The Genetic Information Nondiscrimination Act ("GINA") prohibits discrimination by group health plans, health insurance issuers and employers against an individual based on the individual’s genetic information.
1
Group Health Plan Provisions (Underwriting)
Underwriting. Group health plans and health insurance issuers generally may not request, require, or purchase genetic information for underwriting purposes, and may not collect genetic information about an individual before the individual is enrolled or covered. Underwriting purposes means: (a) rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage; (b) the computation of premium or contribution amounts under the plan or coverage; (c) the application of any preexisting condition exclusion under the plan; and (d) other activities related to the creation, renewal, or replacement of a contract for health insurance or health benefits.
2
Group Health Plan Provisions (Premiums)
Group Health Plan Premiums. Under existing law (HIPAA non-discrimination rules), group health plans and insurers are prohibited from establishing eligibility rules or imposing higher premiums or contributions on an individual on the basis of his or her health factors (including genetic information). However, the HIPAA nondiscrimination rules do not prohibit plans and insurers from establishing rates for the entire group based on a health factors (including genetic information) of an individual enrolled in the plan. Now, under GINA, group health plans and insurers are prohibited from setting premium and contributions for the employer group on the basis of genetic information of an individual enrolled in the plan. GINA does not prohibit plans and insurers from increasing premiums for the group based on manifestation of a disease or disorder in any individual enrolled in a health plan. However, the manifestation of a disease or disorder in one individual cannot also be used as genetic inf
3
Group Health Plan Provisions (Genetic Testing)
Genetic Testing. Group health plans and health insurance issuers offering health insurance coverage in connection with group health plans may not request or require an individual or a family member of such the individual to undergo a genetic test. This rule does not limit the authority of a health care professional to request that an individual undergo a genetic test. And, does not preclude a group health plan or health insurance issuer from obtaining and using the results of a genetic test in making a determination regarding payment (as defined by HIPAA) subject to a minimum necessary standard. There is also an exception for research purposes under certain conditions. ‘Genetic test’ means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes. Genetic test does not include an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or an analysis of proteins.
4
Relationship to HIPAA Regulations
GINA does not prohibit a covered entity from making any use or disclosure of health information that is authorized for the covered entity under the HIPAA regulations. And, GINA requires the HIPAA Privacy regulations to be amended, effective May 21, 2009, to treat genetic information as protected health information, prohibit use of genetic information for underwriting purposes and make the definitions of genetic information and underwriting consistent with GINA.
5
Effective Date for Group Health Plan Provisions
The group health plan provisions are effective for plan years beginning after May 21, 2009. For calendar year plans , this means January 1, 2010. For non-calendar year plans with plan years beginning June 1- December 1, the effective date occurs in 2009. For example, the effective date will be June 1, 2009 for a plan with a plan year running from June 1- May 31.
Comments - add comment