INSURANCE CODE
CHAPTER 546. USE OF GENETIC TESTING INFORMATION
SUBCHAPTER A. GENERAL PROVISIONS
§ 546.001. DEFINITIONS. In this chapter:
(1) "DNA" means deoxyribonucleic acid.
(2) "Genetic characteristic" means a scientifically
or medically identifiable genetic or chromosomal variation,
composition, or alteration that predisposes an individual to a
disease, disorder, or syndrome.
(3) "Genetic information" means information that is:
(A) obtained from or based on a scientific or
medical determination of the presence or absence in an individual
of a genetic characteristic; or
(B) derived from the results of a genetic test
performed on an individual.
(4) "Genetic test" means a presymptomatic laboratory
test of an individual's genes, gene products, or chromosomes that:
(A) analyzes the individual's DNA, RNA,
proteins, or chromosomes; and
(B) is performed to identify any genetic
variation, composition, or alteration that is associated with the
individual's having a predisposition for:
(i) developing a clinically recognized
disease, disorder, or syndrome; or
(ii) being a carrier of a clinically
recognized disease, disorder, or syndrome.
The term does not include a blood test, cholesterol
test, urine test, or other physical test used for a purpose other
than determining a genetic or chromosomal variation, composition,
or alteration in a specific individual; a routine physical
examination or a routine test performed as part of a physical
examination; a test to determine drug use; or a test to determine
the presence of the human immunodeficiency virus.
(5) "RNA" means ribonucleic acid.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.002. APPLICABILITY OF CHAPTER. This chapter
applies only to a group health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) a group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or a group evidence of coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a stipulated premium company operating
under Chapter 884; or
(v) a health maintenance organization
operating under Chapter 843; and
(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a group health benefit plan that is offered by:
(i) a multiple employer welfare arrangement
as defined by Section 3 of that Act;
(ii) another entity not authorized under
this code or another insurance law of this state that directly
contracts for health care services on a risk-sharing basis,
including a capitation basis; or
(iii) another analogous benefit
arrangement; or
(2) is offered by an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.003. EXCEPTIONS. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury; or
(D) as a supplement to liability insurance;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) workers' compensation insurance coverage;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a group health benefit plan as described by Section 546.002.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER B. GENETIC TESTING AND USE OF TEST RESULTS
§ 546.051. CERTAIN TESTING PERMITTED; INDUCEMENT
PROHIBITED. (a) A group health benefit plan issuer that requests
an applicant for coverage under the plan to submit to a genetic test
in connection with the application for coverage for a purpose not
prohibited under Section 546.052 must:
(1) notify the applicant that the test is required;
(2) disclose to the applicant the proposed use of the
test results; and
(3) obtain the applicant's written informed consent
before the test is administered.
(b) The applicant shall state in the consent form whether
the applicant elects to be informed of the test results. If the
applicant elects to be informed, the person or entity that performs
the test shall disclose the test results to the applicant and the
group health benefit plan issuer. The issuer shall ensure that:
(1) the applicant receives an interpretation of the
test results made by a qualified health care practitioner; and
(2) a physician or other health care practitioner
designated by the applicant receives a copy of the test results.
(c) A group health benefit plan issuer may not use the
results of a genetic test conducted in accordance with Subsection
(a) to induce the purchase of coverage under the plan.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.052. IMPROPER USE OF TEST RESULTS; REFUSAL TO
SUBMIT TO TESTING. A group health benefit plan issuer may not use
genetic information or the refusal of an applicant to submit to a
genetic test to reject, deny, limit, cancel, refuse to renew,
increase the premiums for, or otherwise adversely affect
eligibility for or coverage under the plan.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.053. TESTING RELATED TO PREGNANCY. (a) In this
section, "coerce" means to restrain or dominate a woman's free will
by actual or implied:
(1) force; or
(2) threat of rejecting, denying, limiting,
canceling, refusing to renew, or otherwise adversely affecting
eligibility for coverage under a group health benefit plan.
(b) A group health benefit plan issuer may not:
(1) require as a condition of coverage genetic testing
of a child in utero without the pregnant woman's consent; or
(2) use genetic information to coerce or compel a
pregnant woman to have an induced abortion.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.054. DESTRUCTION OF SAMPLE MATERIAL;
EXCEPTIONS. A sample of genetic material obtained from an
individual for a genetic test shall be destroyed promptly after the
purpose for which the sample was obtained is accomplished unless:
(1) the sample is retained under a court order;
(2) the individual authorizes retention of the sample
for medical treatment or scientific research;
(3) the sample was obtained for research that is
cleared by an institutional review board and retention of the
sample is:
(A) under a requirement the institutional review
board imposes on a specific research project; or
(B) authorized by the research participant with
institutional review board approval under federal law; or
(4) the sample was obtained for a screening test
established by the Texas Department of Health under Section 33.011,
Health and Safety Code, and performed by that department or a
laboratory approved by that department.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER C. DISCLOSURE OF GENETIC INFORMATION; CONFIDENTIALITY;
EXCEPTIONS
§ 546.101. DISCLOSURE OF TEST RESULTS TO INDIVIDUAL
TESTED. (a) An individual who submits to a genetic test has the
right to know the results of the test. On the written request by the
individual, the group health benefit plan issuer or other entity
that performed the test shall disclose the test results to:
(1) the individual; or
(2) a physician designated by the individual.
(b) The right to receive information under this section is
in addition to any right or requirement established under Sections
546.051 and 546.052.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.102. CONFIDENTIALITY OF GENETIC
INFORMATION. (a) Except as provided by Sections 546.103(a) and
(b), genetic information is confidential and privileged regardless
of the source of the information.
(b) A person or entity that holds genetic information about
an individual may not disclose or be compelled to disclose, by
subpoena or otherwise, that information unless the disclosure is
specifically authorized by the individual as provided by Section
546.104.
(c) This section applies to a redisclosure of genetic
information by a secondary recipient of the information after
disclosure of the information by an initial recipient. Except as
provided by Section 546.103(b), a group health benefit plan issuer
may not redisclose genetic information unless the redisclosure is
consistent with the disclosures authorized by the tested individual
under an authorization executed under Section 546.104.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.103. EXCEPTIONS TO CONFIDENTIALITY. (a) Subject
to Subchapter G, Chapter 411, Government Code, genetic information
may be disclosed without an authorization under Section 546.104 if
the disclosure is:
(1) authorized under a state or federal criminal law
relating to:
(A) the identification of individuals; or
(B) a criminal or juvenile proceeding, an
inquest, or a child fatality review by a multidisciplinary
child-abuse team;
(2) required under a specific order of a state or
federal court;
(3) for the purpose of establishing paternity as
authorized under a state or federal law;
(4) made to provide genetic information relating to a
decedent and the disclosure is made to the blood relatives of the
decedent for medical diagnosis; or
(5) made to identify a decedent.
(b) A group health benefit plan issuer may redisclose
genetic information without an authorization under Section
546.104:
(1) for actuarial or research studies if:
(A) a tested individual could not be identified
in any actuarial or research report; and
(B) any materials that identify a tested
individual are returned or destroyed as soon as reasonably
practicable;
(2) to the department for the purpose of enforcing
this chapter; or
(3) for a purpose directly related to enabling a
business decision to be made about:
(A) purchasing, transferring, merging, or
selling all or part of an insurance business; or
(B) obtaining reinsurance affecting that
insurance business.
(c) A redisclosure authorized under Subsection (b) may
contain only information reasonably necessary to accomplish the
purpose for which the information is disclosed.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.104. AUTHORIZED DISCLOSURE. An individual or an
individual's legal representative may authorize disclosure of
genetic information relating to the individual by an authorization
that:
(1) is written in plain language;
(2) is dated;
(3) contains a specific description of the information
to be disclosed;
(4) identifies or describes each person authorized to
disclose the genetic information to a group health benefit plan
issuer;
(5) identifies or describes the individuals or
entities to whom the disclosure or subsequent redisclosure of the
genetic information may be made;
(6) describes the specific purpose of the disclosure;
(7) is signed by the individual or legal
representative and, if the disclosure is made to claim proceeds of
an affected life insurance policy, the claimant; and
(8) advises the individual or legal representative
that the individual's authorized representative is entitled to
receive a copy of the authorization.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER D. ENFORCEMENT
§ 546.151. CEASE AND DESIST ORDER. (a) On a finding by
the commissioner that a group health benefit plan issuer is in
violation of this chapter, the commissioner may issue a cease and
desist order in the manner provided by Chapter 83.
(b) If a group health benefit plan issuer refuses or fails
to comply with a cease and desist order issued under this section,
the commissioner may, in the manner provided by this code and other
insurance laws of this state, revoke or suspend the issuer's
certificate of authority or other authorization to operate a group
health benefit plan in this state.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 546.152. ADMINISTRATIVE PENALTY. A group health
benefit plan issuer that operates a plan in violation of this
chapter is subject to an administrative penalty as provided by
Chapter 84.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
