Current through Register Vol. 50, No. 9, September 20, 2024
A. No insurer shall
require an applicant for coverage under a policy or plan, or an individual or
family member who is presently covered under a policy or plan, to be the
subject of a genetic test, release genetic test information, or to be subjected
to questions relating to the medical conditions of persons not being insured
under such policy or plan.
B. All
insurers shall, in the application or enrollment information required to be
provided by the insurer to each applicant concerning a policy or plan, include
a written statement disclosing the rights of the applicant. Such statements
shall be printed in 10-point type or greater with a heading in all capital
letters that states: your rights regarding the release and use of genetic
information. Disclosure statements must be approved by the Department of
Insurance as complying with the requirements of
R.S.
22:1023 prior to utilization.
C.
1. No
insurer shall request, require, or purchase genetic information either:
a. of an individual or family member of an
individual for underwriting purposes.
b. with respect to any individual or family
member of an individual prior to such individuals enrollment under the plan or
coverage in connection with such enrollment.
2. If an insurer offering health insurance
coverage in the individual or group market obtains genetic information
incidental to the requesting, requiring, or purchasing of other information
concerning any individual, such request, requirement, or purchase shall not be
considered a violation of Subparagraph 1.b. of this Subsection if such request,
requirement, or purchase is not in violation of Subparagraph 1.a. of this
Subsection.
D.
1. No insurer shall request or require that
an individual, a family member of such individual, or a group member undergo a
genetic test.
2. Paragraph 1 of
this Subsection shall not be construed to limit the authority of a health care
professional who is providing health care services to an individual to request
that such individual undergo a genetic test.
E.
1. No
insurer shall establish rules for eligibility, including continued eligibility,
of any individual or an individuals family member to enroll or continue
enrollment based on genetic information.
2. Nothing in Paragraph 1 of this Subsection
or in Subparagraphs C.1.a and b of this Section shall be construed to preclude
an insurer from establishing rules for eligibility for an individual to enroll
in individual health insurance coverage based on the manifestation of a disease
or disorder in that individual or in a family member of such individual where
such family member is covered under the policy that covers such
individual.
F.
1. No insurer shall impose any preexisting
condition exclusion on the basis of genetic information of an individual,
family member of an individual, or group member.
2. Nothing in Paragraph 1 of this Subsection
or in Subparagraphs C.1.a. and b. of this Section shall be construed to
preclude an insurer offering coverage in the individual market from imposing
any preexisting condition exclusion for an individual with respect to health
insurance coverage on the basis of a manifestation of a disease or disorder in
that individual.
G.
1. No insurer shall adjust premium or
contribution amounts for an individual or group health plan on the basis of
genetic information concerning the individual or a family member of the
individual.
2. Nothing in Paragraph
1 of this Subsection shall be construed to preclude an insurer offering health
insurance coverage in the individual market from adjusting premium or
contribution amounts for an individual on the basis of a manifestation of a
disease or disorder in that individual, or in a family member of such
individual where such family member is covered under the policy that covers
such individual. In such case, the manifestation of a disease or disorder in
one individual cannot also be used as genetic information about other
individuals covered under the policy issued to such individual and to further
increase premium or contribution amounts.
3. Nothing in Paragraph 1 of this Subsection
shall be construed to preclude an insurer offering health insurance coverage in
connection with a group health plan from increasing the premium for an employer
based upon the manifestation of a disease or disorder of an individual who is
enrolled in the plan. In such case, the manifestation of a disease or disorder
in one individual cannot also be used as genetic information about other group
members and to further increase the premium for the employer.
H.
1. Nothing in Paragraph D.1 of this
Subsection shall be construed to preclude an insurer offering health insurance
coverage in the individual or group market from obtaining and using the results
of a genetic test in making a determination regarding payment, as such term is
defined for the purposes of applying the regulations promulgated by the
secretary of the United States Department of Health and Human Services under
Part C of Title XI of the Social Security Act and Section 264 of the Health
Insurance Portability and Accountability Act of 1996, consistent with
Subsections E and F of this Subsection.
2. For purposes of Paragraph 1 of this
Subsection, an insurer offering health insurance coverage in the individual or
group market may request only the minimum amount of information necessary to
accomplish the intended purpose.
I. Notwithstanding Paragraph D.1 of this
Subsection, an insurer offering health insurance coverage in the individual or
group market may request, but not require, that an individual, family member of
an individual, or a group member undergo a genetic test if each of the
following conditions is met.
1. 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 regulations for the protection of human subjects in
research.
2. The insurer 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 both that:
a. compliance with the request is
voluntary;
b. noncompliance will
have no effect on enrollment status or premium, or contribution
amounts.
3. No genetic
information collected or acquired under this Subsection shall be used for
underwriting purposes.
4. The
insurer notifies the secretary of the United States Department of Health and
Human Services in writing that the issuer is conducting activities pursuant to
the exception provided for under this Subsection, including a description of
the activities conducted.
5. The
insurer complies with such other conditions as the secretary of the United
States Department of Health and Human Services may by regulation require for
activities conducted under this Subsection.
J. The results of any genetic test, including
genetic test information, shall not be used as the basis to:
1. terminate, restrict, limit, or otherwise
apply conditions to the coverage of an individual or family member under the
policy or plan, or restrict the sale of the policy or plan to an individual or
family member;
2. cancel or refuse
to renew the coverage of an individual or family member under the policy or
plan;
3. deny coverage or exclude
an individual or family member from coverage under the policy or
plan;
4. impose a rider that
excludes coverage for certain benefits or services under the policy or
plan;
5. establish differentials in
premium rates or cost sharing for coverage under the policy or plan;
6. otherwise discriminate against an
individual or family member in the provision of insurance.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
22:11,
22:971,
22:258,
22:242(7),
22:1964(22)
and (23),
22:1022,
and
22:1023
of the Insurance Code.
