Underwriting Approach
2.3 (Principle 1)
An individual's general occupation is no guide to their HIV risk, for example, being a cabin crewmember, ballet dancer or hairdresser cannot of itself justify an HIV rating.
Collection of Information
2.4 (Principle 2)
Only ask for information that is relevant. Insurers will not request information which is unnecessary or irrelevant to the risk of being insured, such as speculative questions that rely on inference and assumption on the apart of the underwriter, for example, co-purchasing arrangements.
Question 1: Are the principles the right ones and do you have any comments on them?Answer: A person's occupation has been used in the past by life assurers, as an indicator of sexuality. When receiving an application for life assurance/critical illness cover and income protection, underwriters have used this information as an informal method of identifying gay applicants.
This speculative form of underwriting is clearly unacceptable and offensive towards occupations such as Cabin Crew, Dancers and Hairdressers as not all people in these occupations are gay. The principles within the proposed new guidelines have been updated and brought into the 21st Century. They reflect modern views and attitudes.
Communicating With The Applicant's GP
3.1 & 3.2
Care should be exercised when communicating with an applicant's GP. Prior explicit written permission must be obtained from the applicant before writing to the doctor with any information or questions that could directly or indirectly reveal the sexuality of the applicant to the GP. In particular, information arising from the applicant's answers to questions about belonging to certain HIV risk groups SHOULD NOT be passed on to the GP.
Equally, insurers must not ask the applicant's GP to speculate on whether the applicant is at higher than normal risk of infection from HIV, nor should they request an opinion on a non-clinical issue.
Question 2: Do you agree passing information to an applicant's GP should not be allowed unless the applicant has given explicit consent?
Answer: In past years, transfer of information between insurers and GPs has caused many of my client's distress. The questions that have been asked by insurers have been of a 'speculative' nature, instead of direct questioning.
For example, 'Are there any other relevant health issues that the GP feels the insurer should know about?' This type of questioning has opened the door for GPs to volunteer unnecessary information regarding their patient's sexuality.
As the BMA Blue Book now clearly advises GPs should not share speculative information, their principles that life assurance companies are required to follow.
Asking About The Applicant's HIV Status And Risk
3.5
Since publication of the first version of the ABI Statement of Practice on Underwriting Life Insurance for HIV in July 1994, insurers have not asked whether an applicant has undergone counselling about HIV, or had taken an HIV test. Instead, insurers have been expected only to ask whether the applicant had tested positive for HIV, or was awaiting the results of an HIV test.
Question 3: Do you agree with the wording of the question that appears on the applications form to begin the process of establishing risk of HIV infection. If not, please suggest alternatives and give your reasons.
Answer: We agree that insurers need to establish the risk of HIV infection in order to protect their claims exposure. The current practice of asking if a person has tested positive for HIV, or awaiting results of an HIV test is relevant to life assurance applications. This question safeguards the insurance industry against claims from people who have already been diagnosed HIV Positive.
We believe that insurers should not ask questions about a person's history of HIV testing, as this, in our opinion, is not an indication of HIV risk. It is, in fact, an indication of a responsible attitude towards one's health.
Underwriting Evidence And Exclusions
A.6
If the exclusion means that questions about a person's risk of HIV infection are irrelevant, those questions should NOT be asked. This is particularly likely to be the case for income protection and long term care insurance, because it should usually be relatively simple to establish whether or not HIV/AIDS is the cause of the claim. Insurers may still ask for details of positive HIV tests, as to do otherwise would be to offer an unfair contract to those already affected.
Question 14: Do you agree that where HIV/AIDS exclusions are applied to income protection or long-term care insurance questions relating to the risk of HIV infection should not be asked, for example, Question 15?
Answer: We believe that asking 'lifestyle questions' for HIV Testing and inflated premiums within the application process for Income Protection and Critical Illness cover is unacceptable.
These procedures are clearly intended to identify risk of HIV/AIDS, when in fact the Terms and Conditions of the majority of these policies exclude payment of benefits in the event of HIV/AIDS.
Some providers have taken the lead in this area already, like Norwich Union (and before closing to new business, Swiss Life). It's time the whole of the insurance industry followed.
B.3
'We are currently considering your application for insurance. Before we reach a decision, we require some additional information. We are among a number of insurance companies, which ask for more information from applicants, so that we can protect our overall risk profile. [We have chosen to ask you because statistically, you fall within a recognised high-risk grouping for contracting HIV - delete if not appropriate]
Any information given in your answers will be treated confidentially. We would be grateful if you would complete the questionnaire (following questions) and return it (them) in the envelope provided. If you prefer, you can answer the questionnaire (following questions) separately, and send your answers in a sealed envelope, marked for the attention of the Chief Medical Officer at our company.
Answering 'Yes' to any of the questions may lead to you being charged a higher premium, or to your application being turned down (this will be in proportion to your perceived higher risk of HIV). We may also ask you for additional medical information before taking our decision".
Question 16: Do you have any comments on the wording of the covering letter to the supplementary questionnaire?
Answer: The covering letter for HIV Testing in the past has, in our opinion, been dishonest. Phrases such as 'Randomly Selected', 'Common Practice' and 'Routine' give the recipient the impression that they have been selected for an HIV Test based upon 'luck' or a 'blanket testing'.
This is simply not true, as insurers request HIV Tests from applicants because, 'statistically', they fall within a recognised high-risk grouping for HIV. Also, life assurers then have promoted the idea that the applicant will not be subjected to inflated premiums, or turned down for cover, when in fact Homosexuals are likely to be subjected to increased premiums, and in the event of a positive HIV test, would be declined for cover.
It is time for a new level of honesty from life assurers. It is time for life assurers to respect the intelligence of the people affected by the HIV testing practices that are demanded.
B4
Where companies choose to ask for additional information in their application forms, or in a supplementary form, to determine whether the applicant is at higher risk of HIV infection, the recommended wordings for the questions normally included are set out below.
Companies need not, however, feel obliged to ask all of the questions below.
Question 1:Do you belong, or have you ever belonged, to any of the following groups?
a. Gay Men No/Yes
b. Bisexual Men (having partners of both sexes) No/Yes
c. Intravenous Drug Users No/Yes
Question 2: Have you ever undergone any surgical procedure outside the UK, or been a recipient of blood products outside the UK? No/Yes
If YES, please provide us with the date(s), the country or countries and the reason(s) for each procedure and transfusion undergone.
Question 3: Have you ever stayed in any of the following countries [X] for more than [4 weeks] in the last [5 years] (companies may choose to use this more specific wording than the one in paragraph 3.4) No/Yes
Question 17: Do you have any comments on the wording of the 'Standard' Supplementary Questions?
Answer:We believe that a major risk group for HIV infection is missing from this form. HIV infection rates within the Black African community are statistically higher than gay, bisexual and intravenous drug users. Insurance companies believe that by asking applicants about the places that they have lived will protect their risk to HIV, when in fact, once outside the time period on the questionnaire this is not the case. Supplementary questionnaires, such as those above, should be removed entirely and replaced with a question relating to 'Safe Sexual Behaviour', to be answered by all risk groups.
B.5
The supplementary questionnaire should not be referred to as the 'lifestyle' questionnaire, as this can cause offence. The term 'supplementary questionnaire' should be used and this should relate to 'Safe Sexual Behaviour', and applied to all risk groups.
Additional Supplementary Question
B.6
Insurance companies should take care to ensure that any further questions they ask are relevant and verifiable, for example, they should not ask supplementary questions relating to: -
Question 18: Do you agree that insurers should not ask the supplementary questions listed in Annex B6?
Answer: This second level questionnaire is not focused on relevant issues affecting HIV infection risk and should be removed immediately. The Gay Men's Sex Survey 2002, has statistics which clearly point out that gay men in relationships are at a higher risk to HIV infection than single men.
This makes the questions relating to length of relationships irrelevant. Questions relating to the number of sexual partners and monogamy are also irrelevant to HIV risk, as someone who has few sexual partners, but does not practice 'safe sexual behaviour', is at a far higher risk than those who have multiple partners, but do practice 'safe sexual behaviour'.
This second level questionnaire was a 'knee jerk' reaction, to the fear of underwriting risk presented by HIV/AIDS ten years ago. It was a heterosexual answer to what was perceived to be a homosexual problem. We now know that HIV/AIDS is not solely a gay problem, and the one underwriting factor across all risk groups, gay, straight, bi-sexual, black, white and pink is 'safe sexual behaviour'. It is time that the principles of life assurance, which is underwritten, should reflect this.
B.7
The introduction of a new respectful and relevant supplementary question, declaring "Have You Always Practiced Safe Sexual Behaviour", applicable to all risk groups, not solely gay men.
Question 19: Is the supplementary question in Annex B7 appropriate to help determine levels of risk in some risk groups? Can you suggest others and at which risk groups would they apply to?
Answer:
Civil Partnership
The use of Civil Partnership and length of relationship is again a heterosexual view of the 'ideal' gay relationship. I strongly disagree, with the use of civil partnership and length of relationship as an indication of a lower risk to HIV. Statistics obtained from 'Out and About', The UK gay men's sex survey 2002 - Appendix XI), suggest that single gay men are at a lower risk to HIV infection, as they take individual responsibility for their own sexual behaviour.
The loading of premiums for single gay men is unfair and 'highly discriminatory'. Civil Partnership should not be used as a basis for offering 'standard' premium rates for gay men, as signing a piece of paper gives no indication of monogamy within a relationship, plus Civil Partnership has not even passed into law at the time of writing this document. Another heterosexual answer to what is perceived to be a gay problem.
Adoption / Share of Bills
Although adoption shows that a gay couple are committed to one another on a long-term basis, this still not an acceptable method of assessing the risk of HIV infection. Once more 'gay' relationships are being judged by a heterosexual 'benchmark' of having children as an indication of lower risk. In the 21st Century, it is not unusual for heterosexual, bisexual and homosexuals with children, to have sex outside their relationship. Open relationships, or committed 'swinging' relationships are not uncommon across all communities, even if a couple are committed to bringing up a family. Again, the only factor that clearly is directly related to HIV risk is 'Safe Sexual Behaviour'.
'Safe Sexual Behaviour' - (Our Suggested solution)
It is now time the life assurance industry recognised that HIV/AIDS affects all risk groups. We suggest that instead of asking gay men about their behaviour, that life assurance companies should instead offer standard premium rates to all applicants that sign a declaration of 'safe sexual behaviour'. This question is designed to be inserted on all 'main' application forms and applies to all risk groups, gay, straight, bisexual, black, white or pink.
This question would represent the beginnings of a whole new way of assessing HIV risk. It offers life assurers the opportunity to protect their risk profile across the board with the 'one' question that truly affects a person's exposure to HIV risk. This question would replace the targeting of gay men, outdated speculative underwriting and the discriminatory practice of asking Lifestyle and Supplementary Questions.
Industry Concerns
Recommendations to the Industry
We recommend a series of measures, some immediate, and some to be developed over the next 3 years and introduced at the next review of the HIV Guidelines.
Immediate
'Have you always practiced safe sexual behaviour?'
Ongoing - Introduction Within 3 Years
©2001-2002
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