[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR422.110]



[Page 997]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

             Subpart C_Benefits and Beneficiary Protections

 

Sec. 422.110  Discrimination against beneficiaries prohibited.



    (a) General prohibition. Except as provided in paragraph (b) of this 

section, an MA organization may not deny, limit, or condition the 

coverage or furnishing of benefits to individuals eligible to enroll in 

an MA plan offered by the organization on the basis of any factor that 

is related to health status, including, but not limited to the 

following:

    (1) Medical condition, including mental as well as physical illness.

    (2) Claims experience.

    (3) Receipt of health care.

    (4) Medical history.

    (5) Genetic information.

    (6) Evidence of insurability, including conditions arising out of 

acts of domestic violence.

    (7) Disability.

    (b) Exception. An MA organization may not enroll an individual who 

has been medically determined to have end-stage renal disease. However, 

an enrollee who develops end-stage renal disease while enrolled in a 

particular MA organization may not be disenrolled for that reason. An 

individual who is an enrollee of a particular MA organization, and who 

resides in the MA plan service area at the time he or she first becomes 

MA eligible, or, an individual enrolled by an MA organization that 

allows those who reside outside its MA service area to enroll in an MA 

plan as set forth at Sec. 422.50(a)(3)(ii), then that individual is 

considered to be ``enrolled'' in the MA organization for purposes of the 

preceding sentence.



[63 FR 35077, June 26, 1998; 63 FR 52612, Oct. 1, 1998; 64 FR 7980, Feb. 

17, 1999, as amended at 65 FR 40321, June 29, 2000; 70 FR 4721, Jan. 28, 

2005]