Survival for infected individuals continues to improve as newer, less toxic drugs and simpler one-tablet daily regimens are increasingly available. RGA's Hilary Henly explores what underwriters need to know about HIV in part one of a two part series.
Applicants’ self-disclosed Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) status as well as body mass index (BMI) are important risk factors for morbidity and mortality in both accelerated and traditional (full) underwriting processes. In combination with self-disclosed smoking and medical history (diabetes, hypertension, heart failure, high cholesterol), which was discussed in a previous issue of Contingencies, these conditions constitute a majority of the leading medical inputs to the risk-assessment process.
From the initial recognition of HIV virus in 1981, HIV infection has turned from an almost universally fatal infection, to one that could be managed with medication to extend life, to a disease which can be controlled with newer and revolutionary medication therapies. While many companies continue to see the HIV virus as uninsurable, that corner has also been turned, and life insurance in selected cases of treated HIV infection is now possible. Even though the conditions that must be met are numerous and the criteria stringent, applicants with HIV now have the possibility of acceptable insurance offers.
Recently, RGA’s Dr. Dan Zimmerman spoke to the Association of Home Office Underwriters (AHOU) about the history of HIV/AIDS and insurance, and how risk modeling can reasonably conclude that some individuals with HIV can now be candidates for life insurance coverage. We sat down with Dr. Zimmerman to discuss his presentation and the paradigm shift in the availability of life insurance for people with HIV.
From the end of the 2000s, after the introduction of the first antiretroviral therapies (ART), it became clear that the benefits of these treatments were considerably greater than their side effects, especially when introduced early. The recommendation at present is to begin treatment with ART as soon as CD4 T-cell count falls below the normal level of 500/mm3.
Around 36 million people are living with HIV in the world today (LVWH). 5 million of them are also infected with the hepatitis C virus (HCV) and 4 million with hepatitis B virus (HBV). In both cases, HIV and the immunodeficiency it causes, accelerate the progression of hepatitis B or C, inducing increased morbidity and mortality for all three infections.
Aequalis' methodology may lend itself to other treatable diseases for which life insurers don't provide coverage.
The CDC published HIV Pre-Exposure Prophylaxis (PrEP) Guidelines for use of Truvada in 2012 and has championed its use as a way to help prevent HIV infections in populations at high risk for sex-related acquisition of the virus.
In December, Prudential Financial began offering 10- and 15-year term life policies to a community that (in the U.S.) had been largely shut out of the life insurance market: people living with HIV. The product rollout stems from an unusual partnership with Aequalis, an independent organization that conducted extensive research into the feasibility of availing the HIV community of life products. LifeHealthPro Senior Editor Warren S. Hersch recently interviewed Mike McFarland, chief underwriting officer of Prudential Individual Life Insurance.
When Prudential saw that people living with HIV were living longer, healthier lives, the company knew it had an untapped market for life insurance underwriting.