Under GINA, the definition of underwriting purposes is broader than merely activities relating to rating and pricing a group policy. Under GINA, underwriting purposes means, with respect to a group health plan: • Rules for or determination of eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage (including changes in deductibles […]

Generally, yes. If a plan conditions payment for an item or service based on medical appropriateness and the medical appropriateness depends on the genetic makeup of the patient, then the plan is permitted to condition payment for the item or service on the outcome of a genetic test. The plan may also refuse payment in […]

GINA prohibits a plan from collecting genetic information (including family medical history) prior to or in connection with enrollment. Thus, under GINA, plans must ensure that any HRA conducted prior to or in connection with enrollment does not collect genetic information, including family medical history. Under GINA, there is an exception for genetic information that […]

Under GINA, a plan is permitted to request, but not to require, that a participant or beneficiary undergo a genetic test for research purposes if the following four requirements are met: • The plan makes the request pursuant to research. (Research is defined in 45 CFR 46.102(d).) The research must comply with 45 CFR Part […]

Generally, yes. GINA prohibits a group health plan from requesting or requiring an individual or a family member of an individual to undergo genetic tests. Nonetheless, under GINA, a health care professional who is providing health care services to an individual can request that an individual undergo a genetic test. A health care professional includes […]

Genetic services mean genetic tests, genetic counseling, or genetic education. Genetic test means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, if the analysis detects genotypes, mutations, or chromosomal changes. A genetic test does not include an analysis of proteins or metabolites directly related to a manifested disease, disorder, or pathological condition. Therefore, […]

Genetic information means information about an individual’s genetic tests, the genetic tests of family members of the individual, the manifestation of a disease or disorder in family members of the individual or any request for or receipt of genetic services, or participation in clinical research that includes genetic services by the individual or a family […]

The subject of these Frequently Asked Questions is the requirements of Title I of GINA under the Employee Retirement Income Security Act (ERISA), prohibiting discrimination in group health plan coverage based on genetic information. GINA expands the genetic information nondiscrimination protections included in Title I of the Health Insurance Portability and Accountability Act of 1996 […]