New Jersey’s Autism Insurance Reform Bill – Are You Covered?
On August 13, 2009, New Jersey’s Autism Insurance Reform Bill, P.L.2009, c.115 was approved. On that date, New Jersey became the fifteenth state in the nation to enact Autism Insurance Reform requiring state-regulated health benefits coverage for certain therapies to treat autism and other developmental disabilities.
Does this law apply to me?
Approximately 25% of New Jerseyans have this type of plan.
How do I figure out if I have a state-regulated plan?
To determine if your plan is covered by the new law, see below.
I have a state-regulated plan. When can I expect these benefits?
Existing policy holders’ benefits will go into effect on their first renewal date on or after February 9, 2010. All new policies issued after February 9, 2010 will include this benefit.
The first question you may ask is, “AM I COVERED?” It is essential to know whether you have a (a) state-regulated plan or (b) federally-regulated or “self-funded” plan.
Suggestion 1: Call your Benefits Plan Administrator
Autism New Jersey’s first suggestion is to contact your Benefits Plan Administrator. You can obtain this number from either your insurance card or member policy booklet. Your Benefits Plan Administrator is qualified to answer this question. This is an important first question to ask because only individuals who are covered by a full state-regulated health plan issued in the State of New Jersey will be covered by the Autism Insurance Reform Bill, P.L.2009, and c.115.
Suggestion 2: Refer to Your Insurance Policy Booklet
Go to the Index and then to the “Appeal/Grievance Section.”
If you are referred to New Jersey’s Department of Banking and Insurance (DOBI) (or to the New Jersey Department of Health & Senior Services (DHSS) in the instance of an outdated booklet), more than likely you are covered by a state-regulated plan.
Or, perhaps you are referred to the U.S. Department of Labor and the Employee Retirement Income Security Act (ERISA) is mentioned, you most likely are covered by a federally-regulated or “self-funded” plan that is not covered by this law.
Important: Do not be misled by the fact that your plan refers to a well-known insurance company. Insurance carriers can offer both state- and federally-regulated plans. Learn more about your benefits by using the suggestion above and the resource below.
Additional questions can be directed to:
To Your Health Program
Community Health Law Project
888-838-3180
www.chlp.org/programs
The State Department of Banking and Insurance Issues a Bulletin Regarding the Autism Insurance Law
Many of the items that Autism New Jersey advocated for are included.
On January 14, the State Department of Banking and Insurance issued a bulletin regarding the autism insurance law. This bulletin provides guidance to insurance carriers on how to implement this law beginning on February 9th. (Regulations will follow at a later date.)
Here are the main points:
- Coverage for expenses incurred in screening and diagnosing autism or another developmental disability;
- Coverage for expenses incurred for medically necessary behavioral interventions (ABA) for the treatment of autism in individuals under 21 years old, and that the $36,000 cap may not be applicable;
- Benefits for ABA services provided or supervised by BACB certificants (BCBA and BCBA-D)
- Coverage for expenses incurred for medically necessary physical therapy, occupational therapy, and speech therapy services for the treatment of autism or another developmental disability;
- Carriers must provide the coverage without consideration of whether the services are “restorative;”
- Autism is defined as autism spectrum disorders;
- Benefits for the coverage of the “Family Cost Share” expense incurred for certain services obtained through the NJ Early Intervention System.
These guidelines will likely have a substantial impact on availability of reimbursement for providers and most importantly, children’s access to ABA and other necessary therapies.
To access this bulletin, click here. Your health insurance plan may or may not fall under this new law. Please call 800.4.AUTISM for more information and guidance.
Current Federal Autism Policy Initiatives:
Current Judicial Issues of Note: