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Ethical Issues
  Applying for Health Insurance:
  What Should You Reveal?

By Michele Simon, JD, MPH

Reviewed by Paula Gregory, PhD





One fear that people have about genetic testing is that insurance companies will deny access to health insurance based on the test results. These concerns drive some people to pay for their own genetic tests in order to avoid having the results go into their medical record. Whether you will be required to provide genetic information to potential insurers depends on many things, including the type of insurance you are applying for, the exact wording of the questions, and the state in which you live.

 
 
 

Who Needs to Answer Health Questions?

Not every insured person needs to worry about answering questions regarding genetic testing. Most people in the United States are covered by group health insurance plans through their employer. People who are covered under such plans are generally not asked any individual questions about their health, or about their family's health. The trouble comes in for the millions of Americans who are covered under individual plans and must fill out an application to be approved. These people may run into questions regarding their risk of disease.

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The Role of Medical Records

Most insurance forms do not contain any direct questions related to your genetic health.
Most insurance forms do not contain any direct questions related to genetic health. However, if a form does have such questions you must answer them truthfully or risk being denied coverage based on fraud, either at the outset, or worse, later, when you try to collect benefits.

Even if the application does not contain questions about your genetic health, the company may see this information in your medical records. Insurers request medical records for about one in five individual applications. Depending on where you live, you can try to deny the company access to your medical records by refusing to sign the authorization to release your records. However, if you refuse authorization you may not get covered.

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More on Leaving Genetic Information out of Your Medical Record (Coming Soon)

Answering General Questions

Often, insurance applications have catch-all questions, such as, "Do you have any other conditions?" But if you have something that is pre-symptomatic or predictive, that's not a condition. For example, you shouldn't have to report a positive test for a breast cancer gene mutation unless asked directly. Similarly, you do not have to report a family history of a disease unless the question specifically asks about that disease.

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Can an Insurer Ask About the Results of a Genetic Test?

Whether an insurer can ask about the results of a genetic test at all is a matter of state law
Whether an insurer can ask about the results of a genetic test when you are applying for coverage is a matter of state law. Some states have passed laws that don't allow health insurers to use predictive genetic test results in deciding whether or not to issue coverage or in setting rates. But these laws vary widely in their scope. For example, some states cover only genetic tests, while others include family history.

The federal Health Insurance Portability and Accountability Act (HIPAA) — which prevents group insurance plans from both denying coverage due to genetic information or considering a genetic mutation to be a preexisting condition — does not cover individual plans. Because of the lack of adequate protection, health insurance consumer advocates are calling for a stronger, uniform federal law. In the meantime, it's a good idea to find out what the laws are in your state, if any. Be aware that if you ever move to another state, the situation could change.

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More on Federal and State Laws Regarding Genetic Discrimination (Coming Soon)

The Role of the Insurance Agent

Because agents are motivated to get you covered, they are very skilled at guiding you through the process
The good news is that you usually have to go through an insurance agent to get an individual plan. Because agents are motivated to get you covered, they are very skilled at guiding you through the process, directing you to the best insurance company for your needs, and knowing what you do and don't have to reveal on your application. However, use caution when choosing an agent. Go with someone who comes recommended and whose advice you can trust. Insurance companies will always apply the strictest interpretation to any dispute, so you probably shouldn't reply on an agent for all your advice.
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