Business Group Blog

Top 5 Tips for Mainstreaming HIV/AIDS Insurance Coverage Worldwide

World AIDS Day

Despite great progress on HIV/AIDS-related research, advocacy, and workplace initiatives, very little attention has historically been focused globally on HIV/AIDS and insurance coverage, particularly in the private market. Private insurance is important because it can improve employees’ access to effective HIV testing and treatment. For large employers, this may lead to lower health care costs by reducing hospital admissions. Employees living with HIV/AIDS who have access to effective treatment options may continue to contribute to the workplace by remaining healthy and productive workers. However, at this time, HIV/AIDS is excluded from private insurance plans in many locations outside the United States. 

 

Based on conversations with  employer and insurer members, the Global Business Group on Health? (GBGH) has developed the following tips for large employers: 

 

1. Prepare your business case for mainstreaming HIV/AIDS coverage 

Many employers realize that covering HIV/AIDS is good for business. This realization is crucial for getting organizational leadership, local HR staff and insurer partners on board. While mainstreaming coverage may impact premium costs, HIV/AIDS treatments today are more effective than in years past, allowing employees to continue to be healthy and productive members of the workforce for a limited amount of money. This is a positive for both employees living with HIV and the business. Multiple companies in high-prevalence countries have seen improvements in morale, productivity and staff turnover when they actively address HIV/AIDS.

2. Know what current coverage looks like around the world

??Under close examination, you may be surprised by what coverage really means in locations where it does exist. For example, historically in Mexico, market practice meant a 4-5 year waiting period for HIV coverage. Although many employers believed that HIV/AIDS was covered, in reality the waiting period essentially excluded it from plans. It’s important that you don’t take HIV/AIDS coverage at face value.. Know the details of coverage in each of your locations before you begin or end negotiations.

3. Be aware of what an HIV/AIDS exclusion really means 

In many countries, when HIV/AIDS is excluded, people living with HIV/AIDS cannot receive any medical care or treatment- even that which is not related to HIV (e.g. a broken leg). In places where this is an issue, consider negotiating a removal of this exclusion as a first step towards more comprehensive coverage.

4. Include other stakeholders in your efforts 

Consider including non-governmental organizations or organizations that represent people living with HIV in your negotiation efforts. They may have valuable insights to share from their experience in the field.

5. Be persistent and realistic 

Negotiating mainstreamed HIV/AIDS coverage can take time and dedication. Change doesn’t often happen quickly, particularly when it’s against the market norm. Insurer members have stated several times that the first step is asking for HIV/AIDS coverage; insurers may not have considered adding it because no one has ever asked before. Employer requests may go a long way, particularly in certain locations. If your first attempts haven’t worked, it may be a matter of continuing to ask or asking a different vendor.

 

For more tips, please see the Global Business Group on Health’s Negotiation Tips for Mainstreamed HIV/AIDS Coverage  report.