Ohio State-Regulated Insurance Coverage

Ohio requires meaningful coverage for autism under state-regulated plans.

Ohio’s autism insurance bill, HB 463, was enacted in 2017. Prior to the passage of the law, coverage was granted to some marketplace groups when Governor Kasich ordered that ABA be included in Ohio’s benchmark plan.

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?

  • Speech therapy
  • Occupational therapy
  • Clinical Therapeutic Intervention, including applied behavior analysis
  • Mental/behavioral health outpatient services

Does Ohio have caps on coverage?

Coverage is limited to individuals with autism aged 0-21 years. Benefits are subject to maximum annual or weekly limits.

  • Speech therapy is subject to a maximum annual limit of 20 visits.
  • Occupational therapy is subject to a maximum annual limit of 20 visits.
  • ABA is subject to a maximum weekly limit of 20 hours.
  • Mental/behavioral health outpatient services are subject to a maximum annual limit of 30 visits.

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.

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

 

Last Updated: December 2019

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