Health Insurers Can No Longer Use Genetic Testing For Underwriting

The Genetic Information Nondiscrimination Act of 2008 (GINA) affects health insurers. The statute and its amendment explicitly outline acceptable and unacceptable uses of genetic testing in health insurers underwriting. GINA contains both an employment module that restricts employers from using, asking for, or compelling genetic testing information, and a module that does not allow health insurance to use the genetic testing information in deciding cost and eligibility. The GINA amendments help define key terms more clearly and will become effective on March 26, 2013.

According to GINA, health insurers may not generally use genetic information to disqualify individuals for health plans, to set the cost of monthly payments, or to rule out a preexisting condition. Despite the new rule, health insurers may use the genetic information to find suitable medical treatments for the plan holder as well as to meet his medical needs.Among the factors that health insurers may not use to increase premiums or disqualify candidates are: family medical history (including family by marriage), genetic testing and counseling information, and anything related to genetic education asked for by a plan holder. Additionally, health insurers may not use any of the information belonging to any other person on the plan. Health insurers are also prohibited from disqualifying diseases or disorders detected through genetic information. On the other hand, health insurers can use information about an illness established by a physical examination and corroborated with genetic testing. Moreover, an illness established by a physical examination that results in the examination of proteins or metabolites is not considered a genetic test.

See,Harry R. Silver and Lisa W. Clark, United States: New HIPAA Rules Regarding Genetic Information Affect Employers, Group Health Plans, Health Insurers And Healthcare Providers, Mondaq.com, Mar. 4, 2013.

Special thanks to Brian Cohan (Attorney at Law, Law Offices of Brian J. Cohan, P.C.) for bringing this article to my attention.