Illinois State-Regulated Insurance Coverage

Illinois provides meaningful coverage for autism under state regulated plans.

Illinois autism insurance bill, Public Law 095-1005, was enacted in 2008 and became effective on December 12, 2008.

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

  • State Employee Health Plans - YES
  • Individual Plans - YES
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Plans - YES

What services are covered by law?

  • Diagnosis
  • Psychiatric Care
  • Psychological Care
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Therapeutic care (e.g. Behavioral, speech, occupational and physical therapy)

Does Illinois have caps on ABA coverage?

Yes. The law limits coverage to individuals with autism under the age of 21 years. Coverage for the diagnosis and treatment of autism is subject to a maximum annual benefit of $36,000.

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. 

Where can I find more details about the Illinois autism insurance law?

A copy of Public Law 095-1005 as enrolled can be found here.

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

 

Last Updated: December 2019

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