Colorado state-regulated insurance coverage

Colorado requires meaningful coverage for autism under state-regulated plans.

Colorado’s autism insurance bill, SB 09-244, was enacted in 2009 and became effective on July 1, 2010. Coverage was amended in 2015 under SB 15-015 and became effective on January 1, 2017.

To which plan does the STATE autism insurance law apply?

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

What services are covered by law?

  • Diagnosis
  • Behavior Training, Behavior Management and Applied Behavior Analysis
  • Habilitative or rehabilitative care (e.g. Speech Therapy, Occupational Therapy, Physical Therapy)
  • Pharmacy care
  • Psychiatric care
  • Psychological care, including family counseling

Does Colorado have caps on ABA coverage?

No. The 2015 legislation removed all age and dollar caps on coverage.

  • Whether or not 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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