Insurance

On March 30, 2012, the state of Michigan passed legislation that mandated children with autism be covered by insurance for evidence-based treatments. This ground-breaking legislation changed the availability of supports for individuals with Autism Spectrum Disorders (ASDs) and related developmental disabilities.

In fall of 2012, Michigan’s Autism Insurance Reform Legislation went into effect, requiring health insurance companies in Michigan to provide an autism benefit to their insured members. For details on this legislation and what it means to you, visit the State of Michigan’s Autism Insurance Legislation page.

What is covered?

As of October 15, 2012 state regulated health insurance plans are required to offer an autism benefit for their insured members.

Highlights include:

  1. Coverage for the treatment of ASD may be limited to a member through 18 years of age and may be subject to a maximum annual benefit as follows:
    • For a covered member through 6 years of age, $50,000.
    • For a covered member from 7 years of age through 12 years of age, $40,000.
    • For a covered member from 13 years of age through 18 years of age, $30,000.
  2. A covered member must receive a diagnosis of ASD by a licensed physician or a licensed psychologist to receive coverage for ASD services.
    • Insurance carriers may require an evaluation of the member be conducted every three years.
  3. Treatment of ASD must be evidence based and includes the following care as determined by a licensed physician or a licensed psychologist:
    • Behavioral health treatment (Applied Behavior Analysis or ABA Therapy),
    • Pharmacy care,
    • Psychiatric care,
    • Psychological care, and/or
    • Therapeutic care (speech therapy, occupational therapy).

Navigating the details

We recognize that the legislation and the coverage provided by each individual insurance company can be confusing. The State of Michigan has given individual insurance carriers flexibility in how they implement the legislation. So your coverage will be specific to your carrier and plan. We can help you navigate the specifics of your plan’s coverage.

Contact our Learning Center Operations Manager:

(517)253-7901 (Lansing)
(517)513-3297 (Jackson)
or email info@roi-mi.com for more information.