Do you. chronic conditions. for customers
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1 Do you understand chronic conditions AND HIV? for customers
2 HIV/AIDS, now seen as a chronic condition The sterling success of anti-retroviral therapy and a vastly improved understanding of this condition, has led Old Mutual to view HIV/AIDS in exactly the same light as it does any other managed chronic condition. Old Mutual s customer-focused underwriting philosophy has removed the HIV barrier when you need to cover your financial needs for death, disability and severe illness cover. Everyone now has access to financial protection. We will assess you based on your personal medical history and financial situation, irrespective of your HIV status. If you are afflicted by this condition, whether you are on treatment or not, you can now apply for cover with us. GREENLIGHT remains relevant to your financial needs as we offer a wide range of benefits with no restrictions on the amount of cover you can apply for. We only underwrite you once upfront, so there is no need for yearly checks to monitor your health or to confirm if you are on a managed treatment plan. Old Mutual GREENLIGHT, we are with you from TODAY! Dr Peter Bond Old Mutual Chief Medical Officer 01
3 If you are afflicted by this condition, whether you are on treatment or not, you can now apply for cover with us.
4 This guide will support you in two ways Understanding underwriting and chronic conditions like diabetes mellitus, hypertension and HIV/AIDS 1. Underwriting 2. Chronic conditions 3. I know my HIV status, what are my options with GREENLIGHT? 4. I do not know my HIV status, what are my options with GREENLIGHT? 5. I am interested in getting cover, what are my next steps? 6. Does Old Mutual offer HIV counselling? 7. Do other insurers offer HIV cover? 03
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6 1. Underwriting What is underwriting? Underwriting allows us to balance the premium you pay with the possibility of a claim. Without it, we would charge everyone with the same age, gender and cover, the same premium irrespective of their health. To ensure that you pay the right premium we assess each person individually by considering your health (morbidity) or how long you may live (mortality), or both. This means we may ask you for personal medical and financial information, but rest assured that we treat all your information as confidential. Our practice is to only underwrite you once. This means that we understand the risks upfront and when you claim there are no surprises. At claim stage, we may verify some of the information you initially provided, but we will not underwrite you again. How do we get your personal medical information? The application form This is a requirement for applying for any GREENLIGHT cover. It is our underwriter s first view of your information. Blood tests Blood tests are an effective way of screening your current health status. We use the following blood tests: Glucose: to test the level of sugar in your bloodstream Gamma GT: to test how your liver functions Cholesterol: to test the level of waxy fat in your bloodstream Cotinine: to test the level of nicotine in your bloodstream HIV: to test if the HIV virus is present in your bloodstream 05
7 Questionnaires Sometimes, the answers you give on the application form will mean that we need to get more information. It is important that we have the right information to accurately assess you for cover. We have a variety of questionnaires, covering medical, occupational, lifestyle and financial information. We may ask you or your doctor to complete these questionnaires. What underwriting decisions can be made? Standard terms Our aim is to offer you the standard premium rate. If we are unable to do this, we will give you an alternative (non-standard terms). When underwriting, we consider your health and life expectancy against the norm. If we offer you non-standard terms, it s because you have a higher than normal chance of falling ill, becoming disabled or dying. Non-standard terms may include any of the following: Paying a higher premium We have two ways to cover extra risk a health or a cover loading. A health loading will be offered for any health-related risks identified during our assessment, such as diabetes or heart disease. A cover loading will be offered for any lifestyle or occupational risks, such as a deep-sea driller on an oilrig or rock climbing. Restricting the cover Sometimes we cannot offer full cover to you. We call this excluding or declining cover. Excluding cover means that your cover is restricted as specific illnesses, conditions or events cannot be claimed for. We will decline cover if we are unable to offer the alternatives of a higher premium or an exclusion. What is financial underwriting? When we assess you we will ensure that the amount of cover you apply for matches your current financial position. The cover is not meant to place you in a better financial position than you were in before a life changing event, such as illness, disability or death. 06
8 2. Chronic conditions What is a chronic condition? The World Health Organisation (WHO) defines chronic conditions as diseases of long duration and generally slow progression. They include diseases like heart disease and diabetes. Most chronic conditions are treatable with medications, therapies and lifestyle adjustments. Can I apply for GREENLIGHT cover if I have a chronic condition? Yes you can. GREENLIGHT will assess you based on your medical condition, family history, any treatment programs and therapies, or similar. What are some of the most common chronic conditions that GREENLIGHT sees? Diabetes mellitus (commonly called diabetes) Hypertension (commonly called high blood pressure) HIV/AIDS Diabetes mellitus (commonly called diabetes) What is diabetes mellitus? It is a medical condition where your blood glucose is too high as a result of no insulin or insulin that works ineffectively in your body. The elevated glucose causes damage to the body s organs over time. 07
9 How does GREENLIGHT view diabetes mellitus? It is viewed as a chronic condition that can be controlled with lifestyle change and good medical management. It can cause impairments to the body, such as blindness, loss of limbs, kidney or cardiovascular conditions. The level of impairment depends on the type of diabetes. What are the objectives of treatment? The objective of treatment is to bring the level of glucose in the blood stream under control with as little organ damage as possible. You can do this by making some of these changes to your lifestyle: 1. Increasing physical fitness, stopping smoking and changing your diet. 2. Taking medication that manages your current insulin level more effectively or that replaces low insulin levels. Hypertension (commonly called high blood pressure) What is hypertension? Hypertension is also called high blood pressure. In order for blood to flow from the heart to the organs, a controlled pressure is needed in the arteries that transport blood, to and from the heart. You have hypertension when the pressure in the arteries is constantly too high. How does GREENLIGHT view hypertension? It is viewed as a chronic condition that can be controlled with lifestyle change and good medical management. If you continuously have high blood pressure, it can lead to damage of the kidneys, eyes and heart. High blood pressure contributes to more than 75% of strokes and heart attacks. What are the objectives of treatment? The objective is to bring the blood pressure under control with no organ damage. 08
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11 HIV/AIDS What is HIV/AIDS? The Human Immunodeficiency Virus (HIV) attacks the immune system. The immune system protects the body by fighting off germs and infections. Normally, the body s immune system would be able to fight off infection. But HIV is able to infect key cells, called CD4 cells, which work to protect the body against infections. Over time the HIV virus weakens the immune system so that the body can no longer fight off germs and infections. Once you have the HIV virus in your body you are HIV positive. Acquired Immunodeficiency Syndrome (AIDS) can take from 2 to 15 years to develop after being infected with HIV, depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations. AIDS is regarded as the last stage of HIV infection. A damaged immune system can t protect the body against certain severe opportunistic infections and cancers. They are called opportunistic because they are caused by organisms that are normally controlled by the immune system. This means that they take the opportunity to cause disease if the immune system has been damaged. What HIV medication is available? There are three general target areas when treating HIV infection. 1. Treating opportunistic infections All infections in the body must be treated. Opportunistic infections like Tuberculosis (also called TB) and fungal infections thrive in the body when the immune system is weakened. Treatment options include anti-tb medication or anti-fungal medication. 2. Maintaining a healthy immune system The immune system needs numerous minerals to function well. HIV positive individuals are given iron, vitamins and other supplements, to support and maintain their immune system. 3. Targeting the multiplication of HIV virus in the body This is the most important target. Numerous antiretroviral drugs, also called ARVs, attempt to decrease the multiplication of the virus in the body. There are different types of antiretroviral drugs that can be used depending on the stage of infection.
12 This means that each type acts on a specific stage of the HIV lifecycle. ARVs can be taken at regular intervals in the day or once a day. What diagnostic tests are done to confirm an HIV status? Numerous markers in the blood are tested to determine the presence of HIV infection: 1. Antibody test The body s immune system becomes aware of the HIV infection once it has infected the white blood cells. The body reacts by developing antibodies against the HIV virus. This is usually detectable about three weeks after the onset of HIV infection. Examples of HIV diagnostic tests are ELISA and Western Blot. 2. Antigen test Pathologists can test for certain protein markers on the HIV virus. The most common antigen test is the p24 protein test. 3. Nucleic Acid Tests (NAT) The HIV virus has specific patterns and genetic makeup. The NAT test tries to identify these. This test is fairly expensive. If a test is regarded as positive (reactive to a combination of two or three of these markers) a second sample test will be used to confirm the diagnosis. What blood tests are used if someone has already been diagnosed as HIV positive? CD4 white blood cells fight infection in the body. The HIV virus targets the CD4 cells. The stages of HIV infection can be determined by measuring the amount of healthy CD4 cells in the body. By measuring the level of the HIV virus in the body this gives an indication of how hard the immune system has to fight the virus and how fast the virus is multiplying. This measurement is called a viral load. 11
13 How do doctors determine when HIV has progressed to AIDS? Doctors determine an AIDS diagnosis by looking at blood test results as well as the overall clinical picture of the individual. AIDS is diagnosed if the CD4 count is below 200 and the patient has a combination of some of the following conditions: Weight loss of more than ten percent of the total body weight over a period of six months Shingles Oral or oesophageal thrush Chronic diarrhoea Tuberculosis Kaposi s sarcoma Fungal infection of lungs or brain Unusual infections such as visceral leischmaniasis How does GREENLIGHT view HIV/AIDS? We view HIV/AIDS as a chronic condition that can be well controlled with a change in lifestyle, medication and other therapies. What are the objectives of treatment? The objective is to control the level of HIV virus in the body by using medication, lifestyle changes and other therapies. This will help in treating opportunistic infections that may arise. Education and understanding of HIV/AIDS encourages healthy behaviour which ensures that awareness and treatment is obtained at the right time and may lead to reduced transmission to others. In order to maintain a healthy lifestyle, sufficient social, psychological and medical support is needed. 12
14 3. I know my HIV status, what are my options with GREENLIGHT? I am HIV negative what are my options? Life cover Provides immediate financial protection for your dependants when you die. Pays out a lump sum Provides assistance to pay debts, funeral expenses, estate duty and other financial needs. If re-invested, it can provide a regular income for your dependants. Disability cover Protects your income if you can t work due to an illness or impairment. Pays out a lump sum or an income For settling debts, catching up with home and car payments or other financial gaps. Re-invested, it could assist with covering your loss of income. Some options automatically cover your children for congenital birth defects. It also pays an income to cover regular and additional monthly expenses like frail care, temporary or permanent disability if needed. The premiums to this benefit reduces your income tax. Business cover Keeps your business covered and protects your livelihood. Pays out a lump sum or an income In the event that you, your business partners or any key person dies or are unable to work, your business will continue to prosper. Protects the business from any adverse effect on its creditworthiness as a result of the death or permanent disability of the person who stands surety. Monthly payments also available to cover overheads if you cannot work due to injury or illness. 13
15 All GREENLIGHT benefits will be considered. You will be assessed separately based on your personal medical history and financial situation. Some of the other factors that we may look at are: type and amount of cover, your occupation, your level of education, your monthly income, hazardous activities that you take part in, any other illnesses or impairments. Speaking to a financial adviser or broker can help you build a relevant GREENLIGHT solution to support your holistic financial plan. Lifestyle adjustment cover Helps you to cover the costs of a life changing illness. Pays out a lump sum Assists with a lump sum to cover lifestyle adjustments like alternative treatments, home alterations and vehicle modifications as well as the option of home or frail care. Pays an income Pays an income for up to 6 months to assist you while looking for work. The premiums you pay reduce your income tax. Future needs cover Protects your future needs. Future needs Ensures that you can increase your cover when your health has deteriorated. Protecting your premiums Pays your premiums when you cannot due to death and disability. Savings Save for unforeseen events/emergencies, missed premiums or a well deserved holiday. 14
16 I am HIV positive what are my options? Life cover Provides immediate financial protection for your dependants when you die. Pays out a lump sum Provides assistance to pay debts, funeral expenses, estate duty and other financial needs. If re-invested, it can provide a regular income for your dependants. Disability cover Protects your income if you can t work due to an illness or impairment. Pays out a lump sum For settling debts, catching up with home and car payments or other financial gaps. Re-invested, it could assist with covering your loss of income. Some options also automatically cover your children for congenital birth defects. Business cover Keeps your business covered and protects your livelihood. Pays out a lump sum OR an income In the event that you, your business partners or any key person dies or are unable to work, your business will continue to prosper. Protects the business from any adverse effect on its creditworthiness as a result of the death or permanent disability of the person who stands surety. Monthly payments also available to cover overheads if you cannot work due to injury or illness. 15
17 A selection of GREENLIGHT benefits will be considered. You will be assessed based on your personal medical history and financial situation. Some of the other factors that we may look at are: type and amount of cover, your occupation, your level of education, your monthly income, hazardous activities that you take part in, any other illnesses or impairments. Speaking to a financial adviser or broker can help you build a relevant GREENLIGHT solution to support your holistic financial plan. Lifestyle adjustment cover Helps you to cover the costs of a life changing illness. Pays out a lump sum Assists with a lump sum to cover lifestyle adjustments like alternative treatments, home alterations and vehicle modifications as well as the option of home or frail care. Pays an income Pays an income for up to 6 months to assist you while looking for work. The premiums you pay reduce your income tax. Future needs cover Protects your future needs. Savings Save for unforeseen events/ emergencies, missed premiums or a well deserved holiday. 16
18 4. I do not know my HIV status, what are my options with GREENLIGHT? You can apply for GREENLIGHT cover even if you do not know your HIV status. We will confirm your HIV status with a screening blood test. If your HIV test result is reactive, we will not be able to offer you cover immediately. You will be able to reapply for cover in the near future after you have confirmed your HIV status with your doctor. 5. I am interested in getting cover, what are my next steps? You will need to speak to a financial adviser or broker who can: Give you a quote Help you to complete an application and an underwriting annexure which asks questions about your medical history Arrange for you to go for a blood test. The test screens for: - Glucose (the level of sugar in your bloodstream) - Gamma GT (how your liver functions) - Cholesterol (the level of waxy fat in your bloodstream) - Cotinine (the level of nicotine in your bloodstream) - HIV (the HIV virus is present in your bloodstream) If you have confirmed that you know your HIV status is positive, your treating doctor or clinic will need to complete a supplementary questionnaire. Other information may also be asked for based on your personal circumstances. 17
19 6. Does Old Mutual offer HIV counselling? Old Mutual gives you the option to use ASISA s Healthi Choice Counselling Call Centre for pre and post test counselling. Counselling is telephonically available in all official languages by calling They are available Monday to Friday from 7.00 am to pm. You can apply for GREENLIGHT cover even if you do not know your HIV status. We will confirm your HIV status with a screening blood test. If your HIV test result is reactive, we will not be able to offer you cover immediately. You will be able to reapply for cover in the near future after you have confirmed your HIV status with your doctor. 18
20 OLDM Make an appointment to see your Old Mutual financial adviser or broker today, or call 0860 INVEST ( ). Old Mutual is a Licensed Financial Services Provider.
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