New Jersey State-Regulated Insurance Coverage

New Jersey requires meaningful coverage for autism under state regulated plans.

New Jersey’s autism insurance law, P.L.2006, c. 115, was enacted on August 13, 2009 and became effective on February 9, 2010. A 2010 bulletin removed previous dollar caps on coverage.

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?

  • Applied Behavior Analysis
  • Speech therapy, occupational therapy and physical therapy

Does New Jersey have caps on ABA coverage?

Yes. Coverage for ABA is limited to individuals with autism under 21 years of age.

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 New Jersey autism insurance law?

A copy of PL 2009, c. 115 as enrolled can be found here.

Citing the Mental Health Parity and Addiction Equity Act of 2008 the New Jersey Department of Banking and Insurance prohibited the application of dollar limits on coverage of ABA in 2010. (Available at Bulletin No. 10-02.)

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

 

Last Updated: December 2019

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