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Aetna to pay $1.5 million to Missouri, says Department of Insurance

Due to multiple insurance violations, the Missouri State School Fund will be $1.5 million richer.

Oct. 2, 2012

Insurance company Aetna agreed to pay a $1.5 million penalty to settle claims that the insurer violated Missouri regulations concerning health coverage of abortion, autism treatments and birth control.

Aetna routinely provided coverage for elective abortions in violation of a 1983 Missouri state law, according to the Missouri Department of Insurance. The law forbids insurers from providing coverage of elective abortions as part of a standard health care policy and states customers must request this coverage and pay an extra premium.

“We apologize for this oversight and have taken steps to prevent it from happening again,” Aetna spokesman Scot Roskelley said. “Affected members and plan sponsors will be receiving communications from Aetna as we take corrective action.”

The settlement also claimed Aetna did not cover autism treatments, including but not limited to behavioral analysis and therapy, in direct violation of a 2010 state law. The Department of Insurance mandated Aetna pay all claims regarding treatment of autism with a 9 percent per annum interest rate.

Along with a $1.5 million payment to the Missouri State School Fund, the company will pay $250,000 to a non-profit organization that focuses on the treatment and research of autism.

In another violation within the settlement, Aetna did not inform customers of their right to exclude birth control from their coverage. A 2001 state law states employers and employees have the right to opt out this coverage if it is against their moral or religious beliefs.

A Missouri employer originally brought these issues to the attention of regulators in April 2012 during a public hearing.

“Once alerted to our error, we immediately took action to change our procedures for Missouri and are quickly addressing any resulting issues,” Roskelley said.

But the department maintains Aetna knew of its violations of the 1983 law regarding abortion.

“The Division alleges that Aetna was aware it was in violation of Missouri law regarding coverage for elective abortions,” according to the settlement. “Aetna contends that it was not aware of such violations.”

Throughout the process, the department has stated Aetna has remained cooperative.

“Aetna has fully cooperated with the Department regarding its investigation of these matters, and has been prompt and responsive to the Department’s inquiries and requests," the settlement stated.

Along with the fines, Aetna must also contact all customers clarifying the regulations they now follow and the rights the customers maintain.

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