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State Dept. of Insurance fines insurer for offering contraceptive coverage

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.”

Jo Mannies has been covering Missouri politics and government for almost four decades, much of that time as a reporter and columnist at the St. Louis Post-Dispatch. She was the first woman to cover St. Louis City Hall, was the newspaper’s second woman sportswriter in its history, and spent four years in the Post-Dispatch Washington Bureau. She joined the St. Louis Beacon in 2009. She has won several local, regional and national awards, and has covered every president since Jimmy Carter. She scared fellow first-graders in the late 1950s when she showed them how close Alaska was to Russia and met Richard M. Nixon when she was in high school. She graduated from Valparaiso University in northwest Indiana, and was the daughter of a high school basketball coach. She is married and has two grown children, both lawyers. She’s a history and movie buff, cultivates a massive flower garden, and bakes banana bread regularly for her colleagues.