Nothing in this chapter may be construed so as to preclude a health insurance issuer from:

(1) establishing rules for eligibility for an individual to purchase or enroll for individual coverage based on the manifestation of a disease or disorder in that individual or in a family member of the individual where the family member is covered under the policy or contract of individual health insurance coverage that covers the individual;

Terms Used In South Carolina Code 38-93-80

  • Contract: A legal written agreement that becomes binding when signed.
  • coverage: means as defined in Sections 38-71-670(6) and 38-71-840(14). See South Carolina Code 38-93-10
  • Family member: means , with respect to an individual:

    (a) a dependent of the individual; and

    (b) any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of the individual or his dependent. See South Carolina Code 38-93-10
  • Genetic information: means , with respect to an individual, the:

    (i) individual's genetic tests;

    (ii) genetic tests of the individual's family members; and

    (iii) manifestation of a disease or disorder in family members of the individual. See South Carolina Code 38-93-10
  • Genetic test: means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations or chromosomal changes. See South Carolina Code 38-93-10
  • Individual: means an insured, individual enrollee, covered dependent, participant, covered person, beneficiary, eligible employee, dependent of an eligible employee, or applicant for coverage. See South Carolina Code 38-93-10
  • insurance: includes annuities. See South Carolina Code 38-1-20
  • issuer: means an entity that provides health insurance coverage in this State as defined in Sections 38-71-670(7) and 38-71-840(16). See South Carolina Code 38-93-10
  • Policy: means a contract of insurance. See South Carolina Code 38-1-20
  • Premium: means payment given in consideration of a contract of insurance. See South Carolina Code 38-1-20
  • Secretary: means the Secretary of the United States Department of Health and Human Services. See South Carolina Code 38-93-10

(2) adjusting premium or contribution amounts for an individual on the basis of a manifestation of a disease or disorder in that individual or in a family member of the individual where the family member is covered under the policy or contract of health insurance coverage that covers the individual. In this case, the manifestation of a disease or disorder in one individual must not be used as genetic information about other individuals covered under the policy or contract of health insurance coverage issued to the individual and to further increase premiums or contribution amounts;

(3) imposing a preexisting condition exclusion as otherwise permitted by law for an individual with respect to coverage under the policy or contract of health insurance coverage on the basis of a manifestation of a disease or disorder in that individual; or

(4) obtaining and using the results of a genetic test in making a determination regarding payment (as that term is defined for purposes of applying the regulations promulgated by the secretary under Part C of Title XI of the Social Security Act and Section 264 of HIPAA, as may be revised) consistent with the provisions of this chapter. However, the issuer may request only the minimum amount of information necessary to make a determination.

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