Can genetic information be used to adjust health insurance premiums?


Given recent scientific advances, genetic testing has increased in popularity as a way to detect the risk of developing certain diseases, such as breast cancer. If one of your covered employees undergoes genetic testing, can your group health plan adjust the premium that your company pays based on the employee’s genetic information?


No. The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits a group health plan from adjusting group premium or contribution amounts for a group of similarly situated individuals based on the genetic information of members of the group.

Change from prior rules. This is a change from prior nondiscrimination requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which allowed plans to adjust premiums or contributions for the group health plan or group of similarly situated individuals (but not for specific individuals within the group) based on genetic information, as well as other health factors. Therefore, even if a plan obtained individual genetic information about group members before GINA's effective date, it cannot be used to adjust the group premium.

Under GINA and HIPAA, a plan can charge a higher overall, blended per-participant amount based on the manifestation of a disease or a disorder of an individual enrolled in the plan. However, a plan cannot use the manifestation of a disease or disorder in one individual as genetic information about other group members to further increase the group premium.

A plan can take into account the costs associated with providing benefits for covered genetic tests or genetic services in determining overall premium or contribution amounts. Note, under HIPAA, a plan cannot charge an individual more for coverage than other similarly situated individuals in the group based on any health factor, including a manifested disease or disorder.

Source:  FAQs on the Genetic Information Nondiscrimination Act, U.S. Department of Labor,

[ Return to top of document ]