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Aetna Agrees To Pay $4.5M for Violating Mo. Abortion, Autism Coverage Requirements

May 21, 2015 — Aetna has agreed to pay $4.5 million for violating Missouri law including paying for abortion care for women who were not eligible for the coverage under their health insurance policies, according to an announcement from Gov. Jay Nixon (D) on Tuesday, AP/U-T San Diego reports.

According to AP/U-T San Diego, Aetna in the settlement agreement also acknowledged violating state law about coverage for certain autism treatments. The agreement marks the largest insurance penalty in the state's history.

Agreement Details

In documents detailing the agreement, Aetna reported that it had paid for abortion care for women who did not purchase additional coverage for the procedures. Under a 1983 Missouri law (R.S. 376.805), women are required to purchase optional, separate coverage for "elective abortions" (Ballentine, AP/U-T San Diego, 5/19). According to the harmful 1983 law, "'elective abortion' means an abortion for "any reason other than a spontaneous abortion or to prevent the death" of the pregnant woman (R.S. 376.805).

Specifically, Aetna said the company since 2012 has covered nine abortions for women who did not purchase the additional coverage. According to AP/U-T San Diego, the company previously was fined $1.5 million in 2012 for similar violations against state laws on coverage for autism, abortion care and contraception.

As part of the settlement, Aetna will be placed on a three-year monitoring period. In addition, the Missouri Department of Insurance will be able to stop Aetna from doing business in the state for up to one year if the insurer is found to violate the same laws again. According to the agreement, the department will waive $1.5 million of the $4.5 million fine if Aetna follows state law and complies with other stipulations during those three years.

Aetna spokesperson Rohan Hutchings said the company "takes responsibility" for the violations and "take[s] steps to correct ... errors" (AP/U-T San Diego, 5/19).