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HOUSE BILL NO. 111
INTRODUCED BY M. GUGGENHEIM, L. SOFT, D. GRIMES
BY REQUEST OF THE STATE AUDITOR
AN ACT ESTABLISHING STANDARDS FOR THE COLLECTION, USE, AND DISCLOSURE OF GENETIC INFORMATION IN ISSUING INSURANCE; PROHIBITING INSURERS FROM REQUIRING GENETIC TESTING EXCEPT AS OTHERWISE REQUIRED BY LAW; PROHIBITING DISCRIMINATION ON THE BASIS OF GENETIC TRAITS BY INSURERS, HEALTH SERVICE CORPORATIONS, HEALTH MAINTENANCE ORGANIZATIONS, FRATERNAL BENEFIT SOCIETIES, AND OTHER ISSUERS OF INDIVIDUAL OR GROUP POLICIES OR CERTIFICATES OF INSURANCE; PROHIBITING THE SOLICITATION OF GENETIC INFORMATION FOR NONTHERAPEUTIC PURPOSES; AND AMENDING SECTIONS 2-18-812 AND 33-31-111, MCA.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Section 2-18-812, MCA, is amended to read:
"2-18-812. Alternatives to conventional insurance for providing state employee group benefits authorized -- requirements. The department may establish alternatives to conventional insurance for providing state employee group benefits. The requirements for providing alternatives to conventional insurance are as follows:
(1) The department shall maintain state employee group benefit plans on an actuarially sound basis.
(2) The department shall maintain reserves sufficient to liquidate the unrevealed claims liability and other liabilities of state employee group benefit plans.
(3) The department shall deposit all reserve funds and premiums paid to a state employee group benefit plan, and the deposits must be expended for claims under the plan.
(4) The department shall deposit income earned from the investment of a state employee group benefit plan's reserve fund into the account established under subsection (3) in order to offset the costs of administering the plan. Expenditures for actual and necessary expenses required for the efficient administration of the plan must be made from temporary appropriations, as described in 17-7-501(1) or (2), made for that purpose.
(5) The department shall, prior to implementation of any alternative to conventional insurance, present to the advisory council the evidence upon which the department has concluded that the alternative method will be more efficient, less costly, or otherwise superior to contracting for conventional insurance.
The Except as otherwise provided in [sections 3 through 6], the provisions of Title 33 do not apply to the
department when exercising the powers and duties provided for in this section."
Section 2. Section 33-31-111, MCA, is amended to read:
"33-31-111. Statutory construction and relationship to other laws. (1) Except as otherwise provided in this chapter,
the insurance or health service corporation laws do not apply to
any a health maintenance organization authorized to
transact business under this chapter. This provision does not apply to an insurer or health service corporation licensed and
regulated pursuant to the insurance or health service corporation laws of this state except with respect to its health
maintenance organization activities authorized and regulated pursuant to this chapter.
(2) Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives is not a violation of any law relating to solicitation or advertising by health professionals.
(3) A health maintenance organization authorized under this chapter is not practicing medicine and is exempt from Title 37, chapter 3, relating to the practice of medicine.
(4) This chapter does not exempt a health maintenance organization from the applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.
(5) This section does not exempt a health maintenance organization from the prohibition of pecuniary interest under 33-3-308 or the material transaction disclosure requirements under 33-3-701 through 33-3-704. A health maintenance organization must be considered an insurer for the purposes of 33-3-308 and 33-3-701 through 33-3-704.
(6) This section does not exempt a health maintenance organization from:
(a) prohibitions against interference with certain communications as provided under chapter 1, part 8;
(b) the provisions of Title 33, chapter 22, part 19;
(c) the requirements of 33-22-134 and 33-22-135;
(d) network adequacy and quality assurance requirements provided under chapter 36; or
(e) the requirements of [sections 3 through 6].
(7) Sections 33-22-141, 33-22-142, 33-22-246, 33-22-247, 33-22-514, 33-22-523, 33-22-524, and 33-22-526 apply to health maintenance organizations."
Section 3. Definitions. Unless the context indicates otherwise, the following definitions apply to [sections 3 through 6]:
(1) "Genetic information" means, unless otherwise provided by Public Law 104-191, information derived from genetic testing or medical evaluation to determine the presence or absence of variations or mutations, including carrier status, in an individual's genetic material or genes that are scientifically or medically believed to cause a disease, disorder, or syndrome or are associated with a statistically increased risk of developing a disease, disorder, or syndrome that is asymptomatic at the time of testing.
(2) "Genetic testing" or "genetic test" means a test used to diagnose a presymptomatic genetic factor, including analysis of human deoxyribonucleic acid or ribonucleic acid, chromosomes, proteins, or metabolites. The term does not include a routine physical examination or a chemical, blood, or urine analysis, unless conducted or analyzed purposefully or knowingly to obtain genetic information, or a family history.
(3) "Genetic trait" means any medically or scientifically identified genetic factor, known or presumed to be present in the individual or a biological relative but not presently associated with any manifestations of the disorder in the individual, that could cause a disorder or be statistically associated with an increased risk of development of a disorder.
(4) "Group policy" includes:
(a) the group insurance program authorized by Title 2, chapter 18, part 7;
(b) the state employee group insurance program required by Title 2, chapter 18, part 8; and
(c) a self-funded multiple employer welfare arrangement that is not regulated pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001, et seq.
Section 4. Requirement for genetic testing -- limitations. (1) An insurer, health service corporation, health maintenance organization, fraternal benefit society, or other issuer of an individual or group policy or certificate of insurance may not require an individual to obtain a genetic test unless the test is otherwise required by law for reasons including but not limited to the following:
(a) to establish parentage;
(b) to determine the presence of metabolic disorders in a newborn by testing conducted pursuant to newborn screening and protocols;
(c) in connection with a criminal investigation or prosecution; or
(d) for remains identification.
(2) This section does not apply to transactions of life, disability income, or long-term care insurance.
Section 5. Discrimination on basis of genetic traits prohibited. (1) Unless otherwise required by law, an insurer, health service corporation, health maintenance organization, fraternal benefit society, or other issuer of an individual or group policy or certificate of insurance may not, on the basis of a person's genetic traits:
(a) fail or refuse to accept an application for a policy or certificate of insurance;
(b) fail or refuse to issue a policy or certificate of insurance to an applicant;
(c) cancel a policy or certificate of insurance;
(d) refuse to renew a policy or certificate of insurance;
(e) charge a higher rate or premium for a policy or certificate of insurance; or
(f) offer or provide different terms, conditions, or benefits or place a limitation on coverage under a policy or certificate of insurance.
(2) An insurer, health service corporation, health maintenance organization, fraternal benefit society, or other issuer of an individual or group policy or certificate of insurance may not underwrite or condition coverage on the basis of:
(a) a requirement or agreement that the individual undergo genetic testing; or
(b) genetic information about a member of the individual's family.
(3) Discrimination may not be made in the fees or commissions of agents or brokers for writing or renewing an individual or group policy of insurance on the basis of an individual's genetic traits.
(4) This section does not apply to transactions of life, disability income, or long-term care insurance.
(5) This section does not prohibit an insurer, health service corporation, health maintenance organization, fraternal benefit society, or other issuer of an individual or group policy or certificate of insurance from discriminating as otherwise allowed by law on the basis of other factors unrelated to genetic traits.
Section 6. Seeking genetic information for nontherapeutic purposes prohibited. (1) An insurer, health service corporation, health maintenance organization, fraternal benefit society, or other issuer of an individual or group policy or certificate of insurance may not seek genetic information about an individual for a purpose that is:
(a) unrelated to assessing or managing the individual's current health;
(b) inappropriate in an asymptomatic individual; or
(c) unrelated to research in which a subject is not personally identifiable.
(2) This section does not apply to transactions of life, disability income, or long-term care insurance.
Section 7. Codification instruction. [Sections 3 through 6] are intended to be codified as an integral part of Title 33, chapter 18, and the provisions of Title 33, chapter 18, apply to [sections 3 through 6].
Section 8. Saving clause. [This act] does not affect rights and duties that matured, penalties that were incurred, or proceedings that were begun before [the effective date of this act].
Section 9. Severability. If a part of [this act] is invalid, all valid parts that are severable from the invalid part remain in effect. If a part of [this act] is invalid in one or more of its applications, the part remains in effect in all valid applications that are severable from the invalid applications.
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Latest Version of HB 111 (HB0111.ENR)
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