Deceptive student plan marketing and failure to comply with mandated benefits led to the payments.
Aetna Life Insurance Co. has agreed to restitution and civil penalty payments of over $1 million in order to settle the charges made against it regarding failure to provide Massachusetts health insurance benefits coverage that is mandated by the laws of the state, as well as for college student plans that were marketed in a deceptive way.
Boston’s Suffolk Superior Court received the filing for the consent judgment that contained the deal.
It was received along with the complaint of Martha Coakley, the state Attorney General, which outlined the scope of the alleged violations to Massachusetts health insurance consumers by this company.
Coakley’s office has either reached settlements or filed suit with over 10 companies and individuals over the last three years, which had to do with marketing medical plans in a deceptive or fraudulent way, or for coverage that doesn’t meet the state’s legal minimum standards for consumer protection.
The largest of these Massachusetts health insurance cases was in 2009 for $17 million from HealthMarkets.
According to the office of the Attorney General, in Aetna’s case, it had been providing coverage to approximately 30,000 college students annually, from 2007 through 2010. The complaint against the insurer stated that it had used marketing materials to state that the aggregate maximum amount of some of the coverage from the company was $500,000, when the truth was that the limit was at $50,000.
The complaint also stated that the insurer did not meet the Massachusetts health insurance benefits standards, including mammography, pap tests, mental health care, and pediatric preventive care.
According to the complaint, “Aetna deceived Massachusetts consumers into buying health insurance by misrepresenting the terms, benefits and coverage of the health insurance, by act and material omission.” It also went on to say that prospective customers were not advised by the insurer regarding “significant limitations on its health insurance plans offered in Massachusetts.”
An Aetna spokesperson, Susan G. Millerick, has stated that her company is working hard to provide Massachusetts health insurance through clear and comprehensive plans, and that they believe that many of the concerns that were raised in this case have now been addressed.