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United Healthcare announces ABA coverage as standard benefit

June 24, 2016

For 10 years, Autism Speaks has been working with families across the United States to convince state legislatures to require coverage for Applied Behavior Analysis (ABA) and other autism treatments, and to convince self-funded employers to voluntarily offer such coverage. One of the biggest developments in our decade-long effort to ensure coverage for all individuals on the spectrum was announced this month by United Healthcare.

Starting in 2017, United Healthcare will make ABA coverage part of its standard benefits package. In other words, ABA will be a part of all fully-funded group plans, regardless of whether that plan was issued in a state that has passed an autism insurance mandate.

“UnitedHealthcare currently covers ABA for the treatment of autistic spectrum disorder for our fully insured commercial membership where required by law and for self-funded plans that elect to include ABA benefit coverage, “ UnitedHealthcare stated in a release to its brokers. “Beginning on or after Jan. 1, 2017, UnitedHealthcare will be extending ABA benefit coverage to new and renewing fully insured small and large group plans in the few remaining states that do not mandate ABA coverage.”

“This is the one of the most significant developments ever for families who need access to ABA,” said Lorri Unumb, Esq., vice president of state government affairs at Autism Speaks. “For years, we have slogged through -- state-by-state, company-by-company -- to help each and every family who reaches out to us in need.  With one fell swoop, the nation’s largest health care insurer has now validated and standardized health insurance coverage of ABA.”

Many Autism Speaks volunteer advocates reacted to the news with elation. Kristin Jacobson, of California, said “I predict this is the beginning of the end of autism exclusions!!!” 

Some states have passed autism insurance mandates that are limited to certain markets, such as the state employee health plan.

Regarding the self-funded market, through which a quarter of all Americans get their health insurance, UnitedHealthcare now “recommends that self-funded plans that currently exclude ABA consider removing that exclusion at next renewal.”

United Healthcare (UHC) announced it was making this change because it recognizes “the growing interest in ABA among many consumers and in the marketplace.” UHC cited the number of states that mandate ABA coverage of the treatment of autism as a factor in its decision. 

UHC also noted that a “growing number” of self-funded plans are providing coverage for ABA “based on member demand and other market forces.”

Under the new policy, coverage for ABA under a self-funded plan will be included if the plan does not expressly exclude ABA, starting January 1, 2017. 

This is big news for all autism families across the country but especially in states like Alabama, Ohio, and Tennessee, where no mandate has passed and little-to-no coverage exists.

Read UHC’s full release here.