Kējì Fǎxué Pínglùn (Jun 2009)
基因資訊作為保險人核保與保險費訂定基礎之妥當性辯證 ― 美國法之經驗與析論 Dialectic Studies on the Appropriateness of Utilizing Genetic Information as the Base of Insurance Underwriting and the Determination of Premium - The U.S. Experience and Analysis
Abstract
2008 年5 月21 日，時任美國總統之布希簽署「基因資訊無歧視法」，正式禁止保險人及雇用人以基因測試取得之資訊，作為歧視性待遇之基礎此後，保險人不得以基因資訊作為訂定保險費與可保性判斷之依據，雇用人亦不得以之為雇用、解雇或升遷之基準。細查此一立法通過之理由，有消極面與積極面。就消極面而言，此一立法乃回應大眾對自身基因資訊可能被用以對抗自己之恐懼，亦即美國國會認為大眾不應因出生即存在之可能罹患特定疾病之基因而遭受不利益，因每一個人均或多或少有致病基因，故均有成為基因歧視性待遇之受害者。另自積極面而言，本法之通過將大幅改善大眾對醫療資源之利用，亦即過往對基因歧視性待遇之恐懼，而參與基因檢測與研究之躊躇，及不欲就基因測試之成本申請求保險給付之態度可因之消弭，取而代之者則為藉基因測試之便，以發覺多於以往之治療方法之選擇。實則，於本法通過前，早於二十世紀末基因資訊得否作為人壽或健康保險之保險人於核保時之基礎，以決定特定被保險人之可保性與承保時之費率此一議題，即已廣泛討論且莫衷一是。美國各州立法亦紛對此一高度爭議之議題進行明 文規範，然規範內容歧異性頗大。本文以下即試自保險之本質與交易架構及保險法之基本原則入手，辯證基因資訊作為核保與費率釐定基礎之妥適性，乃至保險交易中風險分類及差別待遇之必要性，圖為基因資訊作為核保與費率釐定基礎尋覓一著力點。 On May 21, 2008, president George W. Bush signed the Genetic Information Nondiscrimination Act, which officially prohibits health insurers from obtaining and using genetic information as bases for calculating premiums or determine enrollment eligibility. Two major rationales behind this promulgation include first, responding to public’s fear of a dystopia in which people’s own DNA could be manipulated against them; and second, increased number of people are expected to take advantage of genetic testing and participate in genetic researches. In fact, starting from the mid-1990’s, the issue regarding the appropriateness of the utilization of genetic information in the underwriting of life and health insurance has always been highly controversial, and the debate has never ceased. Many states address to this issue by enacting their own statutory law but the content and restriction laid in these state laws are diversified. This article, therefore, attempts to analysis such issue from the perspective of the nature of insurance transaction, insurance practice and general principles of insurance laws. Part II of this paper will discuss the nature of genetic information and insurance transaction. Part III will probe into the disputes from theoretical aspect. Then, part IV will examine the existing Federal and state statutory laws as well as case laws addressing this issue. Part V aims to seek for a potential solution through general principles of insurance law and theories of insurance transaction. The entire discussion will conclude in part VI.
