HIV+ Patients: Are They Covered by Health Insurance?

Posted on: Dec 9, 2022 | | Written by:

HIV+ Patients: Are They Covered by Health Insurance?

Published on December 09, 2022. EST READ TIME: 4 minutes

We know health insuranceplans come to our rescue during medical emergencies. And there are certain exclusions mentioned that limit the risk of the insurer. For example, accidents are covered, but if an accident happens due to drunk driving,one may not receive coverage under his/her policy. But what happens if the policyholder gets diagnosed with aninfection that doesn’t have any cure? Yes, HIV is one such deadly infection that is feared by many. A person with HIV not only has to live with the illness, but it also makes the immune system so weak that the patient becomes susceptible to different diseases.Can a health insurance policy cover the person’s treatment? Let’s figure it out.

What is HIV/AIDS?

HIV, or human immunodeficiency virus, affects our immune system. As a result, our body’s ability to fight infections weakens, and we become more vulnerable to infections and diseases.HIV is transmitted through bodily fluids –it can be sexually transmitted (this is the most common) or through blood transfusion or sharing of injection needles. A woman can also transmit HIV to her child during pregnancy,childbirth or breastfeeding.

Acquired immunodeficiency syndrome (AIDS) is a potentially life-threatening disease caused by HIV. If HIV is left untreated, it can lead to AIDS. It is the most advanced stage of HIV, which can take many years to develop.

As of now, HIV/AIDS has no cure,and a person infected with the infection or syndrome has to live with it for the rest of his/her life. But it can be controlled with effective medical care and treatment, helping people with HIV/AIDS lead long and healthy lives.

Is There Any Health Insurance Plan Option Available for HIV Positive Patients?

Even though the Insurance Regulatory and Development Authority of India (IRDAI) says HIV-positive patients cannot be denied insurance coverage, most insurers do not provide coverage to persons with HIV and related ailments because such patients are considered high-risk.However, the insurers which offer coverage have the following conditions:

• The policy is available to those who are already HIV positive. If a person gets infected after a certain period of getting the policy (generally, it is 90 days), the coverage will be withdrawn.

• The applicant should be backed by the government, NGO or agencies serving people with HIV.

• The insurer does not bear the actual cost of treatment of HIV but only the tests and medical procedures in case of AIDS detection.

• Apart from HIV, the health plans do not cover other pre-existing conditions. This means that if a health plan covers HIV, no other pre-existing ailment will be covered.

Why is Health Insurance Commonly Unavailable for HIV Positive Patients?

HIV-positive patients are at high risk of contracting diseases because of weakened immunity. A minor ailment can become severe, and the cost of tests, treatment and hospitalization would be much higher compared to regular patients. Also, the medications and treatment to enable HIV-positive patients to live long, healthy, and happy lives are quite expensive. Insurance companies consider them high-risk and hence stay away from offering coverage to HIV patients.

What are the Challenges Faced in Providing Health Insurance for HIV/AIDS patients?

HIV/AIDS patients become vulnerable to a host of ailments due to their low immunity. When the body cannot fight infections or the immune system is damaged, the patients succumb to the illness faster. Although they can live with the disease, insurance companies still don’t provide them coverage because of the high risks involved. In 2013, despite the IRDAI’s directive to offer some coverage to HIV-positive patients, very few have come forward to provide them with financial security. A lot still needs to be done to protect those with compromised immunity financially.

Conclusion

A person with HIV/AIDS has to live with the illness, as there’s no cure for it.To help manage the condition and delay the progression of HIV, the patients need extra care and treatment. Unfortunately, most insurance companies do not provide individual health insurance or family health insurance to HIV-positive patients making it difficult for them to meet their medical expenses and live a healthy life. The need of the hour is to have health insurance plans for HIV/AIDS patients so that they can fight the deadly infection or syndrome without stressing about the financial aspect.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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