Oklahoma State-Regulated Insurance Coverage
Oklahoma requires meaningful coverage for autism under state-regulated plans.
Oklahoma’s autism insurance law, HB 2962, was enacted in 2016. The law became effective November 1, 2016. However, an August 2021 bulletin from the Oklahoma Department of Insurance removes several benefit limitations, or caps, from the state law.
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?
The 2016 legislation limited coverage 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 required coverage through the age of nine. Applied Behavior Analysis was subject to a maximum annual benefit of $25,000 and a maximum of 25 hours per week under the law.
However, in August 2021, the Oklahoma Insurance Department published a bulletin declaring these limitations in coverage to be violations of federal law and related regulations. Oklahoma-regulated policies are required to change their plan terms and remove these caps in coverage by December 31, 2021.
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.
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Last Updated: August 2021