Aetna failed to meet CMA order requirement for seven years

Aetna International failed to fully meet the requirements of the Competition and Markets Authority’s (CMA) private healthcare market investigation order for almost seven years.

The insurer did not inform its customers data regarding consultants and hospitals was available from the Private Healthcare Information Network (PHIN) which is a requirement of the investigation.

The order came into force on 6 April 2015 and Aetna only informed the CMA that it had not been compliant on 4 February 2022 – almost seven years later.

However, it has since rectified the error.

Article 25 of the order requires private medical insurers to inform patients that helpful information as to consultants and private hospitals is available on the PHIN website.

“Aetna has informed the CMA that it did not include any such wording in relevant communications with customers,” the CMA said in the latest update to its register of competition breaches.

It added: “Aetna has added the appropriate standard wording referring members to PHIN in its welcome emails to new members; in renewal letters to existing members; in member handbooks; and on Aetna’s Health Hub, website.”

The regulator has not published the private letter it issued to the insurer regarding the infringement, the only occasion in the last two years that a letter concerning a breach has not been made publicly available.

Earlier this year Aetna announced it is exiting the international private medical insurance (IPMI) market outside the Americas with its operations in these regions being wound down.

It agreed a preferential referral deal with Allianz Partners to give first renewal offers to Aetna clients, a process which began in May.

Aetna has been approached for comment.

Last year, private hospital The London Clinic was reprimanded by the competition regulator for failing to publish payments made to referring part-time consultants for six and a half years.

 

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