Living with HIV and life insurance

Something has changed

For a long time the answer to this question in Canada was effectively no. Most people living with HIV, and a good many advisors, still believe that, because the material they encounter says so.

It is out of date. A small number of Canadian insurers now underwrite HIV, and offers are made to applicants who meet their criteria. The market is narrow, the terms are more restricted than for the general population, and it exists.

The practical consequence of the outdated belief is that people do not apply. That is the main reason this page is here.

Why insurers changed position

Effective antiretroviral therapy suppresses the virus to undetectable levels and preserves immune function, and the health outcomes for people on stable effective treatment are very different from what they were in earlier decades.

Life insurance is priced on mortality. When the mortality picture changes materially, underwriting eventually follows. It followed slowly here, and it has followed.

What insurers assess

Duration of treatment. How long you have been on antiretroviral therapy. Insurers generally want a defined period, measured in years rather than months, before assessing.

Viral load, sustained. Suppression is the central requirement, and the key word is sustained. A single undetectable result is not the point. What underwriters want is a record showing suppression maintained consistently over a period, with no episodes of the virus becoming detectable again.

CD4 count. Both your current count and, importantly, the lowest count ever recorded. The nadir matters because it indicates how much immune damage occurred before treatment began, and that carries forward.

Adherence. Consistency of treatment, which appears in prescription records and in clinic notes. Gaps in dispensing are visible and are read as interruptions.

History of AIDS-defining illness. Whether any opportunistic infection or AIDS-defining condition has occurred, and when. A history of these shifts the assessment substantially.

Engagement with care. Regular attendance at HIV clinic follow-up with documented bloodwork. This is a file that lives or dies on documentation, and consistent follow-up produces it.

What is typically available

Terms are more limited than in the general market, and it is worth knowing that in advance.

Coverage amounts are usually capped below what a comparable applicant without HIV could obtain. Term lengths available may be shorter. Ratings are the norm rather than the exception. Some insurers offer only certain products.

None of that makes it not worth doing. Coverage on restricted terms is coverage.

Co-existing conditions

Hepatitis co-infection is relevant and is assessed alongside, on the terms in hepatitis B and C. Co-infection with hepatitis C in particular affects the picture.

Substance use history, where present, is assessed on its own terms too. See substance use and recovery.

Mental health conditions are common in this population and are assessed as elsewhere. See depression and anxiety.

Cardiovascular and metabolic factors matter as they do for anyone, and long-term therapy has metabolic considerations that appear in bloodwork.

Privacy

HIV status is sensitive personal information, and applying means disclosing it to an insurer.

Insurers in Canada are subject to privacy legislation governing how they collect, use and protect personal information, and health information receives a higher standard of protection. Your consent on the application governs what they may collect and for what purpose. You have the right to ask what is held about you.

You should know that a declined application is recorded in the shared industry database that Canadian insurers participate in, though what it stores is a coded entry rather than a copy of your medical file. What insurers can access is set out in what insurers check.

If privacy is a significant concern for you, it is a reasonable thing to raise before applying rather than after.

Where fully underwritten coverage is not available

Group coverage through an employer generally involves no medical questions up to a set level and depends on employment rather than health. For many people living with HIV this is the most accessible meaningful coverage, and it is worth maximising where a plan allows optional additional amounts without evidence.

Guaranteed issue asks nothing about health, at a smaller amount, a higher price, and with a waiting period at the start.

Applying

Do not assume the answer. The single most common mistake here is not applying at all.

Work with someone who knows which insurers currently underwrite HIV, because most do not and a misdirected application wastes time and produces a decline that sits on the record. This is a case where the choice of insurer is not a matter of finding a better price, it is a matter of finding one of the few that will look at the file.

Have the details: date of diagnosis, when treatment started, current regimen, your viral load history, your current and nadir CD4 counts, any AIDS-defining illnesses, and your HIV clinic’s details.

The boundary

This page describes how life insurance applications are assessed. It is not health information about HIV or its treatment, and nothing here is guidance about therapy, monitoring or care. That belongs entirely with your HIV care team.