Dive Brief:
- A recent $4.5 million fine against Aetna in Missouri includes penalization for covering nine abortions, contrary to state law. Governor Jay Nixon's announcement of the fine earlier this month did not mention the issue of abortion coverage, but focused exclusively on Aetna's faulire to cover required autism benefits.
- According to Missouri law, insurers should only pay for an abortion if the patient purchases separate coverage.
- Missouri's state insurance regulator, Chris Cline, said the fine covered Aetna's infractions as a whole and that there was no specific portion levied for the abortion coverage alone.
Dive Insight:
As noted by Chris Koller, a former Rhode Island health insurance regulator, it's very unusual to see a health insurer fined for providing too much coverage—although in this instance, perhaps it's not surprising given the highly-politicized nature of abortion coverage.
"I have never heard of a company being penalized for covering more than was required," Koller told Bloomberg Business. "But it had happened before with them."
Missouri has limited abortion coverage since the early 1980s. Nine other states also limit abortion coverage by private insurers, and some states restrict abortion coverage on plans provided through the ACA exchanges and via Medicaid. Under the 2010 Patient Protection and Affordable Care Act, federal funding can't be used to terminate a pregnancy unless it endangers the woman's life or results from rape or incest.
Want to read more? You may enjoy this story about why investors believe a merger between Aetna and Cigna or Humana may be 'imminent.'