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Compliance Assistance Resources

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- Health Benefits Advisor for Employers

Determining Compliance with the GINA Provisions in Part 7 of ERISA

Does the plan comply with GINA's prohibition against group- based discrimination based on genetic information?

A group health plan cannot adjust premium or contribution amounts for the plan, or any similarly situated individuals under the plan, on the basis of genetic information. See CFR 2590.702-1(b)(1).

Nothing limits a plan from increasing the premium for the group health plan or for a group of similarly situated individuals under the plan based on the manifestation of a disease or disorder of an individual enrolled in the plan. However, the manifestation of the disease in one individual cannot be used as genetic information about other group members to further increase the premium for a group health plan or a group of similarly situated individuals under the plan. See 29 CFR 2590.702-1(b)(2).

Note: Unlike HIPAA, the GINA provisions generally do apply to very small health plans (plans with less than two participants who are current employees), including retiree-only health plans.