Conn. Agencies Regs. § 38a-495a-19a - Prohibition against use of genetic information. Requests for genetic testing
This section applies to all policies with policy years beginning on or after May 21, 2009.
(a) For the purposes of this section only:
(1) "Issuer of a Medicare supplement policy
or certificate" includes third-party administrator, or other person acting for
or on behalf of such issuer.
(2)
"Family member" means, with respect to an individual, a first-degree,
second-degree, third-degree, or fourth-degree relative of such
individual.
(3) "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. "Genetic information" includes 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.
(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
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.
(6) "Underwriting purposes" means:
(A) rules for, or determination of,
eligibility or continued eligibility for benefits under the policy;
(B) the computation of premium or
contribution amounts under the policy;
(C) the application of any pre-existing
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.
(b)
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 preexisting condition, on the
basis of an individual's genetic information; 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 such individual's genetic information.
(c) Nothing in subsection (b) of
this section 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 shall not also be used as genetic
information about other group members and to further increase the premium for
the group.
(d) Except as
provided in subsection (e) of this section, 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.
(e) Subsection (d) of this section shall not
be construed to preclude an issuer of a Medicare supplement policy 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 (b) of this section.
(f) For purposes of carrying out subsection
(e) of this section, an issuer of a Medicare supplement policy or certificate
may request only the minimum amount of information necessary to accomplish the
intended purpose.
(g) 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 45 CFR 46, 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 (A) compliance with the request is
voluntary, and (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, 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 this subsection,
including a description of the activities conducted;
(5) the issuer complies with such other
conditions as the secretary may by regulation require for activities conducted
under this subsection.
(h) An issuer of a Medicare supplement policy
or certificate shall not request, require, or purchase genetic information for
underwriting purposes.
(i) 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.
(j) 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 (i) of this section if such request,
requirement, or purchase is not a violation of subsection (h) of this
section.
Notes
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