IB 
Union Calendar No. 46 
110TH CONGRESS 
1ST SESSION 
H. R. 493 
[Report No. 110–28, Parts I, II, and III] 
To prohibit discrimination on the basis of genetic information with respect 
to health insurance and employment. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 16, 2007 
Ms. SLAUGHTER (for herself, Mrs. BIGGERT, Ms. ESHOO, Mr. WALDEN of Or-
egon, Mr. GEORGE MILLER of California, Mr. DINGELL, Mr. RANGEL, 
Mr. ACKERMAN, Mr. ALEXANDER, Mr. ALLEN, Mr. BACHUS, Mr. BAKER, 
Ms. BALDWIN, Mr. BARTLETT of Maryland, Mr. BILIRAKIS, Mrs. 
BLACKBURN, Mr. BLUMENAUER, Mrs. BONO, Mr. BOUSTANY, Mr. 
BROWN of South Carolina, Ms. GINNY BROWN-WAITE of Florida, Mr. 
BURTON of Indiana, Mr. CALVERT, Mrs. CAPITO, Mrs. CAPPS, Mr. 
CAPUANO, Mr. CASTLE, Mr. CHABOT, Mr. CHANDLER, Mr. COLE of 
Oklahoma, Mr. CONAWAY, Mr. CONYERS, Mrs. DAVIS of California, Mr. 
TOM DAVIS of Virginia, Mr. DAVIS of Kentucky, Ms. DEGETTE, Mr. 
DICKS, Mr. DOGGETT, Mrs. DRAKE, Mr. DUNCAN, Mr. EHLERS, Mr. 
EMANUEL, Mrs. EMERSON, Mr. ENGEL, Mr. ENGLISH of Pennsylvania, 
Mr. FARR, Mr. FERGUSON, Mr. FRELINGHUYSEN, Mr. GALLEGLY, Mr. 
GERLACH, Mr. GILCHREST, Mr. GILLMOR, Mr. GOHMERT, Ms. GRANGER, 
Mr. GENE GREEN of Texas, Mr. GRIJALVA, Mr. HALL of Texas, Mr. 
HASTINGS of Washington, Mr. HERGER, Ms. HERSETH, Mr. HINOJOSA, 
Ms. HIRONO, Mr. HOBSON, Mr. HOEKSTRA, Ms. HOOLEY, Mr. HUNTER, 
Mr. ISRAEL, Mr. JOHNSON of Illinois, Mr. JONES of North Carolina, Mr. 
KANJORSKI, Mr. KENNEDY, Mr. KILDEE, Mr. KING of New York, Mr. 
KIRK, Mr. KUCINICH, Mr. KUHL of New York, Mr. LAHOOD, Mr. 
LATHAM, Mr. LEWIS of Kentucky, Mr. LIPINSKI, Mr. LOBIONDO, Ms. 
ZOE LOFGREN of California, Mr. LUCAS, Mrs. MALONEY of New York, 
Mr. MANZULLO, Mr. MARCHANT, Mr. MCCAUL of Texas, Ms. MCCOLLUM 
of Minnesota, Mr. MCCOTTER, Mr. MCHUGH, Mr. MCNULTY, Mr. MICA, 
Mr. MORAN of Virginia, Mrs. MYRICK, Mr. NEUGEBAUER, Mr. NOR-
WOOD, Mr. OLVER, Mr. PEARCE, Mr. PITTS, Mr. PLATTS, Mr. PORTER, 
Mr. PRICE of North Carolina, Ms. PRYCE of Ohio, Mr. PUTNAM, Mr. 
RAMSTAD, Mr. REGULA, Mr. REICHERT, Mr. REYNOLDS, Mr. ROSKAM, 
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Ms. ROS-LEHTINEN, Mr. RYAN
of Wisconsin, Mr. SAXTON, Ms. 
SCHAKOWSKY, Mr. SCHIFF, Mr. SESSIONS, Mr. SHAYS, Mr. SIMPSON, 
Ms. SOLIS, Mr. SOUDER, Mr. STARK, Mr. THOMPSON of California, Mr. 
TIBERI, Mr. TIERNEY, Mr. UDALL of New Mexico, Mr. UPTON, Mr. VAN 
HOLLEN, Mr. WALSH of New York, Mr. WAMP, Ms. WATSON, Mr. WAX-
MAN, Mr. WELLER of Illinois, Mr. WEXLER, Mr. WHITFIELD, Mr. WICK-
ER, Mr. WILSON of South Carolina, Mr. WOLF, Ms. WOOLSEY, Mr. 
YARMUTH, Mr. YOUNG of Florida, Mr. CROWLEY, Mr. HOLT, Mr. 
JINDAL, Mr. LATOURETTE, and Mr. TANCREDO) introduced the following 
bill; which was referred to the Committee on Education and Labor, and 
in addition to the Committees on Energy and Commerce and Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
MARCH 5, 2007 
Reported from the Committee on Education and Labor with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
MARCH 5, 2007 
Referral to the Committees on Energy and Commerce and Ways and Means 
extended for a period ending not later than March 23, 2007 
MARCH 23, 2007 
Referral to the Committees on Energy and Commerce and Ways and Means 
extended for a period ending not later than March 26, 2007 
MARCH 26, 2007 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in boldface roman] 
MARCH 26, 2007 
Referral to the Committee on Energy and Commerce extended for a period 
ending not later than March 29, 2007 
MARCH 29, 2007 
Additional sponsors: Mr. HOYER, Ms. CASTOR, Mrs. JO ANN DAVIS of Vir-
ginia, Mr. ROTHMAN, Mr. FEENEY, Mr. POE, Mr. MEEHAN, Mr. 
DEFAZIO, Mr. WEINER, Mr. OBERSTAR, Mr. PALLONE, Mr. MCGOVERN, 
Mr. MILLER of North Carolina, Ms. NORTON, Mr. PASCRELL, Ms. 
SCHWARTZ, Mr. FRANK of Massachusetts, Mr. LARSON of Connecticut, 
Ms. HARMAN, Mr. LEWIS of Georgia, Mr. TOWNS, Mr. HINCHEY, Mr. 
WU, Mr. LANGEVIN, Mrs. MCCARTHY of New York, Mr. BERRY, Mr. 
CLAY, Mr. HIGGINS, Mrs. LOWEY, Mr. HARE, Mr. SPRATT, Mr. 
MCDERMOTT, Ms. LINDA T. SA´NCHEZ of California, Ms. DELAURO, Mr. 
MOORE
of Kansas, Mr. PAYNE, Mr. BERMAN, Mr. LEVIN, Mr. 
COURTNEY, Mr. MURTHA, Mr. CLEAVER, Mr. GORDON of Tennessee, Mr. 
BOUCHER, Mr. SESTAK, Mr. KIND, Mr. COSTELLO, Ms. SHEA-PORTER, 
Mr. ABERCROMBIE, Mr. CUMMINGS, Mr. SHERMAN, Mr. DOYLE, Mr. 
BISHOP of New York, Mr. SCOTT of Virginia, Mr. MARKEY, Mr. 
LOEBSACK, Mrs. MUSGRAVE, Ms. BERKLEY, Ms. SUTTON, Mr. STUPAK, 
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Mr. COHEN, Mr. MELANCON, Mr. OBEY, Mrs. TAUSCHER, Mr. PICK-
ERING, Mr. MATHESON, Mr. WYNN, Mr. CRAMER, Mr. ETHERIDGE, Mr. 
ROSS, Ms. BEAN, Mr. RUSH, Mr. DAVIS of Illinois, Mr. ALTMIRE, Mr. 
GONZALEZ, Mr. COOPER, Mr. BUTTERFIELD, Mr. INSLEE, Mr. UDALL 
of Colorado, Mr. DAVIS of Alabama, Mr. HILL, and Mr. FATTAH 
MARCH 29, 2007 
Reported from the Committee on Energy and Commerce with an amendment; 
committed to the Committee of the Whole House on the State of the 
Union and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in boldface italic] 
[For text of introduced bill, see copy of bill as introduced on January 16, 2007] 
A BILL 
To prohibit discrimination on the basis of genetic information 
with respect to health insurance and employment. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Ge-
netic Information Nondiscrimination Act of 2007’’. 
(b) TABLE OF CONTENTS.—The table of contents of this 
Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—GENETIC NONDISCRIMINATION IN HEALTH INSURANCE 
Sec. 101. Amendments to Employee Retirement Income Security Act of 1974. 
Sec. 102. Amendments to the Public Health Service Act. 
Sec. 103. Amendments to title XVIII of the Social Security Act relating to 
medigap. 
Sec. 104. Privacy and confidentiality. 
Sec. 105. Assuring coordination. 
Sec. 106. Regulations; effective date. 
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TITLE II—PROHIBITING EMPLOYMENT DISCRIMINATION ON THE 
BASIS OF GENETIC INFORMATION 
Sec. 201. Definitions. 
Sec. 202. Employer practices. 
Sec. 203. Employment agency practices. 
Sec. 204. Labor organization practices. 
Sec. 205. Training programs. 
Sec. 206. Confidentiality of genetic information. 
Sec. 207. Remedies and enforcement. 
Sec. 208. Disparate impact. 
Sec. 209. Construction. 
Sec. 210. Medical information that is not genetic information. 
Sec. 211. Regulations. 
Sec. 212. Authorization of appropriations. 
Sec. 213. Effective date. 
TITLE III—MISCELLANEOUS PROVISION 
Sec. 301. Severability. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Deciphering the sequence of the human ge-
nome and other advances in genetics open major new 
opportunities for medical progress. New knowledge 
about the genetic basis of illness will allow for earlier 
detection of illnesses, often before symptoms have 
begun. Genetic testing can allow individuals to take 
steps to reduce the likelihood that they will contract 
a particular disorder. New knowledge about genetics 
may allow for the development of better therapies that 
are more effective against disease or have fewer side 
effects than current treatments. These advances give 
rise to the potential misuse of genetic information to 
discriminate in health insurance and employment. 
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(2) The early science of genetics became the basis 
of State laws that provided for the sterilization of 
persons having presumed genetic ‘‘defects’’ such as 
mental retardation, mental disease, epilepsy, blind-
ness, and hearing loss, among other conditions. The 
first sterilization law was enacted in the State of In-
diana in 1907. By 1981, a majority of States adopted 
sterilization laws to ‘‘correct’’ apparent genetic traits 
or tendencies. Many of these State laws have since 
been repealed, and many have been modified to in-
clude essential constitutional requirements of due 
process and equal protection. However, the current ex-
plosion in the science of genetics, and the history of 
sterilization laws by the States based on early genetic 
science, compels Congressional action in this area. 
(3) Although genes are facially neutral markers, 
many genetic conditions and disorders are associated 
with particular racial and ethnic groups and gender. 
Because some genetic traits are most prevalent in 
particular groups, members of a particular group 
may be stigmatized or discriminated against as a re-
sult of that genetic information. This form of dis-
crimination was evident in the 1970s, which saw the 
advent of programs to screen and identify carriers of 
sickle cell anemia, a disease which afflicts African- 
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Americans. Once again, State legislatures began to 
enact discriminatory laws in the area, and in the 
early 1970s began mandating genetic screening of all 
African Americans for sickle cell anemia, leading to 
discrimination and unnecessary fear. To alleviate 
some of this stigma, Congress in 1972 passed the Na-
tional Sickle Cell Anemia Control Act, which with-
holds Federal funding from States unless sickle cell 
testing is voluntary. 
(4) Congress has been informed of examples of 
genetic discrimination in the workplace. These in-
clude the use of pre-employment genetic screening at 
Lawrence Berkeley Laboratory, which led to a court 
decision in favor of the employees in that case Nor-
man-Bloodsaw v. Lawrence Berkeley Laboratory (135 
F.3d 1260, 1269 (9th Cir. 1998)). Congress clearly 
has a compelling public interest in relieving the fear 
of discrimination and in prohibiting its actual prac-
tice in employment and health insurance. 
(5) Federal law addressing genetic discrimina-
tion in health insurance and employment is incom-
plete in both the scope and depth of its protections. 
Moreover, while many States have enacted some type 
of genetic non-discrimination law, these laws vary 
widely with respect to their approach, application, 
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and level of protection. Congress has collected substan-
tial evidence that the American public and the med-
ical community find the existing patchwork of State 
and Federal laws to be confusing and inadequate to 
protect them from discrimination. Therefore Federal 
legislation establishing a national and uniform basic 
standard is necessary to fully protect the public from 
discrimination and allay their concerns about the po-
tential for discrimination, thereby allowing individ-
uals to take advantage of genetic testing, technologies, 
research, and new therapies. 
TITLE 
I—GENETIC 
NON-
DISCRIMINATION IN HEALTH 
INSURANCE 
SEC. 101. AMENDMENTS TO EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974. 
(a) PROHIBITION OF HEALTH DISCRIMINATION ON 
THE BASIS OF GENETIC INFORMATION OR GENETIC SERV-
ICES.— 
(1) NO ENROLLMENT RESTRICTION FOR GENETIC 
SERVICES.—Section 702(a)(1)(F) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1182(a)(1)(F)) is amended by inserting before the pe-
riod the following: ‘‘(including information about a 
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request for or receipt of genetic services by an indi-
vidual or family member of such individual)’’. 
(2) NO
DISCRIMINATION
IN
GROUP
PREMIUMS 
BASED ON GENETIC INFORMATION.—Section 702(b) of 
the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1182(b)) is amended— 
(A) in paragraph (2)(A), by inserting before 
the semicolon the following: ‘‘except as provided 
in paragraph (3)’’; and 
(B) by adding at the end the following: 
‘‘(3) NO DISCRIMINATION IN GROUP PREMIUMS 
BASED ON GENETIC INFORMATION.—For purposes of 
this section, a group health plan, or a health insur-
ance issuer offering group health insurance coverage 
in connection with a group health plan, shall not ad-
just premium or contribution amounts for a group on 
the basis of genetic information concerning an indi-
vidual in the group or a family member of the indi-
vidual (including information about a request for or 
receipt of genetic services by an individual or family 
member of such individual).’’. 
(b) LIMITATIONS ON GENETIC TESTING.—Section 702 
of the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1182) is amended by adding at the end the fol-
lowing: 
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‘‘(c) GENETIC TESTING.— 
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING 
GENETIC TESTING.—A group health plan, or a health 
insurance issuer offering health insurance coverage in 
connection with a group health plan, shall not request 
or require an individual or a family member of such 
individual to undergo a genetic test. 
‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 
part shall be construed to— 
‘‘(A) limit the authority of a health care 
professional who is providing health care services 
with respect to an individual to request that 
such individual or a family member of such in-
dividual undergo a genetic test; 
‘‘(B) limit the authority of a health care 
professional who is employed by or affiliated 
with a group health plan or a health insurance 
issuer and who is providing health care services 
to an individual as part of a bona fide wellness 
program to notify such individual of the avail-
ability of a genetic test or to provide information 
to such individual regarding such genetic test; or 
‘‘(C) authorize or permit a health care pro-
fessional to require that an individual undergo a 
genetic test. 
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‘‘(d) APPLICATION TO ALL PLANS.—The provisions of 
subsections (a)(1)(F), (b)(3), and (c) shall apply to group 
health plans and health insurance issuers without regard 
to section 732(a). 
‘‘(e) GENETIC INFORMATION OF A FETUS.—Any ref-
erence in this section to genetic information concerning an 
individual or family member of an individual shall, with 
respect to such an individual or family member of an indi-
vidual who is a pregnant woman, include genetic informa-
tion of any fetus carried by such pregnant woman.’’. 
(c) DEFINITIONS.—Section 733(d) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1191b(d)) 
is amended by adding at the end the following: 
‘‘(5) FAMILY MEMBER.—The term ‘family mem-
ber’ means with respect to an individual— 
‘‘(A) the spouse of the individual; 
‘‘(B) a dependent child of the individual; 
and 
‘‘(C) any other individual who is a first-de-
gree, second-degree, third-degree, or fourth-degree 
relative of an individual described in subpara-
graph (A) or (B). 
‘‘(6) GENETIC INFORMATION.— 
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dition that could reasonably be detected by 
a health care professional with appropriate 
training and expertise in the field of medi-
cine involved. 
‘‘(8) GENETIC
SERVICES.—The term ‘genetic 
services’ means— 
‘‘(A) a genetic test; 
‘‘(B) genetic counseling (including obtain-
ing, interpreting, or assessing genetic informa-
tion); or 
‘‘(C) genetic education.’’. 
(d) ERISA ENFORCEMENT.—Section 502 of the Em-
ployee Retirement Income Security Act of 1974 (29 U.S.C. 
1132) is amended— 
(1) in subsection (a)(6), by striking ‘‘(7), or (8)’’ 
and inserting ‘‘(7), (8), or (9)’’; and 
(2) in subsection (c), by redesignating paragraph 
(9) as paragraph (10), and by inserting after para-
graph (8) the following new paragraph: 
‘‘(9) SECRETARIAL
ENFORCEMENT
AUTHORITY 
RELATING TO USE OF GENETIC INFORMATION.— 
‘‘(A) GENERAL RULE.—The Secretary may 
impose a penalty against any plan sponsor of a 
group health plan, or any health insurance 
issuer offering health insurance coverage in con-
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nection with the plan, for any failure by such 
sponsor or issuer to meet the requirements of 
subsection (a)(1)(F), (b)(3), or (c) of section 702 
or of section 714 in connection with the plan. 
‘‘(B) AMOUNT.— 
‘‘(i) IN GENERAL.—The amount of the 
penalty imposed by subparagraph (A) shall 
be $100 for each day in the noncompliance 
period with respect to each participant or 
beneficiary to whom such failure relates. 
‘‘(ii) NONCOMPLIANCE
PERIOD.—For 
purposes of this paragraph, the term ‘non-
compliance period’ means, with respect to 
any failure, the period— 
‘‘(I) beginning on the date such 
failure first occurs; and 
‘‘(II) ending on the date such fail-
ure is corrected. 
‘‘(C) MINIMUM PENALTIES WHERE FAILURE 
DISCOVERED.—Notwithstanding clauses (i) and 
(ii) of subparagraph (D): 
‘‘(i) IN GENERAL.—In the case of 1 or 
more failures with respect to a participant 
or beneficiary— 
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‘‘(I) which are not corrected before 
the date on which the plan receives a 
notice from the Secretary of such viola-
tion; and 
‘‘(II) which occurred or continued 
during the period involved; 
the amount of penalty imposed by subpara-
graph (A) by reason of such failures with 
respect to such participant or beneficiary 
shall not be less than $2,500. 
‘‘(ii) 
HIGHER
MINIMUM
PENALTY 
WHERE
VIOLATIONS
ARE
MORE
THAN
DE 
MINIMIS.—To the extent violations for 
which any person is liable under this para-
graph for any year are more than de mini-
mis, clause (i) shall be applied by sub-
stituting ‘$15,000’ for ‘$2,500’ with respect 
to such person. 
‘‘(D) LIMITATIONS.— 
‘‘(i) PENALTY NOT TO APPLY WHERE 
FAILURE
NOT
DISCOVERED
EXERCISING 
REASONABLE DILIGENCE.—No penalty shall 
be imposed by subparagraph (A) on any 
failure during any period for which it is es-
tablished to the satisfaction of the Secretary 
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that the person otherwise liable for such 
penalty did not know, and exercising rea-
sonable diligence would not have known, 
that such failure existed. 
‘‘(ii) PENALTY NOT TO APPLY TO FAIL-
URES CORRECTED WITHIN CERTAIN PERI-
ODS.—No penalty shall be imposed by sub-
paragraph (A) on any failure if— 
‘‘(I) such failure was due to rea-
sonable cause and not to willful ne-
glect; and 
‘‘(II) such failure is corrected dur-
ing the 30-day period beginning on the 
first date the person otherwise liable 
for such penalty knew, or exercising 
reasonable diligence would have known, 
that such failure existed. 
‘‘(iii) OVERALL LIMITATION FOR UNIN-
TENTIONAL FAILURES.—In the case of fail-
ures which are due to reasonable cause and 
not to willful neglect, the penalty imposed 
by subparagraph (A) for failures shall not 
exceed the amount equal to the lesser of— 
‘‘(I) 10 percent of the aggregate 
amount paid or incurred by the plan 
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sponsor (or predecessor plan sponsor) 
during the preceding taxable year for 
group health plans; or 
‘‘(II) $500,000. 
‘‘(E) WAIVER BY SECRETARY.—In the case 
of a failure which is due to reasonable cause and 
not to willful neglect, the Secretary may waive 
part or all of the penalty imposed by subpara-
graph (A) to the extent that the payment of such 
penalty would be excessive relative to the failure 
involved. 
‘‘(F) DEFINITIONS.—Terms used in this 
paragraph which are defined in section 733 shall 
have the meanings provided such terms in such 
section.’’. 
(e) REGULATIONS AND EFFECTIVE DATE.— 
(1) REGULATIONS.—The Secretary of Labor shall 
issue final regulations not later than 1 year after the 
date of enactment of this Act to carry out the amend-
ments 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 enactment of this 
title. 
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SEC. 102. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) AMENDMENTS RELATING TO THE GROUP MAR-
KET.— 
(1) PROHIBITION
OF
HEALTH
DISCRIMINATION 
ON THE BASIS OF GENETIC INFORMATION OR GENETIC 
SERVICES.— 
(A) NO ENROLLMENT RESTRICTION FOR GE-
NETIC SERVICES.—Section 2702(a)(1)(F) of the 
Public Health Service Act (42 U.S.C. 300gg– 
1(a)(1)(F)) is amended by inserting before the 
period the following: ‘‘(including information 
about a request for or receipt of genetic services 
by an individual or family member of such indi-
vidual)’’. 
(B) NO
DISCRIMINATION
IN
GROUP
PRE-
MIUMS BASED ON GENETIC INFORMATION.—Sec-
tion 2702(b) of the Public Health Service Act (42 
U.S.C. 300gg–1(b)) is amended— 
(i) in paragraph (2)(A), by inserting 
before the semicolon the following: ‘‘, except 
as provided in paragraph (3)’’; and 
(ii) by adding at the end the following: 
‘‘(3) NO DISCRIMINATION IN GROUP PREMIUMS 
BASED ON GENETIC INFORMATION.—For purposes of 
this section, a group health plan, or a health insur-
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ance issuer offering group health insurance coverage 
in connection with a group health plan, shall not ad-
just premium or contribution amounts for a group on 
the basis of genetic information concerning an indi-
vidual in the group or a family member of the indi-
vidual (including information about a request for or 
receipt of genetic services by an individual or family 
member of such individual).’’. 
(2) LIMITATIONS ON GENETIC TESTING.—Section 
2702 of the Public Health Service Act (42 U.S.C. 
300gg–1) is amended by adding at the end the fol-
lowing: 
‘‘(c) GENETIC TESTING.— 
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING 
GENETIC TESTING.—A group health plan, or a health 
insurance issuer offering health insurance coverage in 
connection with a group health plan, shall not request 
or require an individual or a family member of such 
individual to undergo a genetic test. 
‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 
part shall be construed to— 
‘‘(A) limit the authority of a health care 
professional who is providing health care services 
with respect to an individual to request that 
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such individual or a family member of such in-
dividual undergo a genetic test; 
‘‘(B) limit the authority of a health care 
professional who is employed by or affiliated 
with a group health plan or a health insurance 
issuer and who is providing health care services 
to an individual as part of a bona fide wellness 
program to notify such individual of the avail-
ability of a genetic test or to provide information 
to such individual regarding such genetic test; or 
‘‘(C) authorize or permit a health care pro-
fessional to require that an individual undergo a 
genetic test. 
‘‘(d) APPLICATION TO ALL PLANS.—The provisions of 
subsections (a)(1)(F), (b)(3), and (c) shall apply to group 
health plans and health insurance issuers without regard 
to section 2721(a).’’. 
(3) REMEDIES
AND
ENFORCEMENT.—Section 
2722(b) of the Public Health Service Act (42 U.S.C. 
300gg–22(b)) is amended by adding at the end the fol-
lowing: 
‘‘(3) ENFORCEMENT
AUTHORITY
RELATING
TO 
GENETIC DISCRIMINATION.— 
‘‘(A) GENERAL
RULE.—In the cases de-
scribed in paragraph (1), notwithstanding the 
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provisions of paragraph (2)(C), the following 
provisions shall apply with respect to an action 
under this subsection by the Secretary with re-
spect to any failure of a health insurance issuer 
in connection with a group health plan, to meet 
the requirements of subsection (a)(1)(F), (b)(3), 
or (c) of section 2702. 
‘‘(B) AMOUNT.— 
‘‘(i) IN GENERAL.—The amount of the 
penalty imposed under this paragraph shall 
be $100 for each day in the noncompliance 
period with respect to each individual to 
whom such failure relates. 
‘‘(ii) NONCOMPLIANCE
PERIOD.—For 
purposes of this paragraph, the term ‘non-
compliance period’ means, with respect to 
any failure, the period— 
‘‘(I) beginning on the date such 
failure first occurs; and 
‘‘(II) ending on the date such fail-
ure is corrected. 
‘‘(C) MINIMUM PENALTIES WHERE FAILURE 
DISCOVERED.—Notwithstanding clauses (i) and 
(ii) of subparagraph (D): 
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‘‘(i) IN GENERAL.—In the case of 1 or 
more failures with respect to an indi-
vidual— 
‘‘(I) which are not corrected before 
the date on which the plan receives a 
notice from the Secretary of such viola-
tion; and 
‘‘(II) which occurred or continued 
during the period involved; 
the amount of penalty imposed by subpara-
graph (A) by reason of such failures with 
respect to such individual shall not be less 
than $2,500. 
‘‘(ii) 
HIGHER
MINIMUM
PENALTY 
WHERE
VIOLATIONS
ARE
MORE
THAN
DE 
MINIMIS.—To the extent violations for 
which any person is liable under this para-
graph for any year are more than de mini-
mis, clause (i) shall be applied by sub-
stituting ‘$15,000’ for ‘$2,500’ with respect 
to such person. 
‘‘(D) LIMITATIONS.— 
‘‘(i) PENALTY NOT TO APPLY WHERE 
FAILURE
NOT
DISCOVERED
EXERCISING 
REASONABLE DILIGENCE.—No penalty shall 
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be imposed by subparagraph (A) on any 
failure during any period for which it is es-
tablished to the satisfaction of the Secretary 
that the person otherwise liable for such 
penalty did not know, and exercising rea-
sonable diligence would not have known, 
that such failure existed. 
‘‘(ii) PENALTY NOT TO APPLY TO FAIL-
URES CORRECTED WITHIN CERTAIN PERI-
ODS.—No penalty shall be imposed by sub-
paragraph (A) on any failure if— 
‘‘(I) such failure was due to rea-
sonable cause and not to willful ne-
glect; and 
‘‘(II) such failure is corrected dur-
ing the 30-day period beginning on the 
first date the person otherwise liable 
for such penalty knew, or exercising 
reasonable diligence would have known, 
that such failure existed. 
‘‘(iii) OVERALL LIMITATION FOR UNIN-
TENTIONAL FAILURES.—In the case of fail-
ures which are due to reasonable cause and 
not to willful neglect, the penalty imposed 
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by subparagraph (A) for failures shall not 
exceed the amount equal to the lesser of— 
‘‘(I) 10 percent of the aggregate 
amount paid or incurred by the em-
ployer (or predecessor employer) dur-
ing the preceding taxable year for 
group health plans; or 
‘‘(II) $500,000. 
‘‘(E) WAIVER BY SECRETARY.—In the case 
of a failure which is due to reasonable cause and 
not to willful neglect, the Secretary may waive 
part or all of the penalty imposed by subpara-
graph (A) to the extent that the payment of such 
penalty would be excessive relative to the failure 
involved.’’. 
(4) DEFINITIONS.—Section 2791(d) of the Public 
Health Service Act (42 U.S.C. 300gg–91(d)) is 
amended by adding at the end the following: 
‘‘(15) FAMILY MEMBER.—The term ‘family mem-
ber’ means with respect to an individual— 
‘‘(A) the spouse of the individual; 
‘‘(B) 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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‘‘(C) all other individuals related by blood 
to the individual or the spouse or child described 
in subparagraph (A) or (B). 
‘‘(16) GENETIC INFORMATION.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘genetic information’ 
means information about— 
‘‘(i) an individual’s genetic tests; 
‘‘(ii) the genetic tests of family mem-
bers of the individual; or 
‘‘(iii) the occurrence of a disease or 
disorder in family members of the indi-
vidual. 
‘‘(B) EXCLUSIONS.—The term ‘genetic in-
formation’ shall not include information about 
the sex or age of an individual. 
‘‘(17) GENETIC TEST.— 
‘‘(A) IN GENERAL.—The term ‘genetic test’ 
means an analysis of human DNA, RNA, chro-
mosomes, proteins, or metabolites, that detects 
genotypes, mutations, or chromosomal changes. 
‘‘(B) EXCEPTIONS.—The term ‘genetic test’ 
does not mean— 
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‘‘(i) an analysis of proteins or metabo-
lites 
that 
does 
not 
detect 
genotypes, 
mutations, or chromosomal changes; or 
‘‘(ii) an analysis of proteins or me-
tabolites that is directly related to a mani-
fested disease, disorder, or pathological con-
dition that could reasonably be detected by 
a health care professional with appropriate 
training and expertise in the field of medi-
cine involved. 
‘‘(18) GENETIC
SERVICES.—The term ‘genetic 
services’ means— 
‘‘(A) a genetic test; 
‘‘(B) genetic counseling (such as obtaining, 
interpreting, or assessing genetic information); 
or 
‘‘(C) genetic education.’’. 
(b) AMENDMENT RELATING TO THE INDIVIDUAL MAR-
KET.— 
(1) IN GENERAL.—The first subpart 3 of part B 
of title XXVII of the Public Health Service Act (42 
U.S.C. 300gg–51 et seq.) (relating to other require-
ments) is amended— 
(A) by redesignating such subpart as sub-
part 2; and 
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(B) by adding at the end the following: 
‘‘SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON 
THE BASIS OF GENETIC INFORMATION. 
‘‘(a) PROHIBITION ON GENETIC INFORMATION AS A 
CONDITION OF ELIGIBILITY.—A health insurance issuer of-
fering health insurance coverage in the individual market 
may not establish rules for the eligibility (including contin-
ued eligibility) of any individual to enroll in individual 
health insurance coverage based on genetic information (in-
cluding information about a request for or receipt of genetic 
services by an individual or family member of such indi-
vidual). 
‘‘(b) PROHIBITION ON GENETIC INFORMATION IN SET-
TING PREMIUM RATES.—A health insurance issuer offering 
health insurance coverage in the individual market shall 
not adjust premium or contribution amounts for an indi-
vidual on the basis of genetic information concerning the 
individual or a family member of the individual (including 
information about a request for or receipt of genetic services 
by an individual or family member of such individual). 
‘‘(c) GENETIC TESTING.— 
‘‘(1) LIMITATION ON REQUESTING OR REQUIRING 
GENETIC TESTING.—A health insurance issuer offer-
ing health insurance coverage in the individual mar-
ket shall not request or require an individual or a 
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family member of such individual to undergo a ge-
netic test. 
‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 
part shall be construed to— 
‘‘(A) limit the authority of a health care 
professional who is providing health care services 
with respect to an individual to request that 
such individual or a family member of such in-
dividual undergo a genetic test; 
‘‘(B) limit the authority of a health care 
professional who is employed by or affiliated 
with a health insurance issuer and who is pro-
viding health care services to an individual as 
part of a bona fide wellness program to notify 
such individual of the availability of a genetic 
test or to provide information to such individual 
regarding such genetic test; or 
‘‘(C) authorize or permit a health care pro-
fessional to require that an individual undergo a 
genetic test.’’. 
(2) REMEDIES
AND
ENFORCEMENT.—Section 
2761(b) of the Public Health Service Act (42 U.S.C. 
300gg–61(b)) is amended to read as follows: 
‘‘(b) SECRETARIAL ENFORCEMENT AUTHORITY.—The 
Secretary shall have the same authority in relation to en-
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forcement of the provisions of this part with respect to 
issuers of health insurance coverage in the individual mar-
ket in a State as the Secretary has under section 2722(b)(2), 
and section 2722(b)(3) with respect to violations of genetic 
nondiscrimination provisions, in relation to the enforce-
ment of the provisions of part A with respect to issuers of 
health insurance coverage in the small group market in the 
State.’’. 
(c) ELIMINATION OF OPTION OF NON-FEDERAL GOV-
ERNMENTAL PLANS TO BE EXCEPTED FROM REQUIRE-
MENTS
CONCERNING
GENETIC
INFORMATION.—Section 
2721(b)(2) of the Public Health Service Act (42 U.S.C. 
300gg–21(b)(2)) is amended— 
(1) in subparagraph (A), by striking ‘‘If the 
plan sponsor’’ and inserting ‘‘Except as provided in 
subparagraph (D), if the plan sponsor’’; and 
(2) by adding at the end the following: 
‘‘(D) ELECTION
NOT
APPLICABLE
TO
RE-
QUIREMENTS
CONCERNING
GENETIC
INFORMA-
TION.—The election described in subparagraph 
(A) shall not be available with respect to the pro-
visions of subsections (a)(1)(F) and (c) of section 
2702 and the provisions of section 2702(b) to the 
extent that such provisions apply to genetic in-
formation (or information about a request for or 
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the receipt of genetic services by an individual or 
a family member of such individual).’’. 
(d) REGULATIONS AND EFFECTIVE DATE.— 
(1) REGULATIONS.—Not later than 1 year after 
the date of enactment of this title, the Secretary of 
Health and Human Services shall issue final regula-
tions to carry out the amendments made by this sec-
tion. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply— 
(A) with respect to group health plans, and 
health insurance coverage offered in connection 
with group health plans, for plan years begin-
ning after the date that is 18 months after the 
date of enactment of this title; and 
(B) with respect to health insurance cov-
erage offered, sold, issued, renewed, in effect, or 
operated in the individual market after the date 
that is 18 months after the date of enactment of 
this title. 
SEC. 103. AMENDMENTS TO TITLE XVIII OF THE SOCIAL SE-
CURITY ACT RELATING TO MEDIGAP. 
(a) NONDISCRIMINATION.— 
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(1) IN GENERAL.—Section 1882(s)(2) of the So-
cial Security Act (42 U.S.C. 1395ss(s)(2)) is amended 
by adding at the end the following: 
‘‘(E)(i) An issuer of a medicare supple-
mental policy shall not deny or condition the 
issuance or effectiveness of the policy, and shall 
not discriminate in the pricing of the policy (in-
cluding the adjustment of premium rates) of an 
eligible individual on the basis of genetic infor-
mation concerning the individual (or informa-
tion about a request for, or the receipt of, genetic 
services by such individual or family member of 
such individual). 
‘‘(ii) For purposes of clause (i), the terms 
‘family member’, ‘genetic services’, and ‘genetic 
information’ shall have the meanings given such 
terms in subsection (x).’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall apply with respect to a policy for 
policy years beginning after the date that is 18 
months after the date of enactment of this Act. 
(b) LIMITATIONS ON GENETIC TESTING.— 
(1) IN GENERAL.—Section 1882 of the Social Se-
curity Act (42 U.S.C. 1395ss) is amended by adding 
at the end the following: 
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‘‘(x) LIMITATIONS ON GENETIC TESTING.— 
‘‘(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.—Nothing in 
this title shall be construed to— 
‘‘(i) limit the authority of a health 
care professional who is providing health 
care services with respect to an individual 
to request that such individual or a family 
member of such individual undergo a ge-
netic test; 
‘‘(ii) limit the authority of a health 
care professional who is employed by or af-
filiated with an issuer of a medicare supple-
mental policy and who is providing health 
care services to an individual as part of a 
bona fide wellness program to notify such 
individual of the availability of a genetic 
test or to provide information to such indi-
vidual regarding such genetic test; or 
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‘‘(iii) authorize or permit a health care 
professional to require that an individual 
undergo a genetic test. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) FAMILY MEMBER.—The term ‘family 
member’ means with respect to an individual— 
‘‘(i) the spouse of the individual; 
‘‘(ii) a dependent child of the indi-
vidual, including a child who is born to or 
placed for adoption with the individual; or 
‘‘(iii) any other individuals related by 
blood to the individual or to the spouse or 
child described in clause (i) or (ii). 
‘‘(B) GENETIC INFORMATION.— 
‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), the term ‘genetic information’ 
means information about— 
‘‘(I) an individual’s genetic tests; 
‘‘(II) the genetic tests of family 
members of the individual; or 
‘‘(III) the occurrence of a disease 
or disorder in family members of the 
individual. 
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‘‘(ii) EXCLUSIONS.—The term ‘genetic 
information’ shall not include information 
about the sex or age of an individual. 
‘‘(C) GENETIC TEST.— 
‘‘(i) IN GENERAL.—The term ‘genetic 
test’ means an analysis of human DNA, 
RNA, chromosomes, proteins, or metabolites, 
that detects genotypes, mutations, or chro-
mosomal 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 patho-
logical condition that could reasonably 
be detected by a health care profes-
sional with appropriate training and 
expertise in the field of medicine in-
volved. 
‘‘(D) GENETIC
SERVICES.—The term ‘ge-
netic services’ means— 
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‘‘(i) a genetic test; 
‘‘(ii) genetic counseling (such as ob-
taining, interpreting, or assessing genetic 
information); or 
‘‘(iii) genetic education. 
‘‘(E) ISSUER
OF
A
MEDICARE
SUPPLE-
MENTAL POLICY.—The term ‘issuer of a medicare 
supplemental policy’ includes a third-party ad-
ministrator or other person acting for or on be-
half of such issuer.’’. 
(2) CONFORMING AMENDMENT.—Section 1882(o) 
of the Social Security Act (42 U.S.C. 1395ss(o)) is 
amended by adding at the end the following: 
‘‘(4) The issuer of the medicare supplemental 
policy complies with subsection (s)(2)(E) and sub-
section (x).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to an 
issuer of a medicare supplemental policy for policy 
years beginning on or after the date that is 18 months 
after the date of enactment of this Act. 
(c) 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 
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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 requirements 
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 Com-
missioners (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 
the amendments made by this section, such revised 
regulation incorporating the modifications shall be 
considered to be the applicable NAIC model regulation 
(including the revised NAIC model regulation and the 
1991 NAIC Model Regulation) for the purposes of 
such section. 
(3) SECRETARY STANDARDS.—If the NAIC does 
not make the modifications described in paragraph 
(2) within the period specified in such paragraph, the 
Secretary of Health and Human Services shall, not 
later than October 1, 2008, make the modifications 
described in such paragraph and such revised regula-
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tion incorporating the modifications shall be consid-
ered to be the appropriate regulation for the purposes 
of such section. 
(4) DATE SPECIFIED.— 
(A) IN GENERAL.—Subject to subparagraph 
(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 regulatory 
program to the changes made by this sec-
tion, or 
(ii) October 1, 2008. 
(B) ADDITIONAL LEGISLATIVE ACTION RE-
QUIRED.—In the case of a State which the Sec-
retary identifies as— 
(i) requiring State legislation (other 
than legislation appropriating funds) to 
conform its regulatory program to the 
changes made in this section, but 
(ii) having a legislature which is not 
scheduled to meet in 2008 in a legislative 
session in which such legislation may be 
considered, the date specified in this para-
graph is the first day of the first calendar 
quarter beginning after the close of the first 
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legislative session of the State legislature 
that begins on or after July 1, 2008. For 
purposes of the previous sentence, in the 
case of a State that has a 2-year legislative 
session, each year of such session shall be 
deemed to be a separate regular session of 
the State legislature. 
SEC. 104. PRIVACY AND CONFIDENTIALITY. 
(a) RULES FOR PUBLIC HEALTH SERVICE ACT AND 
INTERNAL REVENUE CODE OF 1986.— 
(1) APPLICABILITY.—Except as provided in 
paragraph (4), the provisions of this subsection shall 
apply to group health plans (other than group health 
plans to which section 714 of the Employee Retire-
ment Income Security Act of 1974 applies), health in-
surance issuers (including issuers in connection with 
group health plans or individual health coverage), 
and issuers of medicare supplemental policies, with-
out regard to— 
(A) section 2721(a) of the Public Health 
Service Act (42 U.S.C. 300gg–21(a)); and 
(B) section 9831(a)(2) of the Internal Rev-
enue Code of 1986. 
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(2) COMPLIANCE
WITH
CERTAIN
CONFIDEN-
TIALITY STANDARDS WITH RESPECT TO GENETIC IN-
FORMATION.— 
(A) IN GENERAL.—The regulations promul-
gated by the Secretary of Health and Human 
Services under part C of title XI of the Social 
Security Act (42 U.S.C. 1320d et seq.) and sec-
tion 264 of the Health Insurance Portability and 
Accountability Act of 1996 (42 U.S.C. 1320d–2 
note) shall apply to the use or disclosure of ge-
netic information. 
(B) PROHIBITION ON UNDERWRITING AND 
PREMIUM
RATING.—Notwithstanding subpara-
graph (A), a group health plan, a health insur-
ance issuer, or issuer of a medicare supplemental 
policy shall not use or disclose genetic informa-
tion (including information about a request for 
or a receipt of genetic services by an individual 
or family member of such individual) for pur-
poses of underwriting, determinations of eligi-
bility to enroll, premium rating, or the creation, 
renewal or replacement of a plan, contract or 
coverage for health insurance or health benefits. 
(3) PROHIBITION ON COLLECTION OF GENETIC 
INFORMATION.— 
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(A) IN
GENERAL.—A group health plan, 
health insurance issuer, or issuer of a medicare 
supplemental policy shall not request, require, or 
purchase genetic information (including infor-
mation about a request for or a receipt of genetic 
services by an individual or family member of 
such individual) for purposes of underwriting, 
determinations of eligibility to enroll, premium 
rating, or the creation, renewal or replacement of 
a plan, contract or coverage for health insurance 
or health benefits. 
(B) LIMITATION RELATING TO THE COLLEC-
TION OF GENETIC INFORMATION PRIOR TO EN-
ROLLMENT.—A group health plan, health insur-
ance issuer, or issuer of a medicare supplemental 
policy shall not request, require, or purchase ge-
netic information (including information about 
a request for or a receipt of genetic services by 
an individual or family member of such indi-
vidual) concerning a participant, beneficiary, or 
enrollee prior to the enrollment, and in connec-
tion with such enrollment, of such individual 
under the plan, coverage, or policy. 
(C) INCIDENTAL
COLLECTION.—Where a 
group health plan, health insurance issuer, or 
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issuer of a medicare supplemental policy obtains 
genetic information incidental to the requesting, 
requiring, or purchasing of other information 
concerning a participant, beneficiary, or en-
rollee, such request, requirement, or purchase 
shall not be considered a violation of this para-
graph if— 
(i) such request, requirement, or pur-
chase is not in violation of subparagraph 
(A); and 
(ii) any genetic information (including 
information about a request for or receipt of 
genetic services) requested, required, or pur-
chased is not used or disclosed in violation 
of paragraph (2). 
(4) APPLICATION OF CONFIDENTIALITY STAND-
ARDS.—The provisions of paragraphs (2) and (3) 
shall not apply— 
(A) to group health plans, health insurance 
issuers, or issuers of medicare supplemental poli-
cies that are not otherwise covered under the reg-
ulations promulgated by the Secretary of Health 
and Human Services under part C of title XI of 
the Social Security Act (42 U.S.C. 1320d et seq.) 
and section 264 of the Health Insurance Port-
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ability and Accountability Act of 1996 (42 
U.S.C. 1320d–2 note); and 
(B) to genetic information that is not con-
sidered to be individually-identifiable health in-
formation under the regulations promulgated by 
the Secretary of Health and Human Services 
under part C of title XI of the Social Security 
Act (42 U.S.C. 1320d et seq.) and section 264 of 
the Health Insurance Portability and Account-
ability Act of 1996 (42 U.S.C. 1320d–2 note). 
(5) ENFORCEMENT.—A group health plan, health 
insurance issuer, or issuer of a medicare supple-
mental policy that violates a provision of this sub-
section shall be subject to the penalties described in 
sections 1176 and 1177 of the Social Security Act (42 
U.S.C. 1320d–5 and 1320d–6) in the same manner 
and to the same extent that such penalties apply to 
violations of part C of title XI of such Act. 
(6) PREEMPTION.— 
(A) IN GENERAL.—A provision or require-
ment under this subsection or a regulation pro-
mulgated under this subsection shall supersede 
any contrary provision of State law unless such 
provision of State law imposes requirements, 
standards, or implementation specifications that 
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are more stringent than the requirements, stand-
ards, or implementation specifications imposed 
under this subsection or such regulations. No 
penalty, remedy, or cause of action to enforce 
such a State law that is more stringent shall be 
preempted by this subsection. 
(B) RULE OF CONSTRUCTION.—Nothing in 
subparagraph (A) shall be construed to establish 
a penalty, remedy, or cause of action under 
State law if such penalty, remedy, or cause of 
action is not otherwise available under such 
State law. 
(7) COORDINATION
WITH
PRIVACY
REGULA-
TIONS.—The Secretary shall implement and admin-
ister this subsection in a manner that is consistent 
with the implementation and administration by the 
Secretary of the regulations promulgated by the Sec-
retary of Health and Human Services under part C 
of title XI of the Social Security Act (42 U.S.C. 
1320d et seq.) and section 264 of the Health Insur-
ance Portability and Accountability Act of 1996 (42 
U.S.C. 1320d–2 note). 
(8) DEFINITIONS.—In this subsection: 
(A) GENETIC INFORMATION; GENETIC SERV-
ICES.—The terms ‘‘family member’’, ‘‘genetic in-
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formation’’, ‘‘genetic services’’, and ‘‘genetic test’’ 
have the meanings given such terms in section 
2791 of the Public Health Service Act (42 U.S.C. 
300gg–91), as amended by this Act. 
(B) GROUP HEALTH PLAN; HEALTH INSUR-
ANCE ISSUER.—The terms ‘‘group health plan’’ 
and ‘‘health insurance issuer’’ include only those 
plans and issuers that are covered under the reg-
ulations described in paragraph (4)(A). 
(C) ISSUER OF A MEDICARE SUPPLEMENTAL 
POLICY.—The term ‘‘issuer of a medicare supple-
mental policy’’ means an issuer described in sec-
tion 1882 of the Social Security Act (42 U.S.C. 
1395ss). 
(D) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human Serv-
ices. 
(b) AMENDMENTS TO ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 is amended by adding after sec-
tion 713 (29 U.S.C. 1185b) the following new section: 
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‘‘SEC. 714. PRIVACY AND CONFIDENTIALITY OF GENETIC IN-
FORMATION. 
‘‘(a) APPLICABILITY.—Except as provided in sub-
section (d), the provisions of this section shall apply to 
group health plans, and health insurance issuers offering 
health insurance coverage in connection with such plans, 
without regard to section 732(a). 
‘‘(b) PROHIBITION ON UNDERWRITING, ELIGIBILITY 
TERMINATION, PREMIUM RATING, AND PLAN FORMULA-
TION.—Notwithstanding section 104(a)(2)(A) of the Genetic 
Information Nondiscrimination Act of 2007, a group health 
plan, or a health insurance issuer offering health insurance 
coverage in connection with such a plan, shall not use or 
disclose genetic information (including information about 
a request for or a receipt of genetic services by an indi-
vidual or family member of such individual) for purposes 
of underwriting, determinations of eligibility to enroll, pre-
mium rating, or the creation, renewal, or replacement of 
a group health plan or health insurance coverage offered 
in connection with such a plan. 
‘‘(c) PROHIBITION ON COLLECTION OF GENETIC IN-
FORMATION.— 
‘‘(1) IN GENERAL.—A group health plan, or a 
health insurance issuer offering health insurance cov-
erage in connection with such a plan, shall not re-
quest, require, or purchase genetic information (in-
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cluding information about a request for or a receipt 
of genetic services by an individual or family member 
of such individual) for purposes of underwriting, de-
terminations of eligibility to enroll, premium rating, 
or the creation, renewal or replacement of a plan, 
contract or coverage for health insurance or health 
benefits. 
‘‘(2) LIMITATION RELATING TO THE COLLECTION 
OF GENETIC INFORMATION PRIOR TO ENROLLMENT.— 
A group health plan, or a health insurance issuer of-
fering health insurance coverage in connection with 
such a plan, shall not request, require, or purchase ge-
netic information (including information about a re-
quest for or a receipt of genetic services by an indi-
vidual or family member of such individual) con-
cerning a participant or beneficiary prior to the en-
rollment, and in connection with such enrollment, of 
such participant or beneficiary under the plan or cov-
erage. 
‘‘(3) INCIDENTAL COLLECTION.—Where a group 
health plan, or a health insurance issuer offering 
health insurance coverage in connection with such a 
plan, obtains genetic information incidental to the re-
questing, requiring, or purchasing of other informa-
tion concerning a participant or beneficiary, such re-
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quest, requirement, or purchase shall not be consid-
ered a violation of this subsection if— 
‘‘(A) such request, requirement, or purchase 
is not in violation of paragraph (1); and 
‘‘(B) any genetic information (including in-
formation about a request for or receipt of ge-
netic services) requested, required, or purchased 
is not used or disclosed in violation of subsection 
(b). 
‘‘(d) APPLICATION
OF
CONFIDENTIALITY
STAND-
ARDS.—The provisions of subsections (b) and (c) shall not 
apply— 
‘‘(1) to group health plans, or health insurance 
issuers offering health insurance coverage in connec-
tion with such plans, that are not otherwise covered 
under the regulations promulgated by the Secretary of 
Health and Human Services under part C of title XI 
of the Social Security Act (42 U.S.C. 1320d et seq.) 
and section 264 of the Health Insurance Portability 
and Accountability Act of 1996 (42 U.S.C. 1320d–2 
note); and 
‘‘(2) to genetic information that is not considered 
to be individually-identifiable health information 
under the regulations promulgated by the Secretary of 
Health and Human Services under part C of title XI 
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of the Social Security Act (42 U.S.C. 1320d et seq.) 
and section 264 of the Health Insurance Portability 
and Accountability Act of 1996 (42 U.S.C. 1320d–2 
note). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) GENETIC
INFORMATION; GENETIC
SERV-
ICES.—The terms ‘family member’, ‘genetic informa-
tion’, ‘genetic services’, and ‘genetic test’ have the 
meanings given such terms in section 733(d). 
‘‘(2) GROUP HEALTH PLAN; HEALTH INSURANCE 
ISSUER.—The terms ‘group health plan’ and ‘health 
insurance issuer’ include only those plans and issuers 
that are covered under the regulations described in 
subsection (d)(1).’’. 
(2) PREEMPTION.—Section 731 of such Act (29 
U.S.C. 1191) is amended— 
(A) by redesignating subsections (c) and (d) 
as subsections (d) and (e), respectively; 
(B) in subsection (a)(1), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) and 
(c)’’; and 
(C) by inserting after subsection (b) the fol-
lowing new subsection: 
‘‘(c) SPECIAL RULES RELATING TO PRIVACY AND CON-
FIDENTIALITY OF GENETIC INFORMATION.— 
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‘‘(1) IN GENERAL.—A provision or requirement 
under section 714 or a regulation promulgated under 
such section shall supersede any contrary provision of 
State law unless such provision of State law imposes 
requirements, standards, or implementation specifica-
tions that are more stringent than the requirements, 
standards, or implementation specifications imposed 
under such section or such regulations. No penalty, 
remedy, or cause of action to enforce such a State law 
that is more stringent shall be preempted by such sec-
tion. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
paragraph (1) shall be construed to establish a pen-
alty, remedy, or cause of action under State law if 
such penalty, remedy, or cause of action is not other-
wise available under such State law.’’. 
(3) CONFORMING
AMENDMENT.—The table of 
contents in section 1 of such Act is amended by in-
serting after the item relating to section 713 the fol-
lowing new item: 
‘‘Sec. 714. Privacy and confidentiality of genetic information.’’. 
SEC. 105. ASSURING COORDINATION. 
(a) IN GENERAL.—Except as provided in subsection 
(b), the Secretary of Health and Human Services, the Sec-
retary of Labor, and the Secretary of the Treasury shall 
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ensure, through the execution of an interagency memo-
randum of understanding among such Secretaries, that— 
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same matter 
over which two or more such Secretaries have respon-
sibility under this title (and the amendments made by 
this title) are administered so as to have the same ef-
fect at all times; and 
(2) coordination of policies relating to enforcing 
the same requirements through such Secretaries in 
order to have a coordinated enforcement strategy that 
avoids duplication of enforcement efforts and assigns 
priorities in enforcement. 
(b) AUTHORITY OF THE SECRETARY.—The Secretary 
of Health and Human Services has the sole authority to 
promulgate regulations to implement section 104(a). 
SEC. 106. REGULATIONS; EFFECTIVE DATE. 
(a) REGULATIONS.—Not later than 1 year after the 
date of enactment of this title, the Secretary of Health and 
Human Services, the Secretary of Labor, and the Secretary 
of the Treasury shall issue final regulations to carry out 
this title. 
(b) EFFECTIVE DATE.—Except as provided in section 
103, the amendments made by this title shall take effect on 
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(v) an entity to which section 717(a) of 
the Civil Rights Act of 1964 applies. 
(C) EMPLOYMENT AGENCY; LABOR ORGANI-
ZATION.—The terms ‘‘employment agency’’ and 
‘‘labor organization’’ have the meanings given 
the terms in section 701 of the Civil Rights Act 
of 1964 (42 U.S.C. 2000e). 
(D) MEMBER.—The term ‘‘member’’, with 
respect to a labor organization, includes an ap-
plicant for membership in a labor organization. 
(3) FAMILY MEMBER.—The term ‘‘family mem-
ber’’ means with respect to an individual— 
(A) the spouse of the individual; 
(B) a dependent child of the individual; and 
(C) any other individual who is a first-de-
gree, second-degree, third-degree, or fourth-degree 
relative of an individual described in subpara-
graph (A) or (B). 
(4) GENETIC INFORMATION.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘‘genetic informa-
tion’’ means information about— 
(i) an individual’s genetic tests; 
(ii) the genetic tests of family members 
of the individual; or 
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(iii) the occurrence of a disease or dis-
order in family members of the individual. 
(B) EXCEPTIONS.—The term ‘‘genetic infor-
mation’’ shall not include information about the 
sex or age of an individual. 
(5) GENETIC MONITORING.—The term ‘‘genetic 
monitoring’’ means the periodic examination of em-
ployees to evaluate acquired modifications to their ge-
netic material, such as chromosomal damage or evi-
dence of increased occurrence of mutations, that may 
have developed in the course of employment due to ex-
posure to toxic substances in the workplace, in order 
to identify, evaluate, and respond to the effects of or 
control adverse environmental exposures in the work-
place. 
(6) GENETIC SERVICES.—The term ‘‘genetic serv-
ices’’ means— 
(A) a genetic test; 
(B) genetic counseling (including obtaining, 
interpreting or assessing genetic information); or 
(C) genetic education. 
(7) GENETIC TEST.— 
(A) IN GENERAL.—The term ‘‘genetic test’’ 
means the analysis of human DNA, RNA, chro-
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mosomes, proteins, or metabolites, that detects 
genotypes, mutations, or chromosomal changes. 
(B) EXCEPTION.—The term ‘‘genetic test’’ 
does not mean an analysis of proteins or metabo-
lites that does not detect genotypes, mutations, or 
chromosomal changes. 
SEC. 202. EMPLOYER PRACTICES. 
(a) DISCRIMINATION BASED ON GENETIC INFORMA-
TION.—It shall be an unlawful employment practice for an 
employer— 
(1) to fail or refuse to hire or to discharge any 
employee, or otherwise to discriminate against any 
employee with respect to the compensation, terms, 
conditions, or privileges of employment of the em-
ployee, because of genetic information with respect to 
the employee (or information about a request for or 
the receipt of genetic services by such employee or 
family member of such employee); or 
(2) to limit, segregate, or classify the employees 
of the employer in any way that would deprive or 
tend to deprive any employee of employment opportu-
nities or otherwise adversely affect the status of the 
employee as an employee, because of genetic informa-
tion with respect to the employee (or information 
about a request for or the receipt of genetic services 
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by such employee or family member of such em-
ployee). 
(b) ACQUISITION OF GENETIC INFORMATION.—It shall 
be an unlawful employment practice for an employer to re-
quest, require, or purchase genetic information with respect 
to an employee or a family member of the employee (or in-
formation about a request for the receipt of genetic services 
by such employee or a family member of such employee) 
except— 
(1) where an employer inadvertently requests or 
requires family medical history of the employee or 
family member of the employee; 
(2) where— 
(A) health or genetic services are offered by 
the employer, including such services offered as 
part of a bona fide wellness program; 
(B) the employee provides prior, knowing, 
voluntary, and written authorization; 
(C) only the employee (or family member if 
the family member is receiving genetic services) 
and the licensed health care professional or board 
certified genetic counselor involved in providing 
such services receive individually identifiable in-
formation concerning the results of such services; 
and 
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(D) any individually identifiable genetic 
information provided under subparagraph (C) in 
connection with the services provided under sub-
paragraph (A) is only available for purposes of 
such services and shall not be disclosed to the em-
ployer except in aggregate terms that do not dis-
close the identity of specific employees; 
(3) where an employer requests or requires fam-
ily medical history from the employee to comply with 
the certification provisions of section 103 of the Fam-
ily and Medical Leave Act of 1993 (29 U.S.C. 2613), 
such requirements under State family and medical 
leave laws; 
(4) where an employer purchases documents that 
are commercially and publicly available (including 
newspapers, magazines, periodicals, and books, but 
not including medical databases or court records) that 
include family medical history; or 
(5) where the information involved is to be used 
for genetic monitoring of the biological effects of toxic 
substances in the workplace, but only if— 
(A) the employer provides written notice of 
the genetic monitoring to the employee; 
(B)(i) the employee provides prior, know-
ing, voluntary, and written authorization; or 
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(ii) the genetic monitoring is required by 
Federal or State law; 
(C) the employee is informed of individual 
monitoring results; 
(D) the monitoring is in compliance with— 
(i) any Federal genetic monitoring reg-
ulations, including any such regulations 
that may be promulgated by the Secretary 
of Labor pursuant to the Occupational 
Safety and Health Act of 1970 (29 U.S.C. 
651 et seq.), the Federal Mine Safety and 
Health Act of 1977 (30 U.S.C. 801 et seq.), 
or the Atomic Energy Act of 1954 (42 
U.S.C. 2011 et seq.); or 
(ii) State genetic monitoring regula-
tions, in the case of a State that is imple-
menting genetic monitoring regulations 
under the authority of the Occupational 
Safety and Health Act of 1970 (29 U.S.C. 
651 et seq.); and 
(E) the employer, excluding any licensed 
health care professional or board certified genetic 
counselor that is involved in the genetic moni-
toring program, receives the results of the moni-
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toring only in aggregate terms that do not dis-
close the identity of specific employees. 
(c) PRESERVATION OF PROTECTIONS.—In the case of 
information to which any of paragraphs (1) through (5) 
of subsection (b) applies, such information may not be used 
in violation of paragraph (1) or (2) of subsection (a) or 
treated or disclosed in a manner that violates section 206. 
SEC. 203. EMPLOYMENT AGENCY PRACTICES. 
(a) DISCRIMINATION BASED ON GENETIC INFORMA-
TION.—It shall be an unlawful employment practice for an 
employment agency— 
(1) to fail or refuse to refer for employment, or 
otherwise to discriminate against, any individual be-
cause of genetic information with respect to the indi-
vidual (or information about a request for or the re-
ceipt of genetic services by such individual or family 
member of such individual); 
(2) to limit, segregate, or classify individuals or 
fail or refuse to refer for employment any individual 
in any way that would deprive or tend to deprive any 
individual of employment opportunities, or otherwise 
adversely affect the status of the individual as an em-
ployee, because of genetic information with respect to 
the individual (or information about a request for or 
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the receipt of genetic services by such individual or 
family member of such individual); or 
(3) to cause or attempt to cause an employer to 
discriminate against an individual in violation of 
this title. 
(b) ACQUISITION OF GENETIC INFORMATION.—It shall 
be an unlawful employment practice for an employment 
agency to request, require, or purchase genetic information 
with respect to an individual or a family member of the 
individual (or information about a request for the receipt 
of genetic services by such individual or a family member 
of such individual) except— 
(1) where an employment agency inadvertently 
requests or requires family medical history of the in-
dividual or family member of the individual; 
(2) where— 
(A) health or genetic services are offered by 
the employment agency, including such services 
offered as part of a bona fide wellness program; 
(B) the individual provides prior, knowing, 
voluntary, and written authorization; 
(C) only the individual (or family member 
if the family member is receiving genetic serv-
ices) and the licensed health care professional or 
board certified genetic counselor involved in pro-
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viding such services receive individually identifi-
able information concerning the results of such 
services; and 
(D) any individually identifiable genetic 
information provided under subparagraph (C) in 
connection with the services provided under sub-
paragraph (A) is only available for purposes of 
such services and shall not be disclosed to the em-
ployment agency except in aggregate terms that 
do not disclose the identity of specific individ-
uals; 
(3) where an employment agency requests or re-
quires family medical history from the individual to 
comply with the certification provisions of section 103 
of the Family and Medical Leave Act of 1993 (29 
U.S.C. 2613) or such requirements under State family 
and medical leave laws; 
(4) where an employment agency purchases doc-
uments that are commercially and publicly available 
(including newspapers, magazines, periodicals, and 
books, but not including medical databases or court 
records) that include family medical history; or 
(5) where the information involved is to be used 
for genetic monitoring of the biological effects of toxic 
substances in the workplace, but only if— 
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(A) the employment agency provides written 
notice of the genetic monitoring to the indi-
vidual; 
(B)(i) the individual provides prior, know-
ing, voluntary, and written authorization; or 
(ii) the genetic monitoring is required by 
Federal or State law; 
(C) the individual is informed of individual 
monitoring results; 
(D) the monitoring is in compliance with— 
(i) any Federal genetic monitoring reg-
ulations, including any such regulations 
that may be promulgated by the Secretary 
of Labor pursuant to the Occupational 
Safety and Health Act of 1970 (29 U.S.C. 
651 et seq.), the Federal Mine Safety and 
Health Act of 1977 (30 U.S.C. 801 et seq.), 
or the Atomic Energy Act of 1954 (42 
U.S.C. 2011 et seq.); or 
(ii) State genetic monitoring regula-
tions, in the case of a State that is imple-
menting genetic monitoring regulations 
under the authority of the Occupational 
Safety and Health Act of 1970 (29 U.S.C. 
651 et seq.); and 
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(E) the employment agency, excluding any 
licensed health care professional or board cer-
tified genetic counselor that is involved in the ge-
netic monitoring program, receives the results of 
the monitoring only in aggregate terms that do 
not disclose the identity of specific individuals. 
(c) PRESERVATION OF PROTECTIONS.—In the case of 
information to which any of paragraphs (1) through (5) 
of subsection (b) applies, such information may not be used 
in violation of paragraph (1) or (2) of subsection (a) or 
treated or disclosed in a manner that violates section 206. 
SEC. 204. LABOR ORGANIZATION PRACTICES. 
(a) DISCRIMINATION BASED ON GENETIC INFORMA-
TION.—It shall be an unlawful employment practice for a 
labor organization— 
(1) to exclude or to expel from the membership 
of the organization, or otherwise to discriminate 
against, any member because of genetic information 
with respect to the member (or information about a 
request for or the receipt of genetic services by such 
member or family member of such member); 
(2) to limit, segregate, or classify the members of 
the organization, or fail or refuse to refer for employ-
ment any member, in any way that would deprive or 
tend to deprive any member of employment opportu-
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nities, or otherwise adversely affect the status of the 
member as an employee, because of genetic informa-
tion with respect to the member (or information about 
a request for or the receipt of genetic services by such 
member or family member of such member); or 
(3) to cause or attempt to cause an employer to 
discriminate against a member in violation of this 
title. 
(b) ACQUISITION OF GENETIC INFORMATION.—It shall 
be an unlawful employment practice for a labor organiza-
tion to request, require, or purchase genetic information 
with respect to a member or a family member of the member 
(or information about a request for the receipt of genetic 
services by such member or a family member of such mem-
ber) except— 
(1) where a labor organization inadvertently re-
quests or requires family medical history of the mem-
ber or family member of the member; 
(2) where— 
(A) health or genetic services are offered by 
the labor organization, including such services 
offered as part of a bona fide wellness program; 
(B) the member provides prior, knowing, 
voluntary, and written authorization; 
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E:\BILLS\H493.RH
H493
hmoore on PROD1PC68 with HMBILLS