When talking about advances in medicine, more effective and tolerable treatment options and significant improvements in life expectancy and quality of life, the story of HIV comes easily to mind.

The history of HIV infection is nothing short of remarkable. In the early 1980s a diagnosis of HIV was considered a death sentence, but it is regarded today as a manageable chronic condition if access to continuous antiretroviral therapy is secured.

People living with HIV today have every chance to lead a “normal” life – “normal” in terms of the achievable life expectancy, and also “normal” with regard to their quality of life and the opportunity to lead their lives as individually desired. They can pursue education, careers, relationships and parenthood goals without limitations.

As a Life & Health insurer and reinsurer, we regard such advances in medicine with awe. At the same time, it is progress such as this that constantly challenges us to review our services for affected applicants.

We benefit from such medical progress not only because the occurrence of a claim becomes less likely in many lines of our business – it also increases the demand for insurance cover in this group of people and pushes us to expand the limits of insurability we set.

Particularly in the case of HIV infection, the greater social acceptance of the disease today helps to encourage those affected to apply for insurance cover in the first place and to provide information about their illness that enables a differentiated assessment and thus a tailor-made offer.

It is the natural task of underwriting to regularly review existing underwriting guidelines in the light of this new reality and to create these improved access options under appropriate conditions, i.e. in proportion to the risk to be insured.

Gen Re’s underwriting guidelines as presented in CLUE, the global underwriting manual, have supported insurers worldwide in the assessment of HIV infection for years. The HIV calculator, introduced in 2017, has supported a very nuanced assessment of the mortality risk associated with the disease. With appropriate treatment and evidence of adequate control, i.e. successful therapy, terms can be offered in almost all cases.

The calculator has been very well received around the world and has been instrumental in breaking down barriers to offering insurance.

But medical progress is continuing. Also ongoing is the de‑stigmatisation of the disease in many regions of the world. This is encouraging more affected people to actively seek insurance coverage, and it is motivating insurers to strive for offering better terms and a wider range of potential benefits to people living with HIV.

Gen Re’s March 2023 updates to its underwriting guidelines once again focus on HIV infection, bringing updated and expanded underwriting options. Based on the latest available clinical evidence, mortality rates could be modified to broaden the range of potential offerings.

In addition, CLUE now includes underwriting guidelines for the full range of disability products, from Income Protection and Total Permanent Disability to Essential Abilities cover, which is still a niche product globally but is becoming more common in some insurance markets.

As with all CLUE updates, this review and expansion of the guidelines is evidence-based. In addition to the usual extensive and intensive research into clinical evidence in relation to the risk to be insured, it is based on interaction with medical professionals, including HIV experts, and insights from the claims perspective of insurance markets that have several years’ experience of covering disability risk, e.g. in products specifically designed for HIV-positive applicants.

All this research showed a very favourable overall picture for the ability of people with HIV to work, due to improved management of the disease and to the reduction of stigma and the almost unrestricted access to the labour market that people with HIV now have in many countries. As a result, nothing stood in the way of expanding insurability and offering affordable, attractive coverage conditions.

Advances in clinical medicine, such as those seen in the treatment of HIV infection, open up new possibilities for Life & Health insurers and provide a constant need to review and refine current underwriting practices.

Translating medical advances into new and improved underwriting guidelines is challenging, but is one of the most rewarding aspects of underwriting.