ADVOCATES SAY PRACTICE IS DISCRIMINATORY
Control and Prevention endorsed in 2014 for anyone at substantial risk of HIV, which includes any gay or bisexual man who might have sex without a condom with anyone of unknown HIV status.
The denials turn the insurance industry’s risk-management standard on its head: men who do not protect themselves can get policies, while men who do cannot.
“It doesn’t make any sense,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and perhaps the nation’s bestknown AIDS doctor. “It ought to be the other way around.”
Dr. Robert M. Grant, the AIDS researcher at the University of California, San Francisco, who led the clinical trial that established the value of PREP, said such denials “really are silly — it’s like refusing to insure someone because they use seat belts.”
Moreover, advocates argue, the practice singles out gay men for discriminatory treatment. Women, for instance, are not denied coverage if they use birth control pills or get the vaccine against human papillomavirus, which can cause cervical cancer. Yet like Truvada, use of these drugs suggests an active sex life, with the accompanying risks.
And insurers routinely cover applicants with actual diseases controlled by medications, including diabetes, epilepsy, high blood pressure and bipolar disorder.
Bennett Klein, a lawyer for GLAD (GLBTQ Legal Advocates and Defenders), based in Boston, said he knew of 14 instances in which companies denied life insurance, long-term-care insurance or disability insurance to gay men on PREP, or told brokers they would do so if asked.
The Times contacted the ACLI, the industry’s trade association, and four of the companies named by Klein, sending each detailed questions about underwriting policies related to Truvada and the sexual habits of applicants, and what other medical conditions caused them to deny coverage. An ACLI spokesman said the council did not collect such information from members.
For competitive reasons, companies do not publicize their underwriting standards and often do not explain why they deny an individual policy. Each policy is denied — or offered at a higher price or shorter term — based on many medical factors, including weight, blood pressure, cholesterol, smoking status and so on.
Mutual of Omaha, which Klein is suing for denying longterm-care insurance to an unnamed gay man, declined to answer any questions and said it did not comment on pending litigation.
In motions filed in GLAD’S suit, Mutual of Omaha conceded that it had denied an applicant coverage because he took Truvada.the drug is indicated only for persons with HIV or at high risk of acquiring HIV, the company said. Therefore it turned down everyone taking Truvada.
“The fact that the drug is less than 100 percent effective adds yet another layer to the risk profile,” the company added.
According to internal underwriting guidelines obtained by Klein, Mutual of Omaha sells long-term-care policies to people with Addison’s disease, bipolar disorder, depression, mild coronary artery disease, diabetes, epilepsy and high blood pressure, as long as they are controlled by medication for various periods, from six months up to three years.
It also insures former alcoholics who were alcohol-free and in support groups, as well as people who had recovered from heart valve surgery or cancers of the bladder, breast, prostate and skin.
“The irrationality is enough to make your mind spin,” Klein said.
Other insurers replied to The Times’s questions with brief answers saying they did not deny coverage solely for taking PREP but declining to describe what conditions or behaviors would cause them to exclude coverage.
“I am fairly certain that this is just slippery language, and that they are excluding applicants when they see a diagnosis of ‘high risk sexual behavior’ or ‘exposure to HIV’ in an applicant’s medical record,” Klein said.
Those descriptions are linked to diagnostic codes that doctors use for reimbursement from health insurers when a patient asks for a prescription for Truvada. “That’s no different from excluding based on PREP usage alone,” Klein argued.