Private Insurance

Fifty states and the District of Columbia have laws that require insurance coverage for Autism services. Despite federal and state mandates that insurance plans cover behavioral treatments for children with Autism, this coverage has been inconsistent in Ohio.

The Ohio Autism Insurance Coalition has information that can help you understand your benefits, find coverage, and navigate the insurance process. Ohio requires meaningful coverage for Autism under state-regulated plans. Ohio’s Autism Insurance Bill, HB 463, was signed into law in 2017.

To which plan types does the State of Ohio 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?

  • Diagnostic testing
  • Speech therapy
  • Occupational therapy
  • Clinical Therapeutic Intervention, including Applied Behavior Analysis (ABA therapy)
  • Mental/behavioral health outpatient services

Does Ohio have caps on coverage in the state’s fully funded health plans and ABA marketplace plans?  Yes, however, they are not enforceable due to MHPAEA (Mental Health Parity and Addiction Equity Act) or federal parity law. 

For only fully funded health plans in Ohio, both employer-based and individual plans, the Autism Mandate language does have age, hours and visit treatment limitations. Also, health plans for employer or individual health plans purchased on the ACA Healthcare Marketplace have similar treatment limitations except the age cap is age 21. However, these treatment limitations violate the federal mental health parity law called MHPAEA. MHPAEA protects ASD, a behavioral health condition, from any treatment limitation such as age, hour or visit caps. All determinations of needed mental health, speech and occupational therapies for treating autism specific symptoms, should be based on an individual basis for all types of health plans including self-funded plans, ACA marketplace and fully funded plans unless the employer has less than 50 employees.

  • Coverage is limited to individuals with Autism aged 0-14 years in fully funded health plans. Benefits are subject to maximum annual or weekly limits. (autism mandate). (not applicable to self funded health plans).
  • Coverage is limited to individuals with Autism aged 0-21 years in ACA marketplace plans.  Benefits are subject to maximum annual or weekly limits. (Governor’s directive letter). (not applicable to self-funded health plans).
  • Speech therapy is subject to a maximum annual limit of 20 visits.
  • Occupational therapy is subject to a maximum annual limit of 20 visits.
  • ABA therapy is subject to a maximum weekly limit of 20 hours.
  • Mental/behavioral health outpatient services are subject to a maximum annual limit of 30 visits.

There are still some insurance plans that do not cover Autism services/treatments in HB 463, despite its legal mandate. If your family’s insurance plan does not include Autism services, call the HR department at your place of employment or the central offices of your insurance company and advocate for your child.

The Ohio Autism Insurance Coalition explains the actions that families can take when trying to receive benefits for ABA Therapy from their insurance plans.