PURPOSE: This rule establishes standards for the use of HIV testing by insurers, health service corporations and health maintenance organizations. This rule is promulgated pursuant to section 374.045, RSMo and implements section 191.671, RSMo.

1. (1) Definitions.

   1. (A) Applicant shall mean the proposed insured.
   2. (B) HIV means the human immunodeficiency virus that causes acquired immunodeficiency syndrome (AIDS).
   3. (C) HIV testing shall mean the performing of a serological test or other tests upon a biological specimen to determine the presence of HIV or its antibodies in the specimen.
   4. (D) Policy shall mean all life and health insurance policies or contracts including both individual and group coverages.

2. (2) Whenever an applicant is requested to submit to HIV testing in connection with an application for an insurance policy, the insurer shall—

   1. (A) Obtain written informed consent from the applicant;
   2. (B) Reveal the use of the test to the applicant;
   3. (C) Provide the applicant with basic information on the means of HIV transmission, HIV testing methodology, the meaning of the results for the specific test(s) to be utilized, behaviors necessary to reduce the risk of infection with HIV, and sources of further information on HIV infection/aids such as the National AIDS Hotline or the Missouri AIDS Hotline;
   4. (D) Make all reasonable efforts to obtain from the applicant the name and address of a physician to which HIV testing results that are other than normal will be reported;
   5. (E) Ensure that an initial positive HIV screening test is followed by a confirmatory test, for example, following the ELISA and Western Blot protocols; and
   6. (F) Disclose the HIV test results in accordance with section 191.671, RSMo. If the applicant does not designate a physician, the insurer, health service corporation or health maintenance organization shall disclose the identity of any applicant residing in Missouri having a confirmed positive HIV test result to the Missouri Department of Health—Bureau of STD/HIV Prevention, P.O. Box 570, Jefferson City, MO 65102. Any disclosure to the Missouri Department of Health shall be made in accordance with procedures acceptable to the Bureau of STD/HIV Prevention.
3. (3) A medical test to determine the presence of HIV virus, its component parts, its antibodies or other evidence of HIV infections, or a medical test for sickness or medical condition derived from this infection shall only be required of or given to a person if the test is based on the person’s current medical condition or medical history or triggered by threshold coverage amounts which apply to all persons within the risk class.

AUTHORITY: section 374.045, RSMo Supp. 1995.* This rule was previously filed as 4 CSR 190-14.140. Original rule filed Aug. 15, 1988, effective Jan. 13, 1989. Amended: Filed May 31, 1996, effective Jan. 30, 1997.

*Original authority: 374.045, RSMo 1967, amended 1993, 1995. Examiner Address To determine your insurability, the Insurer named above (the Insurer) has requested that you provide a biological specimen for testing and analysis. All tests will be performed by a licensed laboratory. Unless precluded by law, tests will be performed to determine the presence of HIV (the AIDS virus), its component parts, or its antibodies. These tests are extremely reliable. Other tests which may be performed include determinations of blood cholesterol and related lipids (fats), cotinine, cocaine, and screening for liver or kidney disorders, diabetes, and immune disorders. All test 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, employees or contractors. If a biological specimen other than blood is tested to determine the presence of HIV virus, its component parts, or its antibodies, the Insurer may at a later time request a specimen of your blood for further HIV testing. If you choose to decline that request, the results of all testing which has been performed will be provided to the physician which you have designated to receive such results. In addition, if the insurer is a member of the Medical Information Bureau (MIB, Inc.) and you choose to decline the request that you submit a blood specimen for further HIV testing, the Insurer will report to the MIB, Inc. a generic code which specifies only a non-specific blood test has been ordered and not received. Regardless of the number of tests requested, if the final HIV testing results (including the results of any confirmatory tests dictated by standard medical practice) are other than normal, the Insurer will report to the MIB, Inc. a generic code which signifies only a non-specific test abnormality. If your final HIV testing results are 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 tests 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 to confirm the name of a physician to whom you authorize disclosure and with whom you may wish to discuss the results. If you are a resident of Missouri and your HIV test(s) indicates confirmed infection with HIV and you have not provided the Insurer with the name of a physician to whom you authorize disclosure of test results, the Insurer will disclose test results to the Missouri Department of Health as required by law. Positive HIV test results or other significant abnormalities detected by additional tests of biological specimens 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. Physician I have read and I understand this Notice of Consent for Testing of biological specimens, which includes HIV testing. I voluntarily consent to provide biological specimen(s) for testing, to the testing of such specimen(s) and the disclosure of the test results as described above. I understand that I have the right to request and receive a copy of this information. A photocopy of this form will be as valid as the original. ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ Proposed Insured ____________________________ Date Signature of Proposed Insured EXHIBIT A ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ Insurer ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ Address ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ NOTICE AND CONSENT FOR TESTING OF BIOLOGICAL SPECIMENS TO INCLUDE HIV (AIDS VIRUS) TESTING ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ Address ⎣⎣⎣⎣⎢ 20 CSR 400-2 ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ Date of Birth ⎣⎣⎣⎣⎣⎣⎣⎣⎣⎣⎢ State of Residence FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION