TOI: No health insurance cover for patients with HIV: August 11, 2008 | HIV / AIDS : News Articles

PAY FROM OWN POCKET
No health insurance cover for patients with HIV ...........Viju B I TNN

Mumbai: This will come as a shocker for several HIV/AIDS patients who need assistance for treating complications arising out of the fatal disease. Their health insurance policies will not provide them a cover in case of hospitalisation.

Insurers say there is no health insurance cover for HIV/AIDS and if a patient is admitted to a hospital for medical complications arising out of AIDS then he will have to settle the medical bills from his pocket.

“Unlike abroad, where a person gets full insurance cover, firms here shy away from giving cover to AIDS patients, fearing that they will have to incur huge losses. This has put many patients on the crossroads and they now have to depend on the state-sponsored welfare

schemes,’’ a senior official with the state-run Mumbai AIDS Control Society said.

Health insurance officials say they reject many claims after they come to know that the policy holders had earlier hidden pre-existing diseases like cancer, AIDS and congenital heart diseases. “But in the case of AIDS, the patient is not eligible for cover even if he had acquired the disease after taking the policy,’’ the official said.

Numerous cases are being fought in the consumer courts, where the policy holders had concealed their pre-existing illnesses and then made claims for hospitalisation. “In some cases, the litigants said though they had acquired AIDS, they were being treated for diseases other than HIVrelated complications,’’ the official said.

But life insurance firm officials said if the family members had taken a life insurance cover, then the surviving members are eligible to claims even if the policy holder died due to AIDS.

“But the policy holders should have taken the insurance cover before they had acquired the disease, only then the surviving nominee members are eligible for compensation,’’ a Life Insurance Corporation officials said.

Insurers also admit that the fast growing medical insurance industry needs to be regulated as tracking the medical records of patients is turning out to be a complicated affair. Last year, the sector grew by around 30%. But only 1% of the total population of the country has got heath insurance cover. “Abroad, citizens go for regular annual medical checks-ups and the insurer comes to know the medical status of the patients,’’ the official said.

PSU insurance firms dealing with medical insurance said they incurred huge losses. “Unless the volume and premiums are increased, the future is not very bright for the insurance firms,’’ an official said.

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