Texas State-Regulated Insurance Coverage
Texas requires meaningful coverage for autism. Texas’ autism insurance bill was originally enacted in 2007 (HB 1919). It was revised in 2009 (HB 451) and 2013 (SB 1484).
To which plan types does the state autism insurance law apply?
- State Employee Health Plans - Some are covered.
- Individual Plans - YES
- Fully Insured Large Group Plans - YES
- Fully Insured Small Group Plans - YES
What services are covered by law?
- Evaluation and assessment services
- Applied Behavior Analysis (ABA)
- Behavior training and behavior management
- Speech therapy, occupational therapy and physical therapy
- Medications or nutritional supplements
Does Texas have caps on coverage?
Yes. As of September 1st, 2013, there is no age limit on coverage for the treatment of autism. However, in order to be eligible for coverage, the individual must have been diagnosed with autism prior to age 10. There is no limit on benefits for individuals under 10 years of age. Coverage for ABA is subject to a maximum benefit of $36,000 for individuals age 10 or older.
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.
Where can I find more details about the Texas autism insurance law?
Subsequent bills amending the law can be found at the following links:
- HB 451 raised the age cap to age 10 and added coverage for public school employees.
- SB 1484 removed the age cap and imposed a maximum annual benefit on ABA for individuals age 10 or older.
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Last Updated: December 2019