Wisconsin State-Regulated Insurance Coverage
Wisconsin 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 - YES
What services are covered by law?
- Evidence-based behavioral therapy (e.g. Applied Behavior Analysis)
- Psychiatric and psychological care
- Speech therapy and occupational therapy
Does Wisconsin have caps on coverage?
The law imposes a maximum annual benefit of $50,000 for “intensive-level services” for a minimum of 4 years between the ages of 2-9 years. After the four-year intensive-level service period has expired, it requires coverage of $25,000 annually for “non-intensive-level services.” There is no age limit on coverage for non-intensive level services.
“Intensive-level services” means evidence-based behavioral therapy that is designed to help an individual with autism spectrum disorder overcome the cognitive, social, and behavioral deficits associated with that disorder. “Nonintensive-level services” means evidence-based therapy that occurs after the completion of treatment with intensive-level services and that is designed to sustain and maximize gains made during treatment with intensive-level services or, for an individual who has not and will not receive intensive-level services, evidence-based therapy that will improve the individual’s condition.
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 Wisconsin autism insurance law?
The Wisconsin Commission of Insurance FAQ page provides additional information.
If you have additional questions, please email firstname.lastname@example.org.
Last Updated: December 2019