29 USC 1182 - Prohibiting discrimination against individual participants and beneficiaries based on health status

U.S Code last checked for updates: Nov 25, 2024

§ 1182.

Prohibiting discrimination against individual participants and beneficiaries based on health status

(a)

In eligibility to enroll

(1)

In general

Subject to paragraph (2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

(A)

Health status.

(B)

Medical condition (including both physical and mental illnesses).

(C)

Claims experience.

(D)

Receipt of health care.

(E)

Medical history.

(F)

Genetic information.

(G)

Evidence of insurability (including conditions arising out of acts of domestic violence).

(H)

Disability.

(2)

No application to benefits or exclusions

To the extent consistent with section 1181 of this title, paragraph (1) shall not be construed—

(A)

to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or

(B)

to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.

(3)

Construction

(b)

In premium contributions

(1)

In general

(2)

Construction

Nothing in paragraph (1) shall be construed—

(A)

to restrict the amount that an employer may be charged for coverage under a group health plan except as provided in paragraph (3); or

(B)

to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

(3)

No group-based discrimination on basis of genetic information

(A)

In general

(B)

Rule of construction

(c)

Genetic testing

(1)

Limitation on requesting or requiring genetic testing

(2)

Rule of construction

(3)

Rule of construction regarding payment

(A)

In general

(B)

Limitation

(4)

Research exception

Notwithstanding paragraph (1), a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, may request, but not require, that a participant or beneficiary undergo a genetic test if each of the following conditions is met:

(A)

The request is made, in writing, pursuant to research that complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of human subjects in research.

(B)

The plan or issuer clearly indicates to each participant or beneficiary, or in the case of a minor child, to the legal guardian of such beneficiary, to whom the request is made that—

(i)

compliance with the request is voluntary; and

(ii)

non-compliance will have no effect on enrollment status or premium or contribution amounts.

(C)

No genetic information collected or acquired under this paragraph shall be used for underwriting purposes.

(D)

The plan or issuer notifies the Secretary in writing that the plan or issuer is conducting activities pursuant to the exception provided for under this paragraph, including a description of the activities conducted.

(E)

The plan or issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this paragraph.

(d)

Prohibition on collection of genetic information

(1)

In general

(2)

Prohibition on collection of genetic information prior to enrollment

(3)

Incidental collection

(e)

Application to all plans

(f)

Genetic information of a fetus or embryo

Any reference in this part to genetic information concerning an individual or family member of an individual shall—

(1)

with respect to such an individual or family member of an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and

(2)

with respect to an individual or family member utilizing an assisted reproductive technology, include genetic information of any embryo legally held by the individual or family member.

(Pub. L. 93–406, title I, § 702, as added Pub. L. 104–191, title I, § 101(a), Aug. 21, 1996, 110 Stat. 1945; amended Pub. L. 110–233, title I, § 101(a)–(c), May 21, 2008, 122 Stat. 883, 885.)

cite as: 29 USC 1182