Discrimination in Health Insurance

Discrimination in health insurance has made necessary protection of patients in areas involving enrollment eligibility, payment, genetics and research, information protection, and benefits. The Office of Civil Rights prevents discrimination and enforces privacy of health information held by insurers.

Enrollment Eligibility

• A group health plan, and a health insurance issuer, may not establish rules for eligibility for an individual's enrollment based on health-status related factors of medical condition (physical and mental), claims experience, medical history, disability, or receipt of health care. Yet the group health insurance coverage need not provide particular benefits other than those under the terms of plan or coverage. Coverage is not prevented from establishing limitations or restrictions on the amount, extent, or nature of benefits.

Genetic Tests

• A group health plan and a health insurance issuer cannot require or request an individual or family member to have genetic testing. Yet this does not prevent a group health plan or health insurance issuer from obtaining the genetic testing results, the minimum amount of information, in determining payment.

Premium Payments

• An individual is not required to pay a premium or contribute to a group health plan or health insurance provider as a condition of enrollment eligibility or continued enrollment of a plan. This does not restrict the amount the employer can charge for coverage or prevent the group health plan and health insurance provider from issuing premium discounts, or modifying applicable co-payments or deductibles, in adherence to programs of health promotion and disease prevention as a return.