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Private Insurance

50 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. Check the Summary Plan Description of your health insurance plan online to see what is covered. In Ohio, behavioral services for Autism up to age 14 are supposed to be covered, but there are exceptions. For example, employers who self-insure are regulated under federal law (ERISA) and may be exempt from state-mandated benefits. 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?

  • Coverage is limited to individuals with Autism aged 0-14 years. Benefits are subject to maximum annual or weekly limits.
  • 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.