For people diagnosed with HIV/AIDS, travel health insurance has usually been difficult, if not impossible, to obtain. Insurers’ eligibility requirements disqualified them even before they completed a medical application. Applicants were lumped into the same category as people with terminal illnesses or metastasized cancer or under physicians’ orders not to travel.
However, given the miraculous advances in the management of HIV since the worldwide AIDS epidemic that erupted in the early 1980s, the total ban on persons infected with the human immunodeficiency virus that has not progressed to AIDS has been clinically unwarranted. HIV, as has always been the case, is not as contagious as is Ebola, SARS, certain stages of pneumonia, or the common cold.
HIV is transmitted through sexual contact or contaminated blood passed on via needles or illicit drug paraphernalia. It is not transmitted by coughs, sneezes, handshakes, toilet seats, or unsanitized drinking glasses.
Consequently, its total prohibition by travel insurers has been medically unwarranted. And, recently, we have seen a relaxation of this exclusion in many travel insurance policies available in Canada.
On November 15, 2015, the Ontario Human Rights Commission issued a press release noting that it had learned about a Canadian insurance company refusing to cover anyone who had ever been diagnosed with HIV or AIDS. The Commission expressed concern that the denial might contravene Ontario’s Human Rights Code. (I should emphasize that, until recently, this insurance company was not alone in banning HIV/AIDS-infected persons from purchasing its travel insurance policies—most insurers did.)
The Commission argued that “While exceptions in the Code allow insurers to make distinctions based on certain Code grounds (including disability), the distinctions must be reasonable and bona fide. The Supreme Court of Canada has established a test for determining whether a rule or restriction is bona fide.”
The OHRC press release noted that the insurer subsequently removed the HIV/AIDs exclusions and that such applicants would now be treated the same as applicants with other pre-existing conditions; it also urged all insurers to review their policies for similar eligibility exclusions to ensure fair coverage for persons living with HIV and other disabilities.
Given the ability of modern medicine to manage the symptoms and, in many cases, the progression of HIV on to full-blown AIDS, the elimination of the exclusion makes clinical sense. HIV is no longer a virtual death sentence as it was in the ’80s, when AIDS terrorized an entire generation.
Many but not all travel insurers in Canada have already amended their policies to accommodate the OHRC’s recommendation. For persons diagnosed with HIV, that’s good news. But that does not mean that persons infected with, and under treatment for HIV, are guaranteed access to travel insurance coverage. Not by a long shot.
By being treated the same as applicants with other pre-existing conditions, they will still be subject to exclusions for unstable symptoms, recent changes in treatment, and ongoing tests or referrals to specialists—in effect, all of the stability requirements that must be met in the insurer’s coverage contract. These requirements are not to be taken lightly. Additionally, given the often complex treatment regimen people with HIV undergo, they should ask their physician to review their insurance application, particularly the medical questionnaire, and ensure it accurately reflects their patient’s medical record.
They still need to be vigilant.
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