Maine State-Regulated Insurance Coverage
Maine requires meaningful coverage for autism under state regulated plans.
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 law?
- Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
- Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker
- Speech, occupational, and physical therapy
Does Maine have caps on ABA coverage?
Yes. The law limits coverage to individuals with autism 10 years of age or under and is subject to a maximum benefit of $36,000 per 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 Maine autism insurance law?
A copy of LD 1198 as enrolled can be found here.
A copy of LD 2768 as enrolled can be found here.
If you have additional questions, please email email@example.com.
Last Updated: December 2019