Subject 120-2-43 MEDICAL OR LIFE-STYLE QUESTIONS ON APPLICATIONS AND UNDERWRITING GUIDELINES AFFECTING AIDS AND ARC
The purpose of this Rule is to establish standards pursuant to O.C.G.A. Sections 33-2-9 and 31-22-9.2 to assist insurers to formulate and design medical or life-style questions in applications and underwriting standards affecting health and life insurance coverages.
|(1)|| Questions relating to medical and other
factual material intended to reveal the possible existence of a medical
condition are permissible if they are not used as a proxy to establish the
sexual orientation of the applicant, and the applicant has been given an
opportunity to provide an explanation for any affirmative answers given in the
application. No question may be asked if the purpose of such question is to
establish the sexual orientation of an applicant.
For example: "Have you had chronic cough, significant weight loss, chronic fatigue, diarrhea, enlarged glands, . . . " These types of questions should be related to a finite period of time, not more than ten years, preceding completion of the application and should be specific. All of the questions above should provide the applicant the opportunity to give a detailed explanation.
|(2)||Questions relating to the applicant having been diagnosed as having or having been advised by a member of the medical profession to seek treatment for a sexually transmitted disease are permissible.|
|(3)||Neither the marital status, the "living arrangements," the occupation, the gender, the medical history, the beneficiary designation, nor the zip code or other territorial classification of an applicant may be used to establish, or aid in establishing the applicant's sexual orientation.|
|(4)||For purposes of rating an applicant for health and life insurance, an insurer may impose territorial rates, but only if the rates are based on sound actuarial principles or are related to actual or reasonably anticipated experience.|
No adverse underwriting decision shall be made because medical records or a report from an insurance support organization shows that the applicant has demonstrated AIDS-related concerns by seeking counseling from health care professionals. This paragraph does not apply to an applicant seeking treatment or diagnosis.
All underwriting questions must be phrased in such a manner as to elicit a factual response.
For example: A question such as: "Do you have any immunodeficiency disorders?" is too broad and would not be readily understood by an applicant and is not designed to elicit a factual answer. An insurer can ask for specific immunodeficiency disorders.
Questions such as: "Have you ever been diagnosed as having AIDS or ARC?" or "Have you tested positive on an AIDS-related blood test?" are also acceptable. An applicant may not be turned down due to a single positive test which is not a complete established test protocol unless the applicant fails to give his written consent to further testing.
Questions such as: "Have you ever been exposed to AIDS or ARC?" or "Have you ever had or been told you had AIDS Related Conditions?" are not acceptable due to the vagueness of the words "exposed" and "conditions."
|(1)||No health insurance policy, individual or group, may contain a provision which excludes expenses due to AIDS or ARC or places lower limits on the benefits available if the insured is being treated for AIDS or ARC under the policy. "Limits" would include, but not be limited to, reduced lifetime benefit caps, lower coinsurance percentages and shorter benefit periods.|
|(2)||Reduction riders excluding or limiting coverage for AIDS or ARC must be restricted to a preexisting condition only of a specified insured.|
Whenever an applicant is requested to take an AIDS-related test in connection with an application for insurance, the use of such a test must be revealed to the applicant and his or her written consent obtained. No adverse underwriting decision shall be made on the basis of a positive AIDS-related test unless an established test protocol has been followed. At a minimum, an established test protocol requires two positive ELISA tests and one positive Western blot. If new and more effective AIDS-related tests are developed, they may be used as a substitute for the aforementioned test.
Shown below is an acceptable "Notice and Consent for Blood Testing" form. The form should contain an appropriate form number and be filed with the Georgia Insurance Department for approval.
NOTICE AND CONSENT FOR BLOOD TESTING WHICH MAY INCLUDE AIDS VIRUS (HIV) ANTIBODY/ANTIGEN TESTING
To determine your insurability, the insurer named above ("the insurer") has requested that you provide a sample of your blood for testing and analysis. All tests will be performed by a licensed laboratory.
Tests may be performed to determine the presence of antibodies or antigens to the Human Immunodeficiency Virus (HIV), also known as the AIDS virus. The HIV antibody test is actually a series of tests done by a medically accepted procedure. The HIV antigen test directly identifies AIDS viral particles. These tests are extremely reliable. Other tests which may be performed include determinations of blood cholesterol and related lipids (fats) and screening for liver or kidney disorders, diabetes, and immune disorders.
All tests results will be treated confidentially. They will be reported by the laboratory to the insurer. When necessary for business reasons in connection with insurance you have or have applied for with the insurer, the insurer may disclose test results to others such as its affiliates, reinsurers, independent contractors, and its employees to whom disclosure is reasonably necessary in the ordinary course of business to carry out the purposes for which that disclosure is authorized or required. If the insurer is a member of the Medical Information Bureau ("MIB, Inc."), and if the test results for HIV antibodies/antigens are other than normal, the insurer will report to the MIB, Inc., a generic code which signifies only a nonspecific blood test abnormality. The test results may also be disclosed to any member company that receives an application for health or life insurance on your life. If your HIV test is normal, no report will be made about it to the MIB, Inc. Other test results may be reported to the MIB, Inc., in a more specific manner. The organizations described in this paragraph may maintain the test results in a file or data bank. There will be no other disclosure of test results or even that the tests have been done except as may be required or permitted by law or as authorized by you.
If your HIV test results are normal, no routine notification will be sent to you. If the HIV test results are other than normal, the insurer will contact you. The insurer may also contact you if there are other abnormal test results which, in the insurer's opinion, are significant. The insurer may ask you for the name of a physician or other health care provider to whom you may authorize disclosure and with whom you may wish to discuss the results.
Positive HIV antibody/antigen test results do not mean that you have AIDS, but that you are at significantly increased risk of developing AIDS or AIDS-related conditions. Federal authorities say that persons who are HIV antibody/antigen positive should be considered infected with the AIDS virus and capable of infecting others.
Positive HIV antibody or antigen test results or other significant blood abnormalities will adversely affect your application for insurance. This means that your application may be declined, that an increased premium may be charged, or that other policy changes may be necessary.
I have read and I understand this Notice and Consent for Blood Testing Which May Include HIV Antibody/Antigen Testing. I voluntarily consent to the withdrawal of blood from me by needle, the testing of blood, and the disclosure of the test results as described above. I understand that this consent shall be valid for thirty (30) months following the date shown below.
I understand that I have the right to request and receive a copy of this authorization. A photocopy or transmitted facsimile of this form will be as valid as the original. I also have the right, upon written request, to an insurance institution (insurers), agent, or insurance support organization for access to recorded personal information and a copy of same within thirty (30) business days from the date such request is received. I have the right to request, in writing, that any recorded personal information be corrected, amended, or deleted within thirty (30) business days from the date of receipt of my written request by an insurance institution, agent, or insurance support organization. If my request is not honored, I have the right to file a concise statement of the correct, relevant or fair information; and the reasons why I disagree with such refusal to correct, amend, or delete recorded personal information.