Makes provisions regarding genetic predisposition

BILL NUMBER:S3726

Title of bill

An act to amend the insurance law, in relation to genetic predisposition

Purpose/summary of provisions

Present law requires community rating for individual and small group health policies and limits pre-existing condition exclusions to twelve months. This bill would specify that genetic predisposition to disease, as determined from a genetic test, could not be used to deny coverage or set different rates, and could not be a basis for any pre-existing condition exclusion.

Section 1 of the bill amends Section 107 of the insurance law by defining "genetic predisposition".

Section 2 amends subsection (a) of S3231 of the Insurance Law to clarify that insurers may not underwrite health insurance based on genetic predisposition under the community rating/open enrollment law.

Section 3 amends subsection (b) of Section 3232 of the Insurance Law by providing that no pre-existing condition provision shall exclude coverage on the basis of any genetic predisposition.

Sections 4 and 5 amend Section 4317 and Section 4318 of the insurance law, which pertain to community rating and pre-existing condition exclusions in contracts with health and hospital service corporations including health maintenance organizations (HMOs).

Justification

By enacting the community rating open enrollment law, the State has established a general policy against health insurance discrimination. Although the community rating law requires individual and small group health insurance to be rated among all similarly situated individuals or small groups without regard to age, sex, health status or occupation, it omits specific mention of genetic predisposition. DNA based genetic tests are being developed which can make more or less valid predictions of future health status given in cases where current health status is unaffected. Neither the time of onset nor the severity of future illness, if any, can be predicted with any certainty by a genetic test and genetic tests are not available for many illnesses that may partially have genetic root. Speculative future health status should be excluded from the rating process at least as much as current health status is excluded under existing law.

The community rating law allows exclusion for coverage for pre-existing conditions, defined as "conditions manifesting themselves in symptoms which would cause an ordinary prudent person to seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received during the six months immediately preceding the effective date of coverage." Even genetic predisposition has, by definition, not resulted in symptoms, it could

contribute to a disease in the indefinite future, and could lead a person to seek medical advice. Any resulting ambiguity should be resolved in a way that does not impair the health insurance of healthy persons merely because they may have an increased likelihood of future illness by virtue of a genetic endowment as much outside of their control as race or gender.

Fiscal implications

None to the State.

Effective date

This act shall take effect on the sixtieth day after it shall have become a law and shall apply to all policies issued, renewed, altered, or modified on or after such date.