Current through August 31, 2023
01.
Banned
Provisions. An issuer of a Medicare supplement policy or certificate:
(3-31-22)
a. Does not deny or condition the
issuance of effectiveness of the policy or certificate (including the
imposition of any exclusion of benefits under the policy based on a preexisting
condition) on the basis of the genetic information with respect to such
individual; and (3-31-22)
b. Does
not discriminate in the pricing of the policy or certificate (including the
adjustment of premium rates) of an individual on the basis of the genetic
information with respect to such individual. (3-31-22)
02.
Denial of Coverage. Nothing
in Subsection 082.01 is
construed to limit the ability of an issuer, to the extent otherwise permitted
by law, from: (3-31-22)
a. Denying or
conditioning the issuance or effectiveness of the policy or certificate or
increasing the premium for a group based on the manifestation of a disease or
disorder of an insured or applicant; or (3-31-22)
b. Increasing the premium for any policy
issued to an individual based on the manifestation of a disease or disorder of
an individual who is covered under the policy (in such case, the manifestation
of a disease or disorder in one individual will not also be used as genetic
information about other group members and to further increase the premium for
the group). (3-31-22)
03.
Genetic Testing. An issuer of a Medicare supplement policy or
certificate cannot request or require an individual or a family member of such
individual to undergo a genetic test. (3-31-22)
04.
Payment. Subsection
082.03 does not preclude an
issuer of a Medicare supplement policy or certificate from obtaining and using
the results of a genetic test in making a determination regarding payment (as
defined for the purposes of applying the regulations promulgated under part C
of title XI and Section
264 of the Health Insurance
Portability and Accountability Act of 1996, as may be revised from time to
time) and consistent with Subsection
082.01. (3-31-22)
05.
Information. For purposes
of carrying out Subsection
082.04, an issuer of a Medicare
supplement policy or certificate may request only the minimum amount of
information necessary to accomplish the intended purpose. (3-31-22)
06.
Allowed Genetic Testing.
Notwithstanding Subsection
082.03, an issuer of a Medicare
supplement policy may request, but not require, that an individual or a family
member of such individual undergo a genetic test if each of the following
conditions is met: (3-31-22)
a. The request is
made pursuant to research that complies with part 46 of title 45, Code of
Federal Regulations, or equivalent Federal regulations, and any applicable
State or local law or rules for the protection of human subjects in research.
(3-31-22)
b. The issuer clearly
indicates to each individual, or in the case of a minor child, to the legal
guardian of such child, to whom the request is made that: (3-31-22)
i. Compliance with the request is voluntary;
and (3-31-22)
ii. Non-compliance
will have no effect on enrollment status or premium or contribution amounts.
(3-31-22)
c. No genetic
information collected or acquired under Subsection
082.06 is used for underwriting,
determination of eligibility to enroll or maintain enrollment status, premium
rates, or the issuance, renewal, or replacement of a policy or certificate.
(3-31-22)
d. The issuer notifies
the Secretary in writing that the issuer is conducting activities pursuant to
the exception provided for under Subsection
082.06, including a description
of the activities conducted. (3-31-22)
e. The issuer complies with such other
conditions as the Secretary may by regulation require for activities conducted
under Subsection 082.06.
(3-31-22)
f. An issuer of a
Medicare supplement policy or certificate cannot request, require, or purchase
genetic information for underwriting purposes. (3-31-22)
g. An issuer of a Medicare supplement policy
or certificate cannot request, require or purchase genetic information with
respect to any individual prior to such individual's enrollment under the
policy in connection with such enrollment. (3-31-22)
h. If an issuer of Medicare supplement policy
or certificate obtains genetic information incidental to the requesting,
requiring, or purchasing of other information concerning an individual, such
request, requirement, or purchase is not considered a violation of Paragraph
082.06.g. if such request, requirement, or purchase is not in violation of
Paragraph 082.06.f. (3-31-22)
07.
Definitions. For the
purposes of this section only; (3-31-22)
a.
"Issuer of a Medicare supplement policy or certificate" includes third-party
administrator, or other person acting for or on behalf of such issuer.
(3-31-22)
b. "Family member" means,
with respect to an individual, any other individual who is a first-degree,
second-degree, third-degree, or fourth-degree relative of such individual.
(3-31-22)
c. "Genetic information"
means, with respect to any individual, information about such individual's
genetic tests, the genetic tests of family members of such individual, and the
manifestation of a disease or disorder in family members of such individual.
Such term includes, with respect to any individual, any request for, or receipt
of, genetic services, or participation in clinical research which includes
genetic services, by such individual or any family member of such individual.
Any reference to genetic information concerning an individual or family member
of an individual who is a pregnant woman, includes genetic information of any
fetus carried by such pregnant woman, or with respect to an individual or
family member utilizing reproductive technology, includes genetic information
of any embryo legally held by an individual or family member. The term "genetic
information" does not include information about the sex or age of any
individual. (3-31-22)
d. "Genetic
services" means a genetic test, genetic counseling (including obtaining,
interpreting, or assessing genetic information), or genetic education.
(3-31-22)
e. "Genetic test" means
an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that
detect genotypes, mutations, or chromosomal changes. The term "genetic test"
does not mean an analysis of proteins or metabolites that does not detect
genotypes, mutations, or chromosomal changes; or an analysis of proteins or
metabolites that is directly related to a manifested disease, disorder, or
pathological condition that could reasonably be detected by a health care
professional with appropriate training and expertise in the field of medicine
involved. (3-31-22)
f.
"Underwriting purposes" means: (3-31-22)
i.
Rules for, or determination of, eligibility (including enrollment and continued
eligibility) for benefits under the policy; (3-31-22)
ii. The computation of premium or
contribution amounts under the policy; (3-31-22)
iii. The application of any preexisting
condition exclusion under the policy; and (3-31-22)
iv. Other activities related to the creation,
renewal, or replacement of a contract of health insurance or health benefits.
(3-31-22)
