U.S. plan sponsors have so many new requirements to meet that they may not appreciate the significance of new regulations under the Genetic Information Nondiscrimination Act of 2008 (PDF) (GINA), which prohibit most uses of genetic information in underwriting and operating group health plans.
The GINA regulations, which come into effect for most plans on January 1, 2010, were jointly issued by the Department of Labor, the Internal Revenue Service, and the Department of Health and Human Services. They interpret the statute broadly and have a particular impact on the use of health risk assessments in popular wellness and disease management programs.
What is new in the GINA regulations? One item of interest is that GINA’s protected group defines family members of participants to include up to fourth degree relatives and any dependents who could be covered under a plan because of a relationship with the participant. It even includes a fetus or embryo. The regulations also broadly interpret “underwriting” to extend far beyond activities relating to pricing and rating a policy, and state that prohibited underwriting includes providing rewards, such as lower premiums, to individuals who complete health risk assessments that request genetic information about the individual or family medical history.
Participants can sue noncompliant plans for damages of $100 per day of noncompliance or for equitable relief, and there could be monetary penalties up to $500,000 for even unintentional violations of the new rules.
Plan sponsors looking to avoid unpleasant surprises should take steps to ensure compliance now, particularly for plans that are self-funded and are not run by insurers. Preparing for compliance involves coordinating software, procedures, forms and communications as well as document amendments, and it won’t be possible to do all of this on December 31.