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Is the most obvious question being adressed in any jurisdiction yet? - Do you legally have to disclose your results to any insurance company you already have an

Is the most obvious question being adressed in any jurisdiction yet? - Do you legally have to disclose your results to any insurance company you already have an existing contract with or prior to any new insurance contract? By chance, I just read a typical life insurance contract and it already stated that if you have undergone a genetic testing, you do have to disclose your results if you enter into a life insurance contract >300.000€. This was stipulated in the contract and not under general German contract law. If you do not disclose your results, the company can void the contract any time and/or terminate it any time in the future. This is going to be THE most important issue with genetic testing - the implications for your insurance contracts. Obviously, your test results can have massively positive or negative results.

apaprocki 14y ago
In the US, President Bush signed the Genetic Information Nondiscrimination Act of 2008 which covers these topics. Some relevant parts are available here: http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493 http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493: edit: Specifically, "`(A) IN GENERAL- For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information."
- khomenko 14y ago
  Also, California has put a more stringent law on the books in 2011: http://www.privacylives.com/california-passes-bill-to-prohibit-genetic-discrimination/2011/09/12/ http://www.privacylives.com/california-passes-bill-to-prohib...
- im3w1l 14y ago
  I think this isnt a good solution. Imagine the following scenario. A disease hits with p=0.001. To cure it is Very Expensive. Everyone gets insurance that covers it. Now imagine we have a test, that can predict it with certainty. Very soon only those with positive results will want insurance. The insurance against it will become unprofitable and discontinued.
  - apaprocki 14y ago
    I'm pretty sure the spirit of the law is to prevent those types of situations from happening. Wouldn't this cover your situation? "`(1) IN GENERAL- A health insurance issuer offering health insurance coverage in the individual market may not, on the basis of genetic information, impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage."
    - philh 14y ago
      In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people. Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck. (Clarification: I'm describing reality-as-I-see-it. I'm not trying to make moral judgements on what laws we should or shouldn't pass.)
      - PeterBB 14y ago
        This is the precise reason for the "individual mandate" in Obamacare. The two provisions only work in combination.
      - chimeracoder 14y ago
        > philh 2 hours ago | link | parent In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people. > Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck. It's a little more nuanced than that. Let's say men are more prone to car crashes than women. Either you charge men more for auto insurance, OR you charge everyone a flat rate, and the market will rapidly clear itself of all women, since that flat rate will be too high to appeal to women. In this case, you end up with a market that's exclusively men, and women are uninsured. When applied to health insurance, this means that, if you're forcing companies to insure everyone, they will have to insure people predisposed to expensive illnesses at incredibly high rates, because that's the expected cost of their lifetime care. One implication of this is that the "no discrimination for pre-existing conditions" portion of the ACA is equivalent to "if you have a pre-existing condition, your coverage will be exorbitantly expensive". There are ways of hiding this extra cost, but at the end of the day, it's like sweeping dust under the rug: it all has to sum to zero.
- martincmartin 14y ago
  Gender is determined genetically, and men and woman have different life expectancies. Does this mean you can't charge men and women different rates (all else being equal)?
  - carbocation 14y ago
    Since these companies don't determine your sex by asking you to submit a DNA sample and then surmising your sex via genetic information, but rather by asking you to indicate 'M' or 'F' on a form, genetic protections would be unlikely to be pertinent in the vast majority of cases. At least, that's my nonlawyer layperson read of things.
  - khomenko 14y ago
    You can. Insurance spreads risk across population pools. You have to carve out those pools somehow, so you use broad variables like age and gender. The problem is genetic information has potential to make the pools too small.
    - rscale 14y ago
      And from a payer perspective, it's problematic if a sizable population secretly learns that they are at meaningfully greater risk of health problems. Those individuals could then adversely select against the payers by buying Cadillac healthcare plans.
    - mikeash 14y ago
      You don't have to carve out those pools at all. Insurance is workable if everyone is lumped into a single huge pool. The trouble is that a company which is able to break their clientele into smaller pools will outcompete those who aren't, so you get a bit of a race to the bottom.
      - khomenko 14y ago
        Indeed. Singe Payer + Universal Coverage = FTW.
  - 14y ago
- hippich 14y ago
  This covers only lucky ones, who are employed and have access to group insurance plans, isn't it? In this case entrepreneurs who just starting will be screwed.
  - apaprocki 14y ago
    If you read the bill, it covers individuals as well. I just didn't go copy-pasting the entire gazillion page document :)
- fluidcruft 14y ago
  Right. But the parent used life insurance as an example, not health insurance.
  - apaprocki 14y ago
    You're right, life insurance is less regulated and is handled by the individual states in the US. Both New York and California prevent genetic discrimination in life insurance, though.
- jellicle 14y ago
  Note that it doesn't prevent discrimination for life insurance, disability insurance or long-term care insurance; if you get a dangerous condition in your DNA testing you'll never get any of those types of insurance again. Also note the limitations are not very comprehensive. Health insurers could use genetic info and then find ways to deny you coverage on a technicality (didn't disclose tonsilitis at age 4 - DENIED). There's no civil remedy in the law so it would be up to you to petition the Federal government to carry out some sort of enforcement action against insurers, which seems less than likely.
  - MichaelSalib 14y ago
    Health insurers could use genetic info and then find ways to deny you coverage on a technicality How could that work once the Affordable Care Act goes into effect? It requires Guaranteed Issue, so insurers can't do that. Insurers have to accept anyone who requests their plan and they can only vary premiums based on age, location, and smoking.
  - apaprocki 14y ago
    The coverage for life/disability/long-term on a state-by-state basis is here: http://www.ncsl.org/issues-research/health/genetic-nondiscrimination-laws-in-life-disability.aspx http://www.ncsl.org/issues-research/health/genetic-nondiscri... While it isn't covered by law in all states (yet), my state restricts discrimination for life/disability and requires informed consent to use genetic information.
jeremyarussell 14y ago
Not sure if you noticed this on their website. Covers a bit of what has been discussed already but I figured while we are talking about the insurance implications involved we should include the answer 23andme already gives the public. https://customercare.23andme.com/entries/21262356-could-my-genetic-data-make-it-hard-for-me-to-get-insurance-coverage https://customercare.23andme.com/entries/21262356-could-my-g...

apaprocki 14y ago

In the US, President Bush signed the Genetic Information Nondiscrimination Act of 2008 which covers these topics. Some relevant parts are available here: http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493 http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493: edit: Specifically, "`(A) IN GENERAL- For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information."

khomenko 14y ago
Also, California has put a more stringent law on the books in 2011: http://www.privacylives.com/california-passes-bill-to-prohibit-genetic-discrimination/2011/09/12/ http://www.privacylives.com/california-passes-bill-to-prohib...
im3w1l 14y ago
I think this isnt a good solution. Imagine the following scenario. A disease hits with p=0.001. To cure it is Very Expensive. Everyone gets insurance that covers it. Now imagine we have a test, that can predict it with certainty. Very soon only those with positive results will want insurance. The insurance against it will become unprofitable and discontinued.
- apaprocki 14y ago
  I'm pretty sure the spirit of the law is to prevent those types of situations from happening. Wouldn't this cover your situation? "`(1) IN GENERAL- A health insurance issuer offering health insurance coverage in the individual market may not, on the basis of genetic information, impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage."
  - philh 14y ago
    In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people. Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck. (Clarification: I'm describing reality-as-I-see-it. I'm not trying to make moral judgements on what laws we should or shouldn't pass.)
    - PeterBB 14y ago
      This is the precise reason for the "individual mandate" in Obamacare. The two provisions only work in combination.
    - chimeracoder 14y ago
      > philh 2 hours ago | link | parent In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people. > Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck. It's a little more nuanced than that. Let's say men are more prone to car crashes than women. Either you charge men more for auto insurance, OR you charge everyone a flat rate, and the market will rapidly clear itself of all women, since that flat rate will be too high to appeal to women. In this case, you end up with a market that's exclusively men, and women are uninsured. When applied to health insurance, this means that, if you're forcing companies to insure everyone, they will have to insure people predisposed to expensive illnesses at incredibly high rates, because that's the expected cost of their lifetime care. One implication of this is that the "no discrimination for pre-existing conditions" portion of the ACA is equivalent to "if you have a pre-existing condition, your coverage will be exorbitantly expensive". There are ways of hiding this extra cost, but at the end of the day, it's like sweeping dust under the rug: it all has to sum to zero.
martincmartin 14y ago
Gender is determined genetically, and men and woman have different life expectancies. Does this mean you can't charge men and women different rates (all else being equal)?
- carbocation 14y ago
  Since these companies don't determine your sex by asking you to submit a DNA sample and then surmising your sex via genetic information, but rather by asking you to indicate 'M' or 'F' on a form, genetic protections would be unlikely to be pertinent in the vast majority of cases. At least, that's my nonlawyer layperson read of things.
- khomenko 14y ago
  You can. Insurance spreads risk across population pools. You have to carve out those pools somehow, so you use broad variables like age and gender. The problem is genetic information has potential to make the pools too small.
  - rscale 14y ago
    And from a payer perspective, it's problematic if a sizable population secretly learns that they are at meaningfully greater risk of health problems. Those individuals could then adversely select against the payers by buying Cadillac healthcare plans.
  - mikeash 14y ago
    You don't have to carve out those pools at all. Insurance is workable if everyone is lumped into a single huge pool. The trouble is that a company which is able to break their clientele into smaller pools will outcompete those who aren't, so you get a bit of a race to the bottom.
    - khomenko 14y ago
      Indeed. Singe Payer + Universal Coverage = FTW.
- 14y ago
hippich 14y ago
This covers only lucky ones, who are employed and have access to group insurance plans, isn't it? In this case entrepreneurs who just starting will be screwed.
- apaprocki 14y ago
  If you read the bill, it covers individuals as well. I just didn't go copy-pasting the entire gazillion page document :)
fluidcruft 14y ago
Right. But the parent used life insurance as an example, not health insurance.
- apaprocki 14y ago
  You're right, life insurance is less regulated and is handled by the individual states in the US. Both New York and California prevent genetic discrimination in life insurance, though.
jellicle 14y ago
Note that it doesn't prevent discrimination for life insurance, disability insurance or long-term care insurance; if you get a dangerous condition in your DNA testing you'll never get any of those types of insurance again. Also note the limitations are not very comprehensive. Health insurers could use genetic info and then find ways to deny you coverage on a technicality (didn't disclose tonsilitis at age 4 - DENIED). There's no civil remedy in the law so it would be up to you to petition the Federal government to carry out some sort of enforcement action against insurers, which seems less than likely.
- MichaelSalib 14y ago
  Health insurers could use genetic info and then find ways to deny you coverage on a technicality How could that work once the Affordable Care Act goes into effect? It requires Guaranteed Issue, so insurers can't do that. Insurers have to accept anyone who requests their plan and they can only vary premiums based on age, location, and smoking.
- apaprocki 14y ago
  The coverage for life/disability/long-term on a state-by-state basis is here: http://www.ncsl.org/issues-research/health/genetic-nondiscrimination-laws-in-life-disability.aspx http://www.ncsl.org/issues-research/health/genetic-nondiscri... While it isn't covered by law in all states (yet), my state restricts discrimination for life/disability and requires informed consent to use genetic information.

jeremyarussell 14y ago

Not sure if you noticed this on their website. Covers a bit of what has been discussed already but I figured while we are talking about the insurance implications involved we should include the answer 23andme already gives the public. https://customercare.23andme.com/entries/21262356-could-my-genetic-data-make-it-hard-for-me-to-get-insurance-coverage https://customercare.23andme.com/entries/21262356-could-my-g...