3 AAC 28.508 - Prohibition against use of genetic information and requests for genetic testing

(a) An issuer may not, based on an individual's genetic information,

(1) deny or condition the issuance or effectiveness of a medicare supplement policy or certificate; or

(2) exclude benefits under a medicare supplement policy or certificate for a preexisting condition.

(b) An issuer may not, based on an individual's genetic information, discriminate in the pricing of a medicare supplement policy or certificate, including the adjustment of premium rates.

(c) Nothing in (a) and (b) of this section limits the ability of an issuer, if permitted by law, to

(1) based on the manifestation of a disease or disorder of an insured or applicant

(A) deny or condition the issuance or effectiveness of a medicare supplement policy or certificate; or

(B) increase of the premium for a group; or

(2) increase the premium for a policy based on the manifestation of a disease or disorder of an individual who is covered under the policy; however, the issuer may not also use the manifestation of a disease or disorder of one individual as genetic information about other group members and to further increase the premium for the group.

(d) Except as provided in (f) of this section, an issuer may not request or require an individual or a family member of an individual to undergo a genetic test.

(e) Nothing in (d) of this section prohibits an issuer from obtaining and using the results of a genetic test in making a determination regarding payment consistent with (a) of this section. An issuer may request only the minimum amount of information necessary in order to make a determination regarding payment.

(f) An issuer may request, but not require, that an individual or a family member of an individual undergo a genetic test if

(1) the request is made according to research that complies with 45 C.F.R. Part 46 and AS 18.13;

(2) the issuer clearly indicates to each individual or, in the case of a minor child, the legal guardian of the child to whom the request is made that

(A) compliance with the request is voluntary; and

(B) noncompliance will have no effect on enrollment status or premium or contribution amounts;

(3) genetic information collected or acquired under this subsection is not 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 according to the exception provided under this subsection and includes a description of the activities the issuer is conducting; and

(5) the issuer complies with all other federal law applicable to activities conducted under this subsection.

(g) An issuer may not request, require, or purchase genetic information for underwriting purposes.

(h) An issuer may not request, require, or purchase genetic information with respect to an individual before the individual's enrollment under the policy in connection with the enrollment.

(i) If an issuer obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, the request, requirement, or purchase will not be considered a violation of (h) of this section if the request, requirement, or purchase is not in violation of (g) of this section.

(j) In this section,

(1) "issuer," in addition to having the meaning given in 3 AAC 28.510, includes a third-party administrator or other person acting for or on behalf of the issuer with respect to a medicare supplement policy or certificate;

(2) "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 the individual;

(3) "genetic information"

(A) means, with respect to an individual, information about the individual's genetic tests, the genetic tests of family members of the individual, and the manifestation of a disease or disorder in family members of the individual;

(B) includes

(i) with respect to an individual, any request for or receipt of, genetic services, or participation in clinical research that includes genetic services, by the individual or any family member of the individual; and

(ii) with respect to an individual or family member of an individual who is a pregnant woman, genetic information of a fetus carried by the pregnant woman, or with respect to an individual or family member using reproductive technology, genetic information of any embryo legally held by an individual or family member;

(C) does not include information about the sex or age of any individual;

(4) "genetic services" means

(A) a genetic test;

(B) genetic counseling, including obtaining, interpreting, or assessing genetic information; or

(C) genetic education;

(5) "genetic test" means an analysis of human deoxyribonucleic acid (DNA), ribonucleic acid (RNA), chromosomes, proteins, or metabolites that detect genotypes, mutations, or chromosomal changes; "genetic test" does not include

(A) an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or

(B) 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;

(6) "underwriting purposes" means

(A) rules for, or determination of, eligibility, including enrollment and continued eligibility, for benefits under the policy;

(B) the computation of premium or contribution amounts under the policy;

(C) the application of any preexisting condition exclusion under the policy; and

(D) other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.

Notes

3 AAC 28.508

Eff. 6/28/2009, Register 190

In 2010 the revisor of statutes, acting under AS 01.05.031, renumbered former AS 21.89.060 as AS 21.96.060. As of Register 196 (January 2011), the regulations attorney made a conforming technical revision under AS 44.62.125(b)(6), to the authority citation that follows 3 AAC 28.508, so that the citation to former AS 21.89.060 now refers to the renumbered statute, AS 21.96.060.

Authority:AS 21.06.090

AS 21.42.130

AS 21.96.060