A. This section shall be known and may be cited as the "Genetic Nondiscrimination in Insurance Act". B. For purposes of the Genetic Nondiscrimination in Insurance Act: 1. "Accident and health insurance" means accident and health insurance as defined in Section 703 of this title, but shall not include disability income or long-term care insurance; 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" means, with respect to any individual, information about the genetic tests of an individual, the genetic tests of family members of an individual, and the manifestation of a disease or disorder in family members of the individual. Genetic information includes, but is not limited to, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by an individual or any family member of the 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 a 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. Genetic information shall not include information about the sex or age of any individual; 4. “Genetic services” mean a genetic test, genetic education, or genetic counseling, including, but not limited to, obtaining, interpreting, or assessing genetic information; 5. "Genetic test" means an analysis of the human DNA, RNA, chromosomes, proteins, or metabolites that detect genotypes, mutations or chromosomal changes. "Genetic test" shall 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. "Insurer" means any individual, corporation, association, partnership, insurance support organization, fraternal benefit society, insurance producer, third-party administrator, self- insurer, or any other legal entity engaged in the business of insurance which is licensed to do business in or incorporated or domesticated or domiciled in or under the statutes of this state, or actually engaged in business in this state, regardless of where the contract of insurance is written or plan is administered or where the corporation is incorporated, that issues accident and health policies or plans or that administers any other type of health insurance policy containing medical provisions including, but not limited to, any nonprofit hospital service and indemnity and medical service and indemnity corporation, health maintenance organizations, preferred provider organizations, prepaid health plans and the State and Education Employees Group Health Insurance Plan. Insurer shall not include insurers issuing life, disability income, or long-term care insurance; 7. "Policy" or "policy form" means any policy, contract, plan or agreement of accident and health insurance, or subscriber certificates of medical care corporations, health care corporations, hospital service associations, or health care maintenance organizations, delivered or issued for delivery in this state by any insurer; any certificate, contract or policy issued by a fraternal benefit society; any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state; and any evidence of coverage issued by a health maintenance organization. Policy or policy form shall not include life, disability income, and long-term care insurance policies; and 8. “Underwriting purposes” means: a. rules for, or determination of, eligibility, including but not limited to 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. C. No insurer offering an individual or group accident and health insurance policy shall: 1. Deny or condition the issuance or effectiveness of the policy or certificate, including but not limited to 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 any individual; and 2. Discriminate in the pricing of the policy or certificate, including but not limited to the adjustment of premium rates, of an individual on the basis of the genetic information with respect to any individual. D. Nothing in subsection C of this section shall be construed to limit the ability of an insurer, to the extent otherwise permitted under this title, from: 1. Denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group on the basis of manifestations of any condition, disease or disorder of an insured or applicant; or 2. Increasing the premium for any policy or certificate issued to an individual based on the manifestation of a condition, disease or disorder of an individual who is covered under the policy. 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. E. An insurer shall not request or require an individual or a family member of an individual to undergo a genetic test. F. Subsection E of this section shall not be construed to preclude an insurer 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 C of this section. G. In accordance with subsection F of this section, an insurer may request only the minimum amount of information necessary to accomplish the intended purpose. H. Notwithstanding subsection E of this section, an insurer may request, but shall not require, that an individual or a family member of an individual undergo a genetic test if each of the following conditions is met: 1. 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; 2. The insurer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of the minor child, to whom the request is made that: a. compliance with the request is voluntary, and b. noncompliance shall have no effect on enrollment status or premium or contribution amounts; 3. No genetic information collected or acquired pursuant to the Genetic Nondiscrimination in Insurance Act 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 insurer notifies the Secretary of Health and Human Services in writing that the insurer is conducting activities pursuant to the exception provided for under this subsection, including but not limited to a description of the activities conducted; and 5. The insurer complies with other conditions as the Secretary of Health and Human Services may by regulation require for activities conducted pursuant to this subsection. I. An insurer shall not request, require, or purchase genetic information for underwriting purposes. J. An insurer shall not request, require, or purchase genetic information with respect to any individual prior to the enrollment of the individual under the policy in connection with the enrollment. K. If an insurer obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, the request, requirement, or purchase shall not be considered a violation of subsection J of this section if the request, requirement, or purchase is not in violation of subsection I of this section.
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