 20 years or more. And our own claims history and re-insurer research is showing that HIV positive clients are at more risk of developing conditions, such as cardiac disorders or cancer, than HIV-related conditions.

The reality is that clients are more likely to die a premature death from an under-rated risk – such as a side-effect of ART – than from the disease itself! Armed with research and statistics, I believe the industry should move forward with insurance cover pricing based on the actual statistics around side effects, thereby shifting the emphasis away from HIV itself.

Managing premiums down

This will bring insurance costs down and improve the benefit limits for the applicant through better ratings across conditions. One of the greatest lessons over the years is that there is no ‘average’ when it comes to HIV/Aids. Everything about this disease comes down to extremes – people who follow a strictly managed treatment programme will in all likelihood live long, fulfilling lives – while those who do not deteriorate rapidly.

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