OAR 836-052-0192
Prohibition Against Use of Genetic Information and Requests for Genetic Testing

(1)

This section applies to all policies with policy years beginning on or after May 21, 2009.

(2)

An issuer of a Medicare supplement policy or certificate shall not:

(a)

Deny or condition the issuance or effectiveness of the policy or certificate including the imposition of any exclusion of benefits under the policy based on a pre-existing condition on the basis of the genetic information with respect to the individual; or

(b)

Discriminate in the pricing of the policy or certificate including the adjustment of premium rates of an individual on the basis of the genetic information with respect to the individual.

(3)

Nothing in section (2) of this rule shall be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from

(a)

Denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant; or

(b)

Increasing the premium for any policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy. In such case, the manifestation of a disease or disorder in one individual may not also be used as genetic information about other group members and to further increase the premium for the group.

(4)

An issuer of a Medicare supplement policy or certificate shall not request or require an individual or a family member of the individual to undergo a genetic test.

(5)

Section (4) of this rule shall not be construed to preclude an issuer of a Medicare supplement policy or certificate from obtaining and using the results of a genetic test in making a determination regarding payment as defined for the purposes of applying the regulations promulgated under part C of title XI and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time and consistent with section (2) of this rule.

(6)

For purposes of carrying out section (5) of this rule, an issuer of a Medicare supplement policy or certificate may request only the minimum amount of information necessary to accomplish the intended purpose.

(7)

Notwithstanding section (4) of this rule, an issuer of a Medicare supplement policy may request, but not require, that an individual or a family member of the individual undergo a genetic test if each of the following conditions is met:

(a)

The request is made 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 regulation for the protection of human subjects in research.

(b)

The issuer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of the child, to whom the request is made that:

(A)

Compliance with the request is voluntary; and

(B)

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

(c)

No genetic information collected or acquired under this section may be used for underwriting, determination of eligibility to enroll or maintain enrollment status, premium rates, or the issuance, renewal, or replacement of a policy or certificate.

(d)

The issuer notifies the Secretary of Health and Human Services in writing that the issuer is conducting activities pursuant to the exception provided for under this section, including a description of the activities conducted.

(e)

The issuer complies with such other conditions as the Secretary of Health and Human Services may by regulation require for activities conducted under this section.

(8)

An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information for underwriting purposes.

(9)

An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information with respect to any individual prior to such individual’s enrollment under the policy in connection with the enrollment.

(10)

If an issuer of a Medicare supplement policy or certificate obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of section (9) of this rule if such request, requirement, or purchase is not in violation of section (8) of this rule.

(11)

As used in this rule:

(a)

“Issuer of a Medicare supplement policy or certificate” includes third-party administrator, or other person acting for or on behalf of such issuer.

(b)

“Family member” means, with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual.

(c)

Intentionally left blank —Ed.

(A)

“Genetic information” means, with respect to any individual, information about such individual’s genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual. “Genetic information” includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman, includes genetic information of any fetus carried by such pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member.

(B)

“Genetic information” does not include information about the sex or age of any individual.

(d)

“Genetic services” means a genetic test, genetic counseling (including obtaining, interpreting, or assessing genetic information), or genetic education.

(e)

“Genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detect genotypes, mutations, or chromosomal changes. “Genetic test” does not mean an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or an analysis of proteins or metabolites that is directly related to a manifested 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.

(f)

“Underwriting purposes” means,

(A)

Rules for, or determination of, eligibility including enrollment and continued eligibility for benefits under the policy;

(B)

The computation of premium or contribution amounts under the policy;

(C)

The application of any pre-existing condition exclusion under the policy; and

(D)

Other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.

Source: Rule 836-052-0192 — Prohibition Against Use of Genetic Information and Requests for Genetic Testing, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0192.

836‑052‑0103
Purpose 836‑052‑0107
Authority 836‑052‑0114
Applicability and Scope 836‑052‑0119
Definitions 836‑052‑0124
Policy Definitions and Terms 836‑052‑0129
Policy Provisions 836‑052‑0132
Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010 836‑052‑0133
Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010 836‑052‑0134
Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992 836‑052‑0136
Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010 836‑052‑0138
Open Enrollment 836‑052‑0139
Medicare Select Policies and Certificates 836‑052‑0140
Standards for Claims Payment 836‑052‑0141
Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date of Coverage on or After June 1, 2010 836‑052‑0142
Guaranteed Issue for Eligible Persons 836‑052‑0143
Annual Opportunity to Select Another Medicare Supplement Policy or Certificate 836‑052‑0144
Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020. 836‑052‑0145
Loss Ratio Standards and Refund or Credit of Premium 836‑052‑0151
Filing and Approval of Policies and Certificates and Premium Rates 836‑052‑0156
Permitted Compensation Arrangements 836‑052‑0160
Required Disclosure Provisions 836‑052‑0165
Requirements for Application Forms, Replacement Coverage 836‑052‑0170
Filing Requirements for Advertising 836‑052‑0175
Standards for Marketing 836‑052‑0180
Appropriateness of Recommended Purchase and Excessive Insurance 836‑052‑0185
Reporting of Multiple Policies 836‑052‑0190
Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates 836‑052‑0192
Prohibition Against Use of Genetic Information and Requests for Genetic Testing 836‑052‑0194
Separability 836‑052‑0225
Durational Limits for Health Maintenance Organizations 836‑052‑0230
Provider Services Limits for Insurers and Health Care Contractors 836‑052‑0500
Statutory Authority 836‑052‑0508
Definitions 836‑052‑0516
Policy Definitions 836‑052‑0526
Policy Practices and Provisions 836‑052‑0531
Long Term Care Insurance Partnership Program 836‑052‑0546
Required Policy Provisions 836‑052‑0556
Required Disclosure of Rating Practices to Consumers 836‑052‑0566
Initial Rate Filing Requirements 836‑052‑0576
Prohibition Against Post-Claims Underwriting, Applications 836‑052‑0586
Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies 836‑052‑0596
Standards for Covered Services 836‑052‑0606
Use and Definition of “Home” or Similar Wording 836‑052‑0616
Requirement to Offer Inflation Protection 836‑052‑0626
Requirements for Application Forms and Replacement Coverage 836‑052‑0636
Reporting Requirements 836‑052‑0637
Annual Rate Certification Requirements 836‑052‑0639
Training for Insurance Producers 836‑052‑0646
Benefits Provided Through Advancement of Life Insurance Proceeds 836‑052‑0656
Reserve Standards 836‑052‑0666
Loss Ratio 836‑052‑0676
Premium Rate Schedule Increases 836‑052‑0680
Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings 836‑052‑0686
Filing Requirements for Out-of-State Group Policies 836‑052‑0696
Filing Requirements for Advertising 836‑052‑0706
Standards for Marketing 836‑052‑0716
Disclosure Statement 836‑052‑0726
Suitability 836‑052‑0736
Prohibition Against Preexisting Conditions, Waiting Periods and Probationary Periods in Replacement Policies and Certificates 836‑052‑0738
Availability of New Services or Providers 836‑052‑0740
Right to Reduce Coverage and Lower Premiums 836‑052‑0746
Nonforfeiture Benefit Requirement 836‑052‑0756
Standards for Benefit Triggers 836‑052‑0766
Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts 836‑052‑0768
Appealing An Insurer’s Determination That The Benefit Trigger Is Not Met 836‑052‑0770
Prompt Payment of Clean Claims 836‑052‑0776
Standard Format Outline of Coverage 836‑052‑0786
Requirement to Deliver Shopper’s Guide 836‑052‑0790
Disclosure of Benefits Paid 836‑052‑0800
Purpose 836‑052‑0810
Replacement Upon Termination 836‑052‑0840
Termination of Coverage 836‑052‑0850
Multiple Employer Trusts 836‑052‑0860
Form of Notice to Group Policyholder 836‑052‑1000
Prosthetic and Orthotic Devices
Last Updated

Jun. 8, 2021

Rule 836-052-0192’s source at or​.us