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Key Highlights of Health Insurance Coverage for HIV AIDS Patients

Team AckoJan 17, 2024

HIV and AIDS are taboo topics. As they are not spoken about freely, there is a lack of awareness about these terms. And things that are unknown are often feared. HIV stands for human immunodeficiency virus and AIDS is an acronym for acquired immunodeficiency syndrome. To simplify things, HIV is a virus that leads to life-threatening syndrome. This disease has claimed uncountable lives all over the world.

Medical advancements are directed towards making life livable for those affected by the disease. Due to high costs, sustainable living with the disease is an expensive affair. This is where a health insurance policy can be helpful as it offers financial assistance. A health insurance policy associated with HIV AIDS is different from other health insurance plans.

Read ahead to know key highlights of health insurance plans for HIV AIDS.




Who can purchase the policy?

One must be infected with HIV (CD4 count should be over 350) to purchase this policy. Note that the person must not have progressed to the AIDS stage, just infected with HIV. Such a policy can be proposed by a government body, Non-Governmental Organization (NGO) and agencies that are actively working towards helping people affected with HIV. Health insurance plans associated with HIV AIDS are not age restricted.

What is covered in the policy?

This policy settles a claim when the insured has reached a level where the HIV has resulted in AIDS. This claim amount is meant for meeting medical contingencies associated with the disease.

Health insurance cover for this kind of policy is similar to a critical illness plan. Usually, in critical illness plans the policyholder is given a predetermined (lump sum) amount if the acquired illness is mentioned in the inclusions of the critical illness plans. In case of HIV AIDS insurance, the lump sum amount in this policy can be a predetermined amount or an amount based on medical expenses.

Cover includes: (based on the terms and conditions of the insurer)

  • Inpatient hospitalization

  • Pre-hospitalization

  • Post-hospitalization

  • Non-allopathic treatments

  • Day-Care procedures

Also read: Family health insurance plans

What are the exceptions in this policy?

Listed below are the key exceptions in a health insurance policy for HIV AIDS:

  • Money spent on treating the disease is not covered.

  • If AIDS is confirmed within a pre-specified period (for example – 90 days) from the policy purchase date, it shall not be covered.

  • Detailed exceptions will be policy specific and mentioned in the policy document

How to raise a claim?

It is extremely critical to inform the insurance company in a timely manner when the insured person reaches the AIDS stage. The timeline needs to be adhered to otherwise it might lead to claim rejection. One can initiate the claim by simply calling the insurance company and then following their claim process.

Unconventional Policy

Such a policy is unconventional in nature. Right from the coverage to its terms and conditions, one needs to dig deep to understand the scope of the policy. A Few years ago, such a policy did not exist in the Indian insurance market. Even now, it is not offered by a lot of health insurance providers in India.

While purchasing such policies, one must make sure it is in compliance with the rules and regulations mentioned by the Insurance Regulatory and Development Authority of India (IRDAI). This can be verified by visiting the website of the insurance company offering such a policy and checking for their IRDAI registration number.

Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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