President of the Private Sector Organisation of Jamaica Beverley Lopez (left) talks with Annesha Taylor, a person living with HIV/AIDS at a breakfact meeting at the Gleaner Company last year - RICARDO MAKYN/STAFF PHOTOGRAPHER
Question: How do life insurers here deal with HIV/AIDS? If someone tests positive, is coverage refused? Are there any "best practices" to guide officials how to handle cases with the disease and the related illnesses? How are those with "risky" lifestyles handled? Does each company do its own thing? Given the high rate of infection and the attendant stigma, are persons with the illness treated fairly by the industry?
- B.S., Kingston 8.
Answer: Thanks for posing some very tough questions. One of the things I like about this column is the wide range of topics - all connected to insurance - that readers ask about. How life insurers manage HIV/AIDS is important: to consumers, victims and their families, investors in the companies and to others in the society. Fair treatment means trying to strike a balance between the needs of all groups, at least in my opinion.
Sources tell me that the local industry - as distinct from its members - does not have 'a bible' to guide it on HIV/AIDS. This is in spite of the facts that: (a) our region has the second-highest incidence in the world; (b) it is the second leading cause of death in males and females between 30 to 34 years old, and (c) persons in the 20-39 age groups (which are key sales segments) face the biggest threat. Two insurers gave me technical information. The issues you have raised are, however, more general. I plan therefore to compare what these companies say they do with the HIV/AIDS statement of practice of the Association of British Insurers (ABI) and our government's policy of the disease.
BUILDING BLOCKS
There are seven building blocks in ABI's statement of practice. They cover the following subjects:
1. The handling and treatment of medical information;
2. The exclusion of existing life policies from the statement even if the result of a HIV test is positive;
3. Information-gathering process for new policies.
4. What happens when an insurer requests a HIVtest.
5. How insurers should deal with cases where the result of the test is negative, but there are adverse features in a particular case.
6. How insurers should deal with cases where the results of the test are positive.
7. How consumer complaints in relation to cases in item 6 should be handled.
The information I received from the local insurers would not get a passing grade when I measure it using my two yardsticks. Procedures and processes here seem to me to ignore the Draft National AIDS/HIV Policy. Even though (according to the Health Ministry), "among reported AIDS cases on who (sic) data about sexual practices are available, heterosexual practice is reported by more than 90 per cent of persons living with AIDS," a leading insurer lists only 'minorities' as members of the "AIDS high-risk group" in its application form. When heterosexuals who engage in high-risk behaviour contract the disease, is coverage assured?
HIV/AIDS AND INSURANCE CONTRACTS
Is HIV/AIDS excluded from insurance contracts? The answer depends on what is written in the policies. In some instances, I would expect to see death resulting from this illness to be excluded. In other cases, particularly policies bought between the 1970s and early 1990s, there should be no exclusion. Claims arising from HIV/AIDS-related deaths under these contracts should therefore be paid without any dispute. Life policies issued after the mid-1990s would exclude AIDS-related claims or provide limited coverage.
Life insurers operating in Jamaica, like elsewhere, try to screen out persons in high risk groups. Additionally, applicants for coverage over certain amounts are routinely tested for HIV/AIDS. If there is evidence of the disease or the individual is thought to be high-risk group, coverage will not be granted. Coverage is, however, available on a non-medical basis for sufferers of HIV/AIDS. This means the sum insured is for a fixed amount. The proposer just answers a few questions and there is no medical exam.
Should we follow the lead of the UK industry or continue to do our own thing? I'll leave the decision to you.
Final words: R.McL., M.D. and W.D., thanks for your kind words. However, I just do not feel competent or comfortable to deal with the management problems of condos you wrote about last week.
Cedric E. Stephens provides independent information and advice about the management of risks and insurance. If you need free information or counsel to help you solve a problem write to The Financial Editor or contact Mr. Stephens directly at aegis@cwjamaica.com.
