Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-43 - MEDICAL OR LIFE-STYLE QUESTIONS ON APPLICATIONS AND UNDERWRITING GUIDELINES AFFECTING AIDS AND ARC › Rule 120-2-43-.06 - Notice and Consent to Blood Testing

Current through Rules and Regulations filed through June 27, 2024
Whenever an applicant is requested to take an AIDS-related
				  test in connection with an application for insurance, the use of such a test
				  must be revealed to the applicant and his or her written consent obtained. No
				  adverse underwriting decision shall be made on the basis of a positive
				  AIDS-related test unless an established test protocol has been followed. At a
				  minimum, an established test protocol requires two positive ELISA tests and one
				  positive Western blot. If new and more effective AIDS-related tests are
				  developed, they may be used as a substitute for the aforementioned test.
Shown below is an acceptable "Notice and Consent for Blood
				  Testing" form. The form should contain an appropriate form number and be filed
				  with the Georgia Insurance Department for approval.
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NOTICE AND CONSENT FOR BLOOD TESTING WHICH MAY INCLUDE AIDS
				  VIRUS (HIV) ANTIBODY/ANTIGEN TESTING
To determine your insurability, the insurer named above ("the
				  insurer") has requested that you provide a sample of your blood for testing and
				  analysis. All tests will be performed by a licensed laboratory.
Tests may be performed to determine the presence of
				  antibodies or antigens to the Human Immunodeficiency Virus (HIV), also known as
				  the AIDS virus. The HIV antibody test is actually a series of tests done by a
				  medically accepted procedure. The HIV antigen test directly identifies AIDS
				  viral particles. These tests are extremely reliable. Other tests which may be
				  performed include determinations of blood cholesterol and related lipids (fats)
				  and screening for liver or kidney disorders, diabetes, and immune
				  disorders.
All tests results will be treated confidentially. They will
				  be reported by the laboratory to the insurer. When necessary for business
				  reasons in connection with insurance you have or have applied for with the
				  insurer, the insurer may disclose test results to others such as its
				  affiliates, reinsurers, independent contractors, and its employees to whom
				  disclosure is reasonably necessary in the ordinary course of business to carry
				  out the purposes for which that disclosure is authorized or required. If the
				  insurer is a member of the Medical Information Bureau ("MIB, Inc."), and if the
				  test results for HIV antibodies/antigens are other than normal, the insurer
				  will report to the MIB, Inc., a generic code which signifies only a nonspecific
				  blood test abnormality. The test results may also be disclosed to any member
				  company that receives an application for health or life insurance on your life.
				  If your HIV test is normal, no report will be made about it to the MIB, Inc.
				  Other test results may be reported to the MIB, Inc., in a more specific manner.
				  The organizations described in this paragraph may maintain the test results in
				  a file or data bank. There will be no other disclosure of test results or even
				  that the tests have been done except as may be required or permitted by law or
				  as authorized by you.
If your HIV test results are normal, no routine notification
				  will be sent to you. If the HIV test results are other than normal, the insurer
				  will contact you. The insurer may also contact you if there are other abnormal
				  test results which, in the insurer's opinion, are significant. The insurer may
				  ask you for the name of a physician or other health care provider to whom you
				  may authorize disclosure and with whom you may wish to discuss the
				  results.
Positive HIV antibody/antigen test results do not mean that
				  you have AIDS, but that you are at significantly increased risk of developing
				  AIDS or AIDS-related conditions. Federal authorities say that persons who are
				  HIV antibody/antigen positive should be considered infected with the AIDS virus
				  and capable of infecting others.
Positive HIV antibody or antigen test results or other
				  significant blood abnormalities will adversely affect your application for
				  insurance. This means that your application may be declined, that an increased
				  premium may be charged, or that other policy changes may be necessary.
I have read and I understand this Notice and Consent for
				  Blood Testing Which May Include HIV Antibody/Antigen Testing. I voluntarily
				  consent to the withdrawal of blood from me by needle, the testing of blood, and
				  the disclosure of the test results as described above. I understand that this
				  consent shall be valid for thirty (30) months following the date shown
				  below.
I understand that I have the right to request and receive a
				  copy of this authorization. A photocopy or transmitted facsimile of this form
				  will be as valid as the original. I also have the right, upon written request,
				  to an insurance institution (insurers), agent, or insurance support
				  organization for access to recorded personal information and a copy of same
				  within thirty (30) business days from the date such request is received. I have
				  the right to request, in writing, that any recorded personal information be
				  corrected, amended, or deleted within thirty (30) business days from the date
				  of receipt of my written request by an insurance institution, agent, or
				  insurance support organization. If my request is not honored, I have the right
				  to file a concise statement of the correct, relevant or fair information; and
				  the reasons why I disagree with such refusal to correct, amend, or delete
				  recorded personal information.
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O.C.G.A. Secs.
				  31-22-9.2,
				  33-2-9.