Ohio Autism Insurance Coalition

Resources related to accessing benefits for autism treatments for all stakeholders: individuals with autism and their families, employers, insurance carriers, legislators, providers, government, regulators, advocates and educators.

Am I Covered?

Step 1: What type of health insurance plan do I have?

If you are employedask your employer’s benefits department or human resources which type of health plan you have. See types of health plans in Ohio Types of Ohio Plans. Once you know the type of health plan you are enrolled on, find out if the plan was authored before the ACA (autism mandate) or after the ACA (autism directive). Then ask for the plan’s benefit manual and look up Autism Spectrum Disorder to review your plans medical necessity requirement and benefits for treatment.

If you have a non-employer Individual or Family Private Plan, ask the person where you purchased your plan which type of health plan you have. See types of health plans in Ohio Types of Ohio Plans Once you know the type of health plan you are enrolled on, find out if the plan was authored before the ACA (autism mandate) or after the ACA (autism directive). Then asks for the plan’s benefit manual and look up Autism Spectrum Disorder to review your plans medical necessity requirement and benefits for treatment.

If you purchased a health plan on the Exchange, your plan was authored after the ACA and have the autism directive benefit.

If you are a state employee, Governor Kasich added the autism directive benefit to your health plan.

If you have a public health plan such as Medicaid, access to autism treatments are fragmented and you do not have access to the mandate or directive. CareSource Medicaid covers ABA and several Comunity Mental Health Centers offer ABA. Medicare does not cover ABA.

If you have a 0 to 3-year old that has been diagnosed or suspected to have an autism spectrum disorder or developmental disabilities, you can look at your health plan type and also reach out to your county board of developmental disabilities to look into Early Intervention Services (Help Me Grow/Part C/POLR).

Step 2: Find your health plan type on our Autism Treatment Coverage by Insurance Plan Type and learn about treatment coverage.

Click on chart to enlarge.Visual Pie Chart of Insurance Coverage in Ohio for Behavior Analytic-ABA Treatments November 1^J 2018

Step 3: Learn about the Autism Directive and Autism Mandate in Ohio  

Autism ACA Directive VS Autism Insurance Mandate – What is the difference

Visual Organizational Chart – Ohio’s overall structure of support systems 2018-05-05 (5)

 

 

Self-Insured Plans covering ABA per State – see pages 6-9 Autism Speaks SELF Funded Tool Kit

 

 

 

 

 

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