Aetna fined $1.5M for violating autism, contraception coverage

Aetna has been fined $1.5 million for violating Missouri state law regarding coverage of autism, contraception and abortions, state officials announced Wednesday.

In a settlement between the Missouri Department of Insurance and Aetna Life Insurance Company, the insurer admitted to violating state law by providing health plans that excluded coverage for autism disorders and that provided coverage of elective abortions and contraceptives.

Missouri law prohibits insurers from covering elective abortions unless a member specifically asks for and pays an additional premium to receive the coverage, Insurance & Financial Advisor reported.

As a result of these violations, Missouri insurance officials fined Aetna $1.5 million--the largest in the state's history--and required it to donate $250,000 to a nonprofit company related to autism. It also must notify members who were entitled to receive coverage for autism treatments, accept claims for treatments received since the law went into effect and pay those claims with 9 percent interest, reported the St. Louis Beacon.

"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 Insurance Director 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 said it took immediate action after it was alerted to its state violations and will reach out to members affected by those breaches, the Associated Press reported. "We have worked closely with the Missouri Department of Insurance since the situation was discovered," Aetna spokesman Scot Roskelley said. "We apologize for this oversight and have taken steps to prevent it from happening again."

To learn more:
- here's the Aetna settlement (.pdf)
- see the St. Louis Beacon article
- read the Associated Press article
- check out the Insurance & Financial Advisor article

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