North Carolina State-Regulated Insurance Coverage
North Carolina requires meaningful coverage for autism under state-regulated plans.
North Carolina’s autism insurance bill, SB 676, was enacted on October 15, 2015. The law became effective on July 1, 2016.
To which plan types does the STATE autism insurance law apply?
- Individual Grandfathered Plans - YES
- Individual Non-Grandfathered Plans - NO
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Grandfathered Plans - YES
- Fully Insured Small Group Non-Grandfathered Plans - NO
What services are covered by law?
- Adaptive Behavior Treatment (Note, only certain licensed individuals can provide these services. As of January, 2020, Board Certified Behavior Analysts are still pursuing licensure in North Carolina. This has created a severe provider shortage.)
- Psychiatric Care
- Psychological Care
- Speech, occupational and physical therapy
- Pharmacy Care
Does North Carolina have caps on ABA coverage?
Yes. Coverage for adaptive behavior treatment is limited to individuals under 19 years of age and is capped at $40,000 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. Learn more here.
Where can I find more details about the North Carolina autism insurance law?
A copy of SB 676 as enrolled can be found here.
If you have additional questions, please email firstname.lastname@example.org.
Last Updated: December 2019