No more HMO discrimination under new AIDS law

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 R50,000, 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.”