New rules offer greater protection to genetic information

by | Oct 5, 2009

Under the Genetic Information Nondiscrimination Act of 2009, two new federal rules have put in additional protections to patient privacy. This interim final rule issued by the Departments of Labor, Treasury, and Health and Human Services prohibits group health plans and health insurance issuers in the group market from:

1. Increasing premiums for the group based on the results of one enrollee’s genetic information,
2. Denying enrollment,
3. Imposing pre-existing condition exclusions, and
4. Conducting other forms of underwriting based on genetic information.

The interim final rule also prohibits issuers in the individual market from using genetic information to deny coverage, raise premiums or impose pre-existing condition exclusions. Further, group health plans and issuers in both the group and individual markets cannot request, require or buy genetic information for underwriting purposes, or in connection with enrollment. They also are “generally” prohibited from asking individuals or family members to undergo a genetic test, according to the federal agencies.

Modifying the HIPAA privacy rule, HHS’ Office for Civil Rights has issued a proposed rule to prohibit insurers from using or disclosing genetic information for underwriting purposes. This rule states that genetic information is health information and prohibits “the use and disclosure of genetic information by covered health plans for eligibility determinations, premium computations, applications of any pre-existing condition exclusions, and any other activities related to the creation, renewal or replacement of a contract of health insurance or health benefits,” according to the agencies. Violations could result in a fine of $100 to $50,000 for each violation. The proposed rule has a 60-day comment period.

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