Insurance companies should avoid asking United Kingdom insurance applicants if they are gay; must not load insurance premiums unfairly simply because applicants are gay; and should only ask an applicant to take an HIV test if they disclose unsafe sex, a history of sexually transmitted infections, or injecting drug use, according to a new guidance from the Association of British Insurers issued this week.
Previous guidance issued in 1994 recommended that companies should not ask about HIV testing, but instead should ask whether an applicant has ever tested positive for HIV. The latest guidelines were developed in consultation with the Terrence Higgins Trust, the United Kingdom’s largest HIV charity, and gay financial service providers.
Although the guidelines should ensure that insurers do not ask unnecessary or intrusive questions about sexuality or sexual behaviour, they will still cause some concern, particularly as they imply that an insurance company will receive notification of a positive HIV test result before the individual having the test.
Assessment of HIV risk
Insurance companies will only be allowed to ask about behaviour that indicates an increased risk of HIV infection, and will not be permitted to ask general questions about sexuality. The guidelines state, “insurance companies should consider each application…on a case by case basis, based solely on the best available relevant evidence.” It’s also stated that insurance companies must not make assumptions about an applicant’s sexuality and HIV risk because of his occupation, “for example, a cabin crew member, ballet dancer or hairdresser cannot of itself justify an HIV rating.”
Applications for insurance should ask, “have you ever tested positive for HIV, hepatitis B or C, or are you awaiting the results for such a test?” As in 1994, a negative result for these tests will “not, of itself, have any effect on…acceptance terms for insurance.”
Insurance companies are recommended to assess an individual’s risk of infection with HIV due to sex by asking, “within the past five years have you ever been exposed to the risk of HIV infection?” Being gay is not grounds to request an HIV test.
However, insurance companies will also be able to assess a person’s HIV risk by asking if an individual has tested positive for, or been treated for, a sexually transmitted infection in the past five years.
Potentially, this could lead to many HIV tests being requested. UK Government figures suggest that up to a fifth of young men and women have chlamydia. It is also open to question if sexually transmitted infections are always a reliable marker of HIV risk activity.
The majority of heterosexual cases of HIV in the United Kingdom were acquired abroad. The new Best Practice Statement does not give explicit guidance on overseas travel or residence as an HIV risk, and states, “companies will need to maintain a list of countries with high HIV prevalence as part of their policy on when to ask for HIV tests and make this available on requests to applicants.”
Rather than asking general questions about recreational drug use, insurers are recommended only to ask about injecting drug use. The recommended question is “have you ever injected non-prescription drugs?”
As regards surgery and blood transfusion, the Statement of Best Practice is unable to offer a clear recommendation. Many companies only ask for an HIV test when these procedures were performed outside the European Union (EU). However, the insurance industry has concerns about the safety of blood products and surgery in some countries in central and Eastern Europe which joined the EU earlier this year. The guidelines, therefore, makes “no recommendation either way as this is a matter for continued policy development.”
HIV testing practices
Guidance is also included in the code on information to be provided to individuals who are asked to have an HIV test, the location of HIV testing, communication of test results, and confidentiality.
Applicants must be explicitly informed why they are being asked to have an HIV test, and must provide their informed consent. HIV tests must not, the Statement of Best Practice states, be performed if an individual does not provide consent.
The Statement clearly implies that HIV tests should be conducted by a clinician of the insurer’s choice and only concedes that, “if the applicant wishes the test to be carried out by their own doctor…this should be treated on its merits.”
To protect confidentiality, insurance sales personnel should not, wherever possible, be told that an individual has been asked to have an HIV test, and must never be told the results of the test. Test results should be provided to individuals as soon as possible, and must not be disclosed to third parties without written consent. If an individual tests HIV-positive, an individual must be told as soon as possible,“ so that arrangements for counselling and future care can be discussed.”
The guidance also implies that insurance companies will know the result of an HIV test before the individual who had the test. The Statement says, “in those rare cases where an HIV test returns a positive result…the insurer must ensure that the applicant is told the result." Worryingly, the Statement also notes that an insurance underwriter could receive the results of an HIV test before the individual having the test, and that the insurance company’s chief medical officer, who will be notified, will then contact the individual.
HIV and health and income protection insurance
HIV is almost always excluded from health and income protection cover. When HIV is excluded, the model wording recommended in the guidelines is, “we will not pay a claim if it is caused directly or indirectly by infection with Human Immunodeficiency Virus (HIV) or by conditions due to any Acquired Immune Deficiency Syndrome (AIDS).” However, the Statement emphasises that policies should not be worded in such a way that excludes an HIV-positive individual from claiming for a condition unrelated to their HIV infection.
The Statement of Best Practice can be read online at www.abi.org.uk.