NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
The date following each state indicates the last time information for the state was reviewed/changed.
STATE
CITATION
SUMMARY
AL
(10/15)
§ 27-54A-2
Health benefit plans shall offer coverage for the screening, diagnosis, and treatment of autism spectrum disorder for
an insured 9 years of age or under in policies and contracts issued or delivered in this state to employers with at least
51 employees for at least 50% of its working days during the preceding calendar year. Coverage for behavioral
therapy is subject to a $36,000 maximum benefit per year.
AK
(10/15)
§ 21.42.397
Health care insurers that offer, issue for delivery, delivers, or renews a health care insurance plan in this state shall
provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders for individuals less than
21 years of age. The mandate does not apply to fraternal benefit societies and insurers providing health care
insurance to a small employer in the group market with 20 or fewer employees.
AZ
(10/15)
§§ 20-826.04; 20-1057.11;
20-1402.03; 20-1404.03
No coverage shall be denied or dollar limits imposed on deductibles and coinsurance based on the diagnosis of
autism spectrum disorder. Includes hospital service corporations, health care services organizations, group disability,
and blanket disability coverage. Coverage for behavioral therapy limited subject to a $50,000 maximum benefit until
age 9 and $25,000 yearly maximum for a person between the ages of 9 and 16.
AR
(10/15)
§ 23-99-418
Health benefit plans shall provide coverage for the diagnosis and treatment of autism spectrum disorders. Limited to
children under the age of 18 and limited to $50,000 per year. Also applies to point of service health care service plan
contracts.
CA
(10/15)
Ins. §§ 10144.5 to 10144.52; 1374.72
to 1374.73
Every policy of disability insurance that covers hospital, medical, or surgical expenses shall provide coverage for the
diagnosis and medically necessary treatment of severe mental illnesses, including autism.
CO
(10/15)
§§ 10-16-104; 10-16-104.5
Autism shall be covered in the same manner as any other accident or sickness.
CT
(10/15)
§ 38a-514b
Group health insurance policy shall provide coverage for the diagnosis and treatment of autism spectrum disorders.
Policies may limit the coverage for behavioral therapy to a yearly benefit of $50,000 for a child who is less than 9
years of age, $35,000 for a child who is at least 9 years of age and less than 13 years of age and $25,000 for a child
who is at least 13 years of age and less than 15 years of age.
DE
(10/15)
18 Del.C. §§ 3366; 3570A
Health benefit plans shall provide coverage for the screening and diagnosis of autism spectrum disorders and the
treatment of autism spectrum disorders in individuals under the age of 21. Coverage for applied behavior analysis
services shall be subject to a maximum benefit of $36,000 per 12-month period per person, but shall not be subject to
any limits on the number of visits an individual may make to an autism services provider or that a provider may make
to an individual regardless of the locations in which services are provided. Such coverage shall not be more
restrictive than coverage provided for physical illness.
© 2015 National Association of Insurance Commissioners
II-HB-26-1
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
CITATION
SUMMARY
DC
(10/15)
§§ 31-3271 to 31-3272
A health insurer shall provide habilitative services for children under the age of 21. Such coverage shall not be more
restrictive than coverage provided for other illnesses or disorders. Habilitative services are those which enhance the
ability to function of children with congenital birth defects, including autism.
FL
(10/15)
§§ 627.6686; 641.31098
Health insurance plans shall provide well-baby and well-child screening for the purpose of diagnosis, and treatment
through speech, occupational, and physical therapy. Coverage shall be limited to $36,000 annually and $200,000 in
total lifetime benefits. Maximum benefit is adjusted annually. Applies to an individual under age 18 who has been
diagnosed by age 8. Applies to HMOs.
GA
(10/15)
§ 33-24-59.10
An insurer that provides benefits for neurological disorders shall not deny providing benefits because of a diagnosis
of autism.
HI
(10/15)
§§ 431:10A-133; 432:1-614
Each hospital, medical service plan contract, individual, group accident, health or sickness policy issued or renewed
after 1/1/16 shall provide to each member under 14 years coverage for the diagnosis and treatment of autism.
ID
(10/15)
No provision
IL
(10/15)
215 ILCS 5/356z.14 to 5/356z.15
Group or individual accident and health insurance policies issued or renewed after 12/12/2008 shall provide
psychiatric, psychological, habilitative, or therapeutic treatment to individuals under the age of 21 who are diagnosed
with autism spectrum disorder. Coverage shall be subject to a maximum benefit of $36,000 per year, but shall not be
subject to any limits on the number of visits to a service provider. Policies must provide coverage for habilitative
services for children under 19 years old so long as certain listed conditions are met.
IN
(10/15)
§§ 27-13-7-14.7; 27-8-14.2-4 to
27-8-14.2-5; Bulletin No. 136
Accident and sickness policies must provide coverage for treatment of autism spectrum disorders. A group contract
with a health maintenance organization that provides basic health care services must provide services for the
treatment of a pervasive developmental disorder, including autism.
IA
(10/15)
§ 514C.28; Reg. 191-35.40
Group plan for state employees shall provide benefits for covered individuals under 21 years of age for the diagnostic
assessment and treatment of autism spectrum disorders. Coverage is subject to a maximum yearly benefit.
KS
(10/15)
§ 40-2,105a
Health insurance plans of any type that provide coverage for mental health shall provide coverage for the diagnosis
and treatment of mental illnesses, including autism.
KY
(10/15)
§§ 304.17A-141 to 304.17A-143;
806 KAR 17:460
All health benefit plans must provide coverage for treatment of autism. Applies to children up to age 21. Provides for
maximum annual benefits for a covered individual. Benefits under individual and small group plans limited to
$50,000 per year for individuals between ages 1 to 7 and $1000 per month for individuals between ages 7 to 21.
© 2015 National Association of Insurance Commissioners
II-HB-26-2
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
CITATION
SUMMARY
LA
(10/15)
§ 22:1050
Any health coverage plan shall provide coverage for the diagnosis and treatment of autism spectrum disorders in
individuals under the age of 21. Subject to yearly and lifetime maximum benefits. Does not apply to health plan
coverage to an employer with less than 50 employees; individually underwritten, guaranteed renewable health
insurance policies; limited benefits health insurance policies.
ME
(10/15)
24 M.R.S.A. § 2325-A;
24-A M.R.S.A. §§ 2749-C; 2843;
4234-A
All individual and group insurance contracts must make available benefits for the treatment and diagnosis of mental
illnesses, including autism, under terms and conditions that are no less extensive than the benefits provided for
medical treatment for physical illnesses.
24-A M.R.S.A. § 2768
Required coverage for autism spectrum disorders for an individual who is 5 years of age; may limit coverage for
applied behavior analysis to $36,000 per year.
24-A M.R.S.A. § 4259
Health maintenance organizations are required to provide coverage for autism spectrum disorders for an individual
who is 5; may limit coverage for applied behavior analysis to $36,000 per year.
MD
(10/15)
Ins. § 15-835
Coverage of habilitative services required for children under the age of 19 with autism.
MA
(10/15)
M.G.L.A. 175 § 47AA
An individual policy of accident and health insurance that provides hospital expense and surgical expense and any
group blanket or general policy of insurance that provides hospital expense and surgical expense shall provide
benefits for the diagnosis and treatment of autism spectrum disorders.
M.G.L.A. 176A § 8DD
A contract between a subscriber and the corporation under an individual or group hospital service plan shall provide
benefits for the diagnosis and treatment of autism spectrum disorders.
M.G.L.A. 176B § 4DD
A subscription certificate under an individual or group medical service agreement shall provide benefits for the
diagnosis and treatment of autism spectrum disorders.
M.G.L.A. 176G § 4V
A health maintenance contract shall provide benefits for the diagnosis and treatment of autism spectrum disorders.
M.G.L.A. 175 § 47B
Policies of accident and sickness insurance which provide hospital expense and surgical expense insurance shall
provide mental health benefits on a non-discriminatory basis to residents of the commonwealth and to all policy
holders with a principal place of business within the commonwealth for the diagnosis and treatment of autism.
§ 550.1416e
Health corporation group or non-group certificates shall provide coverage to the diagnosis and treatment of autism
spectrum disorders. Coverage for treatment may be limited to a member through 18 years of age. Subject to
maximum annual benefits.
MI
(10/15)
© 2015 National Association of Insurance Commissioners
II-HB-26-3
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
CITATION
SUMMARY
MN
(10/15)
§ 62A.3094
A health plan issued to a large employer must provide coverage for the diagnosis, evaluation, multidisciplinary
assessment, and medically necessary care of children under the age of 18 with autism spectrum disorders.
MS
(10/15)
§ 83-9-26
All accident and health insurance policies shall provide coverage for the screening, diagnosis, and treatment of
autism spectrum disorder.
MO
(10/15)
§ 376.1224
All group health benefit plans must provide coverage for the diagnosis and treatment of autism spectrum disorders
subject to maximum annual benefits.
MT
(10/15)
§ 33-22-706
A policy or certificate for health insurance or disability insurance that is delivered, issued for delivery, renewed,
extended or modified must provide a level of benefits for the necessary care and treatment of severe mental illness,
including autism, that is no less favorable than that level provided for other physical illness generally. Mental health
benefits will not be limited for enrollees with autism.
§ 33-22-515
Group disability policies shall provide coverage for the diagnosis and treatment of autism spectrum disorders for a
covered child 18 years or younger. May be subject to maximum yearly benefits.
NE
(10/15)
§ 44-7,106
Any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery,
or renewed in this state shall provide coverage for the screening, diagnosis, and treatment of an autism spectrum
disorder in an individual under 21 years of age.
NV
(10/15)
§§ 689B.0335 (group);
695C.1717 (HMO);
695G.1645 (managed care);
689C.1655 (small employer);
689A.0435 (individual)
A health benefit plan must provide coverage for screening for and diagnosis of autism spectrum disorders and for
treatment of autism spectrum disorders to persons covered by the policy of group health insurance under the age of
18 or, if enrolled in high school, until the person reaches the age of 22. Maximum benefit of $36,000 per year for
applied behavior analysis treatment.
NH
(10/15)
§§ 417-E:1 to 417-E:2
Cover “biologically based” mental illness, including autism, same as any other type of physical illness. Policy may
limit coverage for applied behavior analysis based on age.
© 2015 National Association of Insurance Commissioners
II-HB-26-4
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
NJ
(10/15)
CITATION
SUMMARY
§§ 17:48-6v; 17:48A-7u;
17:48E-35.20; 17B:27-46.1v;
17B:27A-7.5; 17B:27a-19.7;
26:2J-4.20; 17B:26-2.1s
Cover “biologically based” mental illness, including autism, same as any other type of physical illness.
§§ 17B:26-2.1cc; 17B:27-46.1ii;
17B:27A-7.16; 17B:27A-19.20
Insurer shall provide coverage for autism spectrum disorders including expenses for therapy. The maximum benefit
amount for a covered person in any calendar year through 2011 shall be $36,000. After 1/1/2012, the benefit shall be
adjusted based on the consumer price index.
NM
(10/15)
§§ 59A-22-49; 59A-46-50;
59A-23-7.9; 59A-47-45
An individual or group health insurance policy, health care plan or certificate of health insurance shall provide
coverage to an eligible individual who is 19 years of age or younger, or an eligible individual who is 22 years of age
or younger and enrolled in high school for the treatment of autism spectrum disorder through speech therapy,
occupational therapy, physical therapy, and applied behavior analysis. Coverage is limited to $36,000 annually and
shall not exceed $200,000 in total lifetime benefits.
NY
(10/15)
Ins. §§ 3216; 3221; 4303
Every policy that provides physician services, medical, major medical or similar comprehensive-type coverage shall
provide coverage for the screening, diagnosis and treatment of autism spectrum disorder and shall not exclude
coverage for the screening, diagnosis or treatment of medical conditions otherwise covered by the policy because the
individual is diagnosed with autism spectrum disorder.
NC
(10/15)
No provision
ND
(10/15)
No provision
OH
(10/15)
No provision
OK
(10/15)
§ 6060.20
All individual and group health insurance policies that provide medical and surgical benefits shall provide the same
coverage and benefits to any individual under the age of 18 years who has been diagnosed with an autistic disorder as
it would provide coverage and benefits to an individual under the age of 18 years who has not been diagnosed with
an autistic disorder.
OR
(10/15)
§ 743A.190
A health benefit plan must cover for a child enrolled in the plan who is under the age of 18 and who has been
diagnosed with a pervasive developmental disorder, including autism, all medical services, including rehabilitation
services that are medically necessary and are otherwise covered by the plan.
© 2015 National Association of Insurance Commissioners
II-HB-26-5
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
CITATION
SUMMARY
PA
(10/15)
40 P.S. § 764h
A health insurance policy or government program shall provide to covered individuals under the age of 21, coverage
for the diagnostic assessment of autism spectrum disorders and for the treatment of autism spectrum disorders.
Subject to a maximum benefit of $36,000 per year.
PR
(10/15)
No provision
RI
(10/15)
§§ 27-20.11-1 to 27-20.11-8
Every group health insurance contract, group hospital or medical expense policy shall provide coverage for autism
spectrum disorders. Coverage shall continue until individual reaches age 15; maximum yearly limits on applied
behavior analysis.
SC
(10/15)
§ 38-71-280
Requires insurance coverage for treatment of pervasive developmental disorders, including autism. Benefits provided
to any individual under the age of 16 and who was diagnosed by age 8. Yearly maximum benefit is $50,000 adjusted
annually.
SD
(10/15)
§ 58-17-157 (effective 1/1/16)
Health insurance policies shall provide coverage for applied behavior analysis of the treatment of autism spectrum
disorders.
TN
(10/15)
§ 56-7-2367
A contract or policy of an insurer that provides benefits for neurological disorders shall provide benefits and
coverage for the treatment of autism spectrum disorders that are at least as comprehensive as those provided for other
neurological disorders. These benefits for treatment will be provided to a person under the age of 12.
TX
(10/15)
Ins. Code §§ 1355.001; 1355.015;
28 TX ADC §§ 21.4401 to 21.4404
The health benefit plan must provide coverage under this section to the enrollee for all generally recognized services
prescribed in relation to autism spectrum disorder by the enrollee's primary care physician in the treatment plan
recommended by that physician. Such treatment may include evaluation and assessment services, applied behavioral
analysis, speech therapy, occupational therapy, or physical therapy. Certain types of insurance plans are exempt from
the requirements.
UT
(10/15)
§ 31A-22-642
A health benefit plan offered in the individual market or the large group market and entered into or renewed on or
before 1/1/16 shall provide coverage for the treatment of autism spectrum disorder for a child who is at least 2 years
old and younger than 10 years old. Coverage for behavioral health treatment for a person with an autism spectrum
disorder shall cover at least 600 hours a year.
VT
(10/15)
8 V.S.A. § 4088i
A health insurance plan shall provide coverage for the evidence-based diagnosis and treatment of early childhood
developmental disorders, including applied behavior analysis supervised by a nationally board-certified behavior
analyst, for children, beginning at birth and continuing until the child reaches age 21.
© 2015 National Association of Insurance Commissioners
II-HB-26-6
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
11/15
STATE
CITATION
SUMMARY
VI
(10/15)
22 V.I.C. §§ 1732 to 1735
A health care insurer that offers, issues for delivery, delivers, executes, adjusts, uses, or renews a health care
insurance plan shall provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders that
are medically necessary and evidence-based. The insurer may limit the coverage in the insurance health care plan for
behavioral therapy to a yearly benefit of $50,000 for a child who is younger than 9 years of age, $35,000 for a child
who is at least 9 but younger than 13 years of age and $25,000 for a child who is at least 13 years of age but younger
than 15 years of age.
VA
(10/15)
§ 38.2-3418.17
Coverage required for the diagnosis and treatment of autism spectrum disorders for individuals ages 2 to 6 subject to
yearly maximum benefit limits.
WA
(10/15)
No provision
WV
(10/15)
§§ 33-16-3v (group);
33-24-7k (service corporations);
33-25A-8j (HMO)
Insurers shall provide coverage for diagnosis and treatment of autism spectrum disorders in individuals 18 months to
18 years of age. Individual must have been diagnosed at age 8 or under. Contains maximum annual limits for
benefits.
WI
(10/15)
§ 632.895; Reg. Ins. 3.36
Every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or
school district, shall provide coverage for an insured of treatment for the mental health condition of autism spectrum
disorder. The coverage shall provide at least $50,000 for intensive-level services per insured per year, with a
minimum of 30 to 35 hours of care per week for a minimum duration of 4 years, and at least $25,000 for nonintensive level services per insured per year to be adjusted for inflation.
WY
(10/15)
No provision
This chart does not constitute a formal legal opinion by the NAIC staff on the provisions of state law and should not be relied upon as such. Every effort has been made to provide correct and accurate
summaries to assist the reader in targeting useful information. For further details, the statutes and regulations cited should be consulted. The NAIC attempts to provide current information; however,
readers should consult state law for additional adoptions.
© 2015 National Association of Insurance Commissioners
II-HB-26-7
NAIC’s Compendium of State Laws on Insurance Topics
MANDATED BENEFITS FOR AUTISM SPECTRUM DISORDERS
© 2015 National Association of Insurance Commissioners
II-HB-26-8