As Poz People know, the negative effects of contracting the HIV virus continue well beyond the initial diagnosis, spilling into many other aspects of life. The health and relationship challenges are well known. One less obvious consequence has been the denial of life insurance, an important tool for financial planning and arranging for the welfare of one’s family.
The good news is this is no longer applies to all HIV-positive individuals. Manulife Financial was the first to lead the charge in offering medically underwritten life insurance to those who are HIV positive. Sunlife Financial has since followed suit, and it is likely more insurers will follow their lead. With that said, the underwriting requirements are much more strict for individuals who are HIV positive than for those who are not, and not everyone diagnosed with the virus will qualify.
A New Prognosis – Managing Risk Across the Population
Life Insurance is about managing risk. Insurers need to assess the risk of offering life insurance to individuals and price their insurance rates accordingly. It’s only by pooling together many, many individuals and spreading the risk over the population that life insurance companies can offer affordable life insurance to Canadians. Historically, this has meant turning down high risk individuals, those in the potential insurance pool most likely to perish during the insured term and cash out their policies. “High Risk” can mean many things from risky lifestyle choices involving drug or alcohol use, pastimes such as skydiving, and health concerns such as obesity or having cancer markers in your blood.
Until recently, this has also meant denying life insurance coverage for individuals who are HIV positive.
Screening – The Medical Underwriting Process
How does a life insurance company assess your level of risk? Through medical underwriting.
“Underwriting” is the process an individual goes through when applying for life insurance whereby they answer a series of medical and lifestyle questions in addition to providing blood and urine samples. In some cases, the insurer will request additional information such as your motor vehicle report or your attending physician’s statement. The data they collect is carefully analyzed and used to assess whether or not they are willing to offer to insure your life. Testing positive for HIV would have historically resulted in an immediate decline for coverage.
Based on our experience as a Licensed Insurance Broker working with HIV-positive clients, we have outlined some of the common underwriting requirements below. While the list may seem like a lot to navigate, you are not alone in doing so. Working with an experienced insurance professional will make sure you get the advice you need in a professional and confidential manner.
You must be between the ages of 30 and 65.
This one is pretty self-explanatory. If you’re younger than 30, you will have to wait until your 30th birthday to apply. And if you’re older than 65, you will not qualify.
You must disclose in your application that you are HIV positive.
Since the insurer is relying on you to answer all the questions truthfully so they can make an informed risk assessment, any dishonesty discovered during the underwriting process will likely result in a denial of coverage.
You must currently be working with a medical specialist.
Basically, you need to be working with a medical professional and be actively treating your condition. It is likely that as part of the underwriting process the insurer will request an attending physician’s statement which will document for the insurer your treatment program and the results of that program to date.
You must have been compliant with antiretroviral therapy for at least 5 consecutive years.
In conjunction with working with a medical professional, you need to have been treating your HIV infection with an antiretroviral therapy for at least 5 years. This typically means you have been prescribed an anti-HIV cocktail of medications designed to prevent the HIV virus from multiplying, helping to keep your immune system healthy. The 5-year timeframe gives the insurer some assurance that you’ve been compliant with your treatment program and that you condition is stable.
You must not be experiencing viral resistance to treatment.
In brief, you must be responding positively to the antiretroviral therapy above. If you’ve shown resistance to treatment, this is an indication your condition may not be stable and the insurer will likely decline your application for the time being. That said, you may apply again at a later date if after trying different combinations of medications you find a combination that works. You will, however, need to undergo the underwriting process again from scratch.
The viral load must have been undetectable for the last 2 years and current CD4 count ≥350.
CD4 cells are white blood cells that play an important role in your immune system. A healthy person will have a CD4 count that is between 500 and 1,500. HIV attacks your immune system and so your CD4 count is a very important metric that helps identify if you’re at risk of other health complications due to a compromised immune system.
The viral load is essentially the amount of HIV in your blood. Generally, there is a negative correlation between your viral load and your CD4 count; As your CD4 count goes up, your viral load goes down. The goal of antiretroviral therapies is to get your viral load down to undetectable levels.
You must test negative for hepatitis B and C and have had no history of hepatitis.
As part of the underwriting process, you will be required to give blood. This will be tested in a lab for a variety of things, including hepatitis B and C. You must test negative and have had no history of hepatitis. Hepatitis affects the liver and in conjunction with HIV increases your chances of health complications.
You must have no history of IV drug use or other substance abuse.
In fairness, this one applies to HIV-negative individuals as well. Someone who is HIV negative but with a history of intravenous drug use or other substance abuse may be offered life insurance coverage, but would likely be rated, meaning they would pay higher rates. If you are HIV positive and you have a history of IV drug use or other substance abuse, you will likely be declined coverage due to the combined risk associated with both factors.
You must have no history of coronary artery disease, diabetes, or cancer.
As above, if you have a history of coronary artery disease, diabetes or cancer and you’re HIV positive, you present too great a risk and your application for coverage will be declined.
You must have no AIDS-defining illness.
If your HIV infection progresses to a severe stage, your immune system becomes compromised and you may develop other health concerns. Some of these are defined as AIDS-defining illnesses. The list of these conditions is developed by the Centers for Disease Control and Prevention and can be found here.
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