PURPOSE: This rule effectuates or aids in the interpretation of sections 354.085, 354.485, 376.405, 376.675 and 376.777, RSMo regarding applications and underwriting practices relating to HIV infection.

1. (1) Definitions. For the purposes of this rule—

   1. (A) AIDS means acquired immunodeficiency syndrome;
   2. (B) ARC means AIDS related complex; and
   3. (C) HIV means human immunodeficiency virus as these terms from time-to-time may be defined by the Federal Center for Disease Control.

2. (2) Application Questions and Underwriting Practices Relating to HIV Infection.

   1. (A) No question shall be used that is designed to determine, or which would aid in determining, the sexual orientation of the applicant.

   2. (B) The following provisions govern medical questions relating to HIV infection:

      1. 1. Questions relating to the applicant’s

having or having been diagnosed as having HIV infection, including AIDS or ARC, are permissible if the questions are factual and designed to establish the existence of the condition. For example, insurers shall not ask such questions as “Do you believe you may have . . . ?” or “Have you had any indications of . . . ?”, but insurers may ask “Have you been positively diagnosed or treated for . . . ?”; and

1. 2. Questions relating to HIV infection,

including AIDS and ARC, may be asked, but only if questions related to other high risk medical conditions also are asked. The questions must be presented and asked, and the answers used, in the same manner as other questions and their answers relating to other high risk medical conditions.

1. (C) Questions relating to medical and other factual matters that are intended to reveal the possible existence of a medical condition are permissible if they are not used to determine, or which would aid in determining, the sexual orientation of the applicant and if the applicant is given an opportunity to provide a detailed explanation for any affirmative answers given in the application. For example, insurers may ask such questions as, “Have you had chronic cough, significant weight loss, chronic fatigue, diarrhea, enlarged glands . . . ?” The questions must pertain to a finite period of time preceding completion of the application, not to exceed ten (10) years. The finite period does not apply to questions concerning prior diagnosis, treatment or testing.
2. (D) Questions relating to the applicant’s having, or having been diagnosed as having, or having been advised to seek treatment for, a sexually transmitted disease are permissible.
3. (E) Neither the marital status, the living arrangements, the occupation, the gender, the medical history, the beneficiary designation 20 CSR 400-2

nor the zip code or other territorial classification of an applicant may be used to rate an applicant or to determine, or aid in determining, the applicant’s sexual orientation.

1. (F) 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 and are related to actual or reasonably anticipated experience. If an insurer imposes territorial rates, it shall first provide the director with satisfactory actuarial evidence to support these rates.
2. (G) No adverse underwriting decision shall be based on information that the applicant has demonstrated AIDS, ARC or other HIV infection-related concerns by seeking counseling. This section does not apply to an applicant seeking treatment or counseling after having been positively diagnosed as being infected with the HIV virus.

AUTHORITY: section 374.045, RSMo 1986.* This rule was previously filed as 4 CSR 190- 14.145(1) and (3). Original rule filed Aug. 15, 1988, effective Jan. 13, 1989.

*Original authority 1967.