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‘‘(B) the computation of premium or con-
tribution amounts under the plan or coverage; 
‘‘(C) the application of any pre-existing 
condition exclusion under the plan or coverage; 
and 
‘‘(D) other activities related to the cre-
ation, renewal, or replacement of a contract of 
health insurance or health benefits.’’. 
(e) ENFORCEMENT.— 
(1) IN
GENERAL.—Subchapter C of chapter 
100 of the Internal Revenue Code of 1986 (relating 
to general provisions) is amended by adding at the 
end the following new section: 
‘‘SEC. 9834. ENFORCEMENT. 
‘‘For the imposition of tax on any failure of a group 
health plan to meet the requirements of this chapter, see 
section 4980D.’’. 
(2) CONFORMING AMENDMENT.—The table of 
sections for subchapter C of chapter 100 of such 
Code is amended by adding at the end the following 
new item: 
‘‘Sec. 9834. Enforcement.’’. 
(f) REGULATIONS AND EFFECTIVE DATE.— 
(1) REGULATIONS.—The Secretary of the 
Treasury shall issue final regulations or other guid-
ance not later than 1 year after the date of the en-
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HR 1424 PCS
actment of this Act to carry out the amendments 
made by this section. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply with respect to group 
health plans for plan years beginning after the date 
that is 18 months after the date of the enactment 
of this Act. 
SEC. 104. AMENDMENTS TO TITLE XVIII OF THE SOCIAL SE-
CURITY ACT RELATING TO MEDIGAP. 
(a) NONDISCRIMINATION.—Section 1882(s)(2) of the 
Social Security Act (42 U.S.C. 1395ss(s)(2)) is amended 
by adding at the end the following: 
‘‘(E) An issuer of a medicare supplemental 
policy shall not deny or condition the issuance 
or effectiveness of the policy (including the im-
position of any exclusion of benefits under the 
policy based on a pre-existing condition) and 
shall not discriminate in the pricing of the pol-
icy (including the adjustment of premium rates) 
of an individual on the basis of the genetic in-
formation with respect to such individual.’’. 
(b) LIMITATIONS ON GENETIC TESTING AND GE-
NETIC INFORMATION.— 
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HR 1424 PCS
(1) IN GENERAL.—Section 1882 of the Social 
Security Act (42 U.S.C. 1395ss) is amended by add-
ing at the end the following: 
‘‘(x) LIMITATIONS ON GENETIC TESTING AND IN-
FORMATION.— 
‘‘(1) GENETIC TESTING.— 
‘‘(A) LIMITATION ON REQUESTING OR RE-
QUIRING
GENETIC
TESTING.—An issuer of a 
medicare supplemental policy shall not request 
or require an individual or a family member of 
such individual to undergo a genetic test. 
‘‘(B) RULE OF CONSTRUCTION.—Subpara-
graph (A) shall not be construed to limit the 
authority of a health care professional who is 
providing health care services to an individual 
to request that such individual undergo a ge-
netic test. 
‘‘(C) RULE OF CONSTRUCTION REGARDING 
PAYMENT.— 
‘‘(i) IN
GENERAL.—Nothing in sub-
paragraph (A) shall be construed to pre-
clude an issuer of a medicare supplemental 
policy from obtaining and using the results 
of a genetic test in making a determination 
regarding payment (as such term is de-
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HR 1424 PCS
fined for the purposes of applying the reg-
ulations promulgated by the Secretary 
under part C of title XI and section 264 
of the Health Insurance Portability and 
Accountability Act of 1996, as may be re-
vised from time to time) consistent with 
subsection (s)(2)(E). 
‘‘(ii) LIMITATION.—For purposes of 
clause (i), an issuer of a medicare supple-
mental policy may request only the min-
imum amount of information necessary to 
accomplish the intended purpose. 
‘‘(D) RESEARCH
EXCEPTION.—Notwith-
standing subparagraph (A), an issuer of a 
medicare supplemental policy may request, but 
not require, that an individual or a family mem-
ber of such individual undergo a genetic test if 
each of the following conditions is met: 
‘‘(i) The request is made pursuant to 
research that complies with part 46 of title 
45, Code of Federal Regulations, or equiv-
alent Federal regulations, and any applica-
ble State or local law or regulations for the 
protection of human subjects in research. 
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HR 1424 PCS
‘‘(ii) The issuer clearly indicates to 
each individual, or in the case of a minor 
child, to the legal guardian of such child, 
to whom the request is made that— 
‘‘(I) compliance with the request 
is voluntary; and 
‘‘(II) non-compliance will have no 
effect on enrollment status or pre-
mium or contribution amounts. 
‘‘(iii) No genetic information collected 
or acquired under this subparagraph shall 
be used for underwriting, determination of 
eligibility to enroll or maintain enrollment 
status, premium rating, or the creation, re-
newal, or replacement of a plan, contract, 
or coverage for health insurance or health 
benefits. 
‘‘(iv) The issuer notifies the Secretary 
in writing that the issuer is conducting ac-
tivities pursuant to the exception provided 
for under this subparagraph, including a 
description of the activities conducted. 
‘‘(v) The issuer complies with such 
other conditions as the Secretary may by 
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HR 1424 PCS
regulation require for activities conducted 
under this subparagraph. 
‘‘(2) PROHIBITION
ON
COLLECTION
OF
GE-
NETIC INFORMATION.— 
‘‘(A) IN GENERAL.—An issuer of a medi-
care supplemental policy shall not request, re-
quire, or purchase genetic information for un-
derwriting purposes (as defined in paragraph 
(3)). 
‘‘(B) PROHIBITION
ON
COLLECTION
OF 
GENETIC
INFORMATION
PRIOR
TO
ENROLL-
MENT.—An issuer of a medicare supplemental 
policy shall not request, require, or purchase ge-
netic information with respect to any individual 
prior to such individual’s enrollment under the 
policy in connection with such enrollment. 
‘‘(C) INCIDENTAL
COLLECTION.—If an 
issuer of a medicare supplemental policy obtains 
genetic information incidental to the requesting, 
requiring, or purchasing of other information 
concerning any individual, such request, re-
quirement, or purchase shall not be considered 
a violation of subparagraph (B) if such request, 
requirement, or purchase is not in violation of 
subparagraph (A). 
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‘‘(3) DEFINITIONS.—In this subsection: 
‘‘(A) FAMILY MEMBER.—The term ‘family 
member’ means with respect to an individual, 
any other individual who is a first-degree, sec-
ond-degree, third-degree, or fourth-degree rel-
ative of such individual. 
‘‘(B) GENETIC INFORMATION.— 
‘‘(i) IN GENERAL.—The term ‘genetic 
information’ means, with respect to any in-
dividual, information about— 
‘‘(I) such individual’s genetic 
tests, 
‘‘(II) the genetic tests of family 
members of such individual, and 
‘‘(III) subject to clause (iv), the 
manifestation of a disease or disorder 
in family members of such individual. 
‘‘(ii) INCLUSION
OF
GENETIC
SERV-
ICES.—Such term includes, with respect to 
any individual, any request for, or receipt 
of, genetic services (including genetic serv-
ices received pursuant to participation in 
clinical research) by such individual or any 
family member of such individual. 
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HR 1424 PCS
‘‘(iii) EXCLUSIONS.—The term ‘ge-
netic information’ shall not include infor-
mation about the sex or age of any indi-
vidual. 
‘‘(C) GENETIC TEST.— 
‘‘(i) IN GENERAL.—The term ‘genetic 
test’ means an analysis of human DNA, 
RNA, chromosomes, proteins, or metabo-
lites, that detects genotypes, mutations, or 
chromosomal changes. 
‘‘(ii) EXCEPTIONS.—The term ‘genetic 
test’ does not mean— 
‘‘(I) an analysis of proteins or 
metabolites that does not detect 
genotypes, mutations, or chromosomal 
changes; or 
‘‘(II) an analysis of proteins or 
metabolites that is directly related to 
a manifested disease, disorder, or 
pathological condition that could rea-
sonably be detected by a health care 
professional with appropriate training 
and expertise in the field of medicine 
involved. 
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HR 1424 PCS
‘‘(D) GENETIC SERVICES.—The term ‘ge-
netic services’ means— 
‘‘(i) a genetic test; 
‘‘(ii) genetic counseling (including ob-
taining, interpreting, or assessing genetic 
information); or 
‘‘(iii) genetic education. 
‘‘(E) 
UNDERWRITING
PURPOSES.—The 
term ‘underwriting purposes’ means, with re-
spect to a medicare supplemental policy— 
‘‘(i) rules for, or determination of, eli-
gibility (including enrollment and contin-
ued eligibility) for benefits under the pol-
icy; 
‘‘(ii) the computation of premium or 
contribution amounts under the policy; 
‘‘(iii) the application of any pre-exist-
ing condition exclusion under the policy; 
and 
‘‘(iv) other activities related to the 
creation, renewal, or replacement of a con-
tract of health insurance or health bene-
fits. 
‘‘(F) ISSUER
OF
A
MEDICARE
SUPPLE-
MENTAL POLICY.—The term ‘issuer of a medi-
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HR 1424 PCS
care supplemental policy’ includes a third-party 
administrator or other person acting for or on 
behalf of such issuer.’’. 
(2) APPLICATION TO GENETIC INFORMATION OF 
A FETUS OR EMBRYO.—Section 1882(x) of such Act, 
as added by paragraph (1), is further amended by 
adding at the end the following: 
‘‘(4) GENETIC INFORMATION OF A FETUS OR 
EMBRYO.—Any reference in this section to genetic 
information concerning an individual or family mem-
ber of an individual shall— 
‘‘(A) with respect to such an individual or 
family member of an individual who is a preg-
nant woman, include genetic information of any 
fetus carried by such pregnant woman; and 
‘‘(B) with respect to an individual or fam-
ily member utilizing an assisted reproductive 
technology, include genetic information of any 
embryo legally held by the individual or family 
member.’’. 
(3) 
CONFORMING
AMENDMENT.—Section 
1882(o) of the Social Security Act (42 U.S.C. 
1395ss(o)) is amended by adding at the end the fol-
lowing: 
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HR 1424 PCS
‘‘(4) The issuer of the medicare supplemental 
policy complies with subsection (s)(2)(E) and sub-
section (x).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to an issuer of a medi-
care supplemental policy for policy years beginning on or 
after the date that is 18 months after the date of enact-
ment of this Act. 
(d) TRANSITION PROVISIONS.— 
(1) IN GENERAL.—If the Secretary of Health 
and Human Services identifies a State as requiring 
a change to its statutes or regulations to conform its 
regulatory program to the changes made by this sec-
tion, the State regulatory program shall not be con-
sidered to be out of compliance with the require-
ments of section 1882 of the Social Security Act due 
solely to failure to make such change until the date 
specified in paragraph (4). 
(2) NAIC STANDARDS.—If, not later than June 
30, 2008, the National Association of Insurance 
Commissioners (in this subsection referred to as the 
‘‘NAIC’’) modifies its NAIC Model Regulation relat-
ing to section 1882 of the Social Security Act (re-
ferred to in such section as the 1991 NAIC Model 
Regulation, as subsequently modified) to conform to 
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HR 1424 PCS
the amendments made by this section, such revised 
regulation incorporating the modifications shall be 
considered to be the applicable NAIC model regula-
tion (including the revised NAIC model regulation 
and the 1991 NAIC Model Regulation) for the pur-
poses of such section. 
(3) SECRETARY
STANDARDS.—If the NAIC 
does not make the modifications described in para-
graph (2) within the period specified in such para-
graph, the Secretary of Health and Human Services 
shall, not later than October 1, 2008, make the 
modifications described in such paragraph and such 
revised regulation incorporating the modifications 
shall be considered to be the appropriate regulation 
for the purposes of such section. 
(4) DATE SPECIFIED.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the date specified in this paragraph 
for a State is the earlier of— 
(i) the date the State changes its stat-
utes or regulations to conform its regu-
latory program to the changes made by 
this section, or 
(ii) October 1, 2008. 
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