information will be received, unless the collection explicitly provides that genetic information should not be provided. 42 U.S.C. Plan may not request, require, or purchase genetic information for (d)(1) underwriting purposes. 45 CFR §148.180 Health care professional providing care may recommend or request (e)(2) the enrollee to have a genetic test. 45 CFR §148.180 Plan may request, but not require, genetic testing for research (e)(5) purposes under specific conditions. 45 CFR §148.180 Issuer cannot collect genetic information for underwriting purposes, (f)(1)(iii) unless medically appropriate: Eligibility Collection If an enrollee seeks a benefit, the issuer may limit or exclude the (Cont’d) and Use of benefit based on whether is medically appropriate and the Genetic determination of whether the benefit is medically appropriate is not Information for underwriting purposes. Thus, if a plan conditions a benefit on (Cont’d) 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) 45 CFR With respect to a pregnant woman (or a family member of the §146.122 pregnant woman), genetic information of any fetus carried by (a)(3)(iii)(A) the pregnant woman; and 45 CFR With respect to an individual (or a family member of the §146.122 individual) who is utilizing an assisted reproductive technology, (a)(3)(iii)(B) genetic information of any embryo legally held by the individual or family member; (a)(3)(i)(A) Information 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
information will be received, unless the collection explicitly provides that genetic information should not be provided. 42 U.S.C. (d)(1) Plan may not request, require, or purchase genetic information for underwriting purposes. 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 (f)(1)(iii) Issuer cannot collect genetic information for underwriting purposes, unless medically appropriate: Eligibility (Cont’d) Collection and Use of Genetic Information (Cont’d) 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: 45 CFR §146.122 (a)(3)(iii)(A) With respect to a pregnant woman (or a family member of the pregnant woman), genetic information of any fetus carried by the pregnant woman; and 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 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
cl-forms-19-hmo-sg-analyst-checklist.docx