ABA Cost Sharing Rules in Michigan
The cost-sharing rule is parity with physical illness. It is the part of the mandate employers can check against their own plan design.
How cost sharing is measured
The comparison
Dollar limits, copays, deductibles and coinsurance on covered autism treatment cannot be provisions that do not apply to physical illness generally.
The exception
The one carve-out is the age and annual maximum provisions, which the statute permits and which are covered on their own page.
What to compare
Look at the copay or coinsurance for ABA sessions next to the plan’s rate for specialist or outpatient care, and check whether ABA falls under a separate deductible.
What DIFS says
The regulator lists co-payments, deductibles and co-insurance more restrictive than for other medical care among prohibited limits.
Back to the ABA guide.
ABA Cost Sharing Rules in Michigan: short answers
Can a plan charge a higher copay for ABA?
Not a copay or coinsurance that does not apply to physical illness generally. Compare it with the plan’s ordinary medical cost sharing.
Does ABA count toward the deductible and out-of-pocket maximum?
The statute does not carve ABA out of ordinary cost-sharing accumulation. Ask the carrier to confirm in writing how ABA claims accumulate.
Do self-funded plans follow this rule?
Not by state law. A self-funded plan sets its own cost sharing, subject to federal rules such as parity where they apply.
ABA Cost Sharing Rules in Michigan: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
MCL 500.3406s, Insurance Code of 1956
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