Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 45 - Regulation 63-Prohibitions on the Use of Medical Information and Genetic Test Results › Section XIII-4505 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Collection
-obtaining a DNA sample or samples
				  for the purpose of determining inherited or individual characteristics that can
				  be utilized to predict the development of medical conditions in the future.
				  Collection shall not mean diagnostic or medical treatment information about an
				  existing medical condition or the prior medical condition of a person applying
				  for or being covered by a health benefit plan.
Compulsory Disclosure
-any disclosure of
				  genetic information mandated or required by federal or state law in connection
				  with a judicial, legislative, or administrative proceeding.
DNA
-deoxyribonucleic acid including
				  mitochondrial DNA, complementary DNA, as well as any DNA derived from
				  ribonucleic acid (RNA). DNA shall not mean any medical procedure or test
				  utilized in the practice of medicine for the purpose of diagnosing or treating
				  a medical illness or health related condition.
Disclose
-to convey or to provide access to
				  genetic information to a person other than the individual.
Family
-includes an individual's blood
				  relatives and any legal relatives, including a spouse or adopted child, who may
				  have a material interest in the genetic information of the individual. For
				  purposes of providing individual or group health care coverage, the term family
				  shall not be used to prevent the collection of reasonable medical information
				  about individuals applying for health insurance coverage to perform medical
				  underwriting based on existing or past medical conditions of those persons
				  being insured, except genetic information as defined herein.
Family History/Pedigree
-the medical history
				  of blood relatives of an individual that is used to predict the possibility of
				  developing a medical condition in the future. The term shall not include the
				  medical history of an insured or applicant for coverage under a health benefit
				  plan.
Genetic Analysis
-the process of
				  characterizing genetic information from a human tissue sample and does not
				  include the performance of medical tests, including but not limited to blood
				  tests, in the diagnosis or treatment of a medical condition.
Genetic Characteristic
-any gene or
				  chromosome, or alteration thereof, that is scientifically or medically believed
				  to cause a disease, disorder, or syndrome, or to be associated with a
				  statistically significant increased risk of development of a disease, disorder
				  or syndrome. The term shall not apply to identification or disclosure of an
				  individual's gender for the purposes of obtaining or maintaining insurance or
				  establishing insurance rates.
Genetic Information-
all information about
				  genes, gene products, inherited characteristics, or family history/pedigree
				  that is expressed in common language and
1.
Genetic Information
shall include each of
				  the following:
a. an individuals genetic test;
b. the genetic tests of the family members of an
				  individual;
c. the manifestation of a disease or disorder in family
				  members of an individual;
d. with respect to an individual or family member of an
				  individual who is a pregnant woman, genetic information of any fetus or embryo
				  carried by such pregnant woman; and with respect to an individual or family
				  member of an individual utilizing an assisted reproductive technology, genetic
				  information of any embryo legally held by the individual or family
				  member.
2.
Genetic Information
does not include the
				  medical history of an individual insured or applicant for health care coverage
				  and shall not mean information about the sex or age of any individual.
Genetic Services
-a genetic test, genetic
				  counseling, including obtaining, interpreting, or assessing genetic
				  information, or genetic education.
Genetic Test
-any test for determining the
				  presence or absence of genetic characteristics in an individual, including
				  tests of nucleic acids, such as DNA, RNA, and mitochondrial DNA, chromosomes,
				  or proteins in order to diagnose or identify a genetic characteristic or that
				  detects genotypes, mutation, or chromosomal changes. The determination of a
				  genetic characteristic shall not include any diagnosis of the presence of
				  disease, disability, or other existing medical condition. Genetic test shall
				  not mean an analysis of proteins or metabolites that either:
1. does not detect genotypes, mutations, or chromosomal
				  changes;
2. is directly related to a manifested disease, disorder, or
				  pathological condition that could be reasonably detected by a health care
				  professional with appropriate training and expertise in the field of medicine
				  involved.
Health Benefit Plan
-any health insurance
				  policy, plan, or health maintenance organization subscriber agreement issued
				  for delivery in this state under a valid certificate of authority and does not
				  include life, disability income, or long-term care insurance.
Individual
-the source of a human tissue
				  sample from which a DNA sample is extracted or genetic information is
				  characterized.
Individual Identifier
-a name, address,
				  Social Security number, health insurance identification number, or similar
				  information by which the identity of an individual can be determined with
				  reasonable accuracy, either directly or by reference to other available
				  information. Such term does not include characters, numbers, or codes assigned
				  to an individual or a DNA sample that cannot singly be used to identify an
				  individual.
Insurer
-any hospital, health, or medical
				  expense insurance policy, hospital or medical service contract, employee
				  welfare benefit plan, health and accident insurance policy, or any other
				  insurance contract of this type, including a group insurance plan, or any
				  policy of group, family group, blanket, or association health and accident
				  insurance, a self-insurance plan, health maintenance organization, and
				  preferred provider organization, including insurance agents and third-party
				  administrators, which delivers or issues for delivery in this state an
				  insurance policy or plan. The term
insurer
does not include
				  any individual or entity that does not hold a valid certificate of authority to
				  issue, for delivery in this state, an insurance policy or plan. A certificate
				  of authority to issue an insurance policy or plan for delivery shall not
				  include a license or certificate to act as a preferred provider organization,
				  insurance agent, or third-party administrator.
Person
-all persons other than the individual
				  or authorized agent acting on behalf of the individual, who is the source of a
				  tissue sample and shall include a family, corporation, partnership,
				  association, joint venture, government, governmental subdivision or agency, and
				  any other legal or commercial entity. This shall not prevent any licensed
				  insurance agent duly authorized to act on behalf of the individual, from
				  completing and submitting health insurance application documents required to
				  apply for coverage under a health policy or plan.
Research
-scientific investigation that
				  includes systematic development and testing of hypotheses for the purpose of
				  increasing knowledge.
Storage
-retention of a DNA sample or of
				  genetic information for an extended period of time after the initial testing
				  process. The term does not include medical history information about insureds
				  or persons applying for coverage under a health benefit plan.
Underwriting Purposes
-rules for or
				  determination of eligibility, including enrollment and continued eligibility,
				  for benefits under the plan or coverage; the computation of premium or
				  contribution amounts under the plan or coverage; and other activities related
				  to the creation, renewal, or replacement of a contract or policy issued by an
				  insurer.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:971,
				  22:258,
				  22:242(7),
				  22:1964(22)
				  and (23),
				  22:1022,
				  and
				  22:1023
				  of the Insurance Code.