ABA In Plans
Self-Insured ERISA Large Employer-Sponsored Plans Resources
- These plans are not impacted by a mandate or directive. However, many of these employers are adding ABA as a covered benefit.
- These plans need to be in compliance with the Federal Mental Health Parity Law (learn more on Autism & Law tab).
- What can you do if no coverage:
- Ask your employer for the health plan benefits summary or manual to see if they offer an ABA benefit. If not, share the links below and ask them to consider adding the benefit.
- If your child has severe and/or self-injurious behaviors, ask your employer to consider a single case agreement to only provide a benefit for ABA to your child due to the health and safety risks.
- You could consider filing an appeal if you are denied access to ABA treatment citing the Federal Mental Health Parity Law (learn more on Autism & Law tab)
- Purchase a child-only plan from the ACA Exchanges.
- If you cannot get answers or are being denied services you can also reach out to the regulating body:
- Self-Funded ERISA Plans are regulated by the U.S. Department of Labor(DOL) benefits administrator for questions about your employer-based Self-insured plan benefits and/or complaints.
- Cincinnati DOL Regional Office via our direct number (859-578-4680) or https://www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa
- Self-Funded ERISA Plans are regulated by the U.S. Department of Labor(DOL) benefits administrator for questions about your employer-based Self-insured plan benefits and/or complaints.
Fully Funded Employer-Sponsored Group and Individual, Child Only and Family Private Market Broker Plans
- For health plans authored before the ACA (Grandfathered), the benefit is the Autism Mandate benefit.
- For health plans authored after the ACA (non-Grandfathered), the benefit offered is the Autism Directive Essential Health benefit.
- Autism ACA Directive VS Autism Insurance Mandate – What is the difference
Child-Only Health Plans through ACA Exchange Marketplace
- ACA Exchange child-only plans and qualifying for subsidies
- If your child has access to an employer-sponsored plan, you will not be eligible for a discounted (subsidy) Marketplace plan.
- You can still purchase a non-discounted child-only Marketplace plan. Some plans allow you to carry more than one policy while others do not.
- What are Essential Health Benefits?
- A child-only policy may be a good option if:
- the child lives with grandparents who do not have private insurance because they are eligible for Medicare, and the child is not eligible for Medicaid or the Children’s Health Insurance Program.
- Parents who are divorced or live in different states.
- Families affected by autism whose job-based coverage does not include ABA.
- Individuals with autism who do not qualify for Medicaid
- What health insurance providers are selling plans on the exchange in Ohio 2020?
- AultCare Insurance Company
- Buckeye Community Health Plan
- CareSource
- Community Insurance Company
- Medical Health Insuring Corp. of Ohio
- Molina Healthcare of Ohio, Inc.
- Oscar Buckeye State Insurance Corporation
- Oscar Insurance Corporation of Ohio
- Paramount Insurance Company
- Summa Insurance Company
Ohio Dept of Insurance FAQ & Rates for ACA Exchange Plans
In 2019, the weighted average premium for an on-exchange individual market plan was $6,161.56 and for 2020 the weighted average premium based on approved products is $5,690.26 – a decrease of 7.7 percent.
2020 monthly premium is $474 minus any qualifications for premium tax credit and CSRs or cost sharing reduction.
The 4 Medal Plans: https://www.healthcare.gov/choose-a-plan/plans-categories/
Plan Category The insurance company pays You pay
Plan Category The insurance company pays You pay
Bronze | 60% | 40%
Silver | 70% | 30%
Gold | 80% | 20%
Platinum | 90% | 10%
Need a Broker to learn more about Child Only & Family Plans?
The Coalition has teamed up with Halle Morgan with Morgan Benefits, LTD to help parents find the right non-employer health plan for them. Please feel free to reach out to her at 216.230.6391 or halle@morganbenefits.com
Medicaid
- Adult ABA access through TBS and PSR in Community Mental Health Services
- Child ABA access through CPST services in Community Mental Health
- Child ABA access through Medicaid ABA Policy (non-EPSDT)
- Note: All Medicaid managed care plans (MCP) offer ABA benefits through individual member single case agreements.
- How to request a change to another Medicaid MCP to access ABA
- Ohio’s Medicaid Managed Care Benefits
- MyCare Ohio Medicaid-Medicare Plan Dual Eligible
- Ohio’s Behavioral Health Redesign in the Community Mental Health System
Medicaid in Schools Program (MSY)
Medical Necessity – Elements
ABA Treatment and Clinical Structure
- What is Behavior Analysis? What is a BCBA-D, BCBA and BCaBA?
- How are BCBA’s certified in Ohio?
- ABA Treatment for Autism Spectrum Disorders – Practice Guidelines for Healthcare Funders and Managers
- Ohio Association for Behavior Analysis
Ohio’s Autism Directive & Autism Mandate
- ACA Essential Health Benefit for ASD, Governor Kasich’s Letter to CMS
- Autism ACA Directive VS Autism Insurance Mandate – What is the difference
Ohio Department of Insurance
- Glossary of Health Care Definitions
- Appealing Health Care Decisions
- Ohio Department of Insurance – Guide to Insurance