HMOs ordered to provide medical coverage to HIV patients

MANILA, Philippines — The Insurance Commission (IC) has ordered health maintenance organizations (HMOs) to provide medical coverage to those afflicted with the dreaded human immunodeficiency virus (HIV).

Circular Letter No. 2019-30 issued by Insurance Commissioner Dennis B. Funa on June 21 is in line with Republic Act (RA) No. 11166, or the Philippine HIV and AIDS Policy Act, signed by President Duterte last December.

Under the circular, the IC must implement and develop policies that will ensure compliance with Section 42 of RA 11166, which states that no person/s living with HIV “shall be denied or deprived of private health insurance under an HMO on the basis of a person’s HIV status.”

Section 49 of the law also prohibits “denial of health services, or being charged with a higher fee, on the basis of actual, perceived or suspected HIV status.”

The IC said HMOs should provide coverage to people living with HIV under the following conditions:  he/she is undergoing proper medical treatment; he/she has a favorable risk profile; and the results of the medical examinations required by the HMO are within normal limits.

However, HMO applicants may be required to undergo HIV testing “based on parameters such as, but not limited to, age, total amount at risk, and occupation/lifestyle; provided that the applicant voluntarily consents to such testing pursuant to Article IV of RA 11166,” the IC said.

“Said HIV testing shall be performed by health facilities recognized by the Department of Health and have the capacity to provide services on HIV testing and counseling,” it added.