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 Grandfathered Plans - YES
  • Individual Non-Grandfathered Plans - NO
  • 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.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.  This includes quantitative treatment limits like age and dollar caps. Learn more here.

 If you have additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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