Mont. Admin. R. 6.6.527 - PROHIBITION AGAINST USE OF GENETIC INFORMATION AND REQUESTS FOR GENETIC TESTING
(1) This subsection
applies to all policies with policy years beginning on or after May 21, 2009.
An issuer of a Medicare supplement policy or certificate shall not:
(a) 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 the genetic information with respect to such individual; and
(b) 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.
(2) Nothing in (1) shall be
construed to limit the ability of an issuer, to the extent otherwise permitted
by law, from:
(a) 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
(b)
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).
(3) 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.
(4) Section (3) 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 (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 (1).
(5)
For purposes of carrying out (4), an issuer of a Medicare supplement policy or
certificate may request only the minimum amount of information necessary to
accomplish the intended purpose.
(6) Notwithstanding (3), 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:
(a) 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.
(b) 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:
(i) compliance with the request is voluntary;
and
(ii) noncompliance will have no
effect on enrollment status or premium or contribution amounts.
(c) 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.
(d) 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.
(e) The issuer complies with such other
conditions as the Secretary may by regulation require for activities conducted
under this subsection.
(7) An issuer of a Medicare supplement policy
or certificate shall not request, require, or purchase genetic information for
underwriting purposes.
(8) 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.
(9) 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 (8) if such request, requirement, or purchase is not
in violation of (7).
(10) For the
purposes of this section only:
(a) "Issuer of
a Medicare supplement policy or certificate" includes third-party
administrator, or other person acting for or on behalf of such
issuer;
(b) "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 such
individual;
(c) "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. Such term includes, with respect to any individual, 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;
(d) "Genetic services" means a genetic test,
genetic counseling (including obtaining, interpreting, or assessing genetic
information), or genetic education;
(e) "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;
(f) "Underwriting purposes" means:
(i) rules for, or determination of,
eligibility (including enrollment and continued eligibility) for benefits under
the policy;
(ii) the computation of
premium or contribution amounts under the policy;
(iii) the application of any preexisting
condition exclusion under the policy; and
(iv) other activities related to the
creation, renewal, or replacement of a contract of health insurance or health
benefits.
Notes
33-1-313, 33-22-904, MCA; IMP, 33-22-904, 33-18-901, 33-18-902, 33-18-903, 33-18-904, MCA;
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