Michigan State-Regulated Insurance Coverage

Michigan requires meaningful coverage for autism under state-regulated plans. Michigan’s autism insurance bills, SB 414, SB 415, and SB 981, were enacted in 2012. The laws became effective on October 15, 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 law?

  • Behavioral Health Treatment (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care and Psychological care
  • Speech, occupational and physical therapy

Age and Dollar Caps on ABA Coverage

Coverage in the State Employee Health Plans is limited to individuals with autism through 18 years of age. Coverage for the treatment of autism is subject to a maximum annual benefit:

  • Through 6 years of age= $50,000/year
  • From 7 years of age through 12 years of age= $40,000/year
  • From 13 years of age through 18 years of age= $30,000/year

On April 18, 2014 the Michigan Department of Insurance removed annual dollar limits on autism mandate in all fully insured plans, (No. 14- 017- M).

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.

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

Senate Bill 981 created an autism coverage reimbursement program through which carriers and third-party administrators for companies that self-fund their health benefit plans can apply for reimbursement for claims paid for services required by SB 414 and SB 415 visit the State of Michigan Autism Program’s website. 

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

 

Last Updated: December 2019

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