Current through Register Vol. 35, No. 6, March 26, 2024
A. An issuer of a medicare supplement policy
or certificate:
(1) shall not deny or
condition the issuance or effectiveness of the policy or certificate (including
the imposition of any exclusion of benefits under the policy based on a
pre-existing condition) on the basis of the genetic information with respect to
such individual; and
(2) shall 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.
B. Nothing in Subsection A of 13.10.24.8 NMAC
shall be construed to limit the ability of an issuer, to the extent otherwise
permitted by law, from:
(1) 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
(2) 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 cannot also be used as genetic
information about other group members and to further increase the premium for
the group).
C. An issuer
of a medicare supplement policy or certificate shall not request or require an
individual or a family member of such individual to undergo a genetic
test.
D. Subsection C of 13.10.24.8
NMAC shall not be construed to 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.
(1)
Payment shall be defined as 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 A of 13.10.24.8 NMAC.
(2) An issuer of a medicare supplement policy
or certificate may request only the minimum amount of information necessary to
accomplish the intended purpose of this subsection.
E. Notwithstanding Subsection C of 13.10.24.8
NMAC, 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:
(1) the request is made pursuant to research
that complies with part 46 of title 45, code of federal regulations (CFR), or
equivalent federal regulations, and any applicable state or local law or
regulations for the protection of human subjects in research;
(2) 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 compliance with the request is
voluntary, and non-compliance will have no effect on enrollment status or
premium or contribution amounts;
(3) the genetic information collected or
acquired under this subsection shall not be 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;
(4) the issuer
notifies the secretary in writing that the issuer is conducting activities
pursuant to the exception provided for under this subsection, including a
description of the activities conducted; and
(5) the issuer complies with such other
conditions as the secretary may by regulation require for activities conducted
under this subsection.
F. An issuer of a medicare supplement policy
or certificate shall not request, require, or purchase genetic information for
underwriting purposes.
G. An issuer
of a medicare supplement policy or certificate shall not 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.
H. If an issuer of a
medicare supplement policy or certificate 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 Subsection G of 13.10.24.8 NMAC if such request,
requirement, or purchase is not in violation of Subsection F of 13.10.24.8
NMAC.
