Page 49 - Read Online

Loong et al. J Transl Genet Genom 2023;7:27-49 https://dx.doi.org/10.20517/jtgg.2022.20 Page 43

Table 2. Summary of the MOH - LIA moratorium protections on genetic testing and insurance. Reproduced from the MOH website:
https://www.moh.gov.sg/resources-statistics/moratorium-on-genetic-testing-and-insurance, accessed 21st October 2022

1. Insurers are not allowed to:
a. Ask the applicant to take a genetic test (whether diagnostic or predictive) as part of their insurance application
b. Ask the applicant to disclose and use the result of any predictive genetic test for assessing/deciding the outcome of their insurance
application if the test was taken for biomedical research
c. Ask applicant or medical providers to disclose, and use the result of any predictive genetic test for assessing/deciding the outcome of their
insurance application if the insurance or test is any one of these:
i. Health insurance, including Integrated Shield plans
ii. General insurance
iii. Group insurance
iv. Any other insurance not covered by the Moratorium
v. Direct-to-consumer genetic testing
vi. Testing is done on another person (e.g., a blood relative)
vii. Testing is taken after the insurance coverage had started (unless the applicant agreed to take the test before the coverage started).
2. Insurers are allowed to:
a. Ask the applicant to disclose, and use the result of a predictive genetic test for assessing/deciding the outcome of his/her insurance
application if all of the following conditions are met:
i. The insurance applied for is one of the following: life, total permanent disability, long-term care, critical illness, and disability income
insurance;
ii. The sum assured/pay-out of insurance applied for exceeds the financial limits specified in the moratorium;
iii. The applicant has taken a predictive genetic test from the list of approved predictive genetic tests specified in the moratorium for
medical conditions such as Huntington’s disease and breast cancer
b. Ask the applicant to disclose, and use the result of any diagnostic genetic test done for clinical care for assessing/deciding the outcome of
his/her insurance application
c. Use the result of any predictive genetic test (whether provided by the applicant or another person, voluntarily or accidentally, or otherwise)
if the result is favorable to the applicant.

provider orders genetic tests under appropriate clinical indications. These are essential because genomic
testing elements such as consent taking, variant curation, and genetic counseling are complex processes and
carry many implications for the patients and their families . The MOH Code of Practice safeguards the
[140]
interests of the healthcare provider and the patient.

Regulation of the access to genomic data
Access to genomic data and patient health data should be governed to ensure that the information is not
abused. Such abuse could come in the form of unauthorized sharing of genomic information, using samples
collected for purposes other than for the consented reason, or the unauthorized commercial selling of
information, among others . Secure databases, information security training, and regulatory bodies ensure
[141]
that all data collected during these tests are managed responsibly and with sufficient accountability .
[142]
These factors ensure the privacy of the data and enhance public trust in the medical institutes providing
genomic services. These steps go far toward assuring public receptibility to genomic testing.

Insurance (moratorium)
Genetic information can be used for many purposes, including disease prediction, disease management, or
life-changing decisions. This information could also be used for insurance and employment. A key issue
from the public perspective is the insurability of patients undergoing genomic testing, whether for research
or medical indications. It is in the interest of insurance agencies to make use of genomic test results to assess
the probability of individuals developing both rare and complex genetic diseases. This might impact the
individual’s ability to buy insurance and procure insurance claims due to genetic discrimination by
insurance companies. To protect their citizens, many countries have introduced legislation and agreements
to minimize the risk of discrimination .
[143]
In Singapore, the MOH and the Life Insurance Association (LIA) have developed the "Moratorium on
Genetic Testing and Insurance" to support the development of precision medicine. The LIA is a not-for-
profit trade organization representing life insurance products and life reinsurance providers based in