45 CFR Health care professional providing care may recommend or request §148.180(e)(2) the enrollee to have a genetic test. 45 CFR Plan may request, but not require, genetic testing for research §148.180(e)(5) purposes under specific conditions. 45 CFR Issuer cannot collect genetic information for underwriting purposes, §148.180(e)(4), unless medically appropriate: (e)(5)(iii), and If an enrollee seeks a benefit, the issuer may limit or exclude the (f)(1)(i) benefit based on whether is medically appropriate and the determination of whether the benefit is medically appropriate is not for underwriting purposes. Thus, if a plan conditions a benefit on medical appropriateness, and medical appropriateness depends on the genetic information of an individual, the plan can condition the benefit on genetic information. 45 CFR “Genetic information” can include: 148.180(a) Collection and 45 CFR With respect to a pregnant (or a family member of the pregnant Use of Genetic §146.122 woman), genetic information of any fetus carried by the pregnant Information (a)(3)(iii)(A) woman; and (Cont’d) 45 CFR With respect to an individual (or a family member of the individual) §146.122 who is utilizing an assisted reproductive technology, genetic (a)(3)(iii)(B) information of any embryo legally held by the individual or family member; (a)(3)(i)(A) Information about the individual’s genetic tests; (a)(3)(i)(B) Information about the genetic tests of the individual’s family members; (a)(3)(i)(C) Information about the manifestation of a disease or disorder in family members of the individual; and (a)(3)(i)(D) Any request for, or receipt of, genetic services or participation in
45 CFR §148.180(e)(2) Health care professional providing care may recommend or request the enrollee to have a genetic test. 45 CFR §148.180(e)(5) Plan may request, but not require, genetic testing for research purposes under specific conditions. 45 CFR §148.180(e)(4), (e)(5)(iii), and (f)(1)(i) Issuer cannot collect genetic information for underwriting purposes, unless medically appropriate: If an enrollee seeks a benefit, the issuer may limit or exclude the benefit based on whether is medically appropriate and the determination of whether the benefit is medically appropriate is not for underwriting purposes. Thus, if a plan conditions a benefit on medical appropriateness, and medical appropriateness depends on the genetic information of an individual, the plan can condition the benefit on genetic information. 45 CFR 148.180(a) “Genetic information” can include: Collection and Use of Genetic Information 45 CFR §146.122 (a)(3)(iii)(A) With respect to a pregnant (or a family member of the pregnant woman), genetic information of any fetus carried by the pregnant woman; and (Cont’d) 45 CFR §146.122 (a)(3)(iii)(B) With respect to an individual (or a family member of the individual) who is utilizing an assisted reproductive technology, genetic information of any embryo legally held by the individual or family member; (a)(3)(i)(A) Information about the individual’s genetic tests; (a)(3)(i)(B) Information about the genetic tests of the individual’s family members; (a)(3)(i)(C) Information about the manifestation of a disease or disorder in family members of the individual; and (a)(3)(i)(D) Any request for, or receipt of, genetic services or participation in