HIV, CD4 counts and life insurance


Life insurance is a policy that pays out a predetermined amount of money to the dependents of a policyholder who dies. During the policyholder’s life, he/she usually pays a monthly or annual premium.

Failure to do so would result in the cancellation of the policy. Life insurance payouts do not become part of someone’s estate when they die, and are usually paid out much sooner than the estate itself.

Before being granted life insurance, applicants usually have to undergo medical tests to determine their state of health. An insurer is within its rights to refuse a policy application (or load the premium) from someone with serious health issues that might cause them to die in the foreseeable future. 

For years, a positive HIV test result, among other health issues, meant that life insurance was refused to that particular applicant.

Read: Risk factors for HIV infection

Criteria for life insurance

As life insurance pays out when someone dies, various factors are taken into account to determine someone’s supposed lifespan, such as age, state of health, occupation, education level and gender. Based on these criteria, a person could be given or refused life cover.

Premiums would, for instance, be much higher for someone who is 50 years of age, than someone who is 20. In the days before antiretrovirals, HIV was pretty much a death sentence, and no insurance company would give an HIV-positive person a life insurance policy.

There was an Aids exclusion clause on most policies until the 1990s. Then there was a move to reduce the sum insured to 10 – 20% of the  original sum if someone became HIV-positive after taking out life insurance. 

Read: HIV in old age 

But that started changing when it became apparent that people on ARVs had a life expectancy not unlike that of people who were HIV-negative. And as time went by, adherence to treatment also became easier, as people no longer had to take 10 tablets per day, but only one.

ARVs and a much longer life expectancy

In 2013, a study was released by UCT researchers, which stated that HIV patients who had started treatment before they became sick could expect to live about 80% as long as their contemporaries who were HIV-negative. These findings, among others, assisted insurance underwriters to assess the risk of HIV-positive life insurance applicants.

Sanlam was the first big insurance company to offer life insurance for those who were HIV-positive – something that was previously only available from insurers such as Altrisk and All life.

Most insurers who offer these policies insist on regular viral load tests (the amount of the virus in your blood) and CD4 cell counts (measures the health of your immune system), proof of levels of treatment adherence and the extent of disease control.

Which companies offer this?

Among the companies offering life insurance policies for those who are HIV-positive are Liberty, Sanlam, Old Mutual, Metropolitan, Altrisk and All Life (this company specialises in this product).

All Life requires a six-monthly test to check CD4-levels. If someone’s CD4-count falls below 350-200 cells/mm3 antiretroviral therapy must be started immediately. After this, a six-monthly check-up is required. Should your CD4 count fall below 200, the cover is changed to Accidental Death cover if you have an All Life Policy.

A healthy person’s CD4 count will be between 400 – 1 700 cells/mm3. The government will start ARV treatment for those whose CD4 cell count has dropped to below 350. 

Read: What drove women to lie in an HIV clinical trial in southern Africa 

All the different life insurers apply different criteria with regards to adherence tests, CD4 levels, and treatment protocols. Initially, life cover for HIV-positive persons was extremely expensive, putting it beyond the reach of many South Africans, but as the market has become more competitive, the price has dropped.

But it is still often up to 50% more expensive than life cover for people who are HIV-negative. The prices vary from company to company, and also are influenced by the individual health status of each applicant.

It must be remembered, though, that this is comparable to prices for life insurance premiums for people with chronic diseases such as diabetes. This "loading" of premiums often happens on a sliding scale, depending on the stage of the disease.

But the insurance industry has come a long way from showing everyone who was HIV-positive the door. 

Read more: 

Test you HIV/Aids knowledge  

The fight against HIV is far from over for SA  

5 myths about HIV/Aids 

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