Oklahoma State-Regulated Insurance Coverage

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

Oklahoma’s autism insurance law, HB 2962, enacted in 2016. The law became effective November 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?

  • Screening, Diagnosis, and Treatment of Autism Spectrum Disorder (ASD)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic Care
  • Behavioral Health Treatment
  • Applied Behavior Analysis

Does Oklahoma have caps on coverage?

Coverage is limited to at least six years of treatment unless the individual was diagnosed or accessed medically necessary care for autism before the age of three, which then requires coverage through the age of nine. Applied Behavior Analysis is subject to a maximum annual benefit of $25,000 and a maximum of 25 hours per week.

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.  

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

 

Last Updated: December 2019

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