The Genetic Information Nondiscrimination Act of 2008 (GINA) Page: 15 of 22
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disease, disorder, or pathological condition that could reasonably be detected by a
health care professional with appropriate training and expertise in the field of
medicine involved." While Title II does not include this exception, it does contain
Section 210, which states,
An employer, employment agency, labor organization, or joint labor-management
committee shall not be considered to be in violation of this title based on the use,
acquisition, or disclosure of medical information that is not genetic information
about a manifested disease, disorder, or pathological condition of an employee
or member, including a manifested disease, disorder, or pathological condition
that has or may have a genetic basis.
This difference in the definition of genetic test implies that employers who use
genetic information about a manifested disease to discriminate may be in violation
of this act, while health insurers who use genetic information about a manifested
disease to discriminate will not be in violation of this act.
Genetic Nondiscrimination and Health Insurance
Overview of Health Insurance Provisions. Title I of GINA strengthens
and clarifies existing HIPAA nondiscrimination and portability provisions through
amendments to the Employee Retirement Income Security Act of 1974 (ERISA), the
Public Health Services Act (PHSA), and the Internal Revenue Code (IRC), as well
as to the Social Security Act (SSA). In this way, group plans under ERISA, group
and individual plans under the PHSA, Church Plans under the IRC, and Medigap
plans under the SSA are all brought under the jurisdiction of the law. The
complexity of the health care financing system required this multi-faceted approach
in order to ensure protection for all individuals, regardless of their insurance
situation.
Prohibited Health Insurer Practices. Broadly, GINA prohibits health
insurers from engaging in three practices: (1) using genetic information about an
individual to adjust a group plan's premiums, or, in the case of individual plans, to
deny coverage, adjust premiums, or impose a preexisting condition exclusion; (2)
requiring or requesting genetic testing; and (3) requesting, requiring, or purchasing
genetic information for underwriting purposes. Each of these provisions is discussed
below in more detail.
Discrimination in Premium Setting and Eligibility Prohibited. GINA
prohibits health plans, group and individual health insurers and issuers, and issuers
of Medicare supplemental policies from adjusting a group or individual's premium
based on genetic information about an individual in the group, an individual seeking
individual coverage, or an individual's family members. It also prohibits individual
insurers from conditioning eligibility or continuing eligibility on genetic information,
and prohibits individual insurers from treating genetic information as a preexisting
condition. Issuers of supplemental Medicare policies may not deny or condition the
issuance of a policy based on genetic information (and may not impose a preexisting
condition exclusion based on genetic information).
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Jones, Nancy Lee & Sarata, Amanda K. The Genetic Information Nondiscrimination Act of 2008 (GINA), report, October 2, 2008; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc816278/m1/15/: accessed April 24, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.