Alabama state-regulated insurance coverage

Alabama’s autism insurance bill, House Bill 284, was enacted in 2017. The law became effective on October 1, 2017.

To which plan types does the STATE autism insurance law apply?

  • Individual Plans subject to ACA - NO
  • Individual Plans specifically exempt from the ACA (often called Grandfathered Plans) - YES
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Grandfathered Plans - NO
  • Fully Insured Small Group Non-Grandfathered Plans - NO

What services are covered by law?

  • Behavioral health treatment, including applied behavior analysis
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Speech Therapy, Occupational Therapy, Physical Therapy
  • Screening, diagnosis, and treatment of Autism Spectrum Disorder

Does Alabama have caps on ABA coverage?

Yes. Coverage is limited to individuals 0 to 18 years of age. Coverage for applied behavior analysis is subject to cap of $40,000 per year between ages 0 to 9 years, a $30,000 per year between ages 10 to 13 years, and $20,000 per year between ages 14 to 18 years.

  • Whether or not these caps are included in a health insurance plan is specific to each type of plan, and such limitations are required to be disclosed in the plan document. Most often, there is a specific section of the plan that describes the plan’s autism/ABA benefit. A consumer can contact plan representatives to learn where to find autism-related information in the plan document.
  • There are now laws that challenge the validity of the age and dollar cap limitations. These are known as “mental health parity” laws, and they generally apply to services used to treat autism.
  • Mental health parity laws prevent group health plans [and health insurance issuers] that provide mental health or substance-use disorder (MH/SUD) benefits from imposing less favorable limitations on MH/SUD benefits than on medical/surgical benefits. This means that quantitative treatment limits like age and dollar caps are not permitted in most cases. 
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