Health Benefits Advisor for Employers

Determining Compliance with the GINA Provisions in Part 7 of ERISA

Does the plan comply with GINA's prohibition on collection of genetic information, for underwriting purposes?

• Yes
• No

A plan cannot request, require, or purchase ("collect") genetic information for underwriting purposes. See 29 CFR 2590.702-1(d)(1)(i).

Underwriting purposes means, with respect to any group health plan:

• Rules for determination of eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage (including changes in deductibles or other cost-sharing mechanisms in return for activities such as completing a health risk assessment or participating in a wellness program);
• The computation of premium or contribution amounts under the plan or coverage (including discounts, rebates, payments in kind, or other premium differential mechanisms in return for activities such as completing a health risk assessment or participating in a wellness program);
• The application of any preexisting condition exclusion under the plan or coverage; and
• Other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits. See 29 CFR 2590.702-1(d)(1)(ii).

Exception for medical appropriateness (only if an individual seeks a benefit under the plan):

• If an individual seeks a benefit under a plan, the plan may limit or exclude the benefit based on whether the benefit is medically appropriate and the determination of whether the benefit is medically appropriate is not for underwriting purposes.
• 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. A plan or issuer is permitted to request only the minimum amount of genetic information necessary to determine medical appropriateness. See 29 CFR 2590.702-1(d)(1)(iii) and (e).