Florida

The sections of Florida law relevant to parity are found in the state’s Insurance Law. There is a section for mental health coverage, a section for substance use disorder coverage, and two identical sections for autism coverage (one section is for large employer health maintenance contracts, and the other section is for other large employer fully-insured plans ).

This section requires small employer fully-insured plans and large to offer optional coverage for mental health treatment. If an employer chooses this optional coverage, the following is required:

• 30 days of inpatient care for mental health treatment with the same quantitative treatment limitations and financial requirements that are used for other medical services; after 30 days plans do not have to apply the same treatment limitations and financial requirements
• An annual maximum of $1,000 for outpatient care; any coverage provided beyond $1,000 need not be on the same terms and conditions as coverage for other medical services
• Partial hospitalization is covered up to at least the cost of 30 days of inpatient care.

This section requires small employer fully-insured plans and large to offer optional coverage for substance use disorder treatment. If an employer chooses this optional coverage, the following is required:

• At least a lifetime maximum of $2,000 for inpatient care
• 44 visits of outpatient care
• Copayments for outpatient care cannot be greater than $35

This section clearly states that detoxification is not considered outpatient care.

The sections of the law about autism require large employer fully-insured plans to cover autism services for children under age 18 as long as the child was diagnosed with a developmental disability before age 8. Autism spectrum disorder is defined as these 3 conditions:

• Autistic disorder
• Asperger’s disorder
• Pervasive developmental disorder not otherwise specified

There is an annual maximum of $36,000 and a lifetime maximum of $200,000. However, these can be adjusted each year for inflation.

Financial requirements for autism services may not be “less favorable” than those in place for other medical services.

Required treatments include speech therapy, occupational therapy, physical therapy, and applied behavior analysis.