29 U.S.C. § 1182 — Prohibiting discrimination against individual participants and beneficiaries based on health status

(a) Eligibility to enroll. (1) In general. Subject to paragraph (2), a group health plan and a group health insurer connected with it may not base an individual’s eligibility, including continued eligibility, on any of these health-status factors concerning the individual or the individual’s dependent: (A) health status; (B) a medical condition, including physical and mental illnesses; (C) claims experience; (D) receiving health care; (E) medical history; (F) genetic information; (G) evidence of insurability, including conditions resulting from domestic violence; or (H) disability. (2) Benefits and exclusions. Consistent with section 1181, paragraph (1) does not (A) require a plan or coverage to provide benefits other than those in its terms, or (B) stop a plan or coverage from limiting or restricting the amount, level, extent, or nature of benefits or coverage for similarly situated enrollees. (3) Meaning of eligibility rules. For paragraph (1), enrollment-eligibility rules include rules defining applicable waiting periods. (b) Premium contributions. (1) In general. A group health plan and a connected group health insurer may not require an individual, as a condition of enrollment or continued enrollment, to pay a premium or contribution greater than the amount charged to a similarly situated enrollee because of a health-status factor concerning the individual or the individual’s dependent. (2) Meaning. Paragraph (1) does not (A) restrict what an employer may be charged for group-plan coverage, except as paragraph (3) provides, or (B) stop a plan and insurer from offering premium discounts or rebates, or changing otherwise applicable copayments or deductibles, in return for following health-promotion and disease-prevention programs. (3) No group discrimination based on genetic information. (A) A group health plan and connected insurer may not adjust the group’s premium or contribution amounts because of genetic information. (B) This subparagraph and paragraphs (1) and (2) of subsection (d) do not limit an insurer’s ability to raise an employer’s premium because an enrolled person has a manifested disease or disorder. But the manifestation in one person may not also be used as genetic information about other group members to raise the employer’s premium further. (c) Genetic testing. (1) Limits on requesting or requiring tests. A group health plan and connected insurer may not request or require an individual or the individual’s family member to undergo a genetic test. (2) Health-care professional. Paragraph (1) does not limit a health-care professional providing services to an individual from asking that individual to undergo a genetic test. (3) Payment. (A) Paragraph (1) does not stop a plan or insurer from obtaining and using genetic-test results to decide payment, as “payment” is defined for regulations issued by the Secretary of Health and Human Services under Part C of title XI of the Social Security Act [42 U.S.C. 1320d et seq.] and section 264 of the Health Insurance Portability and Accountability Act of 1996, as those rules may later be revised, if the use is consistent with subsection (a). This section does not define “payment.” (B) The plan or insurer may request only the minimum information needed for the intended purpose. (4) Research exception. Despite paragraph (1), a plan or insurer may ask, but not require, a participant or beneficiary to undergo a genetic test only if all these conditions are met: (A) The written request is for research complying with Part 46 of title 45, Code of Federal Regulations, or equivalent Federal rules and applicable State or local rules protecting human research subjects. (B) The plan or issuer clearly tells the participant or beneficiary, or a minor child’s legal guardian, that (i) complying is voluntary and (ii) refusing will not affect enrollment status or premium or contribution amounts. (C) Genetic information collected under this paragraph is not used for underwriting. (D) The plan or issuer tells the Secretary in writing that it is conducting activities under this exception and describes them. (E) The plan or issuer follows other conditions the Secretary may require by regulation. (d) Ban on collecting genetic information. (1) A group health plan and connected insurer may not request, require, or buy genetic information for underwriting, as defined in section 1191b. This section does not define “underwriting.” (2) Before enrollment. A plan or insurer may not request, require, or buy genetic information about an individual before the individual enrolls in the plan or coverage in connection with enrollment. (3) Incidental collection. If a plan or insurer gets genetic information incidentally while requesting, requiring, or buying other information about a person, that request, requirement, or purchase is not a violation of paragraph (2) if it does not violate paragraph (1). (e) Application to all plans. Subsections (a)(1)(F), (b)(3), (c), and (d), and subsection (b)(1) and section 1181 as they concern genetic information, apply to group health plans and group health insurers regardless of section 1191a(a). (f) Genetic information of a fetus or embryo. Any reference in this part to genetic information about an individual or the individual’s family member includes (1), for a pregnant individual or family member, genetic information of any fetus the pregnant individual carries, and (2), for an individual or family member using assisted reproductive technology, genetic information of any embryo legally held by that individual or family member.