Vermont State-Regulated Insurance Coverage

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

Vermont’s autism insurance bill, S.262, was enacted in 2010 and became effective on July 1, 2011. The legislation was amended in 2012 by S.223 which raised the age cap and required the same benefits be provided by the state Medicaid program or any other public health care assistance program.

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

  • State Employee Health Plans - YES
  • Individual Plans - YES
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Plans - YES

What services are covered by law?

  • Diagnosis
  • Behavioral health treatment (e.g. Applied Behavior Analysis)
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care (e.g. services provided by licensed or certified speech language pathologists, occupational therapists, physical therapists or social workers).

Does Vermont have caps on coverage?

Coverage is limited to individuals of autism under age 21.

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 Vermont autism insurance law?

A copy of S.262 as enrolled can be found here.

A copy of S.223 as enrolled can be found here.

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

 

Last Updated: December 2019

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