Aetna Fined Over Autism And Substance Abuse Coverage

State regulators in Pennsylvania fined health insurer Aetna  this week, for violating rules on coverage of drug and alcohol abuse treatment and coverage of autism spectrum disorder. A federal law called the Mental Health Parity and Addiction Equity Act generally forbids health carriers from discriminating against coverage for mental health conditions or substance abuse disorders.  …

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Happy New Year – Washington Health Insurers Are Now Required to Expand Contraceptive Coverage

In 2019, Washington health insurers are required to expand contraceptive coverage. Any health plan in Washington issued or renewed on or after Jan. 1 must now provide coverage for the following: All FDA-approved contraceptives, including drugs and devices; and Voluntary sterilization procedures. The new law also requires coverage for consultations, examinations and procedures necessary to obtain …

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Court Ruling Emphasizes Common Sense Reading of Insurance Policy in Win for Policyholder

The Washington Court of Appeals recently decided Poole v. State Farm Fire and Casualty Company, a case about fine print in a homeowner's policy.  After the Pooles' home burned down, State Farm denied coverage under a technical reading of the words "similar construction."  Washington's Court of Appeals disagreed with State Farm and emphasized the traditional …

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Texas Judge Strikes Down Affordable Care Act

A federal judge in Texas has ruled the Affordable Care Act (a/k/a "Obamacare") can no longer be enforced.  The judge determined the Act cannot function without its individual mandate requiring virtually all Americans to carry minimum health coverage.  Congress repealed the ACA's individual mandate at the end of 2017. If the ruling becomes the law …

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Do I Have To Cooperate With My Insurer After A Loss?

Imagine your house catches fire and you make a claim for coverage under your homeowner's insurance policy.  After a few weeks, the insurer denies the claim.  They don't dispute the fire happened.  But they say they don't have to cover the damage because you didn't cooperate with their investigation.  They claim you should have sent …

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