South Carolina State-Regulated Insurance Coverage

South Carolina requires meaningful coverage for autism under state-regulated plans.

South Carolina’s autism insurance bill, Act No. 65 (R85, S20) was enacted in 2007. The law became effective July 8, 2008.

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

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

What services are covered by law?

Coverage is limited to treatment that is prescribed by the insured’s treating medical doctor in accordance with a treatment plan.

Does South Carolina have caps on coverage?

Yes. Coverage is limited to individuals with autism under the age of 16 years, and the individual must have been diagnosed with autism spectrum disorder by age eight or younger. Coverage for behavioral therapy (e.g. Applied Behavior Analysis) is subject to a maximum benefit of $50,000/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 South Carolina autism insurance law?

A copy of Act No. 65 (R85, S20) 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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