Frequently Asked Questions Final Interim Genetic Information Nondiscrimination Act Title I Regulations (GINA Regulations) These FAQs are intended to provide additional information on GINA regulations, including the impact of these regulations to health plans that use Health Risk Assessments (HRAs). This document will be updated as additional information becomes available. Q: Do you use information from genetic testing when considering an applicant for
coverage?
A: No, we do not use predictive genetic information to set premium rates or as a condition of
eligibility for coverage.
Q: Do your plans cover genetic testing for members?
A: It depends. We recognize the value of some genetic tests to diagnose and predict disease to
improve health outcomes of individuals. However, it is important to consider the merits of
genetic testing on a case-by-case basis as the use of some genetic tests has not been shown
to lead to positive health outcomes. Our Medical Policy and Technology Assessment
Committee has evaluated the medical necessity of several genetic tests and has developed
specific medical policies for many of these. For those that are determined to meet medical
necessity criteria, benefit coverage applies in accordance with the member's health plan
certificate.
Q: Do you support the GINA legislation?
A: Yes, we support the goals of the Genetic Information Nondiscrimination Act of 2008 to ensure
that patients and their families do not face discrimination on the basis of their predictive genetic
information.
Q: What genetic tests do your plans cover?
A: We cover those tests that our Medical Policy and Technology Assessment Committee has
determined meet medical necessity criteria. Benefit coverage applies in accordance with the
member's health plan certificate. Members considering receiving a genetic test should call the
customer service number on the back of their membership card to determine if it is a covered
benefit.
Q: How do you determine which genetic tests are covered and which are not?
A: We consider the merits of genetic testing on a case-by-case basis, as the use of some genetic
tests has not been shown to lead to positive health outcomes. Our medical policies are based
on scientific evidence and the most recent research data available.
Q: Will you keep members’ genetic test results confidential?
A: Yes. Our privacy policy includes provisions to protect the confidentiality of all individual
identifiable information, including genetic information.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non‐HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self‐funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 11/23/09 Q: Will your health risk assessments be revised?
A: Yes. All family medical history questions are being removed from our paper and online HRAs in
order to achieve compliance with the GINA regulations. Additionally, a team is in place to
review and address guidance that the Equal Employment Opportunity Commission (EEOC)
intends to release on Title II of GINA.
Q: Why did your health risk assessments include family medical history questions?
A: Responses to the family medical history questions allowed us to identify possible programs that
would be of benefit to a new member (e.g., a program to provide asthma information to
members at risk for this condition). We do not use predictive genetic information to set premium
rates or as a condition of eligibility for coverage.
Q: Will you offer a reward component for completion of the health risk assessment?
A: No rewards or incentives will be provided for the completion of health risk assessments that
include family medical history questions or other requests for genetic information. We continue
to monitor legal developments and will comply with any applicable requirements.
GINA and Wellness Programs
Q: How did you use family medical history data received during the HRA process?
A: While this information was formerly provided during the HRA process, it was not stored, used to
set premium rates, or as a condition of eligibility for coverage.
Q: Are a member’s own diagnosis questions considered family medical history?
A: No, asking a member about their own “manifested” conditions and health status is permissible
under GINA. These questions will remain part of the HRA and will continue to be used to
identify members for our wellness programs.
Q: Are family medical history questions from the HRA used in predictive models?
A: No, even prior to GINA, this information was not used in predictive modeling for any Disease
Management or Wellness programs.
Q: What influence did family medical history have on the nurses’ recommendations or
discussions with members?
A: Very little. As this information is not stored or used to create cases, our nurses did not have
direct access to this information. If this information became known to the nurse, it was provided
by the member during a conversation with the nurse. In this context, it could lead to a reminder
to obtain recommended screenings or a cautionary emphasis on the condition or risk factor.
Q: Is your interpretation of GINA causing you to not ask any family history questions when
one of your disease management or lifestyle clinical coaches is working with an
individual under a Lifestyle Management or Disease Management telephonic coaching
effort?
A: We are evaluating our practices at this time. In the past, we asked family history questions in
working with members enrolled in our programs. Incentives may have been paid to members for
enrolling in or completing our programs. Since the regulations prohibit rewards associated with
the collection of genetic information, we are evaluating the potential ramifications of this
practice.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non‐HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self‐funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 11/23/09 Q: For biometric screening, were you asking any family medical history questions on a
questionnaire or verbally? Is this practice changing and how? Is there a difference
depending on whether the screening is stand alone or if it is tied in some way to open
enrollment and/or an incentive?
A: Our biometric screenings offered through our Worksite Wellness programs do not ask any
family medical history questions in writing or verbally. This is the same regardless of whether it
is as a standalone screening or tied to open enrollment.
Q: In the face of removing family history questions, are you making any recommendations
to clients as to ways they could mitigate the loss of the data, such as promoting primary
care relationships or other initiatives?
A: Our attention is currently on evaluating the near-term legal impacts of the GINA regulations and
providing prompt resolution. Thereafter, we will begin to identify whether possible alternatives
exist that will not conflict with the regulations but will drive towards improved member care.
Q: What is your obligation to clients using external HRAs?
A: If your client uses an external HRA, then you may wish to make them aware of the regulations
as a courtesy. Talking points have been distributed for your use in doing so. Groups must
discuss the GINA regulations directly with their separately-contracted HRA vendor to assure
compliance.
Q: Do the regulations impact family medical history questions asked as part of the program
engagement process?
A: It depends. The regulations place restrictions on the timing, content and use of requests for
genetic information (including HRAs that have family medical history questions). Genetic
information cannot be requested prior to enrollment, and no rewards or incentives can be
provided for completing a health risk assessment that includes family medical history questions
at any time. In addition, responses to family medical history questions cannot be used for
determining eligibility for our programs or any other benefit. A thorough evaluation is currently
taking place to determine: 1) whether or not we currently use family medical history questions in
our programs and 2) if we do, they are used in a manner that is compliant with the regulations.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non‐HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self‐funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 11/23/09