Georgia State-Regulated Insurance Coverage

Georgia requires meaningful coverage for autism in state-regulated plans.  Ava’s Law was originally passed in Georgia in 2015 after almost a decade of advocacy by the autism community. Governor Deal has signed SB 118, which amends Ava's Law by increasing the limits on the coverage of applied behavior analysis to individuals age twenty and under up to $35,000 per year.

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

  • Individual Grandfathered - YES
  • Individual Non-Grandfathered - NO
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Grandfathered - YES
  • Fully Insured Small Group Non-Grandfathered - NO

What services are covered by law?

  • Diagnosis and treatment of autism spectrum disorder
  • Habilitative or rehabilitative services including applied behavior analysis
  • Counseling services provided by a licensed psychiatrist, licensed psychologist, professional counselor, or clinical social worker
  • Speech, occupational and physical therapy

Does Georgia have caps on ABA coverage?

Yes. Coverage is limited to individuals 0 to 21 years. Coverage for ABA is subject to a maximum annual benefit of $35,000.

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 any additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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