South Dakota State-Regulated Insurance Coverage

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

South Dakota’s autism insurance law, SB 190, was enacted March 19, 2015. The law became effective January 1, 2015.  Beginning in 2021, coverage of applied behavior analysis will also be available in South Dakota’s ACA marketplace small group and individual plans as an essential health benefit.

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

  • Individual Grandfathered Plans - YES
  • Individual Non-Grandfathered Plans - YES (Beginning in 2021)
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Grandfathered Plans - YES
  • Fully Insured Small Group Non-Grandfathered Plans - YES (Beginning in 2021)

What services are covered by law?

  • Behavioral Health Treatment (ABA)
  • Pharmacy Care
  • Therapeutic Care

Does South Dakota have caps on coverage?

Yes. Coverage is limited to individuals under 19 years of age. Coverage for ABA is subject to an annual maximum benefit of $36,0000 for ages 0 to 7 years, a maximum annual benefit of $25,000 for ages 7 to 14 years, and a maximum annual benefit of $12,500 for ages 14 years to 19 years.

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 Dakota autism insurance law?

A copy of SB 190 as enrolled can be found here.

Information regarding the inclusion of ABA in marketplace plans as an essential health benefit can be found here.  

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

 

Last Updated: December 2019

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