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Life Health > Health Insurance > Your Practice

Aetna to pay $1.5 million in settlement with Missouri

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JEFFERSON CITY, Mo. (AP) — Missouri insurance regulators said Wednesday that insurer Aetna (NYSE:AET) has agreed to pay a $1.5 million penalty to settle allegations that the company violated requirements for health coverage of autism, contraception and abortions.

The state insurance agency said Aetna sometimes provided coverage for contraceptives without allowing employers to opt out and routinely covered abortions. Officials say Aetna also had excluded coverage for autism spectrum disorders.

A 2001 Missouri law states birth control prescriptions should be covered under policies with pharmaceutical benefits but allows insurers to offer policies without contraception coverage to people or employers who say it violates their moral or religious beliefs. That law also allows people to purchase a plan with contraception coverage if their employer’s plan does not offer it.

A 1983 state law prohibits abortion coverage from basic insurance policies and instead requires payment of an additional premium. And treatment for autism must be covered under a 2010 law.

“This settlement should be a reminder to all health benefit plans covering Missourians, that state law has stringent requirements honoring the religious and moral beliefs of insurance customers,” Missouri insurancedirector John Huff. “We will be enforcing Missouri’s decade-old contraception coverage law, as well as the new law on the subject, anywhere we see violations.”

Aetna is the sixth-largest insurance company in Missouri. The company said Wednesday that it always seeks to follow federal and states’ insurance requirements and immediately took action when it was alerted to the errors. Aetna will be communicating with those who have been affected.

“We have worked closely with the Missouri Department of Insurance since the situation was discovered. We apologize for this oversight and have taken steps to prevent it from happening again,” Aetna spokesman Scot Roskelley said.

The settlement also calls for Aetna to donate $250,000 to a Missouri nonprofit organization focused on care and treatment of autism, to notify customers they were entitled to coverage for autism and pay claims with 9 percent interest, and to stop issuing insurance policies that violate state law.

The Missouri Department of Insurance, Financial Institutions and Professional Registration announced the settlement two weeks after Missouri’s Republican-controlled Legislature overrode Democratic Gov. Jay Nixon’s veto of a bill expanding religious and moral exemptions for insurance coverage.

Under that newly enacted law, individuals, employers and insurers can cite religious or moral exemptions from mandatory insurance coverage for abortion, contraception and sterilization. It also changes a “may” to a “shall” when describing an insurer’s duty to provide policies without contraception coverage for those who request it.

When he vetoed the legislation, Nixon called the measure unnecessary because of Missouri’s existing laws.

Missouri regulators indicated in the settlement that they first learned of the potential issues involving Aetna from public testimony before a state House committee in April.

Sam Lee, of Campaign Life Missouri, said the settlement with Aetna and the veto override are a “wakeup call” that beliefs of those who oppose coverage for abortion and contraception must be respected.


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