The sections about coverage for mental health conditions and substance use disorders will be summarized in the “Behavioral Health” section below on this page and the sections about autism coverage will be summarized in the “Autism” section below on this page.
Nothing specifies how plans must cover these conditions, just that they must cover these conditions.
The sections about substance use disorders require small employer fully-insured plans to cover substance use disorder services and requires insurers to offer individual plans that cover substance use disorder services, which individuals can accept or reject. This coverage included:
The sections of the state law about autism require large employer fully-insured plans,small employer fully-insured plans, and public employee plans to cover autism services. Individual plans must offer to cover these services, but individuals can choose to accept or reject this coverage. The coverage is for children through age 17 or through age 21, if they are enrolled in high school. When coverage is in place, plans must follow these requirements:
No annual limits for outpatient visits unless the child goes beyond the annual maximum
Defines autism treatment as habilitative or rehabilitative care, prescription care, psychiatric care, psychological care, behavior therapy, or therapeutic care (all of these are defined within the law)
Defines autism as autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified
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