Genetic Nondiscrimination Laws in Health Insurance, Health Law & Policy Institute

Genetic Nondiscrimination Laws in Health Insurance

For the third consecutive year, the United States Congress has sought to pass comprehensive legislation banning genetic discrimination in employment and health insurance. On February 13, 2001, the Genetic Nondiscrimination in Health Insurance and Employment Act (S.318 & H.R.602) was introduced in the Senate by Senator Tom Daschle (D-SD) and in the House by Representative Louise Slaughter (D-NY).

The bill has two major provisions to prevent genetic discrimination in health insurance. First, the bill proposes to prohibit the use of genetic information in determining eligibility or in adjusting premium rates. Second, a health insurer "shall not request, require, collect, or purchase protected genetic information concerning an individual (or information about a request for or the receipt of genetic services by such individual or family member of such individual)." These restrictions would apply to both group and individual health insurance markets. See the full text available at http://thomas.loc.gov/.

For many Americans, a federal law banning genetic discrimination in health insurance makes perfect sense. Who wouldn’t want protection against this type of discrimination? This legislation does have its critics, however. Prohibiting insurance companies from using genetic information for underwriting purposes may ultimately result in a much smaller individual health insurance market with much higher prices through a process of adverse selection. The group health insurance market could be affected as well. See Seth J. Chandler, The Genetic Information Nondiscrimination in Health Insurance Act of 1999: Too Fast and Too Federal? available at
Genetics/000803Nondiscrimination.html.

Currently, the only federal law that protects individuals from genetic discrimination in health insurance is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA does so in two major ways: (1) including genetic information as a factor that may not be used to deny or limit coverage in a group health insurance market; and (2) excluding genetic information from being considered as a preexisting condition.

Although HIPAA takes steps toward preventing genetic discrimination, the scope of the law is limited. HIPAA only provides greatest protection in the group health insurance market. HIPAA also provides protection for those moving from the group health insurance market to the individual market as well as for those who already have coverage in the individual market. However, a person seeking coverage in the individual health insurance market could be denied from or charged more for coverage based on his or her genetic information. Lack of federal protection for genetic discrimination in the individual health insurance market is a gaping gap.

State law in most jurisdictions provides more protection against genetic discrimination than federal law by further protecting those seeking coverage in the individual health insurance market. The following table is a 50-state survey of state genetic nondiscrimination laws in health insurance:

STATE

STATUTE
Prohibits discrimination on the basis of genetic tests and/or genetic information Applies to the individual health insurance market Includes family history in definition of "genetic information"

Alabama Ala. Code §§27-21A-7, 27-52-20, 27-53-1 et seq. X^1,2 X

Alaska Alaska Stat. §21.54.100 X

Arizona Ariz. Rev. Stat. Ann. §§20-1379, 20-2310. X X⁴ YES³

Arkansas Ark. Code Ann. §§23-79-119,
23-86-306
X X⁴

California Cal. Health & Safety Code §1374.7;
Cal. Ins. Code §742.405
X² X

Colorado Colo. Rev. Stat. Ann.
§§10-3-1104.7, 10-16-214
X² X

Connecticut Conn. Gen. Stat. Ann. §38a-816 X X YES

Delaware Del. Code Ann. tit.18, §2317;
Del. Code Ann. Tit.18, §3607
X X⁴ YES

District of Columbia D.C. Code Ann. §§31-3302.1 et seq., 31-3303.1 et seq. X X⁴

Florida Fla. Stat. Ann. §627.4301 X² X NO⁶

Georgia Ga. Code Ann. §§33-54-1 et seq. X² X

Hawaii Haw. Rev. Stat. Ann. §431:10A-118 X² X YES

Idaho Idaho Code §§41-4701 et seq.,
41-5201 et seq.
X X⁴

Illinois 215 Ill. Comp. Stat. Ann.
513/10 et seq.
X² X

Indiana Ind. Code Ann. §§27-8-26-1 et seq. X² X

Iowa Iowa Code Ann. §§513B.9A, 513C.8 X X⁵

Kansas Kan. Stat. Ann. §40-2259 X² X

Kentucky Ky. Rev. Stat. Ann. §304.12-085 X² X

Louisiana La. Rev. Stat. Ann. §22:213.7 X² X YES³

Maine Me. Rev. Stat. Ann. tit. 24-A, §2159-C X² X YES

Maryland Md. Code Ann., Ins. §27-909 X² X YES

Massachusetts Mass. Gen. Laws Ann. ch.175, §108H X² X NO

Michigan Mich. Comp. Laws Ann. §500.3407b X^2,7 X NO

Minnesota Minn. Stat. Ann. §72A.139 X² X

Mississippi⁸

Missouri Mo. Ann. Stat. §§375.1300 et seq. X² X NO⁶

Montana Mon. Code Ann. §§33-18-901 et seq. X² X NO⁶

Nebraska Neb. Rev. Stat. §§44-787, 44-6916 X X⁴

Nevada Nev. Rev. Stat. §689A.417 X² X NO

New Hampshire N.H. Rev. Stat. Ann.
§§141-H:1 et seq.
X² X

New Jersey N.J. Stat. Ann. §17B:30-12 X² X YES

New Mexico N.M. Stat. Ann. §§24-21-1 et seq. X X YES

New York N.Y. Ins. Law §§3216, 4305 X X⁴

North Carolina N.C. Gen. Stat. §§58-3-215,
58-68-35, 58-68-60 et seq.
X X⁴ YES

North Dakota N.D. Cent. Code §§26.1-36.3-01 et
seq., 26.1-36.4-05
X X⁴

Ohio Ohio Rev. Code Ann. §3901.49 X² X

Oklahoma Okla. Stat. Ann. tit.36, §3614.1 X⁹ X NO⁶

Oregon Or. Rev. Stat. §§659.700, 746.135 X X NO

Pennsylvania

Rhode Island R.I. Gen. Laws §§27-18-52, 27-50-3 X² X YES³

South Carolina S.C. Code Ann. §§38-93-10 et seq. X² X YES

South Dakota S.D. Codified Laws §58-17-82 X X⁴

Tennessee Tenn. Code Ann. §§56-7-2701 et
seq., 56-7-2809, 56-7-2810
X² X NO⁶

Texas Tex. Ins. Code Ann. art. 21.73 X² YES¹³

Utah¹⁰

Vermont Vt. Stat. Ann. tit.18, §§9331 et seq. X^2,11 X NO

Virginia Va. Code Ann. §§38.2-508.4,
38.2-3430.1 et seq.
X X⁴ YES

Washington¹²

West Virginia W.Va. Code §33-15-2b X X⁴

Wisconsin Wis. Stat. Ann. §631.89 X² X

Wyoming Wyo. Stat. Ann. §§14-2-109,
26-19-306
X¹⁴ YES¹⁵

^{1
Prohibits genetic test to determine predisposition for cancer}
^{2 Prohibits using, requiring,
and/or requesting genetic tests and/or information}
^{3 "Genetic information"
expressly includes "family history"}
^{4 Insurer may limit
or discontinue coverage in the individual market, but must do so uniformly
without regard to "health status-related factors" which include "genetic
information" (A HIPAA provision for the individual market).}
^{5 See Iowa Code Ann.
§513C.8 where benefits for the standard health benefit plan for the
individual market are substantially similar to those as provided under
chapter 513B with respect to small group coverage.}
^{6 "Genetic information"
expressly excludes "family history"}
^{7 Used in the context
of expense-incurred hospital, medical, or surgical policies or certificate
delivered, issued for delivery, or renewed in this state}
^{8 See Miss. Code Ann.
§83-63-11 prohibiting small employer health benefit plans from transferring
or otherwise providing coverage to a nonrenewed class unless done without
regard to case characteristics, claims experience, health status, or duration
of coverage.}
^{9 Prohibits requiring
or requesting a genetic test}
^{10 See Utah Code Ann.
§31A-30-106 prohibiting individual and small employer health plans
from transferring a covered insured into or out of a class of business
unless done so without regard to case characteristics, claims experience,
health status, or duration of coverage.}
^{11 Prohibits conditioning
insurance on the results of genetic testing of a member of the individual’s
family}
^{12 See Wash. Rev. Code
Ann. §48.46.060 prohibiting canceling or failing to renew HMO enrollment
for reasons relating solely to age, sex, race, or health status.}
^{13 Effective September
1, 2001, "genetic information" means information that is obtained from
or based on a scientific or medical determination of the presence or absence
in an individual of a genetic characteristic; or derived from the results
of a genetic test performed on that individual. This new definition of
"genetic information could possibly include family history.}
^{14 See Wyo. Stat. Ann.
§ 26-19-107 where "health status related factors" are defined in the
group and blanket disability context as including "genetic information."}
^{15 "Genetic information"
defined in the context of paternity actions.}

As of August 2001, forty-six states and the District of Columbia have enacted laws that protect individuals against genetic discrimination. Only Mississippi, Pennsylvania, Utah, and Washington have no general genetic nondiscrimination laws in health insurance.

In almost every state that has laws prohibiting genetic discrimination, the laws apply in both the group and individual health insurance markets. But in Alaska, Texas, and Wyoming, genetic anti-discrimination laws apply only in the group health insurance context leaving many individuals without protection.

Finally, the scope of protection is dependent on the definition of "genetic information" in the statutory language. If its definition is broader, the scope of protection is broader. In a majority of states, the definition of "genetic information" includes "family history." In a minority of states, the definition of "genetic information" either omits "family history" or expressly excludes it. Consequently, states that include "family history" as part of "genetic information" provide greater genetic nondiscrimination protection.

For more information on state laws and legislation regarding genetic information and health insurance, see the National Human Genome Research Institute website available at http://www.nhgri.nih.gov/Policy_and_public_affairs/Legislation/insure.htm.

08/31/01

STATE	STATUTE	Prohibits discrimination on the basis of genetic tests and/or genetic information	Applies to the individual health insurance market	Includes family history in definition of "genetic information"
Alabama	Ala. Code §§27-21A-7, 27-52-20, 27-53-1 et seq.	X^1,2	X
Alaska	Alaska Stat. §21.54.100	X
Arizona	Ariz. Rev. Stat. Ann. §§20-1379, 20-2310.	X	X⁴	YES³
Arkansas	Ark. Code Ann. §§23-79-119, 23-86-306	X	X⁴
California	Cal. Health & Safety Code §1374.7; Cal. Ins. Code §742.405	X²	X
Colorado	Colo. Rev. Stat. Ann. §§10-3-1104.7, 10-16-214	X²	X
Connecticut	Conn. Gen. Stat. Ann. §38a-816	X	X	YES
Delaware	Del. Code Ann. tit.18, §2317; Del. Code Ann. Tit.18, §3607	X	X⁴	YES
District of Columbia	D.C. Code Ann. §§31-3302.1 et seq., 31-3303.1 et seq.	X	X⁴
Florida	Fla. Stat. Ann. §627.4301	X²	X	NO⁶
Georgia	Ga. Code Ann. §§33-54-1 et seq.	X²	X
Hawaii	Haw. Rev. Stat. Ann. §431:10A-118	X²	X	YES
Idaho	Idaho Code §§41-4701 et seq., 41-5201 et seq.	X	X⁴
Illinois	215 Ill. Comp. Stat. Ann. 513/10 et seq.	X²	X
Indiana	Ind. Code Ann. §§27-8-26-1 et seq.	X²	X
Iowa	Iowa Code Ann. §§513B.9A, 513C.8	X	X⁵
Kansas	Kan. Stat. Ann. §40-2259	X²	X
Kentucky	Ky. Rev. Stat. Ann. §304.12-085	X²	X
Louisiana	La. Rev. Stat. Ann. §22:213.7	X²	X	YES³
Maine	Me. Rev. Stat. Ann. tit. 24-A, §2159-C	X²	X	YES
Maryland	Md. Code Ann., Ins. §27-909	X²	X	YES
Massachusetts	Mass. Gen. Laws Ann. ch.175, §108H	X²	X	NO
Michigan	Mich. Comp. Laws Ann. §500.3407b	X^2,7	X	NO
Minnesota	Minn. Stat. Ann. §72A.139	X²	X
Mississippi⁸
Missouri	Mo. Ann. Stat. §§375.1300 et seq.	X²	X	NO⁶
Montana	Mon. Code Ann. §§33-18-901 et seq.	X²	X	NO⁶
Nebraska	Neb. Rev. Stat. §§44-787, 44-6916	X	X⁴
Nevada	Nev. Rev. Stat. §689A.417	X²	X	NO
New Hampshire	N.H. Rev. Stat. Ann. §§141-H:1 et seq.	X²	X
New Jersey	N.J. Stat. Ann. §17B:30-12	X²	X	YES
New Mexico	N.M. Stat. Ann. §§24-21-1 et seq.	X	X	YES
New York	N.Y. Ins. Law §§3216, 4305	X	X⁴
North Carolina	N.C. Gen. Stat. §§58-3-215, 58-68-35, 58-68-60 et seq.	X	X⁴	YES
North Dakota	N.D. Cent. Code §§26.1-36.3-01 et seq., 26.1-36.4-05	X	X⁴
Ohio	Ohio Rev. Code Ann. §3901.49	X²	X
Oklahoma	Okla. Stat. Ann. tit.36, §3614.1	X⁹	X	NO⁶
Oregon	Or. Rev. Stat. §§659.700, 746.135	X	X	NO
Pennsylvania
Rhode Island	R.I. Gen. Laws §§27-18-52, 27-50-3	X²	X	YES³
South Carolina	S.C. Code Ann. §§38-93-10 et seq.	X²	X	YES
South Dakota	S.D. Codified Laws §58-17-82	X	X⁴
Tennessee	Tenn. Code Ann. §§56-7-2701 et seq., 56-7-2809, 56-7-2810	X²	X	NO⁶
Texas	Tex. Ins. Code Ann. art. 21.73	X²		YES¹³
Utah¹⁰
Vermont	Vt. Stat. Ann. tit.18, §§9331 et seq.	X^2,11	X	NO
Virginia	Va. Code Ann. §§38.2-508.4, 38.2-3430.1 et seq.	X	X⁴	YES
Washington¹²
West Virginia	W.Va. Code §33-15-2b	X	X⁴
Wisconsin	Wis. Stat. Ann. §631.89	X²	X
Wyoming	Wyo. Stat. Ann. §§14-2-109, 26-19-306	X¹⁴		YES¹⁵
^{1 Prohibits genetic test to determine predisposition for cancer} ^{2 Prohibits using, requiring, and/or requesting genetic tests and/or information} ^{3 "Genetic information" expressly includes "family history"} ^{4 Insurer may limit or discontinue coverage in the individual market, but must do so uniformly without regard to "health status-related factors" which include "genetic information" (A HIPAA provision for the individual market).} ^{5 See Iowa Code Ann. §513C.8 where benefits for the standard health benefit plan for the individual market are substantially similar to those as provided under chapter 513B with respect to small group coverage.} ^{6 "Genetic information" expressly excludes "family history"} ^{7 Used in the context of expense-incurred hospital, medical, or surgical policies or certificate delivered, issued for delivery, or renewed in this state} ^{8 See Miss. Code Ann. §83-63-11 prohibiting small employer health benefit plans from transferring or otherwise providing coverage to a nonrenewed class unless done without regard to case characteristics, claims experience, health status, or duration of coverage.} ^{9 Prohibits requiring or requesting a genetic test} ^{10 See Utah Code Ann. §31A-30-106 prohibiting individual and small employer health plans from transferring a covered insured into or out of a class of business unless done so without regard to case characteristics, claims experience, health status, or duration of coverage.} ^{11 Prohibits conditioning insurance on the results of genetic testing of a member of the individual’s family} ^{12 See Wash. Rev. Code Ann. §48.46.060 prohibiting canceling or failing to renew HMO enrollment for reasons relating solely to age, sex, race, or health status.} ^{13 Effective September 1, 2001, "genetic information" means information that is obtained from or based on a scientific or medical determination of the presence or absence in an individual of a genetic characteristic; or derived from the results of a genetic test performed on that individual. This new definition of "genetic information could possibly include family history.} ^{14 See Wyo. Stat. Ann. § 26-19-107 where "health status related factors" are defined in the group and blanket disability context as including "genetic information."} ^{15 "Genetic information" defined in the context of paternity actions.}