Utah State-Regulated Insurance Coverage

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

Utah’s autism insurance bill, SB 57, was enacted in 2014 and became effective on January 1, 2016. In 2019, SB 95 was passed eliminating previous age and dollar caps on coverage.

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

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

What services are covered by law?

  • Diagnosis
  • Pharmacy Care
  • Psychiatric Care
  • Psychological Care
  • Applied behavior analysis and other behavioral health treatments
  • Speech therapy, occupational therapy and physical therapy

Does Utah have caps on coverage?

No.

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 Utah autism insurance law?

A copy of SB 74 as enrolled can be found here.

A copy of SB 95 as enrolled can be found here.

Other comments about the law.

The 2019 law (SB 95) also removed a provision that allows the state insurance commissioner to waive the requirement that a health benefit plan cover the diagnosis and treatment of autism if claims for autism coverage caused premiums to increase in excess of 1%.

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

 

Last Updated: December 2019

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