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New guidance on completing health insurance forms

BMA ethics committee chair Dr Michael Wilks outlines a major breakthrough on issues affecting the doctor/patient relationship and the underwriting of insurance

he BMA ethics committee consistently receives calls about completing forms for health insurance companies. Common topics include:

 · How much information do I need to provide?

 · I'm not sure my patients understand the implications of revealing this information.

 · Can I send photocopies of medical reports rather than filling in time-consuming and complicated forms?

Questions about the ethical issue have become more frequent and more complex since joint guidance was first published in 1993. There have been advances in genetic technology and treatment for sexually transmitted infections so it is important that insurance policies reflect this.

Electronic reporting ahead

The new guidelines are the culmination of four years of consultation between the BMA and the Association of British Insurers (ABI). Both organisations are still working together on a number of issues: for example the General Practitioner Report form (GPR) is being revised to make it more patient-friendly.

We are also working towards developing an electronic report generating system, the 'e-GPR', which will generate medical reports from the doctor's existing electronic medical records without revealing information which is not relevant to the insurance application.

The new guidelines, 'Medical Information and Insurance', clarify what information doctors should and should not release to companies processing health information. The guidelines deal with many of the most sensitive issues affecting the doctor-patient relationship and the underwriting of insurance.

Doctors are concerned that some patients may not approach their GPs for treatment for sexually transmitted infection because they do not want this information recorded on their records in case insurance companies find out.

Patients should now be reassured, because the new guidelines state that doctors do not have to reveal all aspects of their patients' sexual health history. There is no reason to disclose single incidents of sexually transmitted infections, or even multiple episodes, provided there are no long-term health implications.

What to tell insurers

In line with existing ABI guidance, insurance companies should not ask whether an applicant for insurance has taken an HIV or hepatitis B or C test, had counselling in connection with such a test, or received a negative test result.

Doctors should not reveal this information when writing reports, and insurance companies will not expect this information to be provided.

Insurers may ask only whether someone has had a positive test result, is awaiting a test result, or is receiving treatment for HIV/AIDS or

hepatitis B or C.

What we are trying to move towards is a situation where doctors are not asked about a patient's lifestyle such as questions on smoking or illicit drug use.

Doctors are only experts in clinical matters. The person applying for life insurance is the only one who can answer truthfully and knowledgeably about the risks to their health that they take as part of their chosen lifestyle.

As well as looking at what actually goes into the GPR, the guidelines have addressed issues like consent and access. GPs have been concerned that some patients do not really understand what they are signing and the BMA and ABI are working to improve this. For example, applicants could be provided with a copy of questions the doctor will be asked to answer.

We are also pleased that the ABI has agreed that applicants have a right to access reports written about them by independent doctors.

The guidelines are an important breakthrough. They should provide reassurance to applicants and a better working relationship between doctors and the insurance industry. Doctors and insurers will now know where they stand.

Doctors and the insurance companies will now know where they stand~

The guidelines are available online from the BMA website (www.bma.org.uk), and the ABI website (www.abi.org.uk)

but if doctors have questions about ethical issues and insurance they should contact the BMA ethics department on 020 7383 6332

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