What Employers Can and Cannot Do Under GINA

The following scenarios are strictly prohibited by Internal Revenue Service rules implementing the Genetic Information Nondiscrimination Act:

• Any group health plan that provides a premium reduction to employees who complete a health risk assessment prior to enrollment that includes questions about family medical history.

• Any group health plan that requests employees to complete a health risk assessment prior to enrollment that includes questions about an individual’s family medical history, but does not offer a reward.

• Any group health plan in which certain individuals completing the health risk assessment become eligible for a disease management program based on their answers to questions about family medical history.

• Any group health plan that waives its annual deductible for individuals who complete a health risk assessment after enrollment that does not include any direct questions about family medical history but asks, “Is there anything else relevant to your health that you would like us to know or discuss with you?”—the answers to which may divulge genetic information.

The following scenarios are permissible under the IRS rules:

• Any group health plan that requests enrollees to complete two distinct health risk assessments after and unrelated to enrollment: one that doesn’t include questions about family medical history but offers a reward; and one that includes family medical history questions but offers no reward.

• Any group health plan that waives its annual deductible for individuals who complete a health risk assessment after enrollment that includes the question, “Is there anything else relevant to your health that you would like us to know or discuss with you? In answering this question, you should not include any genetic information. That is, please do not include any family medical history or any information related to genetic testing, genetic services, and genetic counseling or genetic diseases for which you may be at risk.”

• Any group health plan that normally provides coverage for mammograms only for women 40 and older may choose to extend coverage to younger women who demonstrate they are at increased risk of getting breast cancer, such as through genetic testing or a family history of the disease.