This minor benefit, available in the Trauma (or critical illness) insurance plans of most insurers is one of a number of rarer benefits. Not as rare as CJD, of course, which is supposed to have an incidence rate of about 1 per million. There were 109 new HIV infections in 2011, but how many were caused by criteria that would satisfy the conditions laid out in most policies is obviously a much lower number.
A sample of the policy wordings that apply shows that acquiring the disease through sex or drug use is specifically excluded. This one is typical:
"The accidental infection with the HIV (Human Immunodeficiency Virus) which arose from the following medical necessary events which must have occurred in New Zealand or Australia by a registered health professional - a blood transfusion, transfusion with blood products, organs transplanted to you, assisted reproductive techniques or a medical procedure of operation performed by a registered doctor. Notification and proof of the incident will be required via a statement from a Regional Health Authority or equivalent statutory board that the infection was medically acquired. Also we require open access to test independently all blood samples which were used to supply supporting evidence for any potential claims and to obtain all relevant proofs, including evidence pertaining to the alleged source of infection. HIV infection acquired through sexual activity or recreational drugs is excluded."
The section italicised is editorial.
The balance who could claim under this definition is low. It may be zero. But this is almost the industry standard wording - this company is by no means unusual in choosing this definition. Properly the intention is to avoid a moral hazard. A a situation where are client could deliberately acquire the disease in order to obtain a large lump sum payment. This moral hazard should be considered in no way unique to any group - life insurers go to some lengths to remove moral hazard from the calculations of all their policy holders. Take, for example, the restriction on payments for suicide in the first 13 months of the policy, the only remaining exclusion on most life insurance contracts these days.
But let's return to the benefit.
Note the definition requires that you have a letter from the regional health authority admitting that they caused the infection, and what's more they must admit this before the time period to make the claim has elapsed. I bet the lawyers for the health authorities never say "Oh yeah, probably your fault, hurry up and admit that..." In fact, health authorities have a hard time, like most people, admitting when they are wrong. You might recall they found it difficult to admit they'd got the sex of the patient wrong in this event I reported earlier.
New Zealand AIDS Foundation Epidemiology page shows the breakdown of diagnoses by transmission type. Note that no infections are recorded as a result of medical misadventure. It is simply not a category. There may have been eight infections in 2008 the origin of which are recorded as 'unknown'.
You may draw your own conclusions as the the value of the benefit. In the product ratings we build this is why we ascribe a potential share of claims of 0.43% of the total (for men) to Medically acquired HIV. Even that may be too high.
However, not satisfied with the already high threshold for claim three companies add clauses similar to the following:
This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS.
At first glance this appears perfectly reasonable. In fact the latter part (after 'or') is perfectly reasonably, and perhaps should apply to all benefits, in some form or another. But the former part doesn't strike me as fair, especially after all the other hurdles.
Compare the situation to lung cancer, for example. It is a horrible cancer, which most people do not recover from. However, there is a cure, and there is a person I know who has had lung cancer and survived. Insurers do not exclude on the basis of the presence of a cure for cancer - so why should they for HIV / AIDS? Of course, if a treatment is such that the disease is no more than a minor inconvenience, much like a case of corns, then obviously no payment should be made. But again this could apply to any benefit.
In comparison, consider the development of policy wordings for heart attacks. They tend towards making the definitions more generous with declining thresholds for qualification, even as the inconvenience of the very minor heart attack has reduced considerably.
For more information about these benefits you can review policy wordings in the Quality Product Research section at www.quotemonster.co.nz