Rhode Island State-Regulated Insurance Coverage

Rhode Island requires meaningful coverage for autism under state-regulated plans.

Rhode Island’s autism insurance bills were enacted in 2011 and became effective for fully insured large group plans on January 1, 2012.

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

  • Individual Plans - No
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group - NO

What services are covered by law?

  • Pharmaceuticals
  • Applied Behavior Analysis
  • Physical therapy and Speech therapy
  • Psychology, psychiatric, and occupational therapy services

Does Rhode Island have caps on coverage?

Coverage is limited to individuals with autism under the age of 15 years. Coverage for Applied Behavior Analysis is subject to a maximum benefit of $32,000/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 Rhode Island autism insurance law?

A copy of H 5275 Sub A (2011) as enrolled can be found here.

A copy of H 7165 Sub A (2012) as enrolled can be found here.

Note: H 7165 Sub A added pharmacy, psychology, and psychiatry care as eligible benefits

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

 

Last Updated: December 2019

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