Insurers Discriminating Against Users of PrEP, Truvada

After an investigation by the California Department of Insurance (CDI), Insurance Commissioner Lara has issued a warning against insurance companies discriminating against applicants who use PrEP or Truvada. Insurance products targeting consumers for discrimination are life, disability, and long-term care insurance. The investigation was triggered by complaints to the CDI that insurers were denying insurance coverage for individuals taking Truvada. This underscores the importance of filing complaints with CDI or the Department of Managed Health Care whenever a consumer suspects they have been discriminated against.

Press Release From Ricardo Lara Insurance Commissioner

SACRAMENTO, Calif. – Today California Insurance Commissioner Ricardo Lara warned insurers after an investigation uncovered evidence of discrimination against HIV-negative individuals who used medication to prevent contracting the disease.

The Department of Insurance investigation of life, disability income and long-term care insurance companies found that some insurers had denied or limited coverage, restricted products available through accelerated underwriting, placed conditions on coverage, or charged higher rates to users of pre-exposure prophylaxis, or PrEP, medication.

The Department of Insurance’s notice advises insurers that under California law, a person’s history of PrEP use cannot be used as a justification to deny life, disability or long-term care insurance coverage or charge higher premiums for that coverage. The notice encourages insurers to review their underwriting guidelines and practices to ensure they are not unlawfully discriminating against applicants

With an influential medical panel now recommending daily medication to prevent upwards of 40,000 HIV infections annually in the United States, Insurance Commissioner Ricardo Lara took action to protect patients who could face discrimination from life, disability or long-term care insurers based on a record of taking antiretroviral therapy to prevent HIV.

“PrEP prevents HIV, pure and simple, and I will not tolerate insurers violating California law by discriminating against people taking proactive steps to be healthy,” said Commissioner Lara. “The Department of Insurance warns insurers to stop discrimination against PrEP users and review their underwriting rules before we take action. As we celebrate Pride Month, ending HIV infections is within our reach. But first we have to eliminate prejudice and fear that still stands in the way of a cure.”

The notice applies to all companies who sell life, disability and long-term care insurance in the nation’s largest insurance market. During the Department’s investigation, a number of insurers reported that they have discontinued these practices.

The Department will continue to review insurer compliance with the law, and individuals who believe they were subject to discriminatory underwriting practices can contact the Department of Insurance at 800-927-4357 for assistance.

The influential U.S. Preventive Services Task Force recommended on June 11 that doctors prescribe daily PrEP medication to those at high risk of HIV infection. Studies show only 17 percent of those eligible for daily PrEP actually take it.

The Department of Insurance recently participated in a lawsuit against federal rules that would allow medical providers to deny care to LGBT patients and other vulnerable people.

Notice to Insurers Discriminating Against PrEP Users

The California Department of Insurance (CDI) has received complaints that insurers are denying insurance coverage to individuals taking Truvada. This medication is used to treat the human immunodeficiency virus (HIV) and reduce the risk of HIV infection. When taken by HIV-negative individuals to protect them from contracting HIV, Truvada is known as Pre-Exposure Prophylaxis (PrEP). The Centers for Disease Control and Prevention has determined that daily use of PrEP is highly effective in reducing the risk of contracting HIV. An investigation by CDI found that certain insurers are denying coverage, or offering Life, Disability Income or Long-Term Care Insurance coverage under different conditions, to Truvada/PrEP users. This Notice advises all insurers and fraternal benefit societies licensed to sell Life, Disability Income or Long-Term Care products in California of their obligation to comply with California law when underwriting Truvada/PrEP users.

CDI surveyed the underwriting guidelines and practices of insurers with significant market shares for Life, Disability Income or Long-Term Care Insurance in California. CDI’s investigation found a variety of insurer underwriting practices that appear to discriminate unfairly against HIV-negative individuals taking Truvada/PrEP for preventative purposes. These practices include denying or limiting coverage, restricting products available through accelerated underwriting, placing conditions on coverage, or charging higher rates. A number of insurers have reported that they have since discontinued these practices.

With regard to Life Insurance, California law prohibits insurers and fraternal benefit societies from unfairly discriminating between individuals in the same class and with equal expectation of life in the rates charged, benefits payable, or any other terms or conditions. California Insurance Code (Ins. Code) §§ 790.01 and 790.3(f)(1).

Accordingly, underwriting practices that unfairly discriminate between individuals with equal expectation of life and/or which lack an actuarial basis violate California law.

In addition, California law prohibits any person or entity engaged in the business of insurance from denying coverage, restricting benefits payable, or modifying the terms or conditions of coverage based on the sexual orientation of the insured or prospective insured. Title 10, California Code of Regulations § 2560.3.

CDI requests insurers and fraternal benefit societies to review their underwriting guidelines and practices with regard to Truvada/PrEP users, to ensure that they comply with California law, including the consumer protection provisions noted above. CDI will continue to review insurers’ and fraternal benefit societies’ underwriting guidelines and practices with regard to Truvada/PrEP users for compliance with California law through its market conduct examination authority.