Genetic Nondiscrimination in Health Insurance: A Side-by-Side Comparison of the Title I Provisions in S. 358 and H.R.493

Genetic Nondiscrimination in Health Insurance:
A Side-by-Side Comparison of the Title I
Provisions in S. 358 and H.R. 493
Updated April 25, 2008
C. Stephen Redhead
Specialist in Life Sciences
Domestic Social Policy Division
Amanda K. Sarata
Analyst in Genetics
Domestic Social Policy Division



Genetic Nondiscrimination in Health Insurance:
A Side-by-Side Comparison of the Title I Provisions
in S. 358 and H.R. 493
Summary
On March 29, 2007, the Senate Health, Education, Labor, and Pensions (HELP)
Committee approved the Genetic Information Nondiscrimination Act of 2007 (S.

358). The HELP Committee filed a report to accompany S. 358 on April 10 (S.Rept.


110-48). S. 358 is awaiting Senate floor action. On April 25, the House passed its
own version of the legislation (H.R. 493) on a vote of 420-3. Earlier, the measure
was reported by the Education and Labor Committee (H.Rept. 110-28, Part I), the
Ways and Means Committee (H.Rept. 110-28, Part II), and the Energy and
Commerce Committee (H.Rept. 110-28, Parts III & IV). On March 5, 2008, the text
of H.R. 493, as passed by the House, was added to the end of the Paul Wellstone
Mental Health and Addiction Equity Act of 2007 (H.R. 1424) in the engrossment of
H.R. 1424. On April 24, 2008, the Senate took up H.R. 493, replaced the existing
language with an amendment in the nature of a substitute, and passed the measure,
as amended, by a vote of 95-0. H.R. 493, as amended and passed by the Senate, is
very similar to the version passed by the House last year. The most significant
difference is new language strengthening the “firewall” between Title I and Title II
of the act. The House is expected to pass H.R. 493 (as amended) during the week of
April 28, 2008. The Genetic Information Nondiscrimination Act would restrict
health insurers’ (Title I) and employers’ (Title II) acquisition and use of genetic
information in several ways. These restrictions build upon those already imposed in
federal law.
This report provides a comparison of the Title I provisions in S. 358 and H.R.
493. Those provisions would extend the current Health Insurance Portability and
Accountability Act (HIPAA) protections against discrimination by group health plans
and issuers of health insurance in both the group and individual markets, and restrict
their collection, use and disclosure of genetic information. A separate report, CRS
Report RL33987, Genetic Nondiscrimination in Employment: A Comparison of Title
II Provisions in S. 358 and H.R. 493, 110th Congress, by Nancy Lee Jones, discusses
the Title II employment provisions.



Contents
In troduction ......................................................1
Overview of Title I Provisions in S. 358 and H.R. 493.....................1
List of Tables
Table 1. Genetic Nondiscrimination in Health Insurance: S. 358 (Title I) vs.
H.R. 493 (Title I) ..............................................3



Genetic Nondiscrimination in Health
Insurance: A Side-by-Side Comparison of
the Title I Provisions in S. 358 and H.R. 493
Introduction
On March 29, 2007, the Senate Health, Education, Labor, and Pensions (HELP)
Committee approved the Genetic Information Nondiscrimination Act of 2007 (S.

358). The HELP Committee filed a report to accompany S. 358 on April 10 (S.Rept.


110-48). S. 358 is awaiting Senate floor action. On April 25, the House passed its
own version of the legislation (H.R. 493) on a vote of 420-3. Earlier, the measure
was reported by the Education and Labor Committee (H.Rept. 110-28, Part I), the
Ways and Means Committee (H.Rept. 110-28, Part II), and the Energy and
Commerce Committee (H.Rept. 110-28, Parts III & IV). On March 5, 2008, the text
of H.R. 493, as passed by the House, was added to the end of the Paul Wellstone
Mental Health and Addiction Equity Act of 2007 (H.R. 1424) in the engrossment of
H.R. 1424.1 On April 24, 2008, the Senate took up H.R. 493, replaced the existing
language with an amendment in the nature of a substitute, and passed the measure,
as amended, by a vote of 95-0. H.R. 493, as amended and passed by the Senate, is
very similar to the version passed by the House last year. The most significant
difference is new language strengthening the “firewall” between Title I and Title II
of the act. The House is expected to pass H.R. 493 (as amended) during the week of
April 28, 2008. The Genetic Information Nondiscrimination Act would restrict
health insurers’ and employers’ acquisition and use of genetic information in several
ways. These restrictions build upon those already imposed in federal law.
Overview of Title I Provisions in S. 358 and H.R. 493
Title 1 of S. 358/H.R. 493 would extend the current Health Insurance Portability
and Accountability Act (HIPAA) protections against discrimination by group health
plans and issuers of health insurance in both the group and individual markets, and
restrict their acquisition, use and disclosure of genetic information. The HIPAA


1 For more information about mental health parity and H.R. 1424, see CRS Report RL33820,
The Mental Health Parity Act: A Legislative History, and CRS Report RL31657, Mental
Health Parity: Federal and State Action and Economic Impact, both by Ramya
Sundararaman and C. Stephen Redhead.

nondiscrimination provisions appear in three separate statutes: (1) the Employee
Retirement Income Security Act (ERISA, Part 7), which regulates employee benefit
plans, including employer-sponsored group health plans; (2) the Internal Revenue
Code (IRC, Chapter 100), which also covers group health plans (using a slightly
broader definition than ERISA); and (3) the Public Health Service Act (PHSA, Title
XVII), which applies to insurance companies and managed care organizations, and
to non-federal government health plans. H.R. 493, but not S. 358, would amend the
HIPAA nondiscrimination provisions in all three statutes, as well as amending
comparable provisions in the Medicare statute (Social Security Act Title XVIII)
relating to supplementary health insurance benefits (Medigap).
Table 1, beginning on page 3, provides a side-by-side comparison of the two
bills, using the Senate-reported measure as the referent. The table only includes the
provisions in Title I (Genetic Nondiscrimination in Health Insurance). A separate
report, CRS Report RL33987, Genetic Nondiscrimination in Employment: A
Comparison of Title II Provisions in S. 358 and H.R. 493, 110th Congress, by Nancy
Lee Jones, discusses the Title II employment provisions.
While the Title I provisions in the two bills are broadly similar there are a
number of significant differences, including the following.
!Whereas H.R. 493 would amend the four federal statutes (i.e.,
ERISA, IRC, PHSA, and Medigap), S. 358 would amend only three;
it does not include any provisions to amend IRC.
!Unlike S. 358, H.R. 493 includes a provision relating to the genetic
information of a fetus or embryo. It provides that references to
genetic information include genetic information on a fetus carried by
a pregnant woman and, with respect to an individual utilizing
assisted reproductive technology, includes genetic information of
any embryo legally held by the individual or family member.
!In H.R. 493, language that prohibits the collection of genetic
information by health plans and insurers for the purposes of
underwriting and related activities appears in each of the four
sections amending federal law. Comparable language in S. 358
appears only once in the privacy section (Sec. 104).
!Whereas both bills include provisions that would allow the relevant
Secretary (Labor, Treasury, HHS) to impose the same monetary
penalties for violations of the Title’s nondiscrimination provisions,
S. 358 includes additional remedies and enforcement provisions in
its amendments to ERISA.



Table 1. Genetic Nondiscrimination in Health Insurance: S. 358 (Title I) vs. H.R. 493 (Title I)
S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Amendments to ERISA Part 7 (Group Market Requirements) — Section 101
Clarifies that the ERISA provision prohibiting group health plans and insuranceNo provision.
issuers from denying an individual eligibility to enroll in a group based on that
individual’s genetic information includes information about a request for or
receipt of genetic services by that individual or a family member.
Prohibits group health plans and insurance issuers from adjusting a group’sProhibits group health plans and insurance issuers from adjusting a group’s
premium based on an individual’s (or family members) genetic information,premium on the basis of genetic information.
including information about a request for or receipt of genetic services by that
individual or a family member.
Prohibits group health plans and insurance issuers from requesting or requiringProhibits group health plans and insurance issuers from requesting or requiring
that an individual or a family member of such individual undergo a genetic test. that an individual or a family member of such individual undergo a genetic test.
iki/CRS-RL33988Does not limit the authority of a health care professional who is providing healthcare to an individual to request that the individual (or a family member) undergoDoes not limit the authority of a health care professional who is providing healthcare to an individual to request that the individual undergo a genetic test. Does
g/wa genetic test. Does not limit the authority of a health care professional employednot preclude a group health plan or insurance issuer from obtaining and using
s.orby or affiliated with a group health plan or insurance issuer, and who is providinggenetic test information for payment determinations (only the minimum amount
leakhealth care services to an individual as part of a wellness program, to notify suchof information necessary to accomplish the intended purpose may be requested).
individual about the availability of a genetic test. Does not permit a health carePermits a group health plan or insurance issuer to request, but not require, that an
://wikiprofessional to require that an individual undergo a genetic test.individual voluntarily undergo a genetic test as part of a research project.
http
[Note: language prohibiting the collection of genetic information is in SectionProhibits group health plans and insurance insurers from requesting, requiring, or
104, Privacy and Confidentiality; see below.]purchasing genetic information for the purposes of underwriting, eligibility
determination (before or during the enrollment process), premium rating, or other
activities related to the creation, renewal, or replacement of a health insurance
plan or contract. Obtaining genetic information incidental to the acquisition of
other information would not be considered a violation.
Applies the above nondiscrimination provisions to all group health plans.Applies the above nondiscrimination provisions to all group health plans.



S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
No provisions.Clarifies that any reference to genetic information about an individual or family
member who is pregnant shall include genetic information about the fetus.
Clarifies that any reference to genetic information about an individual or family
member using assisted reproductive technology shall include genetic information
about any fetus legally held by that individual or family member.
Defines family member to include an individual’s spouse and dependent childrenDefines family member to include an individual’s dependent through marriage,
(including those born to or placed for adoption with the individual), as well as allbirth, or adoption or placement for adoption, as well as any first-, second-, third-,
others related by blood to the individual, the spouse, or the dependent or adoptedor fourth-degree relative of the individual or dependent.
child r e n.
Defines genetic information as information about an individual’s genetic tests, orDefines genetic information as information about an individual’s genetic tests, or
those of family members, as well as information about the occurrence of a diseasethose of family members, as well as information about family members’ manifest
or disorder in family members. Does not include age and sex of individual.diseases or disorders, to the extent that such information is taken into account as
genetic information about other individuals. The term genetic information also
includes any request for, or receipt of, genetic services (defined below) by an
individual or family member. Does not include age and sex of individual.
iki/CRS-RL33988
g/wDefines genetic test as an analysis of DNA, RNA, chromosomes, proteins, orSame provisions.
s.ormetabolites that detects genotypes, mutations, or chromosomal changes. Genetic
leaktest does not include an analysis of proteins or metabolites that is directly related
to a manifest disease, disorder or pathological condition.
://wikiDefines genetic services as a genetic test, genetic counseling, or geneticSame provisions.
httpeducation.
Authorizes the Labor Secretary to impose monetary penalties, subject to certainSame provisions.
conditions, for violation of the above nondiscrimination provisions. [Note: these
penalties are the same as the tax penalties in Section 4980D of the IRC.]
Provides for injunctive relief prior to the exhaustion of available administrativeNo provisions.


remedies if the preponderance of evidence shows that the exhaustion of such
remedies would cause irreparable harm to the health of the participant or
beneficiary.

S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Provides for administrative penalties of $100 per day and the retroactiveNo provisions.
reinstatement of coverage for violations of the above nondiscrimination
provisio ns.
Requires the Labor Secretary to issue final implementing regulations within oneSame provisions.
year. Amendments apply to plan years beginning after 18 months from
enactme nt.
Amendments to the Public Health Service Act Title XVII (Group Market Requirements) — Section 102(a)
Clarifies that the PHS Act provision prohibiting group health plans and insuranceNo provision.
issuers from denying an individual eligibility to enroll in a group based on that
individual’s genetic information includes information about a request for or
receipt of genetic services by that individual or a family member.
Prohibits group health plans and insurance issuers from adjusting a group’sProhibits group health plans and insurance issuers from adjusting a group’s
premium based on an individual’s (or family members) genetic information,premium on the basis of genetic information.
iki/CRS-RL33988including information about a request for or receipt of genetic services by that
g/windividual or a family member.
s.orProhibits group health plans and insurance issuers from requesting or requiringProhibits group health plans and insurance issuers from requesting or requiring
leakthat an individual or a family member of such individual undergo a genetic test. that an individual or a family member of such individual undergo a genetic test.
://wikiDoes not limit the authority of a health care professional who is providing healthcare to an individual to request that the individual (or a family member) undergoDoes not limit the authority of a health care professional who is providing healthcare to an individual to request that the individual undergo a genetic test. Does
httpa genetic test. Does not limit the authority of a health care professional employednot preclude a group health plan or insurance issuer from obtaining and using
by or affiliated with a group health plan or insurance issuer, and who is providinggenetic test information for payment determinations (only the minimum amount
health care services to an individual as part of a wellness program, to notify suchof information necessary to accomplish the intended purpose may be requested).
individual about the availability of a genetic test. Does not permit a health carePermits a group health plan or insurance issuer to request, but not require, that an
professional to require that an individual undergo a genetic test.individual voluntarily undergo a genetic test as part of a research project.
[Note: language prohibiting the collection of genetic information is in SectionProhibits group health plans and insurance issuers from requesting, requiring, or
104, Privacy and Confidentiality; see below.]purchasing genetic information for the purposes of underwriting, eligibility
determination (before or during the enrollment process), premium rating, or other
activities related to the creation, renewal, or replacement of a health insurance
plan or contract. Obtaining genetic information incidental to the acquisition of
other information would not be considered a violation.



S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Applies the above nondiscrimination provisions to all group health plans.Applies the above nondiscrimination provisions to all group health plans.
No provisions.Clarifies that any reference to genetic information about an individual or family
member who is pregnant shall include genetic information about the fetus.
Clarifies that any reference to genetic information about an individual or family
member using assisted reproductive technology shall include genetic information
about any fetus legally held by that individual or family member.
Defines family member to include an individual’s spouse and dependent childrenDefines family member to include an individual’s dependent through marriage,
(including those born to or placed for adoption with the individual), as well as allbirth, or adoption or placement for adoption, as well as any first-, second-, third-,
others related by blood to the individual, the spouse, or the dependent or adoptedor fourth-degree relative of the individual or dependent.
child r e n.
Defines genetic information as information about an individual’s genetic tests, orDefines genetic information as information about an individual’s genetic tests, or
those of family members, as well as information about the occurrence of a diseasethose of family members, as well as information about family members’ manifest
or disorder in family members. Does not include age and sex of individual.diseases or disorders, to the extent that such information is taken into account as
genetic information about other individuals. The term genetic information also
iki/CRS-RL33988includes any request for, or receipt of, genetic services (defined below) by an
g/windividual or family member. Does not include age and sex of individual.
s.or
leakDefines genetic test as an analysis of DNA, RNA, chromosomes, proteins, ormetabolites that detects genotypes, mutations, or chromosomal changes. GeneticSame provisions.
://wikitest does not include an analysis of proteins or metabolites that is directly relatedto a manifest disease, disorder or pathological condition.
http
Defines genetic services as a genetic test, genetic counseling, or geneticSame provisions.
education.
Authorizes the HHS Secretary to impose monetary penalties, subject to certainSame provisions.


conditions, for violation of the above nondiscrimination provisions. [Note: these
penalties are the same as the tax penalties in Section 4980D of the IRC.]

S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Requires the HHS Secretary to issue final implementing regulations within oneSame provisions.
year. Amendments apply to plan years beginning after 18 months from
enactme nt.
Amendments to the Public Health Service Act Title XVII (Individual Market Requirements) — Section 102(b)
Prohibits insurance issuers from denying eligibility or adjusting premiums basedProhibits insurance issuers from denying eligibility, adjusting premiums, or
on an individual’s (or family members) genetic information, includingimposing any preexisting condition exclusion on the basis of genetic information.
information about a request for or receipt of genetic services by that individual or
a family member.
Prohibits insurance issuers from requesting or requiring that an individual or aProhibits insurance issuers from requesting or requiring that an individual or a
family member of such individual undergo a genetic test. Does not limit thefamily member of such individual undergo a genetic test. Does not limit the
authority of a health care professional who is providing health care to anauthority of a health care professional who is providing health care to an
individual to request that the individual (or a family member) undergo a geneticindividual to request that the individual undergo a genetic test. Does not preclude
test. Does not limit the authority of a health care professional employed by ora group health plan or insurance issuer from obtaining and using genetic test
affiliated with a health plan or insurance issuer, and who is providing health careinformation for payment determinations (only the minimum amount of
iki/CRS-RL33988services to an individual as part of a wellness program, to notify such individualinformation necessary to accomplish the intended purpose may be requested).
g/wabout the availability of a genetic test. Does not permit a health care professionalPermits a group health plan or insurance issuer to request, but not require, that an
s.orto require that an individual undergo a genetic test.individual voluntarily undergo a genetic test as part of a research project.
leak[Note: language prohibiting the collection of genetic information is in SectionProhibits insurance issuers from requesting, requiring, or purchasing genetic
://wiki104, Privacy and Confidentiality; see below.]information for the purposes of underwriting, eligibility determination (before orduring the enrollment process), premium rating, or other activities related to the
httpcreation, renewal, or replacement of a health insurance plan or contract.
Obtaining genetic information incidental to the acquisition of other information
would not be considered a violation.
No provisions.Clarifies that any reference to genetic information about an individual or family
member who is pregnant shall include genetic information about the fetus.
Clarifies that any reference to genetic information about an individual or family
member using assisted reproductive technology shall include genetic information
about any fetus legally held by that individual or family member.



S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
For violations of the above nondiscrimination provisions, grants the HHSSame provisions.
Secretary the same enforcement authority with respect to insurance issuers in the
individual market as the Secretary has for violations by insurance issuers in the
small group market.
Eliminates the option of nonfederal government plans to be excepted from theSame provision.
above genetic nondiscrimination provisions.
Requires the HHS Secretary to issue final implementing regulations within oneSame provisions.
year. Amendments apply to insurance coverage offered, sold, issued, renewed, or
in effect beginning 18 months after enactment.
Amendments to the Internal Revenue Code Chapter 100 (Group Health Plan Requirements) — Section 103 (H.R. 493)
No provision.Prohibits group health plans from adjusting a group’s premium on the basis of
genetic information.
iki/CRS-RL33988No provisions.Prohibits group health plans from requesting or requiring that an individual or a
g/wfamily member of such individual undergo a genetic test. Does not limit theauthority of a health care professional who is providing health care to an
s.orindividual to request that the individual undergo a genetic test. Does not preclude
leaka group health plan from obtaining and using genetic test information for
://wikipayment determinations (only the minimum amount of information necessary toaccomplish the intended purpose may be requested). Permits a group health plan
httpto request, but not require, that an individual voluntarily undergo a genetic test as
part of a research project.
No provisions.Prohibits group health plans from requesting, requiring, or purchasing genetic
information for the purposes of underwriting, eligibility determination (before or
during the enrollment process), premium rating, or other activities related to the
creation, renewal, or replacement of a health insurance plan or contract.
Obtaining genetic information incidental to the acquisition of other information
would not be considered a violation.
No provision.Applies the above nondiscrimination provisions to all group health plans.



S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
No provisions.Clarifies that any reference to genetic information about an individual or family
member who is pregnant shall include genetic information about the fetus.
Clarifies that any reference to genetic information about an individual or family
member using assisted reproductive technology shall include genetic information
about any fetus legally held by that individual or family member.
No provisions.Defines family member to include an individual’s dependent through marriage,
birth, or adoption or placement for adoption, as well as any first-, second-, third-,
or fourth-degree relative of the individual or dependent.
No provisions.Defines genetic information as information about an individual’s genetic tests, or
those of family members, as well as information about family members’ manifest
diseases or disorders, to the extent that such information is taken into account as
genetic information about other individuals. The term genetic information also
includes any request for, or receipt of, genetic services (defined below) by an
individual or family member. Does not include age and sex of individual.
iki/CRS-RL33988No provisions.Defines genetic test as an analysis of DNA, RNA, chromosomes, proteins, or
g/wmetabolites that detects genotypes, mutations, or chromosomal changes. Genetic
s.ortest does not include an analysis of proteins or metabolites that is directly related
leakto a manifest disease, disorder or pathological condition.
://wikiNo provisions.Defines genetic services as a genetic test, genetic counseling, or geneticeducation.
http
No provisions.Clarifies that group health plans that fail to meet the requirements set out in
Chapter 100 of the IRC, which include the above nondiscrimination provisions,
will be subject to the tax penalties in Section 4980D of the IRC.



S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
No provisions.Requires the Treasury Secretary to issue final implementing regulations within
one year. Amendments apply to plan years beginning at least 18 months after
enactme nt.
Amendments to Social Security Act Title XVIII (Medicare) Relating to Medigap — Section 103 (S. 358), Section 104 (H.R. 493)
Prohibits an issuer of a Medigap policy from: (1) denying or conditioning theProhibits an issuer of a Medigap policy from: (1) denying or conditioning the
issuance or effectiveness of a policy, or (2) discriminating in the pricing of aissuance or effectiveness of a policy; or (2) discriminating in the pricing of a
policy, based on an individual’s (or family members) genetic information,policy, on the basis of genetic information.
including information about a request for or receipt of genetic services by that
individual or a family member.
Prohibits an issuer of a Medigap policy from requesting or requiring that anProhibits an issuer of a Medigap policy from requesting or requiring that an
individual or a family member undergo a genetic test. Does not limit theindividual or a family member of such individual undergo a genetic test. Does
authority of a health care professional who is providing health care to annot limit the authority of a health care professional who is providing health care
individual to request that the individual (or a family member) undergo a geneticto an individual to request that the individual undergo a genetic test. Does not
test. Does not limit the authority of a health care professional employed by orpreclude an issuer of a Medigap policy from obtaining and using genetic test
iki/CRS-RL33988affiliated with a health plan or insurance issuer, and who is providing health careinformation for payment determinations (only the minimum amount of
g/wservices to an individual as part of a wellness program, to notify such individualinformation necessary to accomplish the intended purpose may be requested).
s.orabout the availability of a genetic test. Does not permit a health care professionalPermits an issuer of a Medigap policy to request, but not require, that an
leakto require that an individual undergo a genetic test.individual voluntarily undergo a genetic test as part of a research project.
://wiki[Note: language prohibiting the collection of genetic information is in Section104, Privacy and Confidentiality; see below.]Prohibits an issuer of a Medigap policy from requesting, requiring, or purchasinggenetic information for the purposes of underwriting, eligibility determination
http(before or during the enrollment process), premium rating, or other activities
related to the creation, renewal, or replacement of a health insurance plan or
contract. Obtaining genetic information incidental to the acquisition of other
information would not be considered a violation.
Defines family member to include an individual’s spouse and dependent childrenDefines family member to include any first-, second-, third-, or fourth-degree
(including those born to or placed for adoption with the individual), as well as allrelative of the individual.


others related by blood to the individual, the spouse, or the dependent or adopted
child r e n.

S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Defines genetic information as information about an individual’s genetic tests, orDefines genetic information as information about an individual’s genetic tests, or
those of family members, as well as information about the occurrence of a diseasethose of family members, as well as information about family members’ manifest
or disorder in family members. Does not include age and sex of individual.diseases or disorders. The term genetic information also includes any request for,
or receipt of, genetic services (defined below) by an individual or family member.
Does not include age and sex of individual.
Defines genetic test as an analysis of DNA, RNA, chromosomes, proteins, orSame provisions.
metabolites that detects genotypes, mutations, or chromosomal changes. Genetic
test does not include an analysis of proteins or metabolites that is directly related
to a manifest disease, disorder or pathological condition.
Defines genetic services as a genetic test, genetic counseling, or geneticSame provisions.
education.
Defines issuer of a Medigap policy to include a third-party administrator or otherSame provisions.
person acting for or on behalf of such issuer.
iki/CRS-RL33988No provisions.Clarifies that any reference to genetic information about an individual or family
g/wmember who is pregnant shall include genetic information about the fetus.
s.orClarifies that any reference to genetic information about an individual or family
leakmember using assisted reproductive technology shall include genetic informationabout any fetus legally held by that individual or family member.
://wikiApplies to Medigap policies beginning at least 18 months after enactment.Applies to Medigap policies beginning at least 18 months after enactment.


http

S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
A state identified by the HHS Secretary as requiring a change in its statutes orSame provisions.
regulations to conform its regulatory program to the requirements of this section
would have until October 1, 2008, to make such a change before being considered
out of compliance. States requiring a statutory change that do not meet in
legislative session in 2008 would be given additional time to come into
compliance. The bill would give the National Association of Insurance
Commissioners (NAIC) until June 30, 2008, to modify its model regulation to
conform to the requirements of this section. If NAIC failed to meet that deadline,
the HHS Secretary would have until October 1, 2008, to make the modifications.
Privacy and Confidentiality — Section 104 (S. 358), Section 105 (H.R. 493)
Applies the HIPAA privacy rule protections to the use and disclosure of geneticAmends HIPAA to require the HHS Secretary, by rulemaking, to revise the
information (as defined in this act). Prohibits a group health plan, healthHIPAA privacy rule as follows: (1) genetic information (as defined in the bill)
insurance issuer, or issuer of a Medigap policy from using or disclosing geneticwould be treated as health information under the privacy rule; and (2) the use and
information (including information about a request for or receipt of geneticdisclosure of genetic information by a group health plan, health insurance issuer,
services by an individual or family member) for underwriting, premium rating, oror issuer of a Medigap policy for underwriting and other activities related to the
iki/CRS-RL33988other activities related to the creation, renewal, or replacement of a contract ofcreation, renewal, or replacement of a contract of health insurance or health
g/whealth insurance or health benefits.benefits would be prohibited. Requires the HHS Secretary to publish the
s.orrevisions as a notice in the Federal Register, not later than 60 days after
leakenactment. The revisions would take effect upon publication without any prior
public comment, but may be further modified, after opportunity for public
://wiki c o mme n t .
httpProhibits a group health plan, health insurance issuer, or issuer of a Medigap[Note: similar language prohibiting the collection of genetic information appears
policy from requesting, requiring, or purchasing genetic information (includingin each of Sections 101 — 104; see above.]
information about a request for or receipt of genetic services by an individual or
family member) for underwriting, eligibility determination (before or during the
enrollment process), premium rating, or other activities related to the creation,
renewal, or replacement of a contract for health insurance or health benefits.
Obtaining genetic information incidental to the acquisition of other information
would not be considered a violation.
The above privacy and confidentiality provisions would not apply to plans,No comparable provisions.


insurers, and Medigap issuers that are not HIPAA covered entities, nor would
they apply to genetic information that is not considered individually identifiable
under the HIPAA privacy rule.

S. 358 (as reported by the HELP Committee, March 29, 2007)H.R. 493 (as passed by the House, April 25, 2007)
Provides that any group health plan, health insurance issuer, or issuer of aProvides that any group health plan, health insurance issuer, or issuer of a
Medigap policy who violates the above privacy and confidentiality provisionsMedigap policy who violates the privacy rule with respect to the use or disclosure
would be subject to the civil and criminal penalties set out in the Administrativeof genetic information would be subject to the civil and criminal penalties set out
Simplification provisions of HIPAA.in the Administrative Simplification provisions of HIPAA.
The above privacy and confidentiality provisions would not preempt moreNo comparable provisions.
stringent state requirements.
Requires the HHS Secretary to coordinate implementation of the above privacyRequires the HHS Secretary, within one year, to issue final regulations to
and confidentiality provisions with the administration of the HIPAA privacy rule.implement the above revisions to the privacy rule, in consultation with the
Secretaries of Labor and the Treasury. Provides that the above amendments to
the privacy rule will take effect 18 months after enactment.
Interagency Coordination Sections 105 & 106 (S. 358), Section 106 (H.R. 493)
Requires the Secretaries of HHS, Labor, and the Treasury, through an interagencySame provisions.
memorandum of understanding, to coordinate implementation and enforcement of
iki/CRS-RL33988Title I of this act.
g/wRequires the Secretaries of HHS, Labor, and the Treasury to issue finalNo comparable provisions. [Note: effective date provisions appear in each
s.orregulations within one year of enactment. Unless otherwise noted, thesection of Title I.]


leakamendments made by this Title shall take effect 18 months after enactment.
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