Delaware State-Regulated Insurance Coverage
Delaware requires meaningful coverage for autism under its state-regulated health insurance plans.
Delaware’s autism insurance bill, SB 22 was enacted in 2012. It became effective on December 11, 2012.
To which plan types does the STATE autism insurance law apply?
- Individual Plans - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Plans - YES
What services are covered by the law?
- Behavioral health treatment (including applied behavior analysis)
- Pharmacy Care
- Psychiatric Care and Psychological Care
- Therapeutic care (speech therapy, occupational therapy, physical therapy)
- Necessary Equipment
For purposes of this law, behavioral health treatment means “professional counseling, guidance services or treatment programs, including applied behavior analysis, that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual.” This definition also applies to treatment or counseling to improve social skills and function.
Does Delaware have caps on ABA coverage?
Yes. The law limits coverage to individual with autism under the age of 21. Coverage for ABA is subject to a maximum benefit of $36,000/year.
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.
Where can I find more details about the Delaware autism insurance law?
A copy of SB 22 as enrolled can be found here.
Other comments about the law.
The law also requires coverage for any care for individuals with autism spectrum disorders that is determined by the Secretary of the Department of HSS, based upon their review of best practices and/or evidence-based research, to be medically necessary.
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Last Updated: December 2019