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FIFTEENTH CONGRESS OF THE REPUBLIC) earewc OF TH? SELAE
OF THE PHILIPPINES

First Regular Session )

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RECEIETS BVT

Introduced by Senator Miriam Defensor Santiago

EXPLANATORY NOTE
The Constitution, Article 2, Section 15 provides that:

‘The State shall protect and promote the right to health of
the people and instill health consciousness among them.

The Constitution, Article 13, Section 11 also mandates that:
‘The State shall adopt an integrated and comprehensive approach to
| the development which shall endeavour to make essential goods,
health and social services available to all the people at affordable
cost, priority for the needs of the underprivileged sick, elderly,
disabled,

The State shall endeavor to provide free medical care to paupers. The health of the people
is the wealth of the nation. Health can be maintained by having health insurance available to all.
Unfortunately, the accessibility of health insurance is limited by many factors, one of which is
the susceptibility of a person to contracting certain kinds of diseases.

‘Acceptance of a person as an insured by the health insurance provider depends on the
fitness of the person, which can be gleaned from his family's medical history. With the advent of
new technology for obtaining and interpreting genetic information, applicants with genes that are
predisposed to developing into a specific type of ailment are rejected and left to fend for
themselves when a medical emergency occurs. The health insurer is reluctant to assume the risk
of insuring a person vulnerable to a certain disease.

This bill seeks to prohibit discrimination on the basis of geneti information with

respect to health insurance. '

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{IRIAM DEFENSOR SANTIAY
| Phis bill was originally filed during 14 Congress, 1* Regular Session,
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FIFTEENTH CONGRESS OF THE REPUBLIC) OPP E THE SECRETARY

OF THE PHILIPPINES
First Regular Session )

sno 1522

Introduced by Senator Miriam Defensor Santiago

TO SA PY AIG 4

AN ACT
TO PROHIBIT DISCRIMINATION BECAUSE OF GENETIC INFORMATION
IN HEALTH INSURANCE COVERAGE

Be it enacted by the Senate and the House of Representatives of the Philippines in
Congress assembled:
SECTION 1. Short Title. — This Act shall be known as the “Genetic Information

Nondiscrimination in Health Insurance Act.”

SECTION 2. Declaration of Policy. ~ It is hereby declared the policy of the State to
protect and promote the right to health of the people and instill health consciousness among

them.

SECTION 3. Purposes. ~ It is the purpose of this Act to -
(A) define the right of individuals whose genetic information is disclosed;
(B) define the circumstances under which an individual’s genetic information may be
disclosed; and
_ (© protect against discrimination by a health insurer based upon an individual's

genetic information.

SECTION 3. Health Literacy Implementation Center. ~ The Secretary shall establish
within the Department a Health Literacy Implementation Center, to be headed by a Director to be
appointed by the Secretary, to enhance efforts to help eliminate the problem of low health

literacy by improving measurements, research, development, and information dissemination.

SECTION 4. Definitions. — For the purposes of this Act, the term:


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(A) “Genetic information” means information about genes, gene products, or inherited
characteristics that may be derived from an individual or a family member (including
information about a request for or receipt of genetic services).

(B) “Genetic services” means health services provided to obtain, assess, or interpret
genetic information for diagnostic and therapeutic purposes, and for genetic education and
counselling.

(©) “Predictive genetic information”

(1) IN GENERAL - means the absence of symptoms, clinical signs, or diagnosis of
the condition related to such information -

(a) information about an individual’s genetic tests;

(b) information about genetic tests of family members of the individual; or

(©) information a bout the occurrence o f a disease or disorder in family
members.
(2) EXCEPTIONS - The term “predictive genetic information” shall not include:

(a) information about the sex or age of the individual;

(b) information derived form physical tests, such as the chemical, blood, or
urine analyses of the individual including cholesterol tests; and

(c) information about physical exams of the individual.

(D) “Genetic test” means the analysis of human DNA, RNA, chromosomes, proteins, and
certain metabolites, including analysis of genotypes, mutations, phenotypes, or karyotypes, for
the purpose of diagnosing a genetic characteristic and predicting risk of disease in asymptomatic
or undiagnosed individuals.

(B) “DNA” means deoxyribonucleic acid.

(F) “Enrollee” means the person applying for health insurance.

(G) “Family members” means with respect to an individual -

* (1) the spouse of the individual;
(2) a dependent child of the individual, including a child who is born to or placed for

adoption with the individual; and



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(3) all other individuals related by blood to the individual or the spouse or child
described in subparagraph (1) or (2).
(H) “Health insurance issuer” means an insurance company or health care service

contractor providing health insurance lo regulation under state insurance laws.

SECTION 5. General Prohibition. - An insurer offering health insurance genetic
information to reject, deny, limit, cancel, refuse to renew, increase the otherwise affect health

insurance.

SECTION 6. Prohibition on Predictive Genetic Information as a Condition of Eligibility.
— A health insurance issuer offering health insurance coverage in the individual’ market or in
connection with a group health plan may not use predictive genetic information as a condition of
eligibility of an individual to enroll in individual health insurance coverage (including

information about a request for or receipt of genetic services).

SECTION 7. Prohibition on Use of Predictive Genetic Information in Setting
Premium Rates. - A healtli insurance issuer offering health insurance coverage in the
individual market or in connection with a group health plan shall not adjust premium rates for
individuals oh the basis of predictive genetic information concerning such an enrollee or a family
member of the employee (including information about a request for or receipt of genetic

services).

SECTION 8. Collection ofpredictive Genetic Information. ~

(A) Limitation on requesting or requiring predictive genetic information. ~ Except as
provided in paragraph (B), a health insurance issuer offering health insurance coverage in the
individual market or in connection with a group health plan shall not request r require predictive
genetic infomation concerning an individual or a family member of the individual (including
information about a request for or receipt of genetic services).

(B) Information needed for diagnosis, treatment, or payment, -

(1) IN GENERAL - Notwithstanding paragraph (1), a health insurance issuer offering

health insurance coverage in the individual market or in connection with a group health plan that


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provides health care items and services to an individual or dependent may request (but may not
require) that such individual or dependent disclose, or authorize the collection or disclosure of,
predictive genetic information for purposes of diagnosis, treatment, or payment relating to the
provision of health care items and services to such individual or dependent.

(2) NOTICE OF CONFDENTIALITY PRACTICES AND DESCRIPTION OF
SAFEGUARDS - As part of a request under subparagraph (1), the health insurance issuer
offering health insurance coverage in the individual or in health plan shall provide to the
individual or dependent a description of the procedures in place to safeguard the confidentiality,

1s described in section (9), of such predictive genetic information.

SECTION 9. Confidentiality with Respect to Predictive Genetic Information. -
(A) NOTICE OF CONFIDENTIALITY PRACTICES -

(1) PREPARATION OF WRITTEN NOTICE - a health insurance health insurance
issuer offering health insurance coverage in the individual or in connection with a group
health plan shall post or provide, in writing and in a clear and conspicuous manner, notice
of the issuer’s confidentiality practices, that shall include -

(a) a description of an individual’s rights with respect to predictive genetic
information

(b) the procedures established by the issuer for the exercise of the individual’s
rights; and

(c) the right to obtain a copy of the notice o f the confidentiality practices
required under this subsection.

(2) MODEL NOTICE - The Secretary of Health, in consultation with the Insurance
Commission, and after notice and opportunity for public comment, shall develop and
disseminate model notices of confidentiality practices. Unsettlement notice shall serve as
a defense against claims of receiving inappropriate notice.
®) ESTABLISHMENT OF SAFEGUARDS - A health insurance issuer offering health

insurance coverage in the individual market and in connection with a group health plan shall

establish and maintain appropriate administrative, technical, and physical safeguards to protect



the confidentiality, security, accuracy, and integrity of predictive genetic information created,

received, obtained, maintained, used, transmitted, or disposed of by such issuer.
SECTION 10. Effectivity Date, — The provisions of this Act shall apply with respect to -

(A) group health plans, for plan years beginning after one (1) year after the date of
enactment of this Act; and
(B) health insurance coverage offered, sold, issued, renewed, in effect, or operating in the

individual market after one (1) year after the date of enactment of this Act.

SECTION 11. Separability Cluuse. ~ If any provision or part thereof, is held invalid or
unconstitutional, the reminder o ft he 1 aw o ft he provision not otherwise affected shall remain

valid and subsisting.

SECTION 12. Repealing Clause. ~ Any law, presidential decree or issuance, executive
order, letter of instruction, administrative order, rule or regulation contrary to, or inconsistent

with, the provisions of this Act is hereby repealed, modified or amended accordingly.

SECTION 13. Effectivity Clause. - This Act shall take effect fifteen (15) days after its

publication in at least two (2) newspapers of general circulation

Approved,