July 17, 2019
THE Insurance Commission (IC) has released new rules mandating health maintenance organizations (HMOs) to not discriminate people living with human immunodeficiency virus (HIV).
In a statement on Tuesday, Insurance Commissioner Dennis Funa said the issued new guidelines state “an HMO cannot decline an application of a person living with HIV (PLHIV) on the sole basis of his or her HIV status.”
Under the new rules, an HMO may provide coverage to persons with actual, perceived, or suspected to be with HIV, provided that the applicant is undergoing proper medical treatment, has favorable risk profile, and results of the medical examinations required by insurance companies are within normal limits.
“In case of newly-discovered HIV positive individuals, HMO companies may temporarily suspend the acceptance of newly-discovered HIV positive individuals for a period of not more than one year from the start of continuous Anti-Retro Viral Treatment (ART),” the IC said.
The one-year period is necessary for the evaluation of compliance with and efficacy of the ART, it added.
HMOs hold the discretion to temporarily suspend or decline an application of an HIV victim only if presented with comorbidities, medical condition, or other risk factors that would lead to the suspension or denial of the application without taking into account the applicant’s HIV status.
The agency defines comorbidity as a disease outside the scope of an AIDs-defining illness, such as mellitus, cardiovascular disease, respiratory diseases, and hepatic diseases.
HMO providers may require applicants to voluntarily undergo HIV testing as long as the applicant consents to such testing, pursuant to Article 4 of Republic Act 11166, also known as the Philippine HIV and AIDS Policy Act of 2018.
“The determination on whether or not HIV testing is necessary depends on certain parameters such as the age, occupation or lifestyle of the applicant. The guidelines likewise provide that the testing shall be performed by health facilities which have the capacity to provide services on HIV testing and counseling and are recognized by the Department of Health,” the IC said.
As to the benefits and terms of the contract, HMOs must secure IC’s approval before setting limits of acceptance for people with HIV in terms of age, payment terms, and/or amount of HMO coverage as long as such limits are “reasonable and not discriminatory.”
Funa said the new rules were released in the interest of the effective implementation of RA 11166 signed by President Duterte in December last year.
Under RA 11166, persons living with HIV shall not be denied or deprived of private health insurance under an HMO on the basis of HIV status.
Last month, IC ordered HMOs to provide medical coverage to those diagnosed with HIV.
Citing data from the DOH, the IC noted the Philippines has been reported to be having one of the fastest rate of increase in infections of HIV/AIDS in the world.It had a reported 56,275 cumulative cases since 1984.
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