Step 1: What type of health insurance plan do I have?
If you are employed by a business, ask your employer’s benefits department or human resources which one of the three types of health plans below they offer their employees. Once you know the type of plan, for the plan’s benefit manual and look up Autism Spectrum Disorder to review your plan’s medical necessity definition and benefits for treatment.
Fully-Insured Plans – If a Fully-Insured Health Plan is the type of health plan your employer provides, find out if the plan was authored before the ACA (access to autism mandate benefit) or after the ACA (access to autism directive benefits).
Self-Funded or ERISA Plans – These plans are not impacted by mandates or state legislation and each company chooses whether or not to provide an ABA benefit. Self-Insured Plans covering ABA per State – see pages 6-9 Autism Speaks SELF Funded Tool Kit
ACA Exchange Market Small Business Health Plans – These employer health plans have access to Governor Kasich’s autism directive benefit.
If you are a state or federal employee:
State employees have access to Governor Kasich’s autism directive benefit.
Federal & Military employees have ABA benefits in their health plans.
If you purchased an Individual or Family Private Plan purchased through a Broker, ask the broker when 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 an Individual or Family health plan on the ACA Exchange, your plan was authored after the ACA and has the autism directive benefit.
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. All Medicaid managed care plans cover 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.
Step 3: Learn about the Autism Directive and Autism Mandate in Ohio