Pennsylvania State-Regulated Insurance Coverage

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

Pennsylvania’s autism insurance bill, Act 62 (HB 1150) was enacted in 2008. The law became effective for state employee health plans and fully insured large group plans on July 1, 2009.

To which plan types does the state autism insurance law apply?

  • State Employee Health Plans - YES
  • Individual Plans - NO
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Plans - NO

What services are covered by law?

  • Diagnosis
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (Speech therapy, occupational therapy and physical therapy)

Does Pennsylvania have caps on coverage?

Yes. Coverage for the treatment of autism is limited to individuals under 21 years of age and is subject to a maximum benefit of $36,000/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 Pennsylvania autism insurance law?

A copy of Act 62 (HB 1150) as enrolled can be found here.

A copy of Act 208 (2012) as enrolled can be found here.

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

 

Last Updated: December 2019

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