Sunday, November 27, 2011

State Mandates Autism Family Health Insurance Coverage

Many families struggle with autism. Autistic people have a neurological condition that causes them to have trouble with communication and social interaction. The best chance of success for intervention is during early childhood. Various programs increase the probability that a child on the autism spectrum will be able to live a normal life.

Unfortunately, such treatment can cost tens of thousands of dollars annually. The vast majority of parents don't have that kind of money laying around. Most health insurance plans don't cover it, either. That is about to change in one state.

Missouri recently passed a bill that requires many health insurers to cover autism. The legislation, passed by the State Senate, mandates those plans to cover up to $45,000 annually worth of applied behavioral analysis (ABA) therapy for children under the age of 18 from licensed providers. (The bill would also create a new state licensing process, to make sure that the money is not paid to fraudulent specialists.) If signed by the governor, the new rules would become effective on January 1st.

The bill is a boon to families with one or more autistic children, especially since it includes an annual adjustment of the cap based on inflation. However, there are some catches. The law would only apply to those group health insurance plans regulated by the state: mainly those purchases through small- to medium-sized employers. Large corporations who self-insure - paying out their own claims, and only hiring an insurer for administrative duties - are not subject to the mandate, because they are regulated federally. Small businesses with under 50 employees may also get an exemption if they can prove that the requirement caused their rates to rise by over 2.5% over the year before.

What if you are looking to buy individual or family health insurance on the open market? Options that include autism coverage for diagnosis and treatment will be available, but it will not be required of all plans sold in the state.

Proponents predict that Missouri health insurance premiums will only rise by a fraction of one percent, which they consider a small price to pay for so much benefit. After all, early intervention reduces the chance that the state will have to pay to care for people on disability and unable to live or work independently.

Yamileth Medina is an up-and-coming expert on the health insurance industry. She strives to provide balanced facts about health care reform and other issues in an easily understood manner. Yamileth lives in Miami, Florida.

Article Source:

1 comment:

  1. The law leaves open the question of what level of detail of the requirements will be and how much flexibility will be left to insurers and employers. Insurers argue for flexibility, but some consumer groups want details listed.