Utah State-Regulated Insurance Coverage
Utah requires meaningful coverage for autism under state-regulated plans.
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?
- 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?
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 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%.
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Last Updated: December 2019