HIV Treatment Cost in India. Is it Covered in Health Insurance?

Are HIV treatment costs covered under Health Insurance?

About ten years ago, most health insurance companies in India did not provide insurance to individuals diagnosed with HIV. Then, in 2013, the Insurance Regulatory and Development Authority of India (IRDAI) issued a mandate asking insurance providers to introduce a health insurance policy for HIV patients. This move was a deliberate attempt to lift the taboo associated with HIV and give patients some relief in seeking treatment for these daunting illnesses. However, there are certain conditions under which one can seek health insurance against HIV treatment costs.

Rules governing HIV treatment costs

An HIV infection is typically considered a pre–existing condition with a high treatment cost. But medical advancements have reduced the costs significantly, leading to the introduction of a Health Insurance Policy for HIV patients. Today HIV patients can buy health plans so long as they fulfil the following conditions set by the insurer.

• Insurance companies provide coverage for HIV treatment costs only to individuals diagnosed with HIV. They can refuse to cover patients diagnosed with the infection after a certain period from the policy inception date (typically 90 days). In such a case, the insurer may deem the policy invalid and withdraw the benefits.
• HIV patients looking to buy a health insurance policy must send their application along with a proposal substantiated by a governmental or non–governmental organisation (NGO) or an institution working for the betterment of HIV patients.
• While the insurer is not liable to bear the costs incurred against the HIV treatment costs, the policy can cover the costs associated with medical tests and procedures if the illness progresses to AIDS.
• Policies covering HIV do not offer coverage for other pre–existing conditions.
• The sum insured for HIV treatment costs typically ranges from Rs 30,000 to Rs 100,000, and the cost of the premium depends on the sum insured chosen by the policy buyer.

Benefits covered under HIV health insurance policy 

Under the HIV health insurance plan, insurers must reimburse patients for the following:

• Costs associated with treatment and supplies for applicable in–patient hospitalisation and day–care expenses
• Costs associated with pre and post hospitalisation
• Costs associated with room charges
• Fees levied by the surgeon or specialist
• Pre–determined modern treatment costs

Health insurance policy for HIV patients

Before buying a health insurance plan for an HIV patient, you must do your due diligence. You must research the insurers offering this facility, consider the sum insured and premiums and fulfil their eligibility criteria. Such a health plan can indeed reduce HIV treatment costs.