September 26, 2012
Missouri Department of Insurance takes action against Aetna for violations related to autism, contraception, other coverage
Aetna will pay largest insurance fine in Missouri history, make donation for autism treatment
Jefferson City, Mo. - State insurance regulators say one of the nation's largest health insurance companies has for years been violating Missouri law in the health plans it offers to employers. Insurance Director John M. Huff has announced a settlement with Aetna Life Insurance Company related to its coverage of health benefits required by Missouri law, including autism, contraception and elective abortion.
In the settlement, Aetna admits to numerous violations of Missouri law, including issuing health insurance policies that:
- Excluded coverage for autism spectrum disorders, in violation of Missouri's landmark autism insurance law signed by Gov. Nixon in 2010;
- Routinely provided coverage for elective abortions. Missouri law forbids elective abortion coverage from being part of a standard health insurance policy: customers must specifically request this coverage and must pay extra for it; and
- In some cases, provided coverage for contraceptives without allowing employers to opt out of this coverage. A 2001 Missouri law gives employers and employees the right to exclude this coverage. Also under the law, if an employer excludes the coverage in its group plan, an individual employee can choose to be covered for contraceptives.
"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," said 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."
Under the settlement, Aetna will:
- Stop issuing health insurance policies that violate Missouri law;
- Pay a $1.5 million penalty, the largest in Missouri history for insurance law violations;
- Notify customers that they were entitled to coverage for treatment of autism and accept claims for treatments received since the law went into effect. Aetna will pay claims with nine percent interest; and
- Donate $250,000 to a Missouri nonprofit organization specializing in the care and treatment of autism spectrum disorders.
Aetna is Missouri's sixth largest health insurance company, with premium sales of $340 million in 2011.
Consumers with complaints or questions about insurance claims or policy provisions can call the Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.