This article first appeared in the St. Louis Beacon, Sept. 26, 2012 - The Missouri Department of Insurance has announced that it has levied its largest fine in state history -- $1.5 million – against an insurer who failed to comply with state law regarding coverage, or lack of, for autism treatment, contraception and elective abortions.
Among other things, Aetna Life Insurance Co., “provided coverage for contraceptives without allowing employers to opt out of this coverage,” the department says.
A department spokesman noted that the provisions in question were in an 11-year-old state law, and not part of the new state law regarding abortion, contraceptive and sterilization coverage put in place following the General Assembly’s action earlier this month to override Gov. Jay Nixon’s veto.
Aetna is Missouri's sixth largest health-insurance company, with premium sales of $340 million in 2011.
In a statement, the department said that state insurance regulators has determined that Aetna “has for years been violating Missouri law in the health plans it offers to employers. “
According to the settlement announced by department director John M. Huff, 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.”
Huff said that, under the law, “if an employer excludes (contraceptive) 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."
According to the settlement, Aetna will pay the $1.5 million fine and “stop issuing health-insurance policies that violate Missouri law.”
Sam Lee, head of Campaign Life Missouri, which lobbies against abortion, called the settlement “a wakeup call for Missouri health-insurance companies. The law is clear that the religious beliefs of business owners and employees who don’t want to pay for abortion and contraception must be respected. Insurance companies are being put on notice that the moral concerns of Missouri citizens must take precedence over the standard operating procedure of the insurance industry.”
However, it’s unclear how Missouri’s laws allowing exemptions for contraception will mesh with the federal Affordable Care Act, which mandates free contraceptive coverage for insured people. Religious institutions and affiliates can opt out of such coverage, but the act requires that insurers still offer the option directly to employees who seek it.
Regarding the autism coverage, Aetna is to notify insurance 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 9 percent interest.”
The insurance company also is to “donate $250,000 to a Missouri nonprofit organization specializing in the care and treatment of autism spectrum disorders.”
