No more HMO discrimination under new AIDS law

By Ellson Quismorio, Manila Bulletin, Feb 26, 2019

Health and life insurers can no longer discriminate against Filipinos living with the human immunodeficiency virus (HIV) under the new AIDS Prevention and Control Law, Surigao del Sur 2nd district Rep. Johnny Pimentel said Tuesday.

“All insurers in the country are expected to revise their standard policies to comply with the provision of the law that prohibits the exclusion of persons living with HIV,” Pimentel said.

Under Republic Act (RA) 11166 which took effect January 25, people living with HIV can no longer be left without insurance coverage and protection by reason of their condition.

Pimentel cited Section 42 (e) of the law, which states: “No person living with HIV (PLHIV) shall be denied or deprived of private health insurance under a Health Maintenance Organization (HMO) and private life insurance coverage under a life insurance company on the basis of the person’s HIV status. Furthermore, no person shall be denied of his life insurance claims if he dies of HIV or AIDS under a valid and subsisting life insurance policy.”

Violators of the provision face up to five years imprisonment and a fine of at least P50,000, plus administrative sanctions such as suspension or revocation of business permit, business license or accreditation, and professional license, according to the Mindanao solon.

“We’ve gone over several standard insurance policies issued prior to the passage of the law, and we came across a number (of policies) that categorically excluded HIV-related cases from coverage. These exclusions are no longer possible,” he stressed.

Pimentel cited an unnamed leading insurer’s standard policy which stipulates that: “No benefit shall be payable in cases of HIV and or any HIV-related illness including AIDS and/or any mutations, derivations or variations thereof.”

He also cited another major insurer’s policy which states that: “No benefit shall be payable in malignant cancer cases when the tumors are in the presence of HIV infection.”

Over 62,000 cases

HIV causes AIDS, or the Acquired Immune Deficiency Syndrome, which destroys the human body’s natural ability to fight off all kinds of infections. The condition still does not have any known cure, but Antiretroviral Therapy (ART) slows down the virus.

A total of 11,427 new HIV cases were diagnosed in the country in 2018, according to the Department of Health’s (DOH) National HIV and AIDS Registry.

The figures brought to 62,029 the cumulative number of people found living with HIV since the government began passive surveillance in 1984.

Of the 62,029 cases, the registry said 3,054 have died, while another 7,098 had “clinical manifestations” of advanced infection based on World Health Organization standards.
A total of 33,575 Filipinos living with HIV were undergoing ART as of December 2018.