§1182 — Title 29 Labor | U.S. Code

§1182 Prohibiting discrimination against individual participants and beneficiaries based on health status

Title 29 › Chapter CHAPTER 18— - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › Subchapter SUBCHAPTER I— - PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle Subtitle B— - Regulatory Provisions › Part part 7— - group health plan requirements › Subpart Subpart A— - Requirements Relating to Portability, Access, and Renewability › § 1182

Last updated Apr 6, 2026|Official source

Summary

Group health plans and the companies that sell group coverage must not use a person’s health or health history to keep them out, make them wait, or charge them more than others in the same group. This rule covers things like current health, physical or mental conditions, past claims or treatments, medical history, genetic information, proof that someone can get insurance, and disabilities. Plans still only have to give the benefits they already promise and may set the same kinds of limits for all people who are alike under the plan. Plans and insurers may not force anyone to take a genetic test. Doctors can ask patients to take one as part of care. Plans may use genetic test results only for payment decisions when allowed, and they may only ask for the least amount of information needed. A plan may ask (but not force) people to join approved research genetic testing if participation is voluntary, does not affect coverage or cost, won’t be used to set prices, and the plan follows extra rules and tells the federal government. Plans and insurers may not buy or ask for genetic information to decide who gets coverage or how much it costs before enrollment. Genetic information also covers a fetus or legally held embryo when that is relevant.

Title 29, §1182

Labor — Source: USLM XML via OLRC

(a)(1)Subject to paragraph (2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

(A)Health status.

(B)Medical condition (including both physical and mental illnesses).

(C)Claims experience.

(D)Receipt of health care.

(E)Medical history.

(F)Genetic information.

(G)Evidence of insurability (including conditions arising out of acts of domestic violence).

(H)Disability.

(2)To the extent consistent with section 1181 of this title, paragraph (1) shall not be construed—

(A)to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or

(B)to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.

(3)For purposes of paragraph (1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such enrollment.

(b)(1)A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.

(2)Nothing in paragraph (1) shall be construed—

(A)to restrict the amount that an employer may be charged for coverage under a group health plan except as provided in paragraph (3); or

(B)to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

(3)(A)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.

(B)Nothing in subparagraph (A) or in paragraphs (1) and (2) of subsection (d) shall be construed to limit the ability of a health insurance issuer offering health insurance coverage in connection with a group health plan to increase the premium for an employer based on the manifestation of a disease or disorder of an individual who is enrolled in the plan. In such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the employer.

(c)(1)A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request or require an individual or a family member of such individual to undergo a genetic test.

(2)Paragraph (1) shall not be construed to limit the authority of a health care professional who is providing health care services to an individual to request that such individual undergo a genetic test.

(3)(A)Nothing in paragraph (1) shall be construed to preclude a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, from obtaining and using the results of a genetic test in making a determination regarding payment (as such term is defined for the purposes of applying the regulations promulgated by the Secretary of Health and Human Services under part C of title XI of the Social Security Act [42 U.S.C. 1320d et seq.] and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time) consistent with subsection (a).

(B)For purposes of subparagraph (A), a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, may request only the minimum amount of information necessary to accomplish the intended purpose.

(4)Notwithstanding paragraph (1), a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, may request, but not require, that a participant or beneficiary undergo a genetic test if each of the following conditions is met:

(A)The request is made, in writing, pursuant to research that complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of human subjects in research.

(B)The plan or issuer clearly indicates to each participant or beneficiary, or in the case of a minor child, to the legal guardian of such beneficiary, to whom the request is made that—

(i)compliance with the request is voluntary; and

(ii)non-compliance will have no effect on enrollment status or premium or contribution amounts.

(C)No genetic information collected or acquired under this paragraph shall be used for underwriting purposes.

(D)The plan or issuer notifies the Secretary in writing that the plan or issuer is conducting activities pursuant to the exception provided for under this paragraph, including a description of the activities conducted.

(E)The plan or issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this paragraph.

(d)(1)A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request, require, or purchase genetic information for underwriting purposes (as defined in section 1191b of this title).

(2)A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request, require, or purchase genetic information with respect to any individual prior to such individual’s enrollment under the plan or coverage in connection with such enrollment.

(3)If a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of paragraph (2) if such request, requirement, or purchase is not in violation of paragraph (1).

(e)The provisions of subsections (a)(1)(F), (b)(3), (c), and (d), and subsection (b)(1) and section 1181 of this title with respect to genetic information, shall apply to group health plans and health insurance issuers without regard to section 1191a(a) of this title.

(f)Any reference in this part to genetic information concerning an individual or family member of an individual shall—

(1)with respect to such an individual or family member of an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and

(2)with respect to an individual or family member utilizing an assisted reproductive technology, include genetic information of any embryo legally held by the individual or family member.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsec. (c)(3)(A), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part C of title XI of the Act is classified generally to part C (§ 1320d et seq.) of subchapter XI of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. section 264 of the Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (c)(3)(A), is section 264 of Pub. L. 104–191, which is set out as a note under section 1320d–2 of Title 42, The Public Health and Welfare.

Amendments

2008—Subsec. (b)(2)(A). Pub. L. 110–233, § 101(a)(1), inserted “except as provided in paragraph (3)” before semicolon. Subsec. (b)(3). Pub. L. 110–233, § 101(a)(2), added par. (3). Subsecs. (c) to (e). Pub. L. 110–233, § 101(b), added subsecs. (c) to (e). Subsec. (f). Pub. L. 110–233, § 101(c), added subsec. (f).

Statutory Notes and Related Subsidiaries

Effective Date

of 2008 AmendmentAmendment by Pub. L. 110–233 applicable with respect to group health plans for plan years beginning after the date that is one year after May 21, 2008, see section 101(f)(2) of Pub. L. 110–233, set out as a note under section 1132 of this title.